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

august 2010

official publication of the san diego county medical society

: f l e S o t Note

e c i f f O d in m e R Manager SDC MS Here to Help Pass Along T his Issue . . .

“Physicians United For A Healthy San Diego”

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





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S A N  D I E G O  P HY S I CI A N .or g a u gu st 2010

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


thismonth Volume 97, Number 8



Office Manager Advocacy 24 Your SDCMS Office Manager Bulletin Board by Sonia Gonzales 26 A Medical Office Manager’s Job Is Never Done: SDCMS Member Office Managers Sound off on Their Challenges, Frustrations, Goals, and Successes by Sonia Gonzales 34 SDCMS Seminar Calendar for 2010-11



y c a c o A dv



36 Become a Certified Medical Insurance Specialist • February 2011 37 Become a Certified Medical Coder in Five Days! • October 2010 38 Nominations Being Accepted for Our 2nd Annual “Outstanding Medical Office Manager” Contest

departments 4 Contributors This Issue’s Contributing Writers 6 SDCMS Seminars, webinars, and Events 8 Community Healthcare Calendar 10 Briefly Noted Text4baby, SDCMS Benefit Spotlight, and More … 14 MODE OF PRACTICE A Dinosaur Wth Her Shingle 16 AMERICAN MEDICAL ASSOCIATION June 12–16, 2010, Annual Meeting Highlights 18 Healthcare Financing EA Health On-call Management in San Diego County

44 2

S A N  D I E G O  P HY S I CI A N .or g a u gu st 2010

35 ARE YOU TAKING ADVANTAGE OF Your SDCMS-CMA Member Benefits? 42 PHYSICIAN MARKETPLACE Classifieds 44 Public Health It’s Up to Us: Addressing Mental Health in San Diego County

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


contributors SYLVIA ALDAMA


Ms. Aldama is an office manager for two SDCMS-CMA member physicians.

Ms. Rader is the office manager for two SDCMS-CMA member physicians.



Ms. Binkowski is the office manager for two SDCMS-CMA member physicians.

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@

Dr. Ray, SDCMS-CMA member since 1993, is board-certified in family medicine and has been a family physician since 1978 with the Southern California Permanente Medical Group at Kaiser Permanente, San Diego. He is a clinical professor in the Department of Family and Preventive Medicine at the UC San Diego School of Medicine, served as president of the San Diego Academy of Family Physicians and as president of the San Diego County Medical Society. Dr. Ray is currently a CMA trustee, an AMA alternate delegate, and a member of the SDCMS Foundation board of directors.



SHERRY L. FRANKLIN, MD Dr. Franklin, SDCMS-CMA member since 2002, is a pediatric endocrinologist in solo practice in San Diego.


Dr. Gruen, SDCMS-CMA member since 2010, is CEO and president of EA Health Corporation and medical director of emergency services at Sharp Memorial Hospital.


Ms. Riley is the office manager for an SDCMS-CMA member physician.

LISA SULLIVAN Ms. Sullivan is the office manager for three SDCMS-CMA member physicians.

Ms. Haupert is the office manager for 11 SDCMS-CMA member physicians.



Ms. Thompson is the office manager for an SDCMS-CMA member physician.

Dr. Lewis, SDCMS-CMA member since 2009, is the behavioral health clinical director of the County of San Diego Health and Human Services Agency.

Mr. Villa is the practice administrator for an SDCMS-CMA member physician.




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 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 (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, Mihir Y. Parikh, MD (A: Carol L. Young, MD (sdcms foundation president), Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Alan A. Schoengold, 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

Ms. Marin is an office manager for two SDCMS-CMA member physicians.

DEBBIE MORGAN Ms. Morgan is the practice manager for an SDCMS-CMA member physician.

VICKY MORGAN Ms. Morgan is the office manager for an SDCMS-CMA member physician.

Ms. Williams is the office manager for an SDCMS-CMA member physician.

