BG9084-CANO-May 2010:Layout 1.qxd - American College of ...

Governor’s Newsletter
May 2010 George W. Meyer, MD, FACP, Governor
Governor’s Message
Ihave just returned from a very exciting Internal
Medicine 2010 in Toronto, Canada. The weather
could not have been better. More people registered
for this meeting than last year in Philadelphia—more
than 8,000 attendees!
The CANO (California North) Chapter proposed four of the 18 resolutions
considered at the Board of Governors meeting. Three were
approved in one form or another.
1) The State Health Policy Networking Session had been held each year
at the annual meeting; the resolution accepted that this is an important
advocacy forum and that webinars and a face-to-face get
together at Leadership Day in D.C. annually might be helpful.
Northern California Chapter
In This Issue
Governor’s Message .....................1
Congratulations to Our
New Masters! ............................3
Congratulations New Fellows.........4
CANO Annual Meeting 2010 ..........7
AAJ Continues its Efforts to
Repeal MICRA..........................10
Obituaires .................................11
Did You Know?...........................12
Preceptors Needed.....................13
CANO Committee Activity............13
2) The governors unanimously approved a resolution decrying ABIM’s
increase in license fees for using their SEPs in preparation for Board
recertification. The ACP has been requested to develop programs that can be offered at Chapter
meetings in place of the SEPs.
3) The governors agreed to refer a CANO resolution concerning addiction medicine for study. The ACP is
encouraged to expand educational efforts concerning addiction medicine and identify the American
Society of Addiction Medicine as a resource for such educational development.
4) Other resolutions approved included one to reassess the ACP’s governance structure; review the relationship
ACP has with PriMed; work with the FDA to ensure the content and purity of dietary supplements;
assist the membership with Recovery Audit Contractor (RAC) audits; organize panels to assess
costly (and unnecessary) diagnostic and therapeutic strategies in adult medicine.
We also had several talks and discussion about the ACP stand on the most recent Health
Care bill. ACP was very involved behind the scenes and was invited to the signing of the bill by the
President. Clearly there were portions of the bill that we did not agree with. But we did achieve coverage
for more Americans; we did eliminate the ability of insurers to refuse insurance to those with prior
health issues; we did get a stimulus for young physicians to enter primary care; and we did get more
recognition of the Patient Centered Medical Home.
The SGR was never part of this bill and is being dealt with separately (ACP continues to fight for
PERMANENT repeal of the SGR). We did not get malpractice reform and we plan to continue to advocate
for the same kind of protection that our MICRA affords (see below for some comments from the trial
lawyers).
We had an outstanding group of residents representing us at the meeting in Toronto. Since the winning
Jeopardy team from UCSF was unable to attend the Toronto meeting, a combined team from the
two runners-up (California Pacific and Kaiser Oakland) participated. (Thanks to Alex Krassner from
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Kaiser and Robert Wong and Matt Reimert from CPMC). We had several posters in competition during
the meeting (see photos below). If I missed a poster it was because I had meeting conflicts during
the poster competitions; I missed the Jeopardy competition for the same reason.
Unfortunately, I was unable to attend many educational sessions but one pearl I came away with
that is important for internists and those of us subspecializing in GI and Cardiology is that of the interaction
of PPI’s and Plavix. One presentation suggested that the data that have come out since the initial
publication do not support the allegation that PPI’s inhibit the effect of Plavix enough to discontinue
the PPI: it has been suggested, however, that pantoprazole may have less of an effect than the others.
We had four of our Chapter members honored with advancement to MACP (see below for
their brief bios); although we had more than 40 new FACP’s this year most are waiting to participate in
the annual meeting next year in San Diego (April 7-9, 2011).
Thanks to those of you who sent in a supplement to your dues last year. It helped keep
the cost of the annual meeting down so we did not have to charge our members to attend. This year
we are asking the supplement to go to recruitment efforts, particularly for those in transition to practice.
There will be a reception and wine tasting in Oakland in early June for members.
Finally, I would like to invite you all to the CANO annual meeting in San Francisco at
the Parc 55 Hotel on 19-21 November 2010. This year the Chapter is running our meeting in conjunction
with the California Chapter of the Society of General Internal Medicine (SGIM). There will be a
nominal charge of $100 for members of the CANO Chapter since that is the cost the SGIM Chapter
charges for its meeting. If you register you will have access to both meetings. Our program committee
(see below) led by Suzanne Meyer, FACP, and Margaret Fang, FACP, promises an exciting meeting
focused on women’s health and some of the new controversies over such topics as breast cancer
and cervical cancer screening. On Friday we will, once again, run a preparation for Board review;
Kelley Skeff will do a reprise of his “Teaching Teachers to Teach” for Chief Residents and Chief
Residents-elect; and Steve Roey will again offer his LEADership introduction on Friday afternoon. See
below for more information.
MY GOALS AS GOVERNOR
When I became governor and even before I set some goals for my four- year term. Here is my
assessment of progress the first year:
1. Visit a different area each month each year: In 2009 I have visited the following residency programs:
Stanford, UCD, Kaiser Oakland, Kaiser Santa Clara, and Kaiser San Francisco. I have also visited St
Mary’s, CPMC, San Joaquin, and UCSF in Fresno.
