July 2010

✖ SDCMS Celebrates Its 140th Anniversary in 2010 ✖ Reaching 8,500 Physicians Every Month

j u ly 2 0 1 0

official publication of the san diego county medical society

Unlock the Benefits of

Health Information Technology

“Physicians United For A Healthy San Diego”

July 2010 SAN DIEGO P HY SIC I A N. o rg

A

We fight frivolous claims.

We smash shady litigants.

We over-prepare, and our lawyers do, too. We defend your good name. We face every claim like it’s the heavyweight championship.

We don’t give up. We are not just your insurer. We are your legal defense army.

We are The Doctors Company.

Robert D. Francis Chief Operating Officer, The Doctors Company

The Doctors Company built its reputation on the aggressive defense of our member physicians’ good names and livelihoods. And we do it well: Over 82 percent of all malpractice cases against our members are won without a settlement or trial, and we win 87 percent of the cases that do go to court. So what do you get for your money?

More than a fighting chance, for starters. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our benefits for SDCMS members, call (800) 328-8831, extension 4390, or visit us at www.thedoctors.com/sdcms.

Endorsed by

B

S A N D I E G O P HY S I CI A N .or g july 2010

UNIVERSITY COMPOUNDING PHARMACY

Specializing in: • Bio-Identical Hormones • Clinical Trials Drug Formulation • Transdermal Delivery • Alternative Strengths & Dosage Forms • Sterile Injectables • Discontinued Drugs

FREE Internet Prescribing Software (619) 683-2005 | www.ucprx.com | 1875 3rd Avenue, San Diego, CA 92101 July 2010 SAN DIEGO P HY SICI A N. o rg

1

thismonth Volume 97, Number 7

features HEALTH INFORMATION TECHNOLOGY 18 Federal EHR Certification Rule by the California Medical Association 20 HEALTH INFORMATION EXCHANGEs: CONSIDERATIONs FOR YOUR PRACTICE

by Mark Branning 24

16

FROM IMPACT-ED TO HEALTH INFORMATION EXCHANGE: A PROTOTYPE FOR INFORMATION SHARING

by Ted Chan, MD

25 BEACON COMMUNITY COLLABORATIVE

by Josh Lee, MD, and Ed Babakanian 26 ELECTRONIC MEDICAL RECORD DEPLOYMENT: THE MERCY PHYSICIANS MEDICAL GROUP EXPERIENCE

by Michael Couris, MD 30 MEANINGFUL USE: PRACTICE CONSIDERATIONS FOR PHYSICIANS

by David A. Ginsberg 32 SECURITY AND CONFIdENTIALITY WITH EMRS AND PHRS

by The Doctors Company 34 LOCAL EXTENSION CENTER: WHAT IS IT?

by Kitty Bailey 36 TELEMEDICINE: CLOSING IN ON DISTANCE MEDICINE

by Brett C. Meyer, MD, and Larry S. Friedman, MD

18

departments 4 Contributors This Issue’s Contributing Writers 5 ARE YOU TAKING ADVANTAGE OF Your SDCMS-CMA Member Benefits?

6 SDCMS Seminars, webinars, and Events 8 Community Healthcare Calendar 10 Briefly Noted SDCMS Medical Office Manager Bulletin Board, and More …

16 ACCESS TO CARE How You Can Help Make a Healthier San Diego 42 PHYSICIAN MARKETPLACE Classifieds

44 2

S A N D I E G O P HY S I CI A N .or g july 2010

44 MESSAGE FROM THE PRESIDENT “Individually, We Are One Drop, but Together We Are an Ocean.”

July 2010 SAN DIEGO P HY SICI A N. o rg

3

contributors KITTY BAILEY

Larry S. Friedman, MD

Ms. Bailey is the executive director of the San Diego County Medical Society Foundation.

Dr. Friedman, SDCMS-CMA member since 2005, is UC San Diego’s medical director of ambulatory quality and safety, and co-director of the Southern California Telemedicine Learning Center.

Mark Branning Mr. Branning has spent 30 years in the healthcare information systems industry and is a consultant specializing in health information exchange, interoperability, product positioning, and personal health records.

TOM GEHRING Mr. Gehring is executive director and CEO of the San Diego County Medical Society (SDCMS).

Sonia Gonzales

California Medical Association The California Medical Association (CMA) represents 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

Ms. Gonzales is your SDCMS director of medical office manager support and your SDCMS office manager advocate. She can be reached at (858) 300-2782 or at SGonzales@ SDCMS.org.

Ted Chan, MD

Brett C. Meyer, MD

Dr. Chan, SDCMS-CMA member since 2005, is medical director of the UC San Diego emergency department.

Dr. Meyer, SDCMS-CMA member since 2005, is associate professor of clinical neurosciences at the UC San Diego School of Medicine, co-director of the UC San Diego Stroke Center, and medical director of the UC San Diego Department of Telemedicine.

Michael Couris, MD Dr. Couris, SDCMS-CMA member since 2001, is a solo ophthalmologist who has deployed NextGen EMR and EPM in his office.

Dr. Couris served on an EMR selection committee for Mercy Physicians Medical Group and is an advocate for widespread EMR adoption and interoperability to improve patient care and to provide timely, full, and accurate reimbursement to the practicing physician.

JENNIFER m. tUTEUR, md Dr. Tuteur, SDCMS-CMS member since 2006, is board-certified in family medicine.

From 1997 to 2009, Dr. Tuteur worked at Community Health Centers in San Diego County. Since then, she has been the medical director of the County of San Diego’s County Medical Services.

Managing Editor Kyle Lewis Editorial Board Van L. Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, MD, PhD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Project Designer Lisa Williams Copy Editor Adam Elder SDCMS Board of Directors Officers President Susan Kaweski, MD Past President (AMA Alternate Delegate) Lisa S. Miller, MD President-elect (CMA District 1 Trustee) Robert E. Wailes, MD Treasurer Sherry L. Franklin, MD Secretary (SDCMS At-large Director) Robert E. Peters, MD, PhD

geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody” Zeidman,

MD (A: Venu Prabaker, MD) Hillcrest Niren Angle, MD, Steven A. Ornish, MD (A: Eric C. Yu, MD) Kearny Mesa John G. Lane, MD (A: Jason P. Lujan, MD) La Jolla J. Steven Poceta, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Doug Fenton, MD, Arthur “Tony” Blain, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD) At-large Directors and At-large alternate Directors Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, John W. Allen, MD, Mihir Y. Parikh, MD (A: Carol L. Young, MD (sdcms foundation president), Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Edward L. Singer, MD, Alan A. Schoengold, MD, Jerome A. Robinson, MD) other board members Communications Chair Theodore M. Mazer, MD Young Physician Director Van L. Cheng, MD Alternate Young Physician Director Kimberly M. Lovett, MD Resident Physician Director Katherine M. Whipple, MD Alternate Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD Alternate Retired Physician Director Mitsuo Tomita, MD

SDCMS Tweets!

Follow SDCMS on Twitter.com to keep abreast of H1N1 updates, the latest healthcare reform developments, SDCMS seminars, and more!

››Send your letters to the

editor to Editor@SDCMS.org 4

S A N D I E G O P HY S I CI A N .or g july 2010

Medical Student Director Adi J. Price CMA Speaker of the House James T. Hay, MD

ex-officio, nonvoting board members CMA Past Presidents Robert E. Hertzka, MD, Ralph R. Ocampo, MD CMA district I Trustees Theodore M. Mazer, MD, Albert Ray, MD,

Robert E. Wailes, MD CMA Trustee (other) Catherine D. Moore, MD, CMA Solo and Small-group Practice Forum Delegates

Michael T. Couris, MD, James W. Ochi, MD Alternate CMA Solo and Small-group Practice Forum Delegate Dan I. Giurgiu, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD Alternate AMA Delegates Lisa S. Miller, MD, Albert Ray, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

Are You Taking Advantage of Your SDCMS-CMA Member Benefits? ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛

Are you getting your reimbursement issues resolved?

Does your office manager have an ally she can turn to?

Do you have a tough HR question you need answered?

Are you protecting your assets?

Is your bank working as hard as you?

Are you saving on your professional liability insurance?

Are you writing off bad debt unnecessarily?

Is your prescription pad reorder rut costing you money?

Are you squeezing all you can out of your health plan contracts?

Is outsourcing your billing the solution?

Have you done enough to prevent an IT meltdown?

Is the right person doing your accounting?

Are you unsure about a code and need it verified?

Are your waiting-room magazines increasing your malpractice risk?

Are you letting deadlines critical to your bottom line pass?

Are you meeting your staff’s training needs?

Are you getting stopped unnecessarily on your way to an emergency?

Are you saving on car rentals?

Are you or your spouse paying too much for car insurance?

Contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org today!

July 2010 SAN DIEGO P HY SICI A N. o rg

5

sdcmsseminars/webinars/events

Free to Member Physicians and Their Office Staff!

Don’t See What You Need? Let Us Know!

For further information, visit SDCMS.org/event or contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SDCMS Seminars / Webinars / Events Date

Day

JUL 20

WED

Time

Topic

Presenter

6:30pm – 7:30pm

“The Employee’s Role in Decreasing Liability Risks in the Physician Office” (Risk Management)

The Doctors Company

x

The Doctors Company

x

JUL 21

THU

11:30am – 12:30pm

“The Employee’s Role in Decreasing Liability Risks in the Physician Office” (Risk Management)

JUL 22

THU

6:30pm – 9:00pm

Membership Social

SDCMS (Rock Bottom Brewery-La Jolla)

AUG 7

SAT

8:30am – 12:00pm

“MS Outlook for Busy Docs” (Practice Management)

Tom Gehring, SDCMS

x

AUG 18

WED

11:30am – 1:00pm

OSHA Updates

Tom Gehring, SDCMS

x

x

AUG 25

WED

11:30am – 1:00pm

HIPAA Updates

David Ginsberg, PrivaPlan

x

x

SEP 11

SAT

4:00pm – 7:00pm

Young Physician Summer Social

SDCMS

SEP 15

WED

11:30am – 12:30pm

E-townhall (T)

Tom Gehring, SDCMS

SEP 16

THU

11:30am – 1:00pm

Palmetto / Medicare

Michele Kelly, California Medical Association

x

SEP 18

SAT

9:00am – 12:00pm

Media Training

Tom Gehring, SDCMS

x

8:00am – 4:00pm

Certified Medical Coder Course

Practice Management Institute

x

OCT 1–29 5 FRIDAYS

x

x x x

OCT 7

THU

11:30am – 1:00 pm

Economic Survival

AKT CPAs

x

x

OCT 27

WED

11:30am – 1:00pm

“Scope / Allied Health Professionals” (Legal Issues)

California Medical Association

x

x

NOV 4

THU

11:30am – 1:00pm

“Expert Witness, Medical Board Interactions” (Legal Issues)

Alexander & Alexander, Attorneys At Law

x

x

NOV 12

FRI

6:00pm – 9:00pm

Membership Social (T)

SDCMS (Location TBD) The Doctors Company

x x

NOV 17

WED

6:30pm – 7:30pm

“Emerging Patient Safety Issues Impacting Office Practices” (Risk Management)

NOV 18

THU

11:30am – 12:30pm

“Emerging Patient Safety Issues Impacting Office Practices” (Risk Management)

The Doctors Company

NOV 20

SAT

8:00am – 4:00pm

“Preparing to Practice” Workshop

Multiple Presenters, SDCMS

* "S" = Seminar • "W" = Webinar • "E" = Event

6

S* W* E*

S A N D I E G O P HY S I CI A N .or g july 2010

x

x

?meYfĂœI]kgmj[]kĂœJ]jna[]k

GXike\i1 JkiXk\^`Z ?I 9\e\Ôk1 =i\\ Xejn\ij kf pfli [`]ÔZlck ?I hl\jk`fej% :fekXZk1 =fi Xejn\ij# ZfekXZk DXi`jfc >feqXc\q Xk /,/ *''$)./* fi Xk D>feqXc\q7 J;:DJ%fi^% =fi j\im`Z\j jlZ_ Xj kiX`e`e^# _Xe[Yffbj# fi flkjfliZ`e^ pfli ?I# ZfekXZk :fee`\ 8ik_li Xk 0+0 )-'$ ,')( fi Xk ZXik_li7jkiXk\^`Z_i% Zfd# fi m`j`k JkiXk\^`Z?I%Zfd% Gfk\ek`Xc MXcl\1 (#'''

D]]laf_ĂœPgmjĂœC]_YdĂœE]]\k

GXike\i1 8c\oXe[\i 8c\oXe[\i# 8kkfie\pj Xk CXn 9\e\Ôk1 C\k 8c\oXe[\i 8c\oXe[\iËj le`hl\ Kfn\i CXn Jpjk\d jXm\ pfl XYflk _Xc] f] n_Xk pfl d`^_k efidXccp gXp% J;:DJ d\dY\ij i\Z\`m\ Xe X[[`k`feXc (' [`jZflek% :fekXZk1 Af_e 8c\oXe[\i# D;# =8:J# A;# Xk /,/ *-0$,()( fi Xk akX7gifk\Zk`e^[fZkfij%Zfd# fi m`j`k Gifk\Zk`e^;fZkfij%Zfd% Gfk\ek`Xc MXcl\1 ,''

D]j[`YflĂœJ]jna[]kÂ’Ăœ:j]\alĂœĂœ Yf\Ăœ;]ZalĂœ:Yj\ĂœGjg[]kkaf_

GXike\i1 :_Xj\ GXpd\ek\Z_ 9\e\Ôk1 Lg^iX[\[ Zljkfd\i j\im`Z\% =i\\ fec`e\ i\gfik`e^% >lXiXek\\[ ('Æ)' jXm`e^j ]ifd Zlii\ek Zfjkj% :fekXZk1 =fi X Zfdg\k`k`m\ hlfk\# j\e[ k_i\\ dfek_j f] d\iZ_Xek jkXk\d\ekj kf AXe\k CfZb\kk Xk ACfZb\kk7J;:DJ% fi^# Yp ]Xo kf /,/ ,-0$(**+# fi ZXcc _\i Xk /,/ *''$)../# fi m`j`k :_Xj\GXpd\ek\Z_%Zfd% Gfk\ek`Xc MXcl\1 (#,'' ]fi ?`^_$[fccXi# ?`^_$mfcld\ :fjk