GINNIE YEE Ms. Yee is an associate vice president of the California Medical Association (board of trustees, executive committee, and American Medical Association).

editor to S A N  D I E G O  P HY S I CI A N .or g a u gu st 2010

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

››Send your letters to the 4

CMA Speaker of the House James T. Hay, 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 All advertising inquiries can be sent to San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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“CHMB has been our trusted partner for more than “business CHMB has been our trusted six years.partner It madeforperfect sense business more than that when It wemade decided to move six years. perfect sense forward with EHR in our practice, that when we decided to move we entrusted our implementation forward with EHR in our practice, of Allscripts to them as well. They we entrusted our implementation have been there for us of Allscripts to them asevery well. step They of the way!” have been there for us every step of the way!” ELIZABETH SILVERMAN, MD Partner ELIZABETH SILVERMAN, MD North County OB/GYN Medical Group Partner

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




Free to Member Physicians and Their Office Staff! Don’t See What You Need? Let Us Know!

For further information, visit or contact Sonia Gonzales at (858) 300-2782 or at

SDCMS Seminars / Webinars / Events Date





AUG 18


11:30am – 1:00pm

OSHA Refresher Course

Tom Gehring, SDCMS



AUG 25


11:30am – 1:00pm

HIPAA Updates Course

David Ginsberg, PrivaPlan



SEP 11


4:00pm – 7:00pm

Young Physician Summer Social


SEP 13


11:30am – 1:00pm

CMA Counsel Speaks on ACOs

Francisco Silva, Esq., CMA

SEP 15


11:30am – 12:30pm

E-town hall (T)

Tom Gehring, SDCMS

SEP 16


11:30am – 1:00pm

Palmetto / Medicare

Michele Kelly, California Medical Association


SEP 18


9:00am – 12:00pm

Media Training

Tom Gehring, SDCMS


SEP 30


11:30am – 1:00pm

“The Art of the Appeal” (Billing)

Sandie Hunnicutt, MedVision, Inc.


8:00am – 4:00pm

Certified Medical Coder Course

Practice Management Institute



x x





11:30am – 1:00 pm

Economic Survival




OCT 27


11:30am – 1:00pm

“Scope/Allied Health Professionals” (Legal Issues)

California Medical Association





11:30am – 1:00pm

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

Alexander & Alexander, Attorneys At Law



NOV 12


6:00pm – 9:00pm

Membership Social (T)

SDCMS (Location TBD)

NOV 17


6:30pm – 7:30pm

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

The Doctors Company


NOV 18


11:30am – 12:30pm

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

The Doctors Company


NOV 20


8:00am – 4:00pm

“Preparing to Practice” Workshop

Multiple Presenters, SDCMS

S A N  D I E G O  P HY S I CI A N .or g a u gu st 2010




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


S* W* E*



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



To submit a community healthcare event for possible publication, email All events should be physician-focused and should take place in San Diego County. Prescription Drug Abuse Prevention Summit AUG 13 • Four Points by Sheraton San Diego •

Learn How to Become a POLST Trainer (Physicians Orders for Life-Sustaining Treatment) AUG 19 • SDCMS Meeting Room • CME/CEU Provided • $25 • Contact Nathalia Aryani at (858) 300-2789, at, or Visit

Protect Your Company’s Assets AUG 19 • HRFlyerSDCMS.pdf

The Permanente Federation 12th National Hospital Medicine Conference SEP 2–3 • Hotel del Coronado •

Meeting of the San Diego Chapter of the California Branch of Physicians for a National Health Plan SEP 4 • (858) 454-4473 or

Southwest Regional Integrated Behavioral Health Conference SEP 8–9 • Crowne Plaza Hotel, San Diego • $299 •


S A N  D I E G O  P HY S I CI A N .or g a u gu st 2010

SBIRT Conference (Screening, Brief Intervention, Referral to Treatment)

Cutting Edge Strategies in Diabetes Care: Making the Connection

SEP 9–10 • San Diego Marriott Mission Valley •

OCT 30 • San Diego Convention Center •

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

Sharp Grossmont Hospital Vascular Conference 2010: “Advancing Awareness, Prevention and Treatment of Vascular Disease”

SEP 25 • Skaggs School of Pharmacy, La Jolla •

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

NOV 6 • Hard Rock Hotel, San Diego, 207 5th Ave. • (619) 740-4550 or

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

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

Challenges in the Perioperative Management of OSA Patients

NOV 11–13 • Omni San Diego Hotel • cme.

