2008

“Physicians United for a Healthy San Diego”

SDCMS 2008 ANNUAL REPORT

ADVOCACY BENEFITS

Your Political, Legal, and Economic Advocate Locally, in Sacramento, and in Washington, DC Growing Our Portfolio of Member Benefits to Save You and Your Staff Time and Money

INFRASTRUCTURE How Our Infrastructure Supports You ENGAGEMENT

How We Reach Out to Our Members

COMMUNICATIONS No One Communicates Better to, for, and From San Diego County’s Physicians Than Your SDCMS FOUNDATION

Your SDCMS Foundation Continues to Address San Diego County’s Unmet Healthcare Needs

OUR ADVOCACY SUCCESSES IN 2008 CMA successfully opposed an unfunded mandate that would have burdened physicians to collect a host of measures related to healthcare costs and outcomes.

CMA worked hard to replace the Medical Board of California’s defunct Diversion Program, only to be thwarted by a last-minute gubernatorial veto. To support hospital medical staffs as they grapple with the lack of a diversion program, SDCMS organized a San Diego County Physician Wellbeing Commission to share best practices.

CMA successfully sued Blue Shield and other health insurers who unfairly rescinded health insurance.

CMA sponsored legislation to close the loophole that allowed health plans to use penalties assessed individually to collectively reduce the fee health plans pay to support the Department of Managed Health Care.

CMA killed legislation that would have increased every physician’s workload by forcing them to ask their patients if they would like the intended purpose of prescription to be written on the prescription label.

FIGHTING THE $100 MILLION GPCI INEQUITY TO SAN DIEGO COUNTY PHYSICIANS — NO, WE’RE NOT RURAL! San Diego County’s physicians lose more than $100 million annually because of Medicare’s Geographic Practice Cost Index (GPCI) payment inequity. In 2008, SDCMS sued in federal court for retroactive GPCI relief and to overturn GPCI, a suit that is ongoing. We continue to receive unqualified support from our San Diego County congressional representatives and California senators, and will not stop fighting on all fronts — legislative, judicial, and executive — until this gross inequity is corrected!

ENSURING CORPORATIONS AREN’T ALLOWED TO PRACTICE MEDICINE CMA killed two bills that would have eliminated California’s corporate bar on the practice of medicine, a fundamental protection against the commercial exploitation of medical care.

CONTINUING TO DEFEND MICRA AGAINST THE TRIAL LAWYERS MICRA remains the gold standard for controlling professional liability premiums, and it is always under threat. SDCMS and CMA remain vigilant to keep MICRA safe.

WE STOPPED THE 10% CUT TO AN ALREADY UNDERFUNDED MEDI-CAL PROGRAM, RETURNING MORE THAN $100M TO PHYSICIANS SEEING MEDICAL PATIENTS Faced with a 10% Medi-Cal physician reimbursement rate cut, SDCMS and CMA launched a hardhitting media campaign across the state, admonishing legislators and the governor for their shortsighted and deleterious actions [see “Penny-wise and pound-foolish cuts in Medi-Cal” in the San Diego Union-Tribune and “An Exodus From Medi-Cal” in the Los Angeles Times].

We led a coalition that sued the state to prevent the cuts.

We successfully lobbied the San Diego County’s Board of Supervisors to formally oppose the cuts.

We worked with attorneys on another lawsuit to order the cuts temporarily and then permanently halted.

We ensured no future cuts would be made by a state faced with growing budget deficits.

Your SDCMS physician leadership and staff.

PROTECTING PATIENTS BY PROTECTING PHYSICIAN SCOPE OF PRACTICE

CMA killed legislation that would have allowed psychologists to prescribe psychotropic drugs.

CMA killed legislation that would have allowed acupuncturists to expand their scope of practice.

CMA killed legislation that would have eliminated physician supervision for nurse practitioners.

CMA killed legislation that would have allowed physical therapists to treat patients without a referral from a physician.

CMA ensured legislation that would have allowed optometrists to do ophthalmological surgery was amended so as not to contain scope expansions.

HEALTH PLAN ABUSES STOPPED! BECAUSE OF ACTION ON THE PART OF CMA:

United Healthcare was forced to correct 12,000 erroneously denied California physician claims from 2007, was forced to reprocess 8,700 California physician claims incorrectly processed in 2008, was forced to rescind its new and onerous Advance Notification Protocol, was forced to withdraw nearly 3,000 overpayment requests sent to physicians, and faced fines in in excess of $1.3 billion for unfair payment practices.

Aetna agreed to modify its payment policy to pay assistant surgeons for cardiovascular surgeries.

