Vital Signs August 2012

August 2012 Vol. 34 No. 8Official Magazine of

FRESNO COUNTYFresno-Madera Medical Society

KERN COUNTYKern County Medical Society

KINGS COUNTYKings County Medical Society

MADERA COUNTYFresno-Madera Medical Society

TULARE COUNTYTulare County Medical Society

Vital SignsSee Inside:

Letters to the Editor

CMA: Exchange Plans Now Riskier

Health Reform

2 AUGUST 2012 / V ITAL S IGNS

S A N D I E G O

O R A N G E

L O S A N G E L E S

P A L O A L T O

S A C R A M E N T O

800-252-7706 www.CAPphysicians.com

Superior Physicians. Superior Protection.

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the nearly 12,000 preferred California physicians already enjoying the benefits of CAP membership.

We Celebrate Excellence

– James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

VITAL S IGNS / AUGUST 2012 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

August 2012Vol. 34 – Number 8

Editor, Prahalad Jajodia, MDManaging Editor, Carol Rau

Fresno-Madera Medical SocietyEditorial CommitteeVirgil M. Airola, MDJohn T. Bonner, MDHemant Dhingra, MDDavid N. Hadden, MDRoydon Steinke, MD

Kings RepresentativeTBD

Kern RepresentativeJohn L. Digges, MD

Tulare RepresentativeGail Locke

Vital Signs SubscriptionsSubscriptions to Vital Signs are$24 per year. Payment is due inadvance. Make checks payable tothe Fresno-Madera Medical Society.To subscribe, mail your check andsubscription request to: Vital Signs,Fresno-Madera Medi cal Society,PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact:Display:

Annette Paxton,559-454-9331

[email protected]

Classified:Carol Rau,

559-224-4224, ext. [email protected]

ContentsVitalSigns

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion piecesaccepted for publication do not necessarily reflect the opinion of the Medical Society. All medicalsocieties require authors to disclose any significant conflicts of interest in the text and/or footnotes ofsubmitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118.

CMA NEWS

Exchange Plans Now Riskier Propositions for Physicians ...........................................................7

CMA Economic Services Webinars ...........................................................................................8

CMA 2012 Education Series: Coding for Medical Necessity .......................................................9

NEWS

LETTERS TO THE EDITOR.........................................................................................................5

HEALTH REFORM: California to Continue Reform Efforts Following Ruling..................................11

AIR QUALITY: Support for Clean Energy: Solar.........................................................................13

CLASSIFIEDS ...........................................................................................................................18

FRESNO-MADERA MEDICAL SOCIETY .......................................................................................13

• President’s Message

• Medical Managers Forum

• Educational Program Offered: Differential Diagnosis of Pulmonary Nodules, August 22

• In Memoriam: Cooper Collins, MD

• 2012 Educatdional Series for FMMS members

KERN COUNTY MEDICAL SOCIETY ............................................................................................15

• Nominations Now Being Accepted for KCMS Outstanding Contribution Awards

• Membership Recap

TULARE COUNTY MEDICAL SOCIETY.........................................................................................16

• Executive Director’s Message

• Save the Date September 23: Tulare County Medical Society 2012 Family Day

Cover photography: “Sunflowers”by Newton Seiden, MD

Calling all photographers:Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee


JAMA has devoted whole issues to the latter two. The leadeditorial of our house organ should represent our best selves:scientific, proactive, and engaged in the challenging realities of ourtimes.

– Alex Sherriffs, MDPast President, FMMS

• • •Dear Editor:

The editorial by Dr. Stillwater (July 2012)has disturbed me on several fronts, especiallyin regards to global warming. I disagree withhis assessment that man-made global warmingis a “hoax.” Ninety-seven percent of climatescientists agree that global warming does exist,is unequivocal, continues to increase and isdue primarily to human activity such as the use of fossil fuels,deforestation and others. From 1906 to 2005 the averagetemperature on earth rose 0.74 degrees C. The main culprit is notCO2, which accounts for 9% to 26% of it, but water vaporaccumulation, 30% to 70%, by methane 4% to 9% and by others.

Since 1750, the concentrations of CO2 have increased 36%and of methane 148% and 75% of the CO2 increase is due to theuse of fossil fuels by human activity and 25% by mostlydeforestation. Since 1880, the 11 warmest years have beenbetween 2001 and 2011. The trend is clearly on the upswing, butshort term fluctuations can mask the trend (2007 for example,according to the author). Ice cores studies show that these levelsare the highest in the last 800,000 years.

This is not difficult to understand since the earth’s populationhas been increasing steadily and is now over 6 billion people. Theeconomic improvement of large numbers of this population overthe last 25 to 50 years (the fall of the Soviet Empire, the openingof China, India, etc.) makes this easily understandable, as they areusing more fossil fuels as a result.

The sun is believed not to have a very important effect onglobal warming as its activity has been steady during the years 2005to 2010, while warming has continued. This has produced thepermafrost to thaw, the ice polar caps to decrease, the level of theseas to increase, storms to become more violent and destructive,areas of drought more extensive and more importantly, anaccelerated rate of ocean acidification, which in turn will lead tothe extinction of many species. Studies show the rate ofacidification is greater than in the last 300 million years, etc. Thereis a tremendous amount of bibliography that supports globalwarming, and I can make it available upon request.

It is not too late to try to curb gas emissions. I don’t have toconvince many of you, but to the ones that don’t believe in globalwarming, I ask you to think about if you are wrong, and 30 or 50years from now we have environmental problems that are notsolvable, and civilizations on earth ceases to exist as we know themtoday. I believe it is better to make some adjustments now when wecan, and prevent nightmarish scenarios that can happen in thefuture. Global warming doesn’t have physical limits, doesn’t haveboundaries; it will affect all of us whether we like it or not. We arestarting to see the effects. Think about it.

– Sergio D. Ilic, MD


Dear Editor:This letter is in response to Dr. Stillwater’s

editorial in July’s edition of Vital Signs. Istrongly object to the negative tone of thearticle, and to its one-sided arguments.

I am pleased Dr. Stillwater is in favor ofclean air and clean water. But when he goeson to characterize the greenhouse effect andman-made global warming as “junk scienceand socialist propaganda,” he only serves to anger and alienatephysicians (like myself) who are convinced otherwise. Hisarguments in favor of other issues regarding the carrying ofconcealed handguns and cigar smoking are also unbalanced. Theseissues may all be all good topics for discussion, but the first page ofour medical societies’ newsletter is not the place.

