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Annual CAPM Meeting Held in Sacramento, 10/2/14

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Cropped Lyman w some members Ann Mtg 10-2-14

President Don Lyman leads discussion at Annual CAPM meeting, 11/2/14

The Annual Meeting of CAPM was held at the Hyatt Regency Hotel, Thursday, October 2, in Sacramento, California, in conjunction with the fall CCLHO/HOAC meeting and CME program in Sacramento. Members who had listed their current e-mail addresses were notified of call-in information and sent handouts.

New officers for 2015 were elected. (For the list of 2015 and 2014 officers, see leadership page.)

A legislative report was presented. Four out of nine bills supported by CAPM passed and were signed into law. (For a list of bills and the letters sent by CAPM, see legislative update.)

Four resolutions were approved, to be submitted to the California Medical Association.  Topics included:

1. Promotion of the Wellness Plan issued by the California Department of Public Health

2. Urging abolition of a Medi-Cal regulation preventing reimbursement for visits to different specialists at the same clinic on the same day

3. Calling for restoration of HIV/AIDS prevention funding in the state budget, which was deleted in 2009 and never restored

4. Supporting infection control precautions in ambulatory care settings

Following the meeting, those interested walked to the nearby HOAC office, for the retirement party of Bruce Pomer (HOAC Executive Director and Honorary Member of CAPM).

 

CAPM President’s Report on 2014 CMA Council on Legislation, Legislative Leadership Conference, and Specialty Society Meeting

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California Academy of Preventive Medicine (CAPM)

 REPORT from

CALIFORNIA MEDICAL ASSOCIATION (CMA)

Council on Legislation (COL)

(Sacramento, 20 March, 2014)

40th Annual Legislative Leadership Conference

(Sacramento, 22 April, 2014)

Specialty Society Meeting

(Sacramento, 23 April, 2014)

The CMA held three annual meetings in March/April in Sacramento.  CAPM was represented at each by our President, Donald Lyman.  This is a brief report summarizing all of them together, with special attention to currently pressing matters for the profession as-a-whole.

Council on Legislation: This is the governing Board of the CMA PAC.  CAPM has one vote on the Council of about 100 participants.  It considers CMA’s position on legislative bills and then sends it’s lobbyists into the Capitol to advocate for/against the measures.

 40th Annual Legislative Leadership Conference:  This is CMA’s annual “Lobby Day” at the State Capitol.  It draws more than a thousand CMA members to a briefing on current issues and legislative bills and then sends them into the Capitol to meet legislators with CMA’s position on those bills.  The premium is on the legislative visits by conference participants to advocate for/against targeted bills now under consideration by the legislature.

Specialty Society Meeting: This is a group of Specialty Society Presidents, CEOs and other officials to coordinate efforts and hash out disagreements on policy.

BRIEFINGS:  Clearly CMA is laser-focused on the fall 2014 initiative sponsored by the Trial Lawyers Association to repeal MICRA (Medical Injury Compensation Reform Act).

MICRA: This Act was enacted in 1975 to limit permissible awards for pain and suffering in malpractice suits.  It was almost universally seen as an abused legal-loophole to permit trail lawyers to realize enormous rewards for themselves at the expense of their clients.  Following the enactment, malpractice rates went down and that cost-center became a more stable part of the medical care cost structure.  States which did not enact a MICRA-like statute suffered high attrition rates of specialists (New York has 17 counties with no obstetricians at all) and disincentives for many specialists to stay in those states.

  • Initiative: The trial lawyers have failed to get the statute repealed in the state legislature and so have turned to the initiative process.  The MICRA piece of it is hidden behind an emotional appeal addressing the current heroin epidemic (see: Controlled Substances Misuse below).  It blames wayward physicians for causing the current epidemic with over prescription of opioids and then mandates solutions like random drug/alcohol testing of all physicians.  BUT, the real target is clear – MICRA!  They will clearly run an ugly anti-physician campaign.
  • CMA Response: CMA has lined up an all-star-cast to campaign against the initiative.  Many other CMA priorities are now on the back-burner as they enter this fray.  Most of the strategies and tactics discussed at these meetings are highly confidential (so, I will not put them in this eMail).  We may expect solicitations to join in the effort as election day approaches.

CAPM position:  We are opposed to the initiative as is almost the entire medical care community.  The benefits it would bring to the public are just not there; the damage it would do is considerable.  Does that mean there is no room for amendment of the MICRA law downstream?  NO; that will happen with time.  However, the initiative process is not the place to do that.

