Marin Medical Society

MMS News Briefs


September 2013

• Medicare payment reform bill now includes California GPCI fix

• Chief CMA federal lobbyist to speak at Oct. 23 dinner in Santa Rosa

• Reminder: Medicare transitions to Noridian on Sept. 16

• Top stories from CMA Alert

• Report from the CMA board of trustees





Medicare payment reform bill now includes California GPCI fix

The House Energy & Commerce Committee has unanimously approved a bipartisan bill to overhaul the Medicare sustainable growth rate (SGR) physician payment formula. Included in the bill is the CMA-sponsored update to the geographic practice cost index, commonly known as the “GPCI fix.” The bill now moves to the House Ways & Means Committee; there is a long way to go.

The GPCI fix will be groundbreaking for many localities in California in terms of payment equality. While Medicare updates the hospital geographic regions and payments annually, it has not updated the physician regions in California in over 16 years. According to Medicare’s own data, Marin and 13 other California counties are underpaid by up to 10% each year.

The Medicare SGR payment reform provisions of the bill provide updates for physicians participating in fee-for-service quality measures and clinical improvement projects. The provisions also give physicians incentives to participate in alternative payment models.

The Ways & Means Committee is expected to move its own Medicare payment reform bill in September. Then the Energy & Commerce and Ways & Means committees will reconcile their bills into one package that moves to the House floor. The Senate Finance Committee is also expected to move forward with its legislation in the fall.

Chief CMA federal lobbyist to speak at Oct. 23 dinner in Santa Rosa

Elizabeth McNeil, CMA’s chief lobbyist in Washington, DC, is the featured speaker at a dinner hosted by the Sonoma County Medical Association on Wednesday evening, Oct. 23. Topics include pending changes in healthcare reform, deficit reduction, Medicare and Medi-Cal.

The dinner, to be held at the Fountaingrove Inn in Santa Rosa, is free for MMS members. Spouses, guests and nonmembers are $40 each. The evening begins with a wine reception at 6 p.m., followed by dinner and program at 6:30. Dinner choices include grilled salmon, pesto penne and grilled chicken.

To RSVP, contact Rachel Pandolfi at 707-525-4375 or You can also fax the attached order form to SCMA at 707-525-4328. Be sure to indicate dinner choice.

SCMA Oct. 23 dinner flyer

Reminder: Medicare transitions to Noridian on Sept. 16

Sept. 16 is the cutoff date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion, physician practices will still have to make some changes in their processes, including:

• Electronic claim submitters must change the Contractor ID (Payor ID) on their transmissions. The new ID for Northern California jurisdiction is 01112; for the Southern California jurisdiction, it’s 01182. Please note that the change to the Contractor ID should not be made before Sept. 12 for Part B claims.

• Paper claim submitters will submit claims to a new address, to be announced in the CMA Medicare Transition Guide.

• There will be a new toll-free telephone number (855-609-9960) for all telephone inquiries to Noridian, but the number will not be activated until Sept. 16.

For a comprehensive preparation checklist, see the CMA Medicare Transition Guide.

Top stories from CMA Alert

Here are the top stories from the latest CMA Alert, the California Medical Association’s biweekly email newsletter. For a free subscription, visit

Medical board to suspend licenses of physicians with delinquent taxes

Is your license renewing in September or October? Renew early to avoid delays with new online licensing system

DHCS to implement 10% Medi-Cal cuts beginning in October

MICRA: Haven’t we seen this all before?

Are you ready for the next HIPAA compliance deadline?

Report from the CMA board of trustees

Dr. Peter Bretan, Dr. Mark Davis and Dr. Catherine Gutfreund

[Dr. Bretan (Novato), Dr. Davis (Crescent City) and Dr. Gutfreund (Santa Rosa) are the District X trustees on the CMA board of trustees.]

The July 26 meeting of the CMA board of trustees focused on MICRA, governance issues and the CMA strategic plan.

MICRA. California’s trial attorneys made good on their May threat to ask voters to repeal California’s landmark Medical Injury Compensation Reform Act (MICRA) by submitting language to the California Attorney General, the first step in placing an initiative on the ballot. The initiative’s main provision would increase the cap on speculative, “non-economic” damages from the current $250,000 to more than $1.2 million, with automatic increases every year. The initiative would also require drug and alcohol testing for all physicians on hospital medical staffs.

The measure is nothing more than a self-serving attempt by trial lawyers to generate more in legal fees. CMA and a coalition of doctors, hospitals, insurance companies, nurses, community clinics, local governments, labor unions, police, emergency responders, employer groups and others will wage a significant campaign to expose the lawyers’ self-serving agenda and defeat the measure.