To promote better health for our patients, we physicians needto work together as much as possible. Let’s remember to showrespect for those of differing opinions.

– Don H. Gaede MD• • •

Dear Editor:The July lead editorial in Vital Signs implied

global warming and the contribution ofhuman activity are a hoax, there is a safe levelof tobacco use, and wider public possession offirearms will increase public security. There isa fine print disclaimer (page 3) that editorialsare not necessarily the opinion of thecomponent medical societies.

Understanding that Vital Signs is how members of the publicmay first come to know us and how potential members of ourcomponent societies may come to understand us, I think muchbolder disclaimers are called for.

We use the best available science in the interest of our patientsand the public’s health. My experience with patients suggests theyexpect us to be proactive on their behalf. The data supporting theconcept of global climate change driven by human activitybecomes only stronger and stronger, and the data which suggestadverse health consequences also grows. Of course there are somewho believe otherwise, and of course no modeling is exact. But thepreponderance of evidence pushes in one direction. If you doubtthe science, follow the money: a July 7 Bakersfield Californianeditorial reminds us the reinsurers are convinced, and scramblingto deal with the predicted adverse and extreme weather events.The preponderance of evidence for the adverse effects of tobaccouse has no counter-balancing body of evidence for a safe level ofuse. The data on adverse effects of second-hand smoke grows, asdoes evidence for adverse consequences even when smokersconscientiously smoke outdoors. I heartily congratulate my 2 packper day patient who is down to 1-2 cigarettes per day, but Icontinue to encourage complete abstinence. I anxiously read aboutcriminal violence, but I also have seen the statistics suggesting as agun owner, I am far more likely to harm myself or a loved one withthat firearm than I am to thwart a violent criminal.

These three topics are important issues in our patients’ lives andin the public health arena. There is much to discuss and learn.

L E T T E R T O T H E E D I T O R

Alex Sherriffs, MD

Don H.Gaede, MD

Sergio D.Ilic, MD


Class A Medical O� ce Space Available - 9300 & 9330 Stockdale Highway- Bakers� eld, CA

www.colliers.com

Available Now

9300 Stockdale Highway >Suite 100 - 3,743 rentable s.f. former use - General Medical 9330 Stockdale Highway >Suite 100 - 7,736 rentable s.f. - divisible from 1,500 to 7,736 s.f. - former use - Radiology >Suite 200 - 5,754 rentable s.f. - former use - Orthodontics >Suite 500 - 2,386 rentable s.f. - former use - Dental >Suite 600 - 2,655 rentable s.f. - former use - General Medical

• Located just north of Mercy Southwest Hospital

• Abundant, excess parking with easy access to Stockdale Highway

• All suites separately metered for gas and electricity

• Stockdale Highway monument signage• Located in most desired medical submarket

in Bakers� eld

For Further Information Contact:

David A. Williams, SIOR License Number 00855489 Colliers International 10000 Stockdale Highway, Suite 102 Bakers� eld, CA 93311 Ph 661 631 3816 Fax 661 631 3829 [email protected]


Many physicians will not be able to sustain such cuts and remainin the Medicare program, which would have grave negativeimpacts on Medicare seniors as well as private patients. CMAand our partners in this fight will continue to work with Congressto find a long-term solution that addresses this serious threat.

CMA worked to eliminate the SGR and increase Medicaidreimbursement rates, but unfortunately nothing was done in thefinal bill to fix the grossly inadequate Medi-Cal (California’sMedicaid program) payment rates that leave many patientswithout physicians. This severe underfunding must be addressed,as nearly three million new patients will enroll in Medi-Calunder the ACA. California is leading the way for the Medicaidexpansion across the country, but in order to succeed, we mustlook at the reimbursement structure of the program here in ourhome state. The ACA does increase reimbursement rates forprimary care physicians (and related subspecialties) who seeMedi-Cal up to Medicare payment levels, but only through 2014.While this is a significant step in the right direction, CMA willbe advocating to extend the increase well beyond 2014.

CMA was also strongly opposed to the ACA’s creation of anunaccountable Independent Medicare Payment Advisory Board(IPAB), which will mandate arbitrary spending cuts, force morephysicians out of the program and limit seniors’ treatmentoptions even further. The IPAB removes Congress’saccountability to voters, including to physicians and seniors, forthe Medicare program by simply mandating physician paymentcuts if Medicare spending exceeds congressionally set health carespending limits.

There have been a number of questions about the Medicaidexpansion part of the court’s ruling. The ACA allows anexpansion of Medicaid and would make additional Medicaidfunds available to states that comply with the expansion. Forstates that do not comply with the expansion requirement, theACA intended to impose the penalty of withdrawing allMedicaid matching funds, including funding for currentparticipation levels. The court found that the penalty portion ofthe Medicaid expansion provision is unconstitutional, but thatthe provisions of the ACA that expand Medicaid are otherwisevalid. Therefore, it is up to the states to decide whether toexpand Medicaid – the federal government cannot withholdfederal matching funds if states do not comply.

This Medicaid ruling will not affect California, because thestate has said they will continue to move full steam ahead inimplementing the ACA.

As your CMA President, I understand that the ACA and theSupreme Court ruling are controversial among Californiaphysicians. However, there is deep support among the largemajority of you for the individual mandate and universal healthinsurance coverage. I want to assure you that CMA is firmlycommitted to advocating for improvements and reforms to theACA that will ensure everyone can actually see a doctor when

Please see CMA News on page 18

CMA NEWS

MESSAGE FROM CMA PRESIDENT:RESPONSE TO SUPREME COURT DECISION

Following the U.S. Supreme Court ruling, it is clear thatCalifornians can still expect many changes in health caredelivery and insurance coverage.

The ruling to uphold the Affordable Care Act (ACA),specifically the individual mandate provision, guaranteesinsurance coverage for most of the uninsured patients inCalifornia. It has been the California Medical Association’s goalfor decades to achieve universal health insurance coverage.Despite this monumental step forward, there is tremendous workto be done to ensure appropriate implementation here inCalifornia. Moreover, there are many problems with the law thatneed to be fixed to make the ACA work.

CMA has long advocated for affordable access to care forCalifornia’s uninsured and for an expansion of health insurancecoverage. However, as physicians, we know that insurancecoverage alone does not mean access to doctors.