OCT 15 • Location TBD •

The Complete Scope of Cosmetic Surgery (CACS 11th Annual Meeting) Oct. 15–17 • Hard Rock Hotel, San Diego • 17 Hours CME •

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

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

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

FAST. ACCURATE. POWERFUL. THAT’S HOW CANCER TREATMENT SHOULD BE. At San Diego Radiosurgery, we offer treatment using the Novalis Tx platform for image-guided radiosurgery. Novalis Tx incorporates advanced imaging, treatment planning, and treatment delivery technologies from Varian Medical Systems and BrainLAB, enabling fast, highly precise, non-invasive radiosurgery treatments for cancers and other conditions in the brain, head, neck and body. Offering a dose rate of 1,000 MU per minute, Novalis Tx is the most powerful and fastest radiosurgery system available, penetrating deeper to treat tumors previously considered inoperable. Call or visit our website for more information. Palomar Medical Center Department of Radiation Oncology 555 East Valley Parkway | Escondido, CA 92025 760-739-3835 /

San Diego Radiosurgery is a service of Palomar Medical Center.

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





Free Mobile Health Service to Reduce Infant Mortality Rate

Ever wonder how your patients’ cell phones can be a tool for better health? Text4baby, the first ever free mobile health service in the United States, is now available to pregnant women and new moms, providing timely and expert health information through SMS text through their babies’ first year. Text4baby is a partnership of the Healthy Mothers Healthy Babies Coalition, Centers for Disease Control and Prevention, the White House, the U.S. Department of Health and Human Services, Johnson & Johnson, and cellular phone service providers. By texting BABY to 511411 (or BEBE for Spanish), women receive three free SMS text messages each week timed to their due date or baby’s date of birth. These messages focus on a variety of topics critical to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, mental health,

oral health, and safe sleep. Text4baby messages also connect women to local prenatal and infant care services and other resources. Cell phones represent a great, yet still largely untapped tool for improving individuals’ health. More than 1.5 trillion text messages were sent in the United States in 2008. Nearly 90 percent of adults in the United States own a mobile phone, and 18 percent of American households rely only on a cell phone. Texting is especially prevalent among women of childbearing age and minority populations, who face higher infant mortality rates. “Getting connected to prenatal care and other services for a healthy pregnancy is a problem for a lot of women,” says Wanda Jones, principal deputy assistant secretary for health at the U.S. Department of Health and Human Services. “Text4baby provides pregnant women and new mothers with a new tool to obtain vital information that is critical to maternal and child health.” For more information on Text4baby or to get involved in the San Diego Text4baby coalition, contact Kitty Bailey, executive director, SDCMS Foundation, at

SDCMS Benefit Spotlight

Concierge Care for You and Your Office Manager Are you getting your reimbursement issues resolved? Do you have a question and don’t know where to begin? Does your office manager know she has an ally she can turn to? SDCMS physician members are invited to contact their full-time physician advocate, Marisol Gonzalez, to get answers to their questions, at (858) 300-2783 or at SDCMS physician member office managers are also encouraged to contact their full-time SDCMS office manager advocate, Sonia Gonzales, at (858) 300-2782 or at Both Marisol and Sonia are ready to help you and your office manager with your questions and concerns, free of charge. Another benefit of your SDCMS membership!


