Keeping You Connected

The SCMA and MLCMS keep you up to date on the latest news,
policy developments, and events


March 2009

National physician leader Dr. Palmer to speak in Santa Rosa on March 4

Dr. Elissa J. Palmer, president of the Association of Family Medicine Residency Directors, will be in Santa Rosa on March 4 to speak on the future of primary care. Her speech begins at 6 p.m. in the Carston Cabaret Room at the Wells Fargo Center.

Dr. Palmer will discuss innovative models of patient-centered primary care and characteristics of successful primary care practices. Her speech, sponsored by the Sonoma Health Access Coalition, is free and open to the public, but reservations are requested. To RSVP, contact Donna Paul at or 547-7242, ext. 32.

For additional information about Dr. Palmer and the Sonoma Health Access Coalition, visit


SCMA members to receive patient-feedback postcards for Doctors Day

March 30 is National Doctors Day, and SCMA and the SCMA Alliance are marking the occasion by distributing colorful patient-feedback postcards to the offices of SCMA members. Patients can use the postcards to comment on what makes their doctors special. The cards can be left at the doctor’s office or mailed to the SCMA Alliance, which will gather the comments and share them with individual doctors.

Each year, Doctors Day gives patients a chance to show gratitude to their physicians. The first celebration was held in Georgia in 1933, and Congress officially designated March 30 as National Doctors Day in 1990.


Jerry Brown to speak at CMA Legislative Day on April 14

Attorney General Jerry Brown heads the list of speakers at CMA’s annual Legislative Day in Sacramento on April 14. Hundreds of physicians from across the state are expected to gather in the capital that day to hear Brown and others discuss healthcare policy in a series of morning and luncheon briefings. During the afternoon, SCMA members will be able to meet face-to-face with legislators from Sonoma County.

All SCMA members are encouraged to attend this annual free event. CMA provides all meals and conference materials free of charge. To RSVP, contact Rachel Pandolfi at 525-4375 or SCMA will coordinate carpools.


Nominations needed for SCMA elections

Nominations for the following SCMA positions are due by March 20:

*     SCMA president-elect

*     Individual SCMA board representatives from Healdsburg (1), Petaluma (1), and Santa Rosa (2)

*     Two CMA delegates

*     Two CMA alternate delegates

All positions require a three-year commitment, beginning July 1. Nominations can be e-mailed to, faxed to 525-4328, or mailed to SCMA, 3033 Cleveland Ave. #104, Santa Rosa, CA 95403. Each nomination should include a brief statement about the nominee's qualifications.

For more details, contact Cynthia Melody at or 525-4359.


Health Action takes first steps with iWalk program

Hard on the heels of the iPod and the iPhone, the local Health Action council is stepping out with iWalk, a coordinated effort to promote walking in Sonoma County. The council, which includes SCMA members Dr. Mary Maddux-González and Dr. Bo Greaves, will soon launch a media campaign to encourage bipedal locomotion throughout the county.

Among the many aspects of the campaign will be efforts to improve the walkability of communities and support existing walking groups. For more information, visit


Redwood Regional to spend $2 million on new equipment and offices

Despite the foundering economy, Redwood Regional Medical Group plans to spend roughly $2 million over the next few months to purchase equipment and renovate its offices. About half the money will go for new equipment, including two digital mammography machines. The remaining funds will be used to remodel RRMG facilities in Santa Rosa and Petaluma.

The plans were announced by interim CEO Wayne Fairchild, who joined RRMG last fall. The privately owned group has 10 campuses throughout the North Bay and several dozen physicians on staff.


PFMC grant deadline is April 1

Nonprofit health organizations in Sonoma County are encouraged to apply for Community Grants from the Pacific Foundation for Medical Care. The grants, generally in the $10,000 range, are awarded twice a year by the nonprofit foundation to support local projects that enhance health services.

The application deadline for the next round of grants is April 1. For application materials, contact Marilyn Flowers at 800-548-7677, Ext. 120, or For more information, visit


Stimulus plan includes $19 billion for electronic health records

The economic stimulus package recently signed by President Obama provides approximately $19 billion for electronic health records over the next five years, including bonus payments upwards of $40,000 for each Medicare provider who demonstrates “meaningful use” of an EHR system.

Physicians with significant Medi-Cal patient loads (20% or more for pediatricians, 30% or more for other specialties) may be eligible for additional bonuses paid through state Medicaid programs. As eligibility is based on usage, even physicians who already use EHR systems may be eligible. While the bill does include Medicare payment reductions (starting at 1%) for physicians who do not implement EHR systems, these do not take effect until 2015, and there are exceptions for significant hardship cases.


Medi-Cal giveth and taketh away

California’s recent budget agreement eliminates optional benefits in Medi-Cal for adult dental, acupuncture, audiology, chiropractic, optometry, podiatry, psychology and incontinence treatments. Although there are no reductions for physicians beyond the previously scheduled 1% cut on March 1, reimbursements to public hospitals will be reduced by 10%.