If the initiative is successful, it will cause malpractice rates to skyrocket, force the closure of safety net clinics and recreate the same conditions that threatened to throw California’s healthcare system into crisis during the early 1970s. Imagine receiving notice that your medical malpractice premiums will increase 250% or even 400%. That’s what occurred in 1974 and 1975, leading to a crisis of unprecedented proportions that forced providers to close their doors, leave California or choose to go without coverage. Failure to defend MICRA will destroy medical practices, resulting in irreparable damage and impeding access to care in California.

CMA estimates that it will need $40-60 million to defend MICRA. During the meeting, trustees were asked to contribute $2,000 each; by the end, more than $60,000 had been contributed. [Editor’s note: CMA has raised more than $28 million to date.] The board also authorized CMA to loan the MICRA Education Fund $5 million to defend the measure.

Governance. Your district X trustees expressed our concern that the relevance of the CMA House of Delegates not be undermined, and that the HOD should remain the policymaking body of CMA. We also noted that it would be a reasonable idea to replace reference committees with increased activity in CMA councils and committees; that the business of the HOD should not be predetermined by a few; that previous debate of resolutions is paramount. After much discussion, the board passed a series of governance recommendations. The main points are summarized below.

• Beginning in 2016, the HOD would annually establish broad policy on three to five issues determined by the speakers, subject to the advice and consent of the board of trustees to be the most important issues affecting members, the Association and the practice of medicine. The board of trustees would detail and implement House-adopted policy on these issues and would assume responsibility for policy-making on all other matters. The board would be delegated authority currently vested in the House for internal administrative matters, such as component society charters and confirmation of elections and appointments.

• To enable more extensive and focused expertise to be brought to bear in less rushed deliberations and to promote continuity and coherence in CMA policy making, the issues determined as most important and designated for House of Delegates action would be referred to standing CMA councils and committees, which would replace and serve as reference committees of the House for purposes of studying the assigned issues, receiving testimony, and preparing reports with recommendations for House action.

• Standing councils and committees would be expanded and/or restructured as appropriate and as needed to equip them for their greater role as drivers of CMA policy-making. In addition to consideration of individual qualifications, efforts would continue to achieve reasonable balance in the geographic, specialty and mode-of-practice representation of CMA membership in council and committee appointments.

• Reports and recommendations of the council and committees serving as reference committees would be made available at a date early enough to allow delegation caucus meetings to occur prior to the annual session, enabling floor action on recommendations to commence immediately upon the convening of the HOD and saving CMA and component medical societies substantial costs they would otherwise incur.

• The annual session would become a two-day meeting consisting of: (1) action on council and committee reports addressing the three to five issues specified by the speakers; (2) action on any matters the board of trustees may refer to the House; (3) elections of officers; (4) educational sessions on key issues; and (5) ceremonial functions that would be scheduled during an evening dinner open to all CMA members.

• The ability of individual members to introduce business of the Association would be preserved by enhancing the existing year-round resolution process, whereby resolutions received would be referred to standing councils and committees for purposes of study, receipt of testimony and preparation of reports with recommendations for action by the board of trustees.

• As transitional steps toward a two-day annual session, HOD reference committees would begin functioning as entirely “virtual” reference committees, beginning with one committee in 2013, two or more at the 2014 annual session, and all committees by 2015. Testimony would be received online, and reports with recommended actions would be distributed no later than the opening session of the HOD.

• That the board of trustees direct that a study be undertaken in consultation with component medical societies to explore a possible redrawing of the CMA geographic district boundaries, in order to reflect the growth and redistribution of California’s physician population and provide greater representational equity among component societies and districts.

The implications of these recommendations are significant for District X. Please let your trustees know your views so they can share them with the board of trustees prior to the next HOD, scheduled for Oct. 11-13.

Strategic Plan. The CMA Executive Committee has identified five distinct goals on which CMA should concentrate its efforts: (1) grow membership by 5%; (2) commitment to public health; (3) prosperity for all physicians; (4) defend MICRA; (5) lead change in health reform.


Several community health centers in Marin, Sonoma and Napa counties have banded together to form an accountable care organization called the Redwood Community Care Organization. The new ACO--comprised of health centers in Santa Rosa, Petaluma, Healdsburg, Sebastopol, Napa and Pt. Reyes--will serve about 6,000 Medicare patients in the tri-county area. The ACO is one of the first in the country to be based on health centers rather than physician-hospital alliances.

Physicians from UCSF Benioff Children’s Hospital are now providing pediatric services at Marin General Hospital, helping pediatric patients and their parents avoid the long trip to San Francisco. UCSF perinatologists and neonatologists are working on-site at Marin General, and a range of other pediatric specialists are offering outpatient services. “This affiliation means our patients can benefit from a world-class pediatric hospital and medical center without having to leave Marin,” said Dr. Kara Ornstein, chair of Marin General’s pediatrics department.

Kaiser Permanente has donated more than $175,000 to 19 Marin County nonprofit health agencies, ranging from the Agricultural Institute of Marin to West Marin Senior Services. The money will be used to address several local health issues, including improving access to care; supporting healthy eating and active living; decreasing alcohol, tobacco and other drug use; supporting a sustainable safety net; and addressing high rates of breast cancer.