OTHER BRIEFING ISSUES:

  • The other Trial Lawyers initiative on the fall 2014 ballot is one addressing rate regulation for medical care.  It would award the State Insurance Commissioner authorities over rate setting.  While all seem to agree the current system of multiple regulation loci needs to be changed,  all also seem to agree this is not the solution and the wrong way to find it à Right Problem / Wrong Solution.  It instead builds more redundancy into the system and is yet-another way for the trail lawyers to stretch-out the appeals process with more-and-more hours charged for their services. (NOTE: CAPM has not yet taken a position on this initiative)
  • Covered California (California’s part of the Federal Affordable Care Act {ACA}):  California has been unusually successful in enrolling people into the new system.  Nationally ACA signed up 8 + million people; California signed up 1.4 million in the Covered California system and another 1.9 million as new MediCal patients.
  • Controlled Substances Misuse:
    • Some 15 years ago, advocates for better pain management (that is,  greater use of opioids)  leveraged mandatory physician continuing medical education (CME) of “End of Life and Pain Management.”  Since then, the number of opioid prescriptions has increased 400%.  Concurrently, the frequency of opioid overdose deaths from illicit use of the prescribed drugs has increased 400%.  Also concurrent with this, the State’s CURES system (registry of opioid prescriptions for use by physicians and pharmacists to prevent abuse) fell into disrepair due to its age and to budget cuts at the State Department of Justice.
    • In 2012, the L.A. Times published a seven part exposé on the deaths (“Dying for Relief”) and blamed it all on irresponsible physicians.  Since then, the problem has been identified as a national one with multiple causes.
    • The response to these dynamics is several as it effects California physicians:
      • The Trail Lawyers initiative for fall 2014 builds on this story to blame physicians for the problem and call for rather ugly solutions – all of which are there to clearly mask their real intent to repeal MICRA.
      • The Medical Board of California (MBC) is considering new guidelines for opioid uses.  The CMA has produced a White Paper to help the MBC in its work (on the CMA web site.  http://www.cmanet.org/resource-library/detail?item=prescribing-opioids-care-amid-controversy ).

ADVOCACY (Legislative Bills):  These are bills actively pursued by CMA during these meetings –

SUPPORT:

AB 1771 (V. Manuel Pérez) – Reimbursement for Telephone/ Electronic Patient Management.

AB 1805 (Skinner, Pan) – Restores 10% cuts to MediCal Provider rates.

AB 2400 (Ridley-Thomas) – Elimination of all Product Clauses.

AB 2458 (Bonilla) – Medical Residency Training Program Grants.

SB 1000 (Monning) – Sugar Sweetened Beverages labelling act.

OPPOSE:

SB 1215 (Hernandez) – Self referral

Donald O. Lyman, MD, President CAPM

25 April, 2014; Sacramento

 

Pomer honored at April 17, 2014 CAPM Dinner Meeting, Mission Inn, Riverside, CA

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Bruce Pomer displays honorary membership, with past-presidents Ronald Hattis (L) and Jeff Gunzenhauser (R)
Bruce Pomer displays honorary membership, with past-presidents Ronald Hattis (L) and Jeff Gunzenhauser (R)

In a gesture of respect and admiration, CAPM awarded an honorary membership to Bruce Pomer, longtime director of the Health Officers Association of California (HOAC), on April 17, 2014.  The presentation occurred at a CAPM dinner meeting at the famous Mission Inn in Riverside, CA.  Pomer is completing his final year as Executive Director of HOAC, and has worked for the organization for just over 30 years.  The meeting was scheduled during the annual spring conference of HOAC and its sister organization, the California Conference Of Health Officers (CCLHO) at the same location.

Pomer was given a certificate explaining that the honor was “in recognition of over 3 decades of service to local public health and to physician specialists in preventive medicine.” He spoke to the group about anecdotes from legislative advocacy on behalf of the health officers during this long period, including shifts in funding sources and struggles  to assure sufficient resources to support local public health. Perpetual struggles to safeguard public health were symbolized by the fact that the first bill he lobbied for, and the last 30 years later, both had to do with regulating raw milk, the source of many infectious disease outbreaks.

Also recognized at the meeting for past service was Ellen Alkon, who served as President of CAPM for five years with a total service on the Board of about ten years over three decades.

Members and guests at CAPM meeting 4/17/14
Members and guests at CAPM meeting 4/17/14

Other items of business at the meeting included:

– A report from Ron Hattis on CAPM’s activities, including a new statewide Preventive Medicine Leadership Council promoting specialty training and public health infrastructure (see last blog article), and our new Web site (www.capreventivemed.org)
– Ideas for four 2014 CAPM resolutions to be presented at CMA were proposed, and will be referred to the Board for consideration
– Four current bills in the California Legislature were recommended to the Board for CAPM support.

Bringing Together California’s Medical Leaders of Prevention and Public Health

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Ronald P. Hattis, MD, MPH, Treasurer and Past-President, CAPM

Leadership Summit cropped

CAPM has taken on an exciting project that may soon bring together leaders in Preventive Medicine throughout California, to deal with issues of concern to the specialty.  A little history may help to introduce this idea.