I have visited Fresno, Eureka, Redding, and Jackson, and I am hoping to get to Monterey and Santa
Cruz this summer
2. Give an annual meeting without pharmaceutical support: We have continued to do this for the past
four years.
3. Get California to pass a bill covering retired volunteer physicians for medical malpractice: This past
January the Medical Board had a conference on this topic. There is currently a bill pending – SB 1031
(Corbett) Volunteer Insured Physician (VIP) Program
4. Clean up the membership list: an ongoing struggle
5. Get e-mail addresses for members: an ongoing struggle; we are still 1000 members short of capturing
all e-mail addresses (4700 total).
6. Encourage different residency programs to lead the CANO annual meetings: perhaps not a good
goal?
7. Try to have meetings in different locations to increase participation: Held the 2009 meeting in
Sacramento which was well attended. Exploring other locations including Palo Alto, Monterey and

Fresno – opinions? suggestions?
8. Increase participation by residents: by giving the meeting with the California Chapter of Society for
General Internal Medicine in 2010 we are improving.
9. Work on the Northern California website: still to do
Congratulations to Our New Masters!
M. Eric Gershwin
Dr Gershwin is Distinguished Professor of Medicine in the Division of Rheumatology/Allergy and
Clinical Immunology, University of California at Davis. He is also the Jack and Donald Chia Professsor of
Medicine, Chief of the Division and Director of the Allergy-Clinical Immunology Program. He is considered
an outstanding clinical investigator whose research has significantly advanced understanding of
the autoimmune disease primary biliary cirrhosis and greatly improved quality and standards for
patients with this disorder. He has published over 50 books and monographs, over 700 experimental
papers, and several hundred other shorter contributions to the medical literature, and he has 10
patents. Dr. Gershwin holds lead editorial roles in three allergy/immunology journals and won the
AESKU prize given by AESKU DIAGNOSTICS for a lifetime contribution in autoimmunity. He received an
honorary doctorate from the University of Athens for a lifetime contribution in immunology. He has
been an ACP advisor on alternative care in immunology and has lectured at Northern California at
Northern California Chapter meetings
Ralph I. Horwitz
Dr Horwitz is Chair of the Department of Medicine at Stanford University. Previously he held positions
of Dean of the School of Medicine at Case Western Reserve University and Chair of the
Department of Internal Medicine at Yale University. He is known for his clinical research enhancing the
understanding of the "evidence" in evidence-based medicine and his commitment to excellence in general
clinical medicine. He was co-director of the Robert Wood Johnson Clinical Scholars Program for 25
years; served as Chairman of the Board of Internal Medicine where he negotiated agreement with ACP
on key issues; and sat on committees or advisory boards for the Institute of Medicine, the Association
of Professors of Medicine, and the National Institutes of Health. Dr. Horwitz has had extensive grant
support relating to integrating health care quality principles into medical education and has published
over 180 peer-reviewed articles, some in the Annals of Internal Medicine, and nearly 150 other publications.
He worked with several ACP governors to enhance ACP's presence at Yale University.
Talmadge E. King, Jr
Dr King is Chair of the Department of Medicine and Julius R. Krevans Distinguished Professor in
Internal Medicine at University of California San Francisco. Past positions include Chief of Medical
Services, San Francisco General Hospital, and Executive Vice President for Clinical Affairs, National
Jewish Center for Immunology and Respiratory Medicine. Dr. King has published more than 130 peerreviewed
papers, contributed to or authored numerous textbooks and other publications, and served on
several editorial boards, including Annals of Internal Medicine. He has received numerous honors and
awards, including the Trudeau Medal, the highest honor of the American Thoracic Society; and election
to the Institute of Medicine and the Association of American Physicians. He has served as President of
the American Thoracic Society and on the Executive Committee of the American Board of Internal
Medicine. In addition to his work with Annals of Internal Medicine, he served on the MKSAP Pulmonary
and Critical Care Medicine Subcommittee.
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Neil R. Powe:
Dr Powe is Chief of the Medical Service at San Francisco General Hospital, the Constance B. Wofsy
Distinguished Professor, and Vice Chair of Medicine at the University of California San Francisco. Dr
Powe has published over 300 manuscripts involving clinical epidemiology, health services research, and
patient outcomes research, particularly in chronic kidney disease. Dr. Powe was Chair of the National
Advisory Committee for Healthcare Research and Quality. He received the Garabed Eknoyan Award
from the National Kidney Foundation, the John M. Eisenberg National Award for Career Achievement in
Research from the Society of General Internal Medicine, and the Distinguished Educator Award from
the Association for Clinical Research Training. Prior to joining UCSF, Dr. Powe served as the James Fries
University Distinguished Professor of Medicine and Director of the Welch Center at Johns Hopkins
University. Dr. Powe served as a representative to the American Medical Association for ACP from 1994-
1997.
Congratulations New Fellows!
Arlina Ahluwalia, MD, FACP, Menlo Park
Neera Ahuja, MD, FACP, Stanford
Kyaw Aung, MD, FACP, Vacaville
Nathan M. Bass, MD, FACP, San Francisco
James F. Baxter, MD, FACP, Menlo Park
Amerish B. Bera, MD, FACP, Elk Grove
Ingrid J. Block-Kurbisch, MD, FACP, San Francisco
Terry E. Hill, MD, FACP, Oakland
Ranjit S. Hundal, MBBS, FACP, Vallejo
Andrew Hwang, MD, FACP, Campbell
Catherine Bree Johnston, MD, FACP, San Francisco
Clarissa M. Johnston, MD, FACP, San Francisco
Jessica Keane, MD, FACP, San Rafael
Wendi A. Knapp, MD, FACP, Aptos
Nikheel S. Kolatkar, MD, FACP, San Francisco
Darin A. Latimore, MD, FACP, Fair Oaks
Benjamin P. Lee, MD FACP, Folsom
Eugene Lee, MD, FACP, San Francisco
Jenelyn C. Lim, MD, FACP, San Jose
John F. Macmillan, Jr., MD, FACP, Sacramento
Joseph L. Melendres, MD, FACP, Sacramento
John E. Moran, MD, FACP, Burlingame
Maung M. Myint, MD, FACP, Hercules
Meg D. Newman, MD, FACP, San Francisco
Mary G. Patton, MD, FACP, Oakland
Kwan C. Pun, MD FACP, Palo Alto

Eva S. Quiroz, MD, FACP, Fremont
Sumant R. Ranji, MD, FACP, San Francisco
Kristen A. Robinson, MD, FACP, Sacramento
Brigitte M. Schiller-Moran, MD, FACP, Palo Alto
Brian M. Sebastian, MD, FACP, Sonoma
Michelle Shute, MD, FACP, Berkeley
Neil A. Solomon, MD, FACP, Oakland
Sabine M. Steegers, MD, FACP, Oakland
Michael D. Stein, MD, FACP, Campbell
John Stoner, III MD, FACP, Menlo Park
Upasna M. Swift, MBBS, FACP, Alameda
Michael A. Tom, DO, FACP, Fresno
Mohiuddin Waseem, MBBS, FACP, Modesto
Ronald M. Witteles, MD, FACP, Los Altos
Brian Sebastian, Sandy Barbour, George Meyer, Jennifer Osborn, Pamela Prescott, Donald Kitt,
Shagufta Yasmeen, Mini Swift
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CANO Associates do well at national competition
Helen Chow, MD
Finalists: Clinical Vignettes
Adelaida C. Alfiler MD
Abeer W Kaldas, MBBCh Elizabeth Penumaka, MD, Garmen A. Woo, MD
Rosalio Rubio, MD Anna Maguire, MD
Finalists: Research
Omid Bakhtar, DO Nicole White, DO
Abeer Kaldas, Alameda County Medical Center
Ted Rose, Sabine Steegers, Nicole White, Mini Swift
Helen Chow and Sabine Steegers, Alameda County
Medical Center
Adelaida Alfiler and Sabine Steegers, Alameda
County Medical Center

Elizabeth Penumaka, Sabine Steegers, Abeer Kaldas, Kathy
Matikonis, George Meyer, Helen Chow, Adelaida Alfiler, Yolanda
Cuadros
Rosalio Rubio and Kathy Matikonis
Suzanne Meyer, MD FACP, graduated from UC Davis Medical School,
class of 1981. After an Internal Medicine Residency at Santa Clara Valley
Medical Center she spent six years in private practice of general internal
medicine in a rural community near Modesto and, since 1992, has been on
the teaching faculty for Stanislaus Family Practice Residency. She teaches
residents in the ICU and on the inpatient wards and has her own continuity
clinics through the county health system. She says it’s great work and she
highly recommends this as a career path for any internist who wants to
teach and live in a smaller community. She holds a faculty position at UC
Davis as a Clinical Professor. She and Dr. Fang are co-program directors for
the 2010 Northern California Chapter meeting in San Francisco on 19-21
November at the Parc 55 Hotel.
CANO Annual Meeting 2010
This year’s meeting is a joint effort of SGIM and
ACP CANO. The co-chairs stress the importance of
medical professional societies (including hospital
medicine!) to find shared interests and synergies;
our collaborative efforts can enrich the experience
of attendees.
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Margaret C. Fang, MD, MPH is an Assistant Professor of Medicine at
the University of California, San Francisco (UCSF) in the Division of Hospital
Medicine and Medical Director of the UCSF Anticoagulation Clinic. She is a
graduate of Northwestern University’s Feinberg School of Medicine, completed
residency training in internal medicine at the Beth Israel Deaconess
Medical Center, and subsequently obtained a Masters of Public Health at the
Harvard School of Public Health during a general medicine research fellowship
at the Massachusetts General Hospital. Dr. Fang devotes the majority of
her time to clinical research and hospital-based medicine, studying how to
optimize the use of anticoagulants in clinical care. She serves as a writing
member of the American College of Chest Physicians Guidelines on
Antithrombotic Therapy, an Assistant Editor of the Journal of Hospital
Medicine, and a Deputy Editor of the Journal of General Internal Medicine.
Dr. Fang has been actively involved in the American College of Physicians, the Society of General
Internal Medicine, and the Society of Hospital Medicine and is the current President-elect of the
California Society of General Internal Medicine.
NORTHERN CALIFORNIA CHAPTER ACP and
THE CALIFORNIA SOCIETY OF GENERAL INTERNAL MEDICINE
2010 ANNUAL MEETING
November 19-21
Friday, November 19
7 AM Registration/Continental Breakfast
8 AM – 10 AM Self-Evaluation Program (SEP) for Maintenance of Certification
9 AM – 4:30 PM Chief Residents’ Leadership Training
Kelley Skeff, MD, MACP
10:00 – Noon Self-Evaluation Program (SEP) for Maintenance of Certification
Noon Buffet Lunch
1 – 5 PM LEAD Program (Leadership Enhancement and Development)
Steven C. Roey, MD, FACP
1:30 – 3:30 PM Self-Evaluation Program (SEP) for Maintenance of Certification:
3:30 – 5:30 PM Self-Evaluation Program (SEP) for Maintenance of Certification:
Saturday, November 20
7 AM Registration/Continental Breakfast
7:55 – 8:05 AM Welcome
George W Meyer, MD, FACP, Governor, No. California Chapter ACP
Margaret Fang, MD, FACP, President-elect, SGIM

8:05 – 8:45 AM Keynote Address: Louise Walter, MD, FACP, screening guidelines in women,
particularly focusing on new mammography screening guidelines and
controversies.
8:45 - 9:15 AM Global Health Issues in Women: Ana Maria Lopez, MD, MPH, FACP,
Professor of Medicine and Pathology, Director Arizona Telemedicine
Program, University of Arizona
9:15 – 10:15 AM Updates in Women’s Health: Judith Walsh, MD, FACP (UCSF) and
Dr. Amparo Villablanca (UC Davis)
10:15 – 11 AM Break: Visit Exhibits
11 AM – Noon Concurrent sessions: Oral research presentations
CPMC Images in Medicine: Clinical Problem Solving
Paul Aronowitz, MD, FACP
12:15 PM Awards Luncheon
ACP Representative: Ana Maria Lopez, MD, MPH, FACP, Governor,
Arizona Chapter
SGIM Representative: Washington Update: Rich Trachtman, JD
2:30 PM Poster Viewing and Judging
Career Development session (to be organized by Terrie Mendelson, MD, FACP
St. Mary’s Medical Center
3:30 – 4 PM Break (Light snacks served)
4 – 6 PM Medical Jeopardy
R. Jeffrey Kohlwes, MD, FACP, Moderator
6:15 PM Welcoming Reception
Poster Winners Announced; Raffle Drawing (must be present to win)
Sunday, November 21
7 AM Registration/Continental Breakfast
8 AM Hands-on Skills Concurrent Workshops
Communication Skills Workshop: Charlie Goldberg, MD (current California
SGIM president), David Hatem, MD (University of Massachusetts) and
Preetha Basaviah, MD (Stanford)
Hand-held Ultrasound for the Internist: Elizabeth Kwan, MD (UCSF
Division of Emergency Medicine) and Michelle Mourad, MD, Associate
Member (UCSF Division of Hospital Medicine)
Practice Management: Coding for Success – Appropriate Documentation
Arthur N. Lurvey, MD, FACP, FACE
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9:30 – 10 AM Break
10 – 11 AM California Update and Chapter Business Meeting
George W Meyer, MD, FACP
State Legislative Update
Tom Riley, Legislative Consultant
10-11AM SGIM Business Meeting
11 AM – 12:30 PM Hand-held Ultrasound for the Internist: Elizabeth Kwan, MD and
Michelle Mourad, MD, Associate Member
Practice Management: Coding for Success: Responding to
Challenges//Fighting Back
Arthur Lurvey, MD, FACP, FACE
12:30 PM Adjourn
Please Note: There will be no printed meeting program or registration material mailed this year—
the program and registration information will be posted online by mid-June, so watch your email for the
announcement.
AAJ Continues its Efforts to Repeal MICRA
Below is a portion of a letter from the plaintiff trial lawyers, the American Association for Justice
(AAJ), formerly the Association of Trial Lawyers of America (ATLA): Please note that they are not going
to give up in trying to repeal MICRA. In order to fight this battle we need to maximize the number of
members in the ACP!!!
“Here are some of the highlights of AAJ’s efforts and the obstacles we overcame:
• In the House, AAJ defeated tort reform amendments that were offered in all three committees that
amended the original bill.
• As the House voted on the health care bill in October, AAJ defeated the GOP’s malpractice cap
“motion to recommit,” the only opportunity they had to kill the entire bill. Former AAJ Board Member,
Rep. Bruce Braley, deserves special recognition for speaking in opposition to the motion amidst a vitriolic
attack against trial lawyers.