Marin General Hospital has relaunched the TAM (total arteriosclerosis management) program after a brief hiatus. Originally begun 20 years ago at Cardiology Associates of Marin, the program puts patients through eight weeks of intensive screening and training to minimize cardiac risk. Marin General assumed responsibility for the program two years ago, then put it on hold until it could be relaunched through the hospital’s Center for Integrative Health and Wellness.


A conference on Integrating Mind-Body Medicine into Clinical Practice will be held in San Francisco Oct. 5-9. Sponsored by the Center for Mind-Body Medicine, the conference offers a maximum of 31 Category 1 credits. The focus is on medical techniques to address stress, anxiety, trauma, insomnia and chronic illness. To register, visit

MMS members can get registration discounts for the Napa Primary Care Conference: Caring for the Active and Athletic Patient, to be held at the Napa Valley Marriott from Nov. 6 to 10. The conference is designed for physicians and medical professionals who care for active and athletic patients or who themselves lead such a lifestyle. Topics include common medical and musculoskeletal problems, healthy lifestyles and personal wellness. The conference offers up to 16 hours of CME. To register, visit the conference website.

The following CMA webinars are scheduled for late August and September. Webinars, which are typically worth one CEU credit, begin at 12:15 p.m. and run until 1:15 or later. To register, visit Seminars are free for CMA members and their staff; cost for nonmembers is $99 per person.

Medicare: Proposed Changes for 2014 (Aug. 28)

California's Health Benefit Exchange: The Positives and Perils of Contracting (Sept. 11)

ICD-10 Documentation for Physicians: Part 1 (Sept. 12)

Recipe for Financial Success: Key Steps to Increasing Your Net Income (Sept. 18)

ICD-10 Documentation for Physicians: Part 2 (Sept. 19)

Appropriate Prescribing and Dispensing: New Measures (Sept. 25)

ICD-10 Documentation for Physicians: Part 3 (Sept. 26)


Psychiatrist wanted

A staff psychiatrist at Sonoma Developmental Center participates in the multidisciplinary team process for the management of individuals with intellectual disabilities. Sonoma Developmental Center is operated by the State of California, Department of Developmental Services, and provides long-term residential services for individuals with intellectual disabilities. The psychiatrist performs psychiatric evaluations, participates in the multidisciplinary team meetings and provides recommendations to the primary care physicians in the psychiatric medication management of complex behavioral problems. The psychiatrist is also available via email and pager for consultation with primary care physicians for urgent clinical issues.

SALARY RANGE:$18,146–$22,377 per month

Applications may be downloaded from the California Department of Human Resources website at Applications MUST be filed in person or by mail with:

Sonoma Developmental Ctr., Human Resources Exam Dept., 15000 Arnold Dr., PO Box 1493, Eldridge, CA 95431. For more details, call Dr. Michael Wymore at 707-938-6566.

Staff physicians wanted

Sonoma Developmental Center is a long-term care facility operated by the State of California near Glen Ellen, California. The Center provides comprehensive health services to approximately 500 individuals with intellectual disabilities. We currently have four openings for primary care staff physicians in the fields of Family Practice, Internal Medicine or Pediatrics. The compensation and benefit package is competitive. Sonoma Developmental Center is an Equal Opportunity Employer.

Applications may be downloaded from the California Department of Human Resources website at Applications (Form 678) MUST be filed in person or by mail with: Sonoma Developmental Center, Human Resources–Examination Unit, 15000 Arnold Drive, PO Box 1493, Eldridge, CA 95431. For more information, call Dr. Michael Wymore, medical director, at 707-938-6566.

For Sale: SF family and urgent care practice

Average revenue $407,000; very high profit margin. No third-party plans; all cash. Strong growth potential. The practice is approximately half urgent care and half primary care. Real estate also available. Practice Consultants: or 800-576-6935.

Office space available

Primary Care MD has exam room at 1000 S. Eliseo Dr. Available monthly: 0.5 to 5 days/wk. 

• well-maintained building 

• close to MGH & other practices

• your assistant(s) welcome 

• storage, scheduling assistance possible 

Perfect for specialist or therapist. Contact Heidi at or 415-461-2262.

House for lease

Nicely furnished cozy two-bedroom home plus office available for one-year lease. Five minutes from downtown Santa Rosa. Walk to shopping and public transportation. All furnishings, flat screen TV, linens, dishes, etc. included. Photos available. $1,800 monthly. Deposit and references required. Contact:

MMS members get free classifieds!

MMS members can place free classified ads in News Briefs or Marin Medicine. Cost for nonmember physicians and the general public is $1 per word. To place a classified ad, contact Linda McLaughlin at or 707-525-4359.


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.

© 2013 MMS, PO Box 246, Corte Madera, CA 94976