Throughout the federal health care reform debate, your CMAadvocated for meaningful changes to the health care deliverysystem that build on what works, while fixing only what isbroken. In addition to supporting the individual mandate, CMAhas also fought for the protection of the physician-patientrelationship from third-party interference, for meaningfulreforms to the for-profit health insurance industry, and forsufficient resources to deliver on the promise of improved accessto doctors.

CMA has also supported eliminating egregious healthinsurance cancellation practices, pre-existing conditionexclusions from coverage, lifetime or annual limits on benefits,and excessive insurer profit and administrative costs. Thesereforms will ensure that patients are not denied health insurancebased on what illnesses they have, but rather will help toguarantee coverage for all. While the individual mandate isessential to making coverage affordable for all, these insuranceindustry reforms are also critical to making the ACA work.

The ACA also made important investments in primary care,primary care training, rural health care, medical homes, publichealth and prevention, funding research on the effectiveness ofdifferent treatments, and increased payment rates, albeittemporary for primary care physicians and related subspecialtiesin Medicare and Medi-Cal.

However, the legislation has left several serious problemsunresolved, most specifically the underfunding of Medicare andMedicaid. For a decade, California physicians have been callingon Congress to eliminate the flawed Medicare SustainableGrowth Rate (SGR) fee-for-service payment formula and adopta long-term path to an alternative payment system thatrecognizes the real drivers of health care costs. That issue was notaddressed in the ACA, and physicians are now facing a 32percent cut in payment rates for Medicare patients at the end ofthis year. The Medicare Advantage rates are being cut as well.

Exchange Plans Now Riskier Propositions for PhysiciansJames T. Hay, MD

President, California Medical Association


Economic Services WebinarsAug. 8: CMA and the Courts/ AccessingCMA’s Legal Library – 12:15-1:15 pmLearn about CMA’s role in importantlitigation in California and nationwide,and learn how to navigate CMA’s healthlaw library. The Legal hotline staff willprovide an overview of the wide array oftopics covered CMA’s online library.Aug. 15: Program Integrity in Medi careand Medi-Cal – The Physician’s Role –12:15-1:15 pm This session provides physicians withinformation about the risks ofbecoming a victim of fraud and how totake preventive action. It also coverscompliance with Medicare and Medi-Cal documentation requirements.Aug. 16: California Workers’ CompeBill Part 1: Are You Ready? – 12:15-1:30 pmPart 1 of an extended three-partCalifornia eBill Webinar EducationalSeries. This webinar will provide youwith an overview of what eBill is, how itworks, and the benefits and tools tohelp you evaluate your practice’s eBillreadiness.Aug. 23: California Workers’ CompeBill Part 2: Implementation – 12:15-1:30 pmPart 2 of an extended three-partCalifornia eBill Webinar EducationalSeries. This webinar will provide anoverview of the eBill compliancerequirements and focus on electronicclaims and attachment submissionrequirements including acknowledge -ment transactions.Aug. 30: California Workers’ Comp eBillPart 3: Understanding Remit tanceAdvice Rules – 12:15-1:30 pmPart 3 of an extended three-partCalifornia eBill Webinar EducationalSeries. This session will provide anoverview of the eBill electronicremittance advice rules and how to usethese rule as a tool to help automateyour back office workflow processes.UPCOMING:Sept. 5: A Guide to Reviewing PayorContracts – Kris Marck – 12:15-1:15 pmSept. 6: California Workers' CompeBill Part 4: First-Time SubmissionJopari Solutions/CA Workers’ Comp• 12:15-1:45 p.m.Sept. 19:Creating and ImplementingFinancial and Office PoliciesDebra Phairas • 12:15-1:15 p.m.Oct. 3:Protect Your PracticeFrom Payor AbuseMark Lane • 12:15-1:15 p.m.

CMA NEWS


CMA NEWS

2012 Education Series

A Webinar Invita�on for All Physicians and Their Staff

Coding for Medical NecessityWith Arthur Lurvey, MD,

Palme!o GBA

Wednesday, August 112:15-1:15 pm

CMA hosted webinars are FREE as a benefit of your CMA Membership.*Nonmembers are invited to join this webinar for $99*

What A!endees Can Expect to Learn:

To register for this or any CMA webinar, please visit www.cmanet.org/events.**CMA is pleased to provide 1 PMI CEU credit for medical office staff.**

This webinar is being hosted by the California Medical Associa�on. You must register at least one hour prior to the event.Once your registra�on has been approved, you will be sent an email confirma�on with details on how to join the webinar.

Ques�ons? Call the CMA Member Help Line at (800) 786-4262.

Palmetto GBA®PARTNERS IN EXCELLENCETM

Medicare and private payers all recognize medical necessity as a deciding factor for claims payment and it is important that all prac"ces know the rules. We will discuss applying the rules to your pa"ent encounters, medical decision making and medical necessity, the importance of diagnosis coding, coverage determina"on policies, using an electronic health record, how to respond to requests for records, and how to appeal if you disagree with decisions from outside reviewers.


How Successful IsYour Practice?

Let physician membersknow your practice

is availablefor referrals

Use Vital Signs to advertiseyour practice at special ratesoffered to member physicians.

contact:Annette Paxton

Vital SignsAdvertising Representative

(559) 454-9331

�

�


H E A LT H R E F ORM

Reprinted with permission from California Healthline

Following the U.S. Supreme Court’s rulingto uphold the federal health reform law,California officials said the state willcontinue implementing the law’sprovisions, the Sacramento Bee’s “CapitolAlert” reports (Siders, “Capitol Alert,”Sacramento Bee, 6/28).

Ruling DetailsIn a 5-4 ruling the Supreme Court upheld the federal health

reform law’s individual mandate, reaffirming the law’s requirementthat most U.S. residents must purchase health insurance.

The majority of the justices also affirmed the constitutionality ofthe Medicaid expansion provision in the law, which would requirestates to extend coverage to adults with incomes up to 133% of thefederal poverty level beginning in 2014.

However, the justices struck down the provision that wouldhave allowed the federal government to withhold existingMedicaid funding if the states failed to comply with the expansion.