These and other spending cuts may be averted, however, if California takes advantage of the increased federal matching funds available via the federal government’s economic stimulus plan. Under that legislation, a state’s eligibility and renewal procedures for the Medicaid program (Medi-Cal in California) cannot be more limiting than they were on July 1, 2008.

As part of the budget deal enacted last September, California moved from annual to semi-annual reporting for children in Medi-Cal. If that provision is lifted, California will receive $3.7 billion in additional Medi-Cal funds this year, and $11.2 billion total over the next three years.

In Sonoma County, the Partnership Health Plan Managed Medi-Cal implementation is expected to begin on Oct. 1. Details of that plan will be rolled out later this year.


Pfizer to disclose payments to physicians

Beginning in 2010, Pfizer will disclose on its website all payments to physicians or other prescribers that exceed $500 in a year. A handful of other drugmakers, including Merck and Eli Lilly, have also announced plans to disclose payments to physicians who serve as speakers and consultants for the company.

The drugmakers’ actions come on the heels of proposed federal legislation to require such disclosures. So far, Pfizer is the only drugmaker to include in its disclosures payments to doctors who work on clinical studies and write up reports for medical journals.

The Physician Payments Sunshine Act of 2009 would require makers of drugs and medical devices to report annually all payments to doctors over $100 to the U.S. Department of Health and Human Services. The bill includes penalties of up to $1 million for knowingly failing to report such information.

The Sunshine Act is consistent with CMA policy, which supports mandatory disclosure of financial relationships between physicians and drug companies, with the exception of pharmaceutical samples for patients and meals in conjunction with educational meetings.


Joint Commission requires collection of physician performance data

The Joint Commission has begun requiring medical staffs to collect physician-specific performance data on a regular basis, in addition to the every two-year credentialing cycle. The goal for this “ongoing professional practice evaluation” (OPPE) is to ensure that all physicians with medical staff privileges are monitored routinely and regularly—regardless of whether there are specific performance issues—to find problems in a timelier manner and take appropriate steps to improve quality.

The specific data to be collected will be determined by individual medical staffs, but it could include procedures performed and their outcomes, pharmaceutical usage, diagnostic tests ordered, length of stay patterns, and morbidity and mortality data.

More information on the Joint Commission’s OPPE standard is available in CMA ON-CALL Document #1498, “Ongoing Professional Practice Evaluation.” ON-CALL documents are free to members at Nonmembers can purchase the documents for $2 per page  at

For more details, contact Samantha Pellon at 916-551-2872 or


CME: Sign up now for 2009 CMA Leadership Academy discount

SCMA members who sign up for CMA’s annual Leadership Academy by March 24 will receive a $100 discount on the registration fee. The conference, which offers 17.5 hours of CME, will be held April 24-26 at the Disneyland Hotel in Anaheim.

Topics include health system reform in a new era of Washington politics; the “medical home” and other emerging models for delivering quality care; the promises and perils of hospital EHR initiatives; and health disparities.

Attendees can also select from 14 breakout workshops on topics ranging from survival strategies for practicing in a turbulent economy, to mitigating malpractice risk and developing leadership skills.

Early bird registration by March 24 (including the $100 discount) is just $645 for members, $945 for nonmembers, and $245 for allied health professionals. Tuition for practice managers and other non-MD staff is $295 for CAMGMA members and $395 for nonmembers. SCMA members should register by contacting Cynthia Melody at or 525-4359.

For more details, including the conference brochure, visit the Physician Resources page at


March CME presentations at SDC: anxiety disorders and kidney disease

The Sonoma Developmental Center will host two CME events in March. Both are scheduled for McDougall Hall from 1 to 2 p.m.

On March 5, Dr. Lorrin Koran will discuss management of anxiety disorders, and on March 12, Dr. Gopa Green will present case studies of chronic kidney disease. For details, call JoAnne Rawles at 938-6419.


IMQ needs family physicians and internists as paid consultants

The Institute for Medical Quality is seeking board-certified family physicians or internists to serve on judicial review committees for the California Department of Corrections and Rehabilitation (CDCR). The review committees hear evidence regarding the quality of care provided by CDCR physicians.

Interested physicians must be available to serve for five consecutive days, once or twice per year. Physicians will be paid on an hourly basis for their time and reimbursed travel expenses.

For more information, visit or contact Leslie Anne Iacopi at 415-882-5167 or


CMA to host webinar on effective physician leaders

CMA is hosting a March 5 evening webinar on success factors for becoming an effective physician leader. The webinar runs from 8 to 8:45 p.m. To register, visit

Dr. Susan Reynolds, president and CEO of the Institute for Medical Leadership, will discuss the UCLA Physician Leader Success Factor Study. Webinar registrants will receive a leadership assessment to help them understand their own leadership styles and how they can maximize their leadership effectiveness.