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

SDCMS Member Physician Publishes First Novel: Maimonides Rocks Dr. Steven Brozinsky, SDCMS-CMA member since 1987, has just e-published his first novel, Maimonides Rocks. Dr. Brozinsky is a gastroenterologist and serves on the board of directors of Sharp Chula Vista Medical Center. The novel is available in e-book reading formats, including online HTML and Java Script, Kindle, Epub, PDF, and more. To sample Maimonides Rocks, go to


Please Welcome Our New and Rejoining

SDCMS-CMA Members! Welcome Our New Members! Edwin Suwei Chen, MD Ophthalmology San Diego • (858) 793-0093 Michelle Lynn Matthews, MD Obstetrics and Gynecology San Diego • (858) 505-5500 Kang Zhang, MD Ophthalmology La Jolla • (858) 246-0814

Welcome Our Rejoining Members! Michael S. Bongiovanni, MD Orthopedic Surgery San Diego • (619) 299-3950 Sam Filiciotto, MD Surgery Poway • (858) 487-8741 Linda Louise Hill, MD Public Health and General Preventive Medicine La Jolla • (858) 534-9540

• 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 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

august 2010 SAN  DIEGO  P HY SICIA N. o rg


brieflynoted San Diego County Physician Directory 2010–11 Errata Please Update the Following SDCMS-CMA Member Listings: • BONGIOVANNI MICHAEL S MD {OrS}

T: 6192993950 F: 6192993951 A: 4065 Third Ave, Ste 101, SD 92103 N1: 1992772784 • CHENDRA SANDRY MD {IM} T: 6195285000

F: 6194096310 A: 4647 Zion Ave, SD 92120 N1: 1992872857 • GHOSH KRIS MD {ObG} T: 7604710200

F: 7604710211 W: A: 955 Boardwalk Dr, Ste 100, SM 92078 N1: 1760427884 N2: 1679512024 [GO]

Please Update the Following Nonmember Listings: • Atienza Pamela V MD T: 6196566817 F: 6196566908 A: 890 Eastlake Pkwy, Ste 200, CV 91914 N1: 1417916107 (Ped) • Blum Richard I MD T: 6192963888 F: 6192963898 A: 550 Washington St, Ste 423, SD 92103 N1: 1043310030 (IM/ Cv/CCEP) • Bulkin Anatoly J MD T: 7607397666 F: 7607397633 A: 625 W Citricado Pkwy, #203, ES 92025 N1: 1275593154 (VascS/S) • Chen Margaret K MD T: 7605208100 A: 460 N Elm St, ES 92025 N1: 1659305084 (IM)

• GIGLER VISHAKHA V MD {D} T: 7606343376

F: 7606347955 W: A: 477 N El Camino Real, Ste C204, EN 92024 N1: 1396774220 [DS] • HERBST KAREN A MD {IM} T: 6192581318

F: 6192980843 A: 4060 Fourth Ave, Ste 505, SD 92103 N1: 1285830505 • LOSADA MIGUEL A MD T: 6192822178

F: 6192822179 A: 3250 El Cajon Blvd, SD 92104 N1: 1558441915 [GP] • MANGANELLI MONIQUE L MD {IM/EDM}

T: 6194976188 A: 4060 Fourth Ave, Ste 508, SD 92103 N1: 1659487536

• Doshi Amol N MD T: 6195946681 F: 6195943638 A: SDSU Health Services, Calpulli Center, 5500 Campanile Dr, SD 92182 N1: 1164573234 (PHGPM) • Dozzi Paula A MD <Delete Listing> • Fortune Erin L MD A: 1809 National Ave, SD 92113 (Ped) • Gay Ted W MD T: 7608069263 F: 7608069264 A: 122 Civic Center Dr, Ste 101, VI 92084 N1: 1043382104 • Gross Erin A MD <Delete Address> • Kahn Bruce S MD T: 8587649080 A: 8311 Valley Centre Dr, SD 92130 (ObG) • Kuriyama Steve M MD T: 7608069263 A: 122 Civic Center Dr, Ste 101, VI 92084 N1: 1962412981 (Inf/IM) • Le Yung T. MD A: 4002 Vista Way, OS 92056N1: 1275607020 • Leung Albert Y MD T: 8586577030 A: 9310 Campus Point Dr, LJ 92037 N1: 1669491403 (PM/Anes)

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.


