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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

BULLETINServing East Bay physicians since 1860 January/February 2021

The Alameda-Contra Costa Medical Association is proud to provide physicians with a list of vetted mental health counselors, sponsored small group psychotherapy sessions, and immediate confidential peer assistance as part of the new ACCMA Clinician Wellness Program.

ACCMA CLINICIANWELLNESS PROGRAM

Introducing the

accma.org/Mental-Health-Consultations

To find out more about each counselor, visit accma.org/Mental-Health-Consultations.

(510) [email protected]

GABRIELA BRONSON-CASTAIN,PSYD

CATHY JEFFERSON, LCSW(415) [email protected]

Our resource list of counselors can provide you with confidential counseling or coaching services from vetted mental health specialists who are experienced in working with physicians. For these individual sessions, the ACCMA does not negotiate rates or pay for the consultations. Please contact the counselors directly to schedule an appointment and discuss payment.

The ACCMA Advisory Committee on Physician Wellbeing provides confidential assistance from trusted colleagues who serve on the committee. Committee members are available to provide immediate peer support at no cost. To access immediate confidential peer support, call (510) 654-5383 or send an email to [email protected].

The ACCMA is also sponsoring a limited number of small group psychotherapy sessions via Zoom. Groups of three to eight physicians will meet for up to six sessions starting in mid to late July. Physicians and medical residents in Alameda and Contra Costa counties can contact these therapists directly to register for the sponsored group therapy sessions - please see below for counselor contact information.

GROUP PSYCHOTHERAPY COUNSELORS FOR MORE INFORMATION

To learn more about the ACCMA Clinician Wellness Program, visit accma.org/Clinician-Wellness.

The ACCMA has also compiled a list of wellness resources, which can be accessed by visiting accma.org/Wellness-Resources.

For questions or more information, please contact the ACCMA by calling (510) 654-5383 or [email protected].

23Member Spotlight: Fayola Edwards-Ojeba, MD

25RotaCare Pittsburg Free Medical Clinic at St. Vincent de PaulBy Barb Hunt, SVdP Development Director

27The Alliance’s Commitment to Whole-Person CareBy Scott Coffin, CEO, Alameda Alliance for Health

29NEW MEMBERS

30CLASSIFIED LISTINGS

30IN MEMORIAM

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION6230 Claremont Avenue, Oakland, CA 94618Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

5PRESIDENT’S PAGEGearing Up to Vaccinate 2.8 Million PeopleBy Suparna Dutta, MD, ACCMA President

HEALTH CARE LAWS, LEGISLATION, AND GUIDANCE6Berkeley Healthy Checkout Ordinance

7Congressional Omnibus and COVID Relief Year-End LegislationBy the California Medical Association

10CDPH Sexually Transmitted Diseases Control Branch LetterBy the California Department of Public Health

IN YOUR PRACTICE12Techniques for a Successful Telemedicine VisitBy the Medical Insurance Exchange of California (MIEC)

14Medical and Societal Challenges of a SyndemicBy Kenneth Saffier, MD

192021 Medicare UpdateBy Mary-Jean Sage, CMA-AC

AT THE ACCMA162021 ACCMA Council Pictorial

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ACCMA EXECUTIVE COMMITTEESuparna Dutta, MD, PresidentRobert Edelman, MD, President-ElectEdmon Soliman, MD, Secretary-

TreasurerKatrina Peters, MD, MPH,

Immediate Past President

COUNCILORS & CMA DELEGATESEric Chen, MDRollington Ferguson, MDHarshkumar Gohil, MDRuss Granich, MDJames Hanson, MDShakir Hyder, MDAlexander Kao, MDIrina Kolomey, MDArden Kwan, MDTerence Lin, MDLilia Lizano, MDAbbas Mahdavi, MDRoss Pirkle, MDJeffrey Poage, MDStephen Post, MDThomas Powers, MDRichard Rabens, MDSteven Rosenthal, MDKatrina Saba, MDSuresh Sachdeva, MDAhmed Sadiq, MDJonathan Savell, MDEdmon Soliman, MDJudith Stanton, MDClifford Wong, MD

CMA & AMA REPRESENTATIVESPatricia L. Austin, MD, AMA

DelegateMark Kogan, MD, CMA Trustee,

AMA Alternate-DelegateSuparna Dutta, MD, AMA Alternate

Delegate (at Large)Ronald Wyatt, Jr., MD, CMA Trustee

MEMBERSHIP & COMMUNICATIONS COMMITTEEMark Kogan, MD, ChairPatricia Austin, MDSharon Drager, MDRobert Edelman, MDJames Hanson, MDJeffrey Klingman, MDStephen Larmore, MDTerence Lin, MDIrene Lo, MDLamont Paxton, MDKatrina Peters, MDFrank Staggers, Jr., MDRonald Wyatt, MD

ACCMA STAFFJoseph Greaves, Executive DirectorMae Lum, Deputy DirectorGriffin Rogers, Director, Napa &

Solano County Medical SocietiesDavid Lopez, Assoc. Dir. of Advocacy

and Strategic InitiativesEssence Hickman, Operations

AssociateJennifer Mullins, Education and

Events AssociateHannah Robbins, Policy Associate

REDUCE – REUSE – RECYCLEPrinted in the U.S.A. with soy inks on paper stock certified by the Forest Stewardship Council.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

BULLETINServing East Bay physicians since 1860 January/February 2021 | Vol. LXXVII, No. 1

ACCMA BULLETIN | JANUARY/FEBRUARY 2021 3

NEWS & UPDATES

Linda Hawes Clever, MD, MACP, is the founder of the nonprofit organization Its purpose is to assist health care professionals and others discover ways to lead healthy and fulfilling lives. She is a graduate of the Stanford Medical School and board certified in internal and occupational medicine. Dr. Clever is active at UC Berkeley and Stanford University, a member of the National Academy of Medicine, and the author of The Fatigue Prescription: Four Steps to Renewing Your Energy, Health and Life.

Please contact the ACCMA at (510) 654-5383 or the NCMS-SCMS at (707) 255.3622 for more information.Accreditation Statement: ACCMA is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education.Credit Designation Statement: ACCMA designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FREE | On-Demand Webinar

CME Available

Linda Hawes CleverMD, MACP

BREAK BARRIERS,DISCOVER BOOSTERS,AND REACH YOUR OWN GOALS

at https://bit.ly/2ICusAyAvailable On-Demand

This webinar provides an opportunity for you to pause for a bit and, for a change, to think about yourself, despite the remarkable slurry of uncertainties and challenges in which we find ourselves.

You will be able to visit or re-visit your own purpose and develop ways to move ahead. To do this, we will explore your context, the Big Picture of culture and attitudes that shape society’s, hospitals’, and systems’ policies about physicians.

We look at barriers that can hold you back and — the good news — boosters that can propel you forward.

Learn little steps that can lead to large progress. Through discussions, reflection, and conversation, plus answering some simple–yet-not-so-easy questions on your own, you will discover practical and achievable ways to replenish your energy, find opportunities, and reach toward your own goals.


PRESIDENT'S PAGE

Gearing Up to Vaccinate 2.8 Million PeopleBy Suparna Dutta, MD, President

Please note that the information in this article is current as of February 10, 2021.

Over the past several weeks, I have been humbled by the generosity of so many of my colleagues, who have asked

me how they can help our community’s COVID-19 vaccination effort. With an estimated 2.8 million residents in Alameda and Contra Costa counties, people understand that vaccinating our community is going to be a huge lift. It has been heartening to see so many physicians seeking out opportunities to help even more than physicians already have.

The main challenge right now is insufficient supply of vac-cine. Our local health care partners and public health agencies have done an admirable job planning and launching vaccination operations around the two counties. Both counties have already proceeded to Phase 1B after nearing completion of Phase 1A, which includes thousands of physicians and other health care workers.

Based on current reporting, we understand that there is sufficient capacity in the two counties to manage the volume of vaccine that the East Bay is expected to receive in the near term. At the same time, efforts are underway to expand capacity in anticipation of a significant increase in vaccine production in the coming months. These efforts include:• Mass Vaccination Clinics: These will be large-scale opera-

tions that are capable of vaccinating up to 10,000 patients per day. The first site opened at the Oakland Coliseum on February 16 and is being operated under a federal-state part-nership using plans developed by Alameda County. A second site has also opened at the Alameda County Fairgrounds. Contra Costa’s planning also includes the possibility of mass vaccination sites, but the County has not yet shared any spe-cific plans.

• Community Points of Distribution (PODs): These clinics are capable of vaccinating hundreds of patients per day. They have already been launched and have vaccinated a substantial number of individuals in Phase 1A. They are expected to continue to operate to augment capacity. In Alameda County,

PODs will increasingly focus on reaching underserved com-munities who do not have ready access to transportation and technology.

• Pharmacies: The Biden Administration announced an expanded role for commercial pharmacies, which are expected to play a substantial role augmenting capacity in the health care delivery system. Those vaccinations began on February 11.

• Health Care Providers: Many patients will get vaccinated through their normal health care provider. Large health sys-tems (known as multi-county entities or MCEs) are already receiving their allocations of vaccine. As more vaccine comes online, providers with fewer patients are expected to be allo-cated vaccines as well.

As we gear up to meet this immense challenge, there are several ways that physicians can help:• Encourage People to Get Vaccinated: Many patients are

hesitant to get vaccinated. As trusted medical professionals, physicians are in a unique position to help educate patients about the safety, efficacy, and critical importance of getting vaccinated. Get the word out through social media using the hashtag #ThisIsOurShot. Visit www.thisisourshot.us/ for more information.

• Enroll to Volunteer: Physicians can enroll to volunteer in both medical and non-medical (administrative) capacities. Although volunteer opportunities are currently limited due to the low supply of vaccine available, you can still enroll now so that you are already in the system when the need for volunteers materializes. Information about enrolling to volunteer can be found on the ACCMA website at accma.org/COVID-19 and scroll down to “COVID-19 Volunteer & Paid Opportunities”.

• Enroll to Become a Vaccinator: Physician practices can enroll in the state’s CALVAX system to be allocated vaccine to be administered to your patients. Please note that practices with fewer patients will not be allocated vaccine until the

continued on page 13

HEALTHY CHECKOUT

Berkeley Healthy Checkout OrdinanceThe City Council of Berkeley passed a Healthy Checkout

Ordinance on September 22, 2020, which will go into effect in March 2021, with enforcement beginning in January 2022. This ordinance will ban stores larger than 2,500 square feet, which amounts to approximately 25 stores in Berkeley, from selling items in checkout aisles that contain more than 5 grams of added sugars or 200 milligrams of sodium per serving. Checkout areas

are defined as those accessible to customers within three feet of a cash register.

Less healthy items can still be sold in the stores, but not in the checkout areas. Below, please find a letter from Katrina Peters, MD, ACCMA Immediate Past President, which was sent to the members of the Berkeley City Council in 2019.

Dear Members of the Berkeley City Council:

I am writing on behalf of the Alameda-Contra Costa Medical Association (ACCMA), representing over 4,600 East Bay physicians, to express our support for reducing consumption of unhealthy foods and beverages in our community. During this most recent legislative session, the ACCMA supported The Healthy Checkout Aisles for Healthy Families Act (AB 765), a bill sponsored by the California Medical Association to restrict the sale of sugar-sweetened beverages in checkout aisles across the state. While AB 765 is still going through the legislative process, we believe efforts within our local community to implement similar policies can set the groundwork for nutrition standards in checkout aisles across the state.

According to the CDC, unhealthy beverages are the largest source of added sugars in the diet for U.S. youth. Unhealthy foods dominate our restaurant menus, soda fountains, grocery and retail store checkouts, and supermarket displays, undermin-ing our best efforts to maintain a healthy diet for ourselves and families. While California has made strides in educating and raising awareness for healthier eating and increased physical activity, more needs to be done to curb the consumption of the unhealthiest products, like sugar sweetened-beverages and foods that are high in sugar, sodium and unhealthy fats.

Sugary drinks and sugar- and sodium-laden foods dominate grocery store checkout aisles and can contribute to impulse purchases among shoppers. Removing unhealthy foods and beverages from checkout aisles provides an opportunity to con-tinue the momentum that began with Berkeley Measure D by reducing the consumption of sugary drinks and foods that con-tribute to poor health outcomes. Sugary drinks are the top source of added sugar in the American diet, and 70 percent of the sugary beverages that children consume come from food retail.

For these reasons, we support local efforts to promote healthier alternatives in our community, including by removing unhealthy foods and beverages from supermarket checkout aisles. We would encourage a wholistic approach that also reduces the prevalence of unhealthy foods and beverages at smaller retail establishments in addition to larger grocery stores. We also believe it is important to evaluate how this type of intervention impacts health outcomes and would encourage that develop-ment and inclusion of an evaluation component in the final ordinance.

If you have any questions or wish to discuss this further, please contact Mr. Joe Greaves, ACCMA Executive Director, at 510-654-5383 or [email protected].

Sincerely,

Katrina Peters, MPA, MDPresident

6 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN


YEAR-END LEGISLATION

Congressional Omnibus and COVID Relief Year-End Legislation COVID-19 RELIEF, MEDICARE PHYSICIAN PAYMENTS, EXTENDED HEALTH PROGRAMS, AND SURPRISE MEDICAL BILLING By the California Medical Association

On December 21, 2020, the 116th Congress adjourned for the year after one of the most acrimonious sessions in

recent history. Congress adopted a massive $1.4 trillion spending package to fund the government and other programs and a $900 billion COVID-19 relief package. They also adopted changes to the Medicare physician fee schedule to stop the cuts for almost every specialty, extended several important health care programs, provided 1,000 new graduate medical education (GME) slots and passed a surprise medical billing agreement. The ban on surprise billing will protect patients from out-of-network bills and estab-lish a baseball-style arbitration process for insurers and physicians to resolve disputes. See highlights from the California Medical Association (CMA) below. You can also read a more detailed summary from the American Medical Association (AMA) at https://bit.ly/2KL8vk4.

While this was a tumultuous Congress, it was also one of the most difficult and unprecedented times in our nation’s his-tory. After Congress spent trillions of dollars on the pandemic earlier in the year, Senate leadership became more cautious about future spending on the pandemic, Medicare payments and other issues. While there are disappointments in this year-end package, Congress was able to dedicate billions to help physicians during the pandemic. However, there is more yet to be done.

Our California Congressional leaders are already committing to future COVID aid packages, more Medicare payment assis-tance and surprise billing clean-up next year. Despite the difficult Congressional environment, CMA will never, ever give up. We will keep fighting so that you can focus on your patients and not be distracted or brought down by administrative burdens, declin-ing reimbursements, outside corporate influences or a devastating virus. You are the true heroes in this pandemic and we will con-tinue to stand with you and advocate on your behalf.

YEAR-END COVID-19 RELIEF PACKAGEAfter passing four sweeping COVID-19 relief bills earlier in the year, Congress was unable to reach another agreement until this year-end omnibus package. A summary of the latest COVID aid is

listed below. This latest relief package is in addition to the trillions already dedicated to fighting the pandemic, including $185 billion for physicians and hospitals through the Provider Relief Fund, the $660 billion in the Paycheck Protection Program for practices with 50 or fewer employees, and the Medicare Advance payments not repayable for one year. The COVID-19 pandemic threatens to fundamentally alter our nation’s health care delivery system and CMA will continue to push for more aid in 2021 to sustain the viability of physician practices, maintain patient access to care and ensure that every Californian receives a vaccine. The latest $990 billion COVID relief package includes:

• $69 billion for vaccine purchase and distribution, testing and contact tracing, including $22 billion to help states with testing, tracing and COVID-19 mitigation

• New $3 billion in funding for physicians and hospitals through the Provider Relief Fund

Note that on December 16, the U.S. Department of Health and Human Services (HHS) released another $24 billion to physicians who had applied for funding by the November 6, 2020, deadline. It totals 88% of each physician’s lost revenues and increased costs.

• An additional $284 billion for Paycheck Protection Program (PPP) forgivable loans for physician practices with 50 or fewer employees. Some 501(c)(3) nonprofit organizations are also eligible.

• Allows physicians to deduct expenses associated with their forgivable PPP loans, expands employee retention tax credits for employers and extends a payroll tax sub-sidy for employers offering workers paid sick leave

• $10 billion for childcare, including for health care workers

• $7 billion to increase broadband access, including $250 million for telehealth

• $4.5 billion for mental health, substance abuse; waivers for mental health telehealth services made permanent

• 1,000 new GME positions. Not less than 10% of the continued on page 8


YEAR-END LEGISLATION (continued from page 7)

aggregate number of these new positions will be given to hospitals in rural areas or HPSAs, hospitals that are already above their Medicare cap, and hospitals in states with new medical schools or new locations. Hospitals are limited to 25 additional full-time positions.

Many more issues related to the pandemic remain unre-solved. CMA urged Congress to provide liability safeguards for physicians and hospitals (beyond the Good Samaritan rules) and more direct aid to the states, particularly for Medicaid, but these issues were turfed to 2021. Making the telehealth waivers permanent and extending allowances for audio-only telehealth in Medicare Advantage were also moved to the 2021 Congressional agenda.

MEDICARE PHYSICIAN PAYMENTMedicare E/M: The 2021 Medicare physician fee schedule appropriately increased long overdue primary care evaluation and management (E/M) payment rates by up to 13%, but it also reduced payments to specialists by as much as 10% because the Medicare budget neutrality rules require any payment increases to be offset with corresponding payment reductions. Medicare had also proposed a new CPT code G2211 to report complex cases. In response, CMA and AMA relentlessly urged Congress to intervene and pass HR 8702 (Bera, MD, D-CA and Bucshon, MD, R-IN), which would hold specialists harmless from the 2021 payment cuts while protecting the increases for primary care.

Congress responded by significantly mitigating the budget neutrality adjustment so that most specialties will either see a neu-tral or positive change in total 2021 Medicare payments. The net impact will depend on physician specialty and each practice’s mix of services. Visit https://bit.ly/3a01Uum to see the AMA spe-cialty impact chart. These adjustments will not factor into future calculations of the fee schedule. Congress mitigated the cuts by:

• Delaying the new HCPCS code G2211 for three years• Providing additional funding from the U.S. Treasury and

the Federal Supplementary Medical Insurance Trust Sequestration: Congress continued the extension of the Medicare 2% sequestration cuts moratorium through March 31, 2021. This provides all physicians with an additional 2% payment increase from January 1 to March 31, 2021.

Finally, some of the health care leaders in Congress are com-mitting to CMA to try to extend the moratorium on sequestra-tion to give physicians a 2% rate increase for all of 2021. Due to arcane budget rules, if this issue is legislated during 2021, there could be a budget savings associated with it that would fund the 2% rate increase and other Medicare payment updates. CMA will be pushing for more payment to protect practices through the

pandemic and ensure patient access to care.

HEALTH CARE PROGRAMS EXTENDEDFunding for several important health care programs were extended through 2023: Community Health Centers, the Teaching Health Center primary care GME Program and the National Health Service Corps. The Affordable Care Act (ACA) Disproportionate Share Hospital (DSH) payment cuts were also suspended.

“NO SURPRISES ACT” – SURPRISE MEDICAL BILLING LEGISLATIONIn the last week of the 116th Congress, four bipartisan, bicameral committees agreed to compromise surprise billing legislation, which includes substantial improvements sought by CMA and AMA. We have come a long way from the first committee bills that didn’t even have an arbitration process and only paid median in-network rates. However, there are still a few difficult provisions that CMA and Congress will be tracking to ensure a balanced sys-tem for physicians. This new law is a better deal for physicians than California’s law and it will set the benchmark for CMA’s advocacy to improve California’s surprise medical billing law. Overall, CMA will continue to fight for improvements and a system that protects patients’ long-term access to physicians and incentivizes insurers to contract in good faith with physicians.

General Structure of “No Surprises Act” • The bill only applies to federally regulated ERISA plans that

comprise 45% of California’s market and does not preempt California’s state laws that govern plans regulated by the state.

• Effective January 1, 2022.• Patients are protected from surprise medical bills and only

responsible for the in-network cost-sharing amount for out-of-network (OON) emergency services and other services provided in in-network facilities.

• Plans required to list deductibles and cost-sharing for in-network and OON services on enrollee insurance cards.

• Insurers required to make initial payments directly to OON providers for OON services within 30 days. The law does not define the payment rate. CMA and AMA were successful in eliminating the upfront interim payment rate set at the median in-network rate paid by the insurer in the geographic region. It would have had a significant benchmark rate-setting impact, as it did in California with AB 72. In California, insurers reduced contracted rates to the interim rate in the law, and physicians have lost 81 of the 82 Department of Managed Health Care (DMHC) arbitra-tions because the arbitrator was heavily influenced by the interim upfront payment rate.


YEAR-END LEGISLATION (continued)

• If a provider objects to the payment, they may still deposit the payment and then proceed to the dispute resolution process.

Dispute Resolution Process• There is no dollar threshold for accessing arbitration. CMA

and AMA successfully eliminated the $750- $1,000 threshold to take claims to arbitration.

• The IDR process is baseball-style arbitration, which is better for physicians. There is no negotiation. Both parties submit a payment rate and the arbiter selects one. This process incen-tivizes both parties to submit reasonable rates. CMA and AMA fought for a baseball-style arbitration process.

• Providers may batch claims for the same or similar services delivered within a 30-day time period by payer. CMA and AMA won this provision to help improve administrative simplicity.

• The first step is a 30-day informal “open-negotiation” period, where physicians and insurers may settle disputes over OON claims. In Texas, 70% of the disputes have been settled in this informal process.

• If the parties cannot agree, the physician may request a base-ball-style arbitration process. The physician has four days to request arbitration. Independent entities will administer the arbitration.

• The baseball-style arbitration must be resolved in 30 days.• Once a physician has brought a batch of claims by payer to

the arbitration process, there is a different process for the second time and all subsequent submissions.

• For all subsequent submissions to arbitration by payer, there is a 90-day cooling off period. It includes the 30-day informal “open negotiation process” so it is an additional 60 days. However, all claims that occur during that 90-day “cooling off ” period may go directly to arbitration on day 91. There is also a provision that allows the Secretary to change the timeline for low volume claims and to ensure more effi-ciency. CMA and AMA urged Congress to reduce the cooling-off period because it is difficult for small physician practices to wait 120 days to be paid. Congress changed the provision to allow physicians to collect all claims that occur during the cooling off and immediately bring those claims to arbitration. Congress added a study of the arbitration process and the cooling off period to better assess its impact on practices. Finally, it should be noted that the DMHC process in CA is more than 150 days, with the California Department of Insurance taking at least 75 days.

• In the 30-day baseball arbitration process, the arbiter may only consider the offers made by both parties, and the fol-lowing additional information, which must be considered equally.

• Any information that the provider wants to submit except billed charges. There has been strong bipartisan agreement for two years that Congress opposes allowing physicians to submit billed charges. However, allowing physi-cians to submit any information is a major win. Previous bills restricted arbitration to median in-network rates only.

• Prior contracting history for the four previous years with that payer. CMA and AMA also fought for this to be included.

• Median in-network rates as determined by the payer, with timely audits by the regulator to ensure the accuracy of the median in-network rates. The regulators may also conduct audits in response to complaints. For purposes of determining median in-network rates, insurers will be held to the rates paid in January 2019 and increased by CPI annually thereafter. It is important to note that all of the committee bills included median in-network rates; we were told that it must remain in one place in the bill. If median is removed completely, the bill costs money and Congress did not want to cut another program to fund this legislation. CMA and AMA urged the median rate to be removed as the upfront payment rate to avoid benchmark rate setting. While we con-tinue to oppose inclusion of median in-network rates being a factor in arbitration, we successfully added other factors that must be given equal consideration with the median rate.

• Physician training and experience, complexity of the case, acuity of the patient, good faith efforts to enter (or not enter) into network agreements, and the market share of the insurer and provider.

• Any information the arbiter requests.• The original committee agreement included an allowance for

insurers to submit Medicare and Medicaid payment rates to arbitration. CMA and AMA strongly opposed and the final ver-sion prohibits arbiters from considering public payer rates.

• Loser pays the arbitration fees and both providers and insurers must pay an additional fee to the regulator to be determined.

Timely Billing and Notification Requirements and Studies• All of the burdensome timely billing and notification require-

ments that CMA and AMA objected to were eliminated in the final bill.

• Insurers and providers are responsible for ensuring that insurance company provider directories are up-todate and accurate.



CDPH LETTER

GAVIN NEWSOM Governor

State of California—Health and Human Services Agency California Department of Public Health

Sandra Shewry Acting Director Erica S. Pan, MD, MPH

Acting State Public Health Officer

CDPH STD Control Branch ● 850 Marina Bay Pkwy Bldg P, 2nd Fl Richmond, CA 94804-6403

(510) 620-3400 ● (510) 620-3180 FAX STD Control Branch Website: std.ca.gov

December 8, 2020 Dear Colleague: In 2018, there were 329 infants with congenital syphilis (CS) reported in California, representing a 900 percent increase from 2012, and a magnitude of CS burden not observed since 1995. These trends mirror a sharp rise in syphilis among females, which surpassed 500 percent during the same period. As a result, the California Department of Public Health (CDPH) has just released new guidelines for expanded syphilis detection among people who are or could become pregnant in order to ensure detection, timely treatment, and subsequent CS prevention. The California Department of Public Health recommends: • All pregnant patients should be screened for syphilis at least twice during pregnancy: once at

either confirmation of pregnancy or at the first prenatal encounter (ideally during the first trimester) – and again during the third trimester (ideally between 28–32 weeks’ gestation), regardless of whether such testing was performed or offered during the first two trimesters.

• Patients should be screened for syphilis at delivery, except those at low riski who have a documented negative screen in the third trimester.

• Emergency department (ED) providers in local health jurisdictions with high-CS morbidityii should consider confirming the syphilis status of all pregnant patients prior to discharge, either via documented test results in pregnancy, or a syphilis test in the ED if documentation is unavailable.

• All people who are or could become pregnant entering an adult correctional facility located in a local health jurisdiction with high-CS morbidityii should be screened for syphilis at intake, or as close to intake as feasible.

• All sexually active people who could become pregnant should receive at least one lifetime screen for syphilis, with additional screening for those at increased risk.

• All sexually active people who could become pregnant should be screened for syphilis at the time of each HIV test.

i Syphilis among mothers of infants with CS has been associated with the following: recreational drug use, especially methamphetamine use, homelessness or unstable housing, limited or no prenatal care, incarceration within the prior 12 months and/or having a partner who is incarcerated, reported sex exchange, in addition to other factors listed in Table 2 in the document. ii CDPH defines local health jurisdictions with high-CS morbidity as those with a rate greater than 8.4 CS cases per 100,000 live births for any of the past three consecutive years. This “threshold” reflects the national rate of CS in 2012, prior to recent increases in California and the United States, when California’s CS rate was below that of the national rate.











































December 8, 2020Dear Colleague:

In 2018, there were 329 infants with congenital syphilis (CS) reported in California, representing a 900 percent increase from 2012, and a magnitude of CS burden not observed since 1995. These trends mirror a sharp rise in syphilis among females, which surpassed 500 percent during the same period. As a result, the California Department of Public Health (CDPH) has just released new guidelines for expanded syphilis detection among people who are or could become pregnant in order to ensure detection, timely treatment, and subsequent CS prevention.

The California Department of Public Health recommends:• All pregnant patients should be screened for syphilis at least twice during pregnancy: once at

either confirmation of pregnancy or at the first prenatal encounter (ideally during the first trimes-ter) – and again during the third trimester (ideally between 28–32 weeks’ gestation), regardless of whether such testing was performed or offered during the first two trimesters.

• Patients should be screened for syphilis at delivery, except those at low riski who have a docu-mented negative screen in the third trimester.

• Emergency department (ED) providers in local health jurisdictions with high-CS morbidityii should consider confirming the syphilis status of all pregnant patients prior to discharge, either via docu-mented test results in pregnancy, or a syphilis test in the ED if documentation is unavailable.


CDPH Sexually Transmitted Diseases Control Branch LetterUPDATED GUIDANCE FOR SYPHILIS DETECTION AMONG PEOPLE WHO ARE OR COULD BECOME PREGNANT

The following is a letter from the California Department of Public Health STD Control Branch regarding the recent

increase in cases of congenital syphilis among infants. The let-ter contains updated guidelines for expanded syphilis detection

among people who are or could become pregnant. Visit CDPH's STD Control Branch Congenital Syphilis web-

page at https://bit.ly/3jl7bRy.


CDPH LETTER (continued)

additional resources can be found on page 30



A complete guide to these recommendations, Expanded Syphilis Screening Recommendations for the Prevention of Congenital Syphilis, was published by the CDPH Sexually Transmitted Diseases (STD) Control Branch. This guidance includes evidence underlying these recommendations, analysis of related existing state and national policy, as well as considerations for practice implementation.

Medi-Cal reimbursement for these new syphilis screening recommendations allows for a patient to be screened multiple times depending on their risk if the healthcare professional deems it medically necessary. Therefore, providers caring for fee-for-service Medi-Cal patients in the outpatient or emergency department setting can expect to be reimbursed by the California Department of Healthcare Services (DHCS) for providing this medically necessary care in accordance with these Expanded Syphilis Screening Recommendations for the Prevention of Congenital Syphilis. Additionally, Medi-Cal managed care health plans are required to provide for all medically necessary covered services, in an amount no less than what is offered to beneficiaries under the Medi-Cal Fee-For-Service Program. As a reminder, Medi-Cal managed care health plans are required to provide access to STD services without prior authorization both in and out of the health plan network.

For patients diagnosed with syphilis, detailed recommendations for treatment and follow-up can be accessed via the 2015 Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines along with CDC STD Treatment Recommendations in the Age of COVID-19, shown in the resources below.

Finally, please collaborate with your local health jurisdiction to ensure adequate treatment for all cases of syphilis.

Thank you for your work to improve the sexual health of California’s residents.

Sincerely,

Kathleen Jacobson, MDChief, STD Control Branch California Department of Public Health

i Syphilis among mothers of infants with CS has been associated with the following: recreational drug use, especially methamphet-amine use, homelessness or unstable housing, limited or no prenatal care, incarceration within the prior 12 months and/or having a partner who is incarcerated, reported sex exchange, in addition to other factors listed in Table 2 in the document.

ii CDPH defines local health jurisdictions with high-CS morbidity as those with a rate greater than 8.4 CS cases per 100,000 live births for any of the past three consecutive years. This “threshold” reflects the national rate of CS in 2012, prior to recent increases in California and the United States, when California’s CS rate was below that of the national rate.

Additional Resources• Expanded Syphilis Screening Recommendations for the Prevention of CongenitalSyphilis: 2020

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Expanded-Syphilis-Screening-Recommendations.pdf


SUCCESSFUL TELEMEDICINE

Techniques for a Successful Telemedicine VisitBy the Medical Insurance Exchange of California (MIEC)

As the use of telehealth has continued to explode in the U.S., physicians are increasingly learning how to navigate a new

way of interacting with patients and delivering medical care using real-time videoconferencing. With experience comes an apprecia-tion of the benefits, and the problems, associated with practicing medicine through a remote connection.

Distractions are a major problem during telemedicine visits, both for patients and physicians. A recent study [1] of over 1,000 individuals revealed that 73% of men and 39% of women report multitasking during telehealth visits. Some of the distractions included:

• Surfing online/emailing/texting (24.5%) • Watching TV (24%) • Eating (21%)• Playing a video game (19%) • Smoking (11%) • Driving (10%) • Drinking alcohol (9.4%)While their “extracurricular” activities during telemedicine

sessions are necessarily more limited than what is listed above, even physicians report having to resist the temptation [2] to check email or research online information during virtual visits.

There are various techniques physicians can employ to set up the physical space, minimize distractions, address technology issues, and maximize the overall effectiveness of telemedicine visits. A few of these are listed below.