CME: Primary care conference at Yosemite Lodge on April 3 and 4

A postgraduate institute for primary care physicians will be held at Yosemite Lodge on April 3 and 4. Topics include psychiatric challenges, the biology of aging, and cardiovascular diseases. Includes 16 hours of CME credit. To register, contact the Fresno Madera Medical Society at or 559-224-4224.


Medical office equipment for sale

Several items, including electric exam tables, scales, copier, exam stools, desk, chairs, etc. Excellent condition. Call Marie Johantgen, 707-799-7457, or e-mail


February 2009

Recommendations for Use of Influenza Antiviral Medications

By Dep. Health Officer Mark Netherda, MD

Although influenza activity is low in Sonoma County andthroughout the United States to date, preliminary data from a limited number ofstates indicate that the prevalence of influenza A subtype (H1N1) virusresistant to the antiviral medication oseltamivir (Tamiflu) is high. Therefore,CDC is issuing interim recommendations for antiviral treatment andchemoprophylaxis of influenza during the current flu season.

When influenza A (H1N1) virus infection or exposure issuspected, zanamivir (Relenza) or a combination of oseltamivir and rimantadineare more appropriate options than oseltamivir alone. Most labs in SonomaCounty, including the Public Health Department, do not differentiate betweenspecific subtypes of Type A influenza virus (e.g., H1N1 vs. H3N2). The CDC willupdate their recommendations as more information is gained through furthertesting of more viral isolates across the United States.

Both (1) people providing medical care for patients with suspectedinfluenza and (2) people who are candidates for chemoprophylaxis againstinfluenza should consider the following:

Consider use of influenza tests that can distinguishinfluenza A from influenza B.

Patients testing positive for influenza B may be giveneither oseltamivir or zanamivir (no preference) if treatment is indicated.

People who are candidates for chemoprophylaxis should beprovided with medications most likely to be effective against the influenzavirus that is the cause of the outbreak, if known. Respiratory specimens fromill patients during institutional outbreaks should be obtained and sent fortesting to determine the type and subtype of influenza A viruses associatedwith the outbreak and to guide antiviral therapy decisions.

Zanamivir should be used when people requirechemoprophylaxis due to exposure to influenza A (H1N1) virus and considered foruse when subtyping of Influenza A is unavailable and local/regional data suggesta prevalence of H1N1 activity. Rimantadine can be used if zanamivir use iscontraindicated. People whose need for chemoprophylaxis is due to potentialexposure to a person with laboratory-confirmed influenza A (H3N2) or influenzaB should receive oseltamivir or zanamivir (no preference).

For complete recommendations,



SCMA Board Reaffirms Position Statement on Sutter Proposal

In response to Sutter’s latest proposal to build a newhospital in Santa Rosa, the SCMA board of directors has reaffirmed an earlierposition statement that emphasizes access to care, support for community healthdirectives, and availability of physicians.

The statement says, in part, that SCMA’s paramount concernis to “ensure that patients will continue to have access to care and to theirphysicians. We continue to express concerns that short-term capacity needs willbe insufficient.”

SCMA’s position statement is among many comments that thecounty’s Department of Health Services is analyzing in response to Sutter’sproposal, including those received at public hearings on Jan. 13 and 14. DHSofficials are expected to report their findings to the Board of Supervisors inthe spring.


Physician Directory Set for Delivery

The annual Sonoma County Physician Directory published bySCMA is back from the printer and will be delivered to all members free ofcharge in the first week of February. This year’s directory includes detailedspecialty and contact information for SCMA members, along with alphabeticallistings and specialty indexes for virtually all physicians in Sonoma County.

Additional copies are $30 for members ($40 for nonmembers)and can be ordered at or by contacting Rachel Pandolfi at 525-4375or

Several dozen physicians have joined SCMA during the pastyear, bringing the latest membership count to 666, about two-thirds of thepracticing physicians in Sonoma County. For more information on joining SCMA,visit


Volunteer Needed for SCMA Health Careers Scholarship Committee

SCMA needs a physician volunteer for its Health CareersScholarship Committee, which recommends recipients for scholarships and studentloans. The committee meets only twice a year at lunchtime.

Interested physicians should contact Cynthia Melody at525-4359 or


Nominations Needed for SCMA Elections

Nominations for the following SCMA positions are due by March 20:

*     SCMA president-elect

*     Individual SCMA board representatives from Healdsburg (1), Petaluma (1), and Santa Rosa (2)

*     Two CMA delegates

*     Two CMA alternate delegates

All positions require a three-year commitment, beginning July 1. Nominations can be e-mailed to, faxed to 525-4328, or mailed to SCMA, 3033 Cleveland Ave. #104, Santa Rosa, CA 95403. Each nomination should include a brief statement about the nominee's qualifications.

For more details, contact Cynthia Melody at or 525-4359.