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010


T: 6194357100 F: 6194357115 E: jpedrotty@ A: 1222 First St, Ste 1, CO 92118 N1: 1992861629 N2: 1831125277 [DS/ SM/CAM] • ROBERTS KENDALL R MD {Ped}

T: 8584572043 F: 8584572092 A: 4150 Regents Park Row, Ste 355, LJ 92037 • WILSON STEPHEN C MD {S} T: 7608065660

F: 7606313435 A: 477 N El Camino Real, Ste B-303, EN 92024 N1: 1902810914 N2: 1861477846

• Marshall Catharine H MD T: 8584593710 F: 8584593706 A: 7300 Girard Ave, Ste 204, LJ 92037 N1: 1891877049 (Gy) • Moldovan Stefan MD T: 7607397666 F: 7607397633 A: 625 W Citricado Pkwy, #203, ES 92025 N1: 1245291624 (S) • Nurse Lesley A MD T: 6192051366 F: 6192051377 A: 1637 Third Ave, Ste F, CV 91911 N1: 1407865348 (ObG) • Ordonez Leonor A MD T: 6194293733 F: 6194293823 A: 949 Palm Ave, IB 91933 N1: 1992837629 (FM) • Simmons Sarah L MD <Delete Listing> • Smith Richard C MD T: 7608069263 A: 122 Civic Center Dr, Ste 101, VI 92084 N1: 1518979228 (Inf/IM) • Velesrubio Felisa U MD T: 7608069263 A: 122 Civic Center Dr, Ste 101, VI 92084 N1: 1508928227 (IM/Inf) • Yoo Richard Y MD A: 3250 Fordham St, SD 92110 (ObG/RE) • Zimbric Michael R MD <Delete Listing>

Birthday: SEPTEMBER 4 Congressman Bob Filner E: 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

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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 W • CEO/Executive Director Tom Gehring at (858) 565-8597 or COO/CFO James Beaubeaux at (858) 300-2788 or Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or at Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or SGonzales@ Director of Engagement Jennipher Ohmstede at (858) 300-2781 or at Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or at BUSINESS MANAGER Nathalia Aryani at (858) 300-2789 or administrative assistant Betty Matthews at (858) 565-8888 or at Letters to the Editor General Suggestions

SDCMSF Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 560-0179 W Executive Director Kitty Bailey at (858) 300-2780 or Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at project access PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or at Healthcare Access Manager Lauren Radano at (858) 565-7930 or at



0� ARY IN 201 ANNIVERS y Month Physicians Ever Reaching 8,500





10 M AY 20






SDCMS member physicians receive


advertising in this publication.

Contact Dari Pebdani at 858-231-1231 or

august 2010 SAN  DIEGO  P HY SICIA N. o rg


modeofpractice By Sherry L. Franklin, MD

A Dinosaur With Her Shingle

One Solo Practitioner’s Perspective 14

S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010


Solo practitioners were hit hard with the move to Health Maintenance Organizations and Foundation models for healthcare delivery. The recession of 2009 didn’t help matters. For the first time in U.S. history, doctors working as employees at large group practices outnumber solo practitioners. The proportion of physicians in solo and two-physician practices nationwide decreased from 40.7 percent in 1996–97 to 32.5 percent nearly a decade later, according to a study released by the Center for Studying Health System Change (Table I). Despite this trend, the economy and the reports that solo practitioners and small physician groups have lost the managed care battle, solo practice isn’t going extinct. The pendulum has swung, and my fellow solos are becoming more scarce, but don’t write our obituaries just yet. Some basic truths reveal the etiology for the pendulum swing toward larger groups. Small groups have minimal-to-no leverage in negotiating payment rates. Small pediatric groups face daily the fact that approximately 50 percent of California’s children are covered by the ever-shrinking Medicaid or Healthy Families reimbursement. Small groups lament daily that the cost of overhead is often more than they are able to produce in revenue. We are all constantly under the threat of double-digit rate cuts from Medicare, which secondarily threatens private contracting rates. If all that weren’t enough, increases in physician’s overall compensation have not kept up with inflation. So why haven’t all solos sold? Why haven’t we all been purchased by a Foundation? Why haven’t we all gone bankrupt? The answer: Regardless of the state of the pendulum at this moment in time, small business is and will always be the mainstay of the American economy and the core of entrepreneurship. The solo physician simply has to find the right niche at a time when the pendulum is so far from center. The mere mention of an entrepreneur in medicine assaults the sensibilities of many. We don’t like to think of physicians as profitdriven. We prefer the Marcus Welby persona, i.e., a compassionate, highly intelligent, cross-specialty trained person with an amazing bedside manner who is at the ready until the patient’s personal and professional life is in perfect order. If that isn’t enough, in a perfect world we would prefer to provide infinite care with-