K][`fgdg_qĂœJgdmlagfk

GXike\i1 Jfle[f]] :fdglk`e^ :figfiXk`fe 9\e\Ôk1 =i\\ j`k\ `ejg\Zk`fe Xe[ jlYj\hl\ek `e]iXjkilZkli\ i\Zfdd\e[Xk`fej% =i\\ `em\ekfip Xe[ Xjj\jjd\ek f] e\knfib Xe[ _Xi[nXi\ Zfdglk`e^ Xjj\kj% =i\\ XeXcpj`j f] @ek\ie\k&k\cZf&[XkX XZk`m`kp Xe[ jlYj\hl\ek IF@ i\Zfdd\e[Xk`fej% :fekXZk1 F]\i J_`diXk Xk /,/ ,-0$'*'' fi Xk f]\i7 jfle[f]]Zfdglk`e^%Zfd# fi m`j`k Jfle[f]]:fdglk`e^%Zfd% Gfk\ek`Xc MXcl\1 (#'''

9Yfcaf_ĂœGjg\m[lkĂœĂœ Yf\ĂœJ]jna[]k

GXike\i1 Kfii\p G`e\j 9Xeb 9\e\Ôk1 Ef$]\\ c`e\j f] Zi\[`k% (#''' ]\\ [`jZflekj fe

Zfdd\iZ`Xc i\Xc \jkXk\ cfXej% NX`m\[ dfek_cp dX`ek\eXeZ\ ]\\j fe g\ijfeXc XZZflekj ]fi giXZk`Z\ gXike\ij Xe[ \dgcfp\\j lg kf ('&dfek_% =i\\ Ôijk fi[\i f] jkXe[Xi[ Z_\Zbj ]fi g\ijfeXc XZZflekj% @eZi\Xj\[ [\gfj`k `ek\i\jk iXk\j% NX`m\[ dfek_cp dX`ek\eXeZ\ ]\\ ]fi Ylj`e\jj fec`e\ YXeb`e^ Xe[ Y`cc gXp j\im`Z\j% 8KD ]\\j nX`m\[ lg kf (,&dfek_% =i\\ Zfli`\i j\im`Z\ fi i\dfk\ [\gfj`k j\im`Z\% :fekXZk1 M`eZ\ B`e^jc\p Xk /,/ ),0$,*)* fi Xk mb`e^jc\p7 kfii\pg`e\jYXeb%Zfd# fi m`j`k Kfii\pG`e\j9Xeb%Zfd% Gfk\ek`Xc MXcl\1 )#,''

@fkmjYf[]ĂœGjg\m[lkĂœĂœ Yf\ĂœJ]jna[]k

GXike\i1 8cc`Xek @ejliXeZ\ J\im`Z\j# @eZ% 9\e\Ôk1 ;`jZflekj fe X Zfdgi\_\ej`m\ gfik]fc`f f] `ejliXeZ\ gif[lZkj Xe[ j\im`Z\j% JXm`e^j f] ,Æ(' fi dfi\ f]] f] k_\ Zfjk f] `ejliXeZ\# fi ZXj_ i\YXk\j i\cXk\[ kf giXZk`Z\ j`q\% JXm`e^j f] .Æ() fe cfe^$k\id [`jXY`c`kp `eZfd\ gifk\Zk`fe% Ef$Zfjk _ldXe i\jfliZ\j Zfejlck`e^% :fekXZk1 DXib 8ccXe Xk /'' -,+$+-'0 fi Xk dXccXe7 Xcc`Xek`ejliXeZ\%Zfd# fi m`j`k 8cc`Xek@ejliXeZ\%Zfd% Gfk\ek`Xc MXcl\1 (#'''Æ )#,''

KYeh]jÂĽj]kaklYflĂœĂœ Gj]k[jahlagfĂœGY\k

GXike\i1 8d\i`ZXe J\Zli`kp Io 9\e\Ôk1 ;`jZflekj fe kXdg\i$ i\j`jkXek gi\jZi`gk`fe ]fidj% :fekXZk1 8d\i`ZXe J\Zli`kp Io Xk /.. )0'$+)-) fi Xk `e]f7 Xd\i`ZXej\Zli`kpio%Zfd# fi m`j`k 8d\i`ZXeJ\Zli`kpIo%Zfd% Gfk\ek`Xc MXcl\1 *''

9addaf_ĂœJgdmlagfk

GXike\i1 :?D9 Jfclk`fej 9\e\Ă&#x201D;k1 ,' [`jZflek fe jkXiklg ]\\j% ** g\i$g_pj`Z`Xe$ g\i$dfek_ j\im`Z\j Zi\[`k% (' f]] f] flkjfliZ\[ @K jlggfik% (' f]] f] Xci\X[p [`jZflek\[ ;\cc _Xi[nXi\ jfclk`fej% =i\\ Zf[`e^ _fkc`e\% :fekXZk1 Ife 8e[\ijfe Xk .-' ,)'$(*+' fi Xk iXe[\ijfe7 Z_dYjfclk`fej%Zfd# fi m`j`k :?D9Jfclk`fej%Zfd% <dX`c pfli Zf[`e^ hl\jk`fej kf :f[`e^7 J;:DJ%fi^% Gfk\ek`Xc MXcl\1 (#'''

:gfljY[lĂ&#x153;8fYdqkak

GXike\i1 :fXjkXc ?\Xck_ZXi\ :fejlck`e^ >iflg# @eZ% 9\e\Ă&#x201D;k1 8 ]i\\ ZfekiXZk`e^ XeXcpj`j% ;`jZflek fe _flicp iXk\j% 8 gXZbX^\ gi`Z\ fe j\im`Z\j ]fi ZfekiXZk e\^fk`Xk`fej# `eZcl[`e^ _\Xck_ gcXe ZfekiXZkj :fekXZk1 B`d =\ekfe# gi\j`[\ek# Xk 0+0 +/($0'-- fi Xk b`d]7 _\Xck_ZXi\ZfejlckXek%fi^# fi m`j`k ?\Xck_ZXi\:fejlckXek%fi^% =fi ZfejlckXk`fe jZ_\[lc`e^# ZfekXZk DXi`jfc >feqXc\q Xk /,/ *''$)./* fi Xk D>feqXc\q7J;:DJ%fi^% Gfk\ek`Xc MXcl\1 (' f] E\k I\m\el\

Gjg^]kkagfYdĂ&#x153;Ă&#x153; CaYZadalqĂ&#x153;@fkmjYf[]

GXike\i1 K_\ ;fZkfij :fdgXep 9\e\Ă&#x201D;k1 , [`jZflek fe `ejliXeZ\ gi\d`ldj% .%, [`m`[\e[ Zi\[`k% :fekXZk1 AXe\k CfZb\kk Xk J;:DJ Xk /,/ *''$)../ fi Xk ACfZb\kk7J;:DJ%fi^# fi m`j`k K_\;fZkfij%Zfd% Gfk\ek`Xc MXcl\1 ,''Ă&#x2020; )#,''

:gdd][lagfkĂ&#x153;J]jna[]k

GXike\i1 KJ: 8ZZflekj I\Z\`mXYc\ Jfclk`fej 9\e\Ă&#x201D;k1 (' [`jZflek fe dfek_cp Z_Xi^\j% :fekXZk1 :Xk_\i`e\ J_\idXe

SDCMS

Endorsed Partner Benefits

Total Potential Value to SDCMS Members:

$11,000â&#x20AC;&#x201C;$18,000 GjY[la[]Ă&#x153;DYfY_]e]flĂ&#x153; :gfkmdlaf_

GXike\i1 GiXZk`Z\ G\i]fidXeZ\ >iflg 9\e\Ă&#x201D;k1 ;`jZflek\[ dXeX^\d\ek Zfejlck`e^ fe gif[lZk`m`kp Xe[ gXk`\ek Ă&#x2022;fn# g\ijfee\c# ^fm\ieXeZ\ Xe[ dXeX^\d\ek# dXib\k jkiXk\^p Xe[ kXZk`Zj# giXZk`Z\ XZhl`j`k`fej# jXc\j Xe[ d\i^\ij% =i\\ fe\$p\Xi jlYjZi`gk`fe kf k_\`i e\njc\kk\i# Le:fddfe J\ej\% =i\\ _Xc]$[Xp j\d`eXij ]fi J;:DJ d\dY\ij Xe[ k_\`i jkX]]% :fekXZk1 A\]]i\p ;\ee`e^ fi Al[p 9\\ Xk /,/ +,0$././ fi Xk A\]]7GG>:fejlck`e^%Zfd# fi m`j`k GG>:fejlck`e^%Zfd% Gfk\ek`Xc MXcl\1 (#'''Ă&#x2020; )#,''

Xk /// -/.$+)+'# \ok% (+# fi Xk Zj_\idXe7kjZXijfclk`fej%Zfd# fi m`j`k KJ:8IJfclk`fej%Zfd% Gfk\ek`Xc MXcl\1 *,'Ă&#x2020;,''

8[[gmflaf_Ă&#x153;J]jna[]k

GXike\i1 8BK :G8j Xe[ 9lj`e\jj :fejlck`e^ CCG 9\e\Ă&#x201D;k1 (, [`jZflek fe jkXe[Xi[ iXk\j ]fi gif]\jj`feXc j\im`Z\j% LeZfe[`k`feXc jXk`j]XZk`fe ^lXiXek\\1 Ă&#x2C6;J;:DJ d\dY\ij n_f Xi\ efk Zfdgc\k\cp jXk`jĂ&#x201D;\[ n`k_ k_\ nfib 8BK g\i]fidj ]fi k_\d gXp fecp n_Xk k_\p k_fl^_k k_\ nfib nXj nfik_%Ă&#x2030; :fekXZk1 Ife D`kZ_\cc Xk .-' )-/$')() fi Xk id`kZ_\cc7 XbkZgX%Zfd# fi m`j`k 8BK:G8% Zfd% Gfk\ek`Xc MXcl\1 ,''Ă&#x2020; )#'''

July 2010 SANâ&#x20AC;&#x2C6; DIEGOâ&#x20AC;&#x2C6; P HY SICI A N. o rg

7

communityhealthcarecalendar

To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. All events should be physician-focused and should take place in San Diego County.

Diabetes Day for Primary Care Physicians JUL 17 • Presented by the American Association of Clinical Endocrinologists • Hyatt Regency La Jolla • Contact (904) 353-7878

Critical Care Summer Session 2010

Infertility and Pregnancy Loss: Getting Your Patients the Emotional Help They Need

Cutting-edge Strategies in Diabetes Care: Making the Connection

SEP 25 • Skaggs School of Pharmacy, La Jolla • 8:00am–5:00pm • regonline.com/IPLO

OCT 30 • San Diego Convention Center • cme.ucsd.edu

Southwest Regional Integrated Behavioral Health Conference

4th Annual UCSD Hands-on NOTES and Single Site Surgery Symposium

JUL 22–24 • Catamaran Hotel, San Diego • cme.ucsd.edu/criticalcare

SEP 8–9 • The Crowne Plaza Hotel in San Diego • $299 • mhsinc.org/calendar

Learn How to Become a POLST Trainer (Physicians Orders for Life-Sustaining Treatment)

5th Annual Frontiers of Clinical Investigation Symposium: Pain 2010 Bench to Bedside

AUG 19 • 8:30am–5:00pm • SDCMS Meeting Room • CME/CEU Provided • $25 • Contact SDCMS at (858) 565-8888, at SDCMS@SDCMS.org, or visit CAPOLST.org

12 National Kaiser Permanente Hospital Medicine Conference th

SEP 2–3 • Hotel del Coronado • meetingsbydesign.com

8

S A N D I E G O P HY S I CI A N .or g july 2010

OCT 14–16 • Estancia La Jolla • cme.ucsd.edu/b2b2010

Challenges in the Perioperative Management of OSA Patients OCT 15 • San Diego Location TBD • cme.ucsd.edu

American Society for Bioethics and Humanities 12th Annual Meeting OCT 21–24 • Hilton San Diego Bayfront Hotel • asbh.org

NOV 11–13 • Omni San Diego Hotel • cme.ucsd.edu/notes

West Coast Geriatric Psychiatry Conference FEB 16–19, 2011 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu

Topics and Advances in Internal Medicine MAR 7–13, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

Topics and Advances in Pulmonary and Critical Care Medicine MAR 13–14, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

ARE YOU READY FOR EHR?

CHMB – The Choice for EHR & Successful Adoption Improved business performance starts with CHMB—ranked among the top providers in California for EHR Adoption & Implementation Services. Here’s why hundreds of physicians have selected CHMB for building and installing the Allscripts EHR application into their community practices: NATIONAL AND LOCAL EXPERTISE

• Established footprint with 1,000 community physicians and clinics statewide • Experts who know the full story– Hardware Selection & Procurement, Network Configuration, Application Support TARGETED SOLUTIONS

• World Class Portfolio – Clinical and Business Solutions – Allscripts, Dell, Cox Business

“CHMB has been our trusted business partner for more than six years. It made perfect sense that when we decided to move forward with EHR in our practice, we entrusted our implementation of Allscripts to them as well. They have been there for us every step of the way!”

