…continued on page 2

Permanente Physicians’ Voices Heard in Health Reform Law

In the hectic run-up to the new health reform law, more than 2,500 TPMG physicians joined forces to ask Congress to change a proposed federal tax that threatened to put an inequitable burden on our organiza-tion and the state of California.The proposed tax, buried deep in

the bills written to reform health care, applied only to fully insured health plans, not to self-insured organizations. This inequity would be magnified, because 77 percent of the covered population in California

Curbing Childhood

Obesity

Horberg Sits on

President’s Council

Supporting Physician

Candidates

Physicians’ Voices Heard

in Health Reform Law

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SPRING 2010

Phone Power

Political decision-making relies on personal connections. If you have a close relationship with a member of Congress and would be willing to speak to him or her on behalf of TPMG (or help in some other way), please call Andy Huber, TPMG Government Affairs, at 510-987-1908. “Never underestimate the power of the personal,” Huber said. “Even if you’ve told us before about a relationship you have, please remind us again.”

Permanente Physicians’ Voices… continued from cover

Capitol Matters/Spring 20102

is fully insured compared to about 50 percent nationwide. Thus, more of the tax hit would land on California.

Letters Had an ImpactAll told, TPMG physicians sent more

than 5,100 letters to Senators Barbara Boxer and Dianne Feinstein and more than 2,200 letters to Democratic lawmakers in the House. The letters explained that our organi-zation would be assessed with 8 percent of the proposed tax, even though our members are only about 3 percent of the covered popula-tion. They argued that this burden would in-crease if large employers chose to self fund to avoid the tax and that the structure of the tax could drive up health care costs by perpetuat-ing the fee-for-service payment model.

Ultimately, these arguments had an impact, according to Tony Barrueta, Kaiser Permanente’s senior vice president, Govern-ment Relations: “While the new health reform law does not eliminate the self-funded plan exemption, it does substantially level the playing field for Kaiser Permanente and oth-ers by discounting the tax by 50 percent.”

Grassroots Campaign “The proposed tax replicated a formula

that had been used in the past for another purpose,” said Amy Andersen, director of Government Affairs, TPMG. “We pointed out the unintended consequences, but our legislators were swamped with so many competing demands that we had a hard time getting heard. Our physicians had weighed in with their representatives in the past on health care issues, so we had some experi-ence, but, this time, we knew it would take

a massive effort. We needed a ‘grassroots’ letter-writing campaign in a matter of weeks, and we were blown away by the response we received,” she said.

TPMG was “the first out of the gate” with the letter-writing campaign, said Andy Huber, Government Affairs. “Everyone pitched in, and, for the first time, we were able to coordinate the home addresses of our physicians so that it was clear they were constituents of the legislators to whom they were writing. We became the test run for other Permanente regions.”

”Loud and Clear” “The voice of Permanente physicians

came through loud and clear in the grass-roots letter-writing campaign,” Barrueta said. “Physicians from across the program sent over 20,000 letters to Congress calling for a fairer tax. TPMG led the charge, and we are grate-ful for such strong support. The physician grassroots campaign reminded policymakers that we are first and foremost a care delivery organization that speaks with one voice on behalf of our patients and members.”

POLICYMATTERS

Capitol Matters/Spring 2010 3

First Lady Michelle Obama’s campaign against childhood obesity gives national prominence to a health crisis that has galva-nized Permanente pediatricians for nearly a decade.

“The total impact of childhood obesity on the general health of our country is enormous,” said Edward Martin, MD, chair of TPMG chiefs of pediatrics. “Prevent-ing obesity is probably the most important thing we can do as pediatricians, other than making sure that children are immunized appropriately.”

For Martin and his colleagues, the goals of the First Lady’s “Let’s Move” campaign—information to help parents make healthy choices for their children, healthier food in schools, access to healthy food in the community, and more opportunities for children to be physically active—are famil-iar and welcome.

“Anything that generates interest at the national level in preventing childhood obesity is going to support the work we are doing,” Martin said.

That work runs the gamut from ad-dressing healthy eating and physical activity during well check visits to training other physicians in the community about preven-tion strategies.

Key ToolOne of the key tools our pediatricians

use to identify patients who need to develop healthier habits is body mass index (BMI) screening. A comparison of height to weight, BMI correlates with excess weight and risks for chronic conditions such as diabetes and heart disease later in life.

All TPMG pediatricians measure BMI at well check visits starting at age 2. And a computer-generated Preventive Health Prompt (PHP) developed by Scott Gee, MD, medical director for Prevention and Health Information, Regional Health Education, alerts patients and doctors alike that it’s time for a BMI screening. The reminder appears on patients’ registration slips at visits and can be viewed online through the physician’s home page.

NatioNal CampaigN UNdersCores oUr goals for CUrbiNg Childhood obesity

“This computer-generated reminder sys-tem is unique to TPMG,” Gee said. “When patients come in to see me with a reminder on their receipt, I measure their BMI and provide counseling, even if they’ve come in for a sore throat.”

LeadershipAt the national level, Kaiser Permanente

is one of the founding organizations of the Partnership for a Healthier America, which will participate in the “Let’s Move” campaign by mobilizing support for efforts to address childhood obesity.

In Northern California, designated pediatricians and health educators champion efforts to combat childhood obesity at each medical center, with an organizational focus on prevention and community outreach.

“Obesity is very difficult to manage once it’s there, so the key is to not get there in the first place,” Martin said.

Capitol Matters/Spring 20104

POLICYMATTERS

Michael Horberg, MD, MAS, FACP, AAHIVS, has always been a bit of an activist.

In addition to practicing internal medi-cine with TPMG in Santa Clara, conducting research, and serving as director of HIV/AIDS nationally for The Permanente Federation and Kaiser Permanente, Horberg is a former presi-dent of the Gay & Lesbian Medical Associa-tion and a member of the Bay Area Physicians for Human Rights.

Today, as a member of the President’s Ad-visory Council on HIV/AIDS (PACHA), he is in a position to contribute to the creation of the first-ever U.S. domestic policy on HIV/AIDS.

National Policy“HIV remains an epidemic,” Horberg

said. “In certain American metro-politan areas, the prevalence rivals that of some African nations. It is also a case study in disparities—gay males, African-Americans—these mi-nority populations are the most affected. Having a national policy will be a big step forward.”

Horberg, who was sworn in February 2, brings more than a decade of clinical experi-ence and research to the 25-member advisory council. He will serve on PACHA’s Com-mittee on Access to Care, Models of Care and Quality Measures, areas in which he is a recognized expert. He looks forward to

being able to “inform how government affects policy through its mandates and funding.”

Quality OutcomesAfter the U.S. Department of Veterans

Affairs, Kaiser Permanente is the largest provider of HIV/AIDS care in the nation, and was the first HMO to measure quality outcomes in HIV/AIDS care. Most impres-sively, according to TPMG’s HIV Operations Policy Practice Leader Michael Allerton, MS, “If you look at all of our HIV/AIDS quality

measures across the country, a black female in Georgia has the same outcomes as a gay white male in San Francisco. Our outcomes don’t vary by demographics on a national level, and only we can say

that about HIV care.”This success in the disparities area is

bolstered by our integrated care model, the “medical home” federal policymakers want to create. “This is simply the way we practice medicine,” Horberg says. “PACHA is also a platform to disseminate the great work KP has done in pioneering HIV/AIDS care.”

“Michael has taken our HIV Initiative to new heights,” said Allerton. “He has gotten KP recognized for what we’re doing through valid and appropriate scientific research. Serving on PACHA is a great honor, but his accomplishments here are what put him and the organization on the national stage.”

dr. horberg goes to WashiNgtoN physiCiaN sits oN presideNt’s hiV/aids CoUNCil

Dr. Michael Horberg

OUTREACH

David Lerman, MD, JD, Family Medicine, Los Angeles and PGPM Chairman exchanges views with Don Kurth, MD, candidate in AD 63. SCPMG physicians Frank Yamanishi, MD, Surgery, Fontana; Pamela Anderson, MD, Internal

Medicine, Redlands; Narendra Trivedi, MD, Anesthesiology, Fontana; candidate Don Kurth, MD; Michael Neri, Jr., MD, Family Medicine, Riverside; and Thelma Korpman.

Capitol Matters/Spring 2010 5

reCeptioNs for physiCiaN CaNdidatesIn March, physicians in the Sacramento area turned out to

meet Richard Pan, MD, a candidate for the California Assembly.

Paul Phinney, MD, Pediatrics, Sacramento and his wife Suzanne hosted

the reception, where TPMG physicians got to know Dr. Pan and his

positions on issues that affect health care delivery in California.

A February gathering at the home of Thelma Korpman, MD,

Physician-in-Charge, Ontario Vineyard Ambulatory Surgery Center

gave SCPMG physicians the opportunity to meet Don Kurth, MD,

also a candidate for the California Assembly.

Host Paul Phinney chats with Steven Melcher, MD, Psychiatry, South Sacramento.

Jack Ostrich, MD, Internal Medicine, Sacramento and retired TPMG pediatrician Robert Bonar, MD.

Anthony Retodo, MD, Adult Medicine, Folsom and Jack Rozance, MD, North Valley physician-in-chief with Richard Pan, MD, a pediatrician and candidate in AD 5.

6

at workPGPM

Capitol Matters/Spring 2010

physiCiaNs eNter primariesIn the June primary election, PGPM has the unprecedented opportunity to support two

physicians running in Assembly races: Don Kurth, MD, MPA, MBA (63rd District) and Rich-ard Pan, MD, MPH (5th District).

The advantage of having physicians in the legislature, according to David Pating, MD, Psychiatry, San Francisco, is that “they understand health care issues intimately” and are “able to go straight to the meat of the issue.” That shorter learning curve is especially important in an era of term limits, where there is a constant effort “to educate lawmakers, form alliances, and relationships,” he said. Practice and Advocacy

Don Kurth, the Republican mayor of Rancho Cucamonga, specializes in addiction medi-cine, and was himself a heroin addict as a young man. That experience influences his practice and his advocacy work on behalf of the California Society of Addiction Medicine and the Cali-fornia Medical Association. He also serves on the faculty of the KP Fontana Medical Center.

“Don understands the human qualities needed to practice medicine and to succeed in lead-ership roles. He excels in bringing forward voices that aren’t always heard,” Pating said.

Teaching and Public ServiceA strong commitment to public service underscores Richard Pan’s entire career, according

to Paul Phinney, MD, Pediatrics, Sacramento, and chair of the California Medical Associa-tion’s Board of Trustees. Pan, who is running as a Democrat, teaches pediatrics at UC Davis, where he founded Communities and Physicians Together, a collaboration among the Family Medicine, Internal Medicine, and Pediatrics residency programs and seven community-based organizations. Its goal is to improve health and teach residents how they can make a difference through community partnerships.

“Richard understands medicine and health care policies from the broadest perspective,” Phinney said. “He places high value on preventive care and is in sync with everything embodied in our Thrive program.” Relationships on Both Sides of the Aisle

“PGPM supports candidates of both parties because of the importance of having the voice of medicine present in both caucuses,” Phinney said.

And if the candidates are physicians, so much the better, said Jack Rozance, MD, physician-in-chief for the North Valley: “If I had my way, every legislator would be a physician. Since that isn’t likely, we should do what we can to support as many as possible. Impactful health care legislation needs to be influenced by physicians.”

Richard Pan, MD, MPH

Don Kurth, MD, MPA, MBA

$93,556Donations received

January to March 2010

1,289Number of

TPMG and SCPMG physicians

(active and retired)

who donated January to March 2010

$7,500Contributions

made to 3 candidates January to March 2010

Capitol Matters/Spring 2010

Who’sWho AT PGPMSteering CommitteeDavid Lerman, MD, JD, Chair Sharon Levine, MDEdward Ellison, MD Jack Rozance, MDVito Imbasciani, MD Suketu Sanghvi, MD StaffAmy Andersen Pauline Fox, JD Executive Director Treasurer

WANT TO KNOW MORE?What is PGPM? Learn about PGPM’s mission and how to get involved: http://pgpm.com

Where’s the money? PAC, campaign, and lobbying spending: http://cal-access.ss.ca.gov

What are the rules? Campaign finance, lobbying, and conflict of interest laws: http://www.fppc.ca.gov

Who represents you and info on bills? http://leginfo.ca.gov/

TPMG and SCPMG established Physicians for the Practice of Group Medicine (PGPM) in 1999 as a political action committee (PAC) to:• Increase the visibility and influence of Permanente physicians in

Sacramento. • Channel political and financial support to candidates for state

and local offices in California who share the values of group medical practice and support the interests of TPMG and SCPMG physicians and their patients.

• Help group practice physicians understand and participate in the political process.

Your contribution to PGPM will help secure the future of Permanente medicine, promote high quality practice, and protect our patients in the years ahead. All contributions to PGPM are voluntary.* Please contribute today!Maximum Individual Contribution for 2010: $6,500Payroll Deduction: You can contribute through TPMG’s payroll deduction program. Your annual commitment will be deducted in monthly installments from your payroll check. To sign up, call Amy Andersen at 510-708-4472 or send e-mail to pgpm@pgpm.com.**Personal Check: Send a personal check payable to PGPM to:Physicians for the Group Practice of Medicine1714 Franklin Street, #100-179Oakland, CA 94612FPPC Filer I.D. #992303

PLEASE CONTR IBUTE TODAY !

* Contributions to PGPM are not tax deductible. PGPM is required by law to file the names and employers of individuals who contribute $100 or more annually to the PAC.

**This dedicated telephone line and e-mail address are used only for inquiries regarding political contributions. No resources (including e-mail, telephones or facilities) of any 501(c)(3) organization (including Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals) may be used for or in connection with political fundraising.

grabbiNg a ChaNCe to Chat

“Being able to sit and talk informally with politicians and candidates is an invaluable opportunity to get their undivid-ed attention.” That’s why Anthony Russell, MD, MPH, CMQ, Pediatrics, Sacramento, makes the most of political events like the reception held last December to support Roger

Dickinson’s campaign in the Ninth Assembly District.

“I know Roger from working with him as a member of the Public Health Advisory Board to the Sacramento County Board of Supervisors, so talking with him one-on-one at the reception was a way of deepening our relationship,” Russell said. “I really got a sense for his position on potential changes to MICRA (Medical Insurance Compen-sation Reform Act), which, among other things,

caps the amount of pain and suffering damages allowed in medical malpractice suits. Since changes to the cap would have repercussions for the availability of quality health care access in California, it is an important issue.”

PGPM regularly sends physicians to campaign events as part of its efforts to support candidates and broaden PGPM’s and TPMG’s relationships with elected officials at the state and local levels.

If you would be interested in attending future events, please email pgpm@pgpm.com.

Dr. Anthony Russell

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June 8 Primary election Day

July 13 legislative Forum

sePtember 28 legislative Forum

uPcoming events

SPRING 2010

Presort Standard

U.S. Postage PAID

San Leandro, CA Permit No. 169

The Permanente Medical Group1950 Franklin Street, Oakland, CA 94612

in this issue…Grassroots Campaign Influences

Health Reform Bill 1

National Obesity Campaign Reflects TPMG Values 3

Horberg Serves on Presidential Council 4

Receptions for Physician Candidates 5

PGPM at Work: Supporting Physician Candidates 6