Anthem Blue Cross was forced to pull letters it sent to physicians asking them for information about patients so that it could cancel patient policies and not pay physician bills, and was forced to remove problematic provisions from its standard physician contract.

Two major California health insurance companies accepted external review of their decisions to rescind or cancel policies.

A number of provisions in Health Net’s standard physician contract that did not comply with the terms of the RICO settlement were successfully challenged.

Blue Shield was forced to clarify a new contract amendment to ensure the amendment was not intended to create any new onerous obligations for physicians or interfere with the scope and level of physician services, was forced to provide electronic access to its new standard physician fee schedule rates via its secure Website, and was forced to give physicians electronic access to any future fee schedule changes no less than 45 days prior to the effective date.

Lifeguard Health Plan’s conservator was forced to reissue many physicians’ final distribution checks.

GETTING OUR MEMBERS REIMBURSED THROUGH THE PALMETTO DEBACLE

WORKING TIRELESSLY TO STOP THE CUTS AND CORRECT MEDICARE ABUSES

The transition to National Provider Identifiers (NPIs) and to Palmetto GBA in 2008 created a nightmare of red tape, exhaustive waits, rejected claims, slow or no payments, and massive frustrations for Medicare providers. To help our member physicians get paid: SDCMS conducted Medicare intermediary transition seminars.

SDCMS’ physician advocate assisted more than 60 member physicians experiencing payment delays and was highly successful in getting their problems solved quickly.

SDCMS maintained a direct connection to a Palmetto vice president to ensure SDCMS physician payment issues were resolved quickly.

CMA worked directly with Palmetto, with the Centers for Medicare and Medicaid Services, and with congressional legislators to get the systemic issues resolved.

SUPPORTING HOSPITAL MEDICAL STAFFS CMA stepped in to modulate The Joint Commission’s “disruptive behavior” standards to preclude overzealous hospital crackdowns. As well, SDCMS conducted a special “Medical Staff Legal Issues” seminar on August 15. SDCMS initiated quarterly meetings of San Diego County hospital chiefs of staff to create a forum for ideas and processes.

BRINGING MORE FUNDS TO SAN DIEGO COUNTY’S EMERGENCY ROOMS SDCMS successfully lobbied the San Diego County Board of Supervisors for the renewal of legislation that will continue to channel millions of dollars into San Diego County’s Maddy Emergency Medical Services Fund — legislation that was to sunset on January 1, 2009.

Faced with another 10.6% Medicare physician reimbursement rate cut on July 1, 2008, and a further 5% cut on January 1, 2009, SDCMS sent its leaders to Washington, DC, in March to speak with each of our five congressional representatives and two senators to stop the cuts and fix the Geographic Practice Cost Index (GPCI) inequity.

After the president vetoed legislation that would have eliminated the cuts, SDCMS and CMA leaders and lobbyists worked miracles on California’s congressional delegation to ensure our two senators and all five of our county’s representatives voted to override the veto!

AN NPI DATA BANK FOR OUR MEMBERS SDCMS campaigned throughout 2008 to ensure member physicians were ready for the transition to NPIs. On our website, SDCMS made all San Diego County physician Type 1 NPIs available to member physicians.

THE “PAYMENT FOR SERVICES RENDERED” STRUGGLE SDCMS and CMA fought again in 2008 to defeat the Department of Managed Health Care’s (DMHC) fourth proposal in three years — we defeated the first three — to define “unfair billing patterns” to include the practice of balance billing patients. SDCMS organized 28 physicians to testify against the ban at a public hearing on May 19. In September, CMA and a coalition of healthcare providers filed a petition with the Superior Court of California in Sacramento seeking an injunction against the DMHC’s regulation. Despite our vigorous efforts, the DMHC’s regulation did become effective in October.

Members of SDCMS’ Legislative Committee meet with Rep. Filner and Rep. Bilbray to discuss the issues important to physicians.

DISCOVER OUR NEW WEBINAR TECHNOLOGY SDCMS invested in webinar technology in 2008 so that our members and their staffs could save time by attending our members-only seminars virtually.

MEMBERSHIP GREW TO 2,562 2,600 2,550 2,500 2,450 2,400 2,350 2,300 2,250 2,200 2,150 2,100 2,050 2,000

2562

2390

SDCMS conducted 33 free, members-only seminars, webinars, and trainings (patient safety, risk management, media training, OSHA, practice management, EHR and EMR, e-prescribing, legal issues, physician leadership training, Medicare, political advocacy training, preparing to practice), two discounted seminars (coding certification and medical office manager certification), with 116 member physicians and 496 of their office staff attending.

SDCMS-endorsed carrier, The Doctors Company, along with a 5% discount on premiums for SDCMS members and a 7.5% annual rebate to SDCMS members, cut their rates significantly.

2419

2195 2163

2029

2 0 0 2

33 FREE, MEMBERSONLY SEMINARS / WEBINARS

PROFESSIONAL LIABILITY INSURANCE DISCOUNTS

2056

2 0 0 3

2 0 0 4

2 0 0 5

2 0 0 6

2 0 0 7

2 0 0 8

PHYSICIAN AND OFFICE MANAGER ADVOCATES SDCMS’ physician advocate and office manager advocate answered more than 500 physician and office manager questions (including economic advocacy questions, legal issues questions, and member benefits questions).

WE RESOLVED 60 PALMETTO PAYMENT DISRUPTIONS With Palmetto GBA taking over as Medicare’s new intermediary for California, along with Medicare’s implementation of its National Provider Identifier (NPI) administrative simplification standard, physicians across California encountered huge and complex problems ranging from provider enrollment issues to sudden reimbursement payment stoppages. With the assistance of CMA and SDCMS’ own physician advocate, we were able to help more than 60 member physicians get paid.

FOUR NEW ENDORSED VENDORS SDCMS endorsed four new vendors in 2008 to provide tangible, members-only benefits to SDCMS physicians, including credit and debit card processing from Chase Paymentech, IT solutions from SOUNDOFF Computing, banking products and services from Torrey Pines Bank, and accounting services from AKT CPAs and Business Consultants LLP.

SDCMS INCOME AND EXPENSES SDCMS closed out the 2007–08 fiscal year operations in the black, the sixth time in six years.

Our investments totaled $4,825,941 at the end of the fiscal year, with a loss of $562,991, which equals a 10.27% loss on capital. Over the previous two-year period, SDCMS had annual increases of 7.0% and 9.9% respectively. Considering the stock market has dropped almost 50% in that same time, limiting our losses to 10.3% is exceptional.

In the last quarter of 2008, reduced expenses by over $200,000, and reduced our workforce by two employees.

INCOME SPONSORSHIPS: 5% AMA/CMA COMMISSIONS: 2%

ADVERTISING/SALES: 6%

EXPENSES SDCMS FOUNDATION: 2% SPECIALTY SOCIETIES: 1%

MISCELLANEOUS: 2%

ENGAGEMENT: 6% ADVOCACY: 7%

BENEFITS: 12% DUES: 57%

COMMUNICATIONS: 24%

SDCMS provided its members “vendor-agnostic” e-prescribing and EMR seminars and webinars, an all-day EMR road show, links to valuable resources, an extensive list of EMR vendors, and an SDCMSproduced webinar that included a very detailed and “vendoragnostic” PowerPoint presentation that synthesized all the available information.

DATABASE: 4%

INFRASTRUCTURE: 31%

INVESTMENTS: 28%

EMR AND E-PRESCRIBING RESOURCES

GOVERNANCE: 14%

FREE MAILING LISTS TO MEMBERS SDCMS provided 60 physician mailing lists free to members at a total value of $30,000.

PRSRT STD U.S. POSTAGE PAID San Diego, CA Permit #99

SDCMS held seven member socials in 2008, including young physician socials, new member socials, and SDCMS’ installation dinner and dance with over 200 attendees.

SDCMS invited CMA’s CEO to come to San Diego County on five separate occasions in 2008 to present at regional hospitals and town halls.

SDCMS’ CEO spoke at 12 general medical staff and medical executive committee meetings and five resident staff meetings in 2008.

SDCMS LAUNCHED A NEW WEBSITE WITH TONS OF VALUABLE FEATURES SDCMS launched its new website with tons of new features: Physicians can join and members can renew their memberships online.

Members can build their own customizable websites with SDCMS’ website.

Members can access valuable, members-only content like all San Diego County physician Type 1 NPIs. Members can post and manage their own classified ads free of charge and in real time.

Members can watch past, members-only seminars online at their own time.

Members can search a robust database of frequently asked practice management questions and find the answers when they need them.

Email KLewis@SDCMS.org for assistance in logging in to SDCMS.org!

San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, CA 92123 “Physicians United for a Healthy San Diego”

ENGAGING PHYSICIANS

COMMUNICATING TO, FOR, SAN DIEGO PHYSICIAN WINS “MOST IMPROVED AND FROM PHYSICIANS SDCMS continued its role in 2008 as the go-to health- TRADE PUBLICATION” care resource for San Diego County’s print and broadcast media. Whether being interviewed by KPBS radio, AWARD! by any of our region’s television stations, or by the San Diego Union-Tribune, the Los Angeles Times, the North County Times, the Business Journal, or other print media, your physician leaders are out there communicating in support of your issues!

BRINGING YOU THE NEWS YOU CAN USE! SDCMS distributed 25 issues of its valued e-newsletter — “News You Can Use” — to member physicians and other regional healthcare stakeholders in 2008, keeping physicians informed and encouraging them to take action when necessary!

In recognition of the stellar improvements we made to your monthly San Diego Physician magazine, the Western Publications Association in 2008 bestowed upon us their “Most Improved Trade Publication” Maggie Award, which goes to the most improved trade publication with a circulation under 50,000 west of the Mississippi River.

WORKING WITH SAN DIEGO COUNTY SPECIALTY SOCIETIES PARTNERING WITH In 2008, SDCMS’ specialty society advocate strengthened the relationship between the San Diego Psychiatric Society (SDPS) and SDCMS by providing at-cost, back-office support to SDPS, by creating the infrastructure necessary to bring SDPS and other specialty societies into “The House of Medicine,” and by identifying other specialty societies that would benefit from such an arrangement both functionally and financially.

San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T: (858) 565-8888 F: (858) 569-1334 E: SDCMS@SDCMS.org W: SDCMS.org

HEALTHCARE STAKEHOLDER ORGANIZATIONS SDCMS continued to partner with a variety of regional healthcare organizations in 2008 to ensure the voice of San Diego County’s physicians is heard and to ensure the county’s medical and other issues are communicated back to physicians. Among those organizations: San Diego County Emergency Medical Alert Network County of San Diego Health and Human Services Agency AlertSanDiego Community Health Improvement Partners (CHIP) Health Advisory Council On Threats (HACOT) San Diego Regional Chamber of Commerce San Diego Taxpayers Assn. Healthcare Committee Healthy San Diego Long Term Care Integration Project (LTCIP) 211 Childhood Obesity Initiative Health Services Advisory Board (HSAB) Hospital Assn. of San Diego and Imperial Counties

SDCMS Foundation 2008 Annual Report OUR MISSION: “addressing unmet San Diego health care needs for all patients “and physicians through innovation, education and service”

HOW WE MEET OUR MISSION:

HOW WE MEET OUR MISSION:

Supporting Physician Volunteerism Through Project Access San Diego

Supporting Physician Volunteerism Through Surgery Days

Successes in 2008: • Over 1,000 patients referred to participating physicians.

• In 2009, Project Access San Diego (PASD) will launch a new model of care focused on making it easier for physicians to volunteer. PASD case managers will track and coordinate all aspects of a patient’s care so the volunteer physician doesn’t have to, and a full continuum of care will be available to patients.

Successes in 2008: • Nineteen patients received free outpatient surgeries on December 5, 2008, through an innovative partnership with Kaiser Permanente.

• The total value of the services donated was • $180,000.

“Words are not enough to express my thanks and gratitude to the SDCMS Foundation. The organization gave new meaning to my life. I’m enjoying my new eye and seeing the world again in living color. May you have more power, and I hope the organization will prosper and help more people like me.”

What We Need From You Now: • PASD is actively recruiting volunteer physicians in all areas of care. You can make any level of commitment that is comfortable for you.

• Please contact Kitty Bailey at (858) 300-2780 if you are interested in volunteering.

— Lenora Brogan, Surgery Day patient who received free cataract surgery on Dec. 5, 2008.

A SURGERY DAY SUCCESS STORY HOW WE MEET OUR MISSION:

Supporting Future San Diego County Physicians

One of our patients was routinely using the emergency departments throughout the county as often as four times per month for extreme abdominal pain, nausea, and malaise. The patient received a referral to the Surgery Day program and within one month received an outpatient surgery to remove her gall bladder. This patient has returned to a healthy status, does not need to use the emergency department, and avoided a potentially expensive inpatient hospital stay.

HOW WE MEET OUR MISSION:

Successes in 2008: • We awarded a senior scholarship to graduating UCSD medical student, Melissa Lorang, who has begun her residency in psychiatry in San Diego. Melissa plans to practice medicine in San Diego County.

• We awarded a competitive, first-year scholarship to UCSD medical student, Chuong D. Dang, who is entering his first year of medical school.

• We renewed medical student loans to students who are San Diego County residents and intend to practice medicine in San Diego County.

SDCMSF president, Dr. Carol Young, speaking with a UCSD medical student.

Supporting Retired Physicians Successes in 2008: • In 2008, we held four quarterly Retired Physicians Society luncheons around the county with over 50 physicians attending each.

What We Need From You Now: • We encourage you to join us in 2009 at our quarterly luncheons.

• For more information about the Retired Physicians Society or the history of physicians in San Diego County, contact Ralph Ocampo, MD, at ocamporr@cox.net.