Details of Reform Efforts in CaliforniaSince President Obama signed the reform law two years ago,

California lawmakers have passed several state laws related to theoverhaul, including measures that:

• Allow young adults to remain on their parents’ healthinsurance plans until age 26;

• Block insurers from setting lifetime caps on health benefits; • Establish a state health insurance exchange, called theCalifornia Health Benefit Exchange; and

• Prohibit insurers from denying health coverage to childrenwith pre-existing conditions (California Healthline, 6/28).

State officials estimate that about two million residents, many ofwhom are uninsured, will obtain insurance through the exchangebeginning in 2014 (“Capitol Alert,” Sacramento Bee, 6/28).

In addition, 47 California counties are participating in the“Bridge to Reform” program, which aims to implement the reformlaw’s Medicaid expansion ahead of schedule. The program provideslow-income residents with health coverage that they can use forno-cost treatments at local hospitals and public clinics.

More than 360,000 Californians already are receiving coveragethrough the program (California Healthline, 6/25).

According to “Capitol Alert,” the state is expected to receive$45 billion to $55 billion from the federal government from 2014to 2019 to expand Medi-Cal, California’s Medicaid program.Officials expect that an additional 1.2 million to 1.6 million stateresidents will gain health insurance coverage under the expansion.

State Officials Expect More Progress on Health ReformDiana Dooley – California’s Health and Human Services

Secretary – said, “California has been a leader in health care reformfor a very long time. We’ve had many starts and stops, and we arenow in the full go mode here” (“Capitol Alert,” Sacramento Bee,6/28).

Peter Lee, executive director of the California Health Benefit

California to Continue Reform Efforts Following RulingExchange, said the state is “moving full-speed ahead” to establish the exchange andwill launch a “major media and outreachcampaign” in 2013 (“Capitol Alert,”Sacramento Bee, 6/28).

Officials, Stakeholders Urge CautionHowever, some state officials believe

California should be cautious with healthreform efforts.

Sen. Tom Harman (R-HuntingtonBeach) said that lawmakers should not

enact any reforms that go beyond the federal overhaul because arecent budget plan signed by Brown reduces state spending byhundreds of millions of dollars (Santa Cruz Sentinel, 6/28).

In addition, James Hay, president of the California MedicalAssociation, said that while physicians support reform efforts,more must be done to address shortcomings in Medicare andMedi-Cal. He said that the reform law “builds... on the brokenfoundations of Medicare and Medicaid without addressing theunderlying problems and inadequate funding.”

Meanwhile, Patrick Johnston – president and CEO of theCalifornia Association of Health Plans – said the state must focuson addressing the “underlying cost drivers that are increasing thecost of care” (Herdt, Ventura County Star, 6/28).

Read more: www.californiahealthline.org/articles/2012/6/29/officials-california-to-continue-reform-efforts-following-ruling.aspx#ixzz2092h4f00

THREE COMPETING TAX MEASURES QUALIFYFOR NOVEMBER BALLOTThree tax measures have officially qualified for the Novemberballot, the Sacramento Bee reports.

The tax ballot measures include:• A compromise tax hike plan – developed by Gov. JerryBrown (D) and supporters of the “Millionaires Tax;”

• A tax increase proposal by attorney Molly Munger; and • A tax initiative by hedge fund manager Tom Steyer(Yamamura, Sacramento Bee, 6/21).

Details of Compromise Tax Hike PlanThe compromise tax hike plan would:• Increase the personal income tax by one percentage point forindividuals who earn $250,000 annually or couples who earn$500,000 annually and by two percentage points forindividuals who earn $300,000 annually or couples who earn$600,000 annually;

• Extend the income tax increases on wealthy residents fromfive to seven years; and

• Increase the sales tax by a quarter of a cent.The sales tax hike would expire in four years and would raise an

estimated $9 billion over the next fiscal year (California Healthline,6/11).

The compromise tax hike measure has been incorporated intoa fiscal year 2012-2013 budget plan currently being negotiated byBrown and Democratic legislators (California Healthline, 6/19).

Please see November Ballot on page 18


A I R Q U A L I T Y

Summertime is a great time to relish in the things that are Oh-So-All-American. You know, like baseball, fireworks, picnics,celebrating our independence, waving the American flag andflocking to the beach. This summer in particular is a great time tobe an American. Soon enough we’ll be rooting on our favoriteAmerican Olympic athletes.

As Americans, we take pride inthe great traditions that make uswho we are. We care about ourcountry and now more than ever,we seem to be caring more aboutour country’s resources. In trueAmerican form, most of us will becranking our air conditioners thissummer, especially here in theCentral Valley. I’m guessing,though, that most of this energywill not be generated through aclean energy source.

Americans are quite concernedabout energy and there arenumbers to prove it, according tothe recent results of a surveyreleased June 7 by the Associated Press – NORC Center forPublic Affairs Research. In fact, 78 percent of people surveyed, amajority of whom were homeowners, said that the issue of energyis important to them. Many believe that the nation’s energyproblems are a result of Americans not supporting clean energysources like wind and solar.

This survey makes me wonder. Is there really not enoughsupport for clean energy sources? I think when you get right downto it most people are in support of clean energy. I’ve never seenprotestors with signs screaming “Dirty Energy Now” or “Downwith a Clean Environment.” Perhaps the problem instead is thatthere simply are so many myths circulating about clean energysources that your average American, my neighbor and yours,don’t even give them a second thought.

Support for Clean Energy: SolarTom Cotter

Regional Sales Manager, Real Goods Solar

I work in the energy industry – solar to be specific – so I’veheard nearly every urban legend about clean energy that’s beenpassed along, kind of like a bad game of telephone. You’veprobably heard them, too. At the risk of perpetuating them, I’lllist a few myths about solar here: Solar is too expensive; Youshouldn’t go solar if you’re planning to move; Solar panels willincrease property taxes and home insurance rates. I could go on,but these myths are like nails on a chalkboard to me and they areall just that – myths.

The fact of the matter is that a clean energy source like solaris within nearly every homeowner’s reach. There are manyprograms in the solar industry that help people install solarpanels on their homes with next to nothing down. According tothe Department of Energy, solar panels actually help homes sellfaster – a good thing in today’s saturated real estate market if youask me. In most states, solar panels also are exempt from propertytaxes, unlike other improvements like energy-draining pools.