out the burden of overhead. Remember the Marcus Welby shows? No matter whom the patient was, how much care was needed, how long they stayed in the hospital, or how many times they stopped by the office, no one ever had to pay for care.

For the first time in U.S. history, doctors working as employees at large group practices outnumber solo practitioners. Despite our belief in the Marcus Welby physician, all medical groups (large and small, profit and nonprofit, public and private) are profit-driven. Employees, rent, benefit packages, information technology, and a myriad of other hidden costs loom over the practice of medicine. All modes of practice incentivize in some way through salary changes, bonuses, paid vacation time, awards, advancements in title, and upward mobility in the group. In my opinion, that makes all modes of practice a business. The belief that a salaried physician has no financial incentives is folly for those who criticize physicians for wanting to make a good living, and still others who prefer to ignore the profit-driven motives of their employers and that they, too, are incentivized by those employers. Maneuvering the economic milieu is difficult for any business. My focus has been to move away from third-party payers and provide some uncovered services. Please note that I am not advocating all groups discontinue contracts. I am simply stating that as a solo physician, one might consider the option. To date, I have dropped my contracts with Blue Shield, Blue Cross, and a select number of Independent Physician Associations. This was terrifying, to say the least, as I had always been told that this was simply practice suicide in California. If I were allowed to share with you what Blue Cross and Blue Shield were paying me, you would applaud me for taking the leap of faith. I simply don’t have any negotiating power and can’t see enough patients a day to ethically and responsibly make up the difference. In all honesty, I lost some patients. However, those who stayed are happy and work in a partnership with me to cover the overhead of the practice. In return, I provide 24-hour-

a-day access to me via cell phone and email, state-of-the-art EMR, and same-day appointments for sick patients. Patients with mild-tomoderate diabetic ketoacidosis are brought in to the office for immediate management. My patients rarely go to the emergency room or get admitted to the hospital. Dehydrated patients will soon be given fluids in my office. Lastly, I am going into patient homes to get a better understanding of the family dynamics. You would be amazed at the positive response to treatment plans with some basic psychosocial information. These practices unleash the emergency room for more pressing issues, decrease the number of admissions, decrease out-of-pocket expenses for emergency room visits and hospitalizations, decrease overall cost through decreased utilization, and limit patient exposure to resistant organisms. The only downside to this management style is that I find that I have to focus on maintaining enough hospitalized patients per year to maintain my privileges at Children’s Hospital. Imagine, a physician looking for ways to admit patients so that she

doesn’t lose her privileges. Remember, you have to maintain privileges to stay eligible for the contracts with third-party payers. To put it mildly, the system has a wrinkle. My plan, for now, is to continue negotiating contracts and only eliminate the ones that refuse to sit at the table. In all truth, many third-party payers and IPAs work diligently to keep solo practitioners around to provide the balance in their negotiating power with the larger groups. For those payers, I will always sit at the table. For the others, well, they can take their lead with me from the Blues of California. I am no longer terrified. As a solo practitioner, people often ask me how the move toward a government-run healthcare system will affect me professionally. Speaking honestly, I tell them that it will help my practice. The more constraints placed, the more people are willing to seek a practice meeting their family’s needs. So remember, the solo practitioner may be less obvious these days, but in the land of choice and opportunity, we are unlikely to go extinct!