Local Health Groups Can Apply for PFMC Community Grants

Nonprofit health organizationsin Sonoma County are encouraged to apply for Community Grants from the PacificFoundation for Medical Care. The grants, generally in the $10,000 range, areawarded twice a year by the nonprofit foundation to support local projects thatenhance health services.

The application deadline for thenext round of grants is April 1. For application materials, contact MarilynFlowers at 800-548-7677, Ext. 120, or For more information,visit


Meetings on Health Care Reform Set for Feb. 11 and 21

At least two meetings on healthcare reform will be held in Santa Rosa during February.

Newly elected county supervisorsShirlee Zane and Efren Carrillo will host a Feb. 11 forum on the role of countygovernment in health care delivery. The forum will be held from 6 to 8 p.m. atthe Veterans Building, 1351 Maple Ave. To RSVP,

On Feb. 21, Dr. John Shearerwill moderate a discussion of single-payer plans from 3 to 4:30 p.m. at theGlaser Center, 547 Mendocino Ave. Panelists include Drs. Richard Quint andClaudia Chaufan. No RSVPs are required.


Obama Community Discussion Group Recommends Finance Reform

On Dec. 30, nearly 50 localphysicians and other health care leaders attended a Health Care CommunityDiscussion in Santa Rosa sponsored by the Obama-Biden Transition Project.According to a summary of the meeting provided by RCHC and Health Action, thegroup identified financing as the biggest problem in the health system.

“The health care financing modelis the underlying problem in the system,” the group concluded, “because it iswasteful, does not provide equal access to care, and does not reflect a valueof health care as a civil right equal to education and public safety.”

The group also recommendeduniversal coverage, medical homes, and increased emphasis on preventive care.Their recommendations, along with those from similar groups around the country,will be considered as part of a health care reform package to be unveiled bythe Obama Administration later this year.


BBR Needs Blood Donations

Blood Bank of the Redwoods’blood supply is being depleted by limited donations. They are in great need ofblood donors for all blood types.

Blood may be donated at the BBRoffice, 2324 Bethards Dr., Santa Rosa. The office is open from noon to 7 p.m.Monday to Thursday and 9 a.m. to 3 p.m. on Friday and Saturday.

For details, call 545-1222 or visit book

Medi-Cal Claims with Patient SSNs Will Be Denied as of Feb. 1

Beginning on Feb. 1, physicianscan no longer bill Medi-Cal or the Child Health and Disability PreventionProgram using patients’ Social Security numbers as identifiers. All providersmust use the 14-character Medi-Cal identification number from recipients’Benefits Identification Cards (BIC) or paper ID cards when submitting claims.The ID number is located on the front of the card and consists of a 9-digitclient index number, a check digit, and a 4-digit issue date. (The issue dateis used to deactivate cards that have been reported as lost or stolen.)

The only exemption to this ruleis for Medicare crossover claims. Physicians may continue to bill Medicarecrossover claims using the recipient’s SSN/Medicare number as it appears on beneficiaries’Medicare identification cards.

Physicians are also urged to useMedi-Cal identification numbers when verifying eligibility or submittingtreatment authorization requests. In an emergency or in the event a Medi-Calpatient does not bring his or her BIC to an appointment, physicians may (withthe patient’s permission) use a SSN to verify eligibility via the Medi-CalEligibility Verification System.


Physicians Urged to Complete Balance Billing Survey on CMA Website

CMA is conducting a survey togauge the impact of the recent ban on balance billing by the California SupremeCourt and by the Department of Managed Health Care’s regulation definingbalance billing as an “unfair billing pattern.” CMA also is gathering evidenceconcerning other, broader industry practices by health insurers to underpay forout-of-network services.

The survey is located on thehome page of the CMA website at Physicians are urged tocomplete the survey as fully as possible. The information will be used by CMAin its advocacy efforts and will not be used in a manner that reveals anyphysician’s identity.

To request a paper copy of thesurvey, contact Samantha Pellon at 916-551-2872 or


CME Events at Sonoma Developmental Center

Two CME events will be held atthe Sonoma Developmental Center in February. Both are scheduled for McDougallHall from 1 to 2 p.m.

On Feb. 5, Drs. Ken Christensenand David Gray will discuss ICD-9 coding. On Feb. 26, Dr. Gopa Green willdiscuss renal osteodystrophy. For details, call JoAnne Rawles at 938-6419.


Charles Amezcua, MD
Anatomic & Clinical Pathology
401 Bicentennial Way
Santa Rosa 95403
393-4684 Fax 393-4291
Univ Southern California 1993

Santiago Centurion, MD
106 Lynch Creek Way #8
Petaluma 94954
763-6816 Fax 763-1730
New Jersey Med Sch 1999

Julie Clark, MD
Obstetrics & Gynecology*
1550A Professional Dr. #100
Petaluma 94954
792-2229 Fax 792-1072
Cornell Univ 2001

Randall Hrabko, MD
6880 Palm Ave.
Sebastopol 95472
823-7628 Fax 823-1521
Univ Miami 1976

Daciana Iancu, MD
Internal Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4104 Fax 393-4146
Univ North Carolina 1997

Francesca Manfredi, DO
Family Medicine
144 Stony Point Rd.
Santa Rosa 95401
521-4635 Fax 544-4626
Western Univ 2000

Margaret Marquez, MD
Internal Medicine*
Geriatric Medicine*
3559 Round Barn Blvd.
Santa Rosa 95403
571-3953 Fax 571-3941
UC Davis 1994

David Pastran, MD
Family Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4300 Fax 393-4558
Univ Colorado 2003

Carina Quezada, MD
3925 Old Redwood Hwy.
Santa Rosa 95403
393-4000 Fax 566-5292
Univ Southern California 1994

Mitchell Savitsky, MD
Emergency Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4000 Fax 393-4741
George Washington Univ 1978

Regina Sullivan, MD
Obstetrics & Gynecology*
401 Bicentennial Way
Santa Rosa 95403
393-4696 Fax 393-4299
New Jersey Med Sch 1994

Michael Tsao, MD
3925 Old Redwood Hwy.
Santa Rosa 95403
393-4000 Fax 566-5929
Northwestern Univ 2003

Jamie Weinstein, MD
Family Medicine
5900 State Farm Dr.
Rohnert Park 94928
206-3000 Fax 206-3042
Oregon Health Sciences Univ 2000


January 2009

Additional Palmetto Medicare Billing Seminar at SCMA on Jan. 30

Because of high demand, SCMA will host an additional free seminar on Medicare billing from noon to 2 p.m. on Friday, Jan. 30. Attendees need to bring their own lunch. The first seminar, scheduled for Jan. 26, is completely full.

The Jan. 30 seminar, to be held in SCMA’s office at 3033 Cleveland Ave. in Santa Rosa, will be conducted by Sandra Siddall, a provider outreach consultant for Palmetto GBA, the new Medicare administrator for California. She will address any Medicare billing topics of concern to attendees.

To reserve a spot and suggest topics, contact Rachel Pandolfi at or 525-4375. Space is limited, so early reservations are recommended.


Physicians Invited to Health Care Community Discussion on Dec. 30

All local physicians are invited to attend a Health Care Community Discussion on Dec. 30 sponsored by President-elect Obama’s Healthcare Transition Team. The discussion will be held from noon to 2 p.m. in the Sonoma Community Room at the Redwood Credit Union, 3033 Cleveland Ave., Santa Rosa.

Space is limited, so RSVPs are required. Please RSVP by 9 a.m. on Dec. 30 to Donna Paul of the Redwood Community Health Coalition at or 542-7242.

A Participant Guide for the discussion is available on the SCMA website at The guide includes an overview of health care problems, key points of Obama’s health care plan, questions to address at the discussion, and a participant survey.

For more information on the Obama health care plan, visit


Winter Issue of Sonoma Medicine Examines Children’s Health

The Winter 2009 issue of Sonoma Medicine, due for mailingnext week, features several articles on children’s health by localpediatricians, family physicians and a child psychiatrist. Topics includeimmunizations, nutrition, mental health, autism and the recent Community NeedsAssessment on children’s health.

Physicians interested in submitting article proposals forfuture issues should contact the editor, Steve Osborn, at or525-4325.


Physician Directory Scheduled for Delivery Later This Month

The 2009 edition of the SCMA Physician Directory, one of themost heavily used reference tools in local medical offices, is scheduled fordelivery later this month. This year’s directory includes a new section withdetailed information on SCMA members, along with specialty indexes that listalmost every physician in Sonoma County.

Each SCMA member receives one free copy of the directory.Additional copies cost $30 for SCMA members, $40 for nonmember physicians, and$55 for the general public. To purchase, contact Rachel Pandolfi at 525-4375


County To Hold Public Meetings on Sutter Hospital Proposal

Three public meetings onSutter’s proposal for a new hospital next to the Wells Fargo Center will beheld on Jan. 13 and 14. The meetings, conducted by the  Sonoma County Department of HealthServices, will include presentation of the proposal by Sutter officials,followed by public comments. The proposal has been posted to the SCMA websiteat

All three meetings will be heldin the DHS Rotunda at 3313 Chanate Road in Santa Rosa. Meetings are scheduledfor:

Jan. 13: 3 to 5 p.m.

Jan. 14: 8 to 10 a.m.

Jan. 14: 3 to 5 p.m.

For more information, contactLynn Scuri, DHS administrative services officer, at 565-4417. 


Physicians Mentors Needed for Students in Health Care Program

Physician mentors are needed for students in the HealthcareWorkforce Development Program at Santa Rosa Junior College. This competitiveprogram enrolls bright bilingual students who are pursuing careers in healthcare. Physicians can help these students by offering:

Internships. Studentscan volunteer in physicians’ office for at least 20 hours per semester.

Mentoring.Establish one-on-one relationships with students to help them explore medicalcareers.

Job Shadowing. Allowstudents to shadow you as you work.

Interested physicians should contact Juan Arias, program coordinator, at521-7802 or book

North County Healthcare Foundation Sets Sights on Physician Recruitment

The Healthcare Foundation ofNorthern Sonoma County, a nonprofit group associated with Healdsburg DistrictHospital, has prepared a strategic plan that calls for more physicianrecruitment, improved IT services at the hospital and physicians’ offices, andpurchase of digital mammography and radiology equipment.

The ambitious plan follows asuccessful fundraising drive that began in 2005 and has raised $14.2 million todate. Funds have been used to upgrade the emergency department, ICU and strokecenter at Healdsburg Hospital.

A public meeting on the planwill be held at the Healdsburg City Council chambers at 5 p.m. on Jan. 7.


Medicare Participation Deadline is Dec. 31

Physicians who wish to change their Medicare participation status for 2009 must do so by this Wednesday, Dec. 31. There are three choices: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.

A participating provider must accept Medicare allowed charges as payment in full for all Medicare patients.

A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule.

Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Once you opt out, you cannot opt back in for two years.

For more information, see CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options,” available at You can also contact Michele Kelly at 916-551-2862 or


New CME Reporting Requirements

New CME reporting requirementstake effect in 2009. Physicians will now be required to complete 50 CME hours duringevery two-year licensure period, rather than 100 hours every four years. CMEwill also be calculated based on the physician’s personal license renewal date(the last day of the month of your birthday), not the calendar year.

CMA’s Institute for MedicalQuality’s CME Certification Program, now in its 32nd year, documents andverifies physician participation in approved postgraduate education and otherCME activities. IMQ has modified its processes to adapt to the new reportingrequirements. Reporting forms will now be mailed quarterly to physicians withlicense expiration dates in the following quarter.

Once a completed form has beenreceived by IMQ, the physician’s self-reported CME will be verified forcompliance with medical board requirements.

IMQ’s CME certification is $29for members, $49 for nonmembers. Physicians also can request that their CMEcertification information be other agencies for credentialing or membershiprenewal purposes, without additional charge.

For details, contact Paulette Richardsonat 415-882-3387 or


Neonatal Resuscitation Renewal Program on Jan. 23

A renewal program for neonatalresuscitation (NRP) will be held at Sutter Santa Rosa on Jan. 23. Allparticipants need to complete an online NRP evaluation at attending the class. The program counts for 3 hours of CME credit. Formore details, contact Karen Mack at


Primary Care Conference at Yosemite Lodge on April 3 and 4

A postgraduate institute forprimary care physicians will be held at Yosemite Lodge on April 3 and 4. Topicsinclude psychiatric challenges, the biology of aging, and cardiovasculardiseases. Includes 16 hours of CME credit. To register, contact the FresnoMadera Medical Society at or 559-224-4224.


Marsh Offers Health Insurance Assistance

Marsh, the endorsed healthinsurance broker and consultant for SCMA, offers several resources for members,including:

* No-obligation review of yourcurrent health plan.

* Access to a variety of healthplans from multiple insurers.

* Health savings accounts.

* Tools to help you stay currenton health and benefit issues.

For details, contact a Marshrepresentative at 800-842-3761.


Space to Sublet
Sublet space in small medical office near Memorial Hospital. Call 707-396-4763.

Medical Office Santa Rosa
Office in class "A" medical building at 1111 Sonoma Ave., Santa Rosa. Approx. 100 sq. ft., with sink. $795/mo., including utilities. Access to shared waiting room, reception area, kitchen, private restrooms. Handicap accessible. Ample parking. Contact Judy at 707-528-0911.

Wanted: Vintage Doctor’s Bag
Looking for a vintage doctor’s bag as a gift for my medical student son. If you have one that is in fairly good condition and you are willing to sell it, contact Cynthia Melody at or 707-525-4359.

How to Submit an Ad
To submit a classified ad for News Briefs or Sonoma Medicine, contact Nan Perrott at or 707-525-4226. The cost is one dollar per word.


December 2008

Physicians need to request performance data by Dec. 16

Physicians have until Dec. 16 to request the data used to determine their California Physician Performance Initiative (CPPI) “performance scores.” Payors such as Blue Cross or Blue Shield may soon be using these scores to determine pay-for-performance rates or to create tiered networks.

CPPI recently sent about 20,000 California physicians their performance scores on 15 quality measures based on claims data from Medicare and from United Health, Blue Cross, and Blue Shield PPOs. The letters do not contain the underlying data.

CMA has expressed serious concerns about the accuracy and integrity of the data used to establish these scores. In order to address CMA’s concerns and to improve the quality of the data, CPPI has created a reconsideration process that physicians should use to verify the data.

All physicians should request their data from CPPI and verify its accuracy. If you do not raise concerns now, payors will use the data in the future to adjust your reimbursements and change the flow of patients to your practice.

Step-by-step instructions for obtaining and reviewing your patient data are available at After finishing the reconsideration process, you should also complete the online survey at the same address to tell CMA what, if anything, was wrong with your performance scores.

For more information, contact the CMA member help line at 800-786-4262.


Pay SCMA dues by Dec. 31 to qualify for 5% discount

SCMA members who pay their 2009 dues by Dec. 31 qualify for a 5% discount. Payments need to be at SCMA by Dec. 31; there is no grace period.

Invoices were mailed earlier this fall. If you need a copy of your invoice or have any dues questions, contact Rachel Pandolfi at or 525-4375.


More than 200 attend SCMA’s 150th Anniversary Celebration

SCMA’s 150th anniversary celebration at the Vintner’s Inn on Nov. 11 drew more than 200 local physicians, spouses and community members, making it by far the best attended SCMA event in recent memory.

“The attendance spoke for itself,” said SCMA president-elect Dr. Richard Powers, noting that the event promoted collegiality among physicians and encouraged them to resume their role as community leaders.

SCMA has received many complimentary notes and e-mails about the event from physicians. “The food and the setting were terrific,” wrote former SCMA president Dr. Heather Furnas, “but best of all was the camaraderie of the Sonoma County physicians, the SCMA staff, and physician leaders from our CMA district. … It was a very special evening with an extraordinary group of people.”

“The whole spirit was reassuring,” observed another former SCMA president, Dr. Fred David. “Despite all the troubles with medicine, we get a lot of support from seeing our colleagues in a social setting.”

Complimentary copies of the 16-page commemorative program distributed at the event are still available. To get a copy, contact Cynthia Melody at or 525-4359.

Event photos will soon be posted on the SCMA website at


Palmetto GBA seminar at SCMA on Jan. 26

Palmetto GBA, the new Medicare administrator for California,will be conducting a free seminar on Medicare billing at SCMA from noon to 2p.m. on Monday, Jan. 26. Attendees need to bring their own lunch.

The seminar will be conducted by Sandra Siddall, a provideroutreach consultant for Palmetto. She noted, “We realize that during thetransition period, many physicians have encountered numerous problems [withMedicare billing].” She will address any billing topics of concern toattendees.

To reserve a spot and suggest topics, contact RachelPandolfi at or 525-4375. Space is limited, so early reservationsare recommended.


Inpatient psychiatric care may return to Sonoma County

Inpatient psychiatric care,which has been unavailable in Sonoma County since last spring, may return earlynext year, depending on the outcome of negotiations between several interestedparties.

Drs. Daniel Marrin and JimBerger--owners of the Fulton Road general acute care facility in Santa Rosaclosed by Memorial Hospital earlier this year--are negotiating with twopsychiatric hospital groups that want to reopen the facility. A third companyhas also expressed interest, as has the Joint Powers Authority (JPA) thatrepresents the county’s district hospitals.

Negotiations are complex becauseMarrin and Berger also own a general acute care facility on Sotoyome, acrossfrom Memorial Hospital. Under one scenario, the Fulton facility would be soldto a psychiatric group for inpatient psychiatric care, and the JPA wouldacquire the Sotoyome building for general acute care, possibly establishing anew Santa Rosa hospital district.

“It now costs $3 million to $5million per bed to build a new general acute care hospital,” said Marrin,noting that the Fulton and Sotoyome facilities already have 138 beds, and thatdemand for acute care is likely to increase as the population ages.

If the Fulton Road facility isused for psychiatric care, Sonoma County Mental Health would contract for beds,along with Kaiser and other providers. “Our average daily need is approximately8 to 10 beds, sometimes higher,” said Art Ewart, the county’s mental healthdirector. “This would solve virtually all the needs for psychiatric inpatientcare for adults.”

Further complicatingnegotiations is the possible sale of a portion of the Fulton Road property tothe Southwest Community Health Center, which would construct a 50,000 squarefoot facility to house the Santa Rosa Family Medicine Residency.


Southwest Health Center acquires two more clinics

Southwest Community Health Center has acquired the SantaRosa Homeless Clinic (formerly the Santa Rosa Free Clinic) and the RoselandChildren’s Health Center. Both clinics were threatened with closure because of risingcosts, decreased funding and increasing patient loads.

 “It is verydifficult for these smaller clinics to be financially sustainable in today’shealth care environment,” said SCHC CEO Naomi Fuchs. “Bringing these clinicsinto the SCHC organization will improve access, strengthen programs, andprovide financial sustainability. It is the right thing to do.”


Court upholds balance billing regulation--for now

The Sacramento Superior Courthas determined that the Department of Managed Health Care’s “balance billing”regulation is valid, but only insofar as it seeks to define balance billing asan unfair billing pattern. The court did not address whether the DMHC canenforce the regulation against providers, despite DMHC’s public assertions thatthis regulation “prohibits” balance billing. The DMHC, however, has indicatedthat it intends to take enforcement action against providers who balance bill.

CMA attorneys are reviewing theruling to determine the best strategy for an immediate appeal. They are alsoexploring separate litigation avenues to challenge the DMHC’s authority toprohibit balance billing or take any enforcement action based on thisregulation. 


Influenza and pneumococcal vaccines pricing

The Medicare Part B paymentallowance limits for influenza and pneumococcal vaccines are 95% of the AverageWholesale Price, except where the vaccine is furnished in a hospital outpatientdepartment. In those situations, payment for the vaccine is based on reasonablecost.

Annual Part B deductible andcoinsurance amounts do not apply for the influenza virus and the pneumococcalvaccinations. All physicians, non-physician practitioners and suppliers whoadminister these vaccinations must take assignment on the claim for thevaccine.

The prices below reflect thepayment allowance for the listed CPT codes when the vaccines are furnishedoutside the hospital outpatient department:
* CPT 90655: $16.879
* CPT 90656: $18.198
* CPT 90657: $6.609
* CPT 90658: $13.218
* CPT 90660: $22.316


Operation Access needs physician volunteers

Operation Access, a nonprofit organization that works with hospitals to provide elective outpatient surgeries and procedures to the uninsured, needs physician volunteers. The hospital waives all expenses and covers professional liability and malpractice insurance for physicians and other medical staff who volunteer. Participating hospitals include Petaluma Valley, Memorial and Kaiser Santa Rosa.

To volunteer, contact Daniel Rabkin at or 415-733-0004.


Electronic health records seminar in SF on Dec. 16

A seminar on electronic health records sponsored by the Healthcare Information and Management Systems Society will be held in San Francisco on Tuesday afternoon, Dec. 16. Topics include the current state of EHR systems and EHR usage among hospitals, physician offices, insurance companies and patients.

Tickets cost $55. To register, visit


Online CME program offers advice on helping veterans

Physicians can receive CME credit for accessing, a Web-based series of half-hour television programs that explore the medical, psychological and social issues that confront returning veterans and their families. The series is of particular benefit to doctors who are unfamiliar with the injuries, visible and invisible, that may be present in veterans.


Buck Institute hosts session on drugs and aging

A free public session onpharmacological and non-pharmacological intervention in aging will be held at theBuck Institute in Novato on Tuesday morning, Dec. 9. Topics include drugindustry targeting of aging as a disease and use of yoga techniques assustainable health care. Reservations are required; phone 415-209-2030.


Dr. James Dawson and Dr. Dick Lose pass away

Two longtime SCMA members, Drs.James Dawson and Dick Lose, died in November.

Dr. Dawson, who belonged to SCMAand CMA for more than 50 years, was 88. Originally a general practitioner inPetaluma and Forestville, he became an attending physician at Sonoma StateHospital in the 1960s. He then completed residencies in psychiatry andneurology and served as the facility’s chief of professional education.

Dr. Lose was a family physicianin Sonoma for many years. He served as president of the Sonoma County chapterof the American Academy of Family Physicians and as chief of staff at SonomaValley Hospital. He was 84.


Guy Delorefice, MD
Internal Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4733 Fax 393-4556
Creighton Univ 1996

Mark Hurd, MD
837 Fifth St. 2nd Floor
Santa Rosa 95404
522-1800 Fax 524-4687
Tulane Univ 1986

Amita Kachru, MD
Obstetrics & Gynecology
500 Doyle Park Dr. #103
Santa Rosa 95405
579-1102 Fax 579-1386
Michigan State Coll 2004

Phi-Nga Le, MD
Internal Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4150 Fax 393-4298
Creighton Univ 1992

Yasmin Nibbe, MD
Internal Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4300 fax 393-4558
Chicago Med Sch 2001

Rudy Santos, MD
Internal Medicine*
1165 Montgomery Dr.
Santa Rosa 95405
547-5437 Fax 547-5430
St. George Univ 1997

Jerome Smith, MD
430 W. Napa St. #F
Sonoma 95476
939-6070 Fax 939-6077
George Washington Univ 1997

* board certified


Office in class "A" medical building at 1111 Sonoma Ave., SantaRosa. Approx. 100 sq. ft., with sink. $795/mo., including utilities. Access toshared waiting room, reception area, kitchen, private restrooms. Handicapaccessible. Ample parking. Contact Judy at 707-528-0911.

Suite available: Perkins Medical Center, Sonoma. 1800+/- sq ft. $2890/mo.707-996-4519.

To submit a classified ad forNews Briefs or Sonoma Medicine, contact Nan Perrott or 707-525-4226. The cost is one dollar perword.


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