These myths must be contributing to our energy crisis.Seventy-seven percent of respondents said they believe doingmore to save energy will help save money in the long run. Whatelse would keep them from actually taking the steps necessary tosave energy and to save money? Sixty-nine percent ofrespondents said they wanted to save money on energy costs,while 56 percent wanted to make sure their homes were energyefficient. So why aren’t they taking the steps to save energy?Misinformation is the answer.

From purple mountains majesty to amber waves of grain, mostAmericans want to do what’s right for the environment. Evenmore so, they want to make ends meet for their families. Bothcauses are important and necessary, but they are not mutuallyexclusive of the other.

THE FACT OF THE

MATTER IS THAT

A CLEAN ENERGY

SOURCE LIKE

SOLAR IS WITHIN

NEARLY EVERY

HOMEOWNER’S

REACH.


Fresno-Madera

Post Office Box 28337Fresno, CA 93729-8337

1040 E. Herndon Ave #101Fresno, CA 93720

559-224-4224Fax 559-224-0276

website: www.fmms.org

FMMS Officers

Sergio Ilic, MDPresident

Ranjit Rajpal, MDPresident Elect

Prahalad Jajodia, MDVice President

Stewart Mason, MDSecretary/Treasurer

Oscar Sablan, MDPast President

Board of GovernorsA.M. Aminian, MDHemant Dhingra, MD

Ujagger-Singh Dhillon, MDWilliam Ebbeling, MDBabak Eghbalieh, MDAhmad Emami, MDDavid Hadden, MDS. Nam Kim, MD

Constantine Michas, MDKhalid Rauf, MD

Rohit Sundrani, MDMohammad Sheikh, MD

CMA DelegatesFMMS President

A.M. Aminian, MDJohn Bonner, MDAdam Brant, MDMichael Gen, MDBrent Kane, MDKevin Luu, MD

Andre Minuth, MDRoydon Steinke, MDToussaint Streat, MD

CMA Alternate DelegatesFMMS President-electDon H. Gaede, MDPrahalad Jajodia, MDPeter T. Nassar, MDTrilok Puniani, MD

Dalpinder Sandu, MDSalma Simjee, MDSteven Stoltz, MDRajeev Verma, MD

CMA YPS DelegatePaul J. Grewall, MD

CMA YPS AlternateYuk-Yuen Leung, MD

CMA Trustee District VIVirgil Airola, MD

Staff:Sandi Palumbo

Executive Director

President’s Message

SERGIO D. ILIC, MD

ACA: THE GOOD AND THE BAD

Well, we have a decision. The Affordable Care Act (ACA) was upheld by the Supreme Court onThursday June 28, 2012. This decision has the country and the doctors divided. I also have mix feelingsabout the whole reform.

Let’s examine what I see as positive and negative about the law.First of all, there’s the mandate for all of us to have insurance. I feel this is needed if reform is to work.

Without it, there is not a large enough base to cover everyone. Remember, in the 90’s Washington statepassed a law that required the insurance companies to insure everyone regardless of their health condition,along with a mandate for everyone to purchase insurance. A couple of years later, the mandate wasrepealed. A few years after the repeal, health insurance companies stopped selling policies in the state. Sothe mandate is absolutely necessary for reform to work.

I believe it’s good that young people up to age 26 can stay on their parent’s policy, and insurancecompanies cannot deny coverage for preexisting conditions, cannot terminate your policy if you have amajor or catastrophic event and limits increasing premiums due to age. It’s also good that the insured don’thave a co pay for preventive health care visits, and the doughnut hole payments that seniors frequentlyincur, will close. But most important, reform will provide a mechanism for up to 49 million uninsuredAmericans to get coverage through expansion of Medicaid to cover people up to 133% of the poverty line,amongst other things.

Now, what I don’t like about the ACA. There are many things, but the most important is that thereis no adequate funding to pay for all these people that will be seeking medical care. Medicaid paymentrates are very low and do not cover the expenses of seeing that patient in a private office. The fees to thedifferent providers need to go up. (In addition, don’t forget that because of the SGR system, we are dueto have a 32% payment cut in Medicare the first of the year).

Furthermore, will there be enough providers to take care of all these newly insured people? Especiallyhere in the Valley, we already have a shortage of PCP’s and to a lesser extent of specialists. But thiscertainly is not an excuse to leave people without insurance. We are already hearing that the legislaturewants to empower NPs and PAs to be able to do more by enlarging their scope of practice.

And then we have the ACO’s (Accountable Care Organizations). Basically, these are large groupsbeing formed that include hospitals, doctors, health insurance companies and patients. There are majorproblems I foresee with an ACO. Who is going to control it, and how will the pool of money be divided?Who or what group of doctors will be asked to join? How are the excluded doctors going to survivefinancially speaking, and what is going to happen to doctors that over utilize the system? Are they goingto be penalized, kicked out or be obligated to practice medicine according to certain guidelines etc.?

For example, we all know that a joint replacement ideally should be performed in patients that are over65 years old. But what about the athlete or the trauma patient that develops severe OA at an earlier age?Will that patient have to wait 10 years to have it done?

Remember the idea behind reform is to lower the cost of medical care, which overall is approaching17% of the GNP and make it affordable for everyone. It seems to me that the two goals are incompatibleunless we go into a national health care system in which all the doctors are on a salary, and there is nofinancial incentive to provide services. Medical care would be rationed, making patients wait aninordinate amount of time before they receive non-emergency care.

Socialized medical care is not necessarily better. It has multiple inherent problems, and I personally donot agree that is the best approach or solution.

The ACA provides no provisions to deal with the malpractice crisis affecting many states that haveincreased medical costs because of doctors practicing defensive medicine. I don’t like the creation of anIndependent Medicare Payment Advisory Board (IPAB) which is unaccountable and will have the powerto mandate spending cuts, limit treatment options and force physicians out of the program if they arenoncompliant with guidelines.

I feel the law intends well. There are good parts to it but it needs a lot of tweaking and improving. TheAmerican people should be explained to very clearly what the implications are and the unintendedconsequences of the law. Perhaps after that there should be a national dialog about how to proceed.


Fresno-Madera

2012 Educational Seriesfor FMMS MembersAs a member benefit, a series of Financial Education seminarswill be repeated to FMMS members and their guests during themonths of August, September, October and November. In orderto allow members attendance flexibility, the seminars will berepeated twice each month – the last Wednesday and Thursdayevenings at 6 pm.August 29 & 30, 2012: “Investment Basics” presented by Eric Van Valkenburg, CLU, CHFC and Amy Nuttall-Zwaan, CRPC, CSNA, Financial Consultants with Central ValleyPhysician Benefits.

Presentation will include:• Investment fundamentals, effects of inflation andcompounding

• Understanding risk tolerance• The relationship between risk and reward• Understanding different types of investments and theadvantages and disadvantages of each

• Developing an investment strategy and allocation ofinvestments in line with your objectives

• Challenges facing investors todaySeminars will be held at the Medical Society offices, 1040 E.

Herndon Ave. #101. (NE corner of First/Herndon) Space islimited, so please reserve your spot as soon as possible bycontacting the Medical Society at 559-224-4224, ext. 118 or [email protected]. A light meal will be available.

Future topics: • September 26 & 27, 2012: Estate Planning Basics• October 24 & 25, 2012: Financial Planning Basics• November 28 & 29, 2012: Understanding Society SecurityBenefits

Eric Van Valkenburg and Amy Nuttall-Zwaan are RegisteredRepresentatives with and securities offered through LPL Financial.Member FINRA/SIPC.

COOPER COLLINS, MD61-year member

Cooper Collins, MD, a retired general surgeon, passedaway May 22, 2012 at the age of 93.

Dr. Collins was born in Long Beach in 1918. Hereceived his medical degree from Stanford UniversitySchool of Medicine in 1944, completed his internship atthe U.S. Navy Veterans Hospital in San Francisco andresidency at St. Francis Hospital in San Francisco. AfterWWII, Dr. Collins established his medical practice inFresno. He served as president of the Fresno-MaderaMedical Society in 1965 and retired in 2006.

Dr. Collins is survived by three children, three grand -children, six step children and ten step-grandchildren.

Educational Program Offered:Differential Diagnosisof Pulmonary Nodules

Evaluate and order appropriate diagnostic work-upsfor early detection and diagnosis of pulmonary nodules andknow when to refer

Michael Peterson, MDChief of Medicine, UCSF Fresno

Pulmonary Disease and Critical Care

1 hr, CME credit

Wednesday, August 22, 2012 • 6-7:30 pmFMMS offices

1040 E. Herndon Ave. #101RSVP to: 559-224-4224, ext. 118 or [email protected]

Attention:FMMS PHYSICIANS

Make sure your Medical Manager and/orMedical Office Staff

is a part of the Medical Society’s

MEDICAL MANAGER’S FORUMNETWORK GROUP

The FMMS Medical Managers Forum providesresources, education and networking opportunitiesdesigned to enhance the knowledge of office staffrelated to ever-changing issues impacting practicemanagement, human resources, billing and coding,etc.

Office staff may register by providing:Name, Title/Position, Physician’s Office, Email

Address, Telephone

To sign them up, all it takes is acurrent and active email address!

ContactSHERYL TATARIAN

[email protected]


PO Box 1029Hanford, CA 93230

559-582-0310Fax 559-582-3581

KCMS Officers

Theresa P. Poindexter, MDPresident

Jeffrey W. Csiszar, MDPresident-elect

Mario Deguchi, MDSecretary Treasurer

Mario Deguchi, MDPast President

Board of DirectorsBradley Beard, MDJames E. Dean, MDLaura Howard, MDYing-Chien Lee, MD

Bo Lundy, MDMichael MacLein, MD

Kenny Mai, MD

CMA Delegates:Jeffrey W. Csiszar, MD

Thomas S. Enloe, Jr., MDTheresa P. Poindexter, MD

CMA Alternate Delegates:Laura L. Howard, MD

Staff:Marilyn Rush

Executive Secretary

Kern Kings

2229 Q StreetBakersfield, CA 93301-2900

661-325-9025Fax 661-328-9372

website: www.kms.org

KCMS Officers

Joel R. Cohen, MDPresident

Wilbur Suesberry, MD President-elect

Noel Del Mundo, MDSecretary

Ronald L. Morton, MDTreasurer

Portia S. Choi, MD Immediate Past President

Board of DirectorsAlpha Anders, MDBrad Anderson, MD

Eric Boren, MDLawrence Cosner, MD

John Digges, MDJ. Michael Hewitt, MD

Calvin Kubo, MDMelissa Larsen, MDMark Nystrom, MDEdward Taylor, MD

CMA Delegates:Jennifer Abraham, MD

Eric Boren, MDJohn Digges, MD

Ronald Morton, MD

CMA Alternate Delegates:Lawrence Cosner, Jr., MD

Patrick Leung, MDMichelle Quiogue, MD

Staff:Sandi Palumbo,

Executive Director

Kathy L. HughesMembership Secretary

Nominations Now BeingAccepted for KCMS OutstandingContribution AwardsKCMS is seeking nominations for its Outstanding ContributionAward(s) to be presented at the Award’s Banquet Dinner this Fall.

The Award categories are as follows:

• Outstanding Contribution to the Medical Society – Presentedto a KCMS Member who has exhibited tireless dedication andservice to the Medical Society.

• Outstanding Contribution to the Community – Presented to aKCMS Member who has participated in one or morecommunity activities and/or whose work has benefited thecommunity.

• Outstanding Contribution to Medicine – Presented to aKCMS Member who has donated his/her services and effortstowards the advancement of medicine.

When submitting your nomination, please attach a briefdescription for your selection. Nominations

Are accepted via email at [email protected] or by fax 661-328-9372). Deadline for submission is Friday, August 10, 2012.

JUNE 2012Active ..........................................................................................246Resident Active Members...............................................................2Active/65+/1-20hr...........................................................................5Active/Hship/1/2 Hship ..................................................................0Government Employed ...................................................................7Multiple memberships .....................................................................1Retired ...........................................................................................61Total ............................................................................................322New members, pending dues...........................................................0New members, pending application................................................0Total Members ...........................................................................322

Membership Recap


3333 S. FairwayVisalia, CA 93277

559-627-2262Fax 559-734-0431

website: www.tcmsonline.org

TCMS OfficersGaurang Pandya, MD

President

Steve Cantrell, MDPresident-elect

Thomas Gray, MDSecretary/Treasurer

Steve Carstens, DOImmediate Past President

Board of DirectorsVirinder Bhardwaj, MDCarlos Dominguez, MD

Parul Gupta, MDMonica Manga, MD

Christopher Rodarte, MDH. Charles Wolf, MD

CMA Delegates:Thomas Daglish, MDRoger Haley, MD

John Hipskind, MD

CMA Alternate Delegates:Robert Allen, MD

Ralph Kingsford, MD Mark Tetz, MD

Sixth District CMA TrusteeJames Foxe, MD

Sixth District CMA AlternateThomas Daglish, MD

Staff:Steve M. BeargeonExecutive Director

Francine HipskindProvider Relations

Gail LockePhysician Advocate

Thelma YearyExecutive Assistant

Tulare

WE WILL MISS YOU GAIL

A little more than four years ago the Tulare County Medical Society and Foundation for MedicalCare Boards of Directors decided to co-fund a position focused on helping physicians traverse themyriad of day-to-day operational issues they routinely faced. They believed that if there was a pointperson that was a single point of contact for physicians and their office staff to contact and haveprompt and accurate response, hassle would be reduced.

