NOVEMBER / DECEMBER 2008 | Volume 14: Number 6
Membership Has Its Benefits
We’ve got the pulse on health insurance… Santa Clara County Medical Association members use Marsh to solve health insurance concerns. Premium rates keep increasing. Benefits keep reducing. It’s a never ending roller coaster. And finding the time to review your options for the upcoming year is usually difficult. SCCMA helps make it easier on you. Right now you can easily review and compare health insurance coverage that puts your best interests first — with Marsh, the SCCMA-endorsed health insurance consultant. • Want to make sure your current plan is still the best for you? Marsh will review the options available and compare them to your current plan. No risk, no obligation, no pressure to buy. • Looking to save money on your coverage? Marsh will review your current coverage to make sure you’re not paying more than you need to — and offer suggestions to help you save money.
Examples of how we helped physician offices this year: Practice #1: Implemented a High Deductible Health Plan and started Health Savings Accounts for its two physicians. Saved: $20,000
• Tired of increases from your current insurance company? Marsh works with many insurance carriers so you have access to more alternatives that will work best for you.
Practice #2: Switched carriers but stayed in a comparable plan.
• Wish you had access to HR resources? Small groups that purchase their health insurance through Marsh are also eligible to enroll in Mercer Select HRKnowHow at no charge. If you need to stay current on health & benefit issues, need sample forms for required compliance tasks such as COBRA, or need at-a-glance information about important HR matters, Mercer Select HRKnowHow may be just what you need.
Practice #3: Switched this office to a carrier that offered a lower risk adjustment factor and a high deductible health plan.
• Choice of flexible health insurance solutions: From HMOs and PPOs to HDHPs and HSAs — we’ll find the best solution for you and/or your practice. Marsh has been serving the needs of doctors and their practices for more than 30 years. So you can trust them to help you with your health insurance needs — now and in the future. Endorsed by:
Saved: 24% on annual premiums
Saved: $30,000
Marsh is ready to help you today! Call a Client Service Representative at 800-842-3761.
Administered by:
and the California Medical Association
© 2008 Seabury & Smith Insurance Program Management • CA License #0633005
777 South Figueroa Street, Los Angeles, CA 90017 • (800) 842-3761 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com • 10/08 Marsh is part of the family of MMC companies, including Kroll, Guy Carpenter, Mercer, and the Oliver Wyman Group (including Lippincott and NERA Economic Consulting).
SCCMA the
bulletin
Santa Clara County Medical Association Bulletin
Table of Contents
the Editor’s Desk 4 From Joseph S. Andresen, MD
President’s Message 5 TheHoward Sutkin, MD, FACS
Printed in U.S.A.
6 SCCMA Member Benefits/Services 2007-08 Legislative Wrap-Up 14 CMA’s Dustin Corcoran
16 Hospital News Injuries…What’s Next? 17 Multi-tasking William C. Parrish, Jr.
the Physician-Patient Relationship 18 Terminating NORCAL Mutual Insurance Company
Benefit: Insurance Products and Services 20 Member Marsh Affinity Group Services
21 CMA ON-CALL: Free Practice Resource Service 22 Member Benefit: TPO Human Resource Management Benefit: Billing, Collections, and Office Management Services 24 Member Mark Christiansen, Bureau of Medical Economics
26 Santa Clara County Interpreting and Translation Resources Improve Your Search for a Practice Manager 30 How toGeorge Conomikes
32 Member Benefit: Reimbursement Advocacy Program 34 SCCMA Awards Nomination Form 36 MEDICO NEWS 40 Classified Ads 42 Alliance News Officers
President Howard Sutkin, MD VP-Community Health Cindy Russell, MD VP-External Affairs William Lewis, MD VP-Member Services James G. Hinsdale, MD VP-Professional Conduct Jim Crotty, MD Secretary Thomas M. Dailey, MD Treasurer Martin L. Fishman, MD
Chief Executive Officer William C. Parrish, Jr.
House Officer Representative
Jacob Ballon, MD
AMA Trustee - SCCMA John D. Longwell, MD
SCCMA/CMA Delegation Chair
Tanya W. Spirtos, MD
CMA Trustees - SCCMA
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
Councilors
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.
Community Hospital of Los Gatos:
Judith Dethlefs, MD El Camino Hospital:
Michael Curtis, MD Good Samaritan Hospital:
Eleanor Martinez, MD Kaiser Permanente Hospital:
Allison Schwanda, MD O’Connor Hospital:
Jay Raju, MD Regional Medical Center of San Jose:
Hossein Habibi, MD
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Saint Louise Regional Hospital:
John Saranto, MD Santa Teresa Community Hospital:
Efren Rosas, MD Stanford Univ. Medical Center:
Peter Cassini, MD Santa Clara Valley Med. Center:
Patrick Kearns, MD
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I bet you didn’t know that November is the AMA “Heal That Claim” month. Underpayment, denial of claims, and delay of payment by insurance payers result in significant financial costs to physicians.
From the
Editor’s
Desk…
“Ask not what your country can do for you, but what you can do for your country.” This eloquent call for participation and volunteerism by John F. Kennedy, more than 40 years ago, still rings true today. However, we are going to turn the tables and not ask what you can do for the Santa Clara County Medical Association, but what we can do for you in this month’s SCCMA Bulletin. As a physician- and medical-support organization, there are a myriad of services that physician members are entitled to receive and from which they benefit. I bet you didn’t know that November is the AMA “Heal That Claim” month. Underpayment, denial of claims, and delay of payment by insurance payers result in significant financial costs to physicians. The National Health Insurer Report Card provides a benchmark in timely payment of provider services by all major insurance payers. This information is a powerful tool to help ensure compliance and effective processing of bills for all physician specialties. Did you know that as an SCCMA member, you have a powerful ally in “RAP?” Reimbursement Advocacy Program (RAP) is available exclusively to physician members in dealing with problems in collecting
are paid within 30 days for PPO plans and 45 days
for HMOs, in accordance with state law. Read on to
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On the larger political and legislative stage, the Santa Clara County Medical Association continues to be your strongest advocate. Through these important efforts, we have protected MICRA, that ensures affordable malpractice insurance premiums. Despite the financial crises, cuts in reimbursement for Medicare and Medi-Cal patients have been avoided. This allows us to continue to care for those patients who are often in most need These are only a few of the reasons that I strongly encourage you to speak to your colleagues who are not yet members of SCCMA or their local medical associations. You can be, in essence, a “community organizer” in this regard. And through your example to others, you do have an important responsibility in our patients’ and medical profession’s future. Respectfully submitted, Joseph Andresen, MD | Editor
EDICAL A M Y S T N
R A A CO L C A U NT
program will help ensure that your “clean claims”
NOVEMBER / DECEMBER 2008
this month’s Bulletin.
I recently switched to a higher-deductible plan
and reduced my family’s health insurance costs
by $6,000 per year! Insurance services available to SCCMA members provide guidance to group
cost savings that can magnify significant savings
ION • CIAT SO
from managed care and any insurance plan. This
learn more about this important service.
themselves and others. More details are discussed in
of our services.
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to physicians who are responsible for insuring
The
President’s Message
Dear Members: I want to thank each and every member of SCCMA for hanging in there, during the past year, through all of the faxes, emails, elections, and flutter of speculation surrounding your medical association. Let me assure you that we are poised for the upcoming year to be an effective and responsible organization, well equipped to serve all of our members. The following officers and councilors were elected by ballot: OFFICERS AND COUNCILORS
POSITIONS UP FOR ELECTION President-Elect Vice President for Community Health Vice President for External Affairs Vice President for Member Services Vice President for Professional Conduct Secretary Treasurer Councilor #4 (VMC) Councilor #6 (Stanford) Councilor #8 (El Camino) Councilor #10 (Good Samaritan)
I am serving as your president, filling the term of Doctor Jerry Hanson who has retired from practice. We recently held a strategic planning meeting in October, in order to respond to the needs of our community and to react to all of the attacks on the practice of medicine. Our statewide organization, the CMA, of course continues to be primarily focused on protection of the doctorpatient relationship. Over the past few years, in concert with the CMA, your MICRA protections have been defended successfully, allowing malpractice insurance in our state to be available and affordable. Your delegation to the CMA has just returned from Sacramento and is educated and updated on the current state of legislative affairs. In addition, we continue to fight a good fight holding back, to the best extent possible, Medicare and Medi-Cal rate cuts and, importantly, your ability to send a private bill to patients receiving emergency out-of-plan care. It is critical that we remain together in this fight going forward and, therefore, membership is more critical today than ever. I believe that our medical association can improve itself in many ways. First, I would like us to be
Please be reassured that our leadership is sound, our budget is monitored, and we are on firm ground with growing opportunity.
ELECTED OFFICIAL Howard Sutkin Cindy Russell William Lewis James Hinsdale Jim Crotty Thomas Dailey Martin Fishman Patrick Kearns Peter Cassini Michael Curtis Eleanor Martinez more visible to our members, and I will be asking your councilors if they would be willing to help in a more regular effort to keep you informed with what is going on. Also, I want to encourage all members to get involved. Let us know if you can serve on a committee, join the CMA delegation, or just join us for a council meeting. I would welcome any suggestions you may have regarding how we can be of more help to you. This is a service organization. Countless hours of time are donated because we believe in the goal of steering the practice of medicine back to the noble place that it belongs. I plan on doubling our efforts to recruit new and interested doctors to represent us in our statewide legislative action — this is where we can be most effective. Please be reassured that our leadership is sound, our budget is monitored, and we are on firm ground with growing opportunity. I am convinced that the future of our profession is bright only if we stick together. Let’s all get involved. Respectfully submitted, Howard Sutkin, MD, FACS | SCCMA President
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SCCMA MEMBER BENEFITS / SERVICES
SCCMA
Member Benefits/Services SCCMA members are entitled to a host of discounts from both local and national vendors that provide a wide range of products and services. Enhance your personal and professional life, while saving time and money, by being familiar with our member benefits and services. Listed below is a summary of the different categories of benefits and services currently available. Following the summary is a list of the vendors (with contact information) who provide the special services and/or discounts to SCCMA members.
equipment, or a house; process credit card payments; open new accounts; or invest wisely for the future. Whatever your financial needs, our partners are there to help you.
•
Banking/Financial Services
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Car Rental/Repair/Sales/Leasing
Chase Manhattan Home Mortgage Program •
Savings of 1% of your total loan amount.
•
Catering/Conference Meeting Facilities
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Free pre-approvals (a $75 value).
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Claims Assistance
•
•
Classified Ad Service
Expanded qualifying ratios to help you qualify for a larger loan amount.
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CME Certification Tracking
•
•
Coding & Billing Seminars
For more information, call Scott Hackbarth at 1-866/291-2249 extension 307 or www.chase.com.
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Complaint Resolution
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Computers/Software/Support/Solutions
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Contract/Negotiation Analysis
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Entertainment/Recreation Discounts
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Graphic Design/Printing & Copying
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Home Technology Product Advice and Services
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Information and Advice (free CMA ON-CALL Documents)
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Insurance
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Legal Services
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Legislative Advocacy
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Mailing Lists/Labels
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Medical Collection/Billing/AR Management Agency
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Office Management
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Physician Referral Service
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Physicians’ Confidential Line
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Practice Supplies & Resources
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Publications
•
Real Estate
•
Tax Audit Defense
Banking/Financial Services SCCMA partnerships with some of the largest financial institutions in the nation allow our members to receive special rates on various financial services. Available for both your personal and professional life, these companies can help you buy or sell a medical practice,
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ComericA Bank •
$500 credit towards nonrecurring closing costs at close of escrow.
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1/4% higher than posted CD rate over $50,000.
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1/2% discount off posted rate along with no fee.
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For more information on obtaining a loan to start a practice, purchase office equipment; call Jo Matheson, Vice President at 408/556-5261.
JP Morgan Chase for Credit Card Processing •
Eliminates going through sales companies and resellers for your credit card processing needs.
•
Same corporate wholesaler rates as premier Fortune 500 companies, and SCCMA members will have these benefits passed directly to them.
•
Savings from 15% - 50% – may even pay some or all of your membership dues!
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For a complete free analysis, fax a copy of your recent credit card processing statement to SCCMA, 408/289-1064. After the analysis is complete, it will be faxed back to you for review.
Legacy Wealth Advisors, LLC •
Provides financial planning, investment counseling, retirement planning, professional money management, and more.
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A $2,500-$3,000 comprehensive financial plan is now available to SCCMA members for a $750 fee.
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For more information, call Ed Ryu at 408/452-7700.
MBNA-Credit Card •
Great interest rates – Complete the application over the phone in minutes!
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Call 1-866/GET-MBNA (438-6262) (Use priority code: MPF2).
Mercer Global Advisors (MGA) •
Provides discounted guidance in pension and estate planning, portfolio management, retirement planning, budgeting, personnel issues, and more.
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For more information, call 1-800/898-4642.
SCCMA MEMBER BENEFITS / SERVICES Salomon Smith Barney •
Provides complete retirement plan design, administration, and annual government reporting, while giving members the ability to be their own trustees and have full investment flexibility.
•
For more information, call 1-877/262-6200.
Car Rental/Repair/Sales/Leasing Whether you are servicing your favorite ride or you are looking to upgrade, SCCMA can help you find the service you need. Discounts are available to our members for car purchases, leases, and rentals, as well as quality service and repairs.
Autobahn Los Gatos Auto Repair •
Specializing in BMW and Mercedes Benz.
•
Most foreign cars serviced.
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10% discount on labor for SCCMA members.
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Call Gary or Dave at 408/356-5985 for more information or to schedule an appointment.
Avis •
Provides a 5% - 25% discount to CMA members, depending on travel destination.
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Call 1-800/331-1212 (priority code A895200) and they will book your rental car.
Catering/Conference Meeting Facilities On-site conference center with seating up to 100 people. Catering also available. Contact Maureen Yrigoyen for more information at 408/998-8850 or maureen@sccma.org.
Claims Assistance and Collections Have you ever needed help getting a payment? SCCMA offers a number of services that can help. From reimbursement advocacy to dispute resolution and collection services, our partners will help you get the payment you deserve.
SCCMA Reimbursement Advocacy Program The Reimbursement Advocacy department has helped SCCMA members collect over $2,000,000 in claims from insurance companies after their best efforts failed! Contact Sandie Becker, CMC, Coding/Reimbursement Specialist at 408/998-8850 extension 3007 or email her at sandie@sccma.org for more information.
Insurance Review Analyzes disputes involving patients, physicians, and third party payers. Formed over 30 years ago and comprised of SCCMA physician members. Provided free of charge to SCCMA members. Contact Sandie Becker, CMC, Coding/Reimbursement Specialist at 408/998-8850 extension 3007, email: sandie@sccma.org or refer to our Web site, www.sccma.org for more information.
Hertz •
•
Offers up to 15% off daily member benefit rates and 10% off standard daily, weekly, and weekend rates on all car classes for business and leisure rentals. Call 1-800/654-2200 for more information.
Frontier Ford •
Most new Ford cars and trucks at Fleet Pricing.
•
All rebates and other incentives offered by Ford at the time of delivery will apply.
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Ford’s Red Carpet Lease Program based on the purchase price.
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Access to low mileage previously-leased cars, when available, at significant savings.