ELIZABETH SILVERMAN, MD

Partner North County OB/GYN Medical Group

• Flexible approach to drive efficiencies and meet diverse needs, from multi-specialty and specialty, to single provider, to multiple providers • Innovative technology that delivers at the speed you need PROVEN RESULTS

• Real Utilization – 95% of physicians are at Meaningful Use with CHMB EHR Services • Superior Support – 98% client satisfaction on CHMB Clinical & IT Services during implementation & on-going support • Outstanding ROI – 97% of physicians believe CHMB’s services met all expectations, including cost, training, implementation, and application optimization As your business partner, let us navigate your entire EHR project and create the right solution to fit your practice. Count on us to train you to use the EHR at its optimal level. It’s time to trade up to EHR and discover Meaningful Use with CHMB.

Call today for your FREE EHR Readiness Assessment!

Ron Anderson • 1.760.520.1340 Marianne Gregson • 1.760.520.1333 Geoff Doyle • 1.760.520.1343

San Diego County — 1121 East Washington Ave., Escondido, CA 92025 Orange County — 7700 Irvine Center Drive, Ste 290, Irvine, CA 92618 760.520.1400 • 800.727.5662 • www.chmbsolutions.com

CHMB DELIVERS THE HIGHEST LEVEL OF SERVICE AND EXPERTISE TO ENSURE A SWIFT, SMOOTH AND SUCCESSFUL EHR COMPLETION.

July 2010 SAN DIEGO P HY SICI A N. o rg

9

brieflynoted

SDCMS Medical Office Manager

By Sonia Gonzales, Your Office Manager Advocate ou With Your Help Us Help YT ogy Information echnol ing nts to answer the follow Please take a few mome questions: proper you know if you have the 1. Yes  or No : Do software? security hardware and work you understand your net 2. Yes  or No : Do topology? per backup you sure you have the pro 3. Yes  or No : Are systems in place? nce you have adequate insura 4. Yes  or No : Do work? coverage for your IT net hardware you know how to choose 5. Yes  or No : Do ? with the future in mind or if you any of these questions, If you answered “No” to ology hn re about information tec simply want to learn mo erview” Ov will be conducting an “IT for your office, SDCMS . For p.m 0 1:0 to . y 15 from 11:30 a.m seminar/webinar on Jul page on rs ina sem our list of upcoming more information, see or nt, eve rg/ S.o CM SD ar of Events” at 6, visit SDCMS’ “Calend rg.

SDCMS.o -2782 or at SGonzales@ contact me at (858) 300

10

Sonia

S AN D I E G O P HY S I CI A N . or g july 2010

Spec

l Focus: Medical Boia a r Required No d of California’s tice to

by PhysiciaCnonsumers s Email Your Qu e stions to SGon

zales@SDCM California p S.org hysicians ar e now requ patients th ired to info at they are rm their licensed by California an the Medical d to provide B oard of patients wit information h the MBC’s . The new re co ntact gu lations, whic 27, 2010, re h took effec quire physic t June ia n s to provide of three met this notice hods: by one • By prom inently pos ti n g a si gn in an area that is consp of your offi icuous to pat ce ients, in at le in Arial fon ast 48-poin t. t type • By includ ing the not ice in a writt and dated en statemen by the patie t, signed nt or patie and kept in nt’s represe that patien ntative, t’s file, statin derstands th g the patien at the phys t unic ian is license

by MBC. d and regula ted • By includ ing the not ic e in a statement on discharge in structions, letterhead, or other doc patient or th ument give e patient’s re n to a presentative be placed im ; the notice mediately ab must ove the pat line in at leas ient’s signat t 14-point ty ure pe.

Regardless of which m et hod you ch must read as oose, the n follows: “NO otice TICE TO CO doctors are NSUMERS: licensed an Medical d regulated California, by the Med (800) 633-23 ical Board of 22, www.m According bc.ca.gov.” to the MBC , physician responsible s, not facilit for complia ies, are nce with th settings, on is regulation ly one sign m .

In group u st be posted (s be chosen), hould that op but it must be tion p os ted in a loca be seen by al tion where l patients. Fo it can r m or regulation e informatio and/or to vi n on this new ew samples SDCMS.org. of notificati ons, visit

[SAVE THE DATES!] The Best Events and Seminars for Medical Office Managers

✓

JULY 15: INFORMATION TECHNOLOGY OVERVIEW

✓ AUGUST 18: OSHA UPDATES ✓ AUGUST 25: HIPAA UPDATES ✓ OCTOBER 1–29: CERTIFIED (5 FRIDAYS) MEDICAL CODER COURSE OCTOBER 7: ECONOMIC SURVIVAL

✓

ice Ask Your Off ate! c o v Ad r e g a n Ma

tes ed an EOB that sta We recently receiv h uc m ount reement” for an am Ag d ite ed xp “E it is an e health plan. It racted rate with th less than our cont racted with alth plan has cont he e th at th s te also sta m. I am not sure lution of this clai them for the reso t know why nt rate, and I do no ou sc di a is e er th why e need to sign it rty involved. Do w there is a third pa to be paid?

Question:

alth ld contact the he In this case I wou e it may be a use this sounds lik plan directly beca (Silent PPO). ider Organization ov Pr d re er ef Pr Silent g agents (such as when contractin Silent PPOs result or rent their rs, and PPOs) sell re su in s, an pl th heal ks to third physician networ directly contracted ntage of the ird party the adva th e th ng vi gi s, ie part ed care orgarsement a manag discounted reimbu ician. There ted with the phys tia go ne s ha n tio niza are unfair and why Silent PPOs are many reasons allenges differ l. The potential ch fu w la un lly ia nt pote signed not the physician or er th he w on g dependin wnstream conauthorized the do at th t en em re ag an , and, if so, the ysician’s discount tracting of the ph flags that silent ct. One of the red ra nt co e th of s term

Answer:

PPO activity is occurring is your EOB since it does not specify the source of th e discount claimed. Yo u should scrutinize all EOBs with discounts to ensure that discounts are properly cla imed.

CMA is actively working on many fronts to elimi nate unfair physician disco unts and would appre cia te copies of EOBs or other co rrespondence that do cu ment improper silent PPO act ivity. Please send such documentation to: CMA Legal Center, Attentio n: Sil ent PPOs, California Medic al Association, FAX: (91 6) 5512027. Please indicate all of the following: 1) W hether you believe the activity constitutes a violation of the law by the payer claim ing the discount, the ma na ged organization that “lease d” your discount, or bo th; 2) All violations you belie ve the documentation de mo nstrates; and 3) All effort s you have made to red ress the violation, including co pies of all relevant co rre spondence.

For more information on silent PPOs, see CM A ONCALL document #1907.

Be Sure to Look fore Our August Officof Manager Issue n!

San Diego Physicia Acces RecordedsSSDCMS’ Anytime at eminars SDCMS.org Reminder: If yo u are unab

le to attend ou seminars in pe r rson or our w ebin can log in wit h your SDCMS ars live, you member office manager pass word to view them anytime SDCMS.org. P at lease let me kn your passwor ow if you need d information SGonzales@S by emailing me at DCMS.org.

July 2010 SAN DIEGO P HY SICIA N. o rg

11

brieflynoted

SDCMS Board of Directors for 2010–11 Officers:

At-large Directors:

President: Susan Kaweski, MD Immediate Past President: Lisa S. Miller, MD President-elect: Robert E. Wailes, MD Treasurer: Sherry L. Franklin, MD Secretary: Robert E. Peters, MD, PhD

Jeffrey O. Leach, MD Bing S. Pao, MD Kosala Samarasinghe, MD David E.J. Bazzo, MD Mark W. Sornson, MD John W. Allen, MD Mihir Y. Parikh, MD

Geographic Directors: East County: William T. Tseng, MD East County: Heywood “Woody” Zeidman, MD Hillcrest: Niren Angle, MD Hillcrest: Steven A. Ornish, MD Kearny Mesa: John G. Lane, MD La Jolla: J. Steven Poceta, MD La Jolla: Wynnshang “Wayne” Sun, MD North County: James H. Schultz, MD North County: Doug Fenton, MD North County: Arthur “Tony” Blain, MD South Bay: Vimal I. Nanavati, MD South Bay: Mike H. Verdolin, MD

Geographic Alternate Directors: East County: Venu Prabaker, MD Hillcrest: Eric C. Yu, MD Kearny Mesa: Jason P. Lujan, MD La Jolla: Matt H. Hom, MD North County: Steven A. Green, MD South Bay: Andres Smith, MD

Get Off Autopilot: Squeeze All You Can out of Your Contracts!

Save 10% of Net Revenue 12

S AN D I E G O P HY S I CI A N . or g july 2010

At-large Alternate Directors: Carol L. Young, MD Thomas V. McAfee, MD Ben Medina, MD James E. Bush, MD Edward L. Singer, MD Alan A. Schoengold, MD Jerome A. Robinson, MD

Other Board Members: Communications Chair: Theodore M. Mazer, MD Young Physician Director: Van L. Cheng, MD Alternate Young Physician Director: Kimberly M. Lovett, MD Resident Physician Director: Katherine M. Whipple, MD Alternate Resident Physician Director: Steve H. Koh, MD Retired Physician Director:

Rosemarie M. Johnson, MD Alternate Retired Physician Director: Mitsuo Tomita, MD Medical Student Director: Adi J. Price CMA Speaker of the House: James T. Hay, MD

Other Nonvoting Board Members: CMA Past President: Robert E. Hertzka, MD CMA Past President: Ralph R. Ocampo, MD CMA District I Trustee: Theodore M. Mazer, MD CMA District I Trustee: Albert Ray, MD CMA District I Trustee: Robert E. Wailes, MD CMA Trustee (Other): Catherine D. Moore, MD CMA Solo and Small-group Practice Forum Delegate: Michael T. Couris, MD CMA Solo and Small-group Practice Forum Delegates: James W. Ochi, MD CMA Solo and Small-group Practice Forum Alternate Delegate: Dan I. Giurgiu, MD AMA Delegate: James T. Hay, MD AMA Delegate: Robert E. Hertzka, MD Alternate AMA Delegate: Lisa S. Miller, MD Alternate AMA Delegate: Albert Ray, MD

SDCMS-endorsed Coastal Healthcare Consulting Group, Inc., is a specialty consulting firm that assists clients with managed care contracting, contract negotiations, credentialing, revenue enhancement, and strategic planning. As a benefit of membership, SDCMS physicians receive free contracting analysis, discounts on hourly rates, and package prices on services for contract negotiations, including health plan contracts.

Contact Kim Fenton at (949) 481-9066, at kimf@healthcareconsultant.org, or visit HealthcareConsultant.org.

Take a at San Diego Physician magazine.

Reach all 8,500 doctors in San Diego County.

Contact Dari Pebdani today! 858-231-1231 or DPebdani@SDCMS.org

URGENT CARE ISN’T JUST FOR PATIENTS Torrey Pines Bank has been integral to my success in establishing and growing my practice into the largest independent private medical group in the North County.

My needs and concerns have always been met with respect and expertise in a timely and professional manner. As I re-invent my medical practice, the Bank’s staff has helped make my success more of a certainty and taken the stress out of all my banking needs. I couldn’t have done it without them — then and now!*

TORREY PINES BANK IS A HEALTHY CHOICE FOR YOUR PRACTICE ■ Substantial Capacity to Fund Business Loans & Equipment Financing¹ ■ Up to $1.25 Million in FDIC Insurance Coverage² ■ Broad Array of Cash Management Capabilities To schedule a complimentary Urgent Care banking check-up for your practice, contact our veteran bankers: 858.523.4600 | TORREYPINESBANK.COM

*Stuart B. Kipper, MD, Internal Medicine Torrey Pines Bank customer

%08/508/ t $"3.&- 7"--&: t (0-%&/ 53*"/(-& t ,&"3/: .&4" t 4:.1)0/: 508&34 t -" .&4" t $"3-4#"% t TORREYPINESBANK.COM ¹ Equipment Financing Provided by Western Alliance Equipment Leasing, an Affiliate of Western Alliance Bancorporation – Loan Products are Subject to Credit Approval ² The WALTree Program is provided through each of the affiliates of Western Alliance Bancorporation: Torrey Pines Bank, Bank of Nevada, Alliance Bank of Arizona, and First Independent Bank are members of the FDIC. Alta Alliance Bank is a member of the Federal Reserve. On October 3, 2008 FDIC deposit insurance increased from $100,000 to $250,000 per depositor through December 31, 2013.

TORREY PINES BANK IS AN AFFILIATE OF WESTERN ALLIANCE BANCORPORATION. July 2010 SAN DIEGO P HY SICIA N. o rg

13

brieflynoted Please Welcome Our New and Rejoining

SDCMS-CMA Members!

Welcome Our New Members!

Kathy M. Clewell, MD Internal Medicine Poway • (858) 592-7040 Joseph F. Cutler, MD Internal Medicine San Diego Nancy A. Folks, MD Family Medicine La Mesa Joanna L. Gunn, MD Internal Medicine La Mesa Amy C. Kakimoto, MD Family Medicine Encinitas • (760) 942-0118 Mamata V. Kene, MD Emergency Medicine San Diego • (619) 446-1646

Santosh Kesari, MD Neurology La Jolla • (858) 822-7524

Ramin Raiszadeh, MD Orthopedic Surgery San Diego

A. Marcus Gerber, MD Diagnostic Radiology San Diego • (619) 528-3143

Jennifer L. Khoe, MD Surgery San Diego • (619) 516-6571

Margaret Riley-Hagan, MD Pediatrics Escondido

Scott A. Hacker, MD Orthopedic Surgery San Diego • (619) 286-9480

Tom-Oliver Klein, MD Internal Medicine San Diego • (619) 446-1657

Devjani Saha, MD Anesthesiology San Diego • (858) 565-9666

Eric R. Horton, MD Orthopedic Surgery San Diego • (619) 286-9480

Geva E. Mannor, MD Ophthalmology La Jolla

Sergio D. Sanguesa, MD Family Medicine La Mesa • (800) 290-5000

Mark D. Jacobson, MD Surgery of the Hand San Diego • (619) 286-9480

Glenn P. Murphy, MD Geriatric Medicine Bonita

James Z. Zhou, MD Family Medicine San Diego • (800) 290-5000

John A. Kafka, MD Pediatrics La Mesa • (858) 499-2701

Rosa M. Navarro, MD Pain Medicine Chula Vista • (619) 271-1683

Welcome Our Rejoining Members!

