2012 September/October

SEPTEMBER / OCTOBER 2012 | Volume 18 | Number 5

Embracing Media in Your Practice PLUS: Health Care Apps

MANAGING YOUR ONLINE REPUTATION JOIN THE MOBILE REVOLUTION

at your dental plan 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 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 ending on January 1, 2013.

Call a Client Service Representative at 800-842-3761 for more information. Or visit www.CountyCMAMemberInsurance.com to download a brochure and application.

Sponsored by:

Underwritten 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.

56602 ©Seabury & Smith, Inc. 2012

AR Ins. Lic. #245544 • 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.CountyCMAMemberInsurance.com

2 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

BULLETIN THE

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

700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org

MEMBER BENEFITS

Feature Articles

Billing/Collections

12 Health Care Apps

CME Tracking

18 Embracing Media in Your Practice

Discounted Insurance

22 Managing Your Online Reputation

Financial Services

30 Mandated Disease Reporting Requirements

Health Information Technology Resources House of Delegates Representation Human Resources Services Legal Services/On-Call Library Legislative Advocacy/MICRA Membership Directory iAPP for

32 Join the Mobile Revolution/DocBookMD

Departments 6 From the Editor’s Desk 8 Message From the SCCMA President 10 Message From the MCMS President

the iPhone

20 SCCMA and MCMS Social Media

Physicians’ Confidential Line

28 Member Benefit: CME Cruise

Practice Management Resources and Education

34 Medical Times From the Past

Professional Development

36 MEDICO News

Publications

40 Time to Retire?

Referral Services With

42 Welcome New Members

Membership Directory/Website Reimbursement Advocacy/ Coding Services Verizon Discount

46 SSTEM Essay Contest Winners 48 In Memoriam 50 Classified Ads SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 3

The Santa Clara County Medical Association Officers President Rives C. Chalmers, MD President-Elect Sameer Awsare, MD Past President William S. Lewis, MD VP-Community Health Cindy Russell, MD VP-External Affairs Howard Sutkin, MD VP-Member Services Eleanor Martinez, MD VP-Professional Conduct Seham El-Diwany, MD Secretary Scott Benninghoven, MD Treasurer James Crotty, MD

Chief Executive Officer

Councilors

William C. Parrish, Jr.

El Camino Hospital of Los Gatos: Arthur Basham, MD El Camino Hospital: Dan Fox, MD Good Samaritan Hospital: Richard Newell, MD Kaiser Foundation Hospital - San Jose: Seema Sidhu, MD Kaiser Permanente Hospital: Anh Nguyen, MD O’Connor Hospital: Michael Charney, MD Regional Med. Center of San Jose: Richard Kline, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford Hospital & Clinics: Peter Koltai, MD Santa Clara Valley Medical Center: Richard Kramer, MD

AMA Trustee - SCCMA James G. Hinsdale, MD

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

BULLETIN

THE MONTEREY COUNTY MEDICAL SOCIETY

Printed in U.S.A.

OFFICERS

Editor

President John F. Clark, MD President-Elect Kelly O'Keefe, MD Past President James Ramseur, Jr, MD Secretary Patricia Ruckle, MD Treasurer Steven Vetter, MD

THE

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

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising.

Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2012 by the Santa Clara County Medical Association.

4 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.

DIRECTORS Paul Anderson, MD

David Holley, MD

E. Valerie Barnes, MD

John Jameson, MD

Jose Chibras, MD

Jeff Keating, MD

Ronald Fuerstner, MD

Eliot Light, MD

James Hlavacek, MD

R. Kurt Lofgren, MD

AMA Trustee - mcms David Holley, MD (Alternate)

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Lo n g -T e r m C a r e SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 5

FROM THE EDITOR’S DESK

Joseph S. Andresen, MD Editor, The Bulletin

An Interview With Dr. Ramin Manshadi

By Joseph Andresen, MD Editor, The Bulletin Dr. Ramin Manshadi, cardiologist in Stockton, California has written an informative and provocative article in this issue of The Bulletin. He urges all physicians to be proactive in responding to the rapidly changing health care landscape. He discusses how adoption of new technologies and use of social media have improved his medical practice and ability to care and communicate with his patients. We can all learn something from his experience. This prompted me to ask several timely questions:

Have you taken advantage of the Electronic Medical Records (EMR)?

The American Recovery and Reinvestment Act (ARRA) of 2009 was signed into law in 2009 and included new funding for Health Information Technology (HIT). A large portion of the $17 billion will provide incentives for physicians who adopt Electronic Health Records (EHRs). Up to $44,000 per eligible physician will be an incentive, disbursed over five years, to those who treat Medicare patients and demonstrate that they are using a “certified” EHR in a “meaningful” way.

Physicians who do not meet this requirement by 2015 will have a 1% Medicare reduction in reimbursement. Physicians who treat Medicaid patients and adopt EHR will be eligible for incentive payments, totaling up to $63,750 per physician, over six years.

If you don’t know already, to receive the full incentive, Medicare participation in 2011 or 2012 is required. There is a reduction in the incentive for those who start participating after 2012. The last year to begin participation is 2014. You must demonstrate meaningful use of an EHR for 90 consecutive days in the first year of participation and the entire calendar year thereafter. Therefore, to receive the full incentive, physicians must demonstrate meaningful use of EHRs by October 1, 2012. Medicaid eligibility began in 2010 and runs through 2021, where efforts to adopt, implement, and upgrade to a certified EHR is the requirement of the first year of eligibility. Questions? Find answers here: https://ehrincentives.cms.gov/hitech/login.action.

Have you began to make use of social media in your medical practice?

Facebook, Linkedin, Twitter; how are they relevant to my medical practice? Let’s look at one valuable example. The Mayo Clinic Center for Social Media was created to help individuals use social media tools to get the best information, connect with providers and with each other, 6 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

and inspire healthy choices. It is now recognized that the social media revolution is the most far-reaching communications development since Gutenberg’s printing press. Mayo Clinic’s work in this area began in 2005 with podcasting. It now has the most popular medical provider channel on YouTube, more than 260,000 “followers” on Twitter, and an active Facebook page with 65,000 connections. A consumer health hosts a dozen blogs on topics ranging from Alzheimer’s to The Mayo Clinic Diet. All of these efforts are guided by the strong belief that individuals have the right and responsibility to advocate for their own health. We physicians can use these same tools to better inform, communicate, and empower our patients to find their path to better health.

How do patients find us?

A rapidly growing number of patients are now using the Internet to get medical information and find their doctor. WebMD Physician Directory, DoctorFinder, and Health Grades are several examples of web search sites for physicians. ZocDoc and Betterdoctor.com are examples of referral sites that offer more services and information, including online appointment scheduling to make it easier for patients to locate a doctor. Knowing your web presence is an important factor in ensuring available information accurately reflects one’s professional training, Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.

skills, and expertise to prospective new patients.

Aetna vs Bay Area Surgical Management Group Update

And finally, following up on our previous report of Aetna vs. Bay Area Surgical Management Group, national news outlets reported and the Contra Contra Times ran a story entitled “Aetna targeted by doctors, medical associations in lawsuit.” The Los Angeles County Medical Association and California Medical Association, representing thousands of doctors in California, filed a lawsuit against Aetna. It alleges that Aetna routinely denies patients access to out-of-network doctors even when the patient has purchased a policy giving them the right to choose providers. The lawsuit also accuses Aetna of threatening patients with denial of coverage if their members visit doctors outside the Aetna network of providers, and of threatening doctors with having their Aetna contracts terminated if they refer patients outside the network.

Aetna claims the suit is in retaliation for a suit filed by Aetna in February claiming several California providers, including Bay Area Surgical Management and seven ancillary facilities, sent Aetna members to

Billing Collections Consulting

BASM without revealing that physicians had an ownership interest in the facility or were getting paid by BASM for their referrals. “We have sued some of these same doctors and surgery centers named in the suit for their egregious billing practices in February of this year.” Cynthia Michener, a spokeswoman for Aetna, said in an email. “This is a countersuit disguised as a class-action lawsuit.”

The allegations in these lawsuits touch on many issues concerning all physicians: fair pay covering the cost of care vs. egregious billing practices, patient autonomy and choice vs. financial kickbacks in referrals, reasonable and customary charges and the exponential rise in health care costs. In short, the intersection of medical economics and medical ethics. These are all topics that warrant our close attention and comment. Please let us know your thoughts and we will keep you informed of new developments as they occur.

Please remember to exercise your constitutional right and vote on November 6th!

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MESSAGE FROM THE SCCMA PRESIDENT

Rives C. Chalmers, MD President, Santa Clara County Medical Association

Along For The Ride

By Rives C. Chalmers, MD President, Santa Clara County Medical Association I had not heard of the Santa Clara Family Health Plan (SCFHP) until I joined the Medical Society Council. This insurance plan in our county has 3,200 physicians and cares for children of indigent families and their parents. There are other insurance plans providing similar coverage but this is our plan, begun, and maintained here in our county.

I was researching the effects of Governor Brown’s new state budget, which eliminates the Healthy Families Initiative. Beginning in January, 2013, 880,000 children will need to transfer from their current plan to straight

MediCal. The payments to physicians will be less. But the paperwork, authorizations, and billing requirements for MediCal are much more time consuming and slow in payment than the present system. Merely transferring the families to MediCal involves a flurry of paperwork – Hundreds of thousands of families will have to initiate this process statewide.

A pediatrician who sees many of these patients says the payment from SCFHP is quick and easy. MediCal payments take weeks and are frequently complex. Obviously, this will be a burden on county physicians.

This is another consequence of money problems at the state level. The total budget

8 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

for the last four years for California, not including federal payments, are: 117 billion, 130b, 135b, 142b. Despite “drastic cuts in spending,” we continue to spend more each year in California. Cuts such as Healthy Families Initiative are just the beginning.

Services in our county we have grown and expect will continue to ratchet down. Right now the wealthy are still comfortable, but the double penalty of rising taxes and fees, with an erosion of government provided services will affect everyone. There is the possibility that spending will be controlled, or the economy will rebound and increased tax revenues will restore needed services.

With the gradual phase-in of the Affordable Care Act, there will be another larg-

er group of new patients covered by the Health Exchange insurance care expenditures . The federal payer does not have to balance their plans. The large insurers, the Blues etc., are gearing up for these new budget as does Governor Brown. For our great state to meet it’s obcontracts. I just signed a new contract with Blue Shield opting out ligations, there must be a continued reduction in spending or an inof plans that have been so far poorly described, but are intended to crease in revenue by increasing taxes or by the results of an economic cover these new patients. Consultants have estimated that 30%–50% recovery.

Most industrialized countries have single payor systems, and the of businesses will drop workplace health plans, opting to pay the relatively cheap penalty. The affected workers who lose their work overall revenue to physician providers is less than in America. From provided plans will seek coverage through the statewide Health Ex- a societal perspective, this may be desirable. Before the Great Society changes in the 1960s, physician income was less than today on the change.

As detailed in the Affordable Care Act, the federal government average and in inflation adjusted dollars. In my opinion, we may be is required to pay 100% of MediCal payment for these new claims for in the midst of a return, slowly, to those days , with radical changes the first three years, 95% there after and decreasing to 90% in 2020. to the relationship between physician and patient, the organization of Will this promise hold? (Not a promise; required by law) Governor health care services, and the control of the system.

The best input for the independent physician, like myself, is our Brown attempted a 10% across the board cut in MediCal rates this year, to have it stopped in the courts. Lowered payments may be ex- CMA. The statewide convention is October 13-15. If you want furpected gradually as the local and state governments assume more of ther information, want to get involved, call the SCCMA and volunteer your time and expertise. the payer responsibility.

Next month – the Health Exchanges, What to Expect.

Whether the new payments are made to Accountable Care Organizations, globally, or the pay for service system, state governments currently have deficit Rives C. Chalmers, MD, is the 2012-2013 president of the Santa Clara County Medical problems that will be challenging in meeting Association. He is a board certified orthopaedic surgeon and is currently practicing in the the responsibilities of properly funding health Los Gatos area.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 9

MESSAGE FROM THE MCMS PRESIDENT

John f. clark, MD President, Monterey County Medical Society

In Vivo

By John F. Clark, MD President, Monterey County Medical Society Mortality rate, cure rate, prevalence, sensitivity, incidence, specificity, P value, the placebo response, susceptibility, therapeutic range. All these commonly employed terms in medicine are predicated on one simple, observable characteristic of the expression of disease in human populations; variability. Such inherent variability in human affliction creates uncertainty, produces unreliability in strictly programmatic medical assessments, and forces the practitioner to deal in probabilities and percentages. Variability is a formidable adversary in those that would venture out onto the sobering fields of concurrent medical diagnosis and engage in the in vivo treatment of disease.

It is from this fundamental variability that the need for “art” in the practice of medicine is largely derived.

Such variability and the art needed to manage it also have pertinence in the development and application of health care policy. As the management of our health care system becomes increasingly statistical and in the hands of large population based entities such as Medicare, insurance companies, and large healthcare delivery organizations, there is an impetus to try and standardize the practice of medicine in the service of efficiency and safety. Such an impetus is certainly warranted, given the degree of demonstrated inefficiency in our health care system and the magnitude, as well as cost, of medical errors both financially and in terms of human suffering. In 2003, the Midwest Business Group on Healthcare estimated that 30% of the $2.3 trillion U.S. health care system, at that time, went to waste (i.e., had no demonstratable benefit to health). The Institute of Medicine’s seminal “To Err is Human” report, in 2000, documented the unacceptable extent of injury due to medical errors. In light of the medical profession’s sluggishness at addressing these issues on its own, such revelations have

fostered initiatives to address them from other health care stakeholders. This effort has largely taken the form of attempts at standardization in medical diagnosis and treatment based on evidence garnered through large population studies. However, there is an inherent limit to the utility of such standardization that is imposed by the fundamental variability in the expression of human disease.

What is ultimately needed for the management of disease variability is something that has become somewhat of an issue non-grata in health care policy circles; physician autonomy.

In an age of increasing oversight, public reporting, practice benchmarks, and evidence-based guidelines, physician autonomy has become colored with implications of higher health care costs and increased errors. This is to some degree the fault of the profession. While physician autonomy is a somewhat ill-defined and plastic term, it has traditionally been used by physicians to promote broad latitude in the ordering of tests and the recommending of treatments based on individual professional opinion. It has essentially been synonymous with the statement, “Trust me.” However, I submit that such a formulation of physician autonomy is simplistic. There have always been considerable constraints on physician autonomy imposed, at the very least by the profession itself, through what has been termed the standard of care in medical practice. What is relatively novel to the profession is the imposing of constraints on physician autonomy by non-physician groups based on both resource constraints and formulations of medical quality defined outside the profession. Since our profession has been unwilling to redefine itself with regards to autonomy, in light of demonstrated inefficiency and poor safety, it is being redefined for us from outside the profession. Thus, we have entered a new era of shared oversight in the practice of medicine. Such shared oversight is certainly here to stay, but as shown in a New England Journal of Medicine (NEJM) article

10 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

from November 25, 2010 reviewing 10 years of safety data, in 10 North Carolina hospitals, these efforts have yet to show demonstratable benefits. What is at risk in this new era of global-population-based-medicine is the accommodation of medicine to individual variability needed for accurate diagnosis and appropriate treatment in real-world circumstances. It is an accommodation that is as vital to the effective and efficient practice of medicine as standardization. This accommodation does not happen on spreadsheets, in programmatic treatment guidelines, through practice benchmarks, or in policy statements, but is achieved at the bedside or in the exam room between the practitioner and the patient, in real time. It is in such places that the limits to the utility of standardization in medical practice will ultimately be discovered. Once discovered, a balance must then be struck between the benefits of evidence-based standardization and the needs of accommodating individual variability in disease expression.

In regards to incorporating the dimensions of such a limit into health care policy, there is no participant in our health care system that is better able to appreciate and communicate this limit in light of resource and safety constraints than the physician. It is in part, around these very issues, that the medical profession must redefine itself in our new era.

Such communication requires a dialogue between the exam room and the policy committee conference room. As a profession, we are thus called upon to refine and then advocate for a new definition of physician autonomy, in light of new pressures coming to bear on our profession and the health care system.

Not only must we accommodate the variabilJohn F. Clark, MD, is the 2012-2013 president of the Monterey County Medical Society. He is a board certified family medicine physician and is currently practicing with Salinas Valley PrimeCare Medical Group, Inc.

ity needed for the practice of medicine, but we must also accommodate the needs of efficiency imposed by limited resources and the expectation for quality demanded by our patients. I believe this balance is achievable. It is a balance that will come at the cost of some autonomy for the individual physician, for the sake of the maintenance of the autonomy of the profession of medicine as a whole. This is, to a large degree, as it has always been. We, as a profession, must work in concert to more adequately oversee ourselves in light of a new reality, and it falls to us to take leadership in promoting a new vision for the profession.

With regards to health care policy, it is only through the efforts of organized medicine that this balance between medical standardization and professional autonomy will be adequately incorporated into our health care system. Such an undertaking requires the broad involvement of the profession in health care policy decisions that can only be achieved through organizations, such as hospital medical staffs, state medical associations like the CMA, the AMA, as well as local medical societies.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 11

Here’s just a sampling of the power your smartphone can provide in your practice.

12 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

AAOS Now

CathSource

AAOS Orthopaedic CodeX X-Lite 2012

DG Apps

“Monthly news magazine of the American Academy of Orthopedic Surgeons, ….”

• Free — available for download from iTunes and the Android Market

“Built-in companion for immediate, on-the-go coding.”

• Free — available for download from iTunes and the Android Market

Accent

“OvernightScribe.com is an online medical transcription service catering to U.S. health care providers.”

• Free — available for download from iTunes

Acta Orthopedica Journal

“Presents original articles of basic research interest, as well as clinical studies in the field of orthopaedics and related subdisciplines.”

• Free — available for download from iTunes

AO Surgery Reference

“An online repository for surgical knowledge. It describes the complete surgical management process from diagnosis to aftercare for all fractures of a given anatomical region, and also assembles relevant material that the AO has published before.”

• Free — available for download from iTunes and the Android Market

“An up-to-date medical reference devoted to cardiac catheterization and angiography. Developed by practicing interventional cardiologists for both specialists and trainees in the field of cardiovascular disease.”

• $3.99 — available for download from iTunes “Brings the best of the world of medical apps to the physician or health care professional. Focused 100% on professional practice (rather than apps for the general public), it saves time and keeps users up-to-date with apps of most interest to their particular specialty area(s).”

• Free — available for download from iTunes

DocBookMD

“Free communication tool for SCCMA and MCMS member physicians. DocBookMD allows physicians to send X-rays, EKGs, and other patient information directly to their colleagues for quick consultations.

Completely HIPAA-compliant, DocBookMD allows fast, secure, multimedia messaging between physicians to enhance patient care.”

• Free to SCCMA and MCMS members — available for download from iTunes and the Android Market • To register your DocBookMD app once you’ve downloaded it, all you need is your Medical Society DocBookMD number. To get your number, contact SCCMA or MCMS at 408/998-8850 or 831/455-1008

Dragon Medical Mobile Recorder

“For clinicians authorized to use Dragon Medical Mobile Recorder with Nuance Healthcare’s background speech solutions.”

• Free — available for download from iTunes

DSM Search

“Enables psychiatrists to quickly look up DSM codes.”

• $2.99 — available for download from iTunes

Continued on page 14 SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 13

Health Care Apps, continued from page 13 Epocrates Essentials and Essentials Deluxe

Essentials is an all-in-one clinical reference suite that provides you with searchable drug and disease monographs and diagnostic tools. Essentials Deluxe adds ICD-9 and CPT billing codes and an extensive medical dictionary.

• Essentials, $159 per year; Essentials Deluxe, $199 per year — available for download from iTunes and the Android Market

Epocrates Rx and Rx Pro

Epocrates Rx is a free drug reference tool that allows you to search for brand, generic, and OTC medicines. Rx Pro also includes alternative medicines and infectious disease treatment guidelines.

• Rx, Free; Rx Pro, $99 per year — available for download from iTunes and the Android Market

HandFeed

“RSS-based abstract collection from peer-reviewed journals and other web-based media sources regarding hand surgery and affiliated professions.”

• $0.99 — available for download from iTunes and the Android Market

heartsmart iglobal

Heartsmart is a unique global risk indicator app that calculates your risk of developing diabetes, heart disease, and stroke by using simple measures, your gender, and ethnicity. Heartsmart iglobal includes three components: 1. The first discusses health risk factors and provides statistics about how often heart disease, stroke, and diabetes affect people around the world.

2. The second part is a risk calculator that has the user input data about themselves, including ethnicity, gender, waist size, blood pressure, age, smoking status, and family history of heart disease.

3. The third part offers information on what the user can do to improve his or her health, such as quitting smoking, exercising more, and losing weight.

• $0.99 — available for download from iTunes and the Android Market

Medscape

“Medscape from WebMD is the leading medical resource most used by physicians, medical students, nurses, and other health care professionals for clinical information.”

• Free — available for download from iTunes and the Android Market

mobilePDR for Prescribers

“mobilePDR provides the most accurate FDA-regulated information on more than 2,400 prescription drugs, and is free to all U.S.-based MDs, DOs, residents, NPs, and PAs. This latest update is based on the 2012 edition with additional features, enhanced functionality, and ongoing updates. mobilePDR contains full-label information on the most commonly prescribed drugs, hundreds of full-size and full-color photographs, and more.”

• Free — available for download from iTunes and the Android Market

Monster Anatomy — Lower Limb

“An interactive lower limb radiology atlas presented at the 2009 Radiological Society of North America annual meeting. The application was developed in the Medical Imaging Department of the University Hospital Center of Nancy, France, under the supervision of Professor Alain Blum.”

• $8.99 — Available for download from iTunes

Monthly Prescribing Reference (MPR)

“MPR provides concise prescription and OTC drug information, side effects, and interactions for medical professionals.”

• Free — available for download from iTunes and the Android Market

NEJM This Week

“The latest medical research findings, review articles, and editorial opinion on a wide variety of topics of importance to biomedical science and clinical practice, from the most trusted name in medicine — The New England Journal of Medicine.”

• Free — available for download from iTunes

NeuroMind

MedPage Today Mobile

“Puts breaking medical news, comprehensive drug information, and CME/CE credits at your fingertips ….”

• Free — available for download from iTunes and the Android Market

“One of the highest ranked neurosurgical apps in the world, twice mentioned on iMedicalApps’ ‘Top Apps’ and more than …”

• Free — available for download from iTunes and the Android Market

http://www.medicalappjournal.com

This is a peer-reviewed website listing almost 400 apps for the medical profession, organized by both topic and discipline. It contains apps for all four platforms: iOS (Apple), Android, Windows, and Blackberry.

14 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

ORTHOSuperSite

“From the publisher of Orthopedics Today, Orthopedics Today Europe, and Athletic Training and Sports Health Care, the ORTHOSuperSite mobile application puts news and perspective for the musculoskeletal health and disease specialist at your fingertips. Access daily breaking news articles, blog posts, and meeting highlights from around the world. Sort the news by most recent or most popular and share content with your colleagues.”

• Free — available for download from iTunes

Pocket Eye Exam

“Mobile tool for neuro-ophthalmologists, neurologists, optometrists, medical students and residents, and anyone interested in brain-eye interaction. This application includes an OKN strip, pupil chart, Snellen (visual acuity) chart, red desaturation test, and Ishihara plates, as well as extensive educational material for these tests, the ophthalmoscope and the Maddox Rod.” • $1.99 — available for download from iTunes and the Android Market

Tarascon Pharmacopoeia

“The most popular and most trusted portable drug reference. This must-have resource contains vital drug information on thousands of drugs to help clinicians make better decisions at the point of care.”

• $39.99 — available for download from iTunes and the Android Market

Vlingo — Voice App

“In addition to search, messaging, voice dialing, and directions, Vlingo integrates with your Facebook and Twitter accounts, making it the most social assistant available.”

• Free — available for download from iTunes and the Android Market

Pocket Lab Values

“The perfect companion for health professionals with access to more than 320 common and uncommon lab values.”

• $2.99 — available for download from iTunes and the Android Market

Psych Dx

“Developed by a psychiatrist for mental health providers, from seasoned clinicians to students. Psych Dx aims to be the reference of choice, a learning tool regularly updated with new features.”

• $5.99 — available for download from iTunes

PubMed On Tap (iTunes)/ PubMed Mobile Pro (Android Market)

“PubMed On Tap searches PubMed to find and display reference information.”

• $2.99 — available for download from iTunes and the Android Market

Scoligauge

“An accelerometer-based ‘Scoliometer.’ Scoligauge brings this important screening tool to the iPhone.”

• $0.99 — available for download from iTunes

STAT ICD-9 LITE

“What is the code for hypertensive heart disease with CHF?” • Free — available for download from iTunes

Weigh What Matters New app helps patients achieve healthier lifestyles

Many Americans resolve to become healthier, but have trouble monitoring their progress to achieve their goals. Now “there’s an app for that.” The American Medical Association has released a free app to help patients improve their overall health as part of the AMA Healthier Life Steps program, which promotes healthy choices and healthy lives. “Every day, Americans resolve to eat healthy and increase their physical activity,” says AMA President Peter W. Carmel, MD. “The app encourages people to work with their physicians to set healthy goals, and it allows users to track their progress and accomplish their goals.”

The Weigh What Matters app is free and easy to use, and it encourages users to consult with their physicians to establish personal health goals for three categories: weight, eating, and activity. Once goals are established, users can track their weight, physical activity, and nutrition with daily entries. The app also calculates a user’s Body Mass Index and provides a mechanism to view progress reports and email them to his or her physician. “The AMA Healthier Life Steps program offers tools and information to help physicians and patients work together to promote longer, healthier lives,” says Dr. Carmel.

“Physicians and their staff can use this new app as a resource to work with patients to address challenging behavioral changes.”

The Weigh What Matters App is available free of charge in both the iTunes Store and the Android Marketplace.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 15

ICD-10-CM Training Discounts for CMA Members

The transition to ICD-10 will take strategic planning and considerable preparation. The California Medical Association has partnered with the largest and most respected coding organization, AAPC, to provide CMA members with a complete suite of ICD-10 solutions at steeply discounted rates.

Understand the impact of ICD-10 Educate physicians, managers, and coders Prepare documentation, systems, and processes Training

Learn more at:

www.cmanet.org/aapc 1-800-626-CODE (2633)

List Price

CMA Members

Webinar: Impact of ICD-10-CM (1.5 CEUs) Inform key stakeholders on the impact of this new code set

FREE

ICD-10-CM will bring about some massive changes in healthcare. No matter what the implementation date, you need to understand how you will be impacted and what you should be doing now to prepare.

Webinar or Classroom: Essentials for ICD-10-CM (3 CEUs) Give employees a high-level overview of the transition to ICD-10-CM Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10-CM. You’ll learn

$299.95

$99.95

documentation challenges, the differences with ICD-9-CM, and how ICD-10-CM will affect each business area of your practice.

Boot Camps: ICD-10 Implementation (16 CEUs) Prepare managers with everything they need to implement ICD-10 This 2-day boot camp provides comprehensive training for the transition to ICD-10.

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From systems to processes, your office will be prepared for implementation.

Online: Anatomy & Pathophysiology (14 CEUs) Prepare coders for the increased clinical requirements of ICD-10 Due to the clinical nature of ICD-10-CM a strong understanding of, or experience in anatomy and/or physiology will be required. AAPC’s ICD-10 Anatomy and Pathophysiology training covers all body systems and the key areas of challenge posted in ICD-10-CM.

Training

List Price

CMA Members

$795

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Boot Camps: ICD-10-CM General Code Set (16 CEUs) Prepare coders to code for ICD-10-CM and pass the ICD-10 proficiency assessment This 2-day boot camp covers ICD-10-CM format and structure, guidelines, crosswalking and mapping, and provides hands-on coding exercises.

Online: Specialty Code Set Training (4-8 CEUs) Give your coders advanced ICD-10-CM code set training in their specialty This 4- to 8-hour online course (depending on specialty) provides advanced ICD-10CM code set training in your specialty. An online multi-media presentation is combined with hands-on specialty coding exercises, a downloadable course manual, and evaluation quizzes.

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Webinar Series: Documentation for Physicians - E/M, CPT速, Medical Necessity, and How they Tie into ICD-10-CM (3 CEUs) Give physicians and practitioners a high-level overview of ICD-10's new documentation requirements This 3-part series covers the key information ncecessary to understand key documentation elements to help you not only prepare for ICD-10-CM, but for all the regulations surrounding your practice today.

Online or Classroom: Clinical Requirements of ICD-10-CM (3 CEUs) Prepare physicians and practitioners to document and code for ICD-10 Comprehensive documentation and coding training (by specialty) for ICD-10-CM and from a physician's perspective. 3-hour online interactive training or a 3-hour live classroom event.

Documentation Review: ICD-10 Readiness Assessment Evaluate your current documentation in preparation for ICD-10 One of the largest problems following the October 1, 2014, implementation date for ICD-10 will be documentation insufficient to support the specificity required for he new ICD-10 code sets. Identify the deficiencies within your current documentation and the education needed to improve.

Members must log in to receive the discounted CMA price.

In partnership with

Embracing

Media YourPractice in

With implementation of the Affordable Care Act (ACA) right around the comer, along with tumultuous times currently in the practice of medicine, physicians are left with a grim outlook for the future.

By Ramin Manshadi, MD

Reprinted with permission from the San Joaquin Physician Magazine In general, the practice of medicine has been dramatically affected by the state and federal budget problems. All this translates into a significant adaptation that physicians must implement in order to survive.

Those physicians that can adapt quickly, as the changes come their way, are the ones that will succeed. It is survival of the fittest. Among these changes are taking advantage of the power of having your own website, using Electronic Medical Records (EMR), plus implementation of social networking. As testament to this, the usage of social media grew 50% in the last year, particularly with doctors aged 45-54 where usage has tripled.

How does one get started? I feel the first question to ask yourself is what motivates you to create a website or involve your practice in social networking? Is it for marketing? For better patient-physician communication? Or both?

18 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

My goal in establishing a website was to better serve my patients and to keep up with the changing times. Initially, I hired a marketing company that thoroughly interviewed me to learn my strengths, and establish a brand based on my unique background. This information was then incorporated into the establishment of my website. Just as with building a house, the process is quite detail oriented and each step must be reworked thoroughly until it satisfies your needs. Within the website, I not only have provided information about my practice, but also educational information to help patients better understand their disease process. I knew I had done a good job with this when a nutritionist at a local hospital told me that when searching for optimum diabetic care and education, she was able to find it on my website.

Such a website can also be used by patients to schedule appointments, as well as send confidential information to their providers. All of this can be interfaced with the practice’s EMR to better serve the patients. Forms can be filled out by potential patients prior to consultation,

thus reducing wait time at the office. With Accountable Care Organizations just around the comer and the government pushing for more transparency, the EMR is becoming a must for all practices to such a degree that if a practice does not implement EMR within the next couple of years, they risk losing bonus money from the government.

In addition, my website has links to my practice on Facebook, Twitter, LinkedIn, and in blogs – all of which I am presently in the process of developing. Let us examine these four social networks that could be used for medical social networking. Each functions in its own unique way to keep the line of communication open between provider and patients, or provider and the general population.

Facebook is a social networking service and website launched in February 2004. Users may create personal profiles, add other users as friends, and exchange messages, including automatic notifications when they update their profile. One can have a professional Facebook account, in addition to the personal account.

Twitter is a website owned and operated by Twitter Inc., which offers a social networking and microblogging service, enabling users to send and read messages called tweets. Tweets are text-based posts of up to 140 characters displayed on the user’s profile page.

LinkedIn is a business-oriented social networking site. Launched in May 2003, it is mainly utilized for professional networking. It can be used to find jobs, people, and business opportunities that are recommended by someone in one’s contact network. This is a nice way to be connected not only to medical professionals, but also to professionals across many disciplines.

A blog (a blending of the term web log) is a type of website or portion of a website. Blogs are usually maintained by an individual, with regular entries of commentary, descriptions of events, or other material such as graphics or video. An external blog is a publicly-available blog where company employees, teams, or spokespersons share their views.

Corporate blogs may be written primarily for consumers (business-toconsumer, or B2C) or primarily for other businesses (B2B). In the medical arena, one can use this to repeatedly remind patients to quit smoking, not to overindulge in eating, or to encourage they do their evening walks.

Besides using these four social networks, a provider can also send monthly newsletters, electronically, to the email addresses of all their respective patients. This is more of a proactive approach to keep the patient, and at the same time remind them about their appointments. The four social networks employ a somewhat less direct approach.

Beyond marketing the practice, implementing social networking

can translate into better care for the patients. It can open the line of communication between provider and patients, while at the same time help the busy practitioner stay informed of the latest developments in his or her particular field. Medical information is ever rapidly changing such that by ten years, what you once knew can be obsolete. Social networking can also provide information to patients on various applications that can be used on smart phones. One such application is the Diabetic Connect application provided by Alliance Health Network, Inc., where diabetics can go on and have a social support group. Community Health Network has an application, called Pillbox, that helps patients and their families keep track of their medication list on their iPhone and iPod touch. There are also physician-only networks, such as Sermo, OZmosis, and iMedExchange. Sermo allows doctors to share clinical information, do case studies, explore job opportunities, and even earn honoraria. Sermo has 112,000 physician members across 68 specialties. OZmosis is also physician exclusive, with the same characteristics as Sermo, but on a smaller scale.

The Medical Social Network comes with its own legal issues, of which physicians should be aware. Doctors must be very careful not to post particular names of any patients on the net. If a physician is describing a patient scenario in detail, then the information “needs to be generic enough that nobody can identify a patient in the course of reading a post.” Moreover, on many occasions, I have had some patients asking to be my Facebook friend. We should ignore these requests and draw a fine line between physician and patient relationships. Physicians should set up a practice Facebook account and allow their friends to be the fans of the practice. On this page, patients can follow your updates.

In addition to this, those physicians using Sermo should be careful not to use the curbside consultation as gold standard, since accepting consultation outside of the standard of care can be thought of as malpractice. Further, anything that one writes on Twitter or in a blog is discoverable. Thus, be careful never to say anything derogatory about the hospital where you work, other doctors, or patients. Like anything else in life, always pause and think before posting any tweets or Facebook updates. In fact, because of this, the AMA has published guidelines for the use of Social Media. It emphasizes for us to be aware of patient privacy issues and maintain personal-professional boundaries.

Just as medicine continually changes and evolves, so does our practice of it. All that I am addressing here is no longer “the future.” It is right now and should become part of any physician’s practice.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 19

MEMBER BENEFITS

SCCMA and MCMS Social Media Join the Conversation!

In a world where “tweets,” “trends,” and “likes” can make the difference between being in or out of the loop, the SCCMA and MCMS offer their members several ways to stay connected. On Facebook, using the “like” feature on Santa Clara County Medical Association and/ or Monterey County Medical Society’s group page will instantly allow members to have the latest news updates sent directly to their newsfeed.

This feature will allow physicians to access the latest legal, legislative, and economic updates, simply by logging-in to their personal or professional Facebook account.

For those who like their updates boiled down to 140 characters or less, SCCMA and MCMS’s Twitter accounts, (@SCCMedAssoc and @ MontereyMedSoc), provide members with quick, digestible updates of urgent alerts, information, event notices, etc.

For a decidedly more professional approach to social media, join our LinkedIn groups. This powerful social media platform allows you to post your résumé online, network with other medical professionals, and connect easily with members of the SCCMA and MCMS. Our membersonly group makes it easy to participate remotely in discussions

20 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

concerning your medical association. Just search SCCMA or MCMS in the LinkedIn “Groups” tab to find us!

Information is power. Get the most out of your membership by keeping up with the latest news from your county medical association.

Organized medicine offers you a platform to have your voice heard. It is our pleasure to give you yet another medium to do so and to share your thoughts about the future of medicine with SCCMA and MCMS’s online medical community! Welcome! This is your membership, your association, your voice. So don’t hesitate, find us today on Facebook, Twitter, and LinkedIn and join the conversation.

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Managing Your Online Reputation Adapted From the CMA Medical Legal Library This article is reprinted with the permission of Alameda-Contra Costa Medical Association.

Physicians may find themselves the subject of online postings on an ever increasing number of health care related consumer review websites, such as Healthgrades, Angie’s List, Yelp, RateMDs, and Vitals. Although studies have shown that most patient/consumer reviews on physician rating websites are positive, such sites are a concern for physicians because inappropriate negative comments can damage a physician’s reputation and affect his or her practice. This article discusses how physicians can manage and respond to online comments about them or their practice.

22 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

Are most online comments about physicians positive or negative?

A recent study shows that most online comments about physicians are positive. The study, published in the Journal of General Internal Medicine, concluded that “despite controversy surrounding these sites, their use by patients has been limited to date, and a majority of reviews appear to be positive.” The study examined online reviews of 300 physicians on 33 different physician rating sites and found that 88% of the reviews were positive, with 6% negative and 6% neutral. The study indicated that the development of these sites offer patients an avenue to provide feedback

and obtain information about physician performance. See Tara Lagu et al., “Patients’ evaluations of health care providers in the era of social networking: an analysis of physician-rating websites,” Journal of General Internal Medicine (Epub. May 13, 2010).

How will I know if I am (or my practice is) the subject of an online review?

Unless you routinely monitor the Internet for your online information, you will not necessarily know that you have been reviewed or rated on physician rating websites. Rating websites generally gather business information from public records and/or users to generate profiles. You can search online for your name and/or the name of your practice to find out what is on the Internet. Practices can also set up online alerts (such as Google Alerts) that email you links to any website or blog that contains the practice or physician’s name or other predetermined keywords or phrases. If you do not want to register with physician rating sites, constant monitoring through online searches and alerts will help identify your online presence.

“Our practice takes patient concerns very seriously. However, federal and state privacy laws preclude us from responding to patient concerns publicly. If you are our patient, please contact our office directly at XXX-XXX-XXXX, so we can address your concerns confidentially. Such discussions generally resolve most concerns.”

In cases where the negative comment contains information that is clearly false, inappropriate, and solely inflammatory, contact the site administrator. Many websites have content guidelines and terms and conditions for use and are responsive to removing a post that is clearly defamatory, attacks the physician, and does not provide any pertinent information about the practice or any matter of public interest.

Determining how to respond to a negative online comment depends on many factors including the nature, source, and egregiousness of the comment. Responses can range from simply making internal changes to address a problem, up to legal action against the poster. Physicians should consult with an attorney before considering any legal remedies.

For an article on using online comments to your advantage, see www.amaassn.org/amednews/2010/07/26/bica0726.htm .

Can I demand that the review be taken down?

What can I do about negative reviews online?

Negative online reviews can be a source of consternation for physicians, but it is important to take the occasional negative review with a grain of salt. While it may be tempting to publicly respond to the negative comment and defend your reputation, it is important not to overreact. Responding publicly can expose you to liability and escalate the problem.

Furthermore, publicly responding to negative comments may in fact exacerbate the negative impact to your reputation by drawing more attention to the original negative posting than it would have otherwise attracted on its own. Before responding publicly to negative comments, physicians should seriously consider whether doing so will achieve the desired goal.

As an alternative, if it is possible to positively discern the identity of the reviewer as a patient, a physician may, depending on the circumstances, choose to communicate with the patient privately and confidentially to resolve their grievances. The patient is able to remove content that was publicly posted, and the physician may find that by taking the time to explain their treatments and address the patient’s concerns, the patient will be willing to remove the negative review.

If a physician determines a public response is necessary and appropriate, then physicians should take special care to maintain patientphysician privilege and to comply with federal and state privacy laws.

The practice should limit its response to general updates about how a problem is being addressed, with care not to reveal any patient information. Physicians may wish to use generic language, such as the following, to respond to negative comments:

site’s published content guidelines.

If the negative review violates the website’s content guidelines or terms and conditions for use, the site administrator will remove the review. Some sites also allow the public to flag comments for review for inappropriate content by the site administrator. However, physician rating sites have no obligation to investigate the veracity of information posted in comments and generally will not remove negative opinions or criticisms about you or your practice. For comments to be removed, they must, generally speaking, violate the

Should I or my staff pose as patients to generate positive reviews?

Publishing fake consumer reviews on the Internet may subject you to penalties and fines for “astroturfing,” in which employees pose as independent consumers to post positive reviews and comments on websites and Internet message boards about their own company. In 2009, a cosmetic surgery practice in New York was forced to pay $300,000 in penalties and costs after the practice directed employees to post positive comments and narratives posing as independent and satisfied customers. See www.ag.ny.gov/media_center/2009/july/july14b_09.html.

Can I require my patients to sign an agreement not to post online comments?

Although the law does not prohibit asking patients to sign an agreement barring them from posting negative online comments about the

Continued on page 24 SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 23

Managing Your Online Reputation, continued from page 23 practice, it is unclear whether such an agreement will ultimately be enforceable in court. Such agreements may force patients to choose between health care and their First Amendment rights of providing feedback on their doctors’ performance. Additionally, some ratings websites have a “wall of shame,” which lists physicians who make patients sign “gag” contracts before accepting them as patients. Such a listing may have a negative effect on the physician’s reputation.

Can I sue the Internet site and hold it liable for posting a negative review about my practice?

The federal Communications of Decency Act immunizes Internet providers from liability for defamatory statements made by a third party on their websites. (47 U.S.C. §230.) The California Supreme Court has also held that subjecting Internet service providers to defamation liability would tend to chill online speech, and thus exempts Internet intermediaries from defamation liability for online republication of third party content. (Barrett v. Rosenthal (2006) 40 Cal.4th 33, 51 Cal.Rptr.3d 55.)

Therefore, it is unlikely that a physician could hold an Internet site liable for posting a third party’s negative review publicly.

Can I sue the reviewer and hold him/ her liable for posting a negative review about my practice?

In some cases, physicians may have a claim of defamation or libel against an individual who has posted a negative online comment about their practice. However, physicians should be well-advised that such lawsuits can be expensive, difficult to prevail in, and will be a matter of public record, thus drawing unwanted attention to the disparaging comments that would have otherwise been ignored or overlooked. Before considering any legal action against a reviewer for a negative online posting, physicians should consult with an attorney.

Physicians who sue a patient for posting a negative review online will also likely be subject to an anti-SLAPP (“Strategic Lawsuit Against Public Participation”) motion to strike the complaint on the grounds that the online posting is protected public interest speech. California law protects defendants who are sued as a result of protected speech, in furtherance of their free speech rights of any written or oral statements or writings made in a public forum related to an issue of public interest.

(Code of Civil Procedure §425.16.)

Physician rating websites are public forums for the purposes of the anti-SLAPP statute and if the patient can make a showing that the posting relates to a matter of public health interest, the burden shifts to the physician to prove the likelihood of success in the lawsuit. In a recent decision by the California Court of Appeal for the Sixth District, a dentist sued the parents of a minor patient based on a negative review posted on Yelp.com that criticized the dental services provided to the defendants’ son. The court found in favor of the defendants and directed the trial court to grant the defendant’s anti-SLAPP motion and dismiss all but one of the dentist’s claims. However, because the dentist had evidence which contradicted the defendant’s version of events, as posted on the Yelp review, the court allowed the dentist to proceed with a defamation claim. (Wong v. Jing (2010) 189 Cal.App.4th 1354, 117 Cal.Rptr.3d 747.)

Physicians should therefore determine whether the post is protected public speech or contains statements that are provably false, prior to initiating any lawsuit. Physicians should also be aware that the prevailing party in an anti-SLAPP motion will be entitled to attorney’s fees and 24 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

costs associated with bringing such a motion.

Can I remove my listing from rating websites?

Most physician rating websites will not remove your listing from their site. However, as mentioned above, most sites provide you the ability to manage your profiles, to a certain extent.

What CAN I do to manage online information about my practice?

Physicians concerned about their reputation on the Internet can develop their own practice website where they can control the content and project a positive image about the practice. Physicians can provide information about the practice, what services are offered, level of experience, and generalized statements of satisfaction with your services that are representative of your patients’ experiences. Having a practice website can increase the likelihood that your site will be one of the firstpage-options patients will see when they are searching for you online.

Physicians can also maintain a presence on social media sites, such as Facebook and Twitter, where the practice can control the online content viewed by potential patients. Such sites are more likely to show up on online searches than physician rating sites. Physicians always have an obligation to protect patient confidentiality and comply with all relevant state and federal laws. For information on maintaining physician websites and potential liability of giving advice over the Internet, see CMA ON-CALL document #0823, “Physician Websites, Internet Advice and E-mail.” See also, Steven M. Harris, “Avoiding legal woes when marketing a practice online,” AMA American Medical News (October 18, 2010) at www.ama-assn.org/amednews/2010/10/18/bicb1018.htm. “5 ways to manage your online reputation” – http://www.ama-assn.org/amednews/2011/09/12/bisa0912.htm.

What about companies that claim to protect online reputations for a fee?

The American Medical Association (AMA) recently announced a partnership with Reputation.com to provide AMA members access to Reputation.com’s ReputationDefender solution at a discounted price.

According to the company’s website, “ReputationDefender is used to monitor and shape online identity. The technological solution is proven to increase positive content and actively combat false, misleading or irrelevant Google results.” More information is available at www.reputation.com. Please note that the SCCMA/MCMS does not endorse Reputation.com, and you may wish to review other comparable services.

This article was adapted from a document available to members in CMA’s Medical Legal Library, which can be accessed at www. cmanet.org or by calling 408/998-8850 or 831/455-1008.

Santa Clara County Medical Association Alliance Annual Membership Dues July 2012-June 2013

Membership in the Alliance is very important to our continued efforts to promote quality health in our community.

Your membership or that of your spouse/partner increases the Alliance’s ability to speak with a stronger voice to the health concerns in our community. Alliance membership allows you to be directly involved in our projects, activities, and events. Even if you do not have time to actively participate in our projects, or can only participate occasionally, your dues are very important as they support our ongoing projects and grants.

Membership Categories • • • • •

Regular Member: Physician, spouse, domestic partner, divorced spouse Sustaining Member: Retired physician or spouse, domestic partner, divorced spouse of a part-time, retired, or deceased physician Physician-in-Training: Medical student, resident, or spouse, domestic partner of a medical student or resident Checkbook Member: My time is limited. I will support Alliance programs with my dues only.

Friend of Medicine: Neither a physician, medical student, nor spouse, domestic partner of a physician, or medical student. Must be sponsored annually by an Alliance Member.

Name

Spouse/Domestic Partner’s Name

__________________________________________________________________________________________ ( As you wish it to appear. Please print.)

Address:___________________________________________________________________________________ Street City ST Zip Contact Phone:_________________________________ FAX Number:__________________________________ Email Address:_______________________________________

Regular Membership Dues Sustaining Membership Dues Physician-in-Training Dues Checkbook Member Friend of Medicine

$105.00* $ 80.00* $ 15.00 $105.00* $ 55.00

$_________ $_________ $_________ $_________ $_________

Pay Dues by Mail Send dues to: SCCMAA Membership 700 Empey Way San Jose, CA 95128

(* Included in the dues amount are the AMA Alliance Dues of $50, which are optional.)

Contribution to SCCMAA Health Promotions CALPAC Membership $ 25.00 Total

$_________ $_________ $_________

____ My check is enclosed payable to SCCMAA ____ I prefer to charge my credit card: ____Visa____MC____AExp Card #_______________________________________ Exp____/____

Pay Dues Through the Medical Association

Pay your Alliance dues directly through the invoice from the Medical Association.

.

Sponsor’s Name______________________________________

Pay Dues Online www.sccmaa.org

Signature________________________________________________

Santa Clara County Medical Association Alliance 700 Empey Way, San Jose, CA 95128 408/998-8850 www.sccmaa.org SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 25

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reservations, Final PaYMent and CanCellation PoliCY IMPORTANT! Please refer to and carefully read the TOUR PARTICIPATION AGREEMENT – SUMMARY OF GENERAL TERMS AND CONDITIONS as stated on the reverse side of your invoice relating to deposits and other payments made for this tour, as well as the responsibilities and obligations of both Vantage and the passenger. RESERVATIONS, FINAL PAYMENT AND CANCELLATIONS: Reservations are confirmed upon receipt of deposit of $500 per person (100% of the full payment required if reservation is made within 90 days of departure). Final payment is due 90 days prior to departure. Reservations may be put in a waitlist status or canceled by Vantage if payment is not received by the final payment due date. All cancellations made later than 24 hours after booking will be subject to a $300 per person non-refundable administrative fee.

The charge for cancellations from 89-60 days prior to departure is 25% of the selling price per person; from 59-30 days prior to departure is 65% of the selling price per person; and from 29-0 days prior to departure (including no shows) is 100% of the selling price per person. Passenger Travel Protection fees are nonrefundable. Airfares are subject to applicable airline cancellation fees, which may be in addition to the cancellation fees above. Cancellations must be in writing or facsimile (indicating the reason for cancellation) and must be received by Vantage prior to the final payment due date to avoid cancellation charges. Every effort has been made to produce accurate information. Vantage reserves the right to correct promotional material or pricing errors at any time. Vantage also reserves the right to raise the Original Price and/or airfare in response to increases in government taxes or fuel surcharges until you have paid in full or unless you are participating in the Smart Pay Discount Plan. Additional discounts apply to new reservations only, based on availability at the time of booking, and are not available to passengers travelling as part of a group.

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SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 29

Mandated Disease Reporting Requirements A Roadmap The DHS and DMV would rather have duplicate reporting than none at all.

30 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

By Linda Louise Hill, MD, MPH Practicing physicians are mandated to report a number of conditions to their local Department of Health Services (DHS); the list of reportable conditions in California has been recently updated and can be found at www.cdph.ca.gov/HealthInfo/Pages/ReportableDiseases.aspx.

Compliance is less than ideal, despite potential sanctions against physicians for not reporting. Of importance to note is that some of the conditions must be reported within the hour of diagnosis, others within a day, and the rest within a week. Guidance is provided by the icons (phone, fax, etc.) that precede the diagnosis on the list.

The California Department of Public Health provides forms by county for reporting communicable and noncommunicable diseases, and a separate form for tuberculosis use: http://www.cdph.ca.gov/ HealthInfo/Documents/LHD_CD_Contact_Info.pdf. Do not assume that your laboratory will report for you; it remains the responsibility of the physician to report these diseases to the county. The DHS would rather have duplicates, than lapses in reporting.

The noninfectious diseases that must be reported to DHS include lapses of consciousness, cancers, and pesticide-related illnesses. Lead poisoning is reported by laboratories, but DHS would welcome physician reporting as well. Compliance with reporting of noncommunicable disease has been even more problematic. This is at least partially due to the impaired understanding of the mandate and (unfounded) concerns about the protections afforded to reporting physicians.

The California Department of Motor Vehicles’ (DMV) reporting requirement, “every patient 14 years of age or older, when a physician and surgeon has diagnosed a disorder characterized by lapses of consciousness in a patient,” (dmv.ca.gov/pubs/vctop/appndxa/hlthsaf/hs103900.htm) Title 17, section 2806, describes lapses of consciousness (LOC) as those conditions that involve: • Marked reduction of alertness or responsiveness to external stimuli • Inability to perform one or more activities of daily living, or • Impaired sensory motor functions used to operate a motor vehicle.

Examples of these conditions include: • Loss of consciousness (e.g., syncope, hypoglycemia) • Seizures • Dementia, including Alzheimer’s disease and other dementias (e.g., post-CVA, brain neoplasm) • Conditions such as sleep apnea and narcolepsy, where they interfere with driving Physicians are protected from liability with good-faith reporting for these and other conditions they feel interfere with safe driving. In fact, physicians have had judgments against them for failure to report when drivers with these conditions had subsequent motor vehicle crashes. Physicians do not need to report former drivers who are unlikely to drive again (admitted to long-term care facility, severely impaired, coma, etc.), or when there is documentation in the chart that the patient has been reported previously and you believe they no longer operate a motor vehicle.

As stated above, noncommunicable disease, including lapses of consciousness, can also be reported on the CMR form. The reported cases of lapses of consciousness are forwarded by the DHS to the DMV;

however, simultaneous direct reporting to the DMV will result in timelier follow-up by the DMV. To report directly to the DMV, it is best to use the DMV’s Request for Driver Reexamination (DS699), which can be found at dmv.ca.gov/forms/ds/ds699.pdf, but faxing the CMR form, or even using office letterhead, is acceptable.

Lapses in consciousness should be reported only when associated with an event in a patient who has an underlying condition likely to impair driving. Therefore, while a loss of consciousness due to diabetesassociated hypoglycemia is reportable, the loss of consciousness from an injury-induced mild concussion is not. Narcolepsy associated with somnolence during driving is reportable, but recumbent-only associated sleep apnea is not. Even mild dementia is reportable, but confusion postoperative is not.

The development of a reporting system and written protocols will improve compliance in your institution. The physician making the diagnosis is responsible for the reporting, whether in the emergency department or office. However, do not assume that another physician has reported, unless there is written documentation in the chart. Again, the DHS and DMV would rather have duplicate reporting than none at all. For example, if your epileptic patient had a seizure, was brought to the emergency department, and follows up with you the next week, you should report the incident if you don’t see documentation of reporting in the emergency department records. Similarly, if a patient with dementia transfers to your care, you must report them to the DHS, unless the prior records reflect notification in your state.

As mandated reporters, we are required to report lapses of consciousness, but we can reassure our patients that this does not equal the loss of one’s driving privilege, as only the DMV is authorized to make this determination. The DMV wants to hear about all reportable LOC, but makes a decision on each driver after conducting a thorough investigation that will include additional medical information, usually obtained through DMV form DS 326 (dmv.ca.gov/forms/ ds/ds326.pdf), and may include interviews, vision and written exams, and on-the-road testing. In patients with mild dementia, for example, the DMV may determine that they are safe to continue driving for an abbreviated period of time, with close monitoring.

Identification of age-related driving disorders includes the screening and diagnosis of lapses of consciousness, frailty, vision deficits, and other medical conditions (e.g., use of medications that impair cognition) that influence driving abilities. AMA has provided guidelines for screening at www.ama-assn.org/ama/pub/physician-resources/public-health/ promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers.page. Of the disorders identified through this screening, only lapses of consciousness require reporting. Keeping our patients and the public safe requires attention to driving safety, including compliance with noncommunicable-disease mandated reporting laws. More information on the physician’s role in older driver safety can be found on the TREDS website (treds.ucsd.edu).

Therefore, while a loss of consciousness due to diabetesassociated hypoglycemia is reportable, the loss of consciousness from an injuryinduced mild concussion is not.

Dr. Hill, SDCMS/CMA member since 2010, is a professor in the Department of Family and Preventive Medicine at UCSD, director of the UCSD/SDSU General Preventive Medicine Residency, and the director of TREDS (Training, Research, and Education for Driving Safety).

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 31

member benefits

Join the Mobile Revolution Read how your colleagues all over California are taking advantage of the latest technology by using the DocBookMD app to securely send HIPAA-compliant messages directly from their iPad, iPhone, and Android devices.

• Search a local county medical society directory. Physicians can look up other physicians in their county by first or last name or by specialty. Physicians can then contact other physicians by messaging, office phone, cell phone, or email.

Case Study

• Search a local pharmacy directory. Physicians can search for a local pharmacy alphabetically or find a pharmacy by zip code. Users can also create a “favorites” list of physicians or pharmacies.

A patient arrives in the emergency department (ED) after injuring his toe while mowing his lawn. The ED physician determines that the wound can be treated with antibiotics and local care. He calls the on-call orthopedic surgeon.

The ED physician describes the wound and what is shown in the X-rays to the orthopedic surgeon. The orthopedic surgeon is unsure of the diagnosis, having just treated a patient who lost his toe, due to necrosis, after being lost in follow-up. The orthopedic surgeon must decide whether to accept the ED diagnosis or go to the ED and see the patient in person.

Due to his recent experience, the orthopedic surgeon requests that X-rays and photos of the wound be sent to his smartphone through DocBookMD. Within minutes, the orthopedic surgeon reviews the images and agrees with the ED physician’s assessment of the wound. The patient does not need to see a specialist.

The patient is released from the ED much quicker and received more appropriate care. The orthopedic surgeon could be sure the wound was not severe and did not require him to see the patient in the ED. He avoided an unnecessary trip to the ED and was able to participate in his family event.

DocBookMD

Physician members of SCCMA/MCMS now have access to a tool that can help them communicate more efficiently and save time and money in the process. That tool is DocBookMD, a physicians-only smartphone app that allows physicians to: • Send HIPAA-compliant text messages and photos. Message content can include diagnosis, test results, or medical history.

Physicians can also add a high-resolution image of an EKG, an X-ray, lab report, or anything that can be photographed with a smartphone.

DocBookMD is offered through county and state medical societies to their members and is currently available throughout 23 states. NORCAL Mutual Insurance Company sponsors DocBookMD and makes it possible for physician members of SCCMA and MCMS to use the app at no charge.

Can You Text That to Me?

One of the most popular features of the app is texting, as DocBookMD offers physicians one of the only ways to text patient information securely and in a way that meets HIPAA requirements.

“As we say, a photograph is worth a thousand words, and with DocBookMD, I can have the emergency department physicians send me all the information, with a photograph of a hand injury, or a face laceration,” says San Jose plastic surgeon Howard Sutkin, MD. “I know right where it is, and I can tell them right away what we need to do or where we need to go, assess whether it’s something I need to see right now, or if it can wait until morning.”

Texting features are one reason why medical professional liability carriers sponsor the app and support its use among physicians. Carriers believe DocBookMD can improve communication and help physicians practice safe medicine.

Howard Sutkin, MD says that he is “particularly pleased about the ability to contact physicians through a secure network to request consults or provide follow-up information. This saves a significant amount of time that would previously be spent on-hold or waiting for a return call.” “The ability to know whether or not my message has been read in a timely manner helps prevent delays in patient care.”

County Medical Association Benefits

• Assign an urgency setting to outgoing text messages.

Physicians can assign each message a 5-minute, 15-minute, or normal response time. If the physician does not answer the message within five minutes or if the message does not get to the physician, the sender will receive a message back stating that the message was not received.

In addition to helping physicians communicate and collaborate, DocBookMD also helps county medical associations build membership.

This benefits physicians by creating a stronger county medical association and a louder voice for physician advocacy. Physicians also have access to a broader referral base and more opportunities for networking and community-building.

• Enable enhanced notifications. The physician can enter a cell phone number to receive text messages or an email address to receive notifications that DocBookMD messages are waiting. The email feature will send a weekly reminder to view DocBookMD messages.

Join DocBookMD

32 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

DocBookMD is available for iPad, iPhone, and Android devices and is provided at no charge to members of SCCMA or MCMS. To register or for more information, please visit www.docbookmd.com.

Let’s be everywhere we need to be.

Fast / Easy / Secure • Save Time, Improve Patient Care • Complete directory of your medical society colleagues in the palm of your hand • On-demand HIPAA-compliant messaging with multi-media collaboration — Send and receive high-res images such as X-rays or EKGs instantly and much more.

iPhone / iPad / Android DocbookMD is supplied at no charge to SCCMA and MCMS members thanks to NORCAL. Go directly to the iTunes App Store or Google play on your device and download DocbookMD, the complete the registration process. You will need your medical society member ID number ready.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 33

MEDICAL TIMES FROM THE PAST

John Townsend, MD Pioneer Doctor

By Michael A. Shea, MD Leon P. Fox Medical History Committee John Townsend was born circa 1810 in Fayette County, Pennsylvania. Two years after earning his M.D. degree from Lexington College, he began an odyssey that took him through Ohio, Indiana, and Missouri.

In 1832, while practicing medicine in Ohio, he placed a ring on the finger of Elizabeth Louise Schallenberger. Wanderlust called again, in 1844, when the Missouri couple joined the Stephens Party, bound for a relatively unsettled California. This courageous group of pioneers were the first to cross the Sierra Nevada range with wagons. They accomplished this by way of the Donner-Truckee route, shown to them by an indian named Truckee.

Arriving at Sutter’s Fort, near present-day Sacramento, Dr. Townsend joined Captain Sutters’ forces, in support of Governor Micheltorena, in one of California’s civil wars. He served as surgeon and aide de camp to the group. After this brief and bloodless crusade, he began his practice at Sutter’s Fort.

1847 found the Townsend couple in Monterey, only to move shortly to Buena Vista (renamed that same year to San Francisco, in honor of Saint Francis of Assisi, founder of the Franciscan missionaries who established all of California’s 21 missions). His office and residence was located on the south side of California street, between Montgomery and Sansome.

Political talent surfaced as he was elected alcalde (mayor) of San Francisco, plus was a member of the town council (ayuntamiento). He also served on the first school board and helped establish the first schoolhouse in San Francisco.

He had an interest in real estate, as evidenced by his partnership with a Belgian named, Corneille de Boon. Together, they developed a large project in the Hunter’s Point area. It, however, did not succeed. One project that did succeed was the birth of his only child, a son named John Henry Townsend.

In commemoration of his many public services, one of San Francisco’s important thoroughfares, Townsend Street, bears his name.

Tiring of the fast-paced San Francisco scene, he purchased 195 acres, north of San Jose, on what is now the Old Oakland Road. He also acquired an adobe home nearby. In addition to practicing medicine, he developed his acreage into a prosperous orchard. For years, this area was known as Townsend Corners.

He devoted much energy to keeping the capital of California in San Jose, even offering a sizable gift of land for this purpose. In July 1850, he helped to organize San Jose Lodge No. 10 F. and A.M., the first Masonic Lodge between San Francisco and the Mexican border.

It was at this time that the cholera epidemic found its way to the 34 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

Santa Clara Valley. Dr. Townsend worked diligently to save others but on December 8, 1850, he, himself, died from the disease. One month later, Mrs. Townsend succumbed to the same illness.

John Henry Townsend, orphaned at two years of age, was raised by his uncle, Moses Schallenberger, who lived nearby. John eventually earned a law degree from Cambridge University, and returned to San Jose with his English wife to work and manage the orchard property. He served in the state assembly in 1883 and 1884, was a county supervisor, and also became director of the Santa Clara Valley Agricultural Society.

He died in 1941(age ninety-three).

Doctor John Townsend was a man of many vocations: overland immigrant, soldier of fortune, physician, politician, real estate promoter, and rancher. He also has the distinction of being the first Americantrained physician to settle and practice medicine in California.

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johnmuirhealth.com SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 35

medico news

CMA publishes guide for physicians terminated by Aetna for out-of-network referrals The California Medical Association (CMA) has received a number of calls from physicians who have recently been terminated from Aetna’s provider network for referring Preferred Provider Organization (PPO) patients to out-of-network facilities.

CMA has prepared a guide to answer questions, provide options, and advise of resources available to physicians who have received a termination notice. The toolkit is available free to members in CMA’s online resource library at http://www.cmanet.org/resource-library.

Affected physicians are also encouraged to call CMA’s member help center for assistance. Contact: CMA member help center, 800/786-4262 or memberservice@cmanet.org.

(CMA Alert, September 17, 2012 issue)

Exchange board signs off on plan standards California is now one step closer to selecting which plans will be made available on its soonto-be-established digital insurance marketplace.

This news comes as the board of directors for the California Health Benefit Exchange approved more than 35 individual staff recommendations on issues regarding the establishment of qualified health plans (QHPs) that will be made available on the new marketplace. As an “active purchaser,” California’s exchange board has the ability to select which plans will be offered when the exchange is launched in 2014. These plans, known as QHPs, will be selected through a request for proposals (RFP) process set to begin in October 2012.

Ranging from the number and mix of exchange plans to network adequacy standards, the recommendations adopted by the board will be used to shape the RFP released by the exchange in the coming months. A more detailed analysis of the major provisions of concern to physicians will be included in the upcoming edition of Reform Essentials, but a brief synopsis of some of the adopted recommendations is listed below: • Exchange staff revised their original recommendation that out-of-network benefits be capped, presenting a solution that is significantly friendlier to providers. Under the revised, and now adopted, recommendation, the exchange would use the FAIR health data base to establish the basis for the plan’s out-of-network benefit at 50% of the “nonemergent care” cost.

• The board adopted staff’s recommendation that the exchange rely on the Department of Managed Health Care and Department of Insurance to oversee and verify network adequacy. This recommendation could potentially create problems for physicians, as those departments have trouble verifying network adequacy as it is, and will likely be even more overwhelmed by this added responsibility.

• Also adopted was a recommendation allowing enrollees earning between 100% and 250% of the federal poverty level (FPL) to enroll in any level of plan offered by the exchange. Staff had previously recommended that those individuals between 100% and 250% FPL be limited to bronze and silver plan options.

The board was careful to note that, while recommendations were being adopted, there was still a possibility that minor revisions could take place as the solicitation process moves forward.

(CMA Alert, September 4, 2012 issue) 36 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

CMAsponsored bills head to governor for signature Three bills sponsored by the California Medical Association (CMA) were passed by the legislature and now move to the governor’s desk. The bills include: Health care worker vaccination: This bill (SB 1318) would require all health care workers in health care facilities, including physicians, to either receive the influenza vaccination or wear a mask in patient care areas during flu season.

School vaccinations: This bill (AB 2109) would require a parent or guardian seeking a personal belief exemption from school immunization requirements to first obtain a document signed by a licensed health care practitioner.

Medical school scholarships: This bill (AB 589) would establish the Steven M. Thompson Medical School Scholarship Program, which would provide up to $105,000 in scholarships to selected participants who agree to serve a minimum of three years in an eligible setting upon licensure. Eligible settings are either federally designated “medically underserved areas” or areas of the state where unmet priority needs for physicians exist, as determined by the California Healthcare Workforce Policy Commission.

The fourth CMA-sponsored bill on physician health (SB 1483) was not passed by the legislature, but will return in the next legislative session. This bill would have re-established a physician health program to coordinate care for physicians suffering from mental health, behavioral health, or substance abuse issues.

(CMA Alert, September 4, 2012 issue)

medico news

CMS releases stage 2 requirements for meaningful use Last month, the Centers for Medicare & Medicaid Services (CMS) released the final requirements for stage 2 “meaningful use.” The rule is part of a federal incentive program for Medicare and Medicaid physicians who adopt and achieve “meaningful use” of electronic health records (EHR), as authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. Stage 2 (which will begin as early as 2014) requires physicians to use secure electronic messaging to communicate health information to patients, as well as to allow patients to view health records online.

The final rule modifies the definition of “hospital-based” physicians to create an application process for physicians to demonstrate that they alone fund their EHR systems and are eligible to receive the incentive payments directly.

The new rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

The final rule lays out the timelines physicians will have to follow, in order to avoid payment reductions in 2015. Under the provisions of the HITECH Act and the final rule, physicians who do not demonstrate meaningful use for 90 consecutive days, beginning July 1, 2014, will see a 1% reduction in Medicare payments beginning in 2015.

In addition to its final rule for stage 2 requirements, CMS also announced that more than 120,000 eligible health care professionals have qualified to participate in the program, and receive incentive payments, since it began in January 2011. That exceeds a nationwide 100,000 goal set by the department. To date, $6.6 billion has been paid out in incentives.

CMA is currently reviewing the final rule and will provide additional information as it becomes available.

A fact sheet on CMS’s final rule is available at www.cms.gov/apps/ media/fact_sheets.asp.

(CMA Alert, September 4, 2012 issue)

Could you be contracted with the state’s new exchange plans?

Beginning in 2014, California will begin offering subsidized health care coverage through the state’s Health Benefit Exchange, as required by the Patient Protection and Affordable Care Act. With coverage available to those falling between 133% and 400% of the federal poverty level, anywhere from 1.8 and 2.1 million Californians are expected to receive coverage through the exchange by 2019, according to a joint University of California, Berkeley/UCLA study.

Contracting with exchange plans brings a host of new obligations for physicians, and whether or not to do business with these plans is a decision that shouldn’t be taken lightly.

Knowing this, it may be unsettling to learn that many California physicians could already be signed onto an exchange plan network due to the way that major insurance companies have structured their provider agreements.

Many plans’ provider agreements give the provider the opportunity to opt-in to all of the plan’s product networks or selectively opt-out of certain networks.

This is where the contracting can get tricky.

The exchange’s board of directors is currently in the process of deciding which plans will be offered through the exchange, and because payors don’t know whether they will have a product on the exchange or what they will call those products, they are being identified in contract addenda under ambiguous names.

For instance, in an addendum – titled Exhibit B – Blue Shield identifies its intended exchange provider networks as Commercial PPO/EPO Networks A, B and C, respectively reimbursing 90%, 80%, and 70% of the rates set forward in Blue Shield’s provider manual.

The word “exchange,” however, appears nowhere in the contract.

In the above example, the tiered reimbursement approach reflects what is seen in the “metal tiers” for qualified health plans (QHPs) offered under the exchange, meaning plans are setting physicians up for exchange contracts without explicitly saying so.

With plans’ ability to amend provisions of the contract and provider manual with relative ease, it’s likely that providers who opt-in to the “all products” clause will soon find themselves represented as part of an exchange provider network, despite the absence of any discussion of such networks in the contract.

In fact, Blue Shield’s current recontracting effort was launched, in part, to insert language in anticipation of participating in the state’s exchange.

To later effectuate any new exchange requirements, the plan would only need to send them along as a state-mandated amendment. Generally, unless providers object in writing within 60 days of release, the amendment becomes part of the original contract.

Given that many physicians don’t thoroughly review, much less object to, routine amendments, it’s likely that many practices will be bound by the new exchange requirements in 2014 and not even know it.

For this and many other reasons, practices need to ensure all new and revised contracts are thoroughly reviewed and that all products being signed onto are fully understood.

A variety of contract review resources, including analyses of most major plan contracts, are available through the “professional resources” section of CMA’s website, at www.cmanet.org/resources.

(CMA Alert, August 20, 2012 issue) SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 37

medico news

HHS delays ICD-10 implementation to 2014 The U.S. Department of Health and Human Services (HHS) officially delayed ICD-10 implementation by one year, in a final rule published last month. The delay, first proposed in April, changes the date of compliance for ICD10 from October 1, 2013, to October 1, 2014.

The International Classification of Disease tenth revision (ICD-10) is a system of coding created in 1992 as the successor to the previous ICD-9 system. ICD-10 will include new procedures and diagnoses, which HHS hopes will improve the quality of information available for quality improvement and payment purposes.

In March 2012, the California Medical

Association (CMA), along with other medical associations, authored a letter to the acting administrator of HHS, Marilyn B. Tavenner, pleading for some relief for physicians who must implement ICD-10 in their practices.

The letter asked HHS to delay the ICD-10 implementation because an “imminent storm of multiple programs, creating extraordinary financial and administrative burden as well as mass confusion for physicians,” was about to occur. The programs referred to in the letter include the value-based modifier, electronic prescribing program, the physician quality reporting system, and the electronic health record incentive program, all coinciding with the

transition to ICD-10. CMA considers the delay a win for physicians.

The final rule will also establish unique health plan identifiers. Currently, there is no standard format for identifiers which create time-consuming problems, such as misrouting of transactions and difficulties determining patient eligibility. HHS predicts that $6 billion will be saved over the next 10 years with the creation of unique health plan identifiers.

The final rule may be viewed on the Federal Register website at http://www.ofr.gov/.

(CMA Alert, September 4, 2012 issue)

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SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 39

Time to Retire?

By Richard Mahrer, MD After practicing medicine for over 58 years, patients, children and nearly everyone, except the family dog, ask when am I going to retire? It’s a very logical question and I, therefore, have started compiling a list of reasons which would encourage a practitioner of approximately my age (classified) to finally surrender to the ravages of enduring too many birthdays. The list is extensive, and yet incomplete, so the exact number of reasons for giving up the healing art has not yet been established and will require ongoing investigation by non-physicians, who now control our destiny. The following is only a partial list and not definitely sequential in terms of decision-making severity. However, a doctor can consider retiring when: 1. You arrive on time for your Monday morning patients and find it’s Sunday morning.

2. Your flu vaccine has arrived and you immediately put it into the microwave.

3. Your first patient is Mary and you say with a smile, “Hello, George!”

4. You are listening to Mary’s heart and you comment, “Your heart sounds nice and quiet today.” Mary replies, “Isn’t the stethoscope supposed to be in your ears?”

5. Geraldine has signs of a urinary infection and you say, “Maybe it’s your prostate.”

6. You give an early Alzheimer’s patient three objects to remember and forget to ask what they were.

7. You ask Gladys how her husband is doing and she reminds you she appreciated the nice sympathy card you sent after his recent death.

8. You order prescription hemorrhoid suppositories for Henry with the order, “Swallow one, twice daily,” and you become defensive when the indignant pharmacist calls.

9. You pick up medical supplies and raise the hood, rather than the trunk, and notice a definite lack of space.

10. You enter your office, forgetting to turn off the alarm, and call the police, fearing a break-in.

11. You get a medical page and immediately pick up the TV remote to return the call.

12. You are making a house call, but it’s the wrong street, and nice people you do not know invite you in, offering you coffee and doughnuts, and ask you medical questions about their mother, who is not your patient.

13. You are making hospital rounds and find you are at the wrong hospital, where you do not have privileges, and you become indignant and ask where they transferred your patient, whose name you can’t remember.

14. You are doing a pelvic exam on an eighty-six-year-old patient and ask the date of her last period, since you suspect an early pregnancy.

15. Your patient asks how much was the visit? And you reply, “seventyfive dollars,” and promptly write him a check for that amount.

40 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

16. Your patient complains of a headache and you state that yours is much worse and what does she recommend?

17. You ask your patient to do a balance test by standing on one foot and say, “Like this, Mabel,” and you lose your balance, falling to the floor, and Mabel tries to help you up.

18. A colleague asks you when you plan to retire and you reply, “George, feel free to ask me questions,” as you start to walk away.

19. You ask Maude if she is still taking her birth control pills and she, with self-control replies, “I just had my ninety-second birthday!” You congratulate her and repeat the question.

20. The pharmacist questions your order for 100 Viagra tablets for ninety-year-old Mr. Roberts, with directions stating, “Take one every night,” with prn refills. You indignantly respond, “He states he dreams about sex every night and I thought I could make his dreams more realistic!”

21. You walk into the exam room where Mr. and Mrs. Jones are waiting, and you say to Mrs. Jones, “Okay, take everything off from the waist up!” She haughtily replies, “It’s my husband who has the appointment!”

22. Adam comes back, after you had started him on Aricept, and he enthusiastically states he thinks his memory has improved with the pill, and you ask, What pill?”

23. A new patient asks you how long you have been in practice, and you answer, “I don’t remember, but can I get back to you a little later?”

24. The same patient asks, “Doctor, do you take medicine? You reach into your pocket and pull out a handful of multi-colored pills and capsules and ask, “Can you tell me what any of these are for?”

25. One of your patient’s young sons asks if you served in the Civil War and did you know President Lincoln?

26. You ask your nurse in which exam room Marie is waiting, and she reminds you there is only one exam room and the patient’s name is Arlene.

27. Your patient asks how you are feeling and you spend 30 minutes telling her your symptoms, and then, the appointment time is up.

28. You realize you are taking more medication than any of your patients and most are self-prescribed, with many doses omitted and names forgotten.

29. You receive your medical school alumni bulletin and find there is no one left in your class.

30. Your office overhead has become twice your income.

31. You try to offer your remaining practice for free and you are told the price is still too high!

32. Your wife asks you how many patients you have seen today and you reply, “One,” but you can’t remember her name.

33. You look into the mirror and start to cry.

34. You leave the office to walk your faithful dog and she has to find the way back.

35. You can’t turn on the computer, forget your e-mail address, neglect to charge your pager, and are still using a pen and paper.

36. You take six viagras and the only thing that goes up is your blood pressure and your credit card balance!

37. You can’t remember all the reasons you listed above and you vaguely realize you’re too old to realize you’re too old to continue practicing.

We do what no other medical liability insurer does. We reward loyalty at a level that is entirely unmatched. We honor years spent practicing good medicine with the Tribute® Plan. We salute a great career with an unrivaled monetary award. We give a standing ovation. We are your biggest fans. We are The Doctors Company.

We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine.

Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. Call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293, or visit us at www.doctorsagency.com.

www.thedoctors.com

Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

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8/1/12 1:41 PM SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 41

membership

Welcome 376 New Members Welcome Santa Clara Valley Medical Center Physicians (Phase 1) Santa Clara County Medical Association Name Ingrid O. Aalami (Andrew) A. Abdoli Jennifer M. Abidari Cherine A. Abu-Eid Gregg A. Adams Syed M. Afroz Meenakshi Aggarwal Sangeeta Aggarwal Tyler F. Aguinaldo Scott M. Ahlbrand Muthuraman Alagappan Ali H. Alkoraishi Noel Ayoub Parisa Azizad-Pinto Raymond L. Azzi Natalie Badewski Varalakshmi Bandaru Brian P. Barlics Rand S. Barnard Odmara Barreto-Chang Nirmala Bhat Sundeep Bhat M. Lawrence Bonham Gregory G. Braverman Michael A. Bressack Hollister P. Brewster Elliott Brill Edward M. Brooks Aldene Olia Brown Joy L. Brown Peter D. Cahill David Cahn Laurie Ann Cammon Andrea Cervenka Stephanie Y. Chan Kevin K. Chan Julia Chandler David R. Chen Grace Cheng Leon Cheng Albert B. Chiang Melissa M. Chin Nam K. Cho

City Specialty San Jose OBG San Jose PD San Jose U San Jose AN San Jose GS San Jose P San Jose CD San Jose HEM ON San Jose EDM San Jose AN Stanford US San Jose P Stanford US Santa Clara EM San Jose PTH Mtn View EM San Jose US San Jose PD San Jose IM Stanford GS San Jose OBG Santa Clara US San Jose PD San Jose P San Jose PCCM San Jose CD Santa Clara US San Jose IM Santa Clara OBG San Jose OBG San Jose GS San Jose US San Jose PD San Jose IM San Jose IM San Jose CCM Stanford US San Jose N Mtn View US Mtn View US San Jose AN San Jose IM San Jose RO

Name Shaun Cho Han Yuan Alice Chong Cassandra E. Chow Alexander Chyorny Sara H. Cody Daniela Cohen Heather A. Colbert Iris C. Colon Richard B. Coolman Sarah A. Copeland Brooke Cotter Anthony Cozzolino James D. Crew Erin Cullnan Susan Cummings Jenny Chin-Lin Dai Biller Dawn M. Darbonne Alvaro D. Davila Drew J. Davis Glenn H. De Sandre Juan A. DeHoyos Elizabeth A. Desmond Jasmine Dhaliwal Susan M. Ditter Alexandra DiTullio Bichlan T. Do Tri M. Do Jana Dolnikova Jennifer Domingo Sara L. Doorley Tawnya Dozier Ariel Dubin Neena Duggal Dana D. Duncan Thao T. Duong Benjamin Durkee Brendan O. Duterte James E. Egbert Sarah S. Eitzman Joshua Elder Joseph A. Eliason Jen Eng Raymond A. Fabie

US - Unspecified 42 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

City Specialty Palo Alto US San Jose US San Jose GS San Jose IM San Jose IM San Jose PDE San Jose P San Jose MFM San Jose PD San Jose N CHN Palo Alto US San Jose P San Jose PMR Menlo Park EM San Jose GE San Jose OBG San Jose PTH San Jose GE San Jose PS San Jose PD San Jose P San Jose ORS San Jose US San Jose P Palo Alto EM San Jose CHP San Jose RO San Jose AN San Jose OBG San Jose IM San Jose FP Santa Clara OBG San Jose OBG San Jose PD San Jose PMR Palo Alto RO San Jose PD San Jose OPH San Jose PD Santa Clara EM San Jose OPH San Jose IM San Jose P

Name Rebecca Falik Farshad Fani Marvasti Peter M. Fay April Ferguson James Flaherty Lauren Flaherty Arthur R. Floreza Victoria Fong Jennifer C. Foreman Jeffrey Fraser Miriam H. Friedland Lauren Friedman Kathleen M. Fujino Anitha Gaddipati Michael Garcia Diane Garibaldi Adella M. Garland Megan Garland Christine S. Gartner Michael Gertner Mitchell A. Gevelber Lynn B. Giang Vinita Gidvani Brandon T. Ginieczki Dolly C. Goel Maritza Gonzalez Nirmala Gopalan Balaji Govindaswami Jennifer A. Graber Amarjit S. Grewal Elizabeth Greyber Andrea Griem Angela Guerrero Astrid Haefner Liliana Hamlett Lichy Han Stephen J. Harris Bridget Maureen Harrison Imran Hasan Cathleen A. Hebson Parviz P. Hekmati Becky Higbee Michael J. Hirschklau Tiffany B. Ho Tze Ho

City Specialty Santa Clara EM Stanford US San Jose IM Santa Clara US Stanford US Stanford US San Jose P San Jose OBG San Jose PD San Jose N San Jose CHP Stanford AN San Jose OBG San Jose IM Santa Clara IM San Jose PD San Jose GS Stanford US San Jose P San Jose GS San Jose ADL San Jose P Santa Clara EM San Jose AN San Jose IM San Jose PD San Jose GER San Jose NPM San Jose PD San Jose P San Jose IM Santa Clara OBG Stanford US Santa Clara US San Jose OBG Stanford US San Jose PD San Jose FP Santa Clara IM San Jose PD San Jose OBG Santa Clara EM San Jose PDC San Jose P San Jose US

Name Robert N. Horowitz Eric I. Hsiao Karen Huang Yi-Chao Huang Michele P. Hugin Grace Hunter Michelle Hunter-Behrend Danh Huynh Danagra Ikossi Priya Jegatheesan Andrea T. Jelks Amul K. Jobalia Jason Johns David S. Johnson Stephanie Jones Peter Jun Reza Kafi Ahmad Kamal Kavitha R. Kambham Young S. Kang Yvonne L. Karanas Daniel R. Katzenberg Rami Keisari Stephen Kelleher Jon Keller Sumara Kesh Kulsoom Khan Shahbaz A. Khan Hadie Khodabakhsh Michelle Kiang Rashmi H. Kirpekar Carl M. Kirsch Joseph Klein Scott Klein Marek S. Klem Meeta Kohli Amy L. Kostishack Jeffrey E. Krygier Audrey S. Kuang Gary Kuo Sanjay B. Kurani Mya S. Kyaw Tammy Lai Mary L. Lalakea

City Specialty San Jose GER San Jose PUD Santa Clara US San Jose IM San Jose OBG Stanford US Santa Clara EM San Jose P San Jose US San Jose NPM San Jose MFM San Jose NEP Stanford AN San Jose P Stanford AN Palo Alto US San Jose D San Jose GE San Jose IM San Jose DR San Jose PS San Jose ND San Jose PP Stanford AN Palo Alto US Santa Clara US San Jose P San Jose P Santa Clara IM San Jose PD San Jose PNP San Jose PUD San Jose US San Jose IM San Jose OBG San Jose FP San Jose PD San Jose ORS San Jose IM Santa Clara IM San Jose IM San Jose P Santa Clara US San Jose OTO Continued on page 44

US - Unspecified SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 43

New Members, continued from page 43 Name City Specialty Yueh-Tze Lan San Jose PCCM John Lau San Jose DR Kenneth Lau Stanford AN Patrick Lay Cupertino US Dan C. Le San Jose IM Jennifer T. Le San Jose CHP Viet X. Le San Jose P Angela G. Lee San Jose PD Gary S. Lee San Jose HPM Lisa M. Lee San Jose GO Margaret Lee San Jose R Olivia Lee San Jose IM Wilma K. Lee San Jose OBG Amy Lei Santa Clara US Marcie L. Levine San Jose IM Alexander Li Stanford US Cong Li Stanford AN Cathleen M. Ligman San Jose GS Dwight D. Lim San Jose IM Albert Y. Lin San Jose HEM ON Mark A. Lin San Jose AN Peter T. Lin San Jose N Benjamin Lindquist Santa Clara EM Santhi S. Lingamneni San Jose IM Sonia Liu Mtn View US Timothy Liu Santa Clara IM Christopher Lock E Palo Alto US May Loo San Jose PD Graciela Lopez San Jose FP Teng Lu Santa Clara US Dharitri Mahapatra San Jose P Elisabeth A. Mailhot San Jose PTH Jana L. Mannan San Jose OBG Beatriz Mares San Jose PD Joshua Markowitz Santa Clara US Ronald Masson Stanford EM Roger P. Mateo San Jose P Farhan A. Matin San Jose CHP Jessica Cooper McBeth San Jose ORS Laura J. McClellan San Jose OBG Jennifer L. McGullam San Jose OBG Stephen L. McKenna San Jose IM Michael Meade San Jose P Nubia Medina San Jose FP Katayoun Mehraby Santa Clara US Hansa N. Mehta San Jose CHP Christopher J. Mele San Jose OBG Joshua Melvin Stanford AN Elizabeth A. Mendoza-Levy San Jose PD Miriam A. Menzel San Jose PD Christopher Miller Stanford AN Laurence F. Mirels San Jose ID

Name City Specialty Courtney E. Moblad-Barlics San Jose IM Vibha Mohindra San Jose PUD Harry L. Morrison San Jose VIR William Mulkesin Santa Clara EM Sukhvinder Nagi San Jose US Allen Namath Palo Alto US Hemalatha Narra San Jose N Catherine S. Nelson San Jose PD Lynn Ngo San Jose IM Thanh-Ha T. Ngo San Jose P Hau T. Nguyen San Jose OPH Jamie T. Nguyen San Jose IM Lily K. Nguyen San Jose OBG Mark M. Nguyen San Jose PMR Phuong H. Nguyen San Jose OBG Thomas Nguyen Santa Clara US Vu A. Nguyen San Jose IM Antonio C. Nolasco San Jose P Kristen Noon Stanford AN Jonathan Nucum Union City IM Tomomi Oka Palo Alto US Timothy Ong San Jose IM Thomas M. Ormiston San Jose IM Cheryl Pan San Jose OBG Swati Pandya Mtn View US Anil Panigrahi Stanford AN Mahesh R. Patel San Jose NR Siddhartha Patel Cupertino US Leticia Pelayo San Jose PD Kyoko C. Pena-Robles San Jose FP Krystle Q. Pham San Jose OBG Nhat M. Pham San Jose NEP John Phan San Jose IM Peter M. Phan San Jose R Bridget M. Philip San Jose PAN Andrew Phillips Santa Clara EM Anat Pilpoul San Jose PD Lauren Pischel Stanford US Andrea H. Polesky San Jose ID Justin Pollock Stanford AN Neha Prakash Santa Clara US Sharmila Pramanik San Jose CLP Sulochana Pramanik San Jose PD Christopher Press Stanford AN Denise Provost Palo Alto US Kwan C. Pun San Jose IM Beverly J. Purdy San Jose P Mohammed Qayyum Santa Clara US Huma T. Qureshi San Jose P Krithi Ravindranath San Jose IM Keith S. Rayburn San Jose FP Himabindu Reddy Stanford US

US - Unspecified 44 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

Name City Specialty Jeffrey H. Reese San Jose U Laura Richter Redwood City US Harriet W. Roeder San Jose P Steven C. Roey San Jose IM Daniel Rogan Stanford US Neal L. Rojas San Jose PD Heidi K. Roman San Jose PD Luke L. Romero San Jose AN Daniel Rosenstein San Jose U Janelle Ruiz Stanford US Meenakshi Samantaray San Jose P Miguel A. Sanchez San Jose GER Mark Sanders San Jose FP Vanitha A. Sankaran San Jose P Micah H. Saste San Jose OTO Lawrence Scala Santa Clara US Alan R. Schroeder San Jose PD Michael Shaheen Santa Clara EM Afaaf Shakir Stanford US Abhishek Sharma Santa Clara US Kazuko L. Shem San Jose SCI John P. Sherck San Jose CCS Rajesh Shinghal San Jose U Carla Shnier San Jose AN Chen-Tsen Shu San Jose IM Dennis Paul Siegler San Jose OBG Geeta R. Singh San Jose CD Sharad Singh San Jose AN Yelena Sirbiladze San Jose P Sukyin (Anita) A. Sit San Jose OBG Bernard Siu Stanford US Abraham J. Sklar San Jose OBG Charles S. Smith San Jose IC Eric Smith Palo Alto US Rahul Somani San Jose US Dongli Song San Jose PD Shaina Sonobe Stanford AN Roger A. Spencer San Jose MFM Annie L. Stapleton San Jose OBG Mary Stein Stanford AN Monica L. Stemmle San Jose PD Deborah K. Stephenson San Jose PHPM Holly Stewart Stanford US John Stirling San Jose PD Angela L. Suarez San Jose IM Christine M. Suarez San Jose OBG William D. Sueksdorf San Jose P John M. Sum San Jose ND Nicole Suprovici Santa Clara US Payam Tabrizi San Jose ORS Michelle M. Takase-Sanchez San Jose OBG Clayton T. Tamura San Jose P

Name Claudette Tan Giselda M. Tan Leon L. Tan Maureen Tedesco Alex Thomas Benjamin Tiet Meghan Tieu Vicki W. Ting Maria E. Tiscareno Andrea M. Tom Justin Tong De H. Tran Hoa Tran Nam H. Tran Jacqueline Trudeau Inderjeet Uppal Miel M. Vallejo-Brooks Joyce Viloria Daniel J. Vostrejs Barry L. Waddell Robert J. Wallerstein Jing Wang Rachel Wang Roberta Y. Wang Jan B. Weber John H. Wehner Sunshine Weiss Latasha Williams Dean Lindley Winslow Nora Woiwode Emily K. Wong Meghan Wood John Woolfrey Diane Wu Wendy D. Wu Wendy Yan Radhika A. Yarlagadda Kelly K. Yeh Kenneth K. Yim Jennifer E. Yoo Steven T. Yoshioka Michael Zhang Gary G. Zhao Gefei Zhu Jennifer Zocca

City Specialty Santa Clara US San Jose P San Jose N CHN Santa Clara US Santa Clara US Santa Clara US Stanford AN San Jose AN San Jose IM San Jose EDM Santa Clara US San Jose IM Santa Clara US San Jose P Santa Clara IM Mtn View US San Jose OBG Santa Clara US San Jose PD San Jose AN San Jose GEN San Jose GO Stanford AN San Jose PMR San Jose P San Jose PUD San Jose NPM Santa Clara US San Jose ID Mtn View US San Jose P Santa Clara US Santa Clara IND Stanford US San Jose PTH Santa Clara US San Jose IM San Jose PAN San Jose PS San Jose AI San Jose IM Stanford US San Jose HEM ON Stanford US Stanford AN

US - Unspecified SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 45

SSTEM Essay Contest Winners 2012

The Santa Clara/Stanford Transformative Experience in Medicine Program (SSTEM) is an annual program, which is designed to pique local high school students’ interest in becoming a physician in our community. Following are the three essay contest winners.

1st Place Winner, Thoa Bui

Andrew P. Hill High School – SSTEM, Spring 2012 Before the SSTEM program, I never thought that I could succeed in anything great, let alone having the confidence to dream about, one day, becoming a physician. Before my senior year of high school, I did not even think about medicine or any careers in the medical field. I was completely lost. I have always loved science, especially chemistry, biology, and physiology, but applying it to a career was above me. I had never gone towards the medical field because I have always felt that it was unobtainable. Balancing a part time job and school were always as far as I could stretch.

Before this program, I would never, ever, wake up early on a Saturday, but it was this drive to learn and explore the medical field that made me take interest in it, amongst other medical programs offered at my school. Being able to interact with guest physicians and medical students had to be the most important thing for me in SSTEM, because it made 46 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

me realize that there are many ways to go about becoming a physician.

Entering the program, I was a little apprehensive about dissecting, but I came to love it, because the curiosity of learning about the body, finding, and identifying the parts was just too interesting to be fearful.

Because of the SSTEM program, any evidence of the squeamish person entering the program is completely gone. The best dissection had to be the sheep’s heart, which almost completely resembles the human heart that we saw in the anatomy lab.

This program has opened numerous doors for me. I mentioned the SSTEM program in my interview for a position as a summer intern at Kaiser Permanente, and I was one of ten students who received the position, out of the hundreds that applied. I also learned about the internship program that Dr. Bhatnagar started at her clinic, and she invited me for an interview next year. I have already sent her my resume. This program definitely gave me the confidence to finally feel like I am good enough and with hard work, I can become a physician.

Being accepted into the SSTEM program, having the privilege to participate, and working with the Stanford medical students has inspired me to not only want to become a physician, but has also taught me about how important it is to give back to the community. Watching the medical students work tirelessly to give us this opportunity has definitely inspired me to want to help high school students, such as myself, while I am in medical school, and hopefully after I become a practicing

physician, I can start a program of my own. Words can not describe how grateful I am to everyone who made it possible for me to participate in this program. Thank you all so much. This program has definitely played a huge role in shaping the kind of person, and one day the kind of doctor, I want to be.

2nd Place Winner, Winston Lee

Piedmont Hills High School – SSTEM, Spring 2012 I used to believe only very few people can be doctors, and that the medical field was only reserved for only those who were “born” to be able to work hard and rank as the top in their high school and colleges.

Because I was afraid to decide what I wanted to do in my future, because I was not the best in my class or a prodigy-born genius, the SSTEM program took that fear away. The SSTEM program transformed me by opening up a new and very potential path for me that leads to the field of medicine, despite how intimidating it seemed to me. The daunting number of years in college, and the indefinite amount of information needed to be learned to be a doctor, truly scared me from pursuing this profession. However, the unforgettable experiences with the brain dissections, the thrilling anatomy lab, and the beautiful tour of Stanford helped me realize how enjoyable and wonderful studying medicine can be. Exploring different paths of medicine such as neurology, cardiology, OB/GYN, and pediatrics broadened my view on what extraordinary and wondrous professions exist in the medical field.

But the way this program truly inspired me was not the fascinating hands-on dissections or the intriguing physiological facts given during the presentations, but the hard-working teachers who sacrificed their time to let me have a glimpse into the journey to being a doctor. These physicians and medical students who went through this journey were not only friendly, caring, and very knowledgeable in how to get into medical school, but most importantly, they were people who were just like me. The physicians and students shared how they journeyed their way from being in high school, to studying in the medical profession.

They reassured me that getting into medicine is not about being the student with the highest GPA, but rather having the will to work your very best. They showed me how hard work and determination, along with a passion for life sciences and helping the sick, guided them through high school and past medical school to being the talented doctors they are now. They were all able to accomplish this, regardless of who they were or what their rank in high school was.

Because of the amazing teachers and friends who taught me how possible it is for anyone to work hard and thrive in the medical community, I am now confident that I too can become a doctor as my future career. The people of SSTEM are the reason why I went from thinking I was not meant to be a doctor, to considering a profession in general surgery. Now, it’s not too long before I start applying for my first internship at Kaiser Permanente.

3rd Place Winner, Senait Bekele

Abraham Lincoln High School – SSTEM, Fall 2011 The SSTEM program was by far the most influential program I have ever participated in. Not only did it give me hands-on experience, but it really played a major role in my choice of path towards college. I have been told and believed that I had to follow a “cookie-cutter” path of major and minor, in order to be in the medical field. The experiences shared by the directors and the diverse ways they took to get to this point were a profound revelation that probably saved me from making a big mistake in my senior year. This knowledge solved one of the major dilemmas I had about following my passion, while indulging in my other interests as well.

If I were to look back and sum up one lesson I learned from the program, it would be that no college or dream is too big for me that I shouldn’t attempt to reach it. I don’t know if the directors are aware of this but, the program makes a participant dare to reach higher than they thought possible. From my experience, I would never have considered applying to top-tier universities, like Harvard and Stanford, for the simple fear that I wouldn’t be good enough. I limited myself to a local university or a community college because I didn’t dare to dream high and didn’t believe that I am capable of attaining that dream. The whole saying of “The only limits you have are the ones you set for yourself,” means more than a quote on a bumper sticker to me. The boundaries I set for myself were knocked down as I kept on learning that it is possible for a person of my status to actually attend the best schools. This epiphany resulted by SSTEM is the main reason why I work harder now.

My hands-on experience before SSTEM was limited to a mouse dissection in a biology class. Being able to actually handle organs was truly different from the plastic models usually used in classes. I actually was surprised to realize that the lens of an eye is like a magnifying marble, as opposed to my misassumption of it being a membrane. If it wasn’t for the eye dissection, I most likely would have continued my misunderstanding for years to come. One of the best experiences I had in the program was going to the Stanford anatomy lab. Contrary to my fear of panicking or passing out at the sight of a cadaver, I actually was able to handle the whole experience with no difficulty. Finding myself passing this test was the final reassurance I needed that the medical field is indeed what I want do. I also enjoyed the Stanford tour and the technological advances present in the university that Stanford rose as my first college of choice.

At the end of the program, I came out as a more aware and self assured person who knows what I want to do in life.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 47

In Memoriam Morton Dunn, MD

George Ramsay MD

Family Practice 11/9/27 – 2012 SCCMA member since 1964

*Internal Medicine Underseas Medicine 1/16/26 – 2012 SCCMA member since 1957

Gail Fleming, MD Otolaryngology 7/4/10 – 2012 SCCMA member since 1946

I. Norman Gould, MD *Pediatrics 4/23/24 – 2012 SCCMA member since 1956

Charles Holtfreter, MD

Leon Seley, MD General Practice 1/24/12 – 8/18/12 SCCMA member since 1957

Philip M. Stein, MD Psychoanalysis Psychiatry 1/1/32 – 8/20/12 SCCMA member since 1966

Radiology 9/26/15 – 2012 SCCMA member since 1963

Henry Kaplan, MD Legal Medicine 4/17/35 – 9/9/12 SCCMA member since 1969

Edgar LaVeque, MD Family Practice 1/26/27 – 8/29/12 SCCMA member since 1956

Tracy Zweig Associates A

REGISTRY

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Physicians

Nurse Practitioners ~ Physician Assistants

Locum Tenens ~ Permanent Placement V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tzweig@tracyzweig.com w w w. t r a c y z w e i g . c o m 48 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

California Medical Association Political Action Committee Participation Level: o $6500 - Diamond

2012 MEMBERSHIP FORM Fighting For You! CALPAC, the California Medical Association Political Action Committee, supports candidates and legislators who understand and embrace medicine’s agenda. Health care in California

o $2500 - Platinum

is highly regulated and legislated. As government and the insurance industry continue their quest to control health care, your clinical autonomy is in great jeopardy. Now more than

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Successful legislative advocacy depends upon an integrated approach, consisting of lobbying, continuing grassroots activity and political action through CALPAC. CALPAC

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on the amounts of or failure to make PAC contributions, nor will it affect your membership status with the CMA. Contributions to PACs are voluntary and not limited to the suggested

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amounts. Contributions are not deductible for state or federal income tax purposes.

Name: _____________________________________________________________________________________ Billing Address: _______________________________________________________________________________ City: ______________________________________________________ Zip:_____________________________ Phone: ___________________________________

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1201 J Street, Suite 275, Sacramento, CA 95814 • Fax (916) 551-2549 • Phone (916) 444-5532 SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 49

Classifieds office space for rent/ lease MEDICAL COMPLEX FOR LEASE • MORGAN HILL Available now, 1,200 sq. ft. Well-partitioned, excellent location. Next to lab and family practice offices. New carpet and paint. Flexible term. Call 408/666-4308.

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 Los Gatos Community Hospital. Both units currently available. Call 408/355-1519.

OFFICE FOR SUBLEASE • LOS GATOS Newly renovated office next to El Camino Hospital Los Gatos. 1,891 sq. ft. with reception area, two offices, two waiting rooms, and four exam rooms to share with a lab. Please email joleexxx@gmail.com.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA 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.

OFFICE FOR RENT • PALO ALTO Looking to share a beautiful 1,500 sq. ft. medical office in downtown Palo Alto: 723 Emerson, near Whole Foods, between Forest and Homer; with a surgeon who uses the space 2½ days a week. Well-lit waiting room, three exam rooms, two doctor’s offices, onsite parking lot shared with SkinSpirit, Wifi, autoclave, and washer/dryer. Prefer physician or psychologist, but open to any business professional. Email drwaters@lindawatersmd. com.

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.

MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525.

DOWNTOWN MONTEREY OFFICE FOR SUBLEASE Spacious, recently remodeled, excellent parking, flexible terms. Call Molly at 831/6449800.

FOR LEASE FULLY IMPROVED MEDICAL CLINIC • SOUTH MONTEREY COUNTY 5,858 sq. ft. medical facility includes 10 exam rooms, four doctor office spaces, x-ray room/ viewing area – fully leaded, surgical procedure room, gym/physical therapy area, laboratory, break room/kitchen, two individual men’s and women’s restrooms (staff and public) – ADA accessible, day care area, nurses station, storage/closet areas. Tenant improvements totaled $950,000! Have all construction drawings on hand. If you have any questions, or would like to schedule a tour, please call 831/320-5051. Currently, the clinic is vacant.

PRIME MEDICAL OFFICE FOR LEASE • SAN JOSE Excellent location. Westgate area. 1,584 sq. ft. West Valley Professional Center, 5150 Graves Ave. Suite 2/stand-alone unit. Private office, reception area, exam rooms with sinks. Available 2/1/11. Call owner at 408/8671815 or 408/221-7821.

OFFICE FOR RENT/LEASE • SANTA CRUZ I have a very nice medical office in the 1505 Soquel Drive building (on the Dominican Hospital Campus) which is empty on Fridays and available for rent or sublease to someone who may just need one day a week in Santa Cruz as a satellite location. You can use the entire unit including all office and medical equipment and supplies. Staffing available and optional. Large waiting room, reception/ front office area, consultation room, two exam rooms, storage/misc. area, and restroom.

Approximately 1,150 sq. ft. Perfect for one physician. Approximately 1,150 sq. ft. Contact Bernard Hilberman, MD, at 831/462-4500 or email: bhilberman@pmgscc.com.

50 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

MEDICAL OFFICE TO SHARE • LOS GATOS Available now! To share with two primary physician Internists. Two rooms assigned personally for office use. To share four fully equipped exam rooms, EKG machine, waiting room, and two bathrooms. Price negotiable. Call 408/209-6556.

MEDICAL OFFICE TO RENT • SALINAS Internal Medicine practice for sale. Ideal for general internist, cardiologist, pulmonologist, endocrinologist, or rheumatologist, to get started or to build an excellent practice in a lovely coastal community in Monterey Bay – close to everything, with outstanding/mild weather year round. Call 831/345-9696.

MEDICAL-DENTAL OR PROFESSIONAL MEDICAL OFFICE FOR LEASE • SALINAS At 224-4 San Jose Street. Adjacent to the Salinas Valley Memorial Hospital. 1,235 sq. ft. at $1.49 = $1,840.00 monthly rent. Newly decorated, carpeted, and painted. Open beam ceiling, balcony, and large parking lot.

Call owner, Harold Gordon, at 831/594-8920.

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.

METRO MEDICAL BILLING, INC. • • • • • •

Full Service Billing 25 years in business Book Keeping ClinixMIS web based software Training and Consulting Client References

Contact Lynn (408) 448-9210 lynn@metromedicalbilling.com Visit our Website www.metromedicalbilling.com

EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY 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 Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information.

PART TIME PEDIATRICIAN We are looking for a Pediatrician interested in steady part-time employment with a well established pediatric group in San Jose. Fax or email cover letter and CV to: 408/356-6297 attn: HR or email to: suew@ped-associates. com.

EMPLOYMENT OPPORTUNITY Physician/Locum tenens for Family/Internal Medicine. Office based practice only. Coverage mostly needed during vacation. Parttime, must have excellent communication, interpersonal and clinical skills. Please fax CV to 408/356-6676.

GREAT OPPORTUNITY FOR THE RIGHT PHYSICIAN Our Concierge Medical Practice is looking for a qualified family or internal medicine physician who likes to care for patients to cover the practice two weekends per month and 7-8 weeks per year. Responsibilities include: light phone call coverage, occasional inpatient hospital care, and home visits if necessary. We have delightful patients, an excellent staff and an EMR for remote access to records. The position can be either employment with benefits or an independent contractor relationship. Please contact Grace Laurencin, MD at 831/421-9535 or email: mgl@laurencinpp.com for additional information.

FOR SALE OPHTHALMOLOGY PRACTICE FOR SALE OR PARTNERSHIP Office is 11 years old. PPO, Medicare, and cash. Take over very low rate payment on office loan plus a small amount of cash. Call 408/871-6800.

WANTED CLINICAL CARDIOLOGIST A Cardiologist locum tenens needed for a busy private practice. Call 831/238-2775 for information.

With over 25 years of real world design experience, 1027 Design delivers designs that work. It doesn't matter how "neat, cool or beautiful" a design is if it doesn't work for you and your customers.

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www.1027design.com • 530.941.4706 SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 51

You Create a Brighter Future.

We Work to Protect It. Let us help find the right Long-Term Care insurance plan for you, so you can spend time on things that matter the most.

People are living longer these days, but as life expectancies increase, so does the risk of serious health problems that could require long-term care. In fact, at retirement age, 70% of Americans will need long-term care and 40% will enter a nursing home.1 And with the average cost for nursing home care in a semiprivate room equating to more than $82,855 per year, that could literally cost most or all of your life’s savings.2 Long-Term Care insurance may not be for everyone. But with soaring health care costs, insurance restrictions and the need to stretch retirement savings through more years... it’s a

good idea to seriously consider this valuable coverage while receiving a member premium discount.

Santa Clara County Medical Association and Monterey County Medical Society, Marsh (Seabury & Smith Insurance Program Management) and Long Term Care Resources work together to provide members with a comprehensive long term care program that gives physicians the stability and flexibility they need to protect their future. Members also have access to an interactive and educational Long-Term Care evaluation tool to help them make the best decisions for their specific situation.

To learn more about how members can help protect their assets from the rising cost of long-term care, call 800/616-8759, or visit www.myltcplan.com/scmcma.

1. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, October 2008, www.longtermcare.gov.

2. Genworth 2010 Cost of Care Survey, April 2010, www.genworth.com/ content/genworth/us/en/products/ long_term_care/long_term_care/ cost_of_care.html.

The Long-Term Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in all states.

A Total Disability Can Stop Your Income in a Split Second Make sure you have a reliable financial plan in place that includes long term disability income protection. Members can turn to the Association/Society-sponsored Group Long Term Disability Insurance Plan that protects members in their medical specialty.

Important Features of This Plan Include: • A monthly benefit of up to $10,000 if you become totally disabled. Members age 50–59 are eligible to apply for up to $6,000 per month.

• A 10-Year Medical Specialty Definition of Disability defined as the inability to work in your own medical specialty for the first 10 years after the waiting period (a very important distinction vs. many plans with a broad “inability to do ANY

52 | THE BULLETIN | SEPTEMBER/OCTOBER 2012

job” definition).

• Your monthly benefit payments are not taxable, when you don’t take your premium as a tax deduction under current tax law.

That’s not necessarily the case for employer-provided plans where you could lose up to 40% of your benefit to taxation.

(Always consult your tax advisor.)

• Group rates are negotiated exclusively for SCCMA/MCMS members.

Learn more about this valuable plan today, including: plan features, cost, eligibility, renewability, limitations, and exclusions. Please call a Marsh Client Advisor at 800/842-3761 or email CMACounty.Insurance@marsh.com.

The Black Plague was a major pestilence in the 14th century.

kill

Communication Failures more then 50,000 patients each year in the 21st century. *

eVigils.com eVigils™ is a private, closed-loop, and secure “collaborative texting” service which improves on standard texting, e-mail, and paging to prevent common communications errors.

eVigils™ means never again wasting time trying to reach and hear from team members, never again wading through e-mails looking for what you need.

eVigils™ is compliant with HIPAA and the Joint Commission ruling on texting. * Institute of Medicine. “To err is human: building a safer health system.” Washington, DC: National Academy Press; 2000

© MITEM Corporation, 2012

Artwork copyright © 2012 Dan Harding

Your Legacy

Designed Representing healthcare providers and their families for over 40 years.

Trust and Estate Planning: • Highly Personalized and • Asset and Inheritance Protection Comprehensive Estate Plans • Incapacity Planning • Wealth Transfer Planning www.hinshawestateplanning.com

Medical Malpractice Defense • Administrative Defense Healthcare Labor Law Hinshaw, Marsh, Still & Hinshaw 12901 Saratoga Avenue | Saratoga, CA 95070 408-861-6500 | www.hinshaw-law.com

We Celebrate Excellence – Corey S. Maas, MD, FACS CAP member and founder of “Books for Botox®” community outreach program, benefitting the libraries of underfunded public schools

800-252-7706 www.CAPphysicians.com

San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For over 30 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like San Francisco facial plastic surgeon Corey Maas, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the more than 11,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

SEPTEMBER/OCTOBER 2012 | THE BULLETIN | 55

BULLETIN THE

PRSRT STD U.S. Postage PAID San Jose, CA Permit No. 503

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

NO INDEMNITY REGIONAL CLAIMS OFFICES

29 Years “a” raTeD BY a.M. BesT

86

88 4

TRIALS

700 Empey Way, San Jose, CA 95128-4705

At NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed in 2011, 88% were closed without settlements or jury awards, compared to an industry average of 71%.* We won 86% of our trials, compared to 80% industry-wide.** You’re prepared for each stage of litigation and kept fully informed — and we don’t settle without your consent. We help you manage events so they don’t become claims, and, to back up our promise to stand by you, we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.

Our numbers add up to great claims support for your practice. * Physicians Insurers Association of America Risk Management Review: 2011 Edition. **Jena et al. Research Letter, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Archives of Internal Medicine. May 14, 2012.

Call 1-800-652-1051 or visit norCalmutual.Com Proud to be endorsed by the Monterey County Medical Society and the Santa Clara County Medical Association Our passion protects your practice