PHYSICAL SPACE – PATIENT • Confirm that the patient is in a safe, secure location to receive

medical care. • Confirm that the patient’s location is logistically appropri-

ate for the visit; that it is well-lit, relatively quiet, and free of distractions.

• Verify whether anyone else is present with the patient. • Confirm the patient’s physical location (such as their address)

for safety reasons and to verify compliance with state licen-sure requirements.

• Consider asking the patient whether they are recording the treatment session (see below under “Technology Issues” for physician recording).

• Depending on the type of care being provided, discuss with the patient what will occur in the event of a medical emergency.

PHYSICAL SPACE – PHYSICIAN • Conduct telemedicine sessions in a private, quiet area free of

distractions. • Consider conducting sessions in an examination room or

personal office, rather than a busy space such as a hallway or front office area.

• Dress professionally; consider wearing a lab coat and/or name tag so that patients clearly understand that they are interacting with a physician.

• Place your camera at eye level to maximize eye contact with patients (avoid placing the camera below your face).

• Adjust lighting appropriately; avoid having windows behind you and try using overhead lighting or a ring light.

MINIMIZE DISTRACTIONS • Avoid multitasking and give patients your undivided atten-

tion during telemedicine visits; if you need to do something else, let patients know what you are doing so they know they are your only priority.

• Instruct office staff not to interrupt you during telemedicine sessions.

• Consider placing your phone in a desk drawer or outside your reach so it doesn’t distract you.

• Shut down other devices and/or close programs (email, social media) that might create distractions during sessions.

• Resist the urge to look up information during sessions, even if it is relevant to the patient.

• Instruct patients to avoid distracting activities during tele-medicine sessions and consider requiring patients remove technological distractions during visits.

• Show empathy through carefully chosen statements and non-verbal communication to show that you are listening to the patient and understanding their concerns.

TECHNOLOGY ISSUES • Invest in a high-quality webcam and microphone for better


SUCCESSFUL TELEMEDICINE (continued)

video and audio quality and consider using headphones or a headset.

• Maximize bandwidth by using a wired internet connec-tion, shutting down other programs, and plugging your device/computer into a power source. Test your internet speed at www.fast.com.

• Know the contact information for your video platform’s tech-nical support service.

• Verify that the patient is using a secured internet connection (as opposed to public wifi).

• Ensure that patients know the process for reconnecting in the event of a temporarily lost or dropped connection.

• Provide patients with an alternate means of communication (like a phone number or email address) in the event of a con-nection failure, like a power loss or technical problem.

• Consider having an early log-in process and using a staff member to greet patients and assist with any technical issues.

• Determine whether you will be recording sessions; if so, clearly communicate this to patients before each visit.

DOCUMENTATION • Document each visit thoroughly and accurately in the medi-

cal record as if it were an in-person visit. • Document the patient’s agreement to each telemedicine visit. • To the extent that a telemedicine visit is being conducted in

place of an in-person visit due solely to patient access issues, COVID-19 mitigation, or patient insistence on virtual care, document this as a reason for proceeding with the telemedi-cine visit.

PATIENT PREPARATION • Ask patients to gather their medical history and any medica-

tions prior to the visit, and to come prepared with issues and questions to discuss.

• Ask patients to wear loose-fitting clothing, if appropriate, so they can be prepared for a partial physical exam.

• Consider advising patients what to expect during a virtual visit, such as any information they will be asked to provide or if they will be asked to participate in any testing or a virtual physical examination [3].

• Encourage patients to take notes during the virtual visit. • Instruct patients as to next steps following the virtual visit.

Published on December 8, 2020 at https://www.mi ec .c o m / k n o wl edg e - l i b ra r y / tech ni q ue s - f o r - a - suc c e s s f ul - telemedicine-visit/

Notes1. https://drfirst.com/press-releases/survey-44-americans-

telehealth-coronavirus-pandemic/2. https://www.forbes.com/sites/jessicagold/2020/10/28/according-to-a-new-

study-patients-are-texting-smoking-or-tweeting-during-appointments/? sh=7c0def9129c5

3. https://medicine.stanford.edu/news/current-news/standard-news/virtual-physical-exam.html

• Mandates a study by the Government Accountability Office (GAO) on ERISA plan network adequacy, access, premiums and out-of-pocket costs.

• Mandates a study by HHS, FTC and the U.S. Attorney General on effects of this law on consolidation, costs and access.

• Mandates a GAO study on the surprise billing process, spe-cifically including the impact of the cooling off period.

• Establishes a grant program to create and improve State All Payer Claims Databases. CMA will continue to work for improvements to the bill

through clean-up legislation and regulation. While CMA does not support the inclusion of median in-network rates to be considered in arbitration, there are firewalls around it to protect physicians in the process and to ensure that other factors must be given equal weight in arbitration decisions.

YEAR-END LEGISLATION (continued from page 9)

supply increases in the coming weeks and months. However, you are still encouraged to enroll now.If any ACCMA member is experiencing difficulty in enroll-

ing to volunteer or to become a vaccinator, please contact the ACCMA at [email protected] or (510) 654-5383 for assistance.

As planning and implementation efforts continue, the ACCMA is continuing to engage with our county health depart-ments and raise issues that concern our members. These include calling for equitable access to testing and vaccination enrollment, especially for patients who may not have ready access to tech-nology or transportation; a centralized scheduling system that includes a telephone option; an adequate workforce to rapidly scale up vaccinations; and encouraging greater flexibility, such as a “no wrong door policy” for patients.

Although vaccines provide some light at the end of the tun-nel, we still have a long way to go. By working together and doing what we can to help, we will indeed get through this. Thank you to all ACCMA members for doing your part.

PRESIDENT'S PAGE (continued from page 5)


MAT & COVID-19

Medical and Societal Challenges of a Syndemic OUR DRUG OVERDOSE EPIDEMIC AND COVID-19 PANDEMICBy Kenneth Saffier, MD

Our deadly opioid and drug overdose epidemic has been eclipsed by an ever-increasing, record number of infections

and deaths from COVID-19 in California and the US. With over 400,000 US deaths due to COVID-19, there have been 83,000 overdose deaths from June 2019 to June 2020, a 21% increase from the previous year.1

How do these two diseases interact and what are the treat-ment paths for both? On the brink of mass vaccinations for COVID-19, our medical and societal responsibilities are becom-ing clearer to stem the death and morbidity of this intruder. However, after acknowledging the inter-relationship of overdoses from opioids and other drugs with coronavirus, what challenges do we as medical professionals and society face in order to reduce the harm from drug overdoses and effectively end this deadly syndemic?

WHAT IS A “SYNDEMIC”?“The adverse interaction of diseases of all types (e.g., infections, chronic non-communicable diseases, mental health problems, behavioral conditions, toxic exposure, and malnutrition) com-monly as a result of social conditions that directly and indirectly promote disease clustering. Syndemic interactions enhance the total health burden faced by a population and often play an important role in hard-hitting epidemics.”2 Substance use disor-ders (SUD), whether one considers them brain diseases, mental health or behavioral conditions, affect individuals, families, com-munities, and society. And in turn, SUD are affected by all of these. There is a dynamic between nature (biology) and nurture (social and relationship factors) that contribute to the worsening and mitigation of this syndemic.3

WHAT CAN AN ACTION PLAN LOOK LIKE TO DECREASE DEATHS AND MORBIDITIES?Widespread mask-wearing, social distancing, and vaccinations are hopefully becoming norms to fight COVID-19. Easier access to medications for opioid use disorder (MOUD) can be an immediate, first step response for us as medical professionals and health systems. However, fighting this pandemic, epidemic, and

syndemic requires a broader public health approach that addresses social determinants of individual and community health. We have our work and responsibilities cut out for us and our institutions.

WHAT RISKS FOR INCREASED SUD MORBIDITIES AND DEATHS NEED TO BE ADDRESSED NOW?• Social isolation increases loneliness, depression, and hope-

lessness which leads to seeking relief through drug use.• Using drugs alone increases risks for overdose deaths.• Lack of access to clean needle exchanges increases the risk of

sharing needles, which then increases the risk of contracting or spreading infectious diseases, including COVID-19.

• Decreased drug supply or new suppliers can lead to risks using drugs of unknown potency or potentially deadly com-binations, e.g., fentanyl and stimulants such as methamphet-amine, which are increasingly linked to overdose cases.

• Poverty with the inability to socially isolate as a function of unstable housing, food scarcity, and/or under- and unemployment.

• Living in congregate shelters as overcrowding increases the spread of COVID-19.

• Lack of PPE increases exposure for individuals and others.• Lack of access to health care due to no insurance or under-

insurance, inadequate transportation, co-pays for care leading to delayed diagnoses and complications, including death.

WHAT CAN WE DO AS MEDICAL PROFESSIONALS TO REDUCE OVERDOSE DEATHS AND DRUG-RELATED MORBIDITIES?1. Prescribe buprenorphine to our patients with opioid use

disorders (OUD). After an announcement on 1/12/2021, Alex Azar, then-Secretary of the US Department of Health and Human Services, detailed that all DEA-registered phy-sicians can prescribe buprenorphine to a maximum of 30 patients in the state that they are licensed4; however, the incoming Biden administration put this on hold for addi-tional review.5 Buprenorphine, a partial opioid mu receptor


7. Emergency declaration DEA/SAMHSA 3/31/2020 and DEA guidelines (https://www.deadiversion.usdoj.gov/coronavirus.html)

8. Pytell JD, Rastegar DA 2020 Down the drain: reconsidering routine urine drug testing during the COVID-19 pandemic. Journal Substance Abuse Treatment, 120; (https://doi.org/10.1016/jsat.2020.108155)

9. Olsen Y, Sharfstein J. 2014 Confronting the stigma of opioid use disorder and its .2147 treatment. JAMA (https://doi:10.1001/jama.2014)

10. Compiled by Kelsey Priest, Ph.D., M.D., @kelseycpriest

RESOURCES10 MOUD referrals for patients and clinicians:• In Contra Costa County: Behavioral Access

Line – 1 800 846 1652• In Alameda County: 844 682 7215

For clinicians:• American Society of Addiction Medicine:

COVID-19 Resources: https://bit.ly/3oayBL3 • Harm Reduction Coalition: COVID-19

Resources for People Who Use Drugs and People Vulnerable to Structural Violence: https://bit.ly/3o3pOuf

• Drug Policy Alliance: COVID-19 Resources: https://www.drugpolicy.org/covid19

• Provider Clinical Support System - MAT Waiver Training for MD/DOs, Nurses (NP/CNM/CNS/CRNA), PAs, and Medical Students to Prescribe buprenorphine: https://pcssnow.org/medications-for-addiction-treatment/

• Yale Coursera: https://www.coursera.org/learn/addiction-treatment

• Telehealth Toolkit: https://bit.ly/3o3PB5g

For patients:• Harm Reduction Coalition: COVID-19

Resources for People Who Use Drugs and People Vulnerable to Structural Violence: https://bit.ly/3bYDdRQ

• Yale Addiction Medicine Resources: http://bit.ly/3sHb6MU

• Never Use Alone Hotline or Online Chat: https://neverusealone.com/

• NIAAA Patient Navigator: http://bit.ly/3ixEtg3

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

MAT & COVID-19 (continued)

agonist, which serves as an evidence-based treatment, has been shown to decrease morbidity and mortality for people with OUD.6 As physicians, we can advocate for removing the X-waiver obstacle for physicians, nurse practitioners, and physician assistants. Until further notice, DEA X-waivers are needed to prescribe buprenorphine for OUD.

2. Encourage physician colleagues, nurse practitioners, and physician assistants to become waivered to prescribe buprenorphine.

3. Increase access to medications for OUD (MOUD) by tele-medicine7, as explained in the 3/31/2020 DEA announce-ment in response to the HHS declaration of a public health emergency.

4. Prior recommended guidelines for initial visits and urine toxicology testing are relaxed as of 3/31/2020 by the DEA and SAMHSA.7 The urgency of the syndemic has expanded the potential for increased access for MOUD. For example, during our current declared public health emergency, initial visits can be by telephone or virtually. In-person visits are not required. Although helpful, or often essential on initial visits, urine toxicology screening should not limit providing MOUD.8

5. Decrease the stigma of substance use disorders so that we, as medical professionals and health system administrators, wel-come people with this disease to seek treatment as we would encourage anyone with cardiovascular or other chronic ill-nesses.9 Buprenorphine treatment can be lifesaving and life-reclaiming. Let us widely initiate it as one part of a compre-hensive treatment plan for this chronic disease.

References:1. Products – Vital Statistics Rapid Release – Provisional Drug Overdose Data

(http://bit.ly/36Hwica) 2014 US DHHS announcement submitted to the Federal Register, 1/12/2021, (exact Federal Register publication location pending)

2. Singer M., Syndemics. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, 2419-2423.

3. Priest. K.C. 2020 The COVID-19 Pandemic: Practice And Policy Considerations For Patients With Opioid Use Disorder. Health Affairs Blog. (https://bit.ly/2NYm5BD)

4. HHS Expands Access to Treatment for Opioid Use Disorder (http://bit.ly/36AVqkU)

5. Biden kills Trump plan on opioid-treatment prescriptions – The Washington Post, 1/27/2021 (http://wapo.st/3oRPg6s)

6. Evans E., Li L, et.al. 2015 Mortality among individuals accessing phar-macological treatment for opioid use disorder in California. 2006-2010. Addiction 110(8): 998-1005


2021 ACCMA COUNCIL

Suparna Dutta, MDPresident

Robert Edelman, MDPresident-Elect

Edmon Soliman, MDSecretary-Treasurer

Katrina Peters, MDImmediate Past-President

Lilia Lizano, MDDistrict 1

Russ Granich, MDDistrict 2

Ross Pirkle, MDDistrict 3-A

Kristin Lum, MDDistrict 3-B

Eric Chen, MDDistrict 3-C

Arden Kwan, MDDistrict 3-D

Jeffrey Poage, MDDistrict 3-E

Abbas Mahdavi, MDDistrict 4-A

Irina Kolomey, MDDistrict 4-B

Ahmed Sadiq, MDDistrict 5-A

Shakir Hyder, MDDistrict 5-B

Terence Lin, MDDistrict 5-C

Albert Brooks, MDDistrict 5-D

Clifford Wong, MDDistrict 6

Thomas Powers, MDDistrict 7-A

Steven Rosenthal, MDDistrict 7-B

Stephen Post, MDDistrict 8

Suresh Sachdeva, MDDistrict 9

James Hanson, MDDistrict 10-A

Terry Hill, MDDistrict 10-B

Judith StantonDistrict 10-C

Richard Rabens, MDDistrict 10-D

Rollington Ferguson, MDDistrict 10-E

Alexander Kao, MDDistrict 11

Jonathan Savell, MDDistrict 12-A

Harshkumar Gohil, MDDistrict 12-B

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2021 ACCMA COUNCIL

Kiran Narsinh, MDDistrict 1 - Alternate

Eric Alexander, MDDistrict 2 - Alternate

Michael Stein, MDDistrict 3 - Alternate A

VACANTDistrict 3 - Alternate B

Colin Mansfield, MDDistrict 3 - Alternate C

Joshua Perlroth, MD District 3 - Alternate D

Kenneth Grullon, MDDistrict 3 - Alternate E

Sanjay Ray, MDDistrict 4 - Alternate A

Irene Lo, MDDistrict 4 - Alternate B

Gautam Pareek, MDDistrict 5 - Alternate A


Basil Besh, MDDistrict 5 - Alternate C

Jeffrey Stuart, MDDistrict 5 - Alternate D

Daisy Maron, MDDistrict 6 - Alternate

Chao Ho, MDDistrict 7 - Alternate A

Renee Wachtel, MDDistrict 7 - Alternate B

Robert Deutsch, MDDistrict 8 - Alternate

Paul Wotowic, MDDistrict 9 - Alternate

Katrina Saba, MDDistrict 10 - Alternate A

Warren Strudwick, Jr., MDDistrict 10 - Alternate B

Gary Goldman, MDDistrict 10 - Alternate C

Sijie Zheng, MDDistrict 10 - Alternate D

Renee Fogelberg, MDDistrict 10 - Alternate E

VACANTDistrict 11 - Alternate

Leena Mehandru, MDDistrict 12 - Alternate A


Patricia Austin, MDAMA Delegate

Mark Kogan, MDCMA Trustee/AMA Alternate Delegate

Ronald Wyatt, Jr., MDCMA Trustee

2021 ACCMA Council

District 1: Crockett, El Sobrante, Hercules, Pinole, Richmond, Rodeo, San PabloDistrict 2: Concord, Martinez, Pleasant HillDistrict 3: Alamo, Lafayette, Moraga, Orinda, Walnut CreekDistrict 4: Antioch, Brentwood, Byron, Clayton, Oakley, PittsburgDistrict 5: Fremont, Newark, Union CityDistrict 6: Castro Valley, Dublin, HaywardDistrict 7: San Leandro, San LorenzoDistrict 8: AlamedaDistrict 9: Danville, Diablo, San RamonDistrict 10: Oakland, Piedmont, EmeryvilleDistrict 11: Albany, Berkeley, El Cerrito, KensingtonDistrict 12: Livermore, Pleasanton

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BYLAWS AMENDMENTS

MEDICARE 2021 WHAT YOU NEED TO KNOW

Don’t miss your opportunity to make the most of the ever-changing healthcare reimbursement landscape! First you must understand the challenges you may be facing. Learn the important changes in Medicare for 2021 and how they may a�ect your practice reimbursement for the coming year(s). Changes are sometimes subtle, but they can have a lasting e�ect on your practice.

For Questions about this online seminar, please contact Jenn Mullins, ACCMA Education and Event Associate at [email protected] or 510-654-5383.

On-demand Webinar

REGISTRATION LINK: https://bit.ly/3mViOzwor go to learning.accma.org

FEES:Members: FREENon Members: $49

Overall Payment UpdateMedicare Telehealth ServicesE & M Services: 2021 & beyond Coding and documentation PaymentAdvanced Diagnostic Imaging: Latest updateMIPS 2021 – What you need to report

TOPICS WILL INCLUDESUMMARY

Mary Jean Sage has many, many years of experience working with physicians and other healthcare professionals across the U.S. MJ’s lecture engagements have included the AMA, and many state and local Medical Associations, Specialty Societies and Medical Group Management Associations. She is recognized for her expertise in coding, billing, healthcare compliance and Medicare audit response. Her presentations are known for the practical information she conveys in a clear and concise style.

SPEAKER: MARY JEAN SAGE, CMA-AC


MEDICARE UPDATES

2021 Medicare UpdateTHE IMPORTANT DETAILS FOR YOUR PHYSICIAN PRACTICEBy Mary-Jean Sage, CMA-AC

The 2021 Medicare Physicians Fee Schedule Final Rule (MPFS) was released on December 1, 2020, and most

changes went into effect on January 1, 2021. There are a number of policy changes and/or updates that may affect your medical practice, most of which involve telehealth services and, of course, the new CPT guidelines for selecting levels of service for office visits for new and established patients. Let us summarize some of those important changes.

CONVERSION FACTOR (CF)The conversion factor was decreased by 10% from $36.09 to $32.41 in order to maintain budget neutrality and account for increase in relative value units (RVUs) and payments for office visit codes 99202 – 99215, in addition to an add-on HCPCS code for complexity associated with E/M services.

With the increase in payments for office visits, CMS increased payments for certain other services which have office visits as a component, or whose values were based on its similarity to a specific E/M service. This includes some ESRD monthly pay-ments, maternity care, transitional care management, wellness visits, psychiatric collaborative care management, and assessment of cognitive impairment. CMS did not, however, increase the value of services with 10 and/or 90-day global periods, which also include office visits.

There was an outcry from a number of medical associa-tions and other professional organizations about the significant decrease in conversion factor and the dramatic affect it would have on a medical practice with lobbying beginning at the federal level. As a result, in the stimulus bill that Congress passed on December 21, 2020, which was eventually signed by the President, there are some health care provisions that change policy in the 2021 Physician Fee Schedule Final Rule.

• Implementation of the add-on code G2211 for inherent complexity is delayed for three years

• The money that would have gone to primary care and medical specialties for G2211 will be spread across all specialties, all services, and will increase the CF

• RVUs for office/outpatient codes will remain at the

increased level that CMS published for 2020• There is $3 billion dollars in additional funding to sup-

port a 3.75% payment increaseWith this additional money, CMS has acknowledged that the

2021 conversion factor has been increased to $34.8931 from the $32.4085 that was previously published in the 2021 Final Rule. While this is an increase from the previously published Final Rule, it is still a decrease from the 2020 CF, but only a $1.1969 decrease. The Medicare Administrative Contractors (MACs) will now use this new amount to calculate the 2021 Physician Fee Schedule. Noridian is expected to post the updated schedule soon.

TELEHEALTHA number of services were added to the Medicare telehealth

list on a Category 1 basis – those are services that are similar to services already on the telehealth list and are considered to be per-manent additions. A list of those services with their CPT codes are:

• Group Psychotherapy (90853)• Psychological and Neuropsychological Testing (96121)• Domiciliary, Rest Home, or Custodial Care services,

Established patients (99334-99335) – lower levels of service

• Home Visits, Established Patient (99347-99348) – lower levels

• Cognitive Assessment and Care Planning Services (99483)

• Visit Complexity Inherent to Certain Office/Outpatient E/M (HCPCS G2211) – use of this code has been subse-quently delayed for three years

• Prolonged Services (HCPCS code G2212)There was a creation of a third temporary category of criteria

for adding services to the list of Medicare telehealth services. Category 3 describes services that are added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic that will remain on the list through the cal-endar year in which the PHE ends. These services include some of the same services added on the Category 1 list, but at different



MEDICARE UPDATES (continued from page 19)

levels of service. They are:• Domiciliary, Rest Home, or Custodial Care services,

Established patients (99336-99337)• Home visits, Established Patient (99349 – 99350)• Emergency Department Visits, Levels 1-5 (99281

– 99285)• Nursing facilities discharge day management (99315

– 99316)• Psychological and Neuropsychological Testing (96130 -

96133; 96136 – 96139)• Therapy Services, PT and OT, All levels (97161 –

97168; 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521 – 92524, 92507)

• Hospital discharge day management (99238 – 99239)• Inpatient Neonatal and Pediatric Critical Care,

Subsequent (99469, 99472)• Continuing Neonatal Intensive Care Services (99478

– 99480)• Critical Care Services (99291 – 99292)• End-Stage Renal Disease Monthly Capitation Payment

(90952, 90953, 90956, 90959, 90962)• Subsequent Observation and Observation Discharge

Day Management (99217; 99224 – 99226)Remember – the difference between Category 1 and

Category 3 services is based on permanence – Category 1 are permanent, and Category 3 only lasts through the end of the cal-endar year in which the PHE ends.

OTHER TELEHEALTH ISSUES:• The frequency limitation for subsequent Nursing

Facility telehealth visits was changed to one visit every 14 days (from the once every 30-day frequency.)

• Clarification that LCSW, clinical psychologists, PT, OT, and SLP therapists can furnish brief online assessment and management services as well as virtual check-ins and remote evaluation services. Two new G codes were established to report these services – G2250 for RPM, and G2251 for virtual check-in.

• A new code was established to report a virtual check-in visit of 11-20 minutes of medical discussion by a physi-cian or QHP who has E/M services in their scope of practice. The code is G2252 and has similar rules as code G2012, but it accommodates a longer visit.

• CMS re-iterates its belief that it lacks statutory authority to continue the relaxed telehealth rules when the PHE is over. Specifically, during the PHE, CMS relaxed the

requirement that the patient be in an underserved area, and must receive the telehealth service at a facility, an originating site. CMS believes that after the PHE ends, Congress must pass a law to allow telehealth to continue in its current form, to patients in any geographic area, from their home.

• CMS is not proposing to continue paying for audio only calls (99441 – 99443) after the end of the calendar year in which the PHE ends. These codes will once again have a status indicator of bundled.

PAYMENT FOR OFFICE/OUTPATIENT EVALUATION AND MANAGEMENT SERVICESAs finalized in the CY 2020 PFS final rule, the CY 2021 CMS is aligning their E/M visit coding and documentation policies with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits. RVUs have been updated and times revised. The table on page 21 is a comparison of the 2021 specifics to the previous year of 2020.

As part of the final rule, CMS has finalized separate payment for the new HCPCS code G2212, which describes prolonged office/outpatient visits to be used in place of the new CPT code 99417. The new HCPCS code is to be used only with CPT code 99205 or 99215 when the provider is making his/her code selec-tion based on the time they spent on the patient encounter. It would not be used when the selection is based on MDM (Medical Decision Making). It may only be added on to the encounter reporting when the time spent on the encounter has exceeded the upper threshold of the time range for the respective code. This policy differs from the CPT policy and was the driving force for the new code development.

For an in-depth discussion of the CPT guideline chang-es please access the on-demand E/M changes webinar in the ACCMA Learning Center, “Getting Ready for the 2021 E/M Changes,” at learning.accma.org/recordings.

OTHER FINAL RULE POLICIES/CHANGES• Supervision of Diagnostic Tests by NPPs – made per-

manent the COVID-19 PHE policy that allows NP, CNS, PA and CNM to supervise the performance of diagnostic tests within their scope of practice and state law. CRNAs were added to that list. These practitio-ners must maintain the required statutory relationships under Medicare with supervision or collaborating physi-cians (i.e., they must be enrolled in Medicare).

• Pharmacists Providing Services Incident to Physicians’


Service – pharmacists may fall within the regulatory def-inition of auxiliary personnel under the CMS “incident to” regulations. Therefore, pharmacists may provide ser-vices “incident to” in a physician practice as long as all the “incident to” regulations are followed if the service (s) is not made under the Medicare Part D benefit.

• Therapy Assistants may furnish maintenance therapy – PTAs and OTAs may be utilized to provide rehabilitative services to patients.

• Resident Physician “Moonlighting Services” – clarified when a resident physician may “moonlight” during their training period.

• Opioid Use Disorder Treatment Furnished by OTPS – finalized the proposal to extend the OUD treatment services to include naloxone for emergency treatment of opioid overdose, as well as overdose education.

MEDICARE INCENTIVE PROGRAMSThe Final Rule also updates changes to the Medicare Incentive Programs (MIPS and APM). The MIPS Value Pathway program has been deferred until 2022 (or later). There are at least minimal changes to each of the four reporting categories for MIPS – qual-ity, promoting interoperability, improvement activities and cost.

These changes were discussed in the ACCMA on-demand webi-nar “Medicare 2021; What You Need to Know”. This webinar can be accessed through the ACCMA Learning Center at learning.accma.org/recordings. It is the time of year to make quality mea-sure selections and start gathering data for reporting.

Now is the time of year to start using new CPT and HCPCS codes, using the new CPT guidelines for determining level of ser-vice for office/outpatient visits for new and established patients and updating your systems to start gathering MIPS data. Please remember your ACCMA team has a number of resources to help you with any of these issues, – contact the ACCMA by emailing [email protected] or calling 510-654-5383.

I wish you all a prosperous New Year in your practice.

Mary Jean Sage, CMA-AC has many years of experience work-ing with physicians and other healthcare professionals across the U.S. Mary Jean’s lecture engagements have included the AMA, many state and local Medical Associations, Specialty Societies, and Medical Group Management Associations. She is recognized for her expertise in cod-ing , billing , healthcare compliance, and Medicare audit response. Visit learning.accma.org/recordings to access on-demand content recorded by Mary Jean.

MEDICARE UPDATES (continued)

CPT Pre 2021 Typical Time

Pre 2021 RVU 2021 Minimum Minutes

2021 RVU % Variance in RVU

New Patient99201 10 0.48 NA – Code Eliminated

99202 20 0.93 22 0.93 0.0%

99203 30 1.42 40 1.60 12.7%

99204 45 2.43 60 2.60 7.0%

99205 60 3.07 85 3.50 10.4%

Established Patient99211 5 0.18 NA 0.18 0.0%

99212 10 0.48 18 0.70 45.8%

99213 15 0.97 30 1.30 34.0%

99214 25 1.50 49 1.92 28.0%

99215 40 2.11 70 2.80 32.7%

Prolonged ServiceG2212 NA NA 15 0.61 NA

Join the ACCMA at www.accma.org/membership/join-now

E/M CHANGES (continued from page 21)

As women physicians, we face unique challenges over the course of our careers: from frequent microaggressions to overt differences in salaries, promotions, and leadership roles.

Join the ACCMA and RechargedMD for an introduction to the RechargedMD Women Physician Peer group! We explore our experiences as women physicians, discuss how to overcome these barriers together, and make use of tools to make strides in our personal and professional development.

RechargedMD is the brainchild of CEO and Founder, Dr. Fayola Edwards- Ojeba. As a practicing physician, she relates to the deep gratification and turmoil of clinical practice. She overcame her struggle with burnout using the tools and services she turned into RechargedMD. Through RechargedMD, her mission is to positively impact the healthcare system and improve

Fayola Edwards-Ojeba, MDRechargedMD Founder & CEO

the practice of medicine for doctors and patients alike. Dr. Edwards-Ojeba is a member of the American College of Healthcare Executives, American Medical Women’s Association, and serves on the board of the California Association of Healthcare Leaders.

Women in Medicine:Introduction to Women Physician Peer Group

FREE WEBINAR

Available online at learning.accma.org/recordings

Harjot Mann, MDPhysician Coach

Dr. Harjot Mann is a medical doctor turned Mindset & Leadership Coach. She helps driven and caring health & wellness professionals build emotional resilience and a leadership mindset to run a thriving life and profession.Using Mindset, Leadership and Resilience as the main pillars, she brings a holistic, mind-body-soul approach to her coaching. Her goal is to help professionals working in a high-stress career become resilient leaders, create meaningful impact, and live emotionally liberating lives. Dr. Mann has 15+ years of experience in healthcare across Canada, Romania, and Ireland.

VIEW ON-DEMANDThis program is FREE to access. Visit learning.accma.org/recordings to access the pre-recorded webinar.

For more information about the program, contact Jennifer Mullins, ACCMA Education and Events Associate at 510-654-5383 or email [email protected].


MEMBER SPOTLIGHT

MEMBER SPOTLIGHT:

Fayola Edwards-Ojeba, MDA board-certified internist, Fayola

Edwards-Ojeba, MD, cared for patients while teaching residents as a Clinical Assistant Professor at UCSF. She graduated from Harvard College with honors, and completed her training at Yale Medical School and UCSF Internal Medicine Residency Program.

As a practicing internist, she strove to provide thorough and compassionate care, but felt constrained by her limited time with patients, the burden of battling insurance companies, and long hours of after-clinic administrative work. After speaking with others in the field, she realized many physi-cians suffer in silence. Studies estimate burnout affects up to 55 percent of physicians nationally, and it is clear there are systemic factors at play. COVID-19 has only complicated this further; 62% of US physicians have reported a decreased income, nearly a quar-ter have reported lack of sufficient PPE, and we are seeing higher rates of depression and anxiety.

Dr. Edwards-Ojeba founded RechargedMD to address physi-cian burnout and to work with hospital systems to identify and remediate it. By identifying and addressing the root causes of burnout, promoting physician leadership, and providing a space for physicians to support one another, she believes RechargedMD can make significant progress in addressing this public health crisis.

In addition to the common causes of burnout, female physi-cians and physicians of color are faced with further challenges. With fewer women in leadership roles, they are less likely to be

pegged for promotion, not to mention less likely to receive equal pay. Women also often carry more of the responsibilities related to family life and caregiving. Many can recall encounters in which their credentials, competence or professional titles were ques-tioned or challenged due to their gender and/or race. Combined with the already stressful job of providing patient care, it makes sense that female and minority physicians experience burnout at higher rates.