• In the Senate, 28 tort reform amendments were defeated in the two committees that marked up the
bill.
• On the Senate floor, AAJ decisively defeated a cap on attorney’s fees by a bipartisan 32-66 vote. Many
of you spent the weekend emailing and calling your members of Congress.
• AAJ unveiled one of its largest media campaigns ever – 98000Reasons.org - to educate the public and
lawmakers about the 98,000 deaths that occur every year from preventable medical errors.
• In addition to print, radio and online advertising, AAJ bought all the billboard space in the Union
Station subway for the month of December, specifically targeting Senate staffers who use that station
for their daily commute.
• AAJ staff, officers, and members did hundreds of interviews and letters to the editor, reaching print
and broadcast outlets nationwide. Thousands of messages were sent to members of Congress
through AAJ’s grassroots portal.
You may also remember that back in September, President Obama called on the Department of
Health and Human Services to approve $25 million in planning grants and demonstration projects that
would reduce the number of medical errors and decrease liability costs. At this time, we are still waiting
to hear which planning grants and demonstration projects will receive a federal grant.

While AAJ was fighting tort reform in the halls of Congress, states were also waging their own battles.
In the last several months, with the help of the Center for Constitutional Litigation, caps in Illinois
and Georgia and Washington’s certificate of merit were declared unconstitutional – tremendous victories
for patients in those states. (to say nothing about Trial Lawyers, GM)
That health care has passed unfortunately does not mean our fight is over. Undoubtedly, lawmakers
will need to revisit health care in the months and years to come, and that may lead to future battles on
medical malpractice. We will remain vigilant and ensure the voices of patients (and Trial Lawyers, GM)
are heard.
Whether reading the newspaper or watching C-SPAN, all of you saw the constant assault against
trial lawyers and injured patients. Many opponents of these health care bills had no substantive solutions
of their own, and in turn, levied attacks on our clients. It was distressing, but at the same time, it
was our call-to-action. We knew that only AAJ could protect injured patients and ensure their rights
wouldn’t be used as bargaining chips as the debate moved forward.
That’s what we did, and it was a resounding success.
Please share this message with trial lawyers who are not AAJ members and encourage them to join
our ranks. We need the support of all who care about civil justice as we face the never-ending assault
on trial lawyers and the families we represent, while also working to expand the rights of consumers
and access to justice. With your support, AAJ will continue to protect your clients on Capitol Hill.”
OBITUARIES
Edgar Wayburn, a physician who joined the Sierra Club to take a burro trip and then went on to
become a major figure in the conservation movement, leading campaigns that preserved more than
100 million wild acres, died at age 103.
The Sierra Club called Dr. Wayburn “the 20th-century John Muir,” referring to its founder, who preserved
the Yosemite Valley. When President Bill Clinton awarded Dr. Wayburn the Presidential Medal
of Freedom in 1999, he said Dr. Wayburn had “saved more of our wilderness than any other person
alive.” “Legislators know that if Dr. Wayburn comes into your office, what might have been inconceivable
at the beginning of the conversation is inevitable by the end of it,” Representative Nancy
Pelosi told Sierra magazine in 1999. His case was as much moral as aesthetic. “In destroying wilderness,”
he wrote in his autobiography, “we deny ourselves the full extent of what it means to be alive.”
Dr. Wayburn had central roles in protecting 104 million acres of Alaskan wilderness; establishing
and enlarging Redwood National Park and Point Reyes National Seashore in California; and starting the
Golden Gate National Recreation Area in and around San Francisco.
His methods were the old-fashioned ones of writing letters, raising money, commenting on environmental
studies and attending public hearings. He was widely respected for the authority and persistence
he brought to lobbying public officials, always softly, with a courtly Georgia accent.
Dr. Wayburn helped transform the Sierra Club from the 3,000-member outing and skiing club he
joined in 1939 into a powerful force in environmentalism today with 730,000 members. He served five
one-year terms as president of the club in the 1960s and for many years was honorary president.
Dr. Wayburn was born in Macon, Ga., on Sept. 17, 1906, and grew up devouring nature books. His
mother was from San Francisco, and as a child he visited the city every summer. He graduated from the
University of Georgia at 19 and from Harvard Medical School at 23 before returning to California to
practice medicine. After wartime service in England as a doctor with the Army Air Forces, he returned
to San Francisco and was elected to the executive committee of the local Sierra Club chapter and
started its first conservation committee. As a physician who made house calls, Dr. Wayburn addressed
his environmental mission mainly in the evenings and on weekends and vacations, never accepting
remuneration.
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He practiced medicine for more than 50 years; taught at the medical schools of the University of
California and Stanford University and was president of the San Francisco Medical Society. His many
awards for conservation work included the Albert Schweitzer Prize for Humanitarianism in 1995.
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Bernard Silber, MD, of Atherton and Palo Alto, died March 20, 2010, at age 98. He practiced
Internal Medicine and Cardiology in Redwood City, and at Sequoia Hospital and Stanford University
Medical Center. In addition to being a dedicated physician, Bernard was an expert calligrapher, a student
of etymology and several languages--including Yiddish, his first language.
Bernard Silber was born in 1911 in Baltimore, Maryland. He attended Baltimore City College, the
University of Maryland, and the University of Chicago School of Medicine, 1936.
Dr. Silber completed five years of medical residency, beginning in Pathology and Radiology, and
finally focusing on Internal Medicine. During WWII Dr. Silber was a captain in the US Army, a Medical
Officer stationed at Guadalcanal in the Solomon Islands, in Hawaii, and at the 3000-bed Dibble Army
Hospital in Menlo Park.
After the war Dr. Silber, along with four medical colleagues from Dibble Hospital, opened the
Sequoia Medical Group in Redwood City. He continued to practice Internal Medicine and Cardiology
until his retirement 24 years ago. When asked what kind of physician he was, he always answered, "an
RD" – a real doctor. During his practice he frequently made medical house calls, and was beloved by his
many patients on the S. F. Peninsula.
As a physician he was an excellent diagnostician, and continued to keep abreast of the latest developments
in medicine throughout his five-decade career. Early on he became interested in the relationship
of diet, exercise, and smoking to heart disease, and preached a healthy lifestyle to all his patients.
Dr. Bernard Silber was an uncommonly generous man with his family and friends, and with the many
organizations he supported.
Did You Know?
9/11 Drill Down for Safety was created last year to improve readiness and resiliency, and lessen
the devastating impact of disasters on individuals, their communities, and the Nation. The goal is to
encourage individuals to conduct emergency drills at home, work and in their communities.
The Safe America Foundation has joined with corporate partners, community leaders, and government
agencies to be sure that Americans practice being prepared. In the inaugural event last
September, approximately 400,000 people participated and practiced what they would do in an emergency.
We all recognize the importance of being better prepared now, in order to be better able to
adapt to a hurricane, public health emergency, attack, or other situation as they arise.
This year, the organizers also seek to test the collective ability of Americans to simultaneously react
using telephone and wireless devices. So, as part of the initiative this year, Safe America is also encouraging
a national "texting drill." The goal is to have people make a quick ‘text’ to family members and
others who would be important for them to reach in an emergency. It is becoming better understood
that ‘texting’ may become the first form of communications in a disaster – replacing voice communications
(which may not be generally available).
Osteopathic Medical Board: Did you know that the State of California has a law that puts two
naturopathic physicians on the Osteopathic Medical Board? Sen. Leland Yee has offered a bill, SB 1050,
to correct this situation. This bill would exclude those naturopathic doctors from the membership of
the board, thereby reducing the licensee membership of the board to five osteopathic physicians and
surgeons. The bill would add two additional public members to the board and would require the Senate
Committee on Rules and the Speaker of the Assembly to each appoint one public member.

Volunteerism: Did you know that California is one of only 17 States that have no laws that protect
volunteer physicians from malpractice claims. In February 2008 Governor Schwarzenegger
announced the establishment of a new State cabinet position, Secretary of Service and Volunteering.
Current State law authorizes local government entities to provide insurance or indemnify volunteer
physicians at free clinics but it does NOT require them to do so. The County of Sacramento does provide
such coverage but other counties do not. In January 2010 the Medical Board of California had a
hearing to discuss this issue. Sen. Ellen Corbett has proposed S.B. 1031 which will fix the issue for
those of us who wish to practice as a volunteer but are no longer in practice as well as for those of us
in practice who want to give time to those not covered by health insurance.
Did you know that Amerish Bera, MD, FACP, Sacramento is running for Congress?
PRECEPTORS NEEDED
We have recently received a request from Dr Faroque Khan, MD, MACP who is now teaching in
Saudi Arabia. He wants some of their better medical students to come to the U.S. for preceptorships in
internal medicine offices. The university in Saudi Arabia will negotiate to reimburse you for your time.
Students would have their room and board covered by the program.
If you have any interest in working with what could be a continuing relationship please let me know
at geowmeyer1@earthlink.net. There may be a similar offer for IM residents.
CANO Committee Activity
The Finance Committee has had several virtual meetings over the past year. We have created proposed
guidelines for investments, arranged for an outside audit of the Chapter's financial situation, and
discussed numerous issues relating to dues, the regional meeting, and our financial relationship with
the national ACP.
The Program Directors’ Committee has met twice over the past year. Our primary focus has been
to explore ways to attract more Resident (Associate) members to the ACP, and have them remain active
after completing their Residency. We have also discussed the new RRC-IM regulations that took effect
July 1st, the challenge of work hours compliance, and ways to increase interest in Internal Medicine
among internship applicants.
A few updates for Associates from Lucy Kalanithi, MD, Western Zone representative, national
Council of Associates:
* A team of associate members from Northern California represented our chapter proudly in the
national Doctor's Dilemma competition and IM2010 in Toronto - Congratulations to Alex Krassner
(Kaiser Permanente Oakland), Matt Reimert (California Pacific Medical Center) and Robert Wong
(California Pacific Medical Center) on their hard work and depth of medical knowledge!
