Marin Medical Society

MMS News Briefs


May 2010

MMS sponsoring disaster training session on June 5

MMS is sponsoring a disaster preparedness training session on Saturday morning, June 5, at Novato Community Hospital. The session is intended for physicians in the MMS Disaster Preparedness Physician Volunteer Group (DPPVG), but other physicians are invited to attend as well. A flyer about the event is available at

The session will focus on the National Incident Management System (NIMS), which emphasizes efficient communications and rapid deployment. During the session, instructors from FEMA will present basic courses 100 and 200, each of which lasts 1-2 hours.

To register for the session, or to volunteer for the DPPVG, contact Dr. Peter Bretan at, 382-0339 (voicemail) or 892-0904 (office). If you are not already a member of the DPPVG, please list your specialty, cell phone number and e-mail address. About 40 local physicians have volunteered for the DPPVG, but more are needed.

Survey: Proposed Medicare cuts will likely decrease access to care

A survey of North Bay physicians conducted in early April revealed that Medicare fee-for-service patients will likely have more difficulty accessing care if a proposed 21% physician rate cut takes effect. Almost 90% of the doctors who responded to the survey said they would reduce the number of new Medicare FFS patients they accept or simply stop accepting them altogether, should the rate cut go into effect.

Thirty-two doctors in Marin, Sonoma, Mendocino and Lake counties responded to the impromptu survey, which was prepared by the Alameda-Contra Costa Medical Association and conducted throughout the Bay Area. Results for other Bay Area counties are still pending.

About 40% of the North Bay respondents were primary care physicians, and the rest were specialists. Most were in solo practice or small groups, and three-fourths had been providing care to Medicare FFS patients for more than 10 years. On average, 43% of the patients in the respondents’ practices were enrolled in the Medicare FFS program.

In addition to reducing the number of new Medicare FFS patients, about one-fourth of the respondents said the rate cut would also reduce their time for treating existing Medicare FFS patients. Another fourth said the cut would reduce the number of existing Medicare FFS patients they treat, and an additional 13% said they would stop treating existing Medicare FFS patients altogether.

The survey results will be used in the ongoing debate about repealing the Medicare SGR formula, the source of the proposed rate cuts. After the cuts nearly took effect in April, Congress delayed enactment until June 1. CMA and other physician groups plan to lobby Congress heavily during May in an effort to repeal the SGR formula once and for all.

Physician volunteers needed for RotaCare Clinic

Physician volunteers from all specialties are needed for the RotaCare Clinic, which provides urgent care to uninsured patients. The clinic, located at 1033 Third St. in San Rafael, is open from 6 to 8:30 p.m. on Mondays and Thursdays. “The more doctors we have, the less people we have to turn away,” said clinic administrator Marcia Amada. To volunteer, contact Amada at 479-8889 or

CMA withdraws from Blue Shield doctor rating scheme

CMA has withdrawn from a Blue Shield-led initiative to rate doctor performances because the insurer intends to move forward with publishing its ratings on June 1 despite flaws in data collection that result in gross inaccuracies.

“Publishing erroneous information will only serve to confuse patients, increase costs and unjustly destroy the reputations of many fine doctors,” said Dr. Brennan Cassidy, president of CMA. “We are happy to stand on the merits of our work, as long as it is assessed accurately and fairly, but this initiative is far, far short of achieving that goal.”

CMA worked for two years on the California Physician Performance Initiative (CCPI) with other stakeholders but pulled out in mid-April when Blue Shield indicated that it planned to ignore doctors’ input and publish rating data before fixing flaws in performance assessment.

In a letter informing CPPI of its withdrawal, CMA said major problems include:

Confusion for patients, who may be unduly concerned if their physicians do not get a high rating or may be tempted to select a new doctor who has a high rating. Because the ratings will not be an accurate assessment of doctors’ performances, they may cause confusion and anxiety for patients.

More costs for payers and patients. To receive high ratings, physicians will have to compensate for flaws in the reporting system, meaning some may have to order tests or procedures that have already been done but are not captured in claims data.

Lack of adjustments for major factors affecting the patient. For instance, physicians who don’t order cervical cancer screening tests for their patients, even if the patients have already had hysterectomies, would get a lower rating. 

Lack of relevant data collection. The ratings only capture patient data for physicians contracting with the insurer; none of the out-of-network care is reflected. For instance, if a patient sees an out-of-network OB-GYN for a pap smear and fails to inform her primary care physician, the PCP would be penalized because there would be no pap smear claims data submitted to the health plan.

No consideration of the patient’s role. The ratings do not take patient refusal of treatment into account.

“We have worked in good faith with Blue Shield of California and the California Physician Performance Initiative,” Cassidy said. “Unfortunately, the initiative’s governing board, which is dominated by insurers, has chosen to ignore physicians’ grave concerns about this inaccurate rating system. Blue Shield’s ratings are defective and Blue Shield is exercising poor judgment to publish them.”

Talking points about the CPPI initiative have been posted at

New physician signage regulations take effect June 27

California physicians will soon be required to inform patients that they are licensed by the Medical Board of California, and to provide patients with contact information for the MBC.