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Note: You must bring a member verification letter from SCCMA at time of purchase. Call Jean Cassetta at 408/998-8850 extension 3010.
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For more information, call Tony Hill or Jason Tsoi at 408/5576361.
Prospect Vehicle Leasing & Sales •
Open- or closed-end leases and purchases.
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All makes and models, including foreign cars and trucks.
•
Discounted used and demo vehicles.
•
No termination penalties.
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Free delivery.
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Call Tom Harrington at 1-209/477-9888 for more information.
Classified Ad Service Classified ad service is available through our magazine, The Bulletin at a 50% discount. Contact Pam Jensen, Managing Editor, at 408/9988850 extension 3012, email: pjensen@sccma.org or refer to our Web site, www.sccma.org for more information.
CME Certification Tracking Continuing Medical Education (CME) •
For just $29/year ($49 for non-members), CMA’s Institute for Medical Quality (IMQ) will certify physicians’ CME for credentialing purposes to the MBC, hospitals, health plans, specialty societies, etc.
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Contact CMA’s Certification Department at 1-415/882-5151 for your forms or more information.
Coding & Billing Seminars SCCMA sponsors coding and billing seminars. Seminars will be posted on our Web site, www.sccma.org.
Complaint Resolution SCCMA peer review committees look into problems arising between patients and physicians, physicians and physicians, and problems with insurers or managed care organizations. The committees follow specific protocols and make recommendations based upon case review. Additional information can be found on our Web site, www.sccma.org.
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SCCMA MEMBER BENEFITS / SERVICES
Computers/Software/Support/ Solutions
Entertainment/Recreation Discounts
Technology has an increasingly vital role in today’s marketplace, and health care is no exception. SCCMA has partnered with several companies to ensure its members have access to the latest technology available. Discounts on remote data storage, medical and office-management software, computers, and other office essentials are available to keep you up-to-date without spending a fortune.
Looking for a getaway? SCCMA may be able to help. Our members can purchase discounted tickets to all of our local theme parks, including Monterey Bay Aquarium, as well as lift tickets to Heavenly Lake Tahoe during the winter. Discounts are also available for attractions and hotels throughout the country. For those with a sweet tooth, we offer discounted gift certificates for See’s Candies.
Axcient/Data Back-up Services
Discount Ticket Program
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SCCMA’s official provider of back-up services.
•
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Automated secure offsite data storage, simple data recovery.
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Excellent data back-up requirements mandated by HIPAA.
Discounted tickets available for Gilroy Gardens, Great America, Raging Waters, Six Flags Marine World, Monterey Bay Aquarium, and Heavenly Ski Resort.
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Backs-up medical and financial data securely.
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$10 gift certificates for 1 lb box of See’s Candies.
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Physicians can access vital patient records from home.
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Additional hotel and other discounts available upon request.
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Starts at $12 per month for 1 GB of data.
•
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SCCMA members receive a FREE security and data back-up report at their network.
Contact Rachael Hernandez at 408/998-8850 extension 3008 for delivery or more information.
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To schedule your assessment, call Steve Farnsworth at 408/2871349 extension 104.
Breveon •
Breveon is the leader in developing and marketing the most accurate medical speech recognition tools for health care professionals to use in dictation, transcription, and clinical data management.
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Discount given to SCCMA members.
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For more details, call 1-650/691-2061.
Epocrates •
Save 20% on Epocrates’ premium products, including the Epocrates Essentials all-in-one mobile guide to drugs, diseases, and diagnostics (includes Epocrates Rx Pro premium drug reference, Epocrates Dx disease reference, and Epocrates Lab diagnostic reference).
Graphic Design/Printing & Copying Copyland •
Graphic design, printing, and copying services at 10% discount.
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Free pick up and delivery.
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Call Frank at 408/971-2722.
Home Technology Product Advice and Services Bay Area Gadgets •
15 years experience testing and reviewing technology at Good Guys, CompUSA and Best Buy backed daily research of 40 publications.
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Author of 50 personal technology articles providing unbiased recommendations.
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Unmatched knowledge of technology trends and which products deserve your money.
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Unique ability to match entertainment furniture into quality video and audio.
Contract/Negotiation Analysis
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Up to the minute advice on PCs, peripherals, and software. Personal training.
CMA’s Contract Analysis
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Affordable, bonded installation and handyman services by master craftsmen.
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10% discount for SCCMA members.
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Contact James Stout, Owner, at 408/393-4779. More information is available at www.bayareagadgets.com.
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Point-of-care access to up-to-date information on drugs, diseases, and diagnostics (software for desktop and mobile devices).
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Call 1-800/230-2150 or visit www.epocrates.com for details.
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•
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Physician members have free access to CMA’s Model Managed Care Contract and objective written analysis of major health plan contracts. These documents address issues commonly present in managed care and employment contracts. CMAcontracted attorneys will also provide members with a 15% discount on other contract analysis services. These attorneys will review various types of physician contracts for compliance with California and federal law and determine whether, from a business or practical perspective, the provisions of the contracts are beneficial. For more information, call CMA at 1-415/882-3361.
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SCCMA MEMBER BENEFITS / SERVICES
Information and Advice (Free CMA ON-CALL Documents) The SCCMA and CMA professional staff are available to members and their staffs to answer questions affecting your medical practice. CMA also has an online library containing thousands of pages of medical-legal, regulatory, and reimbursement information. These ON-CALL documents are available free to members and can be downloaded from the members only Web site, http://www.cmanet. org/logon.
•
Employment Practices Defense You are responsible for your behavior in the workplace, as well as the behavior of your staff. PAD reimburses the legal defense costs for employment-related civil actions, including allegations of sexual harassment, discrimination, and wrongful termination (up to the applicable limits of reimbursement).
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Practice Interruption Expense Nothing can be more frustrating—and even crippling—than losing revenue because you have to attend administrative hearings or a lengthy trial. PAD makes direct payments to you to offset lost practice revenue incurred during your required presence at administrative proceedings or employment-related
Insurance SCCMA members may choose from a variety of discounted insurance programs available for both their personal and professional lives, such as group medical, dental, workers’ comp, life, AD&D, auto, and homeowners’ insurance.
Marsh Affinity Group Services •
Competitively priced packages for solo, small, medium and large groups.
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Group medical, workers’ comp, life, and AD&D insurance.
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Health Savings Accounts (HSA) plus investment options.
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Call 1-800/842-3761.
Mercury Insurance Group-Auto Insurance •
Discounted, competitively priced rates – homeowners insurance, too!
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Call 1-888/637-2431 or www.mercuryinsurance.com for more information.
NORCAL Mutual Insurance Company •
SCCMA and 23 other northern County Medical Associations sponsor NORCAL.
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Call Jeanne Zosky at 1-800/652-1051 for details.
Legal Services The legal aspects of practicing medicine can sometimes be overwhelming. When SCCMA members find themselves in need of legal assistance, these often become the most important benefits we offer. For years, our trusted partners have helped our members with issues such as legal costs, audits, and settlements.
CMA’s Legal Information Line
civil actions. SCCMA members incur no out-of-pocket expenses and do not need to be reimbursed for any of the previously mentioned defense costs. For details on how to use PAD, or for defense costs reimbursement specifications, call Jean Cassetta at 408/998-8850 extension 3010 or the NORCAL Claims Department at 1-800/415-0791.
Viaticus •
A viatical settlement enables an individual with a terminal or chronic illness to sell their life insurance policy for cash.
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Call 1-800/390-1390 for more information.
Legislative Advocacy CMA’s staff lobbyists and physician advocates keep legislators aware of how proposed legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. They are overwhelmingly successful at winning lawmaking battles and equally effective at changing and blocking contentious legislation that could adversely impact physicians and their patients. CMA’s Government Relations provides a weekly legislative update as well as additional information on what physicians can do to support or oppose specific pieces of legislation important to medicine. Legislative Hotline: 1-866/462-2819; Legislation Hot List is available on CMA’s Web site, www.cmanet.org,
Mailing Lists/Labels Members may use the SCCMA membership mailing list at a discounted rate. To place an order, contact Pam Jensen, SCCMA Managing Editor, 408/998-8850 extension 3012 or by email to pjensen@sccma.org.
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Health law information specialists are available to assist members in obtaining medico-legal information and resources, including contact information for outside resources when appropriate.
Medical Collection/Billing & AR Management Agency
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For more information call 1-800/786-4262 or email legalinfo@ cmanet.org.
Bureau of Medical Economics (BME)
PAD – Physicians Administrative Defense PAD pays your defense costs for these events: • Medical Licensure, Credentialing, and Privileges Even after a medical liability claim is resolved, an action may be filed against you by an administrative entity, including government agencies, regulatory boards, employers, and thirdparty payers (for example, HMOs).
BME has almost 60 years of experience in collections, and now offers billing and AR management. An affiliate of the Santa Clara County Medical Association, BME has a recovery rate approximately twice the national average. Members receive a 5% or more discount off the basic rate, based on volume. Contact Mark Christiansen, General Manager, at 408/998-5811 extension 3029 for more information.
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SCCMA MEMBER BENEFITS / SERVICES
Office Management Manage your office more effectively while saving time and money! SCCMA has arranged for discounted services for our members on many aspects of office management, including practice valuations, practice planning, human resources, OSHA compliance, staffing, and more. Contact our partners today to learn more.
Business Search (Buying & Selling a Practice)
The Personnel Office (TPO) •
TPO offers consulting for employee handbooks, new hire paperwork, performance appraisal systems, discipline systems, and more.
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SCCMA members receive a free initial inquiry and a 10% discount on all materials and services.
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Call Melissa Irwin at 1-800/277-8448 for more information.
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Christopher Mok, principal broker from Business Search Group, can help prepare business/medical practice valuations.
SCCMA Physician Referral Service
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SCCMA members will receive a 25% discount on valuation and appraisal services.
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Our physician referral service handles around 1,200 calls per month.
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Please contact Christopher Mok at 408/297-7600.
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Any member in good standing is welcome to participate.
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Patients can locate a physician by specialty, language, gender, and/or insurance programs.
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Call Jean at 408/998-8850 extension 3010 for a “Physician Referral Service Participation Agreement.”
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Additional information is available on our Web site at www. sccma.org.
Conomikes •
Consulting and strategic planning for both new and established practices.
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Coding and reimbursement reviews.
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Call Tom Loughrey at 1-800/421-6512 for details.
CPA–McCahan, Helfrick, Thiercof & Butera •
First consultation free for SCCMA members.
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If you are looking for an excellent CPA, with many years of experience working with physicians, call Raymond Thiercof at 408/266-4755.
EnviroMerica •
OSHA compliance audits.
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Emergency training programs.
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Air quality management.
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Call 1-888/323-0583 for more details.
Physicians’ Confidential Line The Confidential Line offers a 24-hour phone service for physicians, medical students, residents, and their families and colleagues, who may have an alcohol or other chemical dependence, or mental/ behavioral problem. This service is completely confidential. Using it will not result in any form of disciplinary action or referral to any disciplinary body. Call 1-650/756-7787.
Practice Supplies & Resources
OfficeWorksRx
Rx Security
When you are short staffed, are you getting the help you really need? OfficeWorksRx is your employment remedy! They specialize in placing: • Office Managers.
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Tamper-resistant security prescription forms.
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Call 1-800/667-9723 or www.rxsecurity.com/cma.php.
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Medical Assistants.
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Medical Receptionists.
CMA members can save 50% off subscriptions to hundreds of popular magazines.
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Medical Records Clerks.
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Billers/Coders/Collectors.
Call 800/289-6247 or visit www.buymags.com/cma for more information.
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Medical Transcriptionists.
Whether you require full, part-time, temporary, permanent employees, vacation or maternity leave coverage, OfficeWorksRx can help! OfficeWorksRx also provides: • Pre-screened candidates that have a health care background. •
Staff within 24-48 hours.
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Free working interview.
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Preferred pricing for SCCMA members.
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Call Kristen Magri at 408/452-1125 for more information.
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NOVEMBER / DECEMBER 2008
Subscription Services Inc.
Publications Annual SCCMA Membership Directory This pictorial directory provides alphabetic, specialty, and geographic listings for all member physicians in Santa Clara County, along with useful information about SCCMA, your member benefits/services, local hospitals, public health services and reporting requirements, and other healthcare resources. This one-of-a-kind directory reaches thousands of medical professionals and is the only comprehensive directory of physicians in our county. Members receive one complimentary copy of each edition, and may purchase additional copies at a price of $30 (50% discount). Directories are available to non-members for a purchase price of $60. To place an order, contact Maureen Yrigoyen at 408/998-8850 or maureen@sccma.org.
SCCMA MEMBER BENEFITS / SERVICES SCCMA Magazine, The Bulletin The Bulletin magazine is published six times per year and is sent to SCCMA members, legislators, community leaders, editors, hospitals, and other health organizations within our county. Each edition contains SCCMA news, articles regarding issues affecting medical practice, legislative updates, coding advice, classified ads, and more. Feel free to contact SCCMA about advertising services or classifieds for office space. For details, contact Pam Jensen, Managing Editor, 408/998-8850 extension 3012 or by email to pjensen@sccma.org.
information materials, CMA publications offer you a variety of useful resources with up-to-date, straight-forward information to help you make the best decisions for you and your practice. Information is available either at no charge or at a discount for members. Best sellers include the CMA/PrivaPlan HIPAA CD-ROM Toolkit, CMA’s Advance Health care Directive Kit, the Patient/Physician Arbitration Agreement form, and the California Physician’s Legal Handbook. For more information go to www.cmanet.org/bookstore or call 1-800/882-1262.
The following CMA publications are available online for members:
Real Estate
CMA Alert
ClickHome
CMA Alert is a concise, weekly news update for members. CMA Alert will keep physicians and their staffs informed of legislative updates, workshops, classes, and more. It is available online at http://www. cmaalert.org. Highlights from CMA Alert are also published in the Medico News column of SCCMA’s magazine, The Bulletin.
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Direct access to multiple listing services (MLS).
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For a virtual tour or to find out more, follow the link to: www. clickhome.us/sccma or call 1-800/927-8111.
California Physician Also available is the California Physician, a quarterly, online magazine, www.calphys.org, which provides in-depth articles on the world of health care, legislation, and technologies, and provides a forum where doctors can communicate with fellow physicians about the latest issues facing medicine.
CMA Bookstore/Publications
Tax Audit Defense Tax Resources, Inc. •
Prepaid audit defense program comprised of highly medicallytrained tax audit specialists.
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Call 1-800/922-8348 for more information or an application.