* The Northern California annual meeting in November 2010 will include this jeopardy-style competition
(the winning team will again advance to the national competition), a lively poster session, and a
chance for residents and fellows to express their views and needs to their national Council of
Associates (COA) representative.
* The national ACP Council of Associates is working on developing guidelines for physicians' use of
social media (e.g., Facebook and Twitter), establishing an ACP policy internship in Washington, D.C.,
and providing support for associate member activities. Please feel free to contact Lucy Kalanithi
(lgkalanithi@gmail.com) any time with ideas or questions.
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* Finally, associates should be aware that with their ACP membership, they receive a substantial discount
on MKSAP materials for internal medicine boards study, including many sample questions. It's
never too early to start!
CMA Letter to Blue Shield re CPPI
RE: CALIFORNIA PHYSICIAN PERFORMANCE INITIATIVE
Dear Messrs: Bodaken and Lansky:
On behalf of the California Medical Association (CMA), I am writing to inform you that, effective
immediately, we hereby terminate our participation with the California Physician Performance Initiative.
We do so because we are deeply disturbed by the process and by Blue Shield of California’s insistence
to move forward with publishing faulty data that will only serve to mislead patients and irreparably
harm physicians’ personal and professional reputation. What follows is the basis for our decision via
policies adopted by our Board of Trustees (BOT). As you may know, CMA’s process to further review
CPPI included establishment of a Quality Technical Advisory Committee (QTAC). Members of the QTAC
included CMA physicians representing a wide variety of physician perspectives. Physicians in large
group and solo practices who have dedicated large portions of their careers to improving the quality of
care delivered in California participated in this process. After three meetings, one with Pacific Business
Group on Health (PBGH) and Blue Shield, the committee concluded that the goal and rationale of CPPI
are inconsistent with the CPPI product. The QTAC concluded that many significant and unresolved
issues remain, and that the CPPI product is a work in progress. Further, the QTAC has concluded that
publication of the CPPI at this time will do more harm than good to California’s collective health care
community—patients, physicians, and payors.
As discussed below, these significant and unresolved issues include, but are not limited to, the following:
1) Inaccurate financial claims data used by insurers for the CPPI may mislead patients in
choosing or retaining physicians, irreparably harm a physician’s professional and personal
reputation, and may not necessarily address payor concerns about costs.
Claims data is set up for billing, and not for quality measurement. One of the intended goals of CPPI
is to provide patients with accurate information when choosing or retaining physicians because public
websites (e.g., Yelp) and word-of-mouth referrals are unreliable. Based on the experience of
physicians with the CPPI and QTAC’s careful review of the CPPI, the QTAC concluded that the CPPI
will not necessarily present more accurate information to patients because the claims data used are
inherently flawed. Indeed, the CPPI branding and messaging may be different from Yelp, but the end
result will likely be the same—unreliable information to patients.
2) Inadequate consideration of patient adherence to recommended physician care may
also discourage physicians to continue seeing non-compliant patients to avoid negative
CPPI scores1. Under the current CPPI model, physicians are 100% accountable even if a patient
refuses to adhere to recommended care. There are strong sentiments from physicians that they
should not be penalized for something that is beyond their control as submitted by physicians who
participated in the CPPI. For example, one physician declined to pursue recommending a
colonoscopy to his bed-ridden dying patient; 2) another patient delayed a recommended procedure
because she lost her job; 3) some patients may forgo recommended care because they are on vacation,
out of the country, or they dropped their health coverage; and 4) other patients by choice may
simply refuse to adhere to certain procedures (like colonoscopy). In sum, CPPI fails to adjust for
patient behavior. This may have the unintended consequence of creating a disincentive to care for
non-compliant patients to avert negative CPPI scores.
1 CMA recognizes that CPPI included patient adherence to a recommended physician procedure in cycle 4, but it has since decided that
such consideration will be excluded moving forward. 2 Journal of American Medical Association: “Measuring Physicians’ Quality and
Performance.” (December 2009)

3) Incorrect patient attribution dilutes the quality of care the physician provided to a
patient, and is inefficient because it may actually lead to duplicative care. For instance, in
a Preferred Provider Organization (PPO) setting, a patient may see an out-of-network, non-contracting
OBGYN for a pap smear, and that patient may not inform her regular in-network, contracting primary
care physician about the pap smear. Under the current CPPI rules, the in-network physician is
attributed the patient and is penalized because there are no pap smear claims data submitted to the
health plan. Also, the out-of-network, non-contracting physician will not receive the credit because
he has no contract with the payers. This example is troubling because it may compel the primary
care physician to order another pap smear to avoid receiving a low CPPI score. Duplicative care is
contrary to the efforts of payers to control the cost of healthcare.
4) Inappropriate use of quality metrics and inclusion of problematic measures. Physicians
are particularly concerned with the lack of efficacy of the quality measurements used by CPPI. These
measures do not capture patient outcomes and offer only a cursory view of the overall care provided
by a physician. To quote the Journal of American of Medical Association, “[by] relying on highly
focused quality metrics one at a time [which CPPI does], [we] are viewing care through a tiny keyhole.2
Furthermore, although CPPI committed to exclude colonoscopy and heart failure from CPPI in
cycle 4 because of the many flaws associated with such measures, there is lingering concern about
other measures that remain problematic. For example, physicians were penalized for not recommending
cervical cancer screening tests to patients who had undergone hysterectomies.
5) Insufficient patient sample size remains unresolved. The CPPI uses insurer commercial data
from Anthem Blue Cross, Blue Shield, and United Health Care. It excludes administrative services
only (ASO) data, public payor data from Medi-Cal and Medicare, and other private carriers like Aetna
and Cigna. Thus, many physicians remain skeptical that CPPI has enough patients in any specific
group to support statistically valid measurement. It is important to note that the Journal of American
Medical Association article discussed in the previous bullet above raised a similar concern.
6) Imbalanced CPPI governance structure. While physicians may have a voice in CPPI’s Physician
Advisory Group, their recommendations are often set aside or overturned by CPPI’s Executive
Committee, which is dominated by payor representatives. This imbalance is contrary to the collaborative
process CPPI agreed to follow.
7) Ineffectiveness of insurer/payor physician rating programs like the CPPI. Some physicians
view ratings to be unproductive because they are judgmental, motivate through blame and
fear, and engender adversarial relationships rather than effectively engage practitioners in change3.
Indeed, a recent New England Journal of Medicine article concluded the following statement about
physician ratings generally: “Consumers, physicians, and purchasers are all at risk of being misled by
the results produced by these tools.4”
3 Health Affairs: “Beyond the Efficiency Index: Finding a Better Way to Reduce Overuse and Increase Efficiency in Physician Care.” (May
2008) 4 New England Journal of Medicine:” Physician Cost Profiling—Reliability and Risk of Misclassification.” (March 2010)
In light of the many significant and unresolved issues with the CPPI, the CMA BOT adopted policies
that would address the issue of providing accurate information to patients, payor concerns about
costs, and publication of misleading information.
These policies acknowledge that patients need more accurate information on quality and costs when
choosing or retaining physician. They encourage CMA to work with all relevant parties to develop a
program, set of information, or system that will help patients choose or retain their physicians in an
accurate, reliable, reasonable, and useful manner. Furthermore, these policies encourage all stakeholders--including
payors--to provide appropriate incentives for patients or employees to follow
healthier, modifiable behaviors and adhere to physician recommended treatments and/or
screening/prevention guidelines. They also state that physicians should not be held accountable for
the patient’s informed decision to not participate in physician recommended treatments and/or
screening/ prevention guidelines. The CMA BOT also supported policies that would allow CMA to col-
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laborate with payors on an alternative quality initiative program that would motivate and engage
physicians to improve patient care and performance, and address payor concerns about costs without
the shortcomings or judgmental features associated with insurer/payor physician public rating
programs.
As to the issue of Blue Shield’s pending publication of the CPPI product, the CMA BOT instructed CMA
to communicate to CPPI and all relevant stakeholders in the strongest terms possible that publication
of the CPPI without addressing significant concerns raised by CMA, local medical societies, and other
physician groups forces CMA to withdraw from CPPI participation. CMA cannot lend credence to nor
continue to participate in a flawed quality initiative program that would mislead patients, irreparably
harm reputations of physicians, and fail to address payor concerns about costs. Publication of CPPI in
its current form further compels CMA to explore and pursue all appropriate courses of action necessary
to protect its physician members and their patients from publication of misleading physician rating
information.
In sum, the CMA BOT concluded that, in light of the many, significant, and unresolved issues with
the CPPI, the CPPI should be voluntary and physicians should be given the opportunity to affirmatively
opt out of the CPPI moving forward.
Based on the feedback from our physician members, we have made a good faith effort to collaborate
on a quality initiative that offers reliable and accurate information. It is important to emphasize that
CMA remains committed to working with payors on a quality initiative other than the CPPI. We recognize
that CPPI and Blue Shield attempted to address some of our concerns in the past couple of
months as reflected on PBGH’s letter dated March 29, 2010. In truth, however, the adjustments
made are inadequate to address the more fundamental issues we have raised. Furthermore, we think
that there is little incentive for Blue Shield or other insurers to address these issues once the CPPI is
published in its current form.
It is now apparent to our physician members that Blue Shield intends to publish the CPPI product
notwithstanding the many significant and unresolved issues we have raised. Such action compels
CMA to disengage from CPPI. We no longer believe our involvement would be worthwhile and cannot
associate ourselves with a deeply flawed project that misleads patients and falsely disparages physicians.
Accordingly, effective immediately, CMA hereby terminates our involvement and participation
on the Physician Advisory Group, Executive Committee, and with CPPI in all manner generally. We
request that you immediately cease mentioning or identifying CMA in any way as a supporter or participant
of, or in association with, CPPI. Please contact me at (916) 444-5532 if you would like to further
discuss these issues.
Sincerely,
Dustin Corcoran Chief Executive Officer