Despite CMA objections, the Office of Administrative Law recently approved signage regulations for informing patients about how to contact the MBC for information or complaints about California physicians. CMA believes these regulations are an unnecessary administrative burden because state law already requires physicians to post their medical license or wear a name tag indicating their licensing status.

The new regulations, which take effect June 27, require physicians to provide the MBC notice by one of three methods:

Prominently posting a sign in an area of their offices that is conspicuous to patients, in at least 48-point type in Arial font.

Including the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the MBC.

Including the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative; the notice must be placed immediately above the patient’s signature line in at least 14-point type.

Regardless of which method you choose, the notice must read as follows: NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322,

According to the MBC, physicians, not facilities, are responsible for compliance with this regulation. In group settings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients.

A sample MBC sign is available at For more information, visit

Cast your vote in the annual MMS election by May 31

As a member of MMS, you are entitled to vote for MMS officers and board representatives, and for local representatives to the CMA House of Delegates.

To vote, print out the ballot below, then sign and fax to 924-2749 by May 31.

MMS President-Elect - vote for one

Irina deFischer, MD, family medicine

___ Yes         ___ No

MMS Secretary/Treasurer - vote for one

Georgianna Farren, MD, internal medicine

___ Yes         ___ No

MMS Board of Directors - vote for one

Anne Cummings, MD, internal medicine

___ Yes         ___ No

CMA Delegation - vote for two

Helen Biren, MD, psychiatry

___ Yes         ___ No

Barbara Nylund, MD, gastroenterology

___ Yes         ___ No



Signature (required)


Dr. Clay Angel, an internist at Kaiser San Rafael, has been named as one of the top North Bay business leaders under the age of 40 by the North Bay Business Journal. Angel was honored for leading the hospital’s Rapid Response and Critical Events teams, and for initiating the Discharge Planning and Rounding Team.

MMS President-elect Dr. Peter Bretan will receive a Lifeboat award from the Marin Board of Supervisors on May 11. The annual award honors individuals who increase the county’s emergency readiness and response capabilities. Bretan is being recognized for his work on disaster preparedness planning.


Marin General Hospital has received $60 million in financing from Union Bank, including a $30 million line of credit and a $30 million loan. The Marin Healthcare District, which will take over control of the hospital from Sutter at the end of June, has also approved a $13 million physician development plan to help retain and recruit local doctors. 


Easter Seals Northern California is sponsoring an all-day Physician Symposium on Saturday, May 15, at the Petaluma Community Center. The topic is developmental and behavioral screening in primary care. Presenters include Dr. Barbara Bennett, a professor of pediatrics at UCSF, and Dr. Maria Pilar Bernal, chief of autism spectrum disorder services at Kaiser Permanente. The symposium offers 5.75 hours of CME. To register, visit or contact Cindy Fasano at 415-382-7450 or

Also on May 15, the Buck Institute is sponsoring a community seminar titled “A Healthy Diet: Good for You, Good for the Planet.” The seminar, which runs from 10:30 a.m. to noon, will cover the impact of diet on individual health and on the health of the global community and wildlife. Reservations are required. To register, contact the institute at 209-2030 or

The Marin Community Clinic is hosting a Summer Solstice Celebration on Thursday evening, June 17, at The Atrium at Autodesk in San Rafael. The event, which benefits the clinic’s pediatric program, features a plenitude of food and drink, along with Champions for Children awards presentations to Drs. Howard Rosenfeld, Michael Grogan and Marisol Muñoz-Kiene. Tickets are $100 per person. To purchase, visit


The May issue of CMA Practice Resources, a free monthly e-mail bulletin, is available at The new bulletin includes articles on reporting unfair payment practices, knowing your rights for timely payments, and other tips and tools for improving practice efficiency and viability.

The American Lung Association is asking physicians to sign a petition supporting advanced clean cars in California. The proposal is intended to improve air quality and reduce petroleum consumption. For the petition and more information, visit Medical Professionals Pledge Support for Clean Air on the ALA website.


Wendell Butler, MD, Internal Medicine, 2250 Tennessee St., Vallejo 94591, 707-644-7277, Case Western Reserve Univ 1955

Anna-Maria Kourumalos, MD, Internal Medicine, 99 Montecillo Rd., San Rafael 94903, 444-2460, Fax 444-4627,, Univ Southern California 2006

Theodore Lee, MD, Radiology*, 99 Montecillo Rd., San Rafael 94903, 444-3158, Fax 444-4960,, UC Davis 1999

Mohammed Zakhireh, MD, General Surgery*, PO Box 2010, Ross 94957, 207-0053, Fax 524-8130,, Texas Tech Univ 1999

* board certified


Locum tenens physician available
Family practice, occ med, urgent care. Part/full-time. Fluent in Spanish. 415-601-7858.

Medical office space to share
Dermatology practice seeks full- or part-time physician to share medical space in San Rafael. Office is a beautifully remodeled building in great location. Two exam rooms with exam tables are available and use of additional rooms is negotiable. Shared restrooms and staff lounge. Contact Kathleen at 415-259-0131 or

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


The Marin Medical Society, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. We are affiliated with the California Medical Association and the American Medical Association.

© MMS 2010
PO Box 246
Corte Madera, CA 94976


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