Ralph E. Rynning, MD Orthopedic Surgery San Diego • (619) 286-9480

Gregory I. Ostrow, MD Pediatric Ophthalmology San Diego • (858) 764-3176

James E. Bates, MD Sports Medicine San Diego • (619) 286-9480

Physicians Get Noticed!

Wish Your Legislators a Happy Birthday!

Physicians: Let your legislators know that you’re paying attention and that you vote by wishing them a happy birthday! NOTE: Due to mail handling procedures for government office buildings, postal mail to Washington, DC offices may be delayed by several weeks or even months. Please fax or email if possible.

14

S AN D I E G O P HY S I CI A N . or g july 2010

Thomas H. Shannon, MD Psychiatry San Diego • (619) 920-6935

Birthday: SEPTEMBER 4 Congressman Bob Filner E: house.gov/filner Washington, DC Office: United States Congress 2428 Rayburn House Office Building Washington, DC 20515 T: (202) 225-8045 F: (202) 225-9073 San Diego County Office: 333 F Street, Suite A Chula Vista, CA 91910 T: (619) 422-5963 F: (619) 422-7290 Imperial County Office: 1101 Airport Road, Suite D Imperial, CA 92251 T: (760) 355-8800 F: (760) 355-8802

Get in

touch

Your SDCMS and SDCMSF Support Teams Are Here to Help!

SDCMS Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or at JLockett@SDCMS.org Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or SGonzales@ SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org BUSINESS MANAGER Nathalia Aryani at (858) 300-2789 or NAryani@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or at BMatthews@SDCMS.org Letters to the Editor Editor@SDCMS.org General Suggestions SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 560-0179 W SDCMSF.org Executive Director Kitty Bailey at (858) 300-2780 or KBailey@SDCMS.org Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at BRodriguez@SDCMS.org project access PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or at BSalcedo@SDCMS.org SURGERY DAY PROGRAM MANAGER Alisha Mann at (858) 565-8156 or at AMann@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or at LRadano@SDCMS.org

Personal: • Income Tax Planning • Wealth Management • Financial Planning

Local: • Employee Benefit Plans • Profitability Reviews • Outsourced professional services (CFO, Controller)

Ron Mitchell, CPA Director of Health Services rmitchell@aktcpa.com 760-431-8440

Global: • Organizational Structure • Succession Planning • Internal Control Review and Risk Assessment 5946 Priestly Drive, Ste. 200 Carlsbad, CA 92008

CPA’s and Consultants

off % 25 SDCMS member physicians receive

advertising in this publication.

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

July 2010 SAN DIEGO P HY SICIA N. o rg

15

accesstocare

By Jennifer M. Tuteur, MD

By Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Vice President of Business and Member Development, American Academy of Professional Coders (AAPC)

How You Can Help Make a

Healthier

San Diego And Find Some Job Satisfaction Too

16

S AN D I E G O P HY S I CI A N . or g july 2010

A.N.’s Story Thirty-five-year-old A.N. worked in San Diego and supported himself. He wasn’t covered by medical insurance through his work but didn’t seem overly concerned about it since he was a healthy, productive member of society. However, last August his life changed in an instant. A.N. was involved in a serious motor vehicle accident and sustained severe trauma to his foot. Paramedics brought him to the ED, where both his medical and his financial needs were assessed. He qualified for medical care through the County of San Diego’s County Medical Services and underwent multiple surgeries, including amputation of his foot, during his month-long hospitalization.

He lost his job during the hospitalization. Without an income, he lost his housing as well. Hospital staff contacted the RN case managers at CMS when he became ready for discharge. While he continued with orthopedics, surgery, physical therapy, and other outpatient specialty visits, A.N. qualified for room and board housing through CMS. He was visited weekly by a CMS social worker, who helped him navigate medical and social assistance programs. During this time, he received food, housing, support, and assistance with transportation to medical visits. In turn, he gave encouragement to other patients undergoing surgical and medical treatments living at the same room and board.

He recovered from his surgeries and received a prosthesis. After several PT sessions, he learned how to walk again and now does so without a discernable limp. After receiving medical clearance from his surgeons, A.N. found a job and returned to work full-time. Six months later, he is completely self-sufficient and, again, a productive member of society.

What Is County of San Diego CMS? The County of San Diego’s County Medical Services (CMS) Program is a medical assistance program available to San Diego County-eligible adult residents with serious medical conditions. The CMS Program assists medically indigent adult county residents who are not eligible for other government healthcare programs. CMS is not health insurance.

Patients may qualify for CMS assistance if they meet medical severity threshold (see below) and are: • a U.S. citizen or legal resident • a permanent resident of San Diego County • 21 through 64 years of age • not eligible for Medi-Cal • determined to meet CMS financial requirements CMS services may cover: • medical visits for evaluation by primary care • primary clinic follow-up care • emergency care • emergency hospital care • prescription medications on the CMS formulary

• • • • •

specialist visits* surgical/diagnostic procedures* emergency medical transportation emergency dental care limited rehabilitation, medical equipment, and home health services*

Medical severity threshold is defined as: • immediately life-threatening or significantly disabling physical conditions, such as myocardial infarction or trauma from MVA • acute illnesses that could ultimately lead to disability or death, such as cholecystitis and gastric ulcer • chronic illnesses, including diabetes and hypertension

Why Help?

The rewards of treating CMS patients are many, including the satisfaction of assisting a patient who may not have needed a physician in years and is now desperate for help. You could help a patient overcome an acute event and become healthy and strong enough to return to work. You might find satisfaction in working on a challenging case, and you will be sure to enjoy working with the CMS team of social workers and RN

case managers. Or you could enjoy helping patients and their families address chronic illnesses in a way that will stave off long-term sequelae for many years.

Physicians like the appreciation they get from the patients they see from CMS. “These patients are so grateful to us, and thank us every time,” says staff at Dr. Musinski’s office in Encinitas. A referral clerk says of one of our RN case managers, “She helps me to help the patients.”

How You Can Help?

You can help care for indigent adult patients with acute and chronic medical conditions.

As a contracted specialty physician, you will have access to an online eligibility website.

Contracted providers also have the use of a new electronic system for submitting and reviewing treatment authorization requests.

Please consider joining hundreds of other San Diego County physicians in providing a medical safety net to indigent, ill, adult residents of San Diego. To become a CMS provider, contact Rebecca Velie, contract administrator/compliance manager, via email at rebecca_g_velie@uhc.com or by phone at (858) 495-1360.

*These services must be approved in advance by the AmeriChoice Medical Management Services Department.

July 2010 SAN DIEGO P HY SICIA N. o rg

17

Health Information Technology

Federal EHR Certification Rule For More Information, Visit healthit.hhs.gov/tempcert

By the California Medical Association

18

S AN D I E G O P HY S I CI A N . or g july 2010

Background

In order to receive electronic health record (EHR) incentive payments under the American Recovery and Reinvestment Act (“ARRA” or the “Stimulus Bill”), physicians will have to demonstrate “meaningful use” of a “certified” EHR system.

Currently, the Office of the National Coordinator for Health IT (ONCHIT) is involved in two separate rulemaking processes to define the process by which physicians will qualify for those incentive payments. The first proposed rule sets up a definition for “meaningful use.” The comment period for that regulation closed on March 15, with the final rule expected to be released sometime this summer.

The second proposed federal rulemaking, which is the focus of this summary, lays out the process by which ONCHIT will certify EHR systems. On June 24, the Federal Health and Human Services Agency (HHS) published a final rule in the Federal Register, laying out the process by which they will select organizations who will certify EHR systems.

The previous version of this EHR certification rule was published in March of this year, and the comment period closed in April.

CMA filed comments based on a review of the proposed rule by CMA’s Council on Information Technology.

It is important for physicians to note that they must use a certified EHR system to qualify for federal provider incentives. Now that this rule is final, it is expected that lists of certified EHR products will be available in early-to-mid fall. This will give physicians a starting point for selecting appropriate EHRs for their practices.

Temporary Process

In the previous version of this rule, HHS had proposed a two-step process. In order to expedite the EHR certification process, HHS proposed a Temporary Certification Program that would begin this summer and continue until December 31, 2011. The entities named to perform certification during this temporary program would be called ONCApproved Testing and Certification Bodies (ONC-ATCBs).

The final rule released on June 24 only

covers the Temporary Certification Program.

The rules governing the permanent program will be published in a subsequent federal rulemaking next year.

While this temporary program is in place, the federal government will be establishing the rules and regulations for a permanent certification program. The permanent program will be more comprehensive and would begin in January 2012.

ONC-ATCB Approval Process

Organizations that are interested in becoming an ONC-ATCB can request an application from ONCHIT in writing. Interested organizations must be able to test EHR systems in real-world situations, such as in a simulation lab. Organizations can either apply to certify complete EHR systems or to only certify one “module” (such as e-prescribing software).

ONCHIT will have 30 days to review and respond to organizations interested in becoming a temporary certification body. It is anticipated these temporary bodies, or ONCATCBs, will be named early this fall.

In the earlier version of this rule, HHS stated that they believed only one or two organizations would be capable of becoming ONC-ATCBs. Based on the level of interest around this proposed rule, they now believe that there will be multiple entities capable of meeting the requirements. This is a positive change for physicians since more ONCATCBs will spread out the work, and products can be certified faster. It will also lessen the chances of one organization controlling the market for certified EHRs.

Certification

Once they begin their work, ONC-ATCBs will only be assessing whether or not EHR systems will enable physicians to demonstrate meaningful use. While they can, at their own discretion, assess EHRs based on other criteria, those other criteria will not affect federal certification.

ONCHIT will develop one website that will list all of the certified products, as well as a standard certification label that vendors can use to identify certified products. ONCATCBs will be required to report to ONCHIT no less than weekly regarding new products

that have been certified.

Once an EHR is certified, it will not need to be recertified if the vendor makes minor upgrades to it. It will need to be recertified, however, when the transition to the permanent program occurs in 2012.

In a few rare cases, providers have self-developed EHRs. In these cases, a provider may have assembled an electronic medical record, an e-prescribing system, and other software into a custom bundle. In these cases, a provider will be allowed to request certification of the self-developed EHR.

Certification and Meaningful Use

By the draft definition, meaningful use will come in three stages: stage 1, which will be finalized this summer, stage 2, which will take effect in 2013, and stage 3, which will take effect in 2015. Because they will only be in effect until the end of 2011, ONC-ATCBs will only be able to certify EHR systems to allow physicians to achieve stage 1 of meaningful use. Certifying EHR systems for stages 2 and 3 of meaningful use will be done in the permanent certification process, which may be different than the temporary process.

Timelines and Next Steps

Due to the urgency of naming ONC-ATCBs as soon as possible, HHS has waived the normal 30-day period for final regulations to take effect. Therefore, this rule became effective immediately upon publication (June 24). There is no further opportunity for public comment.

ONCHIT will now move to begin the application process for organizations interested in becoming ONC-ATCBs. Their stated goal is to begin naming ONC-ATCBs as soon as possible, in order to begin certification of products as early as this fall.

For physicians, now is a good time to prepare for the transition to EHR. Until the first list of certified EHR systems is published, physicians can spend time assessing practice EHR needs, mapping office workflow, and researching potential vendors. This will allow practices to move quickly once vendors are certified.

July 2010 SAN DIEGO P HY SICIA N. o rg

19

Health Information Technology IE (Health Information Exchange) activity can enhance virtually any clinical function by providing a broader set of data to enhance clinical decisionmaking. Although there are many benefits of HIE, key benefits for practitioners are to support: • care coordination — the ability to view more comprehensive patient information • patient engagement • reporting of quality measures, immunizations, and syndromic surveillance HIE is a powerful tool. HIE is, or will soon be, a part of your workflow. The need to exchange information is being driven by a desire to improve care coordination, recent legislation, a more involved consumer, as well as additional quality and public reporting requirements.

The goals of this article are to both inform and assist your planning around workflows and implementation or upgrades of EMR (electronic medical record) software. The article will discuss electronic HIE. Electronic HIE can replace the inefficient paper processes of requesting paper records from other providers and patients carrying their information from one provider to the next.

Health Information Exchanges Considerations for Your Practice

By Mark Branning

20

S AN D I E G O P HY S I CI A N . or g july 2010

What Is HIE?

The following summary is from HIMSS (Healthcare Information and Management Systems Society): “In its most conservative definition, HIE (the verb) is the activity of securing health data exchange between two authorized and consenting trading partners.

Data exchange occurs between any two trading parties — a data supplier and a data receiver. To add complexity, a third party could also be storing data from and on behalf of the data supplier and be transmitting data on behalf of the data supplier ….” Figure 1 is a simple diagram to illustrate the most common structure for HIE. HIE models include: central, where the data is stored at the HIE entity; federated, where the data is stored at each provider;

and hybrid, which has some data stored centrally and some federated. Most successful HIE implementations have incorporated a hybrid model using an HIE entity, who is a third party.

HIE can take place in one of two basic ways: push or pull. Push means the data arrives unsolicited, i.e., the user did not have to do anything to get the data other than be associated with the patient. Pull means the data exchange is a result of a query/request by the user.

What Can HIE Do for You?

Key examples are summarized below. Connections to the stimulus’ HITECH meaningful use legislation criteria will be made as appropriate. Meaningful use (MU) is covered on page 30.

Care Coordination: Labs

The most common HIE is sharing lab results with all providers associated with a patient.

The performing lab sends the results back to the ordering physician through the HIE entity. The results are sent — pushed — to the other providers via email, fax, or directly to an EMR.

Figure 1: Simple HIE Diagram

Care Coordination: Beyond Labs

The same method used for labs can be used for encounter summaries, radiology results, and other data where there are sharing agreements.

Care Coordination: Comprehensive View

Let’s take a new-patient visit as an example and assume the patient has lived in the San Diego area for 10 years. Let’s also assume for the moment that San Diego has already implemented a community HIE solution.

The patient verbally provides his or her history, current medications, perhaps some recent lab results, and a paper encounter summary from a visit to another physician.

All of this information is being recorded by you and your staff in your EMR. Because the patient has lived in the area, you are fairly sure that there is data from previous providers. While in your EMR, you have a button on the screen that is labeled “HIE.” You select “HIE,” and a summary of clinical information is displayed. The information has been pulled and aggregated from a central HIE database, other providers, labs, pharmacy benefits management

sites, and other sources. You may even have information displayed from a patient’s PHR (personal health record). The source of each piece of data is clearly identified. You are able to drill down on any items of interest to you.

You are also able to select items in the display and have them instantly downloaded into your EMR. It’s important to emphasize that to minimize information overload, the data is in a summary format when displayed.

You now have a much more comprehensive view of the patient. Even before you are up and running on an EMR, you may still be able to do this query.

A similar scenario occurs during an ED or urgent care encounter.

Related MU Stage 1 requirements are: providing an electronic summary care record for each transition of care and referrals; and exchanging clinical information electronically with other providers and patient-authorized entities.

Patient Engagement

Patient portals, PHRs, wellness sites, and recent legislation have accelerated patients’ ability to actively participate in their healthcare. Stage 1 MU criteria require that patients be provided with an electronic copy of their information upon request, and that patients have timely electronic access to their information. When a patient requests a copy of his or her record, there’s a button that says “print to paper” and/or “print to a CD, memory stick, or some other electronic media.” At the end of each visit, selecting the “encounter summary button” produces an electronic version of the encounter.

Patient access to information is achieved through patient portals that are being offered now by practically all of the major EMR and HIE vendors. Many healthcare delivery systems have developed their own portals.

The portal can be a view into a single EMR or a display of EMR data from several EMRs. Although PHR exchange is not explicit in Stage 1, it is anticipated that Stage 2 requirements and demands by consumers will result in copies of patient information being sent to PHRs. Several EMR and HIE vendors are already outputting data and sending it to PHRs. HIE supporting patient engagement will

July 2010 SAN DIEGO P HY SICIA N. o rg

21

result in better informed and more engaged patients.

Reporting Requirements

Most EMR vendors know that they must have the ability to send data to CMS, states, immunization registries, and public agencies for Stage 1 compliance. There will be, for example, an “output to public health agency button” providing an electronic file that can be sent to the agency in de-identified formats.

With the increase in reporting requirements, electronic production and transmission of these reports will reduce your office’s workload.

New Methods for HIE Are Emerging

NHIN Direct is a new model of exchange that does not use an HIE entity but instead relies on two parties directly sharing information.

In the past year, this model has gained consid-

erable traction.

Health record banks use PHRs as the coordination tool. Providers would only need agreements between themselves and the bank, and not with every other provider. The State of Washington is implementing this model.

How Close Are We to This Care Coordination Vision in San Diego?

To answer, we need to separate HIE into two categories: enterprise HIE and community HIE. All the major healthcare systems in San Diego have and/or have efforts under way to ensure that EMRs in their system are sharing information both within the system and with affiliated providers, i.e., information that is exchanged across the enterprise.

San Diego is behind other communities in defining a community HIE solution. The community solution will be the glue for exchange of information for all providers whether they

K?< JK8K< F= PFLI @%K% :fdglk\ij# KXYc\kj# J\im\ij# E\knfib# N`i\c\jj E\\[j 8eXcpj`j# GcXee`e^# @e]iXjkilZkli\ Cf^`jk`Zj E\knfib ;\j`^e# ?Xi[nXi\# Jf]knXi\ @ejkXccXk`fe <DI 9\jk GiXZk`Z\j @ejkXccXk`fe @dgc\d\ekXk`fe 9XZblg# J\Zli`kp ;`jXjk\i I\Zfm\ip :fdglk\i KiX`e`e^ GifXZk`m\ DX`ek\eXeZ\

nnn%jfle[f]]Zfdglk`e^%Zfd F]\i J_`diXk /,/ ,-0$'*'' o )')

are part of a system, or a group, or a solo practitioner. There are several worthwhile projects that are under way for coordinating care; however, an overall strategy has not been developed.

With the market for HIE being driven by MU, consumerism, as well as a recent $15 million award to a consortium of the key San Diego healthcare delivery stakeholders, the opportunity for the San Diego community HIE is promising.

Summary

Electronic HIE can provide care coordination, patient engagement, and reporting benefits.

To achieve the benefits of HIE, changes to workflow and EMRs need to be implemented.

As you implement or upgrade your system, keep the functionality/buttons in mind. If vendors cannot clearly show how they can achieve MU and that they have the right functionality, move on.

SDCMS

member physicians receive

25% advertising in this publication.

<e[fij\[ Yp1

F==@:@8C GL9C @:8K@FE F= K?< J8E ;@<>F :F LEKP D<;@:8C JF:@<KP D8P )''0

Update on the Future of Healthcare

E\n 8jjfZ`Xk\ j1 Ef Dfi\ ;flYc\ ; `gg`e^ G%(- I\dfm`e^ Dfm`e^ 9 J_XZbc\j# Xi`\j1 DXp `j D\ekXc ?\fle[ Xck_ Dfek_ G%(/ JZ`\eZ\ f] 8[[ 8 9iX`e ;`j\Xj `Zk`fe1 \ G%)+

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org ÈG?PJ@

=I<< j`k\ `ejg\Zk`fe ]fi J;:DJ d\dY\ij 22

S AN D I E G O P HY S I CI A N . or g july 2010

off

:@8EJ

LE@K<;

=FI 8

? < 8 CK

?P J8E

;@<>F

É

POLITICAL REALITY:

YOU’RE EITHER

AT THE

TABLE OR

YOU’RE ON THE

MENU SDCMS Is at the Table!

By choosing to join the San Diego County Medical Society (SDCMS), over 3,000 practicing physicians, resident physicians, and medical students in San Diego County have given voice to our patients and to our communities in the healthcare reform discussions and in every single healthcare issue being debated locally, in Sacramento, and in Washington, DC.

Ask your colleagues: “Are You a Member of SDCMS?” San Diego County Medical Society (SDCMS) | 5575 Ruffin Road, Suite 250 San Diego | 858.565.8888 | SDCMS.org June July 2010 SAN DIEGO P HY SICIA N. o rg

23

Health Information Technology

From IMPACT-ED to Health Information Exchange A Prototype for Information Sharing

By Ted Chan, MD

24

S AN D I E G O P HY S I CI A N . or g july 2010

ealth information technology (HIT) holds the potential to improve healthcare delivery and enhance the patient experience. In a very specific population, we are showing that HIT can help us solve the problem of emergency room overcrowding, while demonstrating that when separate provider systems work together to share information, patients and providers benefit.

Our project began in response to the two San Diego County safety net assessments that reported that many patients seen in the emergency department are there for nonemergent issues, contributing to the problem of ED overcrowding. Moreover, both reports noted that primary care capacity existed in the community clinics and recommended that systems be developed to refer patients from the ED to the clinics when they were in need of a medical home.

Recognizing that EDs are a costly setting for care that could be provided in the community clinics, which receive federal funding to help support their safety net role, we developed “IMPACT-ED” (Improving Medical home and Primary care Access Through the Emergency Department) in partnership with the San Diego Family Care (SDFC) community clinics. This project, funded by Alliance Healthcare Foundation, electronically links the UC San Diego Medical Center ED directly with an SDFC clinic using a secure, HIPAA-compliant internet connection available on a 24/7 basis. The system allows UC San Diego ED physicians and staff to schedule follow-up appointments for patients, often the next day, directly with a community clinic near the patient’s residence.

We conceived this project based on studies showing a dramatic decrease in ED use by Medi-Cal and unfunded patients when they have access to more appropriate health and social services that address their needs. We theorized that by helping low-income patients establish a relationship with a clinic as

Beacon Community Collaborative

The San Diego healthcare community was recently in the national spotlight when Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius announced that our region was one of only 15 communities across the country selected to pilot the widescale use of health information technology (HIT) to improve quality, safety, efficiency, and cost effectiveness in the delivery of patient care.

The multimillion-dollar Beacon Community Collaborative grant awarded to UC San Diego on behalf of a wide collaboration of healthcare providers and the community is part of a $220 million American Recovery and Reinvestment Act initiative to use HIT to advance meaningful, measurable improvements in healthcare. Thanks to the joint efforts of San Diego’s healthcare providers, the strength of our healthcare stakeholder community, and the innovative application of HIT already taking place throughout San Diego, our region was the only California community to successfully compete for this grant.

To read the complete “Beacon Community Collaborative” article by Josh Lee, MD, information services medical director at UC San Diego Health System, and Ed Babakanian, chief information officer at UC San Diego Health Sciences, visit SDCMS.org/publications.

their medical home for preventive, primary, specialty, and chronic care, they would curtail their reliance on more costly hospital emergency rooms as their primary healthcare resource.

The project has been a success. Since IMPACT-ED was launched in 2007, we have referred more than 2,000 patients to a community clinic provider. Our data indicate that patients who are scheduled for an appointment with a clinic before they leave the ED are 24 times more likely to keep their appointment than those who are simply given contact information and encouraged to call for an appointment and follow up on their own.

Recognizing the potential for this program as a way to rein in healthcare costs and relieve some of the stress on our EDs, UnitedHealth Group/PacificCare provided a grant for UC San Diego Health System and clinic partners to expand the program. The Family Health Centers of San Diego (FHCSD) joined UC San Diego and SDFC to develop the San Diego Health Information Exchange (HIE).

With this program, we are expanding our capabilities to include medical information transmittal so that in addition to setting up an appointment, we can immediately trans-

fer updated medical information about the patient to the clinic. Because FHCSD has an electronic medical record system, we can link directly to share patient information and schedule appointments. In the case of the SDFC clinics, access to the patient’s UC San Diego medical records will be possible through a secure, internet-based link.

We are also pleased to be participating in a regional expansion of this model through Safety Net Connect. This county-funded initiative, which is being implemented through Community Health Improvement Partners (CHIP), aims to connect the region’s hospital emergency departments with community clinics throughout San Diego. The goal is to get even more patients into appropriate medical homes, to decrease the unnecessary use of EDs, while strengthening communication among key players in the region’s health care safety net.

These projects demonstrate the value of creating electronically linked networks among separate systems and providers, resulting in more efficient and appropriate utilization of healthcare resources, while improving the care and service we provide to our patients.

When separate provider systems work together to share information, patients and providers benefit.

July 2010 SAN DIEGO P HY SICIA N. o rg

25

Health Information Technology

Electronic Medical Record Deployment The Mercy Physicians Medical Group Experience

By Michael Couris, MD

26

S AN D I E G O P HY S I CI A N . or g july 2010

ealth information technology (HIT) and specifically the electronic medical record is about to burst onto the scene in private practices throughout the nation. Buoyed by passage of President Obama’s stimulus package, the HITECH Act, the ARRA, and the recent award of a $15 million Beacon Grant to UC San Diego, San Diego practices need to start planning their paths through the IT maze, which is peppered with potential pitfalls.

This article is written from the experience of deploying a combined, single database electronic medical record (EMR)/practice management system in 10 primary care offices of various sizes in Mercy Physicians Medical Group (MPMG), a multispecialty IPA in central and south San Diego County.

The group is involved in capitated care for both Medicare Advantage and commercial patients. Many participating physicians also see fee-for-service Medicare and serve commercial patients. Perhaps some pearls can be gleaned from our physicians’ experience to ease the transition for our colleagues.

Selection of a specific EMR product was accomplished by committee. MPMG’s management company, North American Medical Management, convened representatives from multiple IPAs under its umbrella about two years ago. An initial product selection was a nonstarter and was fortunately tested in a different IPA. The secondary selection proved to be an excellent decision. More than 25 practitioners are now using this software during a one-year rollout period.

EMR deployment was a business decision for MPMG as costs continue to escalate and payers were putting pressure on the group to be more efficient. It was obvious to the MPMG board of directors and to the MPMG EMR Committee that few practices would move forward without significant financial

July 2010 SAN DIEGO P HY SICIA N. o rg

27

The importance government and private payers are placing on electronic initiatives is very obvious considering the large amount of money committed. Where this becomes especially pertinent to the practicing physician is the future reduction in funding for medical care.

28

S AN D I E G O P HY S I CI A N . or g july 2010

support up front. The lure of future government dollars did not figure into past or future IPA calculations, since requirements for government reimbursement are nebulous at this time and were not extant during the planning stages. Significant financial support was afforded practices to relieve the burden of hardware and software costs, training, implementation, and data conversion. A temporary drop in revenue was also somewhat ameliorated with the financial support given. The IPA’s goal was to encourage EMR adoption for more efficient, better patient management at lower cost.

Take Home #1: Be sure to use all local resources before deciding which system to purchase or lease. Check with colleagues to see what works best in your type of practice and specialty. Use companies that have strong financials, good support, and that will be around in the next several years. Finally, see if your hospital or medical group is sponsoring specific EMRs, is providing monetary support, or can lighten the burden for your practice in any way.

Do not go it alone.

The MPMG board decided that any government funds that might materialize should be retained by the physicians who have adopted EMR as a reward for early adoption. This act also served as a statement that the board believed adoption is the right thing to do for countless reasons — the promise of government funding not being of great import.