Until 2001, the California Medical Association (CMA) operated a more expansive set of activities than it does today. Every recognized medical specialty had a scientific advisory panel, which included specialty society leaders and the specialty chairs or their designees from California’s medical schools.  Preventive Medicine and Public Health, as a recognized medical specialty represented at CMA, had its own scientific advisory panel. The panels met in person annually at CMA expense, and evaluated specialty-specific issues for CMA. The elected chairs of the panels constituted CMA’s Council on Scientific Affairs.

In that era, CMA published the Western Journal of Medicine, and each specialty’s scientific advisory panel (including the one for Preventive Medicine and Public Health) also edited manuscripts for and took turns presenting a feature of that journal called “Epitomes.” These consisted of brief summaries of new specialty-specific advances and pearls of wisdom.  Periodically, there would thus be “Epitomes of Preventive Medicine and Public Health.” CMA also used to run an annual Scientific Assembly in conjunction with its annual House of Delegates, and a further task for the panels was to develop the continuing education curricula for that conference, in their respective specialties.

California Medical Association Building, Sacramento (from Don Lyman, MD)
California Medical Association Building, Sacramento (from Don Lyman, MD)

Today, the scientific advisory panels and the Scientific Assembly are gone, part of the history of a past era. So is the Western Journal of Medicine, which was sold to the British Medical Journal Group in 1998. Its “Epitomes” were soon discontinued, and the entire journal folded due to economic unviability in 2002. The Council on Scientific and Clinical Affairs exists and has an important role within CMA, but it consists of one appointed rather than elected member from each specialty.

I had the privilege of being the last elected Chair of the Scientific Advisory Panel on Preventive Medicine and Public Health, serving from 1997 to 2001. Our panel was unique, because in addition to medical schools representatives, we invited representation from the state’s four schools of public health. Since not every medical school had anything resembling a department of preventive medicine, CMA staff and I approached the Deans for permission to involve appropriate medical leaders in prevention and public health.  Some participated by phone, but a few took the trouble to travel to the meetings.

I took advantage of the unique opportunity of having such a collection of medical luminaries in prevention and public health together at one time, to place on the agendas issues beyond the CMA mandates. We discussed academic issues related to training physicians in preventive medicine and public health, specialty-specific challenges for Preventive Medicine, and the needs of the state’s public health system from a medical perspective. We exchanged information on what was happening and being researched in prevention, at the various universities and around the state.

It has been 13 years since such an entity has existed, and I miss the scope and unity, and what it was capable of addressing. I think that with the changes brought by the Affordable Care Act and the cutbacks in public funding for public health and for Preventive Medicine residencies, such a leadership group is needed now more than ever.

The California Academy of Preventive Medicine is sponsoring an attempt to resurrect such meetings by conference call, and to address today’s new set of issues and challenges. We have enlisted the help of Dr. Mark Horton, the most recent past-Director of the California Department of Public Health (and the first director after it split off from the Department of Health Services), in implementing this vision, and it is expected that he will chair the first meetings.

Although we lack the funding once provided by CMA, we have the flexibility to build a new council as we want and need it. To represent physicians in prevention and public health as completely as possible, the California Department of Public Health, the California Department of Healthcare Services, and the Health Officers Association of California will be invited along with the academic institutions. CAPM representatives will attempt to represent diverse modes of Preventive Medicine practice, including non-governmental and non-academic settings.

We also have an opportunity to more fully engage the prevention-oriented component of California’s osteopathic medical community of over 6,000 physicians, many of whose members belong to the Osteopathic Physicians and Surgeons of California (OPSC) but not to CMA. Both osteopathic medical schools in California will be invited to participate.

As I write this, most California universities with schools of medicine or public health have assigned appropriate representatives, and we look forward to getting started on May 6, 2014 with the first call. We have already obtained many ideas for agenda topics. Additional suggestions may be sent to info@capreventivemed.org.

Welcome to our new Web site

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Welcome to the redesigned Web site of CAPM, the California Academy of Preventive Medicine! We have a new address, capreventivemed.org, changed from capm.us.

The previous content that had been assembled by Dr. Richard Sun has been preserved with appropriate updates, and reorganized into a tabbed system. We have added new features, including this blog, and a showplace for members to post educational materials.

Our objective is for this site to serve both our members and the general public.  Joining, renewing, and donating can now be done online through the site. Ideas on prevention of various diseases and on health promotion may be posted from time to time on this blog, and in various other parts of the site.

Our “Preventive Med Links” connect to the most important national and state organizations and agencies, as well as training institutions in California, for physicians with an interest in prevention and public health.  Slide presentations and papers written by members may be found under the “Educational Material” tab.

We welcome input and suggestions. Write to info@capreventivemed.org.

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