From clinical education to practice management and patient
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11
SEE JANE SAVE
with
and
Meet Dr. Jane. She takes advantage of the discounts available to her through her SCCMA / CMA membership. Dr. Jane saved more than $16,000 last year: • Received discounted billing and collection services. Bureau of Medical Economics. SAVED: $1,146 • Received 40% discount on credit card processing fees through JP Morgan Chase. SAVED: $600 • Received a free annual SCCMA Pictorial Membership Directory. SAVED: $60 • Received a $500 discount toward Mercer’s Economic Freedom Program, a comprehensive financial planning, investment management, retirement and estate planning package. SAVED: $500 • Downloaded 10 medical-legal documents from CMA ON-CALL, and spoke with CMA’s legal department (instead of paying an attorney for the same information). SAVED: $1,860 • Called SCCMA’s Reimbursement Specialist. RECOVERED: $500 • Bought security prescription pads from RxSecurity. SAVED: $25 • Received 35% off a two-year subscription to Epocrates clinical reference guides for her PDA. SAVED: $80 • Purchased health insurance for her 8-person staff through CMA’s partner Marsh Affinity Group. SAVED: $12,120
When you join SCCMA / CMA, you hire a powerful professional
MEDI-CAL: A court order obtained by CMA stopped the legislature
staff to protect the viability of your practice. By protecting your
from cutting rates by 10%.
practice from legal, legislative, and regulatory intrusions, your CMA membership lets you focus on what’s really important: your patients. Here are a few examples:
MEDICARE: When Medicare rates were scheduled to be cut 15%, CMA / SCCMA took action, ensuring through coordinated advocacy that California’s congressional delegation supported physicians
Blocked 2% tax on physicians gross receipts called for by the
and their senior patients, not health plans. The immediate, direct
Governor. That’s an average of nearly $5,000 for each practicing
monetary value of this victory for California Physicians is more than
doctor in California!
$1.3 billion. That’s an average of nearly $20,000 for each practic-
RICO LAWSUIT: The RICO settlements require health plans to change
ing doctor in California!
the way they do business with physicians, and have provided more
SCCMA / CMA encourages its members to reach out to non-
than $1 billion in prospective relief to physicians nationwide.
member colleagues and encourage them to join in designing
MICRA: CMA works tirelessly to protect California’s Medical Injury Compensation Reform Act (MICRA). MICRA saves each Santa Clara County physician an average of $69,039 a year in annual malprac-
the future of organized medicine. For more information about membership, contact Jean Cassetta, Membership Director, at 408/998-8850, extension 3010 or jean@sccma.org.
tice premiums. Some high-risk specialties save more than $145,000.
TOTAL SAVINGS: $16,891
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Sacramento was buzzing in January of 2007 with the possibility that universal health care would finally be achieved. Governor Schwarzenegger had proposed a comprehensive proposal that garnered national attention.
CMA’s 2007-08 Legislative Wrap-Up
It Was the Best of Times; It Was the Worst of Times
By Dustin Corcoran, CMA Vice President of Government Relations There are moments in political life that should be preserved in a time capsule to warn future generations from repeating the mistakes of their predecessors. This legislative session could certainly qualify as one of those moments. At the beginning of 2007, the Governor embarked on a massive media blitz to pass universal health reform. But by the end of 2008, the state passed a budget that eliminates health care coverage for 250,000 Californians. What happened? Sacramento was buzzing in January of 2007 with the possibility that universal health care would finally be achieved. Governor Schwarzenegger had proposed a comprehensive proposal that garnered national attention. Both Democratic leaders also had proposed their own plans and the state seemingly was set for a banner year. That year-long effort famously flamed out when the State Senate defeated the Governor’s proposal on January 2, 2008, largely due to concerns over the growing budgetary problems facing the state. As much as 2007 was dominated by hope, 2008 was dominated by anger, animosity, and a broken state budget. The Governor invested mightily in his
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health care reform effort and its defeat left a bad taste in everyone’s mouth. There was enough fingerpointing to satisfy even the most cynical of political observers. The Governor and Assembly Speaker
NOVEMBER / DECEMBER 2008
14
Fabian Núñez blamed Senate President Pro Tem Don Perata. Don Perata blamed the Governor and Fabian Núñez. And while the blame game was in full force, everyone suddenly realized we had a massive budget problem with no real way out of it.
By February of 2008, the Governor was forced to exercise his mid-year cut authority to close a $15 billion budget deficit. The Legislature became immediately embroiled in a fight over whether to adopt or reject the proposed cuts. All of the Legislature’s energy was lost to the reality that the state was, and remains, broke. As part of the mid-year cuts, the Governor and Legislature slashed Medi-Cal reimbursement rates by 10%, forcing CMA to go to court to block the state from implementing the cuts. It is a sad commentary on political reality when politicians are cutting already dismally low reimbursements, and judges are the only ones standing in their way. At least our justice system works, on occasion. The structural deficit remained pegged at over $15 billion dollars, even after $7 billion in mid-year cuts. That massive deficit, combined with a partisan stand-off, led to a historic budget delay. The new budget was not enacted until September 23, 2008. The Governor now holds a dubious record: signing the latest budget in the history of California. And what did Californians get as a result of the historic delay? A gimmicky budget that is already out of balance. Legislators are likely to be called back into special session to consider mid-year budget cuts even before the New Year begins. Such is life in Sacramento. The next two years are likely to be dominated by a perfect financial storm: a legislature unable or unwilling to make difficult decisions to increase revenue or massively cut services, a Governor who has become completely isolated from both Republicans and Democrats in the Legislature, and a weakening economy that will lead to diminishing tax revenues for the state.
Is there a chance that the animosity that has defined the last two
from rescinding treatment authorizations after the service has been
years will disappear or at least diminish in the Governor’s final two
provided in good faith. Perhaps most importantly, an egregious HMO
years? Perhaps. Both the Assembly and Senate have elected leaders,
loophole was closed. HMO fines will no longer be used to offset the
Karen Bass and Darrell Steinberg respectively, who are known to
fees they pay to the Department of Managed Health Care. Instead,
be driven primarily by policy and a desire to do what is best for the
that money will be used to finance the Steve Thompson Loan
state. Whether they can contain the hostility and bitterness of past
Repayment Program (STLRP) and the Major Risk Medical Insurance
battles and find some way to coax Republicans to the negotiating
Program (MRMIP). The STLRP provides loan forgiveness to medical
table remains a very open question. Governor Schwarzenegger
school graduates who agree to practice in underserved areas. MRMIP
vetoed a record number and percentage of bills in 2008, making
provides insurance to those with pre-existing medical conditions that
even more difficult legislative leadership’s efforts to overcome their
cannot obtain coverage in the open market.
colleagues’ animosity and frustration and move forward with a positive agenda.
CMA also defeated a bevy of scope bills and an attempt to obliterate the corporate bar on the practice of medicine. Additionally, CMA
Their success or failure will probably be the best barometer for the
defeated an incredibly onerous bill that would have created a
state’s ability to dig itself out of a massive structural budget deficit.
commission of political hacks to rank physicians. This legislation also
If they fail, the Governor’s final two years will likely be incredibly
would have allowed the commission to demand any and all records
disappointing.
from physicians and medical groups and levy any tax they saw fit on physicians and medical groups.
Given all of that uplifting news, there were still many legislative proposals significant to patients and physicians, and considering
All in all, it was a successful legislative session for CMA despite the
the insanity of the 2007-08 legislative session, CMA was incredibly
major disappointment of not achieving universal health care. For a
successful.
more detailed breakdown of the major issues impacting patients and physicians in California, visit the following website: www.cmanet.
Among the bills signed into law was legislation to provide physicians
org/news/hotlist.asp.
whistleblower protections and a prohibition on insurance companies
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NOVEMBER / DECEMBER 2008
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O’Connor Hospital Update Medical staff practicing at O’Connor Hospital are part of a long tradition of caring for Santa Clara County residents. Established in 1889 by the Daughters of Charity of St. Vincent de Paul, O’Connor Hospital was the first hospital in San Jose, and is now a 358-bed, acute care, Catholic, not-for-profit community hospital. More than 650 physicians are guided by a values-driven mission of providing superior service and compassionate care to the whole person: body, mind, and spirit. O’Connor physicians play an active role in the hospital’s strategic planning process, and partner on initiatives that will begin the journey towards Magnet accreditation. Physician involvement has contributed to O’Connor building a reputation as a top-tier, high quality facility, as evidenced by many awards and accolades. O’Connor is certified by the Joint Commission as a Primary Stroke Center and is the first hospital in Northern California to receive Joint Commission designation as a center of excellence in hip replacement and knee replacement. O’Connor participates in the CMS Premier Hospital Quality Incentive Demonstration project and has sustained dramatic improvements in its core measure results over the last four years, especially in the area of Acute Myocardial Infarction. The hospital has maintained a 100% appropriate care score in this measure for five months in a row and has an average Door-to-Balloon Time of 76 minutes. O’Connor also participates in Surviving Sepsis Campaign and Reducing Hospital-Acquired Infection: Pneumonia as part of the EvidenceBased Practice Initiative funded by the Gordon and Betty Moore Foundation grants, and has exceeded the goals for both projects. O’Connor achieved its goals of reducing sepsis mortality by 25% and hospital-acquired pneumonia incidence rate by 20% within the first year of implementation. O’Connor boasts state-of-the-art, cutting-edge technology and advanced medical capabilities and procedures. A new Cardiac Cath Lab and upgrade is almost complete, and is just the latest in a string of new technologies at O’Connor. The hospital opened a state-ofthe-art MRI suite with a Siemens MAGNETOM Avanto 1.5 Tesla Magnetic Resonance (MR) system; brought in a 64-slice CT scanner, and began using a surgical navigation system for their orthopedics program. Add to these a new vascular intervention room with 3-D reconstructions and an Endovascular Surgery Suite in the operating room and you have a hospital that offers physicians access to the latest diagnostic, surgical, and radiological capabilities.
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The ever-expanding Wound Care Clinic at O’Connor Hospital is one of the largest in California, with 20 private rooms and the latest equipment. In early 2009, the clinic will add two Hyperbaric Chambers to the comprehensive wound management they offer patients. The Clinic staff has advanced training in wound management and clinic physicians are involved with training physicians from across the country.
Jay Raju, MD serves as the Councilor representing O’Connor Hospital for the Santa Clara County Medical Association.
Santa Clara County physicians can depend on the care provided by the O’Connor Emergency Department, with some of the shortest waiting times and highest patient satisfaction scores in the area. The 21-bed Emergency Department sees more than 40,000 patients each year.
With the closure of San Jose Medical Center in 2004, O’Connor Hospital proudly became home to the only Family Medicine Residency Program in the area, affiliated with Stanford University. Under the supervision of 12 faculty physicians, 24 residents recruited from around the country are trained to become community physicians skilled at caring for all age groups of patients. Since 1994, O’Connor Hospital and the Markkula Center for Applied Ethics at Santa Clara University have been involved in a unique partnership where pre-med students intern at the hospital, and the Center for Applied Ethics on the hospital campus lives its mission to clarify and enhance the role of ethics in the practice and delivery of health care. Through their Parish Nursing Program, the hospital carries forth its Catholic heritage and ministry into the community. Parish nurses are registered nurses on staff in local churches, performing independent, professional nursing practice in the provision of faith-based, wholeperson focused, community health nursing services. Additionally, in keeping with the mission of the Daughters of Charity to provide care to those who need it most, O’Connor sponsors the hospital’s Pediatric Center for Life that takes care of over 12,000 children each year that have trouble accessing health care. For more than a century, O’Connor Hospital has steadfastly dedicated itself to building a healthier Santa Clara valley. Partnering with the outstanding Medical Staff, this tradition of compassionate care and provision of the most advanced health care possible will continue to meet the evolving needs of the community.
MESSAGE FROM THE CEO
Multi-tasking Injuries…
What’s Next?
By William C. Parrish, Jr., SCCMA CEO There’s a new group of patients impacting the emergency rooms… multi-taskers. Perhaps, these injuries should be categorized as the “Mr. Magoo Syndrome” (MMS). Specifically, these patients are receiving injuries while attempting to text message, while performing other functions such as walking, cooking, and even driving.
restricted to metropolitan areas or the roadways. Also reported was a teenager who suffered head and back injuries from falling off her horse while texting, and another received serious stomach, leg, and arm burns while cooking noodles and texting her boyfriend. Based on my experience, observation of my children, and my own very informal survey, this seems to be an under-40 affliction. My children text with thumbs flying while watching TV and/or talking with me…and do not skip a beat. I know for me, it takes my total
Most involve minor scrapes, cuts, and sprains from texters who
concentration to text a reply on my phone. But, I’m getting better
walked into stop sign poles, walls, or tripped over curbs. “MMS” is
with practice, so who knows. As life gets busier and we acquire
even impacting the nation’s presidential race; Obama aide Valarie
more tools (toys) that we can’t seem to live without, we best beware.
Jarrett recently fell off a curb in Chicago, while texting away on her
So before you head to your practice, hop behind the wheel,
Blackberry (AKA “Crackberry”).
or just go to the bathroom… holster that device, and…let’s be careful out there!
The American College of Emergency Physicians issued an alert warning of the dangers of more serious incidents involving oblivious multi-tasking texters. ED doctors cite rising reports from doctors around the country of accidents involving text-messaging pedestrians, cyclists, rollerbladers, and motorists. As usual, California seems to be leading the nation in serious multi-tasking texting accidents. A San Francisco woman was hit and killed by a truck as she stepped off a curb while texting, and a Bakersfield man was killed by a car while attempting to cross the street and text a message. Apparently, these injuries are not
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Member Benefit: Professional Liability Insurance
Terminating The Physician-Patient Relationship Reprinted by permission of NORCAL Mutual Insurance Company What are some of the reasons a physician might want to terminate a patient from his or her practice? Courts in California have held that patients who fail to make or keep appointments, refuse to comply with treatment recommendations, fail to pay bills, or who act in a violent or offensive manner that endangers other patients or health care personnel may be terminated from the practice.1 Attorneys emphasize the importance of documenting such activities with an objective tone and maintaining such documentation in the patient’s record. If a patient questions a physician’s right to terminate the relationship, that physician should seek legal advice and also contact his or her professional liability insurance carrier. However, physicians need to be aware of the following constraints on their right to terminate a patient, and be especially aware of the potential for a patient to allege abandonment.
assistance with this situation or information about the difference between the physician’s contractual relationship with the plan and the physician-patient relationship, call NORCAL’s Risk Management Department at 800/652-1051, ext. 2244.
Clinical Constraints Acute conditions must first be resolved or stabilized. Medical causes of objectionable behavior need to be addressed and ruled out. For example, before terminating a drug-seeking patient, the physician should ensure that: •
the cause of the need for more drugs is substance abuse, not inadequate pain relief, a condition known as “pseudo-addiction;”
•
the drug-seeking patient has been confronted with his or her drug-seeking behavior;
•
the patient has been informed of a diagnosis of substance abuse; and
•
appropriate treatment has been offered and refused.
Other providers must be available in the area to assume care.
Ethical and Legal Constraints
Specialists who are “the only game in town” or providers in a rural
Refusing a patient treatment because of that patient’s sex, race, color,
area need to be especially careful.
religion, ancestry, national origin, or physical disability is unethical.
Avoiding Allegations of Abandonment A physician may have some difficulty terminating a relationship with
The issue of patient abandonment must be understood and
a patient who has no alternative source of care. Even if the physician
considered, before deciding to terminate a patient. According
believes that the patient has been given ample notice, the patient’s
to attorneys, “abandonment occurs when a physician fails to
individual circumstances may preclude him or her from finding new
provide necessary medical care to a current patient without
care, and the notice may not be sufficient. Physicians should exercise
adequate justification. Generally speaking, once a physician-
extra caution if they find themselves in this situation, and seek
patient relationship is established, the physician has an ongoing
guidance from their personal attorney or professional liability carrier.
responsibility to the patient until the relationship is terminated. This obligation includes providing (physician) coverage for patients
A contractual agreement between the physician and a managed care
when the physician is ill, on vacation, or treating other patients, etc.
plan or hospital that may require the physician to see any and all
While physicians have the option of withdrawing from a case, they
enrollees or patients.1,2
cannot do so without giving notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to
•
If a plan cancels its contract with the physician, the physician is not automatically released from the obligation to treat established patients who are subscribers to the plan. For
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NOVEMBER / DECEMBER 2008
permit another medical attendant to be secured.”1
Guidelines for Terminating the Relationship If, after considering the constraints outlined above—especially those relating to the physician-patient relationship and abandonment—the physician deems it appropriate to terminate the patient from the practice, the physician should notify the patient of the termination and allow the patient a reasonable amount of time to locate another physician.
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The following guidelines are appropriate for most situations in which the physician decides to terminate the relationship. However, keep in mind that in situations involving specialized care (e.g., a pregnant patient approaching her delivery date), patients with no source of alternative care, or where the location is rural, termination may not be appropriate or the period of time given to the patient to find a new physician may need to be lengthened until these issues are resolved. Acute medical conditions must be resolved prior to termination of the relationship. Give the patient adequate notice to enable him or her to find another physician. The law does not define adequate notice, but a 10-15 day notice is recommended by the American Medical Association. (A longer period of notice, such as 30 days, should be considered for patients in special circumstances or who live in rural areas.) Keep in mind that even the longer time frame may not be sufficient for a patient with no alternative source of care, and that special caution needs to be exercised when encountering this situation. Physicians are advised to contact their personal attorney or professional liability carrier for guidance.
References 1. California Medical Association (CMA) Legal Counsel. Abandonment. San Francisco: California Medical Association, January 2001; CMA On-Call Document #0805. From www.cmanet.org. 2. California Medical Association (CMA) Legal Counsel. Physician-Patient Relationship. San Francisco: California Medical Association, January 2001; CMA On-Call Document #1037. From www.cmanet.org.
COMPANY: NORCAL Mutual Insurance Company SCCMA MEMBER BENEFIT: SCCMA has partnered with NORCAL Mutual Insurance Company, premier provider of professional liability insurance for physicians, medical groups, community clinics, hospitals, and medical facilities. Most SCCMA members who use NORCAL for their professional medical liability insurance receive a 5% discount on that insurance. CONTACT: Call 1-800/652-1051
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NOVEMBER / DECEMBER 2008
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Member Benefit: INSURANCE PRODUCTS AND SERVICES
Insurance Products And Services Workers’ Compensation
It’s Time to Review Your Health Insurance
The WCIRB proposes a 16.0% increase in pure premium rates effective January 1, 2009
•
December 1, 2008: Have your qualified high deductible health plan in place no later than December 1, 2008, in order to maximize 2008 contributions to a health savings account. If you meet eligibility requirements, you may make a federally tax-deductible contribution of up to $2,900 (for individuals) or $5,800 (for families). If you are between the ages of 55–64, you may contribute an additional $900 to the amounts above.
•
As a member of your association/society you may be eligible for a 5% member discount on premiums for any Blue Shield Small Group (2–50 employees) health insurance plan.
•
And members who have Anthem Blue Cross group coverage can save 15% on their workers’ compensation premiums.
The Workers’ Compensation Insurance Rating Bureau recommended to the Department of Insurance (DOI) an average 16% increase to pure premium rates effective January 1, 2009. Approximately 10.8% of the recommended increase is due to increasing medical costs. The DOI will review the recommendation and either confirm it or develop its own recommendation. Insurers may then use these recommendations as a guide in setting their own rates for January 1, 2009. The recommended 16.0% increase in pure premium rates does not reflect the cost impact of the recent changes to the Permanent Disability Rating Schedule (PDRS) proposed by the Division of Workers’ Compensation. If the proposed changes are adopted, the WCIRB may amend its recommendation by an additional 3.7%. As premium increases may take effect in January, make sure you receive the SCCMA member discount on the sponsored workers’ compensation program. Call Marsh today!
How We’ve Helped Members: We’ve been able to help many physician groups during this year. Here are a few examples from the past year: • One medical group saved $20,000 annually by implementing high deductible health plans and health savings accounts for the two physician owners. •
Another office saved over $6,000 on their workers’ compensation premiums by moving them into the sponsored program.
•
Another group took advantage of Marsh’s marketplace knowledge and saved thousands of dollars by changing to an insurer that offered them a lower risk adjustment factor plus high deductible health plans.
•
A member established a high deductible health plan, without changing the staffs’ insurance, and saved $15,000 which he then used to help fund his new Health Savings Account. And he received Mercer Select HRKnowHow, an on-line HR resource for group benefit plans, at no additional cost.
•
When a member realized the risks associated with managing employees, he purchased an employment practices liability policy for $750 that provided access to a labor attorney in addition to insurance and risk management guidance.
Open Enrollment Is Coming for the Dental Program! This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money: • Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers). •
During Open Enrollment only, members may join as an individual or as a group with your employees.
•
Low calendar year deductible of $50 per person, ($100 per calendar year maximum for families).
•
Pay no deductible on oral exams, x-rays, and routine cleanings.
•
A Rollover Benefit that allows for the unused portion of the maximum benefit amount from one year to roll over and be used in the following calendar year.
The open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period that ends on December 31, 2008.
Health Savings Account Limits for 2009: Individual coverage: federally tax-deductible contributions up to $3,000 Family coverage: federally tax-deductible contributions up to $5,950 Catch-up between the ages of 55-64: an additional $1,000 to the above amounts
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NOVEMBER / DECEMBER 2008
How can we help you?
COMPANY: Marsh Affinity Group Services SCCMA-CMA MEMBER BENEFIT: SCCMA-CMA has partnered with Marsh Affinity Group Services to provide its members with discounts on a comprehensive portfolio of insurance products and services. CONTACT: Call 1-800/842-3761
Member Benefit: PRACTICE RESOURCES — CMA ON-CALL
CMA ON-CALL
The California Medical Association’s FREE Information-on-Demand Service Access the answers to all your medical-legal questions — free of charge — with CMA’s ON-CALL documents.
the link that says “CMA’s online medical-legal information library.” From this page, you can search by general topic headings, which parallel the chapters included in CMA’s California Physician’s Legal
CMA ON-CALL is the California Medical Association’s 24-hour
Handbook. To see a list of documents by topic, simply select that
information-on-demand service for physicians. All CMA ON-CALL
topic.
documents are available free to SCCMA-CMA members. Members may access CMA ON-CALL documents on CMA’s website as follows:
You can also search CMA ON-CALL by document number or by keyword search. To do this, scroll down to the bottom of the page
Go to www.cmanet.org. In the upper right-hand corner, click on
and click on the “Search” button in the lower left-hand corner. Under
the blue box that reads “CMA Members Enter Here.” Enter your
step one, check the box next to CMA ON-CALL. Under step two,
username and password. If you are entering the “Members’ Section”
select “Enter Search Criteria.” To search by document number: If you
for the first time, you will need to register by clicking on the words
know the specific document for which you are searching, enter the
“Click here” inside the “Sign In” box. Fill in the three blank fields
document number into the search box. Click on the document title
with:
and number and follow the prompts to download the document. To search by keyword search: Type a keyword(s) search into the search
Your California medical license number (make sure to leave out the
box. When searching for two or more words, use “and” or “or” (e.g.,
leading zeroes in your license number, e.g., if your license number is
needles or syringes, point and of and service). Do not use “and/or.”
“AOOO12345,” enter A12345”); your six-digit CMA ID number; your last name. Click “Register.” Next, follow the prompts to personalize
To view the documents, you will need the Adobe Acrobat program.
your username and password, and record this information for
If you do not have Adobe Acrobat on your computer, you may
future use. Be sure to give CMA your preferred email address when
download the program at no charge by clicking on the Adobe icon
registering, so that they can send you your username and password
to the right of your screen before you click on the blue “Download
via email should you misplace them.
PDF” button. If you have questions about CMA ON-CALL or how to access documents, please call CMA’s Legal Information Line at
Once in the “Members’ Section,” slide your cursor over the words
415/882-5144.
“CMA ON-CALL” on the left side of the homepage, and click on
General Topic Headings: •
ADA/Discrimination
•
Expert Witness Issues
•
Medical Board: Reporting To
•
Peer Review
•
Advertising
•
•
AIDS and HIV
Medical Practice: Employment Issues
•
•
Forgoing Life-sustaining Treatment
Physician/Patient Relationship
•
Allied Health Professionals
•
Fraud and Abuse
•
•
Professional Liability
•
Ancillary Services
•
•
•
Antitrust
Fraud and Abuse: Referral Issues
Medical Practice: Groups, IPAs, MSOs
•
Reimbursement: From HMOs and Other Private Payers
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Business Prohibitions/ Disclosure Requirements
Medical Records: Management
•
Reimbursement: From Patients
•
Clinical Laboratories
Medical Records: Requests for Access
•
Reimbursement: Other Issues
•
Consent
•
Reporting Abuse/Violence
•
Death/Organ Donation
•
•
Drug Prescribing/Dispensing
Reporting Diseases, Conditions, & Events
•
Drug Testing
•
eMedicine/HIPAA
•
Emergency Transfer
•
Managed Care: Overview
•
Managed Care: Contract Termination/Exclusion
•
•
Managed Care: Risk Arrangements
•
Medical Records: Special Confidentiality Rules
•
Managed Care: Utilization Review and Management
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Medical Staffs
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Medicare and Medi-Cal
•
Reproductive Issues
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Medical Board: Discipline and Licensing
•
OSHA/Office Safety
•
Warning Obligations
•
Outpatient Facilities
•
Workers’ Compensation
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Member Benefit: tpo Human resource management
Who we are: TPO is an award-winning HR Consulting Firm serving primarily the Bay Area. Typical services include general HR consulting, employee handbook development, neutral third-part investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices. TPO provides unique solutions to the four primary concerns facing today’s business owners and managers:
Confusion regarding the thousands of state and federal employment laws. Frustration with personality conflict and employee relations issues. Concern that managers are not properly trained on employment laws and leadership skills. Finding expert HR help that won’t cost an arm and a leg.
How we work with SCCMA Members: For the past 14 years, TPO has provided HR support to both SCCMA and SCCMA members. TPO has facilitated numerous HR training programs for SCCMA members to attend and has provided many articles throughout the years. SCCMA members receive a free initial consulting call and then 10% off the initial work with TPO. SCCMA Members receive a FREE initial telephone consulting call (up to 15 minutes) with a qualified HR Consultant. Examples of Common Consulting Calls: “An employee just told me she is pregnant and gets 7 months off…is that right?” “I have an employee with poor performance…how do we get him ‘on-board?’ “I want to terminate an employee, but am not sure if we can…Help!” “An employee is demanding back overtime pay…we paid him a salary to avoid this!” - contact Melissa Irwin, Sr. Consultant: 831/688-4196 or melissai@tpohr.com Two Common Questions Medical Practice Management Ask:
Q: I have an employee who is pregnant and she says she wants to be off work for 7 months. I want to help her out, but I also have a busy practice to run. What are my obligations? How much time is she allowed for this leave?
A: Laws concerning pregnancy are determined by the employee count of the company. When determining the employee count of the company, make sure to include introductory, temporary, part-time, and full-time employees (also include any owners who are also employees of the company). Following are the three categories that are applicable to pregnancy-related absences:
4 or Fewer Employees: If you have four or fewer employees, you are not required by law to grant a leave of absence to accommodate pregnancy or the birth of the child. You are also not required to guarantee a return to the job, if you do grant the leave. Please keep in mind, however, that you are not allowed to discriminate against an employee due to her sex – for example, you cannot refuse to hire an employee simply because she is female and might become pregnant.
5 Through 49 Employees: If you have 5 through 49 employees, you must grant an employee’s request for Pregnancy Disability Leave (PDL) for the time her health care provider verifies that she is actually disabled because of her pregnancy or a related medical condition. A typical disability may be 6-8 weeks, but in no
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Member Benefit: tpo Human resource management event must the leave be greater than four months for a PDL. During this time, you must guarantee reinstatement rights. If the disability is greater than four months, you are not required to guarantee reinstatement. If an employee’s heath care provider recommends a reduced work schedule, this must be accommodated and such portion can be subtracted from the PDL requirement.
50 or More Employees: If you have more than 50 employees, you must coordinate the federal Family Care & Medical Leave Act, the California Family Rights Act, and California’s Pregnancy Disability Leave. Employees who have completed 12 months of service and worked 1250 hours are eligible to take up to 12 weeks of a FCML for the birth of a child or to care for a newborn in addition to the PDL requirement listed above for the employee’s actual pregnancy disability. During these leaves, you must guarantee reinstatement rights upon return, and pay health insurance as was done prior to the leave for the first 12 weeks of the leave.
Bonding – employees may request time off, in addition to the time taken on disability. As long as you have less than 50 employees, you are not required to grant the request. Treat this request as you would any other employee’s request for a personal leave of absence (check your Employee Handbook), and make sure that you treat all employees the same. Posters – All employers must have posters displayed which explain the regulations applicable to the employer of five or more employees. If you do not have this poster, TPO will mail one to you – just give us a call. Other Details – The multiple regulatory requirements are confusing – TPO can help make sure you have the right policies, forms, and tracking systems in place…as well as provide confidence on what to say to the employee!
Q: When it comes to terminating employment, are there any requirements on when to provide the final paycheck? Can I just put it in the mail, so she doesn’t have to come into our office (ever) again?
A: Final pay (including all accrued but unused vacation/PTO) must be made available within specific timeframes. Failure to provide the paychecks as outlined can lead to waiting time penalties of one day’s pay for each day final pay was not paid to the employee (typical days off such as weekends included) up to 30 days. 1. Involuntary Termination of Employment • Employees who are terminated must receive their final paychecks on the last day of employment (in their hand, before they walk out the door). 2. Voluntary Resignation of Employment • Employees who give more than 72 hours notice must receive their final paycheck on their last day of employment. • Employees that give less than 72 hours notice must have their final paycheck available within 72 hours. Final Paycheck by Mail: The regulations require the final paycheck be available at the location the employee normally receives his/her paycheck. It is not allowable to direct deposit or mail the final paycheck, unless the employee has authorized such an action, preferably in writing. If the employee does not authorize mailing and/or the employer is unsuccessful in contacting the employee, the final paycheck should be retained by the employer and made available in the event the employee requests it. You may contact TPO at: 831/647-7292 www.tpohr.com 2008 TPO This information is designed to be accurate in content. TPO provides human resources support services and is not engaged in rendering legal, accounting or other professional services. Readers are advised to consult legal counsel on matters involving employment law or important personnel policies and practices before adoption or implementation.
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Member Benefit: Medical Billing, Collections & Office Management Services
What Is The Bureau Of Medical Economics? By Mark Christiansen, BME General Manager What Is the Bureau of Medical Economics?
The Bureau of Medical Economics (BME), of Santa Clara County, was formed 60 years ago by the Santa Clara County Medical Association, and became a California corporation in 1950. Its mission is to provide its members with medical billing, collections, and office management services.
physicians, 30-plus medical groups, and a major California rural medical clinic non-profit organization. The collection department’s first goal is debt recovery—recovering the greatest amount for clients, while maintaining the integrity of the physician-patient relationship.
BME specializes in medical collections and billing, and has a
BME’s collectors get the job done—
competitive advantage because of its longstanding and close
they are firm, yet they also understand the nature of the debt they
relationship with the health care community. Due to the diversity of
are pursuing (much of it stemming from the necessities of life).
its clients, it has the ability to “pool” accounts that match particular debtors. This means by contracting with BME, physicians, dentists,
The billing department focuses on accuracy and is able to capitalize
and other health care providers are able to create a co-op-type
on full reimbursement for its clients. It specializes in follow-up, a
relationship—allowing accounts which otherwise might not be
key component to complete and timely reimbursement. As an added
economically feasible for follow-up action, such as litigation, to
benefit to SCCMA members, BME staff assist with problems involving
be linked together with other accounts, making capable further
Medicare and Medi-Cal, as well as other billing and collection
collection efforts. No account is too large or too small.
questions.
Who Runs BME?
What Products/Services Does BME Offer?
BME’s managing director/CEO is William Parrish. Mr. Parrish has served as CEO of SCCMA and BME for over 13 years and continues to advocate on behalf of all SCCMA physician members and their
•
BME is a full-service health care collection agency/billing service representing all walks of the health care profession.
•
All staff, whether part- or full-time, are regularly trained and tested on HIPAA-compliance, as well as the State and Federal Debt Collection Practice Acts, and its facilities are secure and HIPAA-compliant.
•
Collection department recovery rates are twice the national average.
•
The billing department focuses on clean claims and diligent follow-up for maximum reimbursement.
•
Experienced staff will partner with clients’ office staff to create an environment of efficiency and productivity.
•
Offers price incentives, depending on the age and number of accounts to be assigned. Additional price incentives are available for utilizing both the collection and billing services.
•
Serves SCCMA members by visiting/evaluating client offices and offering suggestions in the area of office management efficiency.
•
Provides discounts for SCCMA members.
practices. Mark Christiansen has recently been appointed the general manager of BME, and acts as its attorney, as well. He has been on staff for 13 years, and has 25-years experience working in the collection and subrogation industries.
BME Staff The Collection Department staff has an average experience level of 15.5 years in the collection industry (the industry standard is less than one year). BME’s Billing Department staff come from skilled backgrounds which include Lifeguard Insurance Company and El Camino Hospital. Additionally, the Billing Department’s senior billing staff have at least 18-years experience in medical billing and are certified medical coders.
What Is the Purpose of BME? BME serves all medical professionals (i.e., physicians, dentists, and therapists), and its current client list contains over 500 individual
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What Products/Services Doesn’t BME Offer? And Why? BME doesn’t use predictive or auto-dialers, systems which automatically dial-up a debtor and deliver an automated message and/or route the call to a collector. While many companies use
Member Benefit: Medical Billing, Collections & Office Management Services these devices to minimize costs, a major problem with this tactic
for clients, greater ability to provide custom reporting, and an
is that there is a delay between the time the debtor answers the
ever-advancing database system, BME provides its collection and
phone and the time the phone message is delivered or the call is
billing clients with greater real-time access to their patient account
being transferred to the collector. During the delay, in most cases,
information, as well as options regarding practice management
the recipient has already terminated the call without contact with
systems, and the capability of having a relationship which creates
anyone. There are federal and state laws pertaining to the use of
an extension of your office. Whether or not your office management
these automated systems, and if the calls are not properly monitored,
system is in-house, BME’s full-time IT-specialist has the expertise
liability issues may arise.
to help clients with their connectivity and security needs, enabling them to connect to BME, so BME staff can most efficiently meet their
Another reason BME does not use auto-dialer systems is to prevent
clients’ ever-changing needs.
unfamiliarity with accounts. With auto-dialer systems, incoming calls are usually routed to the first available collector, not one
In this era of mergers and acquisitions of various agencies, you need
who is familiar with the individual’s account details. There is no
to know with whom you are placing your accounts and reputation.
substitute for a collector’s personal touch, and BME staff dial debtors
Collection and billing industries in the state of California are not
themselves and make note of each call’s outcome. In the event the
currently regulated by government agencies. This means that almost
party doesn’t respond to a telephone call, follow-up notices are sent.
anyone can claim to be a collection agency or billing company. BME knows the value of its clients and is prepared to serve them for many
BME doesn’t deny access to the general manager. Some
years to come.
agencies work under the premise that a collector has failed, if the manager is brought into the picture, so contact with the manager
BME’s mission statement of providing a membership benefit has
is not allowed. Not so, with BME. Most situations can be handled
not changed since its’ beginning. With recent upgrades to its
by BME’s experienced staff; however, if a debtor is persistent about
infrastructure, including the latest software and hardware updates,
speaking to a “higher authority,” this is not denied at BME. And
BME is a long way from the days of card files and carbon copies.
because BME’s general manager is also its attorney, any potential
However, it has not changed the most important ingredient to a good
claims can be separated from “red herrings.” The time to mitigate any
business—its close relationship with clients.
problems is at the beginning. Customer service contacts for both the Billing Department and the BME will not use abusive tactics, in order to collect a debt.
Collection Department are available during regular business hours.
Any debt can be discussed and collected by referring to the facts.
For more billing information, please contact Yolonda Rubio, billing
BME understands that its clients are professionals, and the way in
supervisor, 408/998-5811 ext. 3002. The collection customer contact
which debt is collected should reflect that standard.
is Karen Jorgenson, 408/998-5811 ext. 3034.
What Is the Cost of BME’s Products and Services?
The Bureau of Medical Economics looks forward to hearing from and
The main feature of BME’s fee structure is there are no hidden costs!
working with you, the members of SCCMA, for years to come.
Some billing companies promise a lower percentage rate, but charge on the total amounts billed, rather than on accounts receivable. With BME’s Collections Department—the client doesn’t pay, unless BME collects. No recovery, no fee. Upon collection of principal on an account, BME retains an agreed upon percentage of the recovery as its fee. With BME’s Billing Department—a competitive fee strategy is used, based on evaluation of the provider’s productivity and current fee profile, to offer fair and competitive pricing. Fees can also be structured on a subscription, for certain types of services.
Where Has BME Been and Where Is It Going? As BME has been around for 60 years, many things have changed since its inception, however, viability has never been an issue, and isn’t today. BME owns its operational headquarters at 700 Empey Way, San Jose, and is ready for changes in the collection industry. By moving forward with newer technologies, such as Web access
COMPANY: Bureau of Medical Economics (BME) SCCMA MEMBER BENEFIT: An affiliate of SCCMA, BME has a recovery rate approximately twice the national average. Members receive a discount off the basic rate, based on volume. CONTACT: For billing information, contact Yolonda Rubio at 408/998-5811 ext. 3002. For collections, contact Karen Jorgenson at 408/998-5811 ext. 3034.
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Santa Clara County Interpreting and Translation Resources The following is a list of interpreter resources available for Santa Clara County physicians. Additional resources can be found on the Interpreter Resource Database at: http://medicalleadership.org.
Definition of Terms •
Interpreting is the oral rendition of a message from one language to another.
•
Translation is the written rendition of a message from one language to another.
•
VMI (Video-conferenced Medical Interpretation) allows patients, providers, and interpreters to communicate through a screen.
Agency
Languages (see language key for letter codes)
Phone Number
Website
Onsite Phone VMI Translation
ALS International Translation
all major languages
800/755-2309
http://www.alsintl.com
•
•
CultureWise, Inc.
C, V, J, S, R
415/717-0708
http://www.eculturewise.com
•
•
Cyracom
all major languages
800/713-4950
http://www.cyracom.com
I-interpret
all major languages
650/614-4714
http://www.iinterpret.com
•
•
Interpreters Unlimited
all major languages
800/821-9999
http://www.interpretersunlimited.com
•
•
•
Language411
all major languages
510/842-3550
http://www.language411.com
•
•
•
Language Solution Services
P, H, U, S, C, R, V, Ko, G, Fr
510/490-4234
http://www.languagesolutionservices.com
•
•
Language World Services all major languages
916/473-0100
http://www.languageworldservices.com
•
•
Now Interpreters
all major languages
800/669-8191
http://www.nowinterpreters.com
•
•
•
San Mateo County Interpreting Services
all major languages
650/669-4977
http://www.smcointerpreting.com
•
•
•
Translex
Spanish
510/366-9797
http://www.translexweb.com
•
•
•
866/967-5313
http://www.e-wwi.com
World Wide Interpreters all major languages Northern California Registry of Interpreters for the Deaf
ASL
www.norcrid.org email: info@norcrid.org
Language Key C – Chinese
J - Japanese
S - Spanish
Fr – French
Ko - Korean
U - Urdu
G – German
P – Punjabi
V - Vietnamese
H – Hindi
R – Russian
ASL – American Sign Language
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•
•
•
•
•
The MLC Website has been designed to allow easy access to information for participating organizations, their members, and other health care professionals. On the site you will find: • News and Information: MLC reports, meeting summaries, and an events calendar • Educational Tools: CME courses, tools, and patient education materials • Resource Center: Interpreter Services Database, MLC presentations, and links • About the MLC: Member organizations, participation agreements, and policies The Interpreter Resource Database is a county-by-county database providing information on interpretation and translation services. The database is updated regularly, and listings may be sent to the CAFP for inclusion. The Interpreter Resource Database includes: • Interpretation Resources by Phone, VMI or On-Site • Language Lines • Community Resources • Interpretation Equipment • Training for Physicians and Staff Members • Websites in Languages Other Than English
Culture determines how people behave, make decisions, communicate, and interact with each other. Culture and language are inseparable. Concepts and words sometimes exist in one language, but not another. Finding equivalent expressions is complex.
Interpreter Roles Within the Health Care Encounter Health care interpreting is a distinct specialty within the interpreting profession. The most frequent roles are those of message converter, message clarifier, cultural clarifier, and patient advocate. These roles are presented in order of increasing complexity and controversy, requiring increasing skill, experience, and caution on the part of the interpreter. The most important consideration when choosing a role is how the interpreter’s actions continue to support the primary relationship between patient and provider, in the context of the health and well-being of the patient.
In any of the roles, when interpreters begin speaking in their own voice and are no longer converting messages of either patient or physician, it is critical they clearly state to both parties that the message is from the interpreter. (For example, the interpreter may interject, “The interpreter would like to say…”)
Role 1. Message Converter
different number of words required to express a
In the message converter role, interpreters listen to both speakers, observe body language, and convert the meaning of all messages from one language to another, without unnecessary additions, deletions, or changes in meaning. To do so, interpreters must manage the flow of communication between all the parties present. Interpreters need to intervene (verbally or nonverbally) when parties speak too fast or fail to allow the interpreter time to interpret. They also need to manage turn-taking, indicating to individuals speaking at the same time that they will be heard in sequential order or that a party must be allowed to finish speaking.
Role 3. Cultural Clarifier Culture determines how people behave, make decisions, communicate, and interact with each other. Culture and language are inseparable. Concepts and words sometimes exist in one language, but not another. Finding equivalent expressions is complex. This accounts for the concept in a second language. Cultural beliefs about health and illness around the world vary significantly from the biomedical perspective. Many traditional health beliefs, practices, and healers lack equivalent terms. The cultural-clarifier role goes beyond word clarification to include a range of actions that typically relate to an interpreter’s ultimate purpose of facilitating communication between parties not sharing a common culture. Interpreters are alert to cultural words or concepts that might lead to a misunderstanding, triggering a shift to the cultural clarifier role. When there is evidence that any of the
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Role 2. Message Clarifier
parties, including the interpreter, may be confused
Interpreters acting in the message clarifier role are alert for possible words or concepts that might lead to a misunderstanding. When there is evidence that any of the parties, including the interpreter, may be confused by a word or phrase, interpreters may need to: a. Interrupt the communication process with a word, comment, or a gesture to the party currently speaking. b. Alert the parties that the interpreter is seeing signs of confusion from one or more of the parties and identify the confusing word or concept. c. Request or assist the speaker of a word or concept unfamiliar to the listener or interpreter to restate or describe the unfamiliar word or concept in a simpler way. d. Explore ways to assist speakers to describe concepts using analogies, or “word pictures,” when there are no linguistic equivalents in either language.
by cultural differences, interpreters need to: a. Interrupt the communication process with a word, comment, or a gesture, as appropriate. b. Alert both parties to potential miscommunication or misunderstanding. (Interpreters may say, for example, “As an interpreter, I think that there may be potential danger for miscommunication/ misunderstanding.…”) c. Suggest cultural concerns that could be impeding mutual understanding. d. Assist the patient in explaining the cultural concept to the physician, or the physician in explaining the biomedical concept. When requested, interpreters also need to explain the cultural custom, health belief, or practice of the patient to the physician, or educate the patient on the biomedical concept.
Role 4. Patient Advocate Limited-English speakers can face major cultural and linguistic barriers in accessing and utilizing services at all levels of the health care system (e.g., eligibility and enrollment,
Tracy Zweig Associates A
REGISTRY
&
PLACEMENT
FIRM
making appointments, clinician visits, billing, understanding prescriptions). Many immigrants may be unfamiliar with U.S. health care system services available and their health care rights. Individuals with limited English proficiency
Physicians
Nurse Practitioners ~ Physician Assistants
find it difficult to advocate for their own right to the same level of care as English-speaking patients. Given the backdrop of such disparities, interpreters are often the only individuals in a position to recognize a problem and advocate on behalf of an individual patient. However, the patient advocate role must remain an optional role for each individual health care interpreter, in light of the high skill level skill required and the potential risk to both patient and interpreter. These standards were obtained from the California Healthcare Interpreting Association. For more information go to www.chiaonline.org and www.calendow.org.
Locum Tenens ~ Permanent Placement V oice: 800-919-9141 o r 805-641-914 1 FA X : 805-641-9143
tzweig@tracyzweig .com www.tracyzweig.co m
Partners in Excellence Our specialized interdisciplinary team of medical directors, nurses, social workers, chaplains, and community grief counselors are trained to assist you in the management of your patients needs. • Our physician’s are experts in palliative and end-of-life care • We guide individuals and families in setting and meeting their goals in this new phase of life and focus on the patient’s and family’s physical and medical needs as well as their emotional and spiritual well-being • Transitions provides pre-hospice clients with volunteer support and assistance in navigating life-liming illness and connection to S.C.C.M.A. community resources
8-12-08
• Our Community Grief Support Center offers age-specific and loss specific support groups including anticipatory grief for children, teens and adults • Since 1979, our legacy of community education, advocacy and outreach has set the standard for quality hospice care state-wide and nationally
Hospice of the Valley…doing hospice in the way it was meant to be done. — California State Surveyors
408.559.5600 • hospicevalley.org
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NOVEMBER / DECEMBER 2008
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Member Benefit: PRACTICE PLANNING / CONSULTING
How to Improve Your Search for a Practice Manager By George Conomikes, CEO In a group, different physicians can have varying perceptions of the job of the Practice Manager. This can create needless stress in the recruiting process among the physician shareholders. The consultants at Conomikes Associates–in their job search assignments–have developed tools to help resolve this problem. In the exhibit (on next page) you will find our specially designed Manager Responsibilities Profile. This profile is a useful tool that allows each physician to provide input. These scores can then be tallied. The solo physician can also use this guide. How to Use the Profile Survey at Your Practice: All shareholder physicians complete their Profile scoring. To tally: For each of the 26 tasks listed, add all the submitted scores. Upon completing the tallies, those tasks that, in the voting of the physicians, add up to the larger scores, have greater weight and stronger priorities than those tasks with lesser numbers. The result: A consensus based on the contributions of each shareholder. Note: Other tasks can be added or subtracted to this listing, depending upon your own practice preferences. For example, for some practices, the investigation and adoption of an Electronic Medical Records system can be included in the survey. Advantages: Physicians can develop a priority of needs, which can also be shared with the selected Manager. The Conomikes practice management consultants have successfully used this profile for their assignments and are happy to share it with you.
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ABOUT THE AUTHOR George Conomikes is CEO of Conomikes Associates, Inc. nationallyrecognized practice consultants, headquartered in San Diego, California. Contact: conomikesg@conomikes.com.
COMPANY: Conomikes MEMBER BENEFIT: Consulting and strategic planning for both new and established practices. CONTACT: Tom Loughrey at 1-800/421-6512
IMPROVE YOUR SEARCH FOR A PRACTICE MANAGER
Administrator Responsibilities Profile Instructions: To the left of each listed task, mark your score, based upon your valuation of each task. Use this guideline: 3—Very important, 2—Important, 1—Somewhat important, 0—Not important Personnel Management: Supervising and directing the work of all employees. Independent performance review of all support staff. Termination of non-physician staff. Creating job expansion opportunities for personnel. Physician Liaison and Reporting: Participate in perpetuating and ensuring practice growth. Identifies, recommends, and implements practice needs: staffing, services, equipment, and facilities. Physician/management meetings: establishes agenda in consultation with physicians, prepares data for meeting, contributes to decisionmaking. Responsible for executing projects/changes as directed by the physicians at management meetings. Interprets management reports. Explains non-normal reports to physicians. Ensures that reports to government agencies are on time: liaison with accountant and attorney.
Financial Management: Preparation of annual budget. Manages practice within budgetary guidelines. Determines economic aspects of equipment, facility, and new service decisions. Responsible and accountable for billing and collection activities. Maintains overhead and collection percentages within (best practice) industry standards. Responsible for negotiating equipment leases and best prices for supplies (business and medical). Facilities and Equipment: Responsible for facilities and premises management. If practice relocates or establishes new location; dealing with architect, contractors, and property management. Investigates new equipment and facility needs. Self-development:
Fee analysis, survey, and review with recommendations to physicians.
Attends managerial-level and other educational programs. Possible membership in MGMA (local and/or national), and specialty management groups.
Negotiates fees and contract term with major plans.
Subscribes to management publications.
Practice Marketing: Practice marketing with patients, referring practices, and with local businesses and industry. Networking to find out what other practices are doing; state-of-the-art.
Practice Name _______________________________ Your Name _________________________________ Date Completed _______________
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Member Benefit: REIMBURSEMENT ADVOCACY PROGRAM
Reimbursement Advocacy Program Reimbursement Advocacy Program (RAP) is a benefit available only to members of the Santa Clara County Medical Association. Through RAP, association members gain leverage in collecting payments from managed care plans (and other payers) slow in honoring claims. The RAP program also provides physicians, their office managers, and/or billing staff with coding and billing guidance. Contact RAP for Assistance With: •
Carrier Failure to Process “Clean Claims” in Accordance With State Law (30 days for PPO plans and 45 days for HMOs)
the additional expense of follow-up billing. Consistent observance of the “pay at time of service” policy not only reduces overhead, but reinforces the custom with patients, resulting in their readiness to pay prior to leaving the office.
Step #3: Electronic Billing Claims should be filed electronically, whenever possible. This practice will significantly expedite payments and save resources, i.e. staff time, supplies, postage. In order to ensure timely reimbursement, whether billing electronically or via submission of paper claims, it is imperative that claims are “clean” and accurate, i.e. employ proper use of CPT procedure codes, modifiers, and ICD-
•
Habitual Downcoding
9 diagnosis codes. The availability of up-to-date coding manuals,
•
Treatment Authorization and Subsequent Denial
familiarity with current coding literature, augmented with attendance
•
Payment Inconsistent With the Physician’s Contract and CPT Guidelines
at billing-related seminars, are essential tools for precise billing.
•
Coding Guidance
Step #4: Obtain “Physician Claims Inquiry” Forms From SCCMA
FOLLOW THESE STEPS TO EXPEDITE IN-OFFICE COLLECTION: Step #1: Collect Accurate Data
These bright green forms, identified with the SCCMA logo, garner
Remember—collection of accurate data is vital to your practice.
in the system. Attach this attention-getting form to a copy of the
Verify the information below at every patient encounter: • HMO or IPA affiliation
original claim(s) and resubmit to the carrier—30 days after the first
excellent results when affixed to claims that seem to be “hung-up”
submission for PPOs and 45 days for HMOs.
•
Name of insurance company
•
Name of Primary Care Physician (PCP)—with some plans this information can change monthly
Step #5: Request Help From SCCMA RAP
•
Patient’s home address. Do not accept a P.O. Box, in lieu of a home address
Inquiry,” complete and sign an RAP form, and attach a copy of
•
Patient’s phone number
correspondence, and mail to:
•
Address and phone number of patient’s current employer
Santa Clara County Medical Association
•
If the patient visit requires a referral from a PCP, secure the referral number prior to the patient visit
700 Empey Way
After 30-45 days, if there is no response to the “Physician Claims the claim, the patient’s insurance card, along with any related
San Jose, CA 95128
Step #2: Discuss Fees and Billing Procedures With Your Patients
To Request “Claims Inquiry” & “Reimbursement Advocacy” Forms,
It is very important to inform new patients about billing policies,
Fax
408/289-1064
when they call for an appointment. Place a sign at the check-in area
Call
408/998-8850 Ext. 3007
advising patients that co-pays and deductibles are due at the time of
Web
www.sccma.org
service. Also, incorporate these policies in your patient registration
See above address
form. Collect any applicable co-pays and/or unmet deductibles at patient checkout. Strict adherence to the foregoing will eliminate
32
the bulletin
NOVEMBER / DECEMBER 2008
Please Contact One of the Following:
Join in December’s
Heal That Claim Month The American Medical Association’s (AMA) “Heal That Claim” month is part of the ongoing campaign to heal the claims process. Physician practices often experience an increase in underpayments and denials during the last quarter of the year. December is an ideal time for physician practices to appeal inappropriately underpaid and denied claims. Instead of accepting the increased claim underpayments and denials, physician practices can appeal these claims and collect the appropriate payment during January and February, when payments from payers are reduced as many patients meet their outof-pocket deductibles. Once reviewing and appealing claims becomes a routine, the physician practice will increase its efficiency and revenue.
objective and reliable source of claims processing information by the health insurance companies that are responsible for paying medical bills.
National Health Insurer Report Card
Physicians and payers are encouraged to review the NHIRC and information about the “Heal the Claims Process” campaign by visiting www.ama-assn.org/ go/healthatclaim. You may access the information, even if you are not a member of the AMA. You may also obtain a copy of the report by mail or email by contacting Sandie Becker at 408/998-8850 ext. 3007 or sandie@sccma.org.
Physicians are spending as much as 14% of their total collections to obtain accurate payment for their services. Even when physicians submit correctly coded health care claims, health insurers and other third-party payers may still inappropriately delay, deny, or significantly reduce payments. The AMA’s National Health Insurer Report Card (NHIRC) is an
When you have questions about eating disorders...
The purpose of the NHIRC is to provide physicians and the general public a reliable and defensible source of critical metrics concerning the timeliness, transparency, and accuracy of claims processing by the health insurance companies that are responsible for paying these claims. The “report card” covers Medicare, Aetna, Cigna, Health Net, Humana, United Healthcare, Anthem Blue Cross and Blue Shield, and Coventry. The data was obtained from electronic standard transactions billed on more than 3 million claims from over 7,500 practicing physicians representing 18 specialties in 20 states. The data covers the second half of 2007 and the first quarter of 2008. Five metrics were surveyed: payment timeliness, accuracy, compliance with generally accepted pricing rules, denials, and transparency of contracted fees.
Would you like to receive updated coding & reimbursement news by email? If so, please call the SCCMA office to provide your email address at: 408/998-8850 ext. 3007 or email: sandie@ sccma.org. You may also visit our website at: www.sccma.org.
Eating Disorders Resource Center Medical education (CMEs) for you and your staff to help you address the needs of patients with eating disorders Advocacy for insurance issues
...we’re here to help.
Awareness, Recovery, Advocacy www.edrcsv.org 408-559-5593
Professionally-facilitated support groups for your patients and their family members (no fee; twice a month)
the bulletin
An online and printed directory of local professionals who specialize in treating anorexia, bulimia, and other eating disorders. Our website provides useful links and information for patients
NOVEMBER / DECEMBER 2008
33
Santa Clara County Medical Association 700 Empey Way • San Jose, CA 95128 • 408/998-8850 • FAX 408/289-1064 January 2009 TO:
All Members, Santa Clara County Medical Association (SCCMA)
FROM:
Howard Sutkin, MD, Chair, 2008-2009 Awards Committee
At the 2009 Medical Association’s annual banquet, the association will honor several individuals with its perpetual awards. These awards are significant honors which reflect the respect, recognition, and appreciation of our membership. The recipients are selected from among our outstanding members who have distinguished themselves with extraordinary service to medicine in general, to the association, to the community, or to medical education. Selections are made by the Awards Committee, with the aid of input from the membership. Your suggestions for recipients for each of the awards outlined on the next page of this memo will be appreciated. Please complete the form below to submit suggestions, keeping in mind the requirements for each award as listed on the opposite page. If you would like to nominate more than one person, or for more than one award, please photocopy this form or send a letter. Suggestions must be received by January 30, 2009. Thank you for your recommendations. If you previously suggested a candidate who was not given an award, please feel free to resubmit that name.
I THINK ________________________________________________________ WOULD BE A GOOD CANDIDATE FOR THE _______________________________________________________________________________________ (Name of Award) PLEASE ATTACH ALL SUPPORTING INFORMATION, INCLUDING ACCOMPLISHMENTS AND CONTRIBUTIONS THAT WILL HELP THE AWARDS COMMITTEE EVALUATE THE CANDIDATE FOR THE AWARD SELECTED. YOU MAY MAIL, FAX, OR EMAIL THE INFORMATION TO PAM JENSEN AT SCCMA. SUBMITTED BY: ____________________________________________________________________________________ MD (Please print) MAIL FORM TO: SCCMA Attn: Pam Jensen 700 Empey Way San Jose, CA 95128 EMAIL: pjensen@sccma.org FAX: 408/289-1064 DEADLINE: January 30, 2009
Santa Clara County Medical Association
Annual Awards
ROBERT D. BURNETT, MD LEGACY AWARD For a physician member of the Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless longterm commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exhalted goals of the medical profession.
BENJAMIN J. CORY, MD AWARD For a physician member of the Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.
AWARD FOR OUTSTANDING ACHIEVEMENT IN MEDICINE For a physician member of the Medical Association who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she has achieved widespread recognition. Consideration shall be given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.
AWARD FOR OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATION For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Association over and above that expected of the membership at-large.
AWARD FOR OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large.
AWARD FOR OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICE For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large.
CITIZEN’S AWARD For an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. (This usually will be a nonphysician, although physicians are not categorically excluded.)
Benjamin J. Cory, Md Award 1994
Robert W. Jamplis
1995 1996
Christopher C. Chow
1997
Outstanding Contribution To The Medical Association
Outstanding Contribution In Medical Education
Outstanding Achievement In Medicine
Richard M. O’Neill
John B. Shinn
Thomas J. Fogarty
Robert W. Andonian
Ronald L. Kaye
Norman E. Shumway
David M. Rosenthal
William C. Fowkes
Thomas A. Stamey
Bernice S. Comfort
Robert J. Frascino
Outstanding Contribution In Community Service Arthur A. Basham / Arthur L. Messinger ---
Citizen’s Award Gary W. Steinke, MD / Mrs. Pamela Steinke Mr. Howard W. Pearce
Cindy Lee Russell / Minoru Yamate
Florene Poyadue, RN
Michael R. Fischetti
Suzanne Jackson, RN
1998
Mansfield F. W. Smith
Stanley D. Harmon
Howard R. Porter
Burton D. Brent
William A. Johnson
Judge Leonard Edwards
1999
Donald J. Prolo
Steven S. Fountain
C. Michael Knauer
Jack S. Remington
M. Ellen Mahoney
Rigo Chacon
2000
Sharon A. Bogerty
Stephen H. Jackson
Theodore Fainstat
Richard P. Jobe
Barbara C. Erny
Janet Childs
Roger P. Kennedy
Bert Johnson
Nelson B. Powell / Robert W. Riley
Robert Michael Gould
Tony & Brandon Silveria
Elliot C. Lepler
Allen H. Johnson
Bruce A. Reitz
David Morgan
Tom Campbell / Ted Lempert
Joseph E. Mason, Jr.
Anthony S. Felsovanyi
David A. Stevens
Martin D. Fenstersheib
Michael E. & Mary Ellen Fox
2001 2002
Robert M. Pearl
2003 2004
Robert Wuerflein
Eugene W. Kansky
Barry Miller
D. Craig Miller
Elizabeth Menkin
Jayne Haberman Cohen, DNSc
2005
Harvey J. Cohen
Richard L. Miller
Gus M. Garmel
Rodney Perkins
Elouise Joseph
Doris Hawks, Esq.
Arthur A. Basham
Robert W. R. Archibald
G. David Adamson
Harmeet S. Sachdev
Edward A. Hinshaw, Esq.
Cindy L. Russell
Catherine L. Albin
John R. Adler, Jr.
Madhur Bhatnagar
Debbi Ricks
2006 2007
Stephen H. Jackson
MEDICO NEWS
MEDICONEWS
Highlights from CMA’s 2008 House of Delegates Hundreds of California doctors convened in Sacramento in October for the 2008 House of Delegates, CMA’s annual meeting. Each year, physicians from all 53 California counties, representing all modes of practice meet to discuss issues related to health care policy, medicine, and patient care, and to elect CMA officers. The following are summaries of some of the resolutions that the House adopted as policy. Prescription Data Mining: Resolution 104-08 reaffirms existing policy that CMA support legislation preventing patient and prescriber identifying data from being sold or used for advertising, marketing, promotion, or any activity intended to influence sales or market share of a pharmaceutical product. Forced Deportation of Patients: The delegates voted (Resolution 105a-08) that CMA oppose forced deportation of patients and referred this issue to AMA for national action. Alcohol Industry Fund for Indigent and Unfunded Patients: Resolution 207a-08 requires CMA to urge the alcohol industry to voluntarily form a fund that would adequately reimburse hospitals and physicians for the direct and spillover costs to the health care system caused by alcohol use. Tax Deduction for Uncompensated Care: The delegates directed CMA (Report B-3-08) to continue to explore alternative methods of compensation for physicians who treat the medically indigent, uninsured, or underinsured and to support legislation to amend the current tax code to allow deductions for uncompensated care. Payor Fee Schedules and Medicare Rates: Resolution 403a-08 requires CMA continue to undertake all appropriate and necessary measures to delink all private payors’ fee schedules from Medicare rates.
Debbi Ricks, CMA Alliance President receives an award at HOD meeting from CMA President, Dr. Richard Frankenstein.
36
the bulletin
NOVEMBER / DECEMBER 2008
Referrals to Noncontracted Providers: The delegates asked (Resolution 409a-08) that CMA continue to take all appropriate steps to eliminate PPO insurance contract clauses that either prohibit or penalize contracted physicians from referring patients to noncontracted physicians or facilities. California School Nurses: Resolution 601a-08 calls on CMA to support improved school health program policies, including but not limited to the Healthy People 2010 goal that there be a minimum of one school nurse to every 750 students and/or one school nurse per school. Retail Health Clinics: The delegates reaffirmed their support (Resolution 610a-08) of the requirement that retail health clinics must be owned by physicians or legally organized physician corporations. The resolution also calls for regulations requiring retail health clinics to disclose the level of training, qualifications, certification, and degree of physician supervision of providers of medical services prior to the provision of services. Smoke Free Gaming Venues: The delegates voted (Resolution 70808) that CMA support legislation mandating 100% smoke-free gaming venues as a prerequisite for issuing/renewing licenses. Tobacco Sales in Pharmacies: Resolution 719-08 declares CMA’s support for prohibitions on the sale of tobacco products in any store that contains a pharmacy. The rest of the resolutions can be viewed at the members-only website, http://www.cmanet.org/member.. (CMA Alert, October 13, 2008 issue)
SCCMA President, Dr. Howard Sutkin presents flowers to Debbi Ricks.
MEDICO NEWS
Physicians Still Facing Severe Medicare Payment Problems
Balance Billing Toolkit Available
Thousands of California physicians continue to face problems getting paid for the care they provide to Medicare patients.
Despite the vigorous efforts of organized medicine, the Department of Managed Health Care (DMHC) regulation that prohibits “balance billing” of HMO patients for out-of-network emergency services became effective on October 15, 2008. CMA has published a toolkit to help physicians deal with the uncertainty caused by this regulation and to answer any questions they have about their rights and responsibilities. The toolkit is available to members only at http://www.cmanet.org. CMA and a coalition of provider groups have filed a lawsuit against DMHC arguing, among other things, that the regulation is unlawful and unenforceable not only because DMHC lacks the authority to regulate doctors, but also because it violates the intent of the Knox Keene Act.
The transition to NPI numbers earlier this year, followed by the switch in September from NHIC to Palmetto as the Medicare carrier for California, has created a bureaucratic nightmare of red tape and rejected claims for doctors, delaying Medicare payments for months for some doctors. CMA and our county societies are working with Palmetto and CMS to resolve these problems. Palmetto vice president and J1 director Mike Barlow recently held a Medicare payment workshop at the 2008 House of Delegates, and also addressed the CMA County Medical Executives and the CMA Board of Trustees as part of Palmetto’s efforts to address these issues. Our Economic Services team has already helped hundreds of doctors fix their Medicare problems and get paid, so that they can get back to doing what they do best: taking care of their patients. CMA is also holding weekly calls with CMS and members of Congress weekly to resolve the systemic issues. CMA has compiled a list of common problems and fixes and posted it online at http://www. cmanet.org/palmetto. Physicians who are still experiencing payment problems are encouraged to review this list to see if their issues are addressed. If after doing so you still have questions or problems, please contact Sandie Becker, SCCMA Reimbursement Specialist at 408/9988850.. (CMA Alert, October 13, 2008 issue)
More information is available at http://www. cmaalert.org. Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org. (CMA Alert, October 13, 2008 issue)
Physicians Urged to Verify Accuracy of CPPI Quality Data The California Cooperative Healthcare Reporting Initiative (CCHRI) will begin soliciting feedback from physicians as part of the California Physician Performance Initiative (CPPI). Affected physicians will be notified via mail. The quality measure scores are based on claims data from patient care provided in 2007. Physicians will be provided with a percentile rank compared to their physician peers, performance scores by measure, and performance scores by patient group. Physician-specific Medicare scores will not at any time be released to the public by either Medicare or CCHRI. Although CCHRI has no current plans to publicly release physician-specific quality scores related to the treatment of private PPO patients, it is possible that the private health plans could use this information in the future. However, the private health plans would only be provided the scores of their network physicians. CMA will be working closely
with CCHRI to vigilantly protect the use of physician information. We encourage physicians to verify the accuracy of the data used to calculate their scores by requesting their private PPO patient lists at the CCHRI website. Beginning on Friday, October 17, you can visit http:// www.cchri.org/cppi to download and complete the “Request for Patient List and Appropriate Data Use” form. The completed forms will be sent to Thomson Reuters (the vendor contracted to collect, standardize, and score the data in strict compliance with HIPAA regulations). Requests must be submitted no later than December 5 and will be processed within five business days of receipt. Additional information about CPPI, including the scoring methodology, can be found at http://www.cchri.org/cppi. Physicians who review their patient lists and believe their scores to be in error can submit correction requests (with supporting data) within 30 days. Thomson Reuters will
log the physician’s request and tabulate the frequency and nature of corrections. A letter acknowledging receipt of the correction request will be mailed to each physician. At the end of the comment period, CCHRI will review the nature of corrections with its Physician Advisory Group and Steering Committee to determine appropriate use of the physician scores. CPPI received federal funding in 2006 to develop a system for measuring and reporting the quality of health care provided by physicians. CPPI collected data on approximately 25,000 physicians for a limited set of nationally-endorsed quality measures for both Medicare patients and private PPO patients from Anthem Blue Cross, Blue Shield of California, and United Healthcare. Contact:Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org. (CMA Alert, October 13, 2008 issue)
the bulletin
NOVEMBER / DECEMBER 2008
37
MEDICO NEWS
San Bernardino County Physician Installed as CMA’s 141st President Dev GnanaDev, MD, 58, took office as CMA’s new president at the close of the association’s Annual House of Delegates, which was held in October in Sacramento. “This is an important time for health care in California,” Dr. GnanaDev stated. “As physicians, we must be a voice for the patients we serve. Our first and most important goal is to ensure that Californians have access to the care they need. The doctors of the California Medical Association will be doing everything in our power to make that happen.” Dr. GnanaDev served for the past year as president-elect before taking office and will serve a one year term. Dr. GnanaDev has been an active member in the CMA for 27 years and was the president of the San Bernardino County Medical Society, founded the New Beginnings Gang Tattoo Removal program for reformed gang members and was also founder of a cardiac rehabilitation program for indigent patients. He is a founding board member of the Inland Empire Burn Institute, and he has served on the board of the Juvenile Diabetes Foundation’s Inland Empire Section. He has a special interest in rehabilitation of children with burns, and has worked with local firefighters to raise money to send children to Burn Camp and to educate children about the dangers of burns in educational programs at schools. Dr. GnanaDev was forced to be a patient himself, suffering a heart attack and enrolling in a heart-health post operative program. Following that experience, in 2002, he donated $30,000 to start the Cardiac Health Management Program at Arrowhead Regional Medical Center in Colton. The program provides free cardiac care to qualified post-operative patients. His great interest in lower-income patients led to his receiving the Medical Board of California Physician Recognition Award in 2005 for contributions to care of indigent patients. Dr. GnanaDev has received numerous additional awards, including the American Medical Association’s Pride in the Profession Award in 2007, and Distinguished Executive of the Year Award from Cal State University San Bernardino this year. In 2005, he received the American Heart Association (Inland Empire) “Star of the Hearts” Award. He was given the Golden Scalpel (best teacher) award from surgical residents at Loma Linda University School of Medicine in 1991, where he serves as an associate professor. He also holds a Professor of Surgery appointment at Western University for Health Science in Pomona. Board certified in general surgery, vascular surgery, and surgical critical care, Dr. GnanaDev earned his Medical Degree in Kurnool, India, at Kurnool Medical College. After interning in his native India, he served his residency in Newark, New Jersey, and was a fellow in cardiovascular surgery at Arizona Heart Institute in Phoenix, Arizona. He earned a master’s degree in business administration from California State University, San Bernardino, in 2001. He is chief of surgery and has served as medical director at Arrowhead Regional Medical Center in Colton since 2000. Before that, he was associate medical director at San Bernardino County Medical Center for eight years. Dr. GnanaDev, his wife, Rosaria, and their children Monica, Yamuna and Raja live in Upland. (CMA Alert, October 13, 2008 issue)
38
the bulletin
NOVEMBER / DECEMBER 2008
Orange County Physician Elected CMA PresidentElect Brennan Cassidy, MD was elected CMA President-Elect at CMA’s annual House of Delegates. He will serve as presidentelect for one year and become president in October 2009. “As president-elect I will be working not just for physicians but for the patients we serve,” says Dr. Cassidy. “In concert with our patients, the physicians of the California Medical Association can steer the health care reform conversation towards solutions which improve access without compromising the quality of care people rely on from their doctor.” Dr. Cassidy is a past president of the Orange County Medical Association and was named OCMA’s “Physician of the Year” in 2004. He has served on many committees throughout his 36 years as a member of CMA., most recently serving as Chair of CMA’s Board of Trustees. He is board certified in emergency medicine and family practice, and has been on the staff of Hoag Memorial Hospital Presbyterian in Newport Beach since 1971. During his time at the hospital, he has served as the founding chair and director of the Department of Emergency Medicine. Dr. Cassidy is currently in private practice at West Coast Laser Dermatology Medical Center in Santa Ana. (CMA Alert, October 13, 2008 issue)
We reward loyalty. We applaud dedication. We believe doctors deserve more than a little gratitude. We do what no other insurer does. We proudly present the Tribute® Plan. We go way beyond dividends. We reward years spent practicing good medicine. We salute a great career. We give a standing ovation. We are your biggest fans. We are The Doctors Company. Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company
You deserve more than a little gratitude for a career spent practicing good medicine. That’s why The Doctors Company created the Tribute Plan. This one-of-a-kind benefit provides our long-term members with a significant financial reward when they leave medicine. How significant? Think “new car.” Or maybe “vacation home.” Now that’s a fitting tribute. To learn more about our medical professional liability program, including the Tribute plan, call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293. You can also visit us at www.doctorsagency.com.
Classified
ADS office space for rent/lease
MEDICAL SUITES • GILROY
OFFICE EXAM ROOMS TO LEASE
First class medical suites available next to
Two nice and large exam rooms (dedicated),
Saint Louise Hospital in Gilroy, CA. Sizes
shared waiting room. Available five
available from 1,000 to 2,500+ sq. ft. Time-
days a week, 2585 Samaritan Drive, San
share also available. Call Betty at 408/848-
Jose. Please call 408/356-7788 for more
2525.
information.
October 2008. First floor, with lab and xray
MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA
MEDICAL OFFICE SUITE FOR RENT • SAN JOSE
suites in the building, to make it convenient
Medical space available in medical building.
Medical office suite for rent at 93 N. 14th
for your patients. Lots of parking available.
Most rooms have water and waste.
St. San Jose 95112. Contact Dr. Sajjadi at
Great visibility at corner of N. Jackson and
Reception, exam rooms, office, and lab.
408/294-1825 or 408/867-1111.
Montpellier Dr., located at 244 N. Jackson
X-ray available in building. Billing available.
Ave. Call Tania at 408/923-0257
2,500–4,000 sq. ft. Call Rick at 408/228-
MEDICAL OFFICE SPACE FOR LEASE • East San Jose 1,380 sq. ft. excellent medical suite across from Regional Medical Center. Available
MEDICAL/DENTAL OFFICES FOR LEASE • WEST SAN JOSE/ CAMPBELL/LOS GATOS/WILLOW GLEN
0454.
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OFFICE SPACE FOR LEASE • SAN JOSE
previously occupied by RAMBLC Pediatric
600–1,900 sq. ft. in West Valley Medical
San Jose, in the Santa Teresa Medical/
Building, second floor, elevator, separate
Professional Center across from Kaiser
entrance. Call Helen at 408/243-6911.
Hospital. Call Virginia at 408/528-0571.
sq. ft. (combined 4,945 sq. ft.). Tenant
OFFICE SPACE FOR RENT • MTN VIEW
NEW MEDICAL BUILDING DOWNTOWN LOS GATOS
improvement allowances. Bldg. elevator.
Consult room and exam room available in
1,717 sq. ft. and 1,559 sq. ft. suites for sale or
Paradise landscape. Minutes from hospitals.
shared office suite, near El Camino Hospital.
for lease in spectacular new building at 235
Excellent visibility and signage with ample
Shared receptionist and billing services
W Main St. Contact Trask Leonard, Bayside
parking. Easy access to Hwys. 17/880 &
available if desired. Contact Len Doberne,
Realty Partners at 650/282-4620.
85. Located at 2242 Camden Ave. (Bascom
MD at 650/967-8841.
Exceptional location for quality suites consisting of first floor: (1) 1,595 sq. ft. Second floor: (2) 1,030 sq. ft.; (3) 1,675 sq. ft. (combined 2,705 sq. ft.); (4) 1,500
Ave.), San Jose. Call Sheldon at 408/3777383.
MEDICAL SUITES • LOS GATOS – SARATOGA
Group. Located at 6140 Camino Verde Dr,
OFFICE SUITE AVAILABLE
OFFICE SPACE FOR SUBLEASE • MTN VIEW
Location is highway 85 at De Anza. One
Two exam rooms and one doctor’s office,
tx rooms/offices, entry, large master office
five days a week, shared waiting room,
with balcony. Street signage to 100,000
Two suites, ranging from 1,000 to 1,645 sq.
in Mountain View, on South Drive. Call
ft., at gross lease cost. Excellent parking.
650/967-7471.
suite available. Currently configured with 6
Hospital. Both units currently available. Call
OFFICE TO SHARE • LOS ALTOS
BRAND NEW HIGH END MEDICAL CONDOS–DOWNTOWN LOS GATOS
408/355-1519.
Options include two exam rooms plus
Design/build-to-suit opportunities
office. Newly remodeled office space perfect
for sale/lease. On-site parking. In the
for cosmetic dermatologist, facial plastic, or
heart of prestigious downtown Los
plastic surgeon. Near El Camino Hospital.
Gatos. Unit sizes 1,400 sq. ft. and up.
Located next door to Los Gatos Community
MEDICAL OFFICE FOR LEASE/ SUBLEASE/SALE Office in close proximity to O’Connor Hospital for lease/sublease/sale. Please call
Call 650/804-9270.
408/923-8098 for more information.
40
the bulletin
NOVEMBER / DECEMBER 2008
Contact Matt–408/282-3835. www. colliersparrish.com/losgatos.
cars a day. Marble entry. Zoned medical/
contact Ms. Veronica Knight at 650/603-8236
office. No variance required. Looking for
to become part of our team.
established business/practice that values prime location in beautiful building. Please be qualified. No start ups. Contact Dr. Newman at 408/996-8717. Brokers welcome if you have a client. Compare with space by Good Sam at $3.50 sq. ft.
A+ TRANSCRIPTION SERVICE
OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on
OFFICE SPACE FOR SUBLEASE • LOS GATOS
call” coverage. We are currently looking
1-2 exam rooms across from Los Gatos
primary care and specialty physicians
Community Hospital. Available Monday,
(orthopedist and physiatrist) interested
Wednesday, Friday. $1,000/month or best
in joining our team of professionals in
offer. Call 408/309-3050.
providing high quality occupational medical
for several knowledgeable and progressive
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PRIVATE PRACTICE for sale PRIVATE PRACTICE FOR SALE IM/FP/GP. Primary care practice for sale, including inventory and equipment. Close to O’Connor Hospital. If interested, please call Stacy at 408/297-2910.
PRIVATE PRACTICE FOR SALE Established/Active Internal Medicine/ Primary care practice for sale. Work/live in Coastal California. Enjoy best of everything. If interested, please call 831/345-9696.
EMPLOYMENT OPPORTUNITY MEDICAL PRACTITIONER WANTED Physicians, Physician Assistants, or Registered Nurses needed for contract positions at the San Jose Military Entrance Processing Station, 546 Vernon Ave. Mountain View. Medical Practitioners will conduct medical qualifications examinations of applicants for all branches of Armed Forces. Must hold a current unrestricted license. Practitioners will be subject to credentials approval by the Headquarters U.S. Military Entrance Processing Command
injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Dan R. Azar MD, MPH at 408/790-2907 or e-mail dazar@allianceoccmed.com for additional information.
FAMILY MEDICINE PHYSICIAN NEEDED Part or full-time physician sought to join existing practice. Currently, we have two full-time MDs and one part-time MD. Busy PPO only practice. Very light call schedule, approx. one weekend in 17. Hospital work
“ A+ Transcription makes us feel like we are their only client. Great work in terms of accuracy and rapid turnaround time.” Wendy Perston, Administrator – Cardiovascular Institute of Southern Oregon “A+ Transcription has provided my Physiatry and Pain Medicine practice with prompt, accurate transcription for many years. I strongly recommend this service to any clinician.” Mark J. Sontag, M.D.
by choice only, close to Good Samaritan Hospital. Employee or expense sharing are options. If interested or for further details, please fax your information to 408/3589028. Upon reviewing your resume, we will call you.
condo/COTTAGE rentals CHRISTMAS/NEW YEAR • NORTH SHORE LAKE TAHOE Front lake, three bedroom, two & half bath townhouse. Sleeps eight. Linen, internet, year-round pool. $400 per night. Call Christiane at 408/356-7453.
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prior to employment. Excellent opportunity for someone looking for a flexible, part-time work schedule from 1-2 days per week to as little as a few hours per month. If you are searching for this unique opportunity,
Continued on page 46
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alliance news
Alliance
News The CMA Alliance held its 79th Annual Fall Leadership Conference on September 19-21, 2008 at the Toll House Hotel in Los Gatos. We would like to extend a special “THANK YOU” to all participants who made the conference possible. Over 75 physicians, spouses, and friends were in attendance. A special round of applause goes to conference co-chairs Jean Cassetta and Suzanne Jackson, members of the Santa Clara County Medical Association, and members of the Santa Clara County Medical Association Alliance, who provided endless hours to make this conference possible. Also, special thanks go to our speakers and workshop leaders. For a complete wrap-up of the conference, go to www.cmaa.net.
OUR APOLOGIES… to Siggie Stillman, SCCMA Alliance and SACPAC Board Member. In the September/ October 2008 issue of The Bulletin, we did not list Siggie’s name as a contributor to SACPAC. Siggie, thank you for your support and contribtion to SACPAC.
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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alliance news
SCCMA Alliance News Santa Clara County Hosts CMA Alliance Fall Conference
Dr. Phil & Siggie Stillman; Chris Crowley, Keynote Speaker
Dr. Bill Ricks; Dr. Bill Plested, Past President, AMA; Dr. Bill Lewis
Dr. Howard Sutkin, President SCCMA; Debbi Ricks, President CMA Alliance
Barbara Fishman, Cheryl Smith Dr. Richard Frankenstein, Immediate Dr. Bill Plested; Dr. Jim Hinsdale, CMA Board Past President, CMA; Debbi Ricks of Trustees Chair; Bonnie Hinsdale
Siggie Stillman; Jean Cassetta; Debbi Ricks; Carolyn Miller, President, SCCMA Alliance; Mary Hayashi
Dr. Felix & Kimberly Lee
Dr. Daniel Stern, Elizabeth Moder-Stern
Dr. Steve Jackson, Dr. Bill Lewis, Dr. Eleanor Martinez
Zeny Seid
Dr. Charles & Heather Goodman
Dr. Tanya Spirtos; Juliet Funt, Keynote Speaker
Suzanne Jackson; Barbara Spector, Mayor, Los Gatos
Dr. Alan & Meg Giberson
Dr. Marty Fishman, CMA Trustee
Diane Morgensen, Jeannine Olson
Kathleen Miller
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Congratulations
Dr. Madhur Bhatnagar Winner of the California Medical Association Alliance
Excellence Award 2008
Presented to Dr. Bhatnagar by CMA Alliance President Debbi Ricks at the Annual CMA Foundation Awards Dinner, October 5, 2008, in Sacramento The CMA Alliance Excellence Award is a recognition award given by the CMA Alliance to a volunteer who is a member of the medical family and has made a significant contribution to a health-related issue in California. Dr. Bhatnagar is the founder of the Annual Gardner Family Health Fair in San Jose, spotlighting a different health issue every year with 700+ visitors participating. This is a day-long event with health education, fun and health screenings. This year, the focus was on childhood obesity. Dr. Bhatnagar involves and energizes all who come in contact with her. Her spirit is â&#x20AC;&#x153;can doâ&#x20AC;? and she includes and welcomes all ages and all backgrounds in her zest for making life better for her patients. The Santa Clara County Medical Association Alliance is honored that Dr. Madhur Bhatnagar is the winner of this prestigious award, the CMA Alliance Excellence Award.
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MEMBER NEWS & HAPPENINGS new
members
WELCOME 133 NEW MEMBERS! Name Venkat Aachi Nicholas Abidi Yi An Adriana Anavitarte Hedviga Arsene Dinah Arumainayaga Mari Asakawa Jennifer Baron Lauren Bentivegna Catherine Berger-Dujmovic Claudia Cardenas Krisna Chai Hongwei Chen Julie Chen Thomas Chen Grace Cheng Marc Chinn Karen Chiu Michael Chiu Michael Choi Sri Madhavi Cholleti Jonathan Chow Susan Chow Vinca Chow Takesha Cooper Malini Daniel Nicole Dâ&#x20AC;&#x2122;Arcy Sharad Dass Santosh Davies Anthony Debs Nikhil Desai Clare Dimaunhan Stesha Doku Marketa Dolnik Robin Eisenhut Harry Flaster Deepa Galaiya Christina Gamba Monsen Ghofrani Robert Gordon Jean Gruver Gordon Haddow Un Har Brant Harradine Michael Hole Andrew Hope Lynna Hwang Plomarz Irani Iliana Jaatmaa
Specialty City *PMR Santa Clara *ORS Santa Cruz Student Stanford Student Stanford IM Santa Clara Student Stanford IM Cupertino D Palo Alto OBG Campbell *OBG PD GE IM IM ON HEM PD PD PD Student U IM *AN EM Student CHP Student Student *IM *PUD *CCM *SDM EM *AN *PM PS PD Student *CCM Student Student Student Student R *CDS *TS *PD *AN OBG ORS Student AI PD EM Student
Santa Clara Santa Clara Santa Clara Santa Clara Milpitas Campbell Santa Clara Santa Clara Santa Clara Stanford Santa Clara Campbell Santa Clara Santa Clara Stanford Menlo Park Stanford Stanford San Jose Santa Clara Santa Clara Santa Clara Santa Clara Stanford Santa Clara Stanford Stanford Stanford Stanford Santa Clara Santa Clara Santa Clara Santa Clara Mtn View Santa Clara Stanford Santa Clara Campbell Santa Clara Stanford
Name Specialty City Richard Jones Student Stanford Namrata Joshi IM Santa Clara Prarag Kale CS Santa Clara Edward Karpman U Mtn View Hulya Kaymaz IM Santa Clara Ryan Knueppel IM Santa Clara Myung Ko Student Stanford Anna Krawisz Student Stanford Chandra Krishnan PD Santa Clara Winne Kwan PD Santa Clara Divya Laxmikant IM Milpitas Hon Lee *CDS *TS Santa Clara Jason Lee IM Santa Clara Claudia Leiva OBG Santa Clara Eric Leroux Student Stanford Karen Leu HEM Santa Clara Roxanne Leung AI San Jose Anna Li OBG San Jose Billy Liang EM Santa Clara Lianghuey Lieu *IM Mtn View Julie Livingston OBG Santa Clara Nadim Mahmud Student Stanford Nima Massoomi ORL Cupertino Nathan Meng Student Stanford Michelle Moore *CCM *IM *PUD Oakland Grace Nadolny P GPSY Cupertino Jay Nathan Student Stanford Lynn Ngo *IM San Jose Neha Nirodi P Cupertino Juno Obedin-Maliver Student Stanford Harpreet Pannu IM Santa Clara Dharti Patel IM Santa Clara Preeti Patel NPM Santa Clara Rita Patel R Santa Clara Edward Pham Student Stanford Mario Pompili *CDS *TS Santa Clara Ioana Popescu *P Cupertino Niusha Rafie IM Santa Clara Kavitha Raj OBG Mtn View Sudhir Rajan CCM Santa Clara Thomas Rarick *OBG Mtn View Raymond Raven *ORS HS Burbank Lawrence Reinish *P *SDM Ontario, CN Christopher Renninger Student Stanford Jin-Sae Rhee PD San Jose Mary Rhee PD Milpitas Alejandrina Rincon OBG Santa Clara Ron Rosen *NM San Jose Edward Rustamzadeh NS San Jose
Name Jackline Saber Amit Sareen Ryan Schubert Judith Schwartz Suhail Sheikh Roopa Siddabasappa Nalma Siddiqui Luz Silverio Christina Stachur Leslie Sullivan Margaret Sullivan Clinson Tan Silvia Tee Morgan Theis Matthew Thompson Marius Tijunelis Jessica Tsai Roberto Valladares Alpana Verma-Alag Israel Villanueva Harsha Vittal Latha Vrittamani David White Jason Hwai Wong Joslyn Woodward Kevin Woolf Yineding Xu Wei Ye Gloria Yiu Atalie Young Justin Young Grace Yu Marc Zare Sergio Zendejas Rita Zorian
Specialty City IM San Jose EM Santa Clara Student Stanford Student Stanford P Cupertino CHP San Jose P Campbell Student Stanford Student Stanford *GS San Jose OBG Campbell AN Santa Clara HEM Santa Clara Student Stanford Student Stanford EM Santa Clara Student Stanford Student Stanford IM San Jose CCM *IM Stanford GE San Jose PD San Jose EM Santa Clara HEM Santa Clara Student Stanford IM Santa Clara Student Stanford IM San Jose Student Stanford Student Stanford P Menlo Park AI Palo Alto GS San Jose AN Santa Clara PD Los Gatos
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NOVEMBER / DECEMBER 2008
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CLASSIFIED ADS, from page 41
MISCELLANEOUS
COTTAGE FOR RENT • SARATOGA Cottage in Saratoga. Retreat-like setting. Close to great hiking and biking trails.
WANTED
Close to Hwy 85. One large bedroom, living
MEDICAL OFFICE EQUIPMENT FOR SALE
PEDIATRIC PRACTICE
room, kitchen, and bath. Private driveway
Reupholstered midmark exam tables with
and fenced yard. Rent $1,290 per month.
Call 408/455-2959.
stirrups and storage drawers; Beam scales
Available mid-August. Contact Carolyn
with height rod and wheels; Adjustable
Silberman 408/867-1815, or cell 408/221-
OFFICE NST MACHINE WANTED
exam stools. Call 650/255-6907 or email:
We need another Corometrics or similar
7821, or email wwswolfe@aol.com.
scope770@aol.com.
portable fetal monitor. Please call 650/988-
Will buy Pediatric practice in South Bay.
7478.
BEAUTIFUL HAWAIIAN CONDO Poipu Beach, Kauai. Lovely 2 BR/2 BA condo, across street from ocean. Recently remodeled bathroom and kitchen with granite countertops, new carpeting
Pajaro Dunes
throughout. Three lanais with ocean and mountain views, and the tropical gardens
Beachfront Condo
which make the Nihi Kai complex so special. $885,000. Call 650/949-3353.
Shorebirds #58 2 Bedroom -- 2 Bath Top Level -- Great Ocean View Great for Families Owners Bill & Debbi Ricks 408-354-5613
Rental Agent Pajaro Dunes Company 1-800-564-1771
Thinking about electronic medical records? What about your paper records? If you are planning going to do with all those records into records to a CD alternative:
to move to an electronic medical record system, what are you your paper patient charts and billing files? Consider scanning a digital database with deliverExchange™. Let us scan your or DVD, and realize the benefits of this cost-effective
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the bulletin
NOVEMBER / DECEMBER 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.
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Current Cardiac Research Being Done at California Pacific Medical Center n Radiofrequency Ablation and Treatment of Heart Failure: Clinical studies are in progress to evaluate the effectiveness of a catheter for the radiofrequency ablation of paroxysmal atrial fibrillation compared to standard medical therapy. Other recent studies have focused on equipment to predict responses to therapy with bi-ventricular pacemaker implants, devices for delivering non-excitatory impulses to the left ventricle of the heart during the time of absolute refractory period and development of algorithms that can predict or detect heart failure decompensation events.
n Allomap study for assessing organ rejection: This study utilizes a test that measures molecular expression from 20 different genes that are related to the immune process to calculate a score that may be useful in identifying patients who may be having rejection following heart transplant. These genes reflect the process going on at a cellular level and may ultimately replace tissue biopsy, which is the standard technique to determine organ rejection. The Allomap test is a simple blood test, so it has a significant advantage over a biopsy, which is an invasive procedure.
n Takotsubo cardiomyopathy (TC): In collaboration with other local hospitals, this study aims to investigate whether there is a genetic basis for the development of TC. Reported initially by Japanese authors, this reversible cardiomyopathy is usually precipitated by acute emotional stress. Typically affecting postmenopausal women, it mimics the symptoms and signs of acute myocardial infarction. Angiography demonstrates no significant coronary artery disease. However the heart is hypocontractile and has a balloon shape with a round (akinetic) apex and narrow (hyperkinetic) base, which resembles an octopus trap â&#x20AC;&#x201C; or Takotsubo. The mechanism of TC is unknown, but catecholamine stimulation is thought to play a major role. Participants of our study provide their saliva samples which are used for genetic analysis and investigation of potential genetic clues to this unique syndrome.
n New Coronary Artery Stent Platforms: Randomized trials are ongoing in the cardiac catheterization laboratory to evaluate the performance of new generation coronary artery drug-eluting stents that employ better pharmaceutical agents to more effectively inhibit smooth muscle cell proliferation and new structural designs for increased flexibility. Several long-term registry studies are underway to determine the three- and five-year outcomes with drug-eluting stents, with special focus on the factors related to the occurrence of in-stent restenosis and very late stent thrombosis.
For more information on all the research being conducted at California Pacific Medical Center, please visit www.cpmc.org/professionals/research
www.cpmc.org
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BULLETIN
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A PUBLICATION OF THE SANTA CLARA COUNTY MEDICAL ASSOCIATION
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