At press time, the Centers for Medicare and Medicaid Services (CMS) has not released “meaningful use” guidelines. These guidelines are to provide a list of EMR functions that must be met in order to receive government support. Many who follow this issue closely believe that one of the requirements for meaningful use will include the ability to share data with colleagues and other entities such as hospitals and laboratories.

There are many companies in the marketplace guaranteeing that they will be able to meet all meaningful use requirements. The requirements have not been finalized, so this claim is specious at best today. One other caveat is that the expense to achieve mean-

ingful use with any one product may be costprohibitive. Many communities, including San Diego, are forming health information exchanges to facilitate data sharing among various healthcare entities. Be sure your EMR can participate in these collaborative ventures or else your practice may be electronic but unable to communicate with your colleagues and affiliated hospitals.

Take Home #2: The hurdles to obtain government dollars might be very high. Cast a wary eye on any company that “guarantees” meaningful use, as the costs to meet the requirements may be onerous. Look to the community for a health information exchange (HIE), which will allow your EMR to interface with the greater healthcare community at a reasonable cost, or one that lets you adopt electronic capabilities in a modular, affordable approach.

“Initial deployment in the office will be disruptive to you, your staff, and patients,” says Billie Green, MD, an adopter of MPMG’s EMR system. “I was pulling my hair out the first two weeks. Things have become much better. I’m already back to seeing the same number of patients that I saw before putting EMR in my office only after four weeks.” Dr. Green’s experience is typical of the physicians who deployed the MPMG-sponsored EMR. A four-month-lead time was required.

Each office was shepherded by an EMR consultant who had experience in setting up more than 250 electronic offices, making the process less daunting for the physicians and office staff.

Take Home #3: Your vendor should be able to provide a consultant to assist with planning. Expect a large lead-time from completing a contract to deployment of your chosen system. A well-thought-out plan is necessary to ensure a successful experience. Remember, there are a limited number of healthcare IT specialists in a time when thousands of physicians are planning to go electronic. Plan accordingly.

Lucy Polak, MD, another adopter of MP-

MG’s EMR, has many observations about her deployment experience. “At first, our office could not see as many patients,” she says.

“Our computer skills eventually improved.

Patients are very impressed with electronic records and have been very supportive. It is much easier to evaluate a patient with all of the data in once place. I can also look at laboratory results, document my interpretation, and phone the patient very efficiently. Internal office communications are also much better as they are now more efficient and task assignment can be audited. I’m sorry to say we may not need as large an office staff going forward.”

Take Home #4: If you are deploying an EMR in the office, be ready for major changes. Workflow changes will be enormous. Things will be difficult at first but will improve with time as long as there is commitment on the part of the staff and Project4:Layout 1

9/22/08

physicians. No transition from paper to computer was easy or without challenges for MPMG physicians. With perseverance, all have made the transition and are now practicing with electronic offices.

The electronic medical office has been slow in coming considering the rate of IT adoption across a range of industries over the past 20 years. The importance government and private payers are placing on electronic initiatives is very obvious considering the large amount of money committed. Where this becomes especially pertinent to the practicing physician is the future reduction in funding for medical care. Physicians hopefully can harness IT effectively, provide more cost-effective care, and, maybe, just maybe, see reimbursements keep up with the costs of keeping their practices open. We at MPMG made a choice to proceed with EMR. We hope you’ll join us.

11:22 AM

It was obvious to the MPMG board of directors and to the MPMG EMR Committee that few practices would move forward without significant financial support up front.

Page 1

Tracy Zweig Associates A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Locum Tenens Permanent Placement V oic e: 800- 9 1 9 - 9 1 4 1 or 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tz w eig@ tra cy zw e i g. com w w w. t r a cy zw e i g. com

July 2010 SAN DIEGO P HY SICIA N. o rg

29

Health Information Technology Making Sense of a Confusing Subject

Meaningful

Use Practical Considerations for Physicians

By David A. Ginsberg

30

S AN D I E G O P HY S I CI A N . or g july 2010

For almost a year physicians have been hearing about the meaningful use criteria that must be demonstrated (or at least attested to in the first year of incentive funding) to be eligible to receive CMS incentive funding. Of course, achieving meaningful use (hereafter referred to simply as “MU”) is only one component of qualifying for incentive funds.

Physicians must also be “eligible providers” (certain hospital-based physician specialties are excluded from incentive funding on the principle that they use electronic health records purchased by the hospital). Physicians as well must use an EHR from a certified vendor — subsequent federal rules and guidance have been issued on how vendors can become certified. Certification itself requires the vendor demonstrate they have the functionality and capability to meet each of the MU criteria. The MU criteria are designed to be met in three stages over a period from 2011 through 2015.

The complete set of MU criteria and measures to demonstrate they have been achieved was released in the “Medicare and Medicaid Programs: Electronic Health Record Initiative Program A” Proposed Rule, released Dec. 30, 2009. This proposed rule generated hundreds of public comments, most of them challenging the MU criteria as too complicated, difficult, or inappropriate, as well as unlikely to be successfully reached by healthcare providers in the allotted timeframe. Timeframes for achieving MU are also tied to the incentive funding timeframe itself. Incentive funding has a limited shelf life and, as proposed, decreases in amount and finally disappears. Thus physicians are faced with the challenge of not achieving MU in the prescribed timeframe and either losing incentive funding opportunities or receiving a reduced incentive.

The proposed MU criteria are organized into several categories that support a health outcomes policy priority, each with a specific goal. For the most part, these make sense and contribute to overall improved patient quality and outcomes, practice efficiency, and even privacy and security of patient information. The categories are the following:

“Privileged to Provide Care and Clinical Research Since 1975” • Improving quality, safety, and efficiency, and reducing disparities.

Some of the criteria in this category are the use of computerized order entry for diagnostic tests or medication prescribing. This category is the largest, with 16 criteria.

• Engage patients and their families in their healthcare, with criteria including the ability to provide patients with a clinical summary of their officebased visit or with timely electronic access to their health information, such as laboratory test results.

• Improve care coordination. An example of the criteria in this category is performing medication reconciliation (prescription medications, home medications, and so forth).

• Improve population and public health. An example of the criteria in this category would be exchanging immunization data with the San Diego County immunization registry program.

• Ensure adequate privacy and security protections for personal health information. This category has only one criterion, which can be demonstrated by showing that you have conducted or reviewed a security risk analysis as required by the HIPAA security rule and have implemented security updates as necessary.

It remains to be seen how responsive CMS will be to the public comments and to what degree MU criteria will be modified. In the

meantime, there are a few practical tips that can be initiated for any medical practice.

These are based on implementing those criteria today that make good sense from a practice efficiency and compliance perspective.

1. Submit claims electronically. Using electronic claims submission generally results in faster reimbursement and better claims adjudication accuracy. Even if your practice management software cannot generate an electronic claim, there are clearinghouses that can help.

2. Check insurance plan eligibility and benefits electronically. The average wait time for telephone eligibility verification nationally is still longer than 20 minutes! This is a terrible waste of office personnel time and very inefficient.

Even if you use a clearinghouse and must pay a small per-eligibility inquiry fee, the cost is usually well worth the time saved!

3. Complete your HIPAA security compliance plan, including the risk analysis. Many medical practices have not completed the security rule compliance, even though it went into effect in 2005. Maintaining privacy safeguards and providing the forms (such as the notice of privacy practices) is not a complete compliance program! There are easy-touse tools to help you achieve compliance and complete a risk analysis.

These three tasks are appropriate and, in the case of HIPAA, required now. They are also three of the proposed MU criteria your practice can achieve early.

The proposed MU criteria are organized into several categories that support a health outcomes policy priority, each with a specific goal. For the most part, these make sense and contribute to overall improved patient quality and outcomes, practice efficiency, and even privacy and security of patient information.

The San Diego Arthritis Medical Clinic is a leading investigational site for the study and treatment of: Rheumatoid Arthritis Ankylosing Spondylitis Osteoarthritis Osteoporosis Fibromyalgia Low Back Pain Hip Pain Knee Pain Lupus Gout

If your patient’s musculoskeletal or rheumatologic condition is not well-controlled, please contact us about our research at:

619.287.1966 San Diego Arthritis Medical Clinic 3633 Camino del Rio South, 3rd Floor (1.7 mi east of Texas Street)

San Diego, CA 92108

Michael I. Keller, M.D., Director Puja Chitkara, M.D. Ara H. Dikranian, M.D. Oleg Gavrilyuk, M.D. G. Paul Ignat, M.D. Timothy F. Lazarek, N.P.

619.287.9730 www.SanDiegoArthritis.com Offices: Mission Valley, Poway, Chula Vista, El Centro, & Yuma, AZ

July 2010 SAN DIEGO P HY SICIA N. o rg

31

Health Information Technology

Security and Confidentiality With

EMRs and PHRs

By The Doctors Company

32

S AN D I E G O P HY S I CI A N . or g july 2010

Electronic Health Records

Breaches of electronic data are growing in frequency from small and large organizations alike. More than 900 medical breaches were reported to the State of California in the first six months of 2009 alone. Many of these breaches were lost data sticks, lost or stolen laptops, and compromised electronic storage.

Ensuring proper electronic medical record keeping that is in line with confidentiality and security laws is critical, as violating these laws may lead patients to take legal action or could result in the imposition of civil and/or criminal penalties. Consider the following issues with respect to protecting patients as well as managing the integrity and security of electronic medical records: • Medical offices need computer systems with log-out and password protection.

Computer systems and servers should be backed up and secure, and online communications should be limited to existing patients. Remember that traditional email is not secure.

• Use a system with appropriate encryption against unauthorized third-party access. Laptops and remote devices need to be password-protected and securely transported. Be particularly cautious when remotely accessing an electronic records system from a home computer or a public computer that is used by others.

• Utilize an electronic system that maintains permanent audit records of all entries and changes. Develop a system for documenting corrections to computerized records, and make sure that no improper alterations are made.

• Develop a data recovery and/or disaster plan to comply with the Red Flags Rule,

the compliance deadline for which has again been delayed by the Federal Trade Commission (FTC) until Dec. 31, 2010.

This set of rules requires many businesses and organizations to implement a written Identity Theft Prevention Program designed to detect the warning signs — or “red flags” — of identity theft in their day-to-day operations. For more information, visit ftc.gov/redflagsrule.

Personal Health Records

Differing from the physician-controlled EHR (electronic health record), the personal health record (PHR) is an electronic file owned and controlled by patients. For physicians, it can be a way to quickly obtain basic patient health information, such as lists of medications, family history, allergies, vaccinations and immunizations, past surgical procedures, and other information related to care provided by all physicians or hospitals. The PHRs can be paper-based, PC-based, hosted on the internet at a third-party site, held on a data stick or CD, and contained in storage on a mobile smart phone. While PHRs are being promoted by the government, health plans, employers, and patient advocacy groups, they do introduce special concerns to the patient’s provider: • The PHR is not a substitute for directly communicating the patient’s medical information to his or her physician in a traditional format (in person, by telephone, etc.).

• It should be made clear to patients that physicians are not responsible for knowing the information contained within a PHR except when they have consulted it in association with a formal office visit or

online consultation.

• The PHR should not be considered a complete record at any one point in time.

• Physicians should make it clear to patients that it is the patient’s responsibility to notify providers of any new information contained in the PHR. • Entries into the PHR do not become part of the medical record unless and until they are formally accepted for inclusion by the clinician.

• The data in the PHR may be exported directly from an EHR, but do not assume that the information was entered, reviewed, or recommended by a physician.

• The provider should make it clear that the responsibility for the accuracy of the information in the PHR remains with the patient as the owner of the record.

For more risk management tips, articles, and information, visit thedoctors.com/ knowledgecenter.

Protect Yourself With Cyberguard Anticipating the growing risks of and mounting penalties for breaches of patient data and financial records, SDCMS-endorsed The Doctors Company has created and added CyberGuard for its members. The new, free coverage protects physicians against regulatory and liability claims arising from the theft, loss, or accidental transmission of confidential patient or financial information, as well as the cost of data recovery. For more information, visit thedoctors.com/cyberguard.

July 2010 SAN DIEGO P HY SICIA N. o rg

33

Health Information Technology

Local Extension Center What is it?

By Kitty Bailey

34

S AN D I E G O P HY S I CI A N . or g july 2010

The California Health Information Services and Partnership Organization (CalHIPSO) is a new nonprofit organization funded by federal stimulus dollars that has been organized to help medical providers around the state successfully adopt electronic health records (EHRs) and to help eligible providers achieve federal meaningful use requirements and take advantage of “incentive payments” from either Medicare or Medi-Cal. CalHIPSO will be working with Local Extension Centers (LECs) around the state of California to help Priority Primary Care Providers (PPCPs) participate in this effort. The LECs will be selected by and will report to CalHIPSO (CalHIPSO.org).

The LEC will be a neutral, third party that will provide the following core services to PPCPs supported by federal grant funds: • Outreach and Enrollment: Build awareness and communicate the value of CalHIPSO and the LEC. • Training and Education: Provide ongoing training and education about HIT, EHRs, and meaningful use.

• Readiness and Workflow Assessment: Work with individual PPCPs to assess the current state of resources — human, technical, and capital — that can be leverages for the upcoming EHR project.

• Assist With Vendor Selection: Assist PPCPs with vendor selection while remaining neutral.

• Project Planning: Develop a highlevel project schedule to prepare PPCPs for sequencing of events and managing expectations.

• Project Monitoring: Coaching PPCPs through the phases of implementation and acting as an advocate with the EHR vendor.

• Meaningful Use Reporting: Assist PPCPs with making progress toward meaningful use.

Depending on the level of services required by the PPCP, some of these services will be offered to PPCPs at no cost to the provider as a part of the federal grant. Additional services above and beyond those covered by

the funding will be available to PPCPs at prenegotiated rates. The LEC will not pay for the cost of the EHR, nor will the LEC become a part of the contract between the PPCP and the EHR vendor. The LEC’s role is to provide education and support to PPCPs as they navigate through the purchase and implementation of an EHR system and achieving meaningful use.

CalHIPSO will be supporting the operations of the LECs through organizing a statewide group purchasing effort and providing best practice tools and templates designed to reduce the complexity of installing and using EHRs. In San Diego and Imperial counties, the San Diego County Medical Society Foundation (SDCMSF) and the Community Clinics Health Network (CCHN) have jointly applied to be an LEC. SDCMSF will provide services to private physicians, and CCHN will provide services to clinics. SDCMSF, which serves all physicians regardless of membership status in SDCMS, is SDCMS’ nonprofit, 501c3 arm. SDCMSF’s mission is to address unmet San Diego healthcare needs for all patients and physicians through innovation, education, and service.

If you are interested in learning more about the LEC or signing up, please contact Kitty Bailey at KBailey@sdcms.org or (858) 300-2780.

In San Diego and Imperial counties, the San Diego County Medical Society Foundation and the Community Clinics Health Network have jointly applied to be an LEC.

A Priority Primary Care Provider is defined as a licensed clinician with a primary care practice (internal medicine, family practice, OB/GYN, pediatrics, geriatrics) and prescriptive privileges (MD, DO, NP, PA) who works in the following practice care settings: 1. private physician practice of 10 or fewer 2. nonprofit primary care clinics, including community health centers and rural health clinics 3. the ambulatory care clinics associated with public, rural, and critical access hospitals If you are a primary care provider working in a practice with 10 or fewer providers, CalHIPSO and the LEC can provide neutral, trusted information and assistance with implementation of EHR and meaningful use regardless of where you are in the process. To learn more, contact Kitty Bailey, SDCMSF executive director, at KBailey@SDCMS.org or at (858) 300-2780.

July 2010 SAN DIEGO P HY SICIA N. o rg

35

Health Information Technology

Telemed Closing in on Distance Medicine

By Brett C. Meyer, MD, and Larry S. Friedman, MD

36

S AN D I E G O P HY S I CI A N . or g july 2010

dicine

elemedicine has the potential to expedite and improve the delivery of high-quality, cost-effective care by extending the reach of practitioners beyond their local practice, using advanced information technologies.

The promise of telemedicine and the availability of funding in recent years have prompted many clinical practices and hospitals to make up-front investments in the hardware and software to connect providers and patients; even so, telemedicine has yet to become a standard approach to care delivery, and in many cases this technology is still sitting in a corner, unused.

That’s not to say there isn’t substantial progress. Today there are an estimated 200 telemedicine networks operating in the United States (excluding radiology networks), linking more than 2,500 institutions, and involving more than 50 subspecialties.

Lawmakers and interested parties are as well working to streamline the credentialing and privileging process for physicians who provide telemedicine services, one of the issues with remote practice relationships.

The STRokE DOC Experience

As the leader of a long-term National Institutes of Health study called STRokE DOC (Stroke Team Remote Evaluation using a Digital Observation Camera), the UC San Diego Health System became an early advocate of telemedicine as a highly effective way to deliver specialty care to remote, medically underserved populations.

The STRokE DOC clinical trial used a huband-spoke model, linking UC San Diego Medical Center stroke specialists (the “hub”) from their desktop or laptop computer, to partner EDs at remote locations (the “spokes”). The system — developed in collaboration with the California Institute for Telecommunications and Information Technology (Calit2), Qualcomm and BF-Technologies, Inc. — allowed us to respond to an emergency page from any location, even using wireless technology. A mobile camera server with an intravenous-pole design placed at the foot of the patient’s bed at the remote site enabled

July 2010 SAN DIEGO P HY SICIA N. o rg

37

From wellestablished radiology networks that enable the viewing of images across continents, to the emerging field of robotically assisted tele-surgery, telemedicine is transforming medical practice

two-way communication. Highly sophisticated video, audio, and internet technology can transmit high-resolution images and real-time data. We can view physical signs of a possible stroke, the CT scan images of the patient’s brain, and other test results to assess the patient’s condition. The medical team, the patient, and family members can see, hear, and communicate directly with the stroke specialist, providing valuable information that can help establish an accurate diagnosis and determine the most effective intervention.

The results of our NIH-funded study, published in Lancet Neurology, showed that these telemedicine evaluations led to far better decision-making than telephone consultations, with our stroke team consultation resulting in the correct decision regarding stroke treatment more than 98 percent of the time, compared to only 82 percent of the time with telephone consultation. For rural areas and other communities where stroke specialists are not available to provide an emergency evaluation in person, this solution could have an immediate and profound impact on the treatment and recovery of stroke patients.

As our study and other successful telemedicine initiatives show, the technology has advanced to the point where today a provider can just as easily be examining a patient in the clinic or evaluating a patient at a distant site through a real-time, web-based connection. Electronic medical record integration adds to a successful program, enabling a standardized, optimized, clinical computing experience.

The Challenges

While the promise of telemedicine is clear — from expediting the secure exchange of patient information, including images and lab results, to providing specialty consultation in areas lacking the full spectrum of healthcare resources — the challenges preventing widespread application are real. But, as the demand for efficient, cost-effective telemedicine services grows, with consumers, employers, and payers recognizing the value of distance medicine, providers will need to be prepared to link into established telemedi-

38

S AN D I E G O P HY S I CI A N . or g july 2010

cine networks or “grow their own.” Some of the components of a successful program are access to advanced technology and adequate training, a business plan with a sustainable financial model, a clinical infrastructure adapted to support a telemedicine practice, and patient acceptance.

To begin with, for any provider to opt into a telemedicine partnership, the program must be financially sustainable. Reimbursement models, especially those dependent upon third-party payers, are variable, but increasingly we are seeing public and private insurers covering telemedicine consults.

Contracts and service agreements provide another model of reimbursement for certain types of programs. Many of us are working with lawmakers and industry representatives to influence payment methodologies for telemedicine services, and we are beginning to see expanded coverage for these types of services.

Access to advanced technology linked with integrated health information systems, and an efficient practice model with clear standards and guidelines, are also key elements of a successful telemedicine program.

A Workable Model

To accelerate the adoption of telemedicine as a major element of clinical practice, the UC San Diego Health System has established a centralized, standardized telemedicine program called UCSD-AnyWhere, a “plug-andplay” model for UC San Diego practitioners who want to expand their expertise to community partners in need by developing a telemedicine partnership. As a first step, we have developed a comprehensive and detailed clinical infrastructure handbook outlining workflow, standards, and documentation requirements; technology specifications; a training plan, and guidelines for external contracting with telemedicine partners.

Using this model, we have established a successful tele-psychiatry partnership with an Indian health center in northern California. When we began, patients had a sixmonth wait to see a specialist. Today, we have been able to respond to urgent appointment requests within minutes. We have a novel interface with the electronic medical record

and a feature that allows the remote clinic to immediately access clinic notes, enabling the patient’s personal physician to act quickly based on the specialist’s evaluation. We are bringing additional clinical subspecialties into this partnership, and we are in discussions with other external partners to develop similar agreements.

At UC San Diego, our focus is to develop systems and technologies that extend the delivery of high-quality specialty care to distant partners, and also to provide training for our colleagues. “Tele-education” will be a focus of the new Medical Education and Telemedicine Building currently under construction on the School of Medicine campus, as part of

our role in the Southern California Telemedicine Learning Center.

From well-established radiology networks that enable the viewing of images across continents, to the emerging field of robotically assisted tele-surgery, telemedicine is transforming medical practice. Future practitioners will not be constrained by geography.

New generations of patients will not only be comfortable seeking medical consultations and interventions online and across distances, they will demand it. Our mandate today is to create practice models that keep pace with the technology, while maintaining high quality and safety standards, and ensuring financial viability.

For rural areas and other communities where stroke specialists are not available to provide an emergency evaluation in person, this solution could have an immediate and profound impact on the treatment and recovery of stroke patients.

July 2010 SAN DIEGO P HY SICIA N. o rg

39

Project Access

San Diego

Volunteerism Made Easy The heart of the program is to link low-income, uninsured adults in San Diego County with specialist volunteers who agree to see a limited number of patients per year in their office for free.

• Physician Volunteer Flexibility: Physicians set their own volunteer commitment (ideal is one patient per month). Project Access patients are seen in the private office setting so you do not have to travel far to provide care for the medically underserved.

• Enrolling Patients Based on Need: Patients are referred to us exclusively from the community clinics in the area and do not qualify for any type of public health insurance program. Specialty care is a significant challenge for the clinics, and many patients endure wait times of up to six months to see a volunteer specialist at their clinic.

• Making Appropriate Referrals: Project Access publishes referral guidelines for community clinic

use. Our Chief Medical Officer also reviews each case individually so that specialists see only the most appropriate referrals.

• Providing Enabling Services: We provide services such as transportation and translation so that you don’t have to wonder if a patient is going to miss an appointment or if there will be a language barrier.

• Providing Case Management Services: We work with each patient one-on-one to coordinate followthrough on all medical needs.

• Providing All Needed Services: Through our partnerships, we ensure that a full scope of services is available to all of our patients, from hospital and ancillary services to a defined pharmacy benefit.

Join over 75 specialists as a Project Access volunteer!

Project Access is actively recruiting physicians, hospitals, and ancillary service providers to participate in our program.

Together we can ensure that our vulnerable populations have access to needed healthcare services.

Your commitment to Project Access is needed for our success! Please visit our website at SDCMSF.org to learn more and to sign up.

Sign up NOW at SDCMSF.org We need your volunteer commitment to help even one patient.

Our Medical Community Liaison, Rosemarie Marshall Johnson, MD, can answer your questions. Dr. Johnson can be paged at 619.290.5351. You may also contact Lauren Radano, Healthcare Access Manager, at 858.565.7930.

40

S AN D I E G O P HY S I CI A N . or g july 2010

Professional Services Absolute Solutions

Sexuality Clinic of San Diego Cognitive/behavioral/psychodynamic therapy allows for understanding and treatment of sexual dysfunction, sexual addiction, and mental health problems.

Relationships with others kindle thoughts in our minds about one’s self. The dramas are powerful and maintain their status at various levels of one’s psyche resulting in sexual and psychological turmoil. The therapeutic relationship with Dr. Silbert rn,cns,phd,faacs, promotes healing by trusting expression and freedom of the authentic self.

Absolute Solutions is a full-service consulting and outsourcing company dedicated to the healthcare industry. Our billing service uses state-of-the-art technology to ensure code validation, electronic submission/remittance, patient statements, structured follow-up/ appeals, electronic document storage and meaningful reporting. Consulting services include business development, credentialing, contracting, executive assistant, financialoperational practice management, relocation coordination and much more. Contact us today for your free consult!

619.326.0700 | www.abs-sol.com

858.483.1430 | www.sextherapyofsandiego.com

Practice Management Consulting

Practice Performance Group

Absolute Solutions International

✓✓ Physician and support productivity ✓✓ Money transaction integrity and effectiveness ✓✓ Support team organization and motivation ✓✓ Management and physician recruiting ✓✓ Group practice formations, acquisitions, sales and mergers ✓✓ Mediation and litigation support

Scalable Outsourcing for Every Practice.

Do you wish you had 10 more hours in your day? ASI can give you all the time your business needs! Services starting as low as $8.00 per hour total cost!

• Accounts Receivable • Demographic Entry • Database Clean-up • Fee Schedule Updates • Online & Telephone • Payment Posting • Special Projects

858.459.7878 | www.PPGConsulting.com

Looking for a costeffective way to reach 8,500 physicians each month?

Place your message here in the Professional Services page of San Diego Physician magazine.

Rates starting at $250 for a six time contract.

Contact: Dari Pebdani 858.231.1231 or DPebdani@sdcms.org

Call 619.326.0700

Your Company Name Here

Your logo here

Professional Services page ads: • Are cost effective • Target physicians and their staff • Get you monthly exposure • Build your business • Start at $250/month for six issues

Your Contact Info Here July 2010 SAN DIEGO P HY SICIA N. o rg

41

classifieds office space SCRIPPS ENCINITAS CONSULTATION ROOM/ EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703] NEW COMMERCIAL BUILDING IN LA MESA • SPACES FOR RENT/PRE-LEASE: Very close to Grossmont Hospital and highways 8 and 125. New building being constructed at 5980 Severin Dr., La Mesa. Near corner of Severin Dr. and Amaya, just north of the Brigantine restaurant. Beautiful and functional design. Spaces available from 1,000 to 5,500ft2. Pre-leasing/renting spaces. Call Nathan at (619) 787-3422 or email hythams@att.net. [823]

NEW MEDICAL BUILDING ALONG I-15: Pinnacle Medical Plaza is a new 80,000 SF building recently completed off Scripps Poway Parkway. The location is perfect for serving patients along the I-15 from Mira Mesa to Rancho Bernardo and reaches west with easy access to Highway 56. Suites are available from 1,000—11,000 SF and will be improved to meet exact requirements.

FREE RENT INCENTIVES and a generous improvement allowance is provided.

For information, contact Ed Muna at 619-702-5655, ed@lankfordsd.com www.pinnaclemedicalplaza.com SHARE OFFICE SPACE IN LA MESA — AVAILABLE IMMEDIATELY: La Mesa (Grossmont Hospital Campus) 1,400ft2 available to an additional doctor. Separate receptionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice compatible with OB/ GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648] OFFICE SPACE IN LA JOLLA: Beautiful bright office, with natural light, perfect for a plastic surgeon or other specialties. Ground level medical office complex (UTC area) across from the Hyatt Regency La Jolla at Aventine. Mult-specialty building. Several plastic surgeons in building. Two surgical centers on site. Ample free parking. From 1,100ft2 — 5,400ft2 / divisible. For further information, call Sidney H. Levine, MD, at (858) 457-4040 or visit 8929 University Center, Suite 100/104, San Diego, CA 92122 (slevine@northcountyomg.com) — ask for Helen. [819] MEDICAL OFFICE BUILDING WITH AN ONSITE SURGICAL CENTER: Prime spaces on the third and fourth floors in the heart of San Diego.

Signage available on heavily traveled Kearny Villa Road. Great location, close to freeways, I-805, and I-163. Nearby Sharp Hospital. Immediate occupancy available. Free rent! Visit www.PromusCommercial. com for pictures and details, or email Scott Cook at

(858) 751-6300 or at Scott@PromusCommercial. com. [813] MEDICAL OFFICE SPACE AVAILABLE PART TIME TO SHARE IN SOLANA BEACH: Excellent location off I-5 by coast. Space includes three fully equipped exam rooms, waiting room, lunchroom, two bathrooms. Available all day Thursdays and other days half-day flexible schedule. Great opportunity for a start-up practice that can’t fill a full-time schedule. Affordable rent and flexible arrangements.

Call (858) 259-9708 or email solanabeachmed@sbcglobal.net for more information. [811] OFFICE SPACE IN HILLCREST: Office space available for a physician with an established primary care practice in Hillcrest, located near Scripps Mercy and UCSD. Turnkey opportunity with excellent staff, state-of-the-art office and equipment. Please send letter of interest to KLewis@sdcms.org. [810] OFFICE SPACE TO SHARE: Currently occupied by orthopaedic surgeon. Great location close to Scripps/Mercy and UCSD Hospital. Looking to share with part-time or full time physician. Fully furnished, fully equipped with fluoro machine and 4 exam rooms and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] MULTI-SPECIALTY MEDICAL OFFICE SPACE AVAILABLE IN BANKER’S HILL AREA: Large office with view of San Diego harbor, eight fully equipped exam rooms, lab on site, and underground parking. Please contact Chris Bobritchi at (619) 2334044 or at hivdocs@yahoo.com. [767] 1,200FT2–1,600FT2 OF OFFICE SPACE IN EAST SAN DIEGO/LA MESA AVAILABLE FOR LEASE: Ideal as a satellite clinic or administrative office, on University Ave. near 70th St. Very visible tower signage provides outstanding visibility and exposure to cars and pedestrians on University Ave. Adjacent to a pediatrics office, and with easy access from Highways 8, 94, 125, and 15, Alvarado and Grossmont College, La Mesa, El Cajon, Spring Valley, Lemon Grove, points south and north. Plenty of parking and directly across from the Joan Kroc Recreation Center (over 3,000 families visit each week). Fixed rent for three years $1.95/ft2 per month, includes lighted tower signage, and NO additional charges for common areas or services. Please contact Venk at (619) 504-5830 or by email at venk@gpeds.sdcoxmail.com. [777] PHYSICIAN POSITIONS AVAILABLE PHYSICIANS WANTED: Founded in 1972 in North San Diego County, California, Vista Community Clinic is a private, nonprofit medical, dental, and social services center, including advocacy and education programs. We serve people who experience social, cultural, or economic barriers to healthcare in a comprehensive, high-quality setting. We provide the highest quality services in five different locations throughout Vista and Oceanside. We currently have openings for part-time and per-diem physicians in the following specialties: family medicine, OB/GYN medicine, and pediatric medicine. All candidates must hold a current Calif. license and DEA license.

Malpractice coverage is provided by the clinic. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414 3702. Visit our website at www.vistacommunityclinic.org. EOE/M/F/D/V [821] MEDICAL DIRECTOR: Licensed physician for busy outpatient substance abuse program. Treatment for opiate addiction — Methadone and Suboxone — MAT format. Thirty-two hours a week. San Diego and El Cajon locations. Contact DWhitmyer@CRCHealth. com or (619) 718-9895. [820] UROLOGIST NEEDED IN CHULA VISTA NOW: Huge potential for association with very busy urologist in practice in Chula Vista since 1977. Next to Scripps Mercy Chula Vista. Full time or locum tenens or part time. Could be just busy office practice and/or very active urological surgical practice. We have more urology work than we can handle. No Medi-Cal or Medi-Cal HMOs. Little managed care.

30% cash practice with potential to expand cash business. Contact Bayside Urology at (619) 4200201, fax (619) 425-7795, or email dbhcv@pacbell. net. Talk with Dr. Dan. Shareholder status or just employee. [815] PART-TIME AND FULL-TIME OPENINGS FOR PRIMARY CARE PHYSICIANS: Board-certified family practice or internal medicine physicians wanted to join our prominent East County private medical group. One year or more experience preferred. Located on the Grossmont Hospital campus, our primary care group practices full-spectrum family medicine, including hospital care. Sharp Community Medical Group providers. Ownership opportunities available. Interested applicants please send CV to brad.kesling@gfmg.net. For further information, visit us at www.gfmg.net. [808] GREAT FP OPPORTUNITY IN RAMONA: Immediate opening for CA-licensed physician in thriving family practice with small-town, rural atmosphere.

We are flexible and friendly with excellent working conditions, loyal staff, and wonderful patients. No hospital work, easy call, attractive compensation package. Email fredarsham@hotmail.com. [807] UNIQUE, PART-TIME INTERNAL MEDICINE OPPORTUNITY IN NORTH SAN DIEGO COUNTY: Tired of working too much? Want more flexibility?

Then this may just what you’re looking for. Wellestablished internal medicine practice in North County seeking part-time, board-certified internist on a long-term basis. This is a rare chance to enjoy the rewards of private practice in a well-respected, single-specialty group setting and still have plenty of free time for other work or family commitments.

If interested, call (619) 248-2324. [806] URGENT CARE PHYSICIAN NEEDED ON A LOCUM TENENS BASIS FOR 4–5 SHIFTS PER MONTH: The location of the urgent care is in the north county coastal area of San Diego County.

Please visit our website at www.cassidymg.com for information on the group and hours of the urgent care. If interested, please send CV to judy@ cassidymg.com or fax to (760) 630-2558, attention: Judy Krueger, Executive Director. [803]

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

42

S AN D I E G O P HY S I CI A N . or g july 2010

SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT 3.5 DAYS PER WEEK POSITION (TO START): Private practice in La Mesa seeks pediatrician 3.5 days per week (to start) on a PARTNERSHIP track. Practice pediatrics in a modern office setting with a reputation for outstanding patient satisfaction for 14 years. Dedicated triagepharmacy-referrals and education nurse takes routine calls off your hands, leaving you to focus on direct, quality patient care. Nine office staff provide experienced, attentive support. Clinic care is three patients per hour, 1-in-3 call is minimal, rounding at Sharp Grossmont on newborns, no high-risk delivery attendance (ALS nurse team present), all make for a very tolerable practice profile. Benefits include paid tail coverage included professional liability insurance, paid holidays/vacation/sick time off, paid practice expenses, professional dues, health and dental insurance, uniforms, CME, disability and life insurance. Please contact Venk at (619) 504-5830 or by email at venk@gpeds.sdcoxmail.com for a July–September placement. [778] PRACTICE FOR SALE DEL MAR-AREA GENERAL PRACTICE: Prime location, huge potential for practice expansion in fast growing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 7550510. [185]

Family Practice for Sale in Grossmont: Solo Family Practice located on Grossmont Hospital Campus.

Established in 2002, huge potential for expansion. Well-established patient base; EMR implemented in 2006; extremely efficient staff; lots of parking; 1250sq ft office space fully equipped and patient ready.

Inquiries call Stacey @ 619-994-3233 or via email stacey.ks@sbcglobal.net.

NONPHYSICIAN POSITIONS AVAILABLE SEEKING MEDICAL TECHNOLOGIST: We are seeking a highly motivated and skilled medical technologist to join our team. We are a busy, five-physician internal medicine practice with an in-house lab, and we are looking for a candidate with five years of experience performing basic chemistries and hematologies, as well as other job functions pertinent to this position. We offer competitive pay and benefits. If interested, please email your resume with salary history to Lydia Gormish (office manager) at idiagormish@cox.net and Kathy Fisher (administrative assistant) at kfisher_sd@hotmail.com. [812] NURSE PRACTITIONER: We are looking for a nurse practitioner with at least two years experience in OB/GYN mandatory. Please call Valerie at (858) 618-1156, ext. 105 or email vrizzotto.kohatsu@ yahoo.com. [805] MEDICAL EQUIPMENT BONE DENSITOMETER: Hologic. Full size hip and spine. Slightly used. $12,000. Call (760) 703-0691.

[755]

OLYMPUS ELF P3 FIBEROPTIC NASOPHARYNGOSCOPE GREAT CONDITION: Lightly used.

Halogen light source, clear Lucite wall stand, carrying case, and all accessories included. Online comparable cost is $3450. Asking $2,750, OBO. Call (858) 277-8600, ext. 4. [817] BIOMERIDIAN MSAS VANTAGE ELECTRODERMAL INSTRUMENT PACKAGE: Includes the instrument, the Epic Probe, hand mass, stylus, and the slim external hard drive. Installed programs in

the computer are Microsoft Windows XP, Symptom Survey Maestro, and MSAS 2007. Included literature: MSAS Vantage Operator’s Manual, BioMeridian Basic Training Manual, Epic Addendum, Protocol Addendum and the Virtual Library Addendum for Metagenics and HEEL products. This system is in excellent condition and is being sold because it is just underutilized in the practice. The asking price is $4,000. A mobile stand and printer for the instrument is included. Monitor is not but is typically at 99-120. Call (858) 277-8600, ext. 4. [818]

Increase Your Referral Business San Diego Physician is the only publication that is distributed to all 8,500 practicing physicians in San Diego County.

Advertising is a cost-effective and profitable way to increase your referral business.

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

July 2010 SAN DIEGO P HY SICIA N. o rg

43

messagefromthepresident

By Susan Kaweski, MD

“Individually, We Are One Drop, but Together We Are an Ocean.”

United We Must Be, Especially in These Tumultuous Times

Note: This speech was delivered by Dr. Kaweski at her installation as SDCMS president for 2010–2011 at our inaugural “White Coat Gala” on Saturday, June 5, 2010.

I

am truly and humbly honored to represent the physicians of San Diego County as your president. Tonight is our White Coat Gala. White coats remind me of the excitement of our medical school days, of the privilege of serving others through being a physician, of the value of being kind, caring, and compassionate, and of the importance of professional growth and reflection.

Sometimes my white coat feels tattered, its fabric torn by the death of a loved patient. Some days it’s wrinkled, exhausted by long hours and emotional drain. Sometimes it’s my energy source that keeps me going.

Sometimes it’s my protective shield from disease. And sometimes it’s a comforter warmed by the generous hugs of my patients.

Our white coat is viewed as the “cloak of compassion,” and a symbol of the caring and hope that patients expect to receive from us, their physicians. Even when we are not wearing it, our patients see it on us. It is our badge of honor and pride, and unites us as a profession.

And united we must be, especially in these tumultuous times. We will only prevail in our efforts to expand access to healthcare, stop the incursion of insurance companies into the doctor-patient relationship, and improve the public health if we are unified.

Integrated advocacy is critical to our success. We must work together to a common good. Contributing to our PAC is important

44

S AN D I E G O P HY S I CI A N . or g july 2010

because it represents the model of what we must do to meet our objectives.

This inaugural marks our 140th year as the San Diego County Medical Society. It all began on July 19, 1870, with 10 members who elected Dr. David Bennett Hoffman, a graduate of Toland Medical College in San Francisco, as their president.

In order to qualify for membership, a physician had to have a good primary education, a diploma from a medical school of good repute, and good professional and moral standing in the community. Not much has changed!

Today the San Diego County Medical Society touts 2,444 members and represents 30 specialty societies. We are only 76 members behind Los Angeles County in membership because we have demonstrated the first-rate value of our membership. Our organization makes sure our doctors have information, opportunities, educational resources, and discounts.

Advocacy skills are provided to help our legislative, legal, membership, and communications agendas.

But physicians have to participate in order for it to work. Remember, “Individually, we are one drop, but together we are an ocean.”

So wear your white coat with distinction and professionalism, and be proud to be a member of our organization.

CAP is ...

Award-Winning Risk Management Assertive Claims Defense The Dedicated Legal Power of Schmid & Voiles An Insurance Agency for Physicians and their Practices Superior Financial Stability A State and Federal Advocate for California Physicians More Than 10,500 Members Strong

MPT

and so much more.

Mutual Protection Trust (MPT) is the nation’s only physician-owned medical professional liability provider Rated A+ (Superior) by A.M. Best!

Superior Physicians. Superior Protection.

SAN DIEGO ORANGE LOS ANGELES PALO ALTO

800-252-7706 www.cap-mpt.com/physicians

SACRAMENTO The Mutual Protection Trust (MPT) is authorized under Section 1280.7 of the California Insurance Code as an unincorporated interindemnity arrangement among physician members of the Cooperative of American Physicians, Inc. (CAP). Members do not pay insurance premiums. Instead, they pay tax-deductible assessments, based on risk classifications, for the amount necessary to pay claims and administrative costs. No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement. ©2010

June July 2010 SAN DIEGO P HY SICIA N. o rg

45

$5.95 | www.SANDIEGOPHYSICIAN.org San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA 92123 [ RETURN SERVICE REQUESTED ]

PRSRT STD U.S. POSTAGE PAID DENVER, CO PERMIT NO. 5377

Mutualinterest Your reputation matters. Period.

Some insurers cap their defense costs or take them from your coverage limits.

NORCAL Mutual does not. We are committed to protecting you regardless of the cost.

There is no cap on the value of the reputation you’ve earned.

Call NORCAL Mutual today at 800.652.1051. Or, visit www.norcalmutual.com.

46

S AN D I E G O P HY S I CI A N . or g july 2010