Dr. Edwards-Ojeba has worked with the ACCMA since the onset of the pandemic to support clinician wellness, with a focus on women physicians. She presented a well-attended webinar on Women in Medicine on September 22. This CME program is now available on-demand at learning.accma.org. In her webinar, she spoke about RechargedMD’s Women Physician Peer Group, which was designed with the disparities that women physicians face in mind. The group aims to create an engaging, supportive environment for female physicians to address the challenges they face in a safe and productive space. Led by certified physician coaches, the participants discuss a wide variety of topics including physician identity, overcoming imposter syndrome, and clarifying their goals, all while earning 7 CME credits.

RechargedMD also hosts free three-week-long physician peer groups led by certified physician coaches on a monthly basis, with optional CME. These sessions unpack practicing in the middle of a global crisis and battling stress with self-care, while giving women physicians the opportunity to build relationships with peers. Dr. Edwards-Ojeba can be contacted at [email protected] or (530) 404-0801.

Fayola Edwards-Ojeba, MD

ACCMA OFFERS FREE GROUP THERAPY SESSIONSWith the increasing stress and pressure physi-

cians are facing, ACCMA is committed to providing all East Bay physicians a place to turn during these difficult times. The ACCMA offers, at no charge, small group wellness sessions with vetted therapists who are experienced in supporting physicians. Any physician or medical resident in Alameda or Contra Costa counties, member or non-member, may use this confidential service. Sessions are held virtually.

To join these ongoing sessions, contact a vetted

therapist directly and let them know that you are accessing the ACCMA Clinician Wellness Program. Therapist contact information can be found on the flyer on page 2.

To learn more about these therapists, go to www.accma.org/Sponsored-Psychotherapy. For questions about the ACCMA Clinician Wellness Program, con-tact the ACCMA at (510) 654-5383, ext. 6307 or [email protected].

As women physicians, we face unique challenges over the course of our careers: from frequent microaggressions to overt differences in salaries, promotions, and leadership roles.

Join the ACCMA and RechargedMD for an introduction to the RechargedMD Women Physician Peer group! We explore our experiences as women physicians, discuss how to overcome these barriers together, and make use of tools to make strides in our personal and professional development.

RechargedMD is the brainchild of CEO and Founder, Dr. Fayola Edwards- Ojeba. As a practicing physician, she relates to the deep gratification and turmoil of clinical practice. She overcame her struggle with burnout using the tools and services she turned into RechargedMD. Through RechargedMD, her mission is to positively impact the healthcare system and improve

Fayola Edwards-Ojeba, MDRechargedMD Founder & CEO

the practice of medicine for doctors and patients alike. Dr. Edwards-Ojeba is a member of the American College of Healthcare Executives, American Medical Women’s Association, and serves on the board of the California Association of Healthcare Leaders.

Women in Medicine:Introduction to Women Physician Peer Group

FREE WEBINAR

Available online at learning.accma.org/recordings

Harjot Mann, MDPhysician Coach

Dr. Harjot Mann is a medical doctor turned Mindset & Leadership Coach. She helps driven and caring health & wellness professionals build emotional resilience and a leadership mindset to run a thriving life and profession.Using Mindset, Leadership and Resilience as the main pillars, she brings a holistic, mind-body-soul approach to her coaching. Her goal is to help professionals working in a high-stress career become resilient leaders, create meaningful impact, and live emotionally liberating lives. Dr. Mann has 15+ years of experience in healthcare across Canada, Romania, and Ireland.

VIEW ON-DEMANDThis program is FREE to access. Visit learning.accma.org/recordings to access the pre-recorded webinar.

For more information about the program, contact Jennifer Mullins, ACCMA Education and Events Associate at 510-654-5383 or email [email protected].

MEMBER PROFILE (continued from page 9)

Medical Malpractice Coverage That Outlasts Today’s Healthcare Challenges

■ Competitive Rates

■ Assertive Claims Management

■ In-house Dedicated Law Firm

■ A+ Superior Rating by A.M. Best

■ Complimentary Risk Reduction Training and Resources

■ Free Tail Coverage at Retirement

■ Guaranteed Issue Disability and Life Insurance

■ Free Practice Management Support

■ Physician-founded and Physician-directed

■ Adverse Event Resolution Programs

To see how much you can save on your medical malpractice coverage, get an easy, no-obligation quote at www.CAPphysicians.com/quoteACC

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code. Members pay tax-deductible assessments, based on risk classifications, for the amount necessary to pay claims and administrative costs. No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement.

For more than 40 years, the Cooperative of American Physicians, Inc. (CAP) has delivered financially secure medical malpractice coverage along with risk management and practice management solutions to help California’s finest physicians succeed.


RotaCare Pittsburg Free Medical Clinic at St. Vincent de PaulLOCAL MEDICAL MISSIONARY VOLUNTEER OPPORTUNITIESBy Barb Hunt, St. Vincent de Paul of Contra Costa County Development Director

ROTACARE

The volunteer-led free medical clinic, “RotaCare Pittsburg Free Medical Clinic at St. Vincent de Paul”, will celebrate its

10th anniversary on February 9, 2021. A major milestone we’ll be recognizing is the provision of over 14,000 patient visits to the uninsured of East Contra Costa County since 2011. Of course, this major accomplishment could not be possible without the important volunteer efforts of the physicians, nurse practitioners, physician assistants, nurses, health educators, and translators that have made the delivery of this important community program possible. The clinic is located in Pittsburg and is seeking new volunteer primary care physicians to join the team, providing “Medical Missionary Work” in our own backyard!

The free clinic is a partnership between St. Vincent de Paul of Contra Costa County and RotaCare Bay Area and is led by volunteer Medical Director, Dr. Hamid Khonsari, who maintains a private medical practice in Antioch. As a volunteer physician and Medical Director of the free clinic, Dr. Khonsari oversees all

medical aspects of the clinic, supervises medical volunteers, trains John Muir 3rd Year residents, and assists in medical provider vol-unteer recruitment. Dr. Khonsari notes that he entered medicine to make a difference.

“I enjoy what I do because it makes a difference. I am not treating patients to make a living – the fulfillment comes from the difference I am able to make for them. If it puts their smile on their face or I can help people prevent certain diseases – I have succeed-ed that day,” Khonsari continued, “Volunteering has always been a part of what I do. I’ve volunteered in other forms of service as well. For example, my wife and I have a non-profit called Families without Borders where we put kids in college in Sierra Leone in Africa. We do that on a volunteer basis, and it’s something where I felt that if I don’t do it – I haven’t fulfilled the mission that I want to fulfill in life – which is to make a difference in humanity. My thinking is, if I don’t do it, who will? You can’t just leave things for someone else to do.”

Every choice Dr. Khonsari has made has been a part of his belief that we are all responsible for making the world a better place.

“I chose to open my private practice in Antioch because there was less access to medical care there – I wanted to be able to make the biggest impact possible,” Khonsari says, “That’s what set the clinic at St. Vincent de Paul apart from other free clinics – it is for people that have no other access. If you have access in some way, some fashion – someone will see you. If you don’t, who’s going to see you? The undocumented can’t be insured, even under the Obama rules – they make up the majority of our patients.”

While the clinic modified services during the early months of the pandemic to provide follow-up care via telephone, the clinic is back to providing face-to-face medical care for its patients. CDC-recommended health & safety measures have been employed to ensure the safety of all volunteers and patients. Extra sanitizing and high-grade HEPA air-filters are utilized. Additionally, ample PPE is provided to all providers and patients are screened before been treated at the clinic to refer any patients with flu or COVID-like symptoms to other resources. The clinic is open on the 1st and 3rd Wednesdays of each month, (5 pm – 8 pm), and will soon open again on Saturdays.

continued on next pageVolunteer Medical Director Dr. Hamid Khonsari

Medical Malpractice Coverage That Outlasts Today’s Healthcare Challenges

■ Competitive Rates

■ Assertive Claims Management

■ In-house Dedicated Law Firm

■ A+ Superior Rating by A.M. Best

■ Complimentary Risk Reduction Training and Resources

■ Free Tail Coverage at Retirement

■ Guaranteed Issue Disability and Life Insurance

■ Free Practice Management Support

■ Physician-founded and Physician-directed

■ Adverse Event Resolution Programs

To see how much you can save on your medical malpractice coverage, get an easy, no-obligation quote at www.CAPphysicians.com/quoteACC

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code. Members pay tax-deductible assessments, based on risk classifications, for the amount necessary to pay claims and administrative costs. No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement.

For more than 40 years, the Cooperative of American Physicians, Inc. (CAP) has delivered financially secure medical malpractice coverage along with risk management and practice management solutions to help California’s finest physicians succeed.


ROTACARE (continued from page 25)

The clinic provides urgent and chronic primary care to patients with a majority of the conditions treated being diabetes and hypertension. All patients are uninsured and have nowhere to turn to for primary care. Dr. Jane Hewitt, volunteer physician notes, “This volunteer experience is extraordinarily fulfilling. The patients are incredibly grateful and since we don’t utilize any insurance or reimbursement programs at the clinic, I feel almost

all my time is spent treating patients – not doing paperwork! I have a personal desire to help other people and it’s delightful to volunteer part-time and use my professional experience in such a meaningful way.”

Additional volunteer and financial support is provided by local Rotary Clubs, Kaiser Permanente Northern California Community Benefit, Sutter Delta, John Muir Health, Los Medanos Community Healthcare District, the City of Pittsburg, the County of Contra Costa, Keller Canyon Mitigation Fund, and numerous churches, organizations and generous individuals.

The clinic is located in Pittsburg at the St. Vincent de Paul Family Resource Center where additional safety-net services are located including a free food pantry, free dining room, free dental program, free auto program, employment & training program, and other basic services are available. Claudia Ramirez, Executive Director of SVdP notes, “SVdP has established a hub of services here in the community where there is a great need.”

In addition to providing face-to-face care, the clinic is imple-menting an electronic medical records system that will support telehealth. If you are interested in volunteering at the clinic once per month or once per quarter, please contact Yazmin Mejia, Clinic Operations Manager at [email protected], or call (925) 439-2009.

Volunteer Physician Dr. Jane Hewitt and patient at RotaCare Pittsburg Free Medical Clinic at St. Vincent de Paul


The Alliance’s Commitment to Whole-Person Care By: Scott Coffin, Alliance CEO

Alameda Alliance for Health (the Alliance) is proud to serve over 276,000 children and adults in Alameda County. In this

edition you will learn new updates about the multi-year initiative – California Advancing and Innovating Medi-Cal “CalAIM,” and how the Alliance is working in alignment to strengthen our orga-nization’s whole-person care approach. You will also learn about the ACEs Aware initiative, a joint effort led by the Office of the California Surgeon General and Department of Health Care Services (DHCS) to screen Californians for adverse childhood expe-riences and to treat the impact of toxic stress. Lastly, you will read an update on Medi-Cal Rx, the new administration system for Medi-Cal pharmacy benefits that will be implemented on April 1st, 2021.

Due to the public health emergency and the need for resourc-es to be focused on addressing the pandemic, the DHCS had pre-viously made the decision to postpone CalAIM implementation timelines. While the state continues to focus on battling COVID-19, the DHCS recently announced that many of the components through the CalAIM effort will resume and are now scheduled to begin in January 2022. With the goal of improving the quality of life and health outcomes of the Medi-Cal population, the CalAIM effort aims to build upon various promising Whole Person Care approaches that were introduced through previous federal waiv-ers. Along with other managed care health plans throughout the state, the Alliance will establish a population health management program that will provide wrap-around flexible services with the goal of keeping our Medi-Cal members healthy, helping them navigate complex health care and other delivery systems, address social determinants of health, and reduce health disparities.

Starting in 2022, the Alliance will administer Enhanced Care Management (ECM) and In-Lieu-of Services (ILOS) that will build on our work through the health homes and whole-person care programs that the Alliance has piloted over the last few years. A few of the target populations for enhanced care management include children or youth with complex care needs, individuals experiencing (or at risk of ) chronic homelessness, individuals who frequently utilize emergency services, people transitioning

from skilled nursing facilities, and individuals transitioning from incarceration. Along with this important benefit, the Alliance will be integrating ILOS, which are flexible wrap-around supports that will help us address medical or social determinants of health that our members experience. Some potential ILOS services include homeless related services, home-based services, day habilitation

programs, respite for caregivers, and medically tailored meals. As the Alliance moves through the implementation planning process in the first and second quarters of 2021, we are hosting virtual community engagement forums with members and providers that will help us improve and

sustain effective care coordination and improve the health of our Medi-Cal members.

ADVERSE CHILDHOOD EXPERIENCESThe Office of the California Surgeon General recently released its first report that addresses Adverse Childhood Experiences (ACEs) and toxic stress. According to the report, 62% of California adults have experienced at least one ACE, and 16.3% have experi-enced four or more ACEs. The report also states that ACEs are strongly associated with some of the most serious health condi-tions, including 9 out of 10 leading causes of death. It provides tools to address ACEs through evidence-based and cross-sector approaches and is part of a larger effort to treat the impacts of toxic stress with trauma-informed care. In December of 2019, the ACEs Aware initiative was launched by the Surgeon General and DHCS purposed to screen Californians for ACEs. Since January 1, 2020, eligible Medi-Cal providers began to receive a $29 payment for conducting qualifying ACEs screenings for children and adults up to 65 years old who have full-scope Medi-Cal. This initiative aims to reduce adverse childhood experiences among our diverse communities and to cut toxic stress by half in one generation. The Office of the Surgeon General and DHCS have committed to partnering with community organizations across the state to ensure that providers have the tools and resources they need to incorporate ACE screenings with their patients and to provide

ALAMEDA ALLIANCE


ALAMEDA ALLIANCE (continued from page 27)

BE A MEDICAL MISSIONARY IN YOUR OWN BACKYARD – SOON OFFERING TELEHEALTH CARE!COVID-19 PRECAUTIONS:

*Health and safety precautions are taken to ensure provider safety*PPE is provided for all volunteers and patients, HEPA UVC Air Filters

*CDC guidelines adhered to for in-person care *pre screening of any patients reporting cold/flu/COVID symptoms

Please join our VOLUNTEER team – WE NEED YOU AND SO DOES THE COMMUNITY, located at:RotaCare Pittsburg Free Medical Clinic at St. Vincent de Paul

2210 Gladstone Dr., Pittsburg, CA, 94565

We need Adult Medicine/ER Physicians, Nurse Practitioners, Physician Assistants and RNsProvider malpractice insurance is provided free of charge

Access Volunteer Application: https://www.rotacarebayarea.org/volunteer

Current clinic hours are: 1st & 3rd Wednesday evenings from 4-8:00 p.m. and Opening Saturdays soon!

For more info contact the Clinic Operations Manager, Yazmin Mejia at [email protected] or call (925) 439-2009


appropriate response and care. Additionally, a Trauma-Informed Network of Care Roadmap has been developed and provides practical steps that health providers and social service and com-munity organizations can take to expand networks of care that support children and adults that have been impacted by adverse childhood experiences and toxic stress. To learn more about the ACEs Aware initiative and the recently released report, visit www.acesaware.org.

MEDI-CAL RXLate last year, the DHCS announced that due to ongoing chal-lenges that the COVID-19 pandemic has presented, the imple-mentation of Medi-Cal Rx would be lengthened by 3 months, and it is now set to begin on April 1, 2021. Once the transition is in place, Medi-Cal Pharmacy Benefits will be administered through the fee-for-service delivery system, and services such as covered outpatient drugs, medical supplies, and enteral nutri-tional products will be carved out from the managed care system. Magellan Medicaid Administration Inc. (Magellan), will man-age the pharmacy benefit for Medi-Cal beneficiaries and will be responsible for claims management, prior authorizations, and utilization management services. The Alliance will support the physician-administered drug treatments for Medi-Cal members and will continue to fully maintain administrative responsibilities for members enrolled in Alliance Group Care. As we get closer to the implementation date, we are encouraging our provider part-ners to contact us with questions or concerns they have and to visit our website at www.alamedaalliance.org for the latest updates on Medi-Cal Rx.

ABOUT ALAMEDA ALLIANCE FOR HEALTHAlameda Alliance for Health (Alliance) is a local, public, not-for-profit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care cover-age to over 276,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

ALAMEDA ALLIANCE (continued from page 27)

NEW MEMBERS

Amardeep Angroola, MDHospitalist Palo Alto Foundation Medical Group

Amy Noelle Badger-Asaravala, MDOphthalmology Palo Alto Foundation Medical Group

Maureen Chapman, MDRadiology Palo Alto Foundation Medical Group

Christina Hopson, DOInfectious Disease Diablo Infectious Disease Consult Servs Medical Group

Pramod Krishnamurthy, MDPulmonary Disease Palo Alto Foundation Medical Group

Andrew Leung, MDUrology Palo Alto Foundation Medical Group

Ryan Lin, MDPediatrics Palo Alto Foundation Medical Group

Rachelle Lo, MDAllergy The Permanente Medical Group

Jayasree Sundaram, MDInternal Medicine Palo Alto Foundation Medical Group

Joy Tung, DOFamily Medicine Palo Alto Foundation Medical Group

Johnny Yep, DOFamily Medicine Palo Alto Foundation Medical Group

To place a classified ad, go to www.accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383.

ACCMA members can place a classified ad for four

months online and in two issues of the ACCMA Bulletin

at NO CHARGE.


RICHARD DEAN SMITH, MD (1931–2021) was born in Wakefield, KS, and served as Captain in the United States Air Force. Dr. Smith graduated from Kemper Military Academy in 1949 before graduating from the University of Kansas School of Medicine in 1957. Dr. Smith completed his fellowship and residency in Internal Medicine and Rheumatology at the Mayo Graduate School of Medicine in Rochester, Minnesota. He later attended Trinity College in Oxford, England, for extended studies in 19th Century Literary Criticism. Dr. Smith was a private practitioner in Internal Medicine and Rheumatology for 50 years in Walnut Creek and was Medical Director of Rehabilitation Services at John Muir Hospital for 25 of those years. Dr. Smith was an ACCMA member for 54 years and a long-time member of the ACCMA Editorial Board.

IN MEMORIAM

CLASSIFIEDS

Medical office suites available at Colby Medical Center, 3000-3010 Colby Street, Berkeley on campus at Alta Bates. Newly refurbished common areas, best on-site parking in area. Suites from approximately 500-4,500 sf. Contact Trask Leonard, Bayside Realty Partners, [email protected], 650-533-2591 or 650-949-0700.

Urgent Care + TeleHealth is searching for Staff Physicians to provide full-time or part-time staffing for our Urgent Care, located in Napa and Benicia. Physician Criteria:• Must have a valid State of California Medical License with

a current DEA. • Must have excellent communication and interpersonal skills

and understand the importance of patient satisfaction. • Be comfortable seeing a variety of primary care conditions

from pediatrics to adults either in person or via telehealth. • Able to perform minor surgical procedures (laceration

repair, I&D of abscess, foreign body removal, etc.)• Review and complete charting by end of shift.• Our facility has a small pharmacy, X-ray suite, and performs

CLIA-waived labs. • X-ray over reads are provided by an offsite radiologist. For further information or inquiry, contact Sherry Hartman, Manager, at 707-377-1005 or [email protected].

Physicians Nurse PractitionersPhysician Assistants

Locum Tenens Permanent Placement

Voice: 800-919-9141 or 805-641-9141FAX: 805-641-9143

[email protected]

Tracy Zweig AssociatesA R E G I S T R Y & P L A C E M E N T F I R M

CDPH LETTER (continued from page 11)

CDPH full recommendations for syphilis screening expansion in California to prevent congenital syphilis, including evidence, analy-sis, and implementation

• CDPH STD Control Branch Congenital Syphilis Webpage https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/CongenitalSyphilis.aspx CDPH information and resources on congenital syphilis for provid-ers, patients, andlocal health jurisdictions

• CDC 2015 STD Treatment Guidelines https://www.cdc.gov/std/tg2015/ CDC 2015 STD Treatment Guidelines, including guidelines for the treatment of syphilisfor adults and pregnant patients

• CDC Interim STD Treatment Recommendations in the Age of COVID-19 https://www.cdc.gov/std/dstdp/DCL-STDTreatment-COVID19-04062020.pdf Dear colleague letter from the CDC on providing effective STD care and prevention when in-person, facility-based services are limited

• California Prevention Training Center https://californiaptc.com/ Educational opportunities and training materials for syphilis and congenital syphilis

• STD Clinical Consultation Network https://stdccn.org/ Online consultation for questions about the evaluation and management of STDs

COUNCIL REPORTS (continued)

www.alamedaalliance.org

YEARSHealth care you can count on.

Service you can trust.

Alameda-Contra Costa Medical Association6230 Claremont AvenueP.O. Box 22895Oakland, California 94609-5895

ADDRESS SERVICE REQUESTED

PRSRT STDUS POSTAGE

PAID85719

PERMIT NO 271

Our experience means better support.

Insuranceby physicians,for physicians.™

miec.com | 800.227.4527

MIEC has been protecting physicians and helping reduce malpractice liability risks for 45 years. As a physician-owned industry leader, MIEC’s tenured and dedicated Patient Safety & Risk Management staff provides unmatched service and support. Whether it is using cutting-edge data analytics, or in-office visits, our team of seasoned account specialists are here to help you proactively address practice issues and minimize potential liability risks. To learn more about the benefits of having MIEC in your corner, visit miec.com or call 800.227.4527.

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