Table1: Physicians by Practice Setting, 1996–97 to 2004–05 1996–97




1–2 Physician Practices





3–5 Physician Practices





6–50 Physician Practices





>50 Physician Practices





Medical School










Hospital (1)





Other (2)





*Change from 1996–97 is statistically significant at p<0.05. 1. Includes physicians employed in hospitals and office-based practices owned by hospitals. Forty percent of physicians in this category were in office-based practices in 2004–05. 2. Includes physicians practicing in community health centers, freestanding clinics, and other settings, as well as independent contractors. Source: HSC Community Tracking Study Physician Survey august 2010 SAN  DIEGO  P HY SICIA N. o rg


americanmedicalassociation By Ginnie Yee and Albert Ray, MD

AMA Annual Meeting Highlights June 12–16, 2010

AMA People and Elections

• District 1 AMA Delegates Jim Hay, MD, and Robert Hertzka, MD, and Alternate Delegates Lisa Miller, MD, and Albert Ray, MD, attended. • Albert Ray, MD, of San Diego began his service as vice chair of the California delegation. • AMA Trustee Peter Carmel, MD, pediatric neurosurgeon from New Jersey, was elected AMA president-elect. • CMA Past President Richard Frankenstein, MD, of Santa Ana was unsuccessful in his bid for election to the AMA board of trustees. • Debra Judelson, MD, of Beverly Hills was unsuccessful in her bid for election to the AMA Council on Science and Public Health. • UC Davis surgical oncologist Steven Chen, MD, was elected AMA YPS delegate.

California Resolutions

1. Patient Confidentiality in Biobanks: Referred a California resolution that asks AMA to: (1) support the development and use of a universal consent form for use with participants in research studies that involve the participant’s biologic materials; and (2) adopt as policy that informed consent for participants in research studies that involve the participant’s biologic materials should include, in addition to other information required


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

by law, a direct statement of the participant’s right to withdraw from the research study at any time, as well as information as to whether the participant’s biologic material will be deidentified; will be pooled in a biobank; will be shared outside of the organization conducting the research study; will be sold or exchanged; will be made available for commercial use; or may be accessed, used, or considered by outside entities. (Res. 001) 2. Medical Practice Guidelines and Conflicts of Interest: Referred a California resolution that asks AMA to support the position that: (1) members of practice guideline development committees must disclose, in conjunction with the practice guidelines developed, any possible conflict of interest; (2) medical and specialty associations should not receive from drug, device, or equipment manufacturers any money for sponsoring, underwriting, or promoting practice guidelines; and (3) practice guidelines should be peer-reviewed by independent reviewers prior to publication to ensure that all guidelines are evidence-based to the greatest possible degree and that any possible conflicts of interest of the committee members or independent reviewers have been disclosed with each publication thereof. (Res. 005) 3. Healthcare Standards: Adopted as amended a California resolution that asks AMA to: (1) support the ability of nongovernmental organizations to evaluate appropriate medical diagnosis or therapy or current or new diagnostic or therapeutic

tests, procedures, medications, or other procedures that improve the quality of patient care; (2) support the position that any practice guidelines, parameters, best-practices models, or similar set of principles or clinical recommendations, whether developed or issued by governmental or nongovernmental organizations, including those that result from any comparative effectiveness research or evidence-based medicine system, do not, and should expressly state that they do not, establish standard of care or create specific requirements for physicians that restrict the exercise of their clinical judgment; (3) urge any organization, whether governmental or nongovernmental, promulgating any practice guidelines, parameters, best-practices models, or similar set of principles or clinical recommendations, to include a statement that they are guidelines only; and (4) urge any organization, whether governmental or nongovernmental, promulgating any practice guidelines, parameters, best-practice models, or similar sets of principles or clinical recommendations, to set and make publicly available a regular schedule for review and update and to include the level of evidence supporting the guidelines. (Res. 205) 4. Issuing a Postage Stamp to Commemorate the First Surgeon General’s Report on Smoking and Health: Adopted a resolution sponsored by Alabama and endorsed by California and other delegations that asks AMA to: (1) urge the Citizens’ Stamp Advisory Committee to recommend that a postage stamp be issued in 2014

