2009 November/December

NOVEMBER/DECEMBER 2009 | Volume 15 | Number 6

CONGRATULATIONS! James Hinsdale, MD, FACS Becomes CMA President-Elect

Open Wide...

With Confidence!

It’s Open Enrollment time for the Santa Clara County Medical Association sponsored Group Dental program. This plan is designed to help you, your family and your employees minimize the out-of-pocket expense of regular dental care.

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.

Remember, 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, 2009.

Call a Client Service Representative at 800-842-3761 for more information, a brochure and application. Or visit www.MarshAffinity.com/cmadownload.html to download an enrollment kit.

Sponsored by:

Underwritten by:

Administered by:

Underwritten by: (IL) - First Commonwealth Insurance Company, (MO) - First Commonwealth of Missouri, (IN) - First Commonwealth Limited Health Services Corporation, (MI) - First Commonwealth Inc., (CA) - Managed Dental Care, (TX) - Managed DentalGuard, Inc. (DHMO), (NJ) - Managed Dental Guard, Inc., (FL, NY) - The Guardian Life Insurance Company of America. All First Commonwealth, Managed DentalGuard, Inc. and Managed Dental Care entities referenced are wholly-owned subsidiaries of The Guardian Life Insurance Company of America. Products are not available in all states.

Limitations and exclusions apply. Plan documents are the final arbiter of coverage.

43410 (11/09) © Seabury & Smith Insurance Program Management 2009 • CA Ins. Lic. #0633005

d/b/a in CA Seabury & Smith Insurance Program Management • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance@marsh.com • www.MarshAffinity.com 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).

BULLETIN THE

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

From the Editor’s Desk.................................................................................5 Joseph S. Andresen, MD

Statement From James G. Hinsdale, MD, FACS, President-Elect, CMA...6 CMA New President and CEO......................................................................7 Preferred Health Technology is now introducing its proprietary and innovative Electronic Payment and Transaction Processing System to medical facilities in Northern California.

More on page 8

New Health Care Payment Solution...........................................................8 Manage 2010 Health Plan Expenses Now..................................................9 SCCMA Alliance News................................................................................10 Member Benefit: Amerinet/Verizon Wireless Discounts......................... 11 Managing Professional Risk......................................................................16 NORCAL Mutual Insurance Company

Prevent Employment-Related Claims......................................................17 Roy S. Lyons, Marsh

Invisible Patients........................................................................................18 It is sometimes difficult to address our colleagues’ problems in the middle of our own busy workday.

Many physicians work long hours and may be unwilling to take a break in their own day to address the issue.

More on page 24

Maribel R. Andonian

Annual SCCMA Awards Nomination Form..............................................20 The Health Debate, 2009...........................................................................22 Lawrence Stern, MD, FACS

Depression..................................................................................................24 Jyoti Rau, MD and Nandini Ganpule, MD

Frequently Asked Questions: Treating Patients in a Difficult Economy...............................................26 Susan Shepard, MSN, MA, RN, CPHRM

Physician Profiling: What You Don’t Know Can Hurt You......................28 AMA Private Sector Advocacy Staff Did you know that the State of California has a quick, easy, and free way for doctors and hospitals to get help with claims payment problems?

More on page 30

Need Help Getting Paid WHat You’re Owed?..........................................30 Cindy Ehnes

MEDICO NEWS............................................................................................32 Classified Ads..............................................................................................36 Welcome New Members/In Memoriam...................................................38

PAGE 3 | THE BULLETIN | NOVEMBER / DECEMBER 2009

The Santa Clara County Medical Association Officers

AMA Trustee - SCCMA

Councilors

President Howard Sutkin, MD President-Elect Thomas Dailey, MD VP-Community Health Cindy Russell, MD VP-External Affairs William Lewis, MD VP-Member Services Judith Dethlefs, MD VP-Professional Conduct Jim Crotty, MD Secretary Sameer Awsare, MD Treasurer Martin L. Fishman, MD

James G. Hinsdale, MD

El Camino Hospital of Los Gatos: Rives Chalmers, MD El Camino Hospital: Open Good Samaritan Hospital: Eleanor Martinez, MD Kaiser Foundation Hospital - San Jose: Efren Rosas, MD Kaiser Permanente Hospital: Allison Schwanda, MD O’Connor Hospital: Jay Raju, MD Regional Med. Center of San Jose: Emiro Burbano, MD Saint Louise Regional Hospital: John Saranto, MD Stanford Hospital & Clinics: Peter Cassini, MD Santa Clara Valley Medical Center: Patrick Kearns, MD

Tanya W. Spirtos, MD (Alternate)

SCCMA/CMA Delegation Chair Tanya W. Spirtos, MD (District VII)

CMA Trustees - SCCMA Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (President-Elect) Randal Pham, MD (Ethnic Member Organization Societies)

Chief Executive Officer

Tanya W. Spirtos, MD (District VII)

William C. Parrish, Jr.

BULLETIN THE

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

Printed in U.S.A.

Editor

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Opinions expressed by authors are their own, and not necessarily those of The Bulletin or the Santa Clara County Medical Association and the Monterey County Medical Society. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by the Santa Clara County Medical Association or the Monterey County Medical Society 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

THE MONTEREY COUNTY MEDICAL SOCIETY OFFICERS President William Khieu, MD, MBA Secretary Eliot Light, MD Treasurer John Clark, MD

CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.

DIRECTORS Valerie Barnes, MD Ronald Fuerstner, MD David Holley, MD R. Kurt Lofgren, MD Oguchi Nkwocha, MD James Ramseur, Jr., MD Scott Schneiderman, DO

CMA TRUSTEE – MCMS Valerie Barnes, MD

© Copyright 2009 by the Santa Clara County Medical Association.

PAGE 4 | THE BULLETIN | NOVEMBER / DECEMBER 2009

FROM THE EDITOR’S DESK

WHAT’S NEW IN THE WORLD OF health care?

By Joseph Andresen, MD What is new in the world of health care since our last issue of The Bulletin?

Well, a great deal! As I alerted you in our last issue, there is gaining momentum and urgency to enact health care reform legislation by the end of this year. The House legislation, HR 3962, just passed on a final floor vote. This bill is similar in framework to HR 3200 that was discussed in our last issue, but with some notable changes. The public insurance option will now be required to negotiate rates with physicians and hospitals, rather than being set at Medicare plus 5%. There are also significant restrictions on federal subsidies for all private insurance plans that offer coverage for abortion services.

This resulted from intense lobbying from conservatives and Roman Catholic bishops and was a compromise of political necessity.

Where do we go from here? Now all attention turns to action in the Senate.

The final Senate bill is beginning to take shape, but faces difficult challenges. Senate majority leader, Harry Reid, has begun this process by combining bills passed by the Finance and Health panels. He did include a public insurance option in this final version and is seeking support for an “opt out” mechanism that would allow states to decline to participate in this program.

There is little room for error and 60 votes are needed both to pass a bill and to avoid a filibuster. Republican Senator Olympia Snowe opposes a public insurance option, unless there is a “trigger” mechanism where a public insurance offering would only come into play if the private insurance sector were unable to lower costs and

provide greater competition in the market place. Senator Joe Lieberman opposes any bill that includes a public option and has threatened to block a floor vote if it appears.

Once the Senate and House have passed separate measures, representatives are appointed to a conference committee that will negotiate the differences. Both the House and Senate must pass the final bill that results from their negotiations again.

This is the phase where the President and administration will be most active in helping to shape the final legislation that is most likely to pass. The final bill will then be sent to the White House to be signed into law.

So, you can see that the next few weeks will be crucial to the success or failure of health care reform legislation. I urge all physicians to stay tuned to this important and potentially historic process, and communicate directly with your legislators as issues arise.

Turning to an important accomplishment closer to home, I would like to congratulate Dr. James Hinsdale as the next President-Elect of the California Medical Association. As a past president of the Santa Clara County Medical Association, I have known him to be the strongest advocate for physicians. His work continues to ensure our ability to give the highest quality of care to our patients. Dr. Hinsdale currently serves as the director of trauma at Marin General Hospital and is executive director of trauma at Regional Medical Center in San Jose. He is the founder and president of the Northern California Trauma Medical Group, an organization of eighteen practicing trauma

Joseph Andresen, MD is the editor of The Bulletin.

He is board certified in anesthesiology and is currently practicing in the Santa Clara valley area. surgeons. His clinical attributes are many, including Assistant Clinical Professor of Surgery at the Stanford University School of Medicine, where he originally completed his internship and residency. Dr. Hinsdale currently specializes in trauma and cancer surgery and has been the medical director of the California Shock-Trauma Air Rescue for the past 23 years. He received his medical degree from the University of Illinois College of Medicine.

In addition to the many accomplishments listed above, Dr. Hinsdale was elected chair of the CMA Board of Trustees in October of 2008. For those of you who don’t know, Santa Clara County Medical Association currently has six members who are CMA Board of Trustee representatives--Dr. Hinsdale as President-Elect, and Trustees Doctors Martin Fishman, Susan Hansen, Tanya Spirtos, and Randal Pham, and Mrs. Debbi Ricks as CMA Alliance President. This speaks very highly of our local organization and the involvement we have at the state level. For our 35,000 CMA members, I can say with great confidence that we will be in good hands with Dr. Hinsdale’s leadership during these both exciting and very challenging times in the profession of medicine.

PAGE 5 | THE BULLETIN | NOVEMBER / DECEMBER 2009

MEMBER SPOTLIGHT

Statement From James G. Hinsdale, MD, FACS, President-Elect, CMA of us chafe. There have already been

Fellow CMA and SCCMA members: I was deeply gratified to be

bigger reform milestones in past decades:

honored to election as the CMA President-

Medicare in 1965, and EMTALA in 1986,

Elect for the upcoming year. As many

wherein organized medicine has not had

know, I have been working on behalf of all

thanks or recognition for its contribution.

physicians for the 23 years that I have been

These reforms dwarf what is on the table

a CMA member. I would like to thank

now, and the public doesn’t have a clue

everyone in SCCMA, for the wonderful

about it.

support and encouragement I have had

One of our biggest challenges is a

over the past six years that I have served as trustee for District VII and on CMA’s executive committee as vice-chair and

public-relations-image one. The majority of the public views us as “fat cats” who should be able to absorb any financial

chairman of the Board of Trustees.

downdraft that a new system of “reform” should propound. It’s not new. In the

There are many challenges to the position of CMA presidency. The

‘50s and ‘60s, when there were financial

biggest, in my opinion, is to get us to work

downswings, the average Joe paid his

together, speaking with one voice, despite

doctor last, after paying the rent, electric

the fact that we all can, and do, practice

bill, and the food bill. These times are

quite differently. Indeed, there are over 32

not different. It’s just that nobody really

specialties, any one of which can practice

hands over much more than a co-pay for

five or more different ways (within groups,

a doctor’s service anymore, if there is any

single, or multi-specialty, etc).

exchange of compensation at all. Some patients change doctors if the co-pay goes

Another challenge is for CMA members to come together on future issues, even when some members did not get their

from five bucks to ten bucks. We have an image problem, make no mistake.

There have been two modern

way on CMA’s position on a past issue.

There is no uplifting place for “payback,”

SCCMA leaders who have ascended to

when we are struggling to get the world

the presidency of CMA in the past few

outside to perceive us as “good guys” and

decades. They are Fred Armstrong and

not just a bunch of money grubs in a trade

Bob Burnett. I hope to continue their

organization.

exemplary leadership on behalf of our organization. I would like to thank Bob,

Doctors are not defining the terms of the current “health care reform” discussions. Indeed, some legislators

in particular, for his personal support and advice over the years.

In addition, there are many

view us, as Uve Reinhardt claims, as a vast labor pool of “providers,” defined by

SCCMA members who have encouraged

our commodity value within a complex

me to lead within CMA in past years. I

mathematical equation. That makes all

can’t put them all down, but some of

them are: Steve Fountain, Jim Silva, John Longwell, Susan Hansen, John Seigel, Elliot Lepler, Tanya Spirtos, Joe Mason, Marty Fishman, Don Prolo, Tom Dailey, and Howard Sutkin. I especially wish to thank my mentor in the Surgery Residency at Stanford, Dr. Harry A. Oberhelman, Jr. And last, but not least, the wonderful Debbi Ricks, our SCCMA Alliance Past President and, now, Alliance President during my tenure, for all of CMA. As we go forward, I would especially like us to unite behind our respected CEO, Bill Parrish. Many in this organization don’t know it, but the leadership we have, in Santa Clara, is well regarded throughout the entire state of California. Bill is a big reason for that. I am honored by this election and look upon it with pride for all of us in Santa Clara County. I hope to live up to this trust and do my best for all physicians in California.

PAGE 6 | THE BULLETIN | NOVEMBER / DECEMBER 2009

CMA NEWS

Orange County Physician Becomes CMA President Orange County physician Brennan Cassidy, MD, took over as CMA’s 142nd president at the close of the association’s Annual House of Delegates.

In his address to nearly 1,000 physicians in attendance, Dr. Cassidy implored physicians to use “time, patience, and persistence” to educate the public and lawmakers about what is needed to provide the best care for patients. He said doctors should “never give in” when fighting for patients and the medical profession.

“As doctors, we take care of people 24/7,” said Dr. Cassidy. “It’s our mission to restore the health of our patients.

As the national debate on health care reform moves forward, it’s crucial that physicians communicate clearly and loudly about what we need to do our jobs and provide the high quality of care that is today’s standard.”

Dr. Cassidy is a past president of the Orange County Medical Association and has participated on many committees throughout his 36 years as a member of CMA, including serving as chair of the CMA Board of Trustees.

New CMA CEO Alfred D. Gilchrist, the former CEO of the Colorado Medical Society and former longtime director of state and federal governmental advocacy for the Texas Medical Association, has been named the new chief executive officer of the California Medical Association.

Mr. Gilchrist brings 30 years of ground-breaking advocacy and strategic innovations from his tenure as the legislative director at the Texas Medical Association (TMA) and, subsequently, as the chief executive officer of the Colorado Medical Society (CMS). His track record of 16 years as TMA’s top legislative quarterback included landmark achievements in patient rights, medical liability, and tobacco control measures. During his five year tenure in Colorado as the medical society’s top executive, Mr. Gilchrist was recognized on two separate occasions in the Denver Business Journal’s “Power Book” as one of the most influential state leaders in health care. On his watch, CMS broke new ground in reforming managed care contracting practices, physician profiling and rating systems, and transparency and disclosure to Colorado’s health plan merger and acquisitions statute, as well as significant expansions and reforms in Medicaid.

“Alfred Gilchrist has extraordinary knowledge on issues facing medicine. His invaluable experience and demonstrated talents at the state and federal level could not come at a more crucial time, as our nation discusses how to improve our health care system,” said Dev GnanaDev, MD, former president of the California Medical Association. “Alfred’s leadership and vision will greatly enhance our efforts to expand access to quality health care, improve the public health, and maintain practice viability for the physicians of California.”

“I am honored and humbled to step into this role in this great state. It has been my privilege to advocate for the medical profession for three decades, and I have never seen greater opportunity nor greater risk for physicians and the patients they serve,” Gilchrist said.

PAGE 7 | THE BULLETIN | NOVEMBER / DECEMBER 2009

MEDICAL PRACTICE INFORMATION

NEW HEALTH CARE PAYMENT SOLUTION (For Medical Practices) Preferred Health Technology, a wholly-owned subsidiary of Blue Cross/ Blue Shield of South Carolina, is now introducing its proprietary and innovative Electronic Payment and Transaction Processing System to medical facilities in Northern California. The system addresses the patient responsibility of a medical bill, the percentage of which has significantly increased over the past decade. This has frequently resulted in collection problems and decreases in cash flows.

This web-based, low-cost system, called A-Claim, is presently being used by over 1,600 medical offices across the country. The A-Claim System can seamlessly interface with any of the practice management software or electronic medical records systems on the market. However, it is more frequently used as a stand-alone system that uses its own electronic swipe-card terminal. A check reader for use with the system is also available as an option.

savings in five-to-six figures. There are also large group practices that have achieved considerably more savings.

30, 60, 90, etc. day billing cycles becomes unnecessary, a considerable savings to the practice in costs and staff time.

A-Claim features include realtime insurance eligibility verification in less than 30-40 seconds, real-time claim adjudication, and arranged automated collections of patient responsibility payments. There are over 1,800 insurance carriers contained in the A-Claim System.

Another patent-pending feature contained in the system allows the patient and provider to set up a payment plan at the time of service that establishes an automatic collection of the patient’s responsibility with a pre-agreed payment schedule. Again, there is no need for mailing out statements on collection dates.

A key component of the system allows the patient and provider to agree to pre-authorize a payment by check or card at the time of service, based on the estimated amount of the patient’s responsibility. Once the claim has been processed and the practice receives the exact amount of the patient’s responsibility from the insurance carrier, the Explanation of Benefits (EOB), that amount can then be automatically deducted from the patient’s card or checking account electronically. Mailing billing statements at

The A-Claim System is available to medical facilities in Northern California through its authorized marketer and reseller, Medical Pay Solutions.

The company offers members of the SCCMA and MCMS a discount on the A-Claim System’s implementation fees.

For further information, please contact their bay area representative at 415/391-2683 and visit the following website: www.medicalpaysolutions.com.

The user-friendly system can easily be incorporated into a medical practice’s front office operation. Upon implementation, the developer provides the practice’s administrative staff with indepth training and orientation in the proper use of its system.

Following implementation, A-Claim significantly reduces billing costs, shortens collection cycles of accounts receivables, and decreases the risk of nonpayment and an on-going debt. The result is an increase and acceleration of cash flows back to the medical practice. Many single and group practices have realized annual PAGE 8 | THE BULLETIN | NOVEMBER / DECEMBER 2009

health and dental insurance

Manage 2010 Health Plan Expenses Now In the current economic climate, spending more than you have to for health insurance doesn’t make sense. As premiums continue to increase, don’t accept the status quo. There are ways to provide health insurance, while effectively managing your expenses.

These are just a few of the strategies that Marsh has used to assist many group practices, to help reduce health insurance premiums: High Deductible Health Plans – Our physician clients, particularly those over age 50, are taking advantage of this cost reduction strategy. Significantly reduces premiums and enables you to open a health savings account. Most physicians should review this strategy.

Rate Adjustment Factors (RAF) – For groups of 6–50 employees, insurers reduce the RAF for new business placing health insurance “on sale.”

Compare – Rate competitiveness and plan design varies by insurer, type of plan (PPO, HMO, or HDHP) and location. We work with many insurers to find the right plan designs to meet your group health insurance needs. There is a special discount available only to CMA members through Blue Shield.

Health Savings Accounts (2009 limits) – Contributions of up to $3,000 for individuals and $5,950 for families; plus another $1,000 if you are between ages 55 and 64. Unused funds roll over each year to be used for future medical, dental, and vision expenses.

HR KnowHow – Provides the latest information on group benefit plans and compliance issues for employers. Available at no cost to association members who purchase their group health insurance through Marsh.

Open Wide…

With Confidence!

It’s open enrollment time for the Santa Clara County Medical Association-and Monterey County Medical Society sponsored Group Dental program. This plan is designed to help you, your family, and your employees minimize the out-of-pocket expense of regular dental care.

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 nonnetwork 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.

Remember, 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, 2009.

Call a Client Service Representative at 800/842-3761 for more information, a brochure, and application. Or visit www.

MarshAffinity.com/cmadownload.html to download an enrollment kit.

Why not use one of your member benefits and let us help select a strategy that works best for you? Call a Marsh Client Service Representative at 800/842-3761 or email CMACounty.Insurance@marsh.com.

CA Ins. Lic. #0633005 | d/b/a in CA Seabury & Smith Insurance Program Management 42542 (10/09) ©Seabury & Smith Insurance Program Management 2009

PAGE 9 | THE BULLETIN | NOVEMBER / DECEMBER 2009

SCCMA Alliance

SCCMA Alliance News (The Santa Clara County Medical Association Alliance is the philanthropic and volunteer arm of SCCMA that consists of physicians, physician spouses, students in training, and friends of medicine. Bettering the health in Santa Clara County is the main focus of the Alliance. In collaboration with other community groups, the Alliance provides health education, underwriting of projects, and legislative support for medical issues. To join, please visit the website at http://www.sccmaa.clubexpress. com. You will also find the most current updates and contact information on that site.)

Several SCCMA Alliance members attended the Fall Leadership Conference in Anaheim from October 16-18. The conference was led by California Medical Association Alliance President Debbi Ricks. It was held in conjunction with the CMA House of Delegates Conference and Debbi’s address to the delegates was well received. CMA Alliance conference topics included recommended statewide health projects, leadership skills, national security issues for physicians, and CMAA bylaws revision. Attendees learned about state and national health projects addressing child helmet safety laws, childhood and adolescent vaccines, portrayals of smokers in cinema, child endangerment concerns, and many other topics.

•

Assistance in the Health Trust Health Fair in September 2010.

In addition, the Alliance is planning a fundraising event in the spring and its annual holiday luncheon on December 14 at Maggiano’s Restaurant at Santana Row. At the luncheon, President Mary Hayashi will present a book of documents and photos commemorating 75 years of Alliance activities. In January, all Alliance members and guests are invited to attend a luncheon and visit to the Star Trek exhibit at the Tech Museum of Innovation in San Jose. Details are available online at http://www.sccmaa. clubexpress.com.

Upcoming Events: As a result of a meeting with Health Trust CEO Fred Ferrer, the Alliance has selected health projects for the upcoming year. Those projects include the following: •

Assisting with the Silicon Valley food basket program by assembling food baskets to support individuals and families living with HIV.

•

Participation in “Dining Out for Life” in the spring of 2010.

•

Assistance with the November 14 high school outreach program.

•

“Not Even for a Minute” – a campaign to display posters in grocery stores which would remind parents of the dangers of leaving children unsupervised in cars with windows closed.

Left to right: CMA Alliance attendees Suzanne Jackson, Kathleen Miller, Carolyn Miller, Debbi Ricks, Mary Hayashi

Mary Hayashi acknowledges CMA Alliance President Debbi Ricks at the CMA House of Delegates in Anaheim

PAGE 10 | THE BULLETIN | NOVEMBER / DECEMBER 2009

MEMBER BENEFITS

MCMS/SCCMA has partnered with the leading group purchasing organization, Amerinet! Amerinet partners with health care providers to reduce costs and improve quality. Health care providers can access contract information, purchasing history, and financial information, all online!

Amerinet offers a wide variety of discounts, including several discounts with Verizon Wireless!

Discounts include 22% off of monthly fees, 35% off of accessories, and much more!

To access the discounts for Verizon Wireless available, please follow the instructions below:

1. Using Internet Explorer (very important!), go to www.amerinet-gpo1.com.

2. Once the site comes up, click the “Amerinet Member Resources” link on the right side of the page.

3. Once the login page loads, click the “Register for Member Resources Account” under the login box.

4. Fill in your personal and facility information and submit. Within 24-48 hours, you will receive a password via email.

Once you have received your password: 1. Follow steps 1 and 2 above to get to the login page.

2. Enter your email and password.

3. Once in, the page should say “Welcome Doctor (your name).” (If not please contact Membership at the phone number below.)

4. Click the Verizon link on the Welcome page.

5. Follow the instructions to start receiving your Verizon discounts immediately! If you have multiple phones on your current plan, be sure to enter the main phone number from your invoice.

NOTE: If you are a Verizon customer that is currently paying for employees’ cellular phones, you will need to set up a corporate account to take advantage of the discounts available. After completing Step 3 immediately above, please call Membership at 831/455-1008 or 408/998-8850.

Not a Verizon customer yet, but want to be? Not a problem!

Contact Membership at 831/455-1008 or 408/998-8850.

PAGE 11 | THE BULLETIN | NOVEMBER / DECEMBER 2009

TPO and Littler will guide you through an informative day, balancing both Legal and Leadership Best Practices to prepare you for 2010!

2010 Employment Law & Leadership Conference A PREMIER CONFERENCE FOR BUSINESS OWNERS, MANAGERS, HR, RISK MANAGEMENT AND LEGAL COUNSEL IN PUBLIC, PRIVATE, AND NON-PROFIT ORGANIZATIONS

LITTLER’S EMPLOYMENT LAW UPDATE Littler Mendelson’s update sessions have earned a national reputation for efficiently delivering an enduring picture and useful advice that will help with practical decision-making and impart a strategic road map long after the conference has ended. The Littler Update will draw on the collective experience and insight of Littler’s 775 employment, labor, benefits, and immigration attorneys to provide thought-provoking analysis of the most critical employment and labor law issues confronting employers right now. Learn from leading Littler attorneys about the many compliance issues that are of greatest concern to corporate counsel, human resources professionals, executives, and other managers on a day-to-day basis.

PANEL OF EXPERTS The perfect complement to the Littler Update, the final portion of the morning general session will provide an interactive panel composed of top Littler attorneys and TPO HR experts to respond to a broad range of questions from the audience – from the legal and HR perspective.

AFTERNOON BREAK-OUT SESSIONS (Please go to second page to read full session descriptions)

BLOGGING, SEXTING & SOCIAL NETWORKING: Feeling Behind the Curve? You’re Not Alone! (Presented by Littler) Most employers are playing catch-up with the new technology of their workers' virtual activities (such as Facebook, Twitter, LinkedIn and MySpace)...

EMPLOYEE FREE CHOICE ACT: Are You Ready for a Union ...Without Having a SAY? (Presented by Littler)

The passage of EFCA may be the biggest legislative change to labor-management relations in 60 years, and will completely re-energize the union movement...

GENERATIONS IN THE WORK PLACE: Why We Each Think the Other “Doesn’t Get It!” (But We Actually DO!) (Presented by TPO)

For the first time in American history, we are faced with the challenge of having four generations working together in the work place...

8 WAYS TO ENJOY BEING A LEADER - AGAIN! (Presented by TPO)

Leadership is the rewarding and fun part of the job, but how do you make time for it with so many other pressing demands?

ONE-ON-ONE CLINICS These clinics will run through lunch and concurrently with the afternoon sessions to provide you with the opportunity to sit

down one-on-one with an experienced attorney who specializes in the employment law area of greatest interest or concern to you. In one room, arranged at subject-specific “clinics,” attorneys experienced in wage-hour issues, employee benefits, substance abuse, employee training, compliance audits, executive compensation, labor-management relations, public sector, and every other conceivable employment, labor, and benefits issue will be ready to answer your specific questions. TPO Consultants will also be available for topics such as investigations, hiring practices, and any other HR-related questions.

JANUARY 11, 2010 Embassy Suites Hotel Monterey Bay PAGE 12 | THE BULLETIN | NOVEMBER / DECEMBER 2009

CONFERENCE AT A GLANCE

5 PHR/SPHR/GPHR OR CLE H OURS !

8:00 – 8:30 am

Registration and Breakfast

8:30 – 9:00 am

Opening Session

9:00 – 10:30 am

Employment Law Update

10:30 –10:45 am

Break

10:45 – 11:45 am

Panel of Experts

11:45 – 12:00 pm

Close Employment Update

12:00 – 12:45 pm

Lunch

12:45 – 4:00 pm

One–On-One Clinics (running concurrently with break-out sessions all afternoon)

12:45 – 2:15 pm

Afternoon Break-Out Sessions

2:15 – 3:00 pm

Break

This conference has been approved for 5 credit hours toward PHR/SPHR/GPHR/CLE The use of this seal is not an endorsement by HRCI of the quality of the program. It means that this program has met HRCI’s criteria to be preapproved for recertification credit.

; Please check two powerful and informative afternoon sessions you are most likely to attend:

SPONSORED BY:

BLOGGING, SEXTING & SOCIAL NETWORKING: Feeling Behind the Curve? You’re Not Alone!

Most employers are playing catch-up with the new technology of their workers' virtual activities (such as Facebook, Twitter, LinkedIn and MySpace). The employment law risks are plentiful, including harassment, discrimination, invasion of privacy, disclosure of confidential information, and ethical violations. During this session, you will learn: How the latest technological trends are impacting your workplace; The resulting legal risks – from recruiting through termination; How to protect your organization; and, How to modernize your organization’s policies, training, and practices.

EMPLOYEE FREE CHOICE ACT: Are You Ready for a Union ...Without Having a SAY?

The passage of EFCA may be the biggest legislative change to labor-management relations in 60 years, and will completely re-energize the union movement. With EFCA, if a majority of employees sign union authorization cards, employers are required to bargain with a union, with no notice of an ongoing union campaign. Your business could be unionized before the managers even know what’s happening. And the arbitration requirement means that an outside party with no knowledge of your industry could be making decisions for you about contract terms like compensation, benefits, work rules, and more. Attend this program for critical guidance on things employers can and should be doing now to prepare for EFCA. GENERATIONS IN THE WORK PLACE: Why We Each Think the Other “Doesn’t Get It!” (But We Actually DO!)

For the first time in American history, we are faced with the challenge of having four generations working together in the work place. This, of course, presents a major communication challenge. That challenge arises due to opposing environments, traditions, societies, technologies, etc. Attend this session for an amusing and enlightening look at the differences and similarities of today’s workforce – you will come away with a better understanding of what each needs and how to manage each generation more effectively.

8 WAYS TO ENJOY BEING A LEADER - AGAIN!

Leadership is the rewarding and fun part of the job, but how do you make time for it with so many other pressing demands?

And how can you make sure your efforts are paying off? In this upbeat workshop, you will learn to use 8 Tried-and-True Leadership Tools that will energize your Leadership IQ and help you turn even small segments of time into Leadership opportunities and success stories. Can’t you just hear your employees bragging about your great leadership?

DATE/TIME: January 11th, 8:00 a.m. – 4:00 p.m. (Continental Breakfast & Lunch are included!)

LOCATION: Embassy Suites Hotel Monterey Bay, 1441 Canyon Del Rey, Seaside COST: TPO Members attend FREE* as part of their Annual Membership!

SCCMA & MCMS Members Receive TPO’s MEMBER RATE!

REGISTRATION CAN’T BE EASIER!

CANCELLATIONS: TPO Members:

(*Based on number of authorized representatives) Regular

Early Bird

(Must be paid by 12/15/09)

Team

Team Early Bird (Must be

Type of Registrant (3 or more) paid by 12/15/09) Non-Members $349 $299 $299 $269 TPO Member** $299 $249 n/a n/a **Charge for participants above the number of your authorized representatives.

Online Call Email www.tpohr.com/conference 1.800.277.8448 tpo@tpohr.com

Paying Registrants Non-Paying TPO Members

By December 15 Full Refund No charge

By December 21 75% No Charge

By December 29 50% No Charge

After December 29 No refund $100 per seat

Registration is limited! Please register for your free seats only if you are planning to attend! Regrettably, TPO Members reserving free seats will be assessed a $100 cancellation fee per seat for cancellations not received before December 29, 2009 or for no shows.

PAGE 13 | THE BULLETIN | NOVEMBER / DECEMBER 2009

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PAGE 15 | THE BULLETIN | NOVEMBER / DECEMBER 2009

RISK MANAGEMENT

managing professional risk Tips for Steering Clear of Problems With Pain-Med Prescribing The following tips will help you prescribe narcotics/opioids appropriately to patients in chronic pain: Obtain a thorough history and determine the specific cause of pain.

In an article on treating patients’ pain, Eliot Cole, MD, a physician associated with the American Academy of Pain Management, advises “Do not call [a patient’s] pain a headache or backache, but try to find a specific pathological process to explain why your patients hurt.”1 Stephen Richeimer, MD, Chief of Pain Medicine at the University of Southern California, says, “Assessment is a key issue. The history and physical examination provides the information that allows the physician to judge if the patient is legitimately in pain or if the patient is improperly seeking drugs.”2 Document well. Dr. Cole advises, “Chart everything you see, think, feel, and hear about your patients. Leave nothing to the imagination of the future reader. Explain what you are doing, why you believe opioid analgesics will be helpful or continue to be helpful, what alternatives have been considered, that your patient agrees to the treatment, and how you intend to follow your patient over time.”1 Dr. Richeimer agrees: “Good record keeping is part of good medicine, and it is also your best protection from frivolous lawsuits,” he says.2 Ask chronic-pain patients to agree to use a single pharmacy.

Discussing pain treatment with the patient and getting the patient to agree to certain parameters associated with long-term pain management are mutually

beneficial strategies: they help you avoid inadvertently supplying medication that might be diverted for street sale, and they reassure the patient in pain that he or she can count on obtaining needed medication.

An especially useful rule is that the patient will use a single pharmacy for all pain medications.

Make use of a written pain medication agreement with chronicpain patients. A signed agreement by the patient that he or she will follow rules for obtaining pain medication will improve the likelihood of appropriate behavior by the patient. It discourages patients from seeking an unlimited supply of medication and helps staff members verify the legitimacy of refill requests.

Monitor patients over time on their needs for and use of pain medication. Dr. Richeimer observes that patient trustworthiness “can only be assessed by monitoring the patient over time.”2 Dr. Cole suggests talking with patients periodically to reduce dosage appropriately, as well as periodically ordering “urine drug screens for patients of concern to document that you are able to recover their prescribed medications.”1 If you keep controlled substances in your office, establish a reliable process for safeguarding and reconciling such medications and for tracking their distribution. The federal Drug Enforcement Administration (DEA) requires physicians who administer or dispense controlled substances from their offices to have effective controls to guard against theft and diversion. Controlled

substances must be stored in a securely locked, substantially-constructed cabinet.

Using a controlled substances inventory log can help you account for each and every dose of medication that goes through your office.

These strategies are aimed at fostering appropriate pain management within the limits of professional practice.

Furthermore, they can help physicians and staff consistently meet regulatory requirements on the management of pain medications.

References 1. Cole E. Prescribing opioids, relieving patient suffering, and staying out of personal trouble with regulators.

The Pain Practitioner. 2002;12(3):58. Available at: http://www. aapainmanage.org/literature/PainPrac/ V12N3_Cole_PrescribingOpioids.pdf.

Accessed June 3, 2009.

2. Richeimer S. Opioids for pain: risk management. California Society of Anesthesiologists Online CME Program. Available at: http://www. csahq.org/cme2/course.module. php?course=3&module=12. Accessed June 3, 2009.

Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL insureds.

To learn more, visit www.norcalmutual. com/cme.

PAGE 16 | THE BULLETIN | NOVEMBER / DECEMBER 2009

practice tips

PREVENT EMPLOYMENT-RELATED CLAIMS Use these eight tips to lessen your risk for employment-related claims

By Roy S. Lyons 1. Create an up-to-date employee handbook. A good employee handbook should define the workplace environment including hours of operation, dress code, holidays, employee benefits, safety procedures, and policies. Every employee should have a current copy.

2. Create formal, written anti-harassment and antidiscrimination policies.

Having strong anti-harassment and anti-discrimination policies and complaint procedures in place provide documentation of appropriate workplace behavior. With a written policy, your practice is also armed with an important affirmative defense, which may actually bar an employee’s lawsuit if the employee did not use the internal complaint procedures. Again, make sure that all employees have a copy of the policies.

3. Make sure that you and your supervisors have formal training in employment practices. Most physicians go to medical school to become physicians, not to manage employees. Without formal training on what is appropriate and what is not, you are at risk of potentially making a mistake with an employee, resulting in a claim. Training on basic Equal Employment Opportunity compliance principles can reduce this risk.

4. Create written employee job descriptions. Each employee should

have a clearly defined job description.

Without a written description, your practice may be exposed to a potential lawsuit if you decide to terminate an employee for failing to do his or her job and clear documentation on what the job actually entailed is not available.

5. Document all hiring, promotional, disciplinary, and discharge decisions. The more frequently you make employee “moves,” the more likely affected employees may feel discriminated against. It is critical to have documentation that shows an employer’s thought process leading up to any employment decision.

The importance of

documentation cannot be understated.

them. Depending on the job responsibilities and what is discovered during the background check, you may not be able to use the information with respect to your hiring decision.

7. Provide accurate written evaluations to employees on a regular basis. Providing accurate written evaluations of employees on a regular basis is an important tool for demonstrating an employee’s job performance and behavior. This will help reduce your risk in “failure to promote” or “wrongful termination” situations.

8. Provide written offers of employment to prospective new hires. It’s important to provide a written offer of employment to your prospective new hire that includes salary, title, reporting, and other general job duties. Having a clearly written document alleviates any misunderstanding about the core elements of the individual’s employment.

6. Perform background and reference checks on all employees.

Although background and reference checks are typically part of most job situations, it’s important that best management practices are followed when conducting

PAGE 17 | THE BULLETIN | NOVEMBER / DECEMBER 2009

Roy S. Lyons is Managing Director of Marsh Affinity.

Visit them at www. marshaffinity.com.

A Familiar story

INVISIBLE PATIENTS Submitted by Maribel R. Andonian My father had open-heart surgery, followed by a series of mini-strokes, in the early 1990s. My mother-in-law began to exhibit symptoms of dementia around the same time. For the next 20 years, someone in our family was constantly making major adjustments to work and family life to care for aging parents. I frequently took the red-eye from San Jose to Cleveland to check up on my parents, after putting in a full day at work. During my visits, I helped my mother (a retired physician) make hard decisions about my father’s care and acknowledge her own medical needs. My husband and his sister had a shorter commute to local nursing facilities, but their mother’s inevitable deterioration was a constant presence in their lives.

They couldn’t board a plane to get some distance for a while, as I could. Neither could my mother, whose own health was deteriorating. She lived alone and, without close family nearby, she often postponed her own medical care until my next visit.

My father died in a nursing home while my mother was hospitalized with pneumonia, the only days in four years that she missed visiting him.

During the early days of my mother-in-law’s decline into Alzheimer’s, we received frequent calls from my fatherin-law frantically begging my husband to come over because he couldn’t handle his agitated and terrified wife. As her disease progressed, he was forced to admit that she needed more care than he could give her at home, and reluctantly agreed to place her

in a nursing facility. She lived for almost eight years in nursing homes. During that time, she had a family visitor nearly every day.

Over the years, we came to know other caregivers whose loved ones were in the same facilities as our parents. Many of us were caught in the “sandwich” dilemma,

risk of dementia (obesity, high cholesterol, and diabetes)—are on the rise.

Consider this: •

Five million Americans will be diagnosed with Alzheimer’s disease during the next 20 years.5

•

Nearly one out of every four U.S. households (22.4 million households) is caring for someone aged 50 or over.6

•

The older adult population in Santa Clara County is expected to increase from 13% to 21.3% by 2020, and then to 27% by 2040, with a corresponding increase in the number of family caregivers.7

among the 20 million people in the U.S. who are caring for their children and aging

The best prescription for caregivers is often a simple one—a few hours of respite each week… parents at the same time.1 We recognized in each other symptoms and behaviors that mirrored our own, symptoms related to the stresses of coping with ailing parents, dependent children, and our own issues.

At times, emotional stress broke through and became physical illnesses—migraines, frequent URIs, sleep deprivation, and mood swings. Several studies have shown that caregivers may have increased blood pressure and insulin levels, 2 may have impaired immune systems,3 and may be at increased risk for cardiovascular disease,4 among other adverse health outcomes.

The boomers are entering their retirement years in droves.

Diseases common to the elderly— like dementia, Alzheimer’s, and factors that trigger heart disease thought to increase the

Caring for a dependent relative is a “round-the-clock” proposition.

More and more families with stories like ours will need help caring for ailing loved ones over the coming years.

Our family was fortunate and could afford quality, skilled nursing assistance (approaching $8,000/mo in northern California). Those without means care for their relatives at home, 24-hours a day, day after day, week after week, year after year.

A recent United Way Silicon Valley report estimates that more than 400,000 people in Santa Clara County (approximately 23%) live below the level of self-sufficiency.

These are the invisible patients in the doctor’s waiting room.

Often, they don’t call the doctor’s attention to their caregiver role when they bring their older loved one in for an appointment. If they see a doctor for their

PAGE 18 | THE BULLETIN | NOVEMBER / DECEMBER 2009

own health problems, they may or may not ascribe their ailments to the stresses of caregiving. Catholic Charities’ Making the Link: Connecting Caregivers Through Physicians* campaign is designed to (1) help physicians better identify caregiving patients, and (2) connect them to the help they need.

A simple solution.

The best prescription for caregivers is often a simple one—a few hours of respite each week to rest, regroup, and care for their own needs. Adult day care centers such as those run by Catholic Charities’ Caregiver Services provide safe, licensed socialization for frail older adults, and much-needed respite for their caregivers. Google “adult day care in Santa Clara County” for links to these invaluable resources and make them available in your office. Family caregivers are the unsung heroes of our health care

system, and physicians can play a key role in helping to support their ongoing health and success. * To learn more about Catholic Charities’ Making the Link campaign, please call 408/325-5237 or email aandonian@catholiccharitiesscc.org.

Endnotes 1. Stone, R., Cafferata, G.L., & Sangl, J. (1987). Caregivers of the Frail Elderly; A National Profile. The Gerontologist, 27(5): 616-626.

2. Cannuscio, C.C., J. Jones, I. Kawachi, G.A. Colditz, L. Berkman and E. Rimm. 2002. Reverberation of Family Illness: A Longitudinal Assessment of Informal Caregiver and Mental Health Status in the Nurses’ Health Study.

American Journal of Public Health 92:305-1311.

FOR LEASE

3. Kiecolt Glaser, Ja., and R. Glaser.

Chronic Stress and Age-Related Increases in the Proinflammatory Cytokine IL-6. In proceedings of the National Academy of Sciences, 2003.

4. Lee, S., G.A. Colditz, L. Berkman, and I. Kawachi. 2003. Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study.

American Journal of Preventive Medicine 24: 113-119.

5. World Alzheimer’s Report.

6. National Alliance for Caregiving and the AARP. 7. Community for a Lifetime: A Ten Year Strategic Plan to Advance the Well-Being of Older Adults in Santa Clara County, City of San Jose and County of Santa Clara (2005).

Medical/Dental Office Space Available PROPERTY INFORMATION

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PAGE 19 | THE BULLETIN | NOVEMBER / DECEMBER 2009

Santa Clara County Medical Association 700 Empey Way • San Jose, CA 95128 • 408/998-8850 • FAX 408/289-1064 December 2009 TO:

All Members, Santa Clara County Medical Association (SCCMA)

FROM:

Thomas Dailey, MD, Chair, 2009-2010 Awards Committee

At the 2010 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 20, 2010. 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 20, 2010

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 Richard M. O’Neill

Outstanding Contribution In Medical Education John B. Shinn

Outstanding Achievement In Medicine 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.

2006 2007

Stephen H. Jackson Cindy L. Russell

Catherine L. Albin

John R. Adler, Jr.

Madhur Bhatnagar

Debbi Ricks

2009

Bernadette Loftus

George P. Kent

Thomas Krummel

Seham El-Diwany

Peggy Fleming-Jenkins

Martin L. Fishman

guest commentary

the health debate, 2009

By Lawrence Stern, MD, FACS A discussion with a friend this morning about the current Congressional debate about health care reform led to a more detailed analysis of the conflict and misunderstanding that lies at the heart of this serious matter.

My friend started off the argument by noting that free choice of doctor was very important to him, and I realized that if this was worrying him, it was probably worrying a lot of people.

In the first place, nowhere in the presentations I have heard is there any mention proscribing a change in the insurance coverage now held by many Americans. If one had insurance prior to this debate, and was satisfied with it, one may continue it; case closed, or is it?

Perhaps both my friend and I were confused by the complexity of the term “health care.” Perhaps one should analyze what makes a person healthy, and see if one can summarize these to include all variations of the term: 1. I would think that everyone would agree that to be healthy, one should be able to breathe good clean air, free of the usual contaminants such as cinders, fumes, toxic chemicals, etc.

2. In addition to air, one would agree that clean untainted water is a necessity, both for drinking, as well as cooking and cleaning one’s body.

Monitoring pollution and enforcement of compliance needs governmental oversight.

3. Everyone agrees that to live, one must eat as well as have shelter. Let us discuss eating and food in general: we can look around right now and

immediately see a difference in the appearance of most people from what was the usual case less than 50 years ago. At that time, there were no fast food outlets, and one carried a paper bag with fruit and a sandwich from home if unable to go home at noon.

Or, one walked or drove home for a hot freshly prepared meal. In addition, one usually either walked or took a bicycle to get home at lunch; in consequence, we saw very few overweight people on the streets or at work, as most people had a lot more exercise than they do today.

4. In addition, food on the table depended on where one lived; if in the northern part of the country, seasonal foods, being cheaper, were usually root vegetables and meat or fish, in the winter, and some vegetables and fruit, as well as meat and fish, in the summer. Imported foods were expensive and rarely seen on most tables. If one lived in a warmer clime, fresh fruit and vegetables were more evenly spread throughout the year.

a cob with kernels.

7. To produce the abundance of food that we desire, we have abandoned animals drawing the plough, substituting diesel tractors, etc. using large quantities of fuel (much of which must be imported), such that consumption of energy to produce food varies from the extravagant consumption in the U.S. to more primitive societies where animals continue to pull the plough, and where energy consumption is accordingly less.

8. To permit mechanized equipment to process the soil requires fuel, and in the U.S., we now have less than formerly, such that we import more than one-half of the total fuel consumed in this country. Frequently,

5. In addition, meals were smaller in the cities, as people did not work as hard, and more lavish on the farms, where work started at cock crow and finished only at sunset. Caloric consumption usually was balanced against output and most farm kids were lean, worked hard, and were very strong.

6. Food comes now from every corner of the world, and we have agencies that supposedly inspect and certify its purity; cans and jars come from all over, and with super fertilization, crops arrive with giant roots, or corn cobs with every kernel in place, while formerly, one was lucky to have half

PAGE 22 | THE BULLETIN | NOVEMBER / DECEMBER 2009

this fuel comes from countries which are less than friendly to this country.

In an effort to facilitate importation of fuel, we must make national accommodation both economic and political. This leads to: 9. Foreign policy, which is the responsibility of the Congress and the administration. It changes with each administration.

10. Food, as produced in this country, is composed of fish, meat, poultry, and grains and milk, as well as vegetables and fruits. Farming in this country has become the responsibility of large organizations, in view of the enormous expenditure required to make a farm profitable when big machinery is used.

To ensure adequate money to make a profit, agribusiness must lobby the Congress intensively and, accordingly, one notes policies such as tax exemptions and subsidies becoming fixed as each administration realizes that a satisfied farm industry means votes.

11. Insurance companies have supplanted cash payments for medical care by individual citizens, as the complexity of care is now much more expensive than when the doctor held the pulse and pronounced life or death in solemn terms. Insurance premiums, once inexpensive, are now a major

part of every home budget, treatment and medications (pharmaceuticals) have become increasingly expensive, such that we now have over 45 million citizens of the republic without any insurance coverage. In order to reduce the cost of insurance, a number of plans have developed contracted groups of physicians who have agreed to accept discounted payments in exchange for assurance that at least some payment would be forthcoming, if care is provided. Some of these plans offer NO choice of physician, some do.

12. Because of the increasing tendency in this country to resolve interpersonal conflict with violent, frequently bloody clashes, using lethal weapons, and a substantial number of our citizenry demanding the right to own lethal weapons, based on a presumption that it is a constitutional “right,” we now have a situation in which no amount of legislation is permitted to control the dissemination of weapons. The death rate is greatest in the poorer sections of communities, where income is less and unemployment greater. One might pose the question, is life or death a constitutional matter? Certainly, it affects health when one is shot, and facilities must exist to care for the aftereffects.

13. I have not discussed clothing, but obviously a healthy population needs adequate clothing to permit the citizenry to withstand the vagaries of weather, etc. This opens up the discussion of our textile industry, and the employment of workers here and offshore, a matter of national policy.

14. As one can now see, health care is not a small task, and is interwoven with most aspects of our daily lives. Most physician-centered care is repair work, in the manner of carpentry. Where there is a problem, there is a nail. Or an operation, or a prescription….etc. But most of all, good health is dependent on political decisions that apportion money for

full employment, environmentally suitable facilities, prevention of crime, and poisoning of the air, water and soil, as well as clothing for the citizenry,and protection from tainted foods. To regulate these items, one must turn to our legislatures for majority decisions.

Thus, after this lengthy prologue, we are faced with a BIG task. Must we consider more regulation of medicallyprovided health care, such as doctors and hospitals, or do we realize that we must look at health care in a larger context? Is a healthy population more or less expensive, can a healthy or a sick population best deal with a foreign invader or an epidemic, or simply manufacture the goods and services that will keep the population prosperous and fed and clothed.

Is health care a right or a privilege? We have never had this debate, although we consider police and fire fighters as necessities, and there is no doubt that we need both. Do we need good health? I think that we would all agree that we do. Is it a national priority? I do not think that we can dispute that. Therefore, I pose the question: why not have the basic debate in Congress first, questioning the components of health that are relevant, and putting the question to a vote?

Recent extreme remarks about not wanting government to interpose itself between the citizen and the doctor are totally inane. Health care in its broadest sense is a major national priority and, as such, IS the business of government!

Almost every factor regarding health requires governmental oversight!

If our legislators agree that the health of the citizenry is too big a subject to be left to the doctors or the insurance companies, and is or should be a RIGHT of citizenship, then we have the BEGINNING of a solution.

Otherwise, our current debates are an exercise in futility, and we are sheep heading to the slaughter.

PAGE 23 | THE BULLETIN | NOVEMBER / DECEMBER 2009

physician’s well-being

depression

By Jyoti Rau, MD and Nandini Ganpule, MD

Have you ever wondered whether you should talk to the doctor next door, who sits in the dark and seems glum and moody? Do you ever wonder why your colleague’s professional performance has slipped lately or why another colleague seems more irritable and hostile? Should you make an attempt to talk about it?

Should you mention it to someone?

Personal and professional barriers may prevent a doctor from asking for help.

Physicians have a rate of depression similar to that in the population, with 13% of male physicians and about 20% of female physicians reporting an episode of clinical depression during their lifetimes. Although depression is a common illness, with 20% of individuals in the general population who have experienced a significant depressive episode at some point in their lives, doctors may be more reluctant to admit they have a problem.

Both depression and substance disorders have been identified as major risk factors for high suicide rates among physicians, with more than 90% of those physicians who commit suicide having a history of mood disorder and/or substance abuse. Nationwide, suicide rates in physicians exceed those in the general population,­about 70% higher for male physicians compared to non-physicians and about 250% to 400% higher for female

physicians. The unsettling truth is that doctors have the highest rate of suicide of any profession. Every year, between 300 and 400 physicians take their own lives, ­ roughly one a day. And, in sharp contrast to the general population, where male suicides outnumber female suicides four to one, the suicide rate among male and female doctors is the equivalent.

Some physicians believe that if they have a problem, they should remain silent. Others may self treat. Only 35% of doctors have a personal physician. Many physicians have a need for control, which

It is sometimes difficult to address our colleagues’ problems in the middle of our own busy workday.

Many physicians work long hours and may be unwilling to take a break in their own day to address the issue. can make it difficult to accept a patient role and to ask physician colleagues for help.

Perhaps they are afraid of getting behind in their work or having to miss calls. They may feel that they are not in control. They may fear repercussions or professional stigmatization.

It is sometimes difficult to know if someone is depressed or at-risk for suicide. While these warning signs are not specific, they may indicate the need for concerned questions or recommendation for evaluation. Physicians with depression may have a decline in job performance, inability to keep up with the work flow, or a higher rate of absenteeism or “sick Mondays.” They may become noticeably more withdrawn, irritable, or argumentative. There may be a noticeable decline in their physical appearance.

Depressed physicians may begin to more frequently complain of aches and pains or express concerns of illness. Physicians who are undergoing marital problems, financial stresses, or a lawsuit may be more at-risk for depression. If you know of someone who is under more stress, offer a few minutes of your time. Note that symptoms in depressed physicians may show up in the workplace last, after symptoms have led to withdrawal from community or recreational activities, problems with friends or peers, and difficulties in relationships with family.

It is sometimes difficult to address our colleagues’ problems in the middle of our own busy workday. Many physicians work long hours and may be unwilling to

PAGE 24 | THE BULLETIN | NOVEMBER / DECEMBER 2009

take a break in their own day to address the issue. However, it is always wise to offer help and to guide our colleagues to seek appropriate resources. We surely would say something if it is our patient or a family member, so it is even more important to help our trusted and esteemed colleagues.

This is good patient care, as well as a safeguard to ensure that patients get good care.

Center, C., et al. (June, 2003), Confronting Depression and Suicide in Physicians: A Consensus Statement.

JAMA, 289(23), 3161-3166.

“If we teach doctors to recognize depression in themselves,” says Dr. Paula Clayton, the medical director for the American Foundation for Suicide Prevention, “they will recognize it in their patients and then everybody will feel better.” The website doctorswithdepression. org provides highlights and clips from films the foundation has made, to bring attention to the problem and educate physicians about depression. The goal is to help physicians better recognize the symptoms in themselves, their colleagues, and their patients, while also cultivating a more thorough understanding of mood disorders.

Gendel, M. H., & Early, S. R. (March, 2006), Assisting the Physician with Physical Health Problems. Physician Health News, 11(1), 13-16.

There is a physician well-being committee at most hospitals and an employee assistance program that can assist our colleagues in getting the care they need.

Related Information doctorswithdepression.org Noonan, D., NEWSWEEK Apr 19, 2008 URL: http://www.newsweek.com/ id/132887.

Adams, S.M., Pharmacologic management of adult depression. Am Fam

Gendel, M.H. (September 2004), Physician Health Issues: Depression in Times of Stress. Presentation conducted at the Medical Staff Meeting of Penrose St. Francis Health Services, Colorado Springs, Colorado.

Hampton, T. (2005), Experts Address Risk of Physician Suicide. JAMA, 294(10), 1189-1191.

Mansky, P. (March, 2006), Physician Health Programs Help Stem the Tide of Suicide. Physician Health News, 11(1), 6-7.

Physician - 15-MAR-2008; 77(6): 785-92 From NIH/NLM MEDLINE Review Full Text Abstract PDF. Blashki, G., Managing depression and suicide risk in men presenting to primary care physicians. Prim Care - 01MAR-2006; 33(1): 211-21, x-xi. From NIH/NLM MEDLINE Review Full Text PDF Gaynes, B.N., Major depression symptoms in primary care and psychiatric care settings: a cross-sectional analysis.

Ann Fam Med - 01-MAR-2007; 5(2): 12634.

Maurer D., An evidence-based approach to the management of depression.

Prim Care - 01-DEC-2006; 33(4): 923-41, vii From NIH/NLM MEDLINE Review Full Text Abstract PDF. Schernhammer, E., & Colditz, G. (December 2004), Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry, 161(12), 2295-2302.

Williams, C.D., Assessment of Occupational Impairment and Disability From Depression. J Occup Environ Med April 2008; 50(4); 441-450 Full Text PDF.

PAGE 25 | THE BULLETIN | NOVEMBER / DECEMBER 2009

risk management

frequently asked questions: Treating Patients in a Difficult Economy

By Susan Shepard, MSN, MA, RN, CPHRM This article answers questions that our regional patient safety/risk managers address about the serious problems that are occurring when patients become unable to or don’t pay their co-pays or when they refuse to pay their physician charges.

Q: When a patient is dissatisfied with care, can he or she dispute the charge with the credit card company?

A: A credit card customer can always request that a charge be questioned.

Normally, when this situation occurs, the credit card issuer will open an investigation into the disputed charge. In the meantime, the card issuer may also withhold paying the credit charge amount to the physician.

Q: What is the appropriate response when an established patient comes in, but is unable to pay?

A: Talk to the patient first. Investigate why the patient isn’t paying the bill; e.g., is he or she unhappy with the care? After that, you can consider alternative financing options, including bill collection.

It is helpful to have a written policy summarizing the practice’s policy on financial matters that you give to each patient at the initial visit. A physician has the right to expect payment for services rendered. The practice should have a policy and apply it consistently in a nondiscriminatory fashion. When you can, “remind” a patient that he or she received a copy of your policy at the time of the first visit. It makes handling this type of difficult situation easier.

If you decide to terminate the patient relationship for nonpayment, you must follow a formal process that includes giving the patient proper notice and treating emergencies in the interim.

Q: Can the physician refuse to establish a patient-physician relationship based on the patient’s inability to pay?

A: Yes, as long as the patient is not seeing you based on a referral from an emergency department where you were on-call when the patient was seen. If that is the case, determine the requirements of the particular hospital, as established in the hospital’s medical staff bylaws and rules and regulations. You must follow those requirements.

At a minimum, you will likely be required to see the patient at least one time to determine the patient’s status and whether he or she has an emergency medical condition, under EMTALA. If the patient is in need of emergent treatment, you will likely be required to provide the care regardless of his or her ability to pay, although you can ask for payment or payment arrangements.

If the patient did not come to you as a result of an ED call and you have an established policy of not accepting patients who cannot pay, you can refuse to establish the relationship. Potential patients should be given some indication of your practice’s financial requirements when they make an initial appointment for treatment.

If the potential patient is not aware of your financial requirements, he or she may delay making other arrangements for care while waiting for an appointment with you. If

the patient then arrives for an appointment and you decide not to accept him or her for financial reasons, your decision can appear questionable, in retrospect, if the patient is injured by the subsequent delay in receiving medical care.

A process in which the biller checks the status of coverage, before the patient comes in, can expedite your decision on whether to accept him or her as your patient.

Q: When a patient is dissatisfied with the result of an elective procedure and demands a concession (a free revision, a refund, a discount, or refuses to pay credit card charges), what recourse does the physician have?

A: Selecting the correct patient, providing very thorough informed consent, and keeping the lines of communication open are your best defenses against patient dissatisfaction. However, once a patient who is dissatisfied asks for compensation, contact your patient safety/risk manager, who will help you evaluate the situation from professional liability and compliance standpoints. In some situations, making a concession may be viewed as a “courtesy” gesture and may be a positive factor in the defense of a claim. Other situations may warrant the use of a Release of Claims form.

Q: What factors should I consider in choosing a commercial credit company to provide a line of credit to my patients? Where can I find a reputable company?

A: Some commercial credit companies hold the physician responsible if the patient defaults on a payment. Before using a commercial credit company, read the

PAGE 26 | THE BULLETIN | NOVEMBER / DECEMBER 2009

contract carefully to make sure you won’t be liable for a patient’s outstanding balance.

Patient Safety Tips

You should also be aware of your state’s consumer protection laws regarding lending and disclosure and make sure that your patients understand the terms and conditions of the financing.

•

A credit card company will notify the physician in writing about an inquiry into a charge that is being challenged. It is very important that you respond to the letter.

If you don’t clarify the dispute, the charge will be disallowed. Educate your office staff so that they recognize these letters and they bring them to your attention. Be sure to respond to any letter related to charges that are in question.

Your bank, local medical society, or professional society can help you locate a commercial credit company.

•

If you accept a credit card for payment, you may want to consider a limit on allowable credit card charges. The limit can be a percentage of the total treatment charge or a dollar limit, e.g., $3,500, $5,000, or not more than 50 percent of the procedure cost.

•

Payment plans should be in writing and signed by the patient.

•

Be sure to obtain a reference for credit applications. This will ultimately assist you in locating the patient if the account needs to be sent to a collection agency.

•

Put a time limit on any adjustments or revisions to the original procedure (such as 60 or 90 days from the procedure date). Otherwise, a patient could come in years later and request a revision that was discussed when the procedure was first done.

•

Identify poor payers early on and deal with the problem. Do not wait until the situation reaches a crisis point and puts your doctor-patient relationship at risk.

•

Make sure you select a reputable collection agency. There are very specific state laws dealing with fair debt collection. A physician who selects an agency that violates state laws could face liability for negligent selection.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider, in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission by The Doctors Company.

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PAGE 27 | THE BULLETIN | NOVEMBER / DECEMBER 2009

PRACTICE MANAGEMENT

Physician profiling What you don’t know can hurt you By the AMA Private Sector Advocacy Staff Big news related to physician profiling came out of New York last year, when Attorney General Cuomo announced his landmark settlements with insurers operating in his state. The insurers are now required to submit the rating criteria they use to place physicians in tiered networks, in which members pay lower co-pays or otherwise receive discounts for seeing favored physicians. In addition, these insurers must abide by a set of standards for their physician profiling programs and hire an independent Ratings Examiner to report to the Attorney General every six months or incur penalties.

Shortly after the insurers signed agreements with Mr. Cuomo, members of the Consumer-Purchaser Disclosure Project adopted the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs. Under this voluntary agreement, health insurers will follow a set of standards, hire an independent entity to audit their programs to ensure they use valid measures to rate physicians, and work toward pooling their data.

Although neither the New York settlements nor the Patient Charter is a panacea for the problems associated with physician profiling, they represent important steps forward. However, the AMA contends that all physician-profiling programs must follow standards that require the use of valid methodologies, promote transparency at all levels, and assure accurate results. In order

to encourage legislation on physician profiling programs, the AMA developed a model bill, which mandates profiling programs adhere to a set of standards, use valid quality standards, properly adjust for risk, use sufficient sample sizes, and correctly attribute episodes of care. Additionally, insurers must fully

the state’s health insurers. The Colorado law requires health insurers to make their processes for profiling, rating, or characterizing physicians more transparent, and ensure greater accuracy in the results.

The law also provides for an appeal mechanism so physicians can challenge the validity of their rankings prior to their release or use by health insurers.

In order to encourage legislation on physician profiling programs, the AMA developed a model bill, which mandates profiling programs adhere to a set of standards, use valid quality standards, properly adjust for risk, use sufficient sample sizes, and correctly attribute episodes of care.

Regulations like those adopted in New York and now Colorado, and documents such as the Patient Charter, are essential to help ensure that the physician performance information that health insurers provide patients is both reliable and meaningful. They establish processes that temper some of the inherent risks that can result from physician profiling.

disclose the methodology used to profile physicians and disclose the limitations of the methodology, profile physicians at the group level, establish a reconsideration or appeal process, and hire an independent third party to oversee the program.

The AMA neither supports nor opposes physician profiling per se, but patients and physicians have the right to understand how profiles are developed and to expect that results accurately reflect the realities of the physician practice. Some health insurers have unfairly evaluated physicians’ individual work. Not only can incorrect and misleading information tarnish a physician’s reputation, it is unfair to patients who may consider it when choosing a physician. Erroneous information can erode patient confidence, trust in physicians, and disrupt patients’ longstanding relationships with doctors who know them and have cared for them for years.

Recently, Colorado Governor Bill Ritter signed legislation regulating the physician rating systems used by many of

PAGE 28 | THE BULLETIN | NOVEMBER / DECEMBER 2009

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PAGE 29 | THE BULLETIN | NOVEMBER / DECEMBER 2009

reimbursement

NEED HELP GETTING PAID WHAT YOU’RE OWED?

By Cindy Ehnes, Director, California

and problems with post-emergency

decided by an independent third-party

Department of Managed Health Care

stabilization care.

review organization.

of California has a quick, easy, and free way for doctors and hospitals to get help with claims payment problems? The Department of Managed Health Care’s (DMHC) Provider Complaint Unit has recovered more than $16 million in additional payments owed by health plans to doctors and hospitals, since it was created in 2005.

The DMHC’s Provider Complaint Unit (PCU) was created as

If you didn’t know about this free

We’ve also established an

Did you know that the State

Independent Dispute Resolution Process

service, you are not alone. While we don’t

(IDRP) to give non-contracted providers

directly oversee physician practices, the

of EMTALA-required emergency hospital

DMHC is the state agency that regulates all

and physician services a fast, fair, and cost

California HMOs, and Anthem Blue Cross

effective way to resolve claim payment

and Blue Shield PPOs. We make sure that

disputes with health care service plans

health plans follow the law and that health

and their capitated provider groups. The

plan members receive the right care at the

IDRP is voluntary for both non-contracted

right time. We recognize that health care

providers and payers. Disputes are

providers are a crucial part of California’s health care delivery system and we want to learn about the particular issues facing the provider community, including

an alternative way for doctors and

helping California physicians,

hospitals to resolve claims

hospitals, and other licensed

payment issues without

health care providers

having to go to court.

resolve disputed claim

We developed an

issues with payers.

online Provider

If you

Complaint

are a provider

System to

and would

evaluate claim

like to report

reimbursement

a problem

disputes such

regarding

as timely

claims payment

submission

or learn more

and payment

about the

of claims, failure

independent

to pay according

dispute resolution

to contracts, coding

process, please contact

disputes, enforcement of

us at 1-877/525-1295, or go

the provider bill of rights,

to www.healthhelp.ca.gov.

PAGE 30 | THE BULLETIN | NOVEMBER / DECEMBER 2009

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PAGE 31 | THE BULLETIN | NOVEMBER / DECEMBER 2009

MEDICO NEWS

MEDICONEWS Are Your Payors in Good Financial Health?

One of the symptoms of an insolvent health plan, IPA, or other payor is a failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory time frames, but does not release the checks in a timely manner. If you are experiencing repeated payment delays, you should investigate the financial health of the payor.

To help physicians monitor the financial health of their contracted payors, CMA has put together the following checklist.

1. Check the financial solvency reports on the DMHC’s website.

• The Department of Managed Health Care (DMHC) is required to collect and analyze the financial statements of health plans and risk-bearing organizations (RBOs), such as IPAs, on a quarterly and annual basis. This allows DMHC to monitor their financial solvency.

• RBO financial solvency reports can be found at http:// www.hmohelp.ca.gov/providers/rbo/rbo_results.aspx.

For each payor, a designation of “met” or “not met” will be assigned for each grading criteria. The reports also indicate whether organizations that have “not met” any of the grading criteria have implemented correction action plans (CAP), and whether they are in compliance with the terms of the CAP. • Health plan financial statements and the results of DMHC financial examinations can also be found at http://www.hmohelp.ca.gov/healthplans/rep/rep_ financial.aspx.

2. Verify receipt of claims with the payor.

• A few years ago, during the time of the devastating IPA bankruptcies in California, one of the ways payors avoided paying for claims was to routinely tell physicians that there was “no claim on file.” California law now requires health plans and their contracting medical groups and IPAs to acknowledge receipt of claims within two business days for electronic claims and within 15 days for paper claims.

• Confirming receipt of your claims with a payor, particularly a problem payor, allows you to quickly identify potential solvency issues and ensures your

claims won’t be denied at a later date for failure to file them in a timely manner.

3. Appeal claims that haven’t been paid within the regulatory time frame.

• State law requires that PPO claims be paid within 30 working days and HMO claims within 45 working days of receipt of a clean claim. There is a misconception that claims that haven’t been paid or denied can’t be appealed. If a plan or IPA has not paid your claim in a timely fashion, you can and should file an appeal based on lack of payment (a sample letter is available in CMA ON-Call document #0124, “Late Payment”).

4. Call SCCMA/MCMS’s reimbursement help line.

• If you are not successful with your appeal or believe the payor may be in trouble, contact SCCMA/ MCMS’s reimbursement help line at 408/998-8850 or 831/455-1008 or sandie@sccma.org.

5. File a complaint with the appropriate regulator.

• DMHC regulates all California HMOs, as well as Blue Cross and Blue Shield PPOs. To file a complaint with DMHC visit http://www.dmhc.ca.gov/providers/ clm/clm_comp.aspx or call 877/525-1295.

• Most PPOs and other non-HMO insurers are regulated by the Department of Insurance (DOI).

Even though DOI is not required to collect the same type of financial data from its regulated insurers, it is still important to notify them of any solvency concerns. To file a complaint with DOI, visit http:// www.insurance.ca.gov/0100-consumers/0020-healthrelated/0010-consumer-provider-complaints/ or call 800/927-HELP (4357).

For more information, see CMA ON-Call documents #0223, “Risk-Bearing Medical Groups, Including IPAs: Regulation of Solvency;” #0131, “Insolvency of Health Plan, IPA or Other Entities That Contract With Health Plans (Pre-Bankruptcy or Closure);” and #0106, “Bankruptcy of IPAs or Health Plans.”

ON-Call documents are free to members at http://www.cmanet.org/ member.

PAGE 32 | THE BULLETIN | NOVEMBER / DECEMBER 2009

(CMA Alert, November 16, 2009 issue)

MEDICO NEWS

Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data The California Cooperative Healthcare Reporting Initiative (CCHRI) is operating a quality reporting pilot project called the California Physician Performance Initiative (CPPI). Over the past two years, CPPI has used claims data from private PPO patients from Anthem Blue Cross, Blue Shield, and United Healthcare to measure physicians on a set of quality measures.

CMA continues to have serious concerns with the validity and accuracy of the data that has been collected. Results of CCHRI’s own reconsideration process in 2009 found significant inaccuracies, with 33% of physician scores being overturned during the reconsideration process.

CMA also surveyed members who completed the reconsideration process and found similar results. Because the CPPI program relies solely on claims data, it fails to comprehensively document the care a patient receives or the reasons why a patient may not receive the care that is the focus of a quality measure.

For example, one physician reported that he was marked down for not recommending cervical cancer screening to patients who had undergone hysterectomies. Another physician was penalized for a procedure that he recommended, but that was subsequently denied by the HMO for medical necessity.

Many organizations have voiced similar concern with the validity of the CPPI data, including county medical associations, major physician groups, the University of California at San Diego, and CCHRI’s own physician advisory group (PAG).

Despite the recommendation from CCHRI’s physician advisory group not to release the faulty data, Blue Shield has indicated that it will likely publish the results. At this point, Blue Cross and United Healthcare have not said whether they will publish the 2009 CPPI results.

CMA has learned that Blue Shield is planning to give digital “blue ribbons” to physicians who scored in the top 50th percentile, and will possibly reopen the reconsideration process for physicians who are interested in improving their scores. Blue Shield has tentative plans to publish this information by the end of December.

CMA is very concerned about the implications of making this data public, given the serious concerns about its accuracy. Even a “partial” publication of the results, as is being planned by Blue Shield, is problematic given the faulty data used to score physicians.

It also infers that some physicians are not quality doctors because they did not receive a “blue ribbon.”

CMA continues to work to dissuade payors from publishing the 2009 CPPI results, and to persuade CCHRI to fix the flaws in the CPPI data gathering process before moving forward with the project.

More information is available at http://www.cmaalert.org.

Contact: Armand Feliciano, 916/551-2552 or afeliciano@ cmanet.org.

(CMA Alert, November 16, 2009 issue)

Physicians’ Personal Data Stolen More than ten thousand California doctors contracted with Anthem Blue Cross and Blue Shield of California are being notified that their personal information, including Social Security, taxpayer ID, and NPI numbers, may have been compromised when a laptop containing sensitive data was stolen. While there have been no reported misuses of this information, physicians are urged to take steps to protect themselves from identity theft.

The theft occurred in late August in the Chicago area when a Blue Cross-Blue Shield Association employee’s laptop was stolen from a car. The breach involved a data set containing information on as many as 800,000 physicians, including names, addresses, tax ID numbers, and NPI numbers. Physicians who use their Social Security numbers as their taxpayer ID numbers should have received a letter notifying them of the data breach, urging them to take advantage of the free credit monitoring services being offered to affected physicians by the insurers.

To take advantage of the free credit monitoring offer, you must enroll by the end of the year using the unique activation code

provided in the letter. The program offers $25,000 in identity theft insurance with no deductible and provides alerts to changes in credit reports.

Physicians are encouraged, as always, to be vigilant in protecting themselves from those who may try to use their identity as a physician to submit fraudulent prescriptions or claims. If you suspect that your personal information is being used fraudulently, you should take immediate action. For more information on what you should do if you believe you are a victim of identity theft, see CMA ON-Call document #0608, “Who’s Got Your Number?

How Physicians Become the Victims of Identity Theft.” ON-Call documents are free to CMA members at http//www.cmanet.org/ member.

If you have questions about the Blue Cross/Blue Shield data breach, please call the Blue Shield Provider Liaison Unit at 800/2583091 or Blue Cross Provider Services at 800/933-6633.

PAGE 33 | THE BULLETIN | NOVEMBER / DECEMBER 2009

(CMA Alert, October 21, 2009 issue)

MEDICO NEWS

House Introduces New Health Reform Bills House Democratic leaders unveiled their latest version of health reform recently, in HR 3962, “America’s Affordable Health Choices Act of 2009” and HR 3961, “Medicare Physician Payment Reform Act of 2009.” These bills are a combination of the three versions of HR 3200 that had passed out of the Ways and Means Committee, Energy Commerce Committee, and the Education and Labor Committee.

CMA is still reviewing the bill, but will likely continue to support some provisions and oppose others. CMA is continuously working to improve the bill and, indeed, several improvements were made to HR 3962 (see below).

The two bills continue to include the $400 billion in physicianrelated payment fixes for Medicare and Medicaid services, including a repeal of the Medicare sustainable growth rate formula, increases for primary care physicians, and the California geographic locality payment fix. House leaders were forced to move the physician payment provisions to a separate bill because President Obama asked that the health reform bill not increase the deficit. By doing so, the remaining health reform provisions come in well under the $900 billion limit set by President Obama and would reduce the deficit by $30 billion over 10 years.

Other notable changes include a new “millionaires’ tax” that would tax couples with gross incomes above $1 million at a rate of

5.4% to help pay for health reform. The bill also repeals anti-trust exemptions for the health insurance industry and clearly prohibits the use of “comparative effectiveness research” to make coverage or payment decisions or to interfere with the physician-patient relationship.

HR 3962 also expands the Medicaid program to cover families making up to 150% of the federal poverty level ($33,000 for a family of four). HR 3200 only covered families up to 133%. CMA supports this coverage expansion, but is strongly advocating that Medicaid payment rates must be raised so that this promise of coverage is not an empty one. While the bill does increase Medicaid payment rates for primary care physicians, we believe that specialty rates must also be raised.

The House reforms remain more favorable for physicians than the Senate reforms. CMA will continue to fight to improve both bills, and to ensure that the physician-friendly provisions in HR 3962 do not get lost when these bills get to conference committee.

Most predictions are that health reform will happen this year.

Physicians must let Congress and the public know that the coverage expansions are an empty promise unless patients can find a doctor.

(CMA Alert, November 2, 2009 issue)

2009 State Legislative Wrap Up Despite the paralyzing impact of the state’s $40 billion budget deficit on legislation in 2009, CMA put three sponsored bills on Governor Schwarzenegger’s desk this year – AB 2 (rescission), AB 120 (peer review), and SB 606 (medical school loan repayment).

While the Governor signed SB 606, he vetoed both AB 2 and AB 120, undermining CMA efforts to protect patients from insurance companies and to improve the peer review process.

AB 2, authored by Assemblymember Hector De La Torre, would have required insurers to get approval from an independent panel prior to rescinding health insurance coverage. The bill was aimed at stopping the practice of insurance companies looking for excuses to cancel an enrollee’s coverage after they get sick and run up expensive medical bills. Despite more than a year of rhetoric from the Governor decrying rescissions and strong editorial support for AB 2, he vetoed the bill, abandoning California patients who lose health care when they need it the most.

“The insurance industry has made billions of dollars from its practice of rescission by unfairly canceling health insurance policies with little to no oversight,” says De La Torre, who plans on reintroducing similar legislation next session. “Currently, there are no protections for consumers. Californians no longer can afford to allow the health insurance industry to be the judge and the jury.”

Governor Schwarzenegger also vetoed AB 120 (Hayashi), legislation designed to strengthen California’s robust system of

peer review. While nearly all peer review done in California is done efficiently, timely, and in a manner that protects patients from quality of care deficiencies, the current peer review system can be strengthened. Instead of taking advantage of an opportunity to strengthen a vital part of California’s system of ensuring quality patient care, the Governor chose to veto these important improvements.

The Governor did sign SB 606 (Ducheny), which extended the Steve Thompson Loan Repayment Program to D.O.s. The program offers loan repayment assistance to doctors who agree to work in underserved areas for at least three years. Since its inception in 2003, more than 100 physicians have participated in the program, which plays an important part in CMA’s efforts to expand access to care to the underserved.

CMA also defeated every bill that we opposed, including attempts to erode California’s bar on the corporate practice of medicine and to expand the scope of practice of allied health professionals.

Over the next few months, CMA will be setting its legislative priorities for next year, guided by the policies and priorities set by CMA’s House of Delegates.

PAGE 34 | THE BULLETIN | NOVEMBER / DECEMBER 2009

(CMA Alert, October 21, 2009 issue)

MEDICO NEWS

Highlights from CMA’s 2009 House of Delegates Hundreds of California doctors convened in Anaheim recently for the 2009 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, patient care, and to elect CMA officers. The following are summaries of some of the resolutions that the House adopted as policy.

Health System Reform (Resolution 203a-09): The delegates voiced their support for health system reform that (1) is directed to help the truly uninsured, (2) helps those who are eligible for coverage to obtain it, (3) allows total deductibility of all health care expenses, and (4) enacts tort reform nationally, as has been done in California. The delegates also restated their support for the “Guiding Principles of Health Reform” that they passed at last year’s meeting.

Immunization for Health Care Workers (Resolution 701a09): The delegates voted to support universal seasonal influenza vaccination for all health care workers with direct patient contact; and recommended vaccination against H1N1 and other pandemic influenza strains for health care workers according to CDC guidelines.

Nutrition Labeling of Saturated and Trans Fats (Resolution 709a-09): The delegates expressed strong support for changing nutrition labeling requirements so that saturated fat and trans fat contents are accurately reported to a 0.1 gram level per serving.

Soda Tax (Resolution 721a-09): The delegates directed CMA to support increased taxes on sodas and other sugar sweetened beverages, with the revenues to be utilized for public health education efforts and other health purposes. The delegates voted that physicians should educate their patients about the health risks

associated with the consumption of food and beverages containing high amounts of processed simple or refined sugars, such as high fructose corn syrup.

Online Defamation of Health Care Providers (Resolution 415a-09): The delegates voted to support legislation requiring vendors who operate online forums that review physician performance to require users to agree to terms of use that include, but are not limited to: agreeing to only post factual statements; attesting that they are a current or former patient of any physician they are reviewing; and disclosing within their posts any conflicts of interest or business relationship they have with the vendor of the online forum. The delegates also asked CMA to seek federal guidance on misleading or false statements regarding physician performance posted online or on other public venues, particularly when the false statements involve patients’ protected health information (PHI).

Medical Practice Guidelines (Resolution 504a-09): The delegates urged CMA to advocate that members of practice guideline development committees must disclose any possible conflict of interest and that such guidelines should be peer reviewed by independent reviewers prior to publication to ensure that guidelines are evidence-based and that all conflicts have been disclosed. The delegates also agreed that medical and specialty associations should not receive any money for sponsoring, underwriting, or promoting practice guidelines from drug, device, or equipment manufacturers.

The rest of the resolutions can be viewed at the members-only website, http://www.cmanet.org/member.

(CMA Alert, October 21, 2009 issue)

U.S. House Introduces Bill That Would Exempt Small Health Care Organizations From Red Flags Rule The Federal Trade Commission (FTC) recently announced it would again delay enforcement of its new Red Flags Rule, which requires “creditors” — including physicians — to develop and implement identity theft detection and prevention programs. The new regulations are now scheduled to take effect on June 1, 2010.

This is the third time the FTC has delayed implementation.

Several factors appear to be causing these delays, including objections from CMA and others in organized medicine, as well as objections from other professionals, such as accountants and attorneys. In fact, the American Bar Association recently won a lawsuit in federal court holding that the Red Flags Rule could not be

applied to attorneys. It is possible this decision may have an impact on the FTC’s decision to apply the Red Flags Rule to physicians.

Congress also has reviewed the scope of the rule and has recently introduced a bill (HR 3763) that would create an exemption for health organizations, including physician practices, with 20 or fewer employees.

For more information, see CMA’s updated Red Flags Rule toolkit, available free to members, at the members-only website, http://www.cmanet.org/member.

PAGE 35 | THE BULLETIN | NOVEMBER / DECEMBER 2009

(CMA Alert, November 16, 2009 issue)

CLASSIFIED ADS office space for rent/lease MEDICAL OFFICE SPACE FOR LEASE • BY O’CONNOR HOSPITAL 1,927 sq. ft., divisible. Located adjacent to O’Connor Hospital. Freestanding building with on-site parking. Call brokers to tour: Alice Teng 408/282-3808 or Steve Hunt 408/282-3846.

OFFICE SPACE TO SHARE • NEAR GOOD SAMARITAN HOSPITAL Two exam rooms plus office. Shared reception and waiting rooms, x-ray, and bone density available. Near Good Samaritan Hospital. Please call Barbara at 408/356-6108.

MEDICAL SUITES • LOS GATOS – SARATOGA Two suites, ranging from 1,000 to 1,645 sq. ft., at gross lease cost. Excellent parking.

Located next door to El Camino Los Gatos Hospital. Both units currently available.

Call 408/355-1519.

MEDICAL OFFICE FOR LEASE/ SUBLEASE/SALE Office in close proximity to O’Connor Hospital for lease/sublease/sale. Please call 408/923-8098 for more information.

ATHERTON SQUARE MEDICAL/ DENTAL BUILDING A newly upgraded Class A building offers a variety of spaces from 1,166 sq. ft. and up for medical/dental use at 3301-3351 El Camino Real, Atherton. Tenant improvement allowances available to design suite to meet your needs. Excellent onsite parking, close to Stanford and Sequoia. Trask Leonard, Bayside Realty Partners, 650/282-4620 or Alice Teng, Colliers, 408/282-3808.

MEDICAL SUITES • GILROY

OFFICE EXAM ROOMS TO LEASE

First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.

Two nice and large exam rooms (dedicated), shared waiting room. Available five days a week, 2585 Samaritan Drive, San Jose. Please call 408/356-7788 for more information.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA

MEDICAL OFFICE TO SHARE • SUNNYVALE

Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500–4,000 sq. ft. Call Rick at 408/228-0454.

One exam room plus one large office, shared waiting room and front office.

Newly built, 1,280 sq. ft. Call 408/4381593.

OFFICE SPACE FOR LEASE • SAN JOSE

Three suites available from 1,108 sq. ft.— 1,339 sq. ft. Easy access to 101 and 280/680. Offices fully plumbed. Located across from the Regional Medical Center of San Jose. Good visibility and on-site parking. Call for more information at 408/282-3848.

600–1,900 sq. ft. in West Valley Medical Building, second floor, elevator, separate entrance. Call Helen at 408/243-6911.

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

OFFICE TO SHARE • NEXT TO GOOD SAMARITAN HOSPITAL Looking for physician to share medical office. Small, attractive office, ideal for physician with light, not-every-day, outpatient practice, next to the Good Samaritan Hospital. Call 408/356-8636.

BRAND NEW HIGH END MEDICAL CONDOS– DOWNTOWN LOS GATOS Design/build-to-suit opportunities for sale/lease. On-site parking. In the heart of prestigious downtown Los Gatos. Unit sizes 1,400 sq. ft. and up.

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

MEDICAL/DENTAL OFFICE SPACE AVAILABLE FOR LEASE

MEDICAL OFFICE BUILDING FOR LEASE • SAN JOSE 4,360 sq. ft., ideal for single tenant use. Abundant on-site parking. Easy access to Highways 101, 280, and 87. Located across from the former San Jose Hospital. For questions, call Patrice DeLorey at 408/282-3848.

LOS GATOS MEDICAL OFFICE SUITES FOR LEASE Los Gatos Medical Office Suites available for lease from 1,000–2,157 sq. ft. For more information contact Patrice DeLorey at 408/282-3848 or Alice Teng at 408/282-3808.

PAGE 36 | THE BULLETIN | NOVEMBER / DECEMBER 2009

PRIME MEDICAL OFFICE SPACE AVAILABLE Beautiful Spanish-style building immediately adjacent to new El Camino Hospital in Los Gatos. 2,040 sq. ft. suite and 2,107 sq. ft. suite on second floor. $2.50/sq. ft. Call Mark at 650/324-9021 x307.

ELEGANT AND SPACIOUS LOS GATOS MEDICAL OFFICE Available to share with prominent aesthetic dermatologist. This upscale office has seven exam rooms, a lab, two large administrative offices, and a marble and granite waiting room with comfortable seating for eight patients. Call Irene at 408/358-5757 to schedule your private showing. Price is negotiable.

PRIVATE PRACTICE/ OFFICE 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 Available immediately. Urgent Care/Family Practice in West Valley area. Established 30 years, $0 down. Contact Helen at 408/4763450.

EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY

R. Azar MD, MPH at 408/790-2907 or e-mail dazar@ allianceoccmed. com for additional information.

ONSITE PHYSICIAN NEEDED AT A NEW MEDICAL MARIJUANA PATIENT IDENTIFICATION CENTER

Pajaro Dunes Beachfront Condo Shorebirds #58 2 Bedroom -- 2 Bath Top Level -- Great Ocean View Great for Families Owners Bill & Debbi Ricks 408-354-5613

Cannimed USA is a clean, professional, and legal business located in the Willow Glen area of San Jose. Looking for a parttime to full-time compassionate California licensed physician who wants to become part of the rapidly expanding medical marijuana industry while rewarding and improving the quality of life for patients.

We invite you to join us in building a kinder and compassionate world. Contact 408/448-4798 to arrange for an interview.

condo/COTTAGE rentals SKIING AND NEW YEAR • NORTH SHORE, LAKE TAHOE Front lake, three bedroom, two and half bath townhouse, sleeps eight. Linen, internet, year around pool. December 18–24, $350/night. December 29–Jan 3, $400/night. Two nights minimum. Call Neda at 650/704-3161.

OCEAN FRONT CONDO ON KONA COAST

Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Dan

Beautiful setting on the big island of Hawaii. Sleeps four. Great views. Call 408/354-3253 for more info.

FOR SALE 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 throughout. Three lanais with ocean and mountain views, and the tropical gardens which make the Nihi Kai complex so

Rental Agent Pajaro Dunes Company 1-800-564-1771

special. Price reduced to $785,000. Call 650/949-3353.

FOR SALE! LIONEL ELECTRIC TRAINS What child or serious collector doesn’t enjoy Lionel Electric Trains? Just in time for Christmas! Sealed, never used, original condition! All purchased in 1973. Golden State Arrow is a top of the Lionel line huge Santa Fe GP-20 freight train set, sale price $88.95. Rock Island Express is a rugged, die cast engine train set, sale price $89.95.

Milwaukee Special is a Lionel passenger train, sale price $99.00. Call Sheila at 408/866-0558.

WANTED PEDIATRIC PRACTICE Will buy Pediatric practice in South Bay. Call 408/455-2959.

MEDICAL BILLING PHYSICIAN NETWORK • MEDICAL BILLING AND CONSULTING SERVICES Over 18 years of experience managing medical and specialty billing; customized to fit the needs of your practice. Services include, but are not limited to, full medical billing (including patient statements), coding, authorization, insurance eligibility, monthly summaries, and financial counseling. Call us today and allow our professionals to reduce the frustration and time consumed processing medical claims and account follow-up, so you can focus your valuable time on patient care. Office: 408/998-8537, Email: physnet@sonic.net.

PAGE 37 | THE BULLETIN | NOVEMBER / DECEMBER 2009

MEMBER NEWS & HAPPENINGS

Welcome 42 New SCCMA Members!

Name Anna Barbara Wendy Brown Peter Castillo Peter Cham Nina Chicharoen Sheila Gonzalgo Visakha Goonewardena Kavitha Jayachandran Carolyn Krieg Shallu Kulthia Melvin Lee Dan Li Jerome Liu June Magallanes Marlowe Magallanes Jessica Mathieson Craig McCormick Judeth McGann Rijuna Menon Jessica Murphy Surabhi Narayan John Neely

Specialty HNS N GYN D EM IM IM IM IM IM D GE PS FP IM EM R PHO IM IM GER N

City San Jose San Jose Santa Clara San Jose Santa Clara Santa Clara San Jose Santa Clara Santa Clara Campbell Santa Clara Santa Clara Mtn View Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara San Jose

Name Bao-Chau Nguyen June Ong Pina Patel Imtiaz Qureshi Mohammadreza Rohaninejad Melissa Ross Edward Sheen Susan Smith Saroja Sripathi Denah Taggart Susan Tien Tatiana Tinkelenberg Mai Thy Truong Kavid Udompanyanan Joseph Vu James Weisel Andrew Wu Maryam Yamini Mary Yang Steven Yoshioka

Specialty PD PMR EM *DR GS

City Milpitas San Jose Santa Clara Cupertino Los Gatos

PD US P PUD PHO IM IM PDO EM EDM OPH IM IM IM IM

Santa Clara Palo Alto Santa Clara San Jose Santa Clara Mtn View Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara San Jose

*Board Certified; US -- Unspecified; [ ] Not Practicing

Welcome 12 New MCMS Members!

Name Candice Blagmon Weaver Vincent Defilippi Becky Kroll Michelle Melo Michael Moeller Samer Muala

Lawrence J. Comfort, MD *Otolaryngology Head & Neck Surgery 7/20/28 – 11/12/09 SCCMA member since 1960

Specialty US *CS US US *EM US

City Salinas Salinas Salinas Salinas Salinas Salinas

Name Racquel Quema Nancy Salama Shyni Subash Craig Walls Jeannine Wane Leann Watson

In Memoriam

John W. Curtis, MD *Dermatology 2/11/31 – 10/09 MCMS member since 1968

Franklin Gee, MD *Diagnostic Radiology 2/17/42 – 10/23/09 SCCMA member since 1975

A. Paul Miller, MD *Pathology, Anatomical & Clinical *General Surgery 6/29/18 – 10/15/53 SCCMA member since 1975

PAGE 38 | THE BULLETIN | NOVEMBER / DECEMBER 2009

Specialty FP US US EM US GS

City Salinas Salinas Salinas Salinas Salinas Salinas

Leonard Monteleone, MD Anesthesiology 1/1/28 – 11/11/09 SCCMA member since 1961 Paul D. Wilson, MD *Internal Medicine 11/12/27 – 10/22/09 SCCMA member since 1981

When was the last time a doctor came to YOU?

At California Pacific Medical Center’s Atrial Fibrillation and Arrhythmia Center we are committed to a comprehensive team approach in treating your patient. Whether a patient is having debilitating palpitations, recurrent syncope or severe heart failure, sensitive and difficult challenges await – for them and their family.

We are Andrea Natale, M.D., Steven Hao, M.D. and Richard Hongo, M.D., electrophysiologists who specialize in complex ablation procedures.

In fact, we have the highest atrial fibrillation ablation volume on the West Coast; last year, we performed over 450 procedures. We would like make an appointment to see you in your office.

The Atrial Fibrillation and Arrhythmia Center offers:

Why?

•

Board certified, fellowship trained cardiac electrophysiology specialists

We’d like the opportunity to acquaint you with our facilities, staff and equipment – including

•

State of the art technology and facilities for the treatment of arrhythmias•

•

Nationally and internationally recognized expertise in complex ablations, providing care for patients and education for physicians throughout the world

•

In 2008, HealthGrades® ranked California Pacific “Best in the San Francisco Area for Cardiology and Overall Cardiac Services”

•

Dedicated arrhythmia nurse and nurse practitioner to provide continuity from the consultation through the procedure to follow ups

California Pacific’s new Stereotaxis lab. We’d also like to help familiarize you with referral indicators for your patients with arrhythmias, particularly atrial fibrillation.

Let’s schedule an appointment for a visit to your office: 415-600-7459

www.cpmc.org/services/heart

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700 Empey Way, San Jose, CA 95128-4705

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When’s the last time your insurance company paid you?

We’ve declared more than $386 million in dividends to our policyholders since 1975. That includes $14 million in dividends paid in the past year. When you become a NORCAL Mutual policyholder you own a piece of one of the nation’s top medical liability insurers.

Visit www.norcalmutual.com today, or call 800.652.1051.

Our passion protects your practice NORCAL Mutual is proud to be endorsed by the Santa Clara County Medical Association as the preferred professional liability insurer for its members.