Gail Locke expressed interest in the concept and became our first Physician’s Advocate. Gailworked tirelessly to expand her knowledge and avail herself to the local physicians. Their problemsbecame her concern and she reached out to experts at the California Medical Association,American Medical Association and educated herself on the issues and responded with accurateinformation in friendly and helpful manner. She quickly became a resource that countlessphysicians relied upon and accessed.

Under Gail’s leadership, the educational seminars offered locally grew in attendance andrelevance. Often it was necessary to offer multiple sessions of a seminar because the sign-upsexceeded the capacity of the meeting space. Our annual holiday event grew from 100 attendees toclose to two hundred in recent years. Gail’s attention to detail and desire to the event memorablemade it a night everyone appreciated.

Unfortunately, Gail will be moving to Chicago with her spouse, Steve. Steve accepted apromotion from his employer. As CEO, I have been blessed with many talented staff members. Gailstands tall as one who excelled in their job. Her shoes will be hard to fill as she set the barincredibly high.

On behalf of local organized medicine, thank you Gail and good luck in your future endeavors.

Executive Director’s Message

STEVE M. BEARGEON EXECUTIVE DIRECTOR

SAVE THE DATE!Tulare County Medical Society

“Family Day 2012”at Adventure Park, Visalia

Sunday, September 2311 am-3 pm

Buffet lunch

Bumper Boats

Miniature Golf

Family Race Track

Arcade Games and

Laser Tag, too!

Please Plan to Join Us!(Invitations will be mailed soon)


Tulare


Classifieds

MEDICAL OFFICES

Gar McIndoe (661) 631-3808David Williams (661) 631-3816Jason Alexander (661) 631-3818

FOR LEASE2701 16th St. – 2,400

2031 17th Street – 1,776 sf.4817 Centennial Plaza Way – 2,370 rsf.Crown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.3115 Latte Lane – 2,660-2,925 sf.

Meridian Professional Center – 1,740-9,260 rsf.2204 “Q” Street – 2,894 rsf.

3941 San Dimas Street – 3,959 rsf.4040 San Dimas St. – 2,035 rsf.

9300 Stockdale Hwy. – 3,743 - 5,378 rsf.9330 Stockdale Hwy. – 1,500-7,700 rsf.

SUB-LEASE4100 Truxtun Ave. – Can Be Split

Medical Records & OfficesSprinklered – 4,764 usf.

Adm. & Billing – 6,613 rsf.FOR SALE

Crown Pointe Phase II – 2,000-9,277 rsf.Meridian Professional Center – 1,740-9,260 rsf.

9900 Stockdale Hwy. – 2,000-6,000 rsf.

Naeem Akhtar, MD, Ambreen Khurshid,MD and Mikhail Alper, PA-C at CaliforniaGastroenterology Associates arepleased to welcome Carlos C. Hernandez,MD to their practice. For appts. Call 559-299-9395Christine Lopopolo, MD announces herboutique obstetrics and gynecology prac-tice in Fresno. Accepting new patients. Call559-261-9320.University Psychiatry Clinic: A slidingfee scale clinic operated by the UCSFFresno Dept. of Psychiatry at CRMC M-F8am-5 pm. Call 559-320-0580.

Medical office space. 850-3,500 sf atValley Medical Plaza at Herndon, nearSAMC. Rates starting at $1 sf, no triple net.Tenant improvements available. Call Brianat 559-281-15001,650 sf medical office space in Madera onYosemite Ave. Call Dr. T. Nassar at 559-674-0917Medical office space 1,000 sf up to 2500sf at First & Herndon and First & Bullard,starting at $1psf++ by owner. Call 559-449-7668 or 559-284-2625.

ANNOUNCEMENT

FOR RENT / LEASE

MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words.NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30.*Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word.Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

3,400 sq.ft. spaceSuitable for a Physical Therapy or

Individual practice; may be divided & remodeled to suit

Excellent parking andclose to St. Agnes Medical Center

Carl Abercrombie559-227-4658

c: 559-970-9035Jim Abercrombie

530-626-0321

Professional/Medical Office for LeaseCambridge Court

6335 N. Fresno Street, Fresno

NEWLYREMODELED1,200sq.ft. officewith fiveexam rooms

FRESNO/MADERA

TULARE

KERN

5 rm. office space, 1 mile off Hwy 99 in SWBakersfield in 112,000 sf. neighborhoodcenter anchored by InShape City Fitness.Underserved area in need of healthcareprofessionals. Other spaces available. CallBalmeet at 661-717-8383.

Cardiology practice in Bakersfield closingSept. 15. All office furnishing, supplies andequipment for sale. Call for specifics andarrangement: 661-323-5976.

FOR RENT / LEASE

FOR SALE

1,800 sf. medical space in Porterville inprime location w/ ample parking. AvailableFT or PT, brand new, 5 private exam rms.Contact Casey, 559-784-4925.

FT opening for MD in busy practice inVisalia. Offering full benefit package andmore. Contact Rhonda: 559-627-2333 [email protected].

PHYSICIAN/PROVIDED WANTED

FOR RENT / LEASE

Details of Munger’s Tax Hike ProposalMunger’s tax hike proposal, called “Our

Children, Our Future,” aims to raiseincome tax for all residents, with highestearners seeing the largest hike. Most of therevenue would support education programs(California Healthline, 6/11).Details of Steyer’s Plan

Steyer’s plan would raise about $1billion annually by changing California’scorporate tax formula (Sacramento Bee,6/21). About half of the funds would go toCalifornia’s general fund (Adler, “KXJZNews,” Capital Public Radio, 6/20).Read more: www.californiahealthline.org/articles/2012/6/21/three-competing-tax-me a s u r e s - q u a l i f y - f o r - n o v embe r-ballot.aspx#ixzz2096QtWvP

November Ballot

Continued from page 11

they become ill or injured. We will beaggressive in pursuing appropriatepayment reforms so that you can sustainyour practice. We will continue to bevigilant in fighting to protect us and ourpatients from any government or privateinsurance intrusion into the doctor-patient relationship.

CMA will keep you updated on ACAimplementation issues, such as the stateHealth Benefit Exchange and health caredelivery innovations, and their impact onour practices. Physician involvement in itsimplementation is crucial to a successfulhealth care system.

CMA News

Continued from page 7

800.616.8759 www.myltcplan.com/fmms.

Long-Term CareResourcesFMMS, KCMS and TCMS are pleased that members have access to an interactive and educational Long-Term Care evaluation tool to help you make the best decisions for your specific situation. To learn more, visit: www.myltcplan.com/fmms.

Let us help find the right Long-Tplan for you, so you can spend time on things thatmatter the most

ing longer these daeople are livP

er d the right Long-T Term Carplan for you, so you can spend time on things that

.matter the most

ys, but as life expectanc ger these da ays, but as life expectanc

ane insurerm Car me on things tha

ies increase, so doesys, but as life expectanc

g ,

g

ing longer these daeople are livP

the risk of serious health problems that c

at retirement age, 70%

enter a nursing home

ost most or all of your lifec

erm Care insurancong-TTerm Care insurancL

osts, insuranchealthcare c

g

ys, but as life expectanc ger these da ays, but as life expectanc

ould require long-term care. In fact,the risk of serious health problems that c

ill need long-term care and 40% w % of Americans w

e.1 ost for nursing home care in average cith the a v And w

.ingsvs sa’’s saost most or all of your life 2

yone. But we for every not be maerm Care insuranc

e restrictions and the need to stretch retirementosts, insuranc

g

ies increase, so doesys, but as life expectanc

re long-term care. In fact,

g-term care and 40% w

or nursing home care in a

ould literally

ith soaringyone. But w

eed to stretch retirement

ings through more years . . . itvsa

overage while recvaluable c

e abo learn morTTo learn morers can help prmemb

cost of long-term car

s a good idea to ’’s a good idea to seriously cings through more years . . . it

er premium discing a membeivoverage while rec

S, KCMMout how Fe abotect their assets frers can help pre, call us or go online todacost of long-term car

onsider thiss a good idea to seriously c

.ounter premium disc

SMCS and TMom the risingotect their assets fr

.ye, call us or go online toda

1Department of Health and Human Services, National Clearinghouse for Long-T2Genworth 2010 Cost of Care Survey

erm Care Resources The Long-T Term Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in a

CA Ins. Lic. #0633005, AR Ins. Lic. #245544, d/b/a in CA Seabury & Smith Insurance Program Manage58458 (8/12) ©Seabury & Smith, Inc. 2012

Call 616.8759.008

Department of Health and Human Services, National Clearinghouse for Long-T.genworth.com/content/genworth/us/en/products/long_term_care/long_term_care/cost_of_care.html. , April 2010, www urvey ,

erm Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in a

CA Ins. Lic. #0633005, AR Ins. Lic. #245544, d/b/a in CA Seabury & Smith Insurance Program Manage58458 (8/12) ©Seabury & Smith, Inc. 2012

616.8759 sit or vi .myltcplan.com/fmms.www

erm Care Information, October 2008, www ng-T Term Care Information, October 2008, wwwent/genworth/us/en/products/lon

e United States. Coverage may v

44, d/b/a in CA Sea

.myltcplan.com/fmms.

VITAL SIGNSPost Office Box 28337Fresno, California 93729-8337

HAVE YOU MOVED?Please notify your medical society ofyour new address and phone number.

PRSRT STDU.S. Postage PAIDFresno, CAPermit No. 30

CALL 1-800-652-1051 OR VISIT NORCALMUTUAL.COMProud to be endorsed by the Fresno-Madera Medical Society and the Kern, Kings and Tulare County Medical Societies

Our numbers add up to great claims support for your practice.

* Physicians Insurers Association of America Risk Management Review: 2011 Edition. **Jena et al. Research Letter, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Archives of Internal Medicine. May 14, 2012.

88 NO INDEMNITY

REGIONAL CLAIMSOFFICES

YEARS “A” RATED BY A.M. BEST29

TRIALS

86

At NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed





Our numbers add up to gr

we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.you manage events so they don’t become claims, and, to back up our promise to stand by you, stage of litigation and kept fully informed

W* of 71%.in 2011, 88% were closed without settlements or jurAt NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed

**Jena et al. Research LetterPhysicians Insurers Association of America Risk Management Review: 2011 Edition.*

eat claims support for your practice.Our numbers add up to gr

we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.you manage events so they don’t become claims, and, to back up our promise to stand by you, stage of litigation and kept fully informed

our trials, compared e won 86% of Win 2011, 88% were closed without settlements or jurAt NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed

, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. **Jena et al. Research LetterPhysicians Insurers Association of America Risk Management Review: 2011 Edition.

eat claims support for your practice.

we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.you manage events so they don’t become claims, and, to back up our promise to stand by you,

and we don’t settle without your consent. W— stage of litigation and kept fully informed y-wide.industrto 80% our trials, compared

y awards, compared to an industrin 2011, 88% were closed without settlements or jurAt NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed

, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Physicians Insurers Association of America Risk Management Review: 2011 Edition.

eat claims support for your practice.


e helpand we don’t settle without your consent. Weach ou’re prepared for YYou’re prepared for ** y-wide.

y averagey awards, compared to an industrAt NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed

. May 14, 2012.nal MedicineArchives of Inter rnal Medicine, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians.


e helpeach

y averageAt NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed

. May 14, 2012.

CALL

the KerPr

NSIT R VIO1 051--800-6521CALL

e County Medical Societiesularn, Kings and T Tularthe Keresno-Madera Medical Society andoud to be endorsed by the FrPr

OMCALMUTUAL.CRON

e County Medical Societiesesno-Madera Medical Society and

your practiceOur passion protects

Documents

Vital Signs August 2012