to commemorate the 50th anniversary of the release of the first surgeon general’s report on smoking and health on Jan. 11, 1964; and (2) implement this action by sending a signon letter to the Citizens’ Stamp Advisory Committee, with endorsements by national medical specialty societies, state medical associations, and other appropriate health organizations. (Res. 405) 5. Endocrine-disrupting Chemicals: Reaffirmed existing policy in lieu of a California resolution that asked AMA to: (1) urge further collaboration among medical and scientific groups to identify ways to decrease exposure to endocrine-disrupting chemicals (EDCs); (2) urge that regulatory oversight of EDCs be centralized to ensure coordination among agencies; (3) urge that policy regarding EDCs be based on comprehensive data covering both low-level and high-level exposures; and (4) encourage the education of all health professionals on the human health effects of toxic chemical exposures, including EDCs. (Res. 406) 6. Adult Film Industry Worker Safety and Health: Adopted a California resolution that asks AMA to: (1) support legislation that would require the mandatory use of condoms in the production of adult films; (2) support legislation that would improve the ability of local health departments and OSHA to investigate and control occupational exposures to infectious diseases and enforce workplace regulations in a timely manner; and (3) urge that existing OSHA and other occupational standards be vigorously enforced to reduce exposure to infectious diseases within the adult film industry. (Res. 407) 7. Safety and Labeling of Pharmaceuticals and Nutraceuticals: Adopted a substitute resolution in lieu of a California resolution that asked AMA to advocate that the Food and Drug Administration (FDA): (1) be funded and staffed to adequately inspect and ensure safety of all pharmaceuticals and nutraceuticals, including over-the-counter products, consumed in the United States; and (2) require labeling of all pharmaceuticals and nutraceuticals with their ingredients and their respective countries of origin. (Res. 504) 8. AMA Business Model Proposal: Defeated a California resolution, and endorsed

by the Florida delegation, that asked AMA to: (1) form a Technical Advisory Committee (TAC) to work with an independent business consulting firm to study AMA’s business model in order to recommend ways to assure it will be responsible to membership’s needs as its first priority; (2) that the TAC be comprised of members who are not fiduciaries of AMA, including state, county, and specialty society executives and physician leadership; and (3) that the TAC report back to the AMA HOD at A-2011. (Res. 614) 9. Translator Service for Hearingimpaired Patients: Reaffirmed existing policy in lieu of a California resolution that asked AMA to: (1) seek federal legislation requiring all third-party payers to provide appropriate interpretive services to all of their hearing-impaired enrollees as a benefit and provide appropriate compensation; and (2) educate physicians about the insurance industry’s practice of assigning the financial responsibility for interpreter services to the physician. (Res. 701) 10. Free Electronic Claims Billing: Adopted as amended a California resolution that asks AMA to: (1) support the ability of physicians to submit claims directly to payers, either electronically or by mailing paper claims; and (2) oppose clearinghouses that charge physicians for claim submission, alter codes, or otherwise inappropriately reduce reimbursements. (Res. 702) 11. Free Electronic Prescribing: Reaffirmed existing policy in lieu of a California resolution that asked AMA to support: (1) a physician’s right to have direct electronic prescribing capability without being forced to pay setup fees, service charges, and/or purchase proprietary software; (2) the ability of physicians to electronically prescribe on a system that is technology neutral and does not require proprietary software, including free or open-source software; (3) the princi-

ple that mandatory e-prescribing programs should provide assistance for physician practices, and that any mandate should provide instructions offering no less than one option that will satisfy the mandate at no cost to the physician; and (4) all privacy protections where electronic prescribing takes place. (Res. 703) 12. Electronic Health Records Software: Reaffirmed existing policy in lieu of a California resolution that asked AMA to: (1) support the ability of physicians to have their own electronic health record/electronic medical record systems with applicationneutral, commercial, off-the-shelf software and/or open-source software, and recognize this as a viable solution for some physicians; (2) oppose any laws, rules, or regulations that mandate a vendor-specific operating system, browