2008 March/April

MARCH / APRIL 2008 | Volume 14: Number 2

Federal legislative issues: Lessons learned from 2007 and priorities for 2008

INSIDE:

An Evening With Dr. George Lundberg, Former Editor-in-Chief of JAMA

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SCCMA the

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Table of Contents

the Editor’s Desk…

4 From Joseph S. Andresen, MD Know? Grounds for Medical Board Discipline 5 Did You Atul S. Sheth, MD With Dr. George Lundberg 6 An Evening Joseph S. Andresen, MD Green: Collaborating for Your Health and the Environment 9 Going Cindy L. Russell, MD End of the Physician Diversion Program 10 The Mark A. Singleton, MD; Atul S. Sheth, MD 12 New Resources Available Meeting AMA House of Delegates 14 217th Donald J. Prolo, MD, Delegate; John D. Longwell, MD, Alternate 18 New Member Benefits 20 CMA’s 34th Annual Legislative Leadership Conference 21 New Members / In Memoriam News: Tips for Choosing a Billing Company 22 Coding Sandie Becker, CMC 23 Apologies and Notices Legislative Issues: Lessons From 2007 and Priorities for 2008 24 Federal Elizabeth McNeil, CMA Vice President of Federal Issues 26 Classified Ads Editor: High Cost of Dying!

30 To theJames R. Cohen, MD

Officers

President Atul S. Sheth, MD President-Elect Jerry A. Hanson, MD Past President Donald J. Prolo, MD VP-Community Health Martin D. Fenstersheib, MD VP-External Affairs William Lewis, MD VP-Member Services Howard Sutkin, MD VP-Professional Conduct Michael Hirschklau, MD Secretary Thomas M. Dailey, MD Treasurer Martin L. Fishman, MD

Executive Director

William C. Parrish, Jr.

House Officer Representative

Jacob Ballon, MD

AMA Trustees - SCCMA Donald J. Prolo, MD John D. Longwell, MD (Alternate)

Councilors

Community Hospital of Los Gatos:

SCCMA/CMA Delegation Chair

CMA Trustees - SCCMA

Kaiser Permanente Hospital:

Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (District VII) John D. Longwell, MD (Hospital Based Physician)

Editor

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Printed in U.S.A. Opinions expressed by authors are their own, and not necessarily those of The Bulletin or the Santa Clara County Medical Association.

Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by the Santa Clara County Medical Association of products or services advertised.

Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org Copyright 2008 by the Santa Clara County Medical Association.

Judith Dethlefs, MD El Camino Hospital:

Tanya W. Spirtos, MD

Santa Clara County Medical Association Bulletin

Michael Curtis, MD Good Samaritan Hospital:

John Rashkis, MD Allison Schwanda, MD O’Connor Hospital:

Jay Raju, MD Regional Medical Center of San Jose:

Hossein Habibi, MD Saint Louise Regional Hospital:

John Saranto, MD Santa Teresa Community Hospital:

Efren Rosas, MD Stanford Univ. Medical Center:

Bryan Bohman, MD Santa Clara Valley Med. Center:

Phuong H. Nguyen, MD

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Trudging door-todoor on snowy streets, we met Iowans in their homes, churches, and, finally, at their caucus sites.

From The

Editor’s

Desk…

My teenage son and daughter envisioned a family holiday vacation in some warm place, such as Hawaii, this past December. However for the first time, beaconed by history in the making, we found ourselves in Iowa for 10 days. Trudging door-to-door on snowy streets, we met Iowans in their homes, churches, and, finally, at their caucus sites.

Much like taking a good medical history, there is no better way to feel the pulse of a community than by directly meeting and talking with its constituents. Nowhere else can you better hear the message and more closely measure the authenticity of those few individuals seeking to become our next President. What we learned and carried away from this experience is the importance and power of individuals joining together with a common purpose. There is no more important lesson in democracy than that.

Our 10 SCCMA councilors represent you and are designated by hospitals throughout Santa Clara County. In upcoming issues, I will be asking our councilors to reach out and listen to you and give updates in this Bulletin. We need to hear your concerns, challenges, and triumphs. Sharing these experiences and insights with all our members will be an important step in strengthening our county medical association. Hopefully, through this process and dialog, we will emerge stronger and more unified.

Please contact your councilors and let them know

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that you want your voice heard: Community Hospital of Los Gatos: Judith Dethlefs,

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MD El Camino Hospital: Michael Curtis, MD Good Samaritan Hospital: John Rashkis, MD Kaiser Permanente Hospital: Allison Schwanda, MD O’Connor Hospital: Jay Raju, MD

Regional Medical Center of San Jose: Hossein Habibi, MD Saint Louise Regional Hospital: John Saranto, MD Santa Teresa Community Hospital: Efren Rosas, MD Stanford University Medical Center: Bryan Bohman, MD Santa Clara Valley Medical Center: Phuong H. Nguyen, MD In this month’s Bulletin, to name just a few highlights, Dr. George Lundberg discusses his tenure as editor-in-chief of JAMA for 17 years. CMA Vice President of Federal Issues Elizabeth McNeil talks about lessons from 2007 and priorities for 2008.

AMA Trustees Drs. Donald Prolo and John Longwell report on the 217th AMA House of Delegates meeting. James Cohen, MD, oncologist, writes about his unexpected discovery of the high costs of dying!

Finally, Dr. Atul Sheth brings a new column entitled “Did You Know?” to The Bulletin, which informs SCCMA members of some of the laws that affect the medical license and practice of medicine.

Respectfully submitted, Joseph Andresen, MD | Editor

DID YOU KNOW?

Grounds for

Medical Board Discipline

By Atul S. Sheth, MD, 2007-2008 SCCMA President Drugs and Alcohol

Overdue Child Support Obligations California law requires that the Medical Board determine, prior to the issuance or renewal of a license, whether the name of the person who is

Did you know that the Medical Board of California

applying for the license appears on the most recent

could administer disciplinary action against your

monthly list of persons who are overdue on child

medical license for charges of unprofessional

support obligations. The Board may not renew or

conduct for misdemeanor convictions involving

issue a license to any person whose name is on

consumption of alcohol (driving while under the

that list until it receives a copy of a release stating

influence)?

that the person is in compliance with the judgment

(See, e.g., Griffiths v. Superior Court) (2002) 96 Cal.

or order of support. (Welfare & Institutions Code

App. 4th 757, 117 Cal.Rptr.2d 445 [“Convictions

§11350.6.)

involving alcohol consumption reflect a lack of sound professional and personal judgment that is relevant to a physician’s fitness and competence to

Refund to Patient for Overpayment of Fees by Third Party Payor

practice medicine”]).

If a third party payor makes a duplicative payment

Human Biological Specimens Physicians who collect human biological specimens

subsequent to payment made by the patient, the physician has a duty to refund the overpaid amount to the patient. (Business & Professions Code §732.)

for testing or examination must ensure that those specimens are secured in a locked container when

Treating Patients While Intoxicated

they are placed in a public location outside the

Business & Professions Code §2280 declares that any

physician’s custodial control. (Business & Professions

physician who attends a patient while intoxicated,

Code §2244.) For more information, see CMA

to such an extent as to impair his or her ability to

ON-CALL Document #0305, “Clinical Laboratories:

conduct the practice of medicine with safety to

Disclosure, Payment, Billing, Record Retention, and

the public and his or her patients, is guilty of both

Storage.”

unprofessional conduct and a misdemeanor.

Infection Control

Workers’ Compensation Fraud

Business & Professions Code §2221.1 requires that

A physician’s license will be automatically

the Medical Board investigate and take disciplinary

suspended if the physician is convicted of any felony

action against physicians and surgeons (and other

involving fraud committed in conjunction with the

MBC licentiates) who knowingly fail to protect

workers’ compensation or Medi-Cal programs.

BENEFIT SPOTLIGHT Do you have questions about medical-legal or other information of importance to physicians? Take advantage of California Medical Association’s online library, CMA ON-CALL. (Look for the complete index of topics in your new 2008 SCCMA Membership Directory.) Members have full access to the resource, which includes most of the Center for Legal Affair’s annual publication, the California Physician’s Legal Handbook (CPLH), as well as more specialized information on peer review and other topics, including information from the CMA’s Center for Medical Policy and Economics.

These documents are available free to members at the members-only website, www.cmanet.org/ member and click “CMA On-Call” on the upper right side of the screen.

If you have questions about particular documents, call the CMA Legal Department at 916/551-2872.

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patients by failing to follow infection control guidelines, thereby risking transmission of blood-

(Source: CMA ON-Call Document #0790 “Grounds

borne infectious diseases between physicians and

for Medical Board Discipline”)

patients. For more information on this law, see CMA ON-CALL Document #1805, “Bloodborne Pathogens.”

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During Dr. Lundberg’s early tenure, a number of the AMA trustees owned tobacco farms and smoking was commonplace at AMA conventions.

An Evening With

Dr. George Lundberg

Former Editor-in-Chief of JAMA and “Online Health Care’s Medicine Man”

By Joseph Andresen, MD, Editor Several months ago, SCCMA members gathered in San Jose to hear Dr. George Lundberg reflect on his 17-year tenure as editor-in-chief of The Journal of the American Medical Association. Prior to his presentation, I “googled” Dr. Lundberg and received 781,000 references!

The topic of the evening focused on the history and publication of JAMA and Dr. Lundberg’s role as editor-in-chief of the journal over a 17-year period from 1982 until 1999. We learned that JAMA was founded in July 1883. It was created with a stated mission “to promote the science and art of medicine and the betterment of the public health.” It was and is the journal of the American Medical Association, offering peer-reviewed clinical and laboratory articles on a wide range of medical topics, as well as

Dr. Lundberg had no formal training as an editor

examinations of controversial health care issues and

and learned his skills on the job. He attributes his

their ethical, legal, and societal implications.

interest in writing to his mother, who was a first grade school teacher who wrote a weekly column

In 1982, as incoming editor, Dr. Lundberg was

for a local newspaper. Dr. Lundberg was born in

charged with making JAMA the dominant medical

Florida and grew up in rural southern Alabama. His

journal. The New England Journal of Medicine,

first experiences working in a hospital began as a

the British Medical Journal, and The Lancet were

janitor, mopping the floors of the operating rooms

competing publications at that time. Under Dr.

in a hospital in Selma, Alabama at a time when

Lundberg’s watch, JAMA began to develop close

white and black patients were segregated.

associations with the strongest organizations in science and medicine. Paid editors were stationed

Dr. Lundberg received his M.D. degree at the

at Harvard, UCSF, Johns Hopkins, and Stanford to

Medical College of Alabama. He completed a clinical

accomplish this task.

internship in Hawaii and a pathology residency in

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San Antonio. He served in the U.S. Army during the

Dr. Lundberg used a “Trust Relationships”

Vietnam War in San Francisco and El Paso, leaving

pie diagram to demonstrate the important

as a lieutenant colonel after 11 years. Dr. Lundberg

responsibilities of medical editorship. Answering

was then professor of pathology and associate

ultimately to the best interests of the patient, the

director of laboratories at the Los Angeles County/

editor must maintain trust relationships with the

USC Medical Center for 10 years, and for five years

readers, advertisers, reviewers, government, editorial

served as professor and chair of pathology at the

board, authors, media, owners, students, and staff.

University of California-Davis. Dr. Lundberg has

When informed that a published article offended an

worked in tropical medicine in Central America

advertiser who brought JAMA millions of dollars,

and forensic medicine in New York, Sweden,

Dr. Lundberg, without blinking an eye, would

and England. His major professional interests are

acknowledge that he understood that fact. However,

toxicology, violence, communication, physician

he would defend his autonomy and editorial

behavior, strategic management, and health system

responsibility by asking the questioning board

reform. He is past president of the American Society

member the following question: “Would you not

of Clinical Pathologists.

want your wife, child, mother, or family member to benefit from the latest information and therapeutic advances?”

AN EVENING WITH DR. GEORGE LUNDBERG, FORMER EDITOR-IN-CHIEF OF JAMA

Through his work with JAMA, Dr. Lundberg utilized the 10 AMA Archives journals to function with JAMA as a consortium. Thus, an author submitting a new article would have 11 chances to have their article reviewed and published. JAMA went international, first in France and Japan, and ultimately to 19 countries, and is published in 11 languages. There was an important medical missionary void that JAMA filled. In nearly all international editions, including nine countries of Southeast Asia, JAMA was distributed monthly, free of charge.

Dr. Lundberg was told there were three sensitive areas to stay clear of, as the newly appointed editor in January 1982: Nuclear War, Tobacco, and Guns. He promptly launched into an intellectual investigation and discussion of the public health and medical aspects of all three.

Nuclear War: It was the era of Ronald Reagan’s presidency. Reagan was a popular leader and was supporting the concept of limited nuclear tactical weapons and a “Star Wars” missile defense system.

It was, and still is, believed that nuclear war is the greatest potential threat to the public health and wellbeing of mankind. The August 5, 1983 issue of JAMA was dedicated to the prevention of nuclear war. It details the medical consequences of Hiroshima’s population exposed to radiation and the atomic bomb. The front cover is the work of a Japanese artist and has been repeated every August since its first publication. Subsequent issues have included discussions of chemical and biological warfare and rape as weapons of war.

Tobacco: During Dr. Lundberg’s early tenure, a number of the AMA trustees owned tobacco farms and smoking was commonplace at AMA conventions. As a pathologist, he has done autopsies on many patients who had succumbed to lung disease as a result of smoking.

The February 28, 1986 JAMA issue displayed the first tobacco theme cover. It was a Van Gough work depicting a skull inhaling a cigarette. Since then, there have been 14 JAMA theme issues on tobacco. This heightened awareness resulted in a major policy shift by the AMA on combating smoking related illness.

AIDS: The JAMA HIV theme cover issue features a blank white cover. This symbolizes all those in the world who would have created great art but who have died of HIV-related illnesses. A 400-page book entitled, “AIDS from the beginning” is a compilation of articles from JAMA over this time span.

In May 15, 1991, the JAMA cover issue pictured a young boy who, at the time, represented the 33 million medically uninsured. That number has now risen to 47 million. Other JAMA theme issues include “Violence in America” (June, 1992) and “Managed Care” (October, 1996), with a cover depicting the sinking of the Titanic.

George Lundberg, MD and Joseph Andresen, MD

Special JAMA publications have included a recent and special compilation of 230 articles from 35 countries entitled “Poverty and Health.” “The Fifty Best Articles in JAMA” is another publication looking back at noteworthy past articles from JAMA over the years.

This included the original Salk and Sabin articles on their respective vaccines, a description of the first blood bank, the first kidney transplant, as well as Walter Reed Hospital and Yellow Fever among many others. “A Piece of My Mind” is a column included in each issue of JAMA that features individual physicians writing about their day-to-day experiences and concerns.

His tenure as editor of JAMA came to an end, like others before him; he was fired. The board’s decision was predicated on the assertion that “JAMA had been inserted into politics where it did not belong.”

Dr. Lundberg described advice he received from John Tupper, the previous dean of medicine at UC Davis, who hired him as chair of pathology in 1976, and later president of the AMA. The first day on the job, you will have no enemies. The second day, you will have one, and so on. At some point, you will have offended more people than those who support you and you are in danger of losing your job. The most important principle through all of this is that you uphold the interests of the patient and the public. Dr. Lundberg described the tipping point as coming in the fall of 1998. There was a scholarly article presented for publication that followed in Kinsey’s footsteps. It examined college students’ attitudes on what constituted sexual relations. Sixty percent of college students studied believed that oral sex was not considered as having sexual relations. The publication of this article occurred during the impeachment trial of former President Bill Clinton.

In concluding his discussion, Dr. Lundberg stated that the new forum of medical information and publication is the Internet.

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MARCH / APRIL 2008

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AN EVENING WITH DR. GEORGE LUNDBERG, FROM PREVIOUS PAGE In 1999, Dr. Lundberg became editor-in-chief of Medscape, the world’s leading source of online health information and education for physicians and health care professionals, and the founding editor-inchief of both Medscape General Medicine and CBS HealthWatch.com.

Examples of Dr. Lundberg’s work in this area include a discussion of our current health care system in the following series of Web cast Video Editorials: 1. The American Healthcare “System” in 2005 – Part 1: Context http://www.medscape.com/viewarticle/496865 2. Who Is in Charge?: http://www.medscape.com/ viewarticle/497484 3. The American Healthcare “System” in 2005–Part 3 Why Not Put the Patient in Charge? http://www.medscape.com/viewarticle/498158 4. Why Not the Single-Payer Solution?

Atul Sheth, MD (SCCMA President), George Lundberg, MD and Jerry Hanson, MD (SCCMA President-Elect)

http://www.medscape.com/viewarticle/498712 5. Good Options for Fixing Our Broken System

peer reviewed and some not (WebMD as an example). There will be

http://www.medscape.com/viewarticle/499376 6. How to Grade the Current System and Proposed Reforms 7.

a continued decline in journal publications, as their costs outweigh

http://www.medscape.com/viewarticle/500423

their benefits. Medical meeting and industry-sponsored dinners are

A Public-Private Is the Best Way to Fix Our Broken System

declining. They are being significantly outpaced by the Internet,

http://www.medscape.com/viewarticle/500796

where 99% of physicians are now getting their medical information.

We look forward to another fascinating and insightful presentation

This topic is worthy of a discussion of its own. The Internet is now

by Dr. Lundberg on this next chapter in the advancement of medical

where most physicians are getting their medical information; some

and scientific knowledge.

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MARCH / APRIL 2008

GOING GREEN:

Collaborating for and the Your Health

Environment

By Cindy Lee Russell, MD | Chair,

accumulating research

SCCMA Environmental Health Committee

and collaboration will

Ecosystems are complex and human physiology is complex. They are also both fragile. This is especially true during development, when the delicate ballet between DNA and an astonishing array of chemical messengers pirouette to produce a healthy, functional living being able to successfully reproduce for the next generation. Life goes on.

help to guide us in our decisions. A wonderful source for doctors and scientists is a group called Collaborative for Health and the Environment. The SCCMA is an affiliate, along with a diverse partnership of scientists, physicians, individuals, and organizations who work collectively to provide the strongest, most up-todate, peer-reviewed science linking environmental

Our natural environment that supported the evolution of humans and ecosystems has become contaminated and not so “natural” anymore.

contaminants and disease. They are our co-sponsors for our upcoming SCCMA Environmental Health Conference Series. Join us for the 2008 series. By

Complex technology is in direct conflict with our

working together, effective change can happen.

complex physiology and ecosystems. Synthetic chemicals that mimic hormones like estrogen

For more information, visit the following websites:

are found throughout our households in our

www.healthandenvironment.org

plastics, pesticides, car seats, food, and our

Our natural environment that supported the evolution of humans and ecosystems has become contaminated and not so “natural” anymore.

Complex technology is in direct conflict with our complex physiology and ecosystems.

www.sccma.org

bodies. Carcinogens are found in air fresheners and styrofoam cups. Brominated flame retardants are found in animals on remote islands where there is no furniture. Contaminants, such as mercury, threaten the neurologic development of our children. Cell phones change neural pathways. Genetically-engineered foods threaten ecosystems and our food security. Science is now demonstrating that we are altering our own reproductive capabilities

and

predisposing our girls to breast cancer.

This is the price of our “modern” society.

What can we do? It seems overwhelming.

Awareness and change are happening. There

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has been a significant shift in communities, industry, and schools to go green. That is simply to use products that are produced, degraded, and used in a way that is in harmony with nature and does not destroy it. It is a challenge in this modern world, but science has helped. Rapidly

MARCH / APRIL 2008

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We stand ready to work with the Legislature, the Medical Board, and the larger community of interested parties to fashion a state-of-the-art public protection/ physician health program for California. We believe that the citizens of the state deserve the protection such a program offers. Only by having the ability to identify and monitor impaired physicians, until they regain the ability to practice safely, is the public interest protected.

The End of the

Physician Diversion Program

By Mark A. Singleton, MD and Atul S. Sheth, MD

The following statement was submitted to the MBC

Although many of you may not even be aware

Framework Public Protection and Physician Health Program October 2007

of this program, run for the past several decades under a legislative mandate by the Medical Board of California (MBC), the Diversion Program has helped many impaired California physicians be rehabilitated and protected the patients from harm. Despite

On July 26, 2007, the Medical Board of California

its important mission and history of success, the

voted to close the Physician Diversion Program

program has been the object of repeated criticism by

on June 30, 2008. The following represents joint

independent “public interest” reviewers, which has

preliminary recommendations on the goals and

brought negative publicity. This has been focused,

parameters of a new Public Protection and Physician

largely, on poorly administered monitoring protocols

Health Program in California that will serve to

and a number of tragic outcomes of addictive

protect California patients.

disease. Under the weight of this scrutiny, the MBC decided last summer to abandon the Diversion

We stand ready to work with the Legislature,

Program and allow the law that mandated it to

the Medical Board, and the larger community of

sunset. Physicians who have been successful in the

interested parties to fashion a state-of-the-art public

program for at least three years will be successfully

protection/physician health program for California.

“graduated,” that is, released with no blemishes on

We believe that the citizens of the state deserve

their record. Others will be handled by the MBC, as

the protection such a program offers. Only by

their individual cases warrant, including presumably,

having the ability to identify and monitor impaired

disciplinary action.

physicians, until they regain the ability to practice safely, is the public interest protected.

When this announcement was made, California physicians and medical societies objected strongly to

CMA, CPA, CSA, and CSAM recommend that the

what was viewed as a failure of the MBC to uphold

California Public Protection and Physician Health

its responsibility to the public and to physicians.

Despite strenuous and well-reasoned appeals, the

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MBC appears to be firm in its position. A “summit” meeting was held by the MBC in January, inviting public comment and proposals. It is unclear what the outcome will be, but the CMA and other

MARCH / APRIL 2008

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at the January Summit meeting:

physician advocacy groups will continue to look for a solution, and remain devoted to the well being of physicians and the recognition and treatment of addictive disease and mental illness among us.

Program entity be established expeditiously with the following goals:

other contract or volunteer personnel associated with the program.

•

To ensure the safety and protection of patients.

•

To focus on early intervention, assessment, and monitoring for

physicians with expertise in physician health and impairment;

physicians with significant health impairments that may impact

managed by a medical director who is knowledgeable and

their ability to practice.

responsive to the board; and staffed by individuals with strong

10. Governed by a board composed of both physicians and non-

clinical training where participant contact is required.

The following are specific operational recommendations. A California Public Protection and Physician Health Program should be: 1. Established as a formal, legislatively-sanctioned, not-for-profit, independent, but publicly accountable entity.

2. Regularly audited for clinical quality and fiscal integrity.

3. Supported by a stable and continuing source of funds from professional licensing fees.

4. Structured to provide a continuum of medically-based services including comprehensive assessment, triage, and monitoring services for behavioral disorders, including psychiatric, substance abuse, and possibly other medical conditions.

5. Open to voluntary and board-referred participants.

6. Confidential for compliant participants.

7.

Coordinator of a statewide system for drug testing with a Medical Review Officer (MRO) employed to assure the oversight of procedures and toxicology reporting and standards.

8. Actively engaged with Physician Wellbeing Committees in all phases of the assessment, triage, and monitoring of physicians.

9. Providing training of wellbeing committees, evaluators, and

Doctors are everyday heroes. They are also human.

Substance abuse, depression, and career burnout can impact anyone. Including doctors. The Physicians’ and Dentists’ Confidential Line is here to help.

About the hotline: We are a confidential hotline for impaired physicians and dentists. Our sole mission is to help impaired doctors and dentists help themselves before their lives and livelihood are put into jeopardy.

How it works: Callers are quickly put in touch with hotline staff, all of whom are physicians or dentists with expertise in the field of addiction. We are supportive and nonjudgmental, and all calls are treated with the utmost confidentiality.

Who should call: If you are a physician or dentist looking for help with substance abuse or a psychological or emotional problem, we are here to help you. Also, if you are a colleague or family member of an impaired physician, please call.

Asking for help is one of the most difficult and heroic things you can do.

Be a hero. Call us today.

Physicians’ and Dentists’ Confidential Line In Northern California: (650) 756-7787 • In Southern California: (213) 383-2691

The Physicians’ and Dentists’ Confidential Line is a project of the California Medical Association, with additional support from the California Dental Association. Membership in these organizations is encouraged, but is not required to use the hotline.

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MARCH / APRIL 2008

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New Resources Available New Resource for the Early Identification of Autism

CMA Foundation Provides Human Papillomavirus/ Cervical Cancer Toolkit

The Center for Developing Minds, a behavioral and developmental

The California Medical Association Foundation has produced

pediatric clinic in Los Gatos, now offers mini-assessments for the

a new HPV/Cervical Cancer toolkit for health care providers.

early identification of children with autism spectrum disorders (ASDs)

This toolkit includes provider and patient information in

at its Autism Screening Clinic. The program will support community

multiple languages, vaccination and screening guidelines,

clinicians in the prompt recognition of autism, so local children

newsletter articles, CME, and more. It is also available free

with ASDs, who might not otherwise receive an evaluation, will be

of charge on CD. More information is available at www.

directed into appropriate community resources and services. Children

calmedfoundation.org/projects/HPV/index.aspx.

with ASDs who begin intensive therapy at a young age achieve better overall outcomes.

Physicians today play a particularly important role in the early recognition of autism spectrum disorders. At the annual meeting of the American Academy of Pediatrics, pediatricians were advised to

AWARE Project Launches New Website

Therefore, it is critical that pediatricians be able to recognize the

Site offers the most up-to-date resources for patients and providers

signs and symptoms of ASDs and have a strategy for assessing them

The CMA Foundation is pleased to announce the launch of its all-

systematically. Yet, some doctors feel unprepared to identify and

new AWARE website at www.aware.md. The new site features the

manage children with ASDs because, until recently, many medical

latest information for patients and providers about the appropriate

schools offered little education in the area of ASDs.

use of antibiotics and related topics.

screen all children for ASDs during their 18- and 24-month-old visits.1

“For busy pediatricians, with a concern that their patient may fall in the ‘grey area’ of autism spectrum disorders, or for parents who would like reassurance at a reduced cost, these ASD miniassessments will provide a needed service in our area,” according

A new feature to the site is a comprehensive collection of CA-MRSA resources and best practices. Resources include information specific to medical professionals, athletes, childcare providers, schools and, the workplace.

to clinic director Damon Korb, MD. The 75-minute visit will include

“All of the tools that AWARE has developed for clinicians and

an evaluation summary and treatment plan. At the completion of the

patients are easy to find and download on the new website, which

exam, the family will be informed about whether or not it appears

is really convenient,” said Joe Toscano, MD, attending emergency

that their child has an ASD or other developmental delay, as well as if

physician at San Ramon Regional Medical Center. “With the new

further evaluation is recommended. A developmental and behavioral

format of the site, it’s even easier to navigate and find what you

specialist will help each family navigate possible treatment options

need. The site also contains a lot of great information about the

available through community resources. In addition, the Center for

organization, its history, mission, and goals.”

Developing Minds will continue to offer its more comprehensive ASD evaluations for families who wish to collect as much information as

Topics available for patients and consumers include frequently

possible about their developing child. For more information about

asked questions about bacteria and how to stay healthy during cold

the Autism Screening Clinic, please contact the Center for Developing

and flu season, antibiotic facts, vaccine information, and childcare

Minds, 408/358-1853 or www.devminds.com.

provider resources. Health care professionals will find valuable information on clinical resources, surveillance data and resources,

1

“Identification and Evaluation of Children with Autistic Spectrum

Disorder,” November, 2007, Pediatrics.

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MARCH / APRIL 2008

continuing education programs, and more.

Visit the new site at www.aware.md.

Continuing mediCal eduCation The California Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Medical Association designates this educational activity for a maximum of 19 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

THE DIABETES SOCIETY IS THE ANSWER TO EFFECTIVELY MANAGING BLOOD GLUCOSE LEVELS IN YOUR DIABETIC PATIENTS The Diabetes Society is an independent non-profit organization founded in San Jose as a one-stop shop for diabetes education and support in the communities you serve!

Services Offered: • ADA certified 3-step diabetes self-management program • Nutrition education and counseling • Free meters and instruction • Group classes (English and Spanish) • Support Groups (English and Spanish) • Insulin start appointments and pump training • Weight loss consultation and carb counting • Children’s diabetes camps throughout California Easy referral process with a variety of fee options including most insurance plans, Medicare and local IPA’s

> If you never thought about us for your patients, now is the time < For more information or brochures: 1165 Lincoln Avenue, Suite 300, San Jose, CA 95125 (408) 287-3785 Fax: (408) 287-2701 Email: info@thediabetessociety.org

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MARCH / APRIL 2008

13

A major focus was to seek legislation enabling physicians (a) to bargain collectively, (b) to restore lost rights to contract privately, and (c) to balance bill patients covered by all commercial and governmental insurers.

217th MEETING OF THE AMA HOUSE OF DELEGATES

217th Meeting

AMA House of Delegates RESTORE MDs’ LOST RIGHTS TO BARGAIN COLLECTIVELY MEDICARE PAYMENT REFORM: BALANCE BILLING FOR ALL PHYSICIANS STATE EFFORTS TO EXPAND COVERAGE TO THE UNINSURED TAX TREATMENT OF HEALTH INSURANCE: COMPARING TAX CREDITS AND TAX DEDUCTIONS OTHER HOD RESOLUTIONS: Economic Profiling, Medicare’s Limiting Charge, Medical Staff Autonomy, Costs of EMR, Declining Numbers of Primary Care Doctors, Public Education on Health System Reform, Regulation of Store-Based (Retail) Clinics

By Donald J. Prolo, MD, Delegate; John D. Longwell, MD, Alternate 550 delegates and an equal number of alternate delegates assembled November 10-13, 2007, in Honolulu, to parse reports and resolutions first in delegations and then reference committees, before adopting, rejecting, or referring them on the following topics: Amendments to Constitution and Bylaws, AMA Finance, AMA Governance, Advocacy in the Public Sector, Advocacy in the Private Sector, and Legislation. A major focus was to seek legislation enabling physicians (a) to bargain collectively, (b) to restore lost rights to contract privately, and (c) to balance bill patients covered by all commercial and governmental insurers.

Reference Committee L on legislation was the home

1304 (Campbell) was approved in the U.S. House of Representatives, 276 ayes to 136 nays. The bill was blocked from being heard in the Senate by then Majority Leader Doctor Bill Frist, encouraged by a $100,000,000 war chest provided by the insurance industry to defeat it and the Patient’s Bill of Rights.

With the electoral victory of Democrats in November 2006, and ascension of Congressman John Conyers to chair the Judiciary Committee in the House, an opportunity arose to revisit antitrust relief for doctors. Chairman Conyers concurrently was introducing bills that would allow community pharmacists and theater writers to bargain collectively. The chief counsel for the House Judiciary Committee told Tom Campbell, now dean of the Haas Graduate School of Business, UC Berkeley, that if the AMA considered antitrust relief a top priority, Chairman Conyers would include physicians in his bill with the pharmacists and writers. Hence, the AMA House of Delegates’ support of the following resolutions was intended to

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of two “blockbuster” resolutions:

Physician Collective Bargaining/ Antitrust Relief

RESOLVED, That our AMA redouble its efforts

MARCH / APRIL 2008

During 2007, five separate resolutions were

priority, providing the necessary foundation for fair

introduced at the AMA Annual and Interim Meetings

contract negotiations designed to preserve clinical

to reinvigorate efforts to gain Congressional

autonomy and patient interest and to redirect

sanctions that would allow physicians to negotiate

medical decision making to patients and physicians.

collectively. In the 106th Congress in 2000, HR

(Directive to Take Action); and be it further

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resonate in Washington and across the fruited plain:

to make physician antitrust relief a top legislative

november 10-13, 2007 RESOLVED, That our AMA affirm its commitment

senior care. These

to undertake all appropriate efforts to seek

statistics belie the fact

legislative and regulatory reform of state and federal

that so many physicians

law, including federal antitrust law, to enable

now restrict the number

physicians to negotiate effectively with health

of Medicare patients in

insurers. (Directive to Take Action.)

their practices, effectively

Medicare Payment Reform; Balance Billing for All Physicians

reducing access of

Between November 15 and December 31 of each

The federal government

calendar year, physicians must adopt or continue one of three possible contractual relationships with Medicare: (1) Participating physicians (PAR) agree to take assignment on all Medicare claims, wherein the physician accepts Medicare’s approved amount (Medicare pays 80% and patient has a 20% copayment) for all covered services for the duration of the calendar year. (2) Nonparticipating physicians (non-PAR) can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis, which allows the physician to bill Medicare 95% of the approved amount for the PAR physician and bill the patient up to 115% of this lower approved amount (effectively only 9.25% above the PAR approved amounts for services). (3) Physicians who opt out of Medicare are bound only by their private contracts with their patients.

Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Once a physician opts out, he/she cannot opt back in for two years.

An easily understood description of these options is available from the AMA entitled “Medicare Participation Options for Physicians.” This information is available on-line by typing in the search window www.ama-assn.org, then clicking on Participation tools for Medicare’s Physician Quality Reporting Initiative. With the annual writ of passage that requires begging the Congress not to cut allowed charges, many physicians are leaving practice, restricting their Medicare patients, or privately contracting. The Congress sees statistics that over 99% of physicians are PAR or non-PAR, still participate in Medicare in one of these two ways and thereby believes Medicare recipients are still being served by overwhelming numbers of physicians, leading the Congress annually to reduce payment without consequences of jeopardizing

seniors to care.

Medicare Payment Reform; Balance Billing for All Physicians Donald J. Prolo, MD

stipulates annual budget neutrality for those accepting the Medicare Physician Payment structure. Congress has stipulated a Sustainable Growth Rate (SGR) that is used to restrict overall outlays for medical services in the

John D. Longwell, MD

face of escalating annual costs. To accommodate this budgetary neutrality, CMS annually plans cuts in physician payment. In the waning hours of the 2007 legislative session, Congress postponed the 10% Medicare conversion factor cut and instead provided a 0.5% increase for six months. Because Congress acted very late in the session to stop the physician pay cut, the Centers for Medicare & Medicaid Services (CMS) reopened the participation

Between November 15 and December 31 of each calendar year, physicians must adopt or continue one of three possible contractual relationships with Medicare…

decision period for an additional 45 days. Physicians had until February 15 to make any changes to their participation status for 2008.

Because the reprieve was brief, participation decisions become more complicated. Physicians are still faced with a 10% payment reduction on July 1, unless Congress revamps the hopelessly broken formula used to calculate physician pay (or acts again with another last-minute fix). While it is possible that CMS will again reopen the participation decision period, there is no guarantee that CMS will allow physicians to change their participation status in July, should the cut go into effect at that time.

The following strong resolutions at the AMA Interim House of Delegates gave strong support to American doctors dismayed over these restrictions to contract

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privately and to bill fairly for services rendered.

RESOLVED, That our AMA devote the necessary political and financial resources to introduce immediately national legislation to bring about implementation of Medicare balance billing

�

and to introduce immediately legislation to end

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15

217th MEETING OF THE AMA HOUSE OF DELEGATES REPORT, FROM PAGE 15 the budget neutral restrictions inherent in the current Medicare

(5) Financing – Health care coverage should be equitable,

physician payment structure that interfere with patient access to care.

affordable, and sustainable. The financing system should strive for

(Directive to Take Action.); and be it further

simplicity, transparency and efficiency. It should emphasize personal

RESOLVED, That our Board of Trustees report back to our AMA

responsibility, as well as societal obligations. (New HOD policy.)

House of Delegates electronically by March 15, 2008, and at other times as appropriate, and every House of Delegates meeting on its

COMS Report 5 – I-07: Tax Treatment of Health Insurance: Comparing Tax Credits and Tax Deductions

progress toward the completion of all of these goals. (Directive to

Resolution 104 (A – 07) called upon the AMA to “support the idea

Take Action.)

of both tax deductions and tax credits being used to encourage the

Representative Feeney Introduces Balance Billing Legislation Immediately After HOD

individual ownership of health insurance and…use the necessary

Rep. Tom Feeney, R-Fla., introduced legislation (HR 4736) on

end.”

December 17, 2007, that would allow physicians to balance bill

Inequality and unfairness exists for the insured and the uninsured

under Medicare and for certain non-Medicare patients. The bill,

in the present system. Tax code subsidies for health insurance

based on AMA model legislation, allows physicians who elect “non-

are regressive in that people who receive insurance through their

participating” status in Medicare to balance bill patients under the

employer pay no income or payroll taxes on the value of the benefit.

Medicare program by removing the current 115% limiting charge of

If these losses were converted to the equivalent of direct

the non-participating Medicare fee schedule amount. The bill also

spending, the tax exemption would have cost the federal

preempts state laws that prohibit balance billing. The bill has been

government more than $208 billion in 2006. The only federal

referred to the House Committee on Ways and Means and House

programs that cost more are Social Security, Medicare, and national

Committee on Energy and Commerce.

defense. But all this federal money supports only employer-provided

Two Council on Medical Service (COMS) reports are of great

insurance. Individuals who buy policies do not receive any tax

importance to us practicing physicians in period of analysis and

resources to obtain passage of federal legislation to achieve that

breaks and pay with after-tax dollars. If the purpose of health care

attempts at health system reform.

reform is to decrease the ranks of the uninsured, these job-related

COMS Report 3 – I-07: State Efforts to Expand Coverage to the Uninsured (Resolution 136, A-07)

the employer health plan, the more the subsidies increase. Subsidies

tax breaks are poorly targeted and regressive: The more generous are worth more than $3,000 for upper-income families (with higher

Resolution 136 (A-07) provides the framework for the Council’s

marginal tax rates) and less than $1,000 for those on the lower rungs.

analysis of state reform efforts to expand coverage to the uninsured

Curbing these subsidies would generate billions for “universal” health

and focuses on the following considerations: (1) Coverage –

care programs. The present tax code shortchanges working-class and

Health insurance coverage for state residents should be universal,

middle-income families.

continuous, and portable. Coverage should be mandatory only if health insurance subsidies are available for those living below a defined poverty level. (2) Benefits – The health care system should emphasize patient choice of plans and health benefits, including mental health, which should be value-based. Existing federal guidelines regarding types of health insurance coverage (e.g., Title 26 of the U.S. Tax Code and Federal Employees Health Benefit Program [FEHBP] regulations) should be used as references when considering if a given plan would provide meaningful coverage. (3) Delivery system – The delivery system should ensure choice of health insurance and physician for patients, choice of participation and payment method for physicians, and preserve the patient/physician relationship. The system should focus on providing care that is safe, timely, efficient, effective, patient-centered, and equitable. (4) Administration and governance – The administration and governance system should be simple, transparent, accountable, efficient, and effective in order to reduce administrative costs and maximize funding for patient care. The system should be overseen by a governing body that includes regulatory agencies, payers, consumers, and caregivers and is accountable to the citizens.

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For purposes of expanding health insurance coverage, tax credits are more effective than tax deductions. Tax credits are defined as the amount of money subtracted directly from the income tax one owes.

Tax credits can offset the cost of health insurance coverage dollar for dollar. Health insurance tax credits should be inversely related to income and be both advanceable and refundable. Advanceable tax credits (vouchers) would provide funding to low-income individuals and families that would enable them to afford the monthly out-ofpocket premium costs of coverage. Refundable tax credits would be available for those who owe no taxes or who have tax liabilities less than the value of the credits.

Tax deductions are another form of premium subsidy for health insurance coverage. Mathematically equivalent to the tax exclusions presently available through employer-provided health insurance, tax deductions are defined as the amount of money included in gross (reported) income, but subtracted from adjusted (taxable) income.

Tax deductions provide unequal benefits per dollar spent because the benefit varies by marginal tax rate. Those paying taxes at 35% of adjusted gross income receive a much greater benefit than those

paying at 10% adjusted gross income. The value of a tax deduction

medical records and do little to cover the costs.

increases with the marginal tax rate of a taxpayer. The primary

PROPOSED ACTION: The AMA House of Delegates said

advantage of tax credits over tax deductions is that tax credits can be designed to target low-income individuals and families who have little or no tax liabilities and are most likely to be uninsured.

physicians should get a full refundable tax credit to help them buy and use health information technology, such as electronic medical record and prescribing systems. The House also reaffirmed the AMA’s support for legislation promoting technology-neutral IT,

The AMA HOD supported the COMS recommendation “That our

as well as regulations requiring stronger standardized security

American Medical Association support the use of appropriately

measures, such as encryption of data at rest. (Res. 818)

structured and adequately funded tax credits as preferable to tax

ISSUE: A declining number of family physicians and internists, and

deductions, as the most effective mechanism for enabling uninsured

fewer medical students are choosing primary care as a career.

individuals to obtain health insurance coverage.” (New HOD Policy.)

PROPOSED ACTION: Study barriers to primary care medicine as

To be effective, the tax credits (vouchers) must be advanceable and refundable for those who pay no tax or tax less than the value of the tax credit necessary to purchase health insurance.

The AMA HOD further RESOLVED “That our American Medical Association study the tax ramifications of eliminating the employee income tax exclusion for employment-based health insurance, including the possible impact of both on payroll taxes (e.g. FICA and Medicare tax to employees and employers) and individual income taxes at the state, city, and county levels with report back to the Annual Meeting in 2008. It is clear that eliminating the tax exclusion pays for tax credits; the American taxpayer cannot have both.

OTHER HIGHLIGHTS FROM THE INTERIM MEETING:

a career choice and the impact of these barriers on the profession of medicine as a whole and on access to health care.

ISSUE: Educating the American people about health system reform.

PROPOSED ACTION: Our AMA adopted a resolution to: (1) reaffirm AMA policy in support of pluralism, freedom of enterprise, and its strong opposition to a single payer system; (2) distribute its policy positions on health system reform to all declared candidates for the presidency of the United States of America and formally request their public support of these positions; and (3) undertake a media campaign designed to educate the American people about AMA policy on health system reform, emphasizing pluralism, individual ownership of health insurance and the insurance market

ISSUE: Insurance company economic profiling of physicians.

reforms necessary to allow free market principles to function. (Res.

PROPOSED ACTION: A California resolution was adopted to

717)

(1) take all appropriate steps to actively oppose all efforts by third

ISSUE: Regulation of store-based (retail) clinics.

party payers to rank, profile, or otherwise “score” physicians purely

PROPOSED ACTION: Council on Medical Service Report 5

for corporate cost containment purposes; and (2) widely publicize insurance industry economic profiling practices and how they impact patient care and access. (Res. 820)

recommended adoption of the following policy: Health insurers and other third-party payers should be prohibited from waiving and/or lowering co-payments only for patients who receive services at store-

ISSUE: Limiting charge rule adjustment.

based health clinics.

PROPOSED ACTION: That our AMA reaffirm Policy H-390.856

THE HOD RESOLVED, That our AMA ask the appropriate state

which advocates for eliminating Medicare’s limiting charge; and (2)

and federal agencies to investigate ventures between retail clinics

that until such time as Medicare’s limiting charge is eliminated, the

and pharmacy chains with an emphasis on the inherent conflicts

AMA advocate for increasing Medicare’s limiting charge each year

of interest in such relationships, patients’ welfare and risk, and

until reimbursement reflects the cost of providing physician services

professional liability concerns. (Directive to Take Action.); and

plus a reasonable allowance for the physician’s efforts. (Res. 718)

further

ISSUE: Hospital leaders’ attempts to undermine physician autonomy

RESOLVED, That our AMA continue to work with interested state

and interfere with patient care.

and specialty societies in developing guidelines for model legislation

PROPOSED ACTION: That our AMA join with other physician

that regulate the operation of store-based health clinics. (Directive to

groups in the Federation of Medicine to advocate for improved

Take Action.); and further

physician hospital relationships in discussion with the American

RESOLVED, That our AMA oppose waiving any state and/or federal

Hospital Association, the Joint Commission and the Centers for

regulations for store-based health clinics that do not comply with

Medicare & Medicaid Services, and to adopt 12 principles as AMA

existing standards of medical practice facilities. (Directive to Take

policy. (Res. 828)

Action.) (Res 705, 706).

ISSUE: Private and government payers have asked doctors to implement quality initiatives that are highly dependent on electronic

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To be eligible to receive this new benefit, you must be an SCCMA member and purchase group medical insurance for two or more members and employees through Marsh.

This service is available to qualifying SCCMA members at no charge.

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18

New Member Benefit:

Mercer Select HRKnowHow! SCCMA members who purchase their group health insurance through Marsh, SCCMA’s sponsored insurance program broker and administrator, are eligible to receive a new benefit: Mercer Select HRKnowHow. Developed by Mercer, a sister company of Marsh that is a leader in human resource consulting, outsourcing, and investments, Mercer Select HRKnowHow is a tool that helps provide employers with important human resources information.

Members now have access to important information about medical and other group benefits plans in one location. Mercer Select HRKnowHow provides the following information: •

Mercer Alerts, Updates, and Perspectives providing timely news and analysis of important benefit issues;

•

Access to the Compliance Link tool to assist with topics such as Cafeteria Plans, COBRA, Domestic Partnership, ERISA, FMLA and HIPAA;

•

Notices and Forms Connection for the above topics to help you satisfy employer compliance requirements and provide your employees with the correct forms;

•

Weekly highlights of major judicial, regulatory, and legislative developments affecting retirement, health, compensation, and employment issues;

•

California specific news and analysis to keep you abreast of state compliance issues;

•

Daily articles and news from leading newspapers and trade publications.

To be eligible to receive this new benefit, you must be an SCCMA member and purchase group medical insurance for two or more members and employees through Marsh. This service is available to qualifying SCCMA members at no charge.

Interested members should contact Marsh at 800/842-3761 for further details or for assistance with their group health insurance needs.

CALIFORNIA MEDICAL ASSOCIATION 34th Annual Legislative Leadership Conference DATE & LOCATION Tuesday, April 15, 2008– Sacramento Convention Center, 1400 J Street, Sacramento

TENTATIVE AGENDA 8:00 am 9:00 am 9:30 am 10:15 am

11:00 am 11:00 am 12:00 pm 1:30 pm 5:00 pm

Registration/Continental Breakfast CMA Welcome Health Issues and Policy Agenda Briefing Dustin Corcoran, Vice President, CMA Government Relations Political Pundits panel � Richie Ross, Democratic Strategist (confirmed) � Dan Schnur, Republican Strategist (invited) � Greg Lucas, Moderator (confirmed) Meetings With Legislators Optional Breakout Sessions Luncheon and Keynote Speaker � Insurance Commissioner Steve Poizner (invited) Meetings With Legislators (scheduled by county medical societies) Adjourn

HOTEL, TRAVEL & REIMBURSEMENT Travel, hotel arrangements, and expenses for the Legislative Leadership Conference will be the obligation of each individual participant, unless other arrangements are made through your county medical society.

The CMA room block is at the Residence Inn at Capitol Park, 1501 L Street, Sacramento, CA. You may make reservations by calling 916/443.0500 or through the website, www.marriott.com/hotels/travel/sacdtresidence-inn-sacramento-at-capitol-park.

CMA will provide meals and conference materials to all participants free of charge.

RSVP

Three ways to RSVP: Email: jean@sccma.org Fax: 408/289-1064 Phone: 408/998-8850 Ext. 3010

“FAX BACK” 408/289-1064 RSVP TODAY! SCCMA Student, Resident, Alliance, and Physician members are invited to attend!

This is your chance to make your voice count and to see what CMA is doing for you! SCCMA will provide transportation to and from Sacramento on a chartered bus. Breakfast and lunch also provided.To RSVP for Legislative Day and/or a seat on the chartered bus, please RSVP no later than April 2, 2008, to Jean Boileau Cassetta, Membership Director. We will leave from the SCCMA parking lot at 6:00 AM and return to the parking lot at approximately 6:00 PM. Seats are limited. Agenda packets will be mailed to you prior to April 15, 2008. Any questions, call Jean at 408/998-8850 Ext. 3010.

Name:

Fax:

 Yes, I will ride on the bus.

 I will meet you there

PLEASE WEAR YOUR WHITE COAT!

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MARCH / APRIL 2008

MEMBER NEWS & HAPPENINGS new

members, in memoriam

New Members Name Parvez Ahmed Jeffrey Arnold Subhas Banerjee Joseph Bistrain Bryan Chan Jeff Chan Nhu Chau Edwin Chen Marina Dergun Michael Edwards Jonathan Engelhardt Ian Ferguson Neville Golden Katherine Gray Radmila Grin Sawsawn Hayatdavoudi Paul Jackson Paulose John Michael Jones Dilshad Kekobad Heideh Khalilnejad Tim Lee John Lieu Patrick Lin

Specialty *PD *EM *GE *EM *R *EM IM OPH IM *PNS [*NS] EM *EM *ADL ORS EM EM NS *FP *EM *FP *FP *PD DR US-Student

City San Jose Salinas Stanford San Jose Mtn View San Jose San Jose San Jose San Jose Stanford Mtn View San Jose Mtn View San Jose San Jose San Jose Palo Alto San Jose Salinas Santa Clara Sunnyvale Mtn View Stanford Stanford

Name Chien-Ye Liu Seamus Lonergan Melissa Lynch Yvonne Maldonado Swati Mungekar Tuan Nguyen Walter Ogawa-Silva Donald Olson Widchanun Praserthdam Kavitha Raja Chad Rammohan Howard Rice Steven Roey Brian Saavedra Richard Sibley Vernell Smith Karl Sorensen Anna Vawter Cheryl Vu Adejare Windokun David Yeh Ken Yew

Specialty *N EMG EM *EM *PID *IM IM US-Student *CNP CD *P *CD *IM IC *IM *ID IM EM *PTH *EM *AN D US AN NS *AN

City Mtn View San Jose Gilroy Stanford Campbell San Jose Stanford Stanford San Jose San Jose Mtn View Mtn View San Jose San Jose Stanford San Jose Mtn View San Jose Sunnyvale Palo Alto San Jose Cupertino

*Board Certified | US - Unspecified

In Memoriam…

James E. Arnold, MD *Dermatology 2/4/41 – 11/3/07 SCCMA member since 1973

Paul A. Hensleigh, MD *Obstetrics & Gynecology 7/15/39 – 11/6/07 SCCMA member since 1981

Jeffrey E. Doty, MD *General Surgery 3/28/52 – 3/8/08 SCCMA member since 1990

David I. Hull, MD *Orthopaedic Surgery 1/3/21 – 2/14/08 SCCMA member since 1956

Duncan E. Govan, MD *Urology 1/1/23 – 9/07 SCCMA member since 1962

Joseph W. Kraut, Sr., MD *Radiation Oncology 1/1/29 – 11/24/07 SCCMA member since 1963

Jay V. Stanger, MD *Plastic Surgery 6/28/22 – 11/29/07 SCCMA member since 1954

Richard S. Nelson, MD *Pediatrics 10/6/23 – 2/10/08 SCCMA member since 1955

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This is one of the more important decisions that doctors face, but unfortunately is not one of the more informed ones.

Many physicians will usually hire a billing service based upon the recommendation of a colleague or simply because other physicians in their group are using the same company.

Coding NEWS

Coding

News Tips for Choosing a Billing Company

By Sandie Becker, CMC SCCMA Coding/Reimbursement Specialist

• •

This is one of the more important decisions that doctors face, but unfortunately is not one of the more informed ones. Many physicians will usually hire a

•

billing service based upon the recommendation of a colleague or simply because other physicians in their group are using the same company. However, each physician’s needs and billing functions may be

• •

different, based upon factors such as their specialty.

For example, you might have Dr. Jones, internal

•

medicine, rave about his billing service and how “on-top of things they are,” while Dr. Smith, who

•

specializes in orthopedic surgery with a sub-specialty in orthopedic oncology, needs a billing service with someone who is knowledgeable in coding and

•

reimbursement guidelines specific to this specialty.

While billing and A/R functions will have the same basic elements, Dr. Jones’ billing company may

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Request references from other companies which bill within the same specialty as yours.

Ask plenty of questions about what software they are using, request sample reports they provide, and inquire as to how often they will be onsite at your office providing you with feedback on how your collection efforts are going.

Ask them to explain their appeals process to you and how it corresponds to what the carriers use as an appeals process.

Do they provide, as part of their service, annual updates to your encounter forms?

Can they negotiate your fee schedule with insurance carriers?

Do they have certified coders on staff and, if so, what company provided certification (PMI, AAPC, or AHIMA)?

Have they adopted a third-party billing company compliance program and can they develop one for your group if you do not currently have one?

Review how their fees are structured and then compare this to other companies. The most expensive companies are not always the best, yet going with the cheapest may put you in a position that is not very comfortable.

Are they bonded and insured? How much?

suit his needs to a tee, but Dr. Smith will need to

•

know if they employ a person who understands the

The bottom line is do your homework when

differences in billing for his practice.

choosing a billing company, to ensure that you make

Please note that this article is intended to neither

the most informed decision possible. The key to

promote nor discourage physicians from out-

maintaining a healthy A/R is checking-up regularly.

sourcing their billing needs. In the interest of

Even a good company can make bad staff changes.

helping physicians find the right fit, here is a list of

Your billing company should be more than willing

suggestions if you opt to outsource: • Check to see if the company has been reported to the Better Business Bureau.

• Check to see if any of the officers or employees of the company are listed on the excluded or sanctioned provider lists. This is a searchable database located on the Web at http://oig.hhs. gov/fraud/exclusions/listofexcluded.html. The OIG maintains the List of Excluded Individuals/ Entities (LEIE), a database that provides information to the public, health care providers, patients, and others relating to parties excluded from participation in the Medicare, Medicaid, and all federal health care programs.

to provide you with updated reports, upon your request. Don’t be intimidated because you think they know more than you do. That is probably true from a coding stand-point, but you, the physician, know what you want and expect your bottom line to be.

It’s up to you to keep yourself in the loop, so you can make sure your A/R is where you want it to be.

Sources: Practice Management Institute, The Link Newsletter Yolonda Rubio, Medical Biller, Bureau of Medical Economics

Please Note: SCCMA’s Annual Awards Banquet scheduled on June 10, 2008 has been cancelled.

Our apologies... to James G. Hinsdale, MD, Vice-Chair, CMA’s Board of Trustees. In the February 2008 issue of The Bulletin, there was a typographical spelling error in Dr. Hinsdale’s name in the headlines of his article titled: “Dr. James G. Hinsdale Testifies Before the Department of Managed Health Care.”

We extend our sincere apologies to Dr. Hinsdale for this unfortunate error.

Meet Me at the Vineyard La Rusticana D’Orsa 2008

SCCMA Alliance Fundraiser Has Been Cancelled Due to recent unforeseen circumstances, your Board of Directors has been unable to complete the arrangements for holding our planned Sunday, May 18th fundraiser at La Rusticana Vineyards.

Absent availability of this attractive and inviting venue that served our highly successful fundraisers for the past three years, your Board did consider alternate sites. However, after appropriate deliberations, we decided that it would be in the best interests of the Alliance’s mission to cancel this year’s event. The support and enthusiasm of the gracious owners of La Rusticana that we deemed to be so unique and essential, led us to believe that any urgent attempt to organize our fundraiser at another location would jeopardize the historical successes of this event.

Nonetheless, your Board has reviewed the many grant applications for financial support for health initiatives from worthy community organizations. Without our fundraiser’s additional funds, we are unable to match the funding expectations of these previous three years. However, we do plan to continue to reward selected worthy agencies to the best of our financial ability. We will be selecting the grant recipients at our next Board meeting on Monday, April 14th.

We are hopeful that next year will once again provide the opportunity for us to partner with the owners of La Rusticana to help raise funding necessary for our ongoing support of many worthy health programs in our County.

Board of Directors, Santa Clara County Medical Association Alliance

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MARCH / APRIL 2008

23

Behind-thescenes, CMA will be working with the health leaders in Congress to be ready to pass a longterm Medicare SGR fix in early 2009.

CMA unveiled a longterm overhaul of the SGR in 2007 and will continue to push for its passage.

Federal Legislative Issues:

Lessons From 2007 and Priorities for 2008

By Elizabeth McNeil, CMA Vice President of Federal Issues 2007 Medicare Payment Reform PostMortem

and became consumed by the SCHIP-Healthy Families reauthorization debate. By the time the Senate turned back to solving the Medicare issues in late October, they had run out of time and money.

The CMA began early in 2007 to lay the

In December, in response to the House Democratic

groundwork for meaningful Medicare payment

leadership’s protest against the Senate’s inaction, the

reform by working with local Congressman Pete

Senate cobbled together a bill to stop the 10% cut

Stark, chairman of the Ways and Means Health

for six months. They could not get a consensus on

Subcommittee, to restore the Medicare program.

funding sources to stop the cut beyond July, since it

Congressman Stark shares our concerns that

costs nearly $15 billion to stop the 10% cut for one

Medicare Advantage health plans have been richly

year.

incentivized and rewarded for participation in the Medicare program at the expense of patients in

While the CMA is extremely grateful to the House

the traditional fee-for-service Medicare program

leaders (particularly California Speaker Nancy Pelosi,

and their physicians. In this dire federal budget

Chairman Pete Stark and Congressman Sam Farr)

environment – with Medicare near fiscal insolvency

who passed a $22 billion physician payment fix,

– it is difficult to justify 12% – 50% subsidies to for-

CMA leaders are extremely frustrated by the Senate’s

profit health plans making billions in profits while

inaction and the White House veto threats. CMA has

the fee-for-service program is nearly decimated and

let Congress know that the final action in 2007 is not

facing 40% cuts.

acceptable. The six month delay in the SGR cuts and a mere .5% update is a slap in the face to physicians

In July 2007, the House of Representatives

working hard to manage diminishing resources and

passed the Children’s Health and Medicare

increasingly complex Medicare patients.

Protection (CHAMP) Act (HR 3162). It included an unprecedented $22 billion in Medicare payment

2008 Federal Agenda

reforms for physicians. Moreover, it laid the fiscal

The top priorities for 2008 are to stop the 10%

and programmatic groundwork to eliminate the

cuts slated for July 1, 2008, by requesting another

SGR in 2009. The bill stipulated that the increases

shortterm 18-month temporary fix, and to lay the

in fee-for-service physician payments would be

groundwork to permanently fix the SGR.

financed by reducing payments subsidies to the GPCI geographic locality update for California and

Medicare SGR: Short Term/Long Term Goals

the rest of the nation. CMA and AMA worked closely

Faced with the July 1, 2008 10% payment cut,

together on the passage of this important legislation.

House leaders have indicated that they would like

The AMA correctly committed substantial resources

to include a Medicare payment fix in a budget

to this fight and the AMA also took the lead in

reconciliation bill prior to the July deadline. A

forming a national alliance with the AARP, which

budget reconciliation bill has the advantage of

was a crucial factor in the success of the bill.

being a large package of budget and spending

Medicare Advantage plans. Also included was a

the bulletin MARCH / APRIL 2008

24

provisions with enough in it for everyone to garner Unfortunately, Senate Republicans and some Senate

the necessary votes for passage and overcome the

Democrats did not support the CHAMP Act’s deep

60-vote filibuster hurdle in the Senate.

cuts to the Medicare Advantage health. When Congress returned from their month-long recess in

The most promising outcome for physicians appears

September, the Senate Finance Committee turned

to be another 18-month shortterm Medicare SGR

their attention away from Medicare payment reform

fix. Given election year politics, Congress and the

White House are not likely to produce agreement

for CMA to address the access problems and

on funding a longterm Medicare SGR fix in 2008.

physician reimbursement issues in California.

Moreover, the Congressional calendar is truncated

CMA is working with members of the California

this year because of the elections, and the recently

Congressional delegation to introduce legislation

announced economic stimulus package will

that would increase the counties/areas qualifying

consume much of the attention and available

for the HPSAs and Medicare Scarcity Area bonus

funding. An 18-month Medicare SGR package would

payments. CMA is considering changes to lower

stop the July 1, 2008 cuts and the 2009 cuts until

the physician-patient ratio criteria (both

Congress and the new administration have time

primary care and specialist) to allow

to settle-in and begin to address new business.

more areas to qualify and to allow

Finally, including a Medicare SGR provision with

physicians in the nearest cities and

Medicare Advantage funding in a large budget

towns to be eligible for the increased

reconciliation package may be the only way to

payments, as well.

overcome a presidential veto, if there are other begin an aggressive physician grassroots campaign

NHIC/Palmetto-Trailblazer Medicare Part B Contract

immediately this year to help motivate Congress to

As reported, Palmetto has been awarded the

act as soon as possible before the July 1 deadline.

Medicare Part A & B contract in California to

larger provisions that the President wants. CMA will

process claims for physician services. NHIC has filed Behind-the-scenes, CMA will be working with the

a formal protest and the GAO is expected to rule on

health leaders in Congress to be ready to pass a

the protest in the next month. CMA is advocating

longterm Medicare SGR fix in early 2009. CMA

for NHIC to maintain the contract, given its long-

unveiled a longterm overhaul of the SGR in 2007

standing history of working closely with CMA to

and will continue to push for its passage.

resolve physician payment issues. However, CMA has also begun meeting with Palmetto to ensure

Medicare GPCI

that physician issues are addressed prior to the

The House leaders, including Speaker Nancy Pelosi,

implementation date in the event that Palmetto

Chairman Pete Stark, and Congressman Sam Farr,

prevails. CMA is particularly concerned with the

have been supportive of including the GPCI fix in

transition issues and the level of resources Palmetto

any Medicare legislation this year. Unfortunately,

will commit to physician customer service.

the regularly scheduled GPCI updates took effect on January 1, 2008 around the country through the

Medical Student Loan Deferment

normal Centers for Medicare & Medicaid Servicesâ&#x20AC;&#x2122;

In 2007, the President signed legislation that

updates. Because practice costs (mainly rents) in

eliminated the economic hardship student loan

California are either declining or not increasing as

deferment program that many medical students use

fast as other regions of the country, many California

to defer payment on medical school loans until after

physicians experienced GPCI payment reductions

residency. AMA is working with the Department

ranging from 0.5% to 4% in the Bay Area. The

of Education to alleviate the short term impact on

CHAMP Act legislation was designed to not only

medical students. CMA and AMA are working on

update the payment localities, but prevent all GPCI

legislation to reinstate the program for medical

cuts in California until 2011, even the regularly-

students.

scheduled CMS updates. Because the legislation was not enacted, the CMS cuts took effect.

Anti-Trust Relief

Updating the payment localities will continue to be

Finally, CMA will begin an aggressive legislative

a major legislative priority for CMA in 2008.

pursuit of anti-trust relief for physicians. CMA is working with former State Finance Director, FTC

Medicare Rural Physician Payment Assistance

Director and Congressman Tom Campbell who

In tandem with the GPCI updates, CMA is also

Congress in 2001. It is CMAâ&#x20AC;&#x2122;s goal to introduce

seeking to provide higher Medicare reimbursement

legislation and begin committee hearings on the

to physicians practicing in the rural and suburban

issue in 2008, for passage in 2009.

areas of California. The Health Professional Shortage Area (HPSA) law is up for reauthorization this year, which provides a natural legislative venue

authored anti-trust legislation for physicians in

the bulletin MARCH / APRIL 2008

25

Classified

ADS Office Space For Rent/Lease

MEDICAL SUITES • LOS GATOS – SARATOGA

OFFICE SPACE FOR LEASE • SAN JOSE

Two suites, ranging from 1,000 to 1,645 sq.

600–1,900 sq. ft. in West Valley Medical

ft., at gross lease cost. Excellent parking.

Building, second floor, elevator, separate

MEDICAL OFFICE SPACE FOR LEASE • LOS GATOS

Located next door to Los Gatos Community

entrance. Call Helen at 408/243-6911.

Adjacent to Los Gatos Community Hospital

408/355-1519.

OFFICE SPACE FOR LEASE • SAN JOSE

All suites are built out for a medical

OFFICE FOR LEASE

Six exam rooms available, in newly

professional. Elevator served. TI allowances

Lease approximately 1,900 sq. ft. Free-

remodeled building. Located near O’Connor

available. Call Alice Teng for more

standing building—zoned medical. Turn

Hospital. Contact 408/292-0100.

information: 408/282-3808.

Key. Marble entry. Street front. Six treatment

Hospital. Both units currently available. Call

and near Good Samaritan Hospital.

OFFICE SPACE FOR LEASE • SAN JOSE & CUPERTINO

rooms. Prestigious physician’s office with balcony. Highway 85 at DeAnza Blvd. Call 408/996-8717.

Medical/Dental office for lease. 1,500 sq. ft. in San Jose and Cupertino. Contact Cindy

OFFICE SPACE • SAN JOSE

408/921-2814.

Beautiful office near Santana Row. 1,700

MEDICAL OFFICE SPACE FOR LEASE • LOS GATOS 1,974 sq. ft. located on National Avenue near Good Samaritan Hospital. Great location, elevator served. Exam rooms already built

sq. ft., seven large exam rooms + reception area, whole or part, available for sub-let.

Contact Dr. Younger 408/464-7226.

MEDICAL SUITES • GILROY First class medical suites available next

out with sinks. TI allowance available.

to Saint Louise Hospital in Gilroy, CA.

Call Alice Teng for more information:

Sizes available from 1,000 to 2,500+ sq.

408/282-3808.

ft. Time-share also available. Call Betty at

MEDICAL OFFICE SPACE FOR SUBLEASE • EVERGREEN 1,116 sq. ft. in prime San Jose location on corner of Aborn Rd and Capitol Expy.

408/848-2525.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical

Improved interiors. Signage and visability.

building. Most rooms have water and

Three exam rooms. Call Alice Teng for more

waste. Reception, exam rooms, office, and

information: 408/282-3808.

lab. X-ray available in building. Billing

MEDICAL OFFICE SPACE FOR LEASE • WILLOW GLEN Approx. 1,125 sq. ft., located in prestigious Willow Glen. Easy freeway access to I-280.

Previous use was dental lab. Call Alice Teng for more information: 408/282-3808. www.colliersparrish.com/ateng.

26

the bulletin

MARCH / APRIL 2008

available. 2,500–4,000 sq. ft. Call Rick at 408/228-0454.

MEDICAL OFFICE SPACE FOR LEASE • LOS GATOS Share office space and/or practice. Call 408/374-3303 for more information.

EXCEPTIONAL MEDICAL/DENTAL OFFICE SPACE • GILROY Convenient location with excellent visibility and accessibility. 1,280 sq. ft. suite in well established medical park. To make appointment call 408/842-2320.

MEDICAL OFFICE SPACE FOR LEASE • LOS GATOS Medical/Dental office space available for lease in Los Gatos. Close to Good Samaritan Hospital on Los Gatos Blvd. 1,057 sq. ft.

Call Alice Teng for more information: 408/282-3808. www.colliersparrish.com/ ateng.

OFFICE SPACE FOR SUBLEASE • MTN VIEW Two exam rooms and one doctor’s office, five days a week, shared waiting room, in Mountain View, on South Drive. Call 650/967-7471.

OFFICE FOR RENT • SAN JOSE Office for rent at 150 N Jackson Avenue.

862 sq. ft. $2,000 a month. Full service lease included. Please call Dr. Fishenfeld at 408/926-2200.

MEDICAL OFFICE • SAN JOSE

OFFICE FOR SUBLEASE • SAN JOSE

Valley Medical Center, prime medical

Office available for sublease near O’Connor

office suites located directly across from

Hospital. Call 408/294-7179 or 408/923-8098

and future Valley Medical Specialty Center.

for info.

Suites range from 742 sq. ft. to 2,600 sq. ft.

BRAND NEW HIGH END MEDICAL CONDOS–DOWNTOWN LOS GATOS Design/build-to-suit opportunities

Easy access to Hwys 280 & 880. Call Ngoc

OFFICE FOR LEASE • MORGAN HILL

for sale/lease. On-site parking. In the

Vu at 408/436-3606.

Ten minutes from San Jose. 1,100 sq. ft.

heart of prestigious downtown Los

Next to two primary care offices and Quest

OFFICE TO SHARE • LOS ALTOS

Lab. $2,000/month, water/sewer provided.

Options include two exam rooms plus

No net. Call 408/779-7348.

office. Newly remodeled office space perfect

SHARE OFFICE SPACE • SAN JOSE

plastic surgeon. Near El Camino Hospital.

Would like to share office space near Good

Call 650/804-9270.

Samaritan Hospital about two days per week: 408/926-2182.

FOR LEASE • SAN JOSE medical offices. Prime San Jose location.

Signage/visibility at Capitol Expy/Aborn Rd. Three exam rooms. Call broker for floor plan, tour at 408/971-2700 x112, x118.

Contact Matt–408/282-3835. www. colliersparrish.com/losgatos.

for cosmetic dermatologist, facial plastic, or

Professional medical building, 1,116 sq. ft.

Gatos. Unit sizes 1,400 sq. ft. and up.

MEDICAL CONDOS FOR SALE IN SAN JOSE Brand new, Class A medical condominiums for sale adjacent to

Private Practice For Sale

Regional Medical Center of San Jose.

Units range from 1,071–4,150 sq. ft., and some units can be combined.

Building is completed. On site parking, beautiful finishes. Call Alice Teng for more info 408/282-3808.

MEDICAL OFFICE SPACE FOR LEASE • GOOD SAMARITAN AREA

PRIVATE PRACTICE FOR SALE

Established Medical Practice has office/exam

including inventory and equipment. Close to

room space available, fully equipped. Share

O’Connor Hospital. If interested, please call

existing reception staff. Across the street

Stacy at 408/297-2910.

MEDICAL BLDG FOR SALE BY OWNER

PRIVATE PRACTICE FOR SALE

medical/dental office. 1,150 sq. ft. with

Established/Active Internal Medicine/

5,850 sq. ft. lot paved for parking. Central

Primary care practice for sale. Work/live in

San Jose location, five minutes to O’Connor

Coastal California. Enjoy best of everything.

Hosp. Upgraded or new services. Call

If interested, please call 831/345-9696.

408/247-8889.

private office, three bathrooms. Call Susan

OFFICE BUILDING FOR SALE • DOWNTOWN MTN VIEW

SMALL MEDICAL PROFESSIONAL BUILDING CONDO

408/253-6081.

7,614 sq. ft. Owner/user or investment

For sale 1,029 sq. ft. medical condo. At

opportunity. Located in downtown Mtn.

McKee & 680. Three exam rooms. Ground

View near Caltrans/VTA. Current use is

floor. Call Agt. At 408/971-2700 x112.

IM/FP/GP. Primary care practice for sale,

from Good Sam, includes patient parking.

Contact Carmen 408/371-6842.

MEDICAL OFFICE FOR LEASE • CUPERTINO 1,898 sq. ft., prime location. Easy access from hwys. 85 & 280. Two operatories, sterilization, business, reception, staff, lab,

MEDICAL OFFICE SUITE FOR RENT • SAN JOSE

medical building. Call Alice Teng for

Medical office suite for rent at 93 N. 14th

more information: 408/282-3808. www.

St. San Jose 95112. Contact Dr. Sajjadi at

colliersparrish.com/ateng.

408/294-1825 or 408/867-1111.

www.colliersparrish.com/josefigueres.

Zoned and built as general commercial

PERFECT FOR SEMI-RETIRED MD, NP, OR PA Cash-based alternative practice in biofeedback/neurofeedback. Low stress,

OFFICE FOR LEASE • SAN JOSE

MED/RETAIL/PROFESSIONAL OFFICE CONDO FOR SALE • SUNNYVALE

Available for short or long term lease. A

1,250 sq. ft. Professional/Medical/Retail

helping patients to heal themselves.

2,600 sq. ft. medical office/medical spa in

condominium Lawrence & Arques. Don’t

Ongoing mentoring provided. Terms

South San Jose, Blossom Hill Road. Rent

miss this one! Call Alice Teng or B. Mason

negotiable.

negotiable. Call 408/578-5831 for more

at 408/282-3800.

children and adults. High satisfaction

�

information.

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MARCH / APRIL 2008

27

classified ads, FROM PAGE 27

EMPLOYMENT OPPORTUNITY

OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY

FAMILY PHYSICIAN NEEDED

Our occupational medical facilities offer

MEDICAL PRACTITIONER WANTED

(16 hours) per week. Email C.V. to skale.

a challenging environment with minimal

md@gmail.com.

Physicians, Physician Assistants, or

stress, without weekend, evening, or “on

Registered Nurses needed for contract

call” coverage. We are currently looking

positions at the San Jose Military Entrance

for several knowledgeable and progressive

COLLEGE HEALTH PHYSICIAN • MISSION COLLEGE, SANTA CLARA

Processing Station, 546 Vernon Ave.,

primary care and specialty physicians

Physician needed (part-time, 4-5 hours/1-2

Mountain View. Medical Practitioners will

(orthopedist and physiatrist) interested

weeks/regular semesters). CA medical/

conduct medical qualifications examinations

in joining our team of professionals in

active DEA license. Immediate opening.

of applicants for all branches of Armed

providing high quality occupational medical

Call 408/855-5141, fax CV/resume to

Forces. Must hold a current unrestricted

services to Silicon Valley firms and their

408/567-0510, or email: rosalyn_chan@wvm.

license. Practitioners will be subject to

injured employees. We can provide either

edu.

credentials approval by the Headquarters

an employment relationship including

U.S. Military Entrance Processing Command

full benefits or an independent contractor

prior to employment. Excellent opportunity

relationship. Please contact Dan R. Azar

FAMILY PRACTICE PHYSICIAN OPENING

for someone looking for a flexible, part-time

MD, MPH at 408/790-2907 or e-mail

Six MD Family Practice Group is searching

work schedule from 1-2 days per week to

dazar@allianceoccmed.com for additional

for a full-time Board Certified FP. Position

as little as a few hours per month. If you

information.

immediately available. Contact David

board certified physician to work part-time

W. McCullough, MD at AFPMG, phone:

are searching for this unique opportunity, contact Ms. Veronica Knight at 650/603-8236 to become part of our team.

A growing private practice in San Jose seeks

WWW.SHSMEDICAL.NET HIRING

408/997-9155, fax: 408/997-9106, or email:

New 6,000 sq. ft. medical facility in

afpmg@hotmail.com.

Manteca. Looking for physicians, PA-C or NPs with X-RAY. Limited license helpful.

Apply business@shsmedical.net.

TRACY ZWEIG ASSOCIATES, INC. Physicians Physician Assistants Nurse Practitioners LOCUM TENENS PERMANENT PLACEMENT

VOICE: (800) 919-9141 or (805) 641-9141 FAX: (805) 641-9143 E-Mail: tzweig@tracyzweig.com Website: www.tracyzweig.com

28

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MARCH / APRIL 2008

PEDIATRIC PRACTICE OPPORTUNITY Busy Pediatrician in an established group practice in San Jose is looking for a partner to practice-share or work part-time. Excellent call rotation and hospitalist coverage. Great

ROSA ELENA CHILDCARE CENTER

opportunity for someone looking for work-

A+ TRANSCRIPTION SERVICE Providing Clinicians Quality Medical Transcription Since 1995

life balance. Email: pedmd@yahoo.com.

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condo rentals CONDO RENTAL • ON THE BEACH AT MONTEREY BAY Vacation respite at Pajaro Dunes on Monterey Bay, smack dab on the beach, with full ocean view from 2nd level. Shorebirds

A safe, play-based, nurturing environment that develops confident, happy children.

section, one bedroom, fireplace, fully equipped, tennis courts on the property, $250 per night, two-night minimum.

Contact Robert Weinmann or Marie Barry at 408/292-0802.

INCLINE VILLAGE NEVADA Large 4 bedroom house with deck facing lake. Weekly rentals only. $2,100/week with deposit. Call rental agency: C. A. Silva, 408/834-0557.

FOR SALE

Wonderful outdoor & indoor spaces.

Caring teachers, low ratio.

Featuring Kindergarten-readiness & intergenerational programs.

Now offering potty-training Full-time and Part-time Available

MEDICAL OFFICE EQUIPMENT Retiring. Office and medical equipment for sale, available now. Call 408/374-9900 for information.

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the bulletin

MARCH / APRIL 2008

29

To the Editor…

As a practicing oncologist for the past 30 years or so, I have obviously seen many patients die of their disease. It was not until a family friend visiting from out of town died unexpectedly this Christmas, however, that I was confronted with the actual cost of dying!

My friend died unexpectedly at 3:00 a.m. the day after Christmas and, after the coroner released the body, the family was confronted with “what do we do now?” So they looked in the phone book and picked a reputable mortuary. A van was sent to pick up the body ($695). The next day, the new widow and her children went to the mortuary to arrange for the funeral and burial. They were confronted with a long list of options, and likened the experience to that of trying to buy a car. The “salesman” would quote a price and if the family objected, he would disappear to “talk to his manager” and come back 20 minutes later with a discounted price or a new offer.

The casket could be anywhere from $500 to $22,995. They could forgo a casket if they chose cremation ($3,290), but of course, there had to be a cremation casket ($995 to $2,995), and then a cremation container ($495 to $7,795). The family chose a simple casket ($2,000) and declined embalming ($995), but still had to pay for bathing the deceased ($195), dressing the deceased ($395), and refrigeration ($775). Then, there was the actual burial plot. Land is scarce in Santa Clara County and the cheapest they were offered was $8,000. Then, of course, there is the actual grave, which has to be lined ($1,500). Then, there was the use of staff for a graveside service ($695), the visitation fee ($500), and, of course, the reception fee ($250). This was after the transfer of the body from the funeral home to the cemetery ($695), and, finally, the charge for the “funeral director’s overhead, facility maintenance, equipment and inventory costs, insurance and administration expenses, and governmental compliance” ($2,645). Then, of course, there is the death certificate at $75 per copy—recommendation a minimum of seven copies. It all adds up to about $20,000!

Everybody dies and everybody needs to be buried or cremated, and it seems to me that these charges are way out of line—it costs more to die than to be kept alive. Medicine is, of course, the most heavily regulated profession in America. Are there any regulations or controls on charges by mortuaries?

James R. Cohen, MD

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the bulletin

MARCH / APRIL 2008

You may not know our name, but if you practice in Santa Clara county you know our service. For over 30 years, SOURCECORP Deliverex has been the vendor of choice for record management in the Bay Area.

Where Do You SenD Your Patients with end-Stage heart Disease?

California Pacific Medical Center’s Adult Heart Transplant and End Stage Heart Disease Programs offer leading-edge therapies plus quality care and compassion for patients needing: • • • • •

Late stage heart failure diagnosis and therapy Temporary percutaneous total cardiac support Heart transplantation First- and second-generation LVAD devices for bridge-to-transplantation Permanent implantable cardiac support devices

Acute and chronic heart failure, acute myocardial infarction with shock, cardiovascular collapse, heartbased secondary organ failure and post-cardiac surgery acute heart failure are now all selectively treatable with good results using a variety of recent drugs and devices – but timing is crucial.

California Pacific is a certified CMS destination therapy center for patients with end-stage heart failure who are ineligible for a transplant due to age, additional health problems or other complications. We go “beyond medicine” by being the only Bay-area hospital to provide a dedicated nursing unit for heart failure, VAD and transplant patients, featuring: • • • • •

Private rooms Beds available 24/7 for your emergency transfers Family room outfitted for patient and family’s use with exercise and video equipment A dedicated, specially-trained nursing staff > 90% patient satisfaction scores

We also go beyond medical care and provide our patients and families with disease counseling, spiritual support and reduced rates for patient and family housing.

heart Transplant outcomes 1 Yr CPMC

1 Yr National

3 Yr CPMC

3 Yr National

Patient Survival

82.61

85.15

88.24

82.13

Graft Survival

84.00

84.81

89.47

79.28

Source: SRTR Data released 07/2007 and CPMC internal data

For more information: 888-637-2762 The Adult Heart Transplant and End Stage Heart Disease Program is associated with California Pacific’s Heart and Vascular Center, which offers quality, comprehensive, patient-centered cardiovascular care by a team of pioneering physicians integrating leading-edge technology.

Our team Of surgeOns & cardiOlOgists combined have over 80 years of heart failure, heart transplant and Vad experience:

J. donald Hill, m.d. g. James avery, m.d.

Preben Brandenhoff, m.d. ernest Haeusslein, m.d.

www.cpmc.org

partnership

whatdrivesyou?

A commitment to excellence.

A passion for the art of medicine.

A basic desire to heal.

Whatever it is that sustains you through the daily challenges of your profession, know that you have an ally in NORCAL.

(800) 652-1051 l www.norcalmutual.com

NORCAL is proud to be endorsed by the Santa Clara County Medical Association as the preferred professional liability insurer for its members.

THE

BULLETIN

A PUBLICATION OF THE SANTA CLARA COUNTY MEDICAL ASSOCIATION

700 Empey Way, San Jose, CA 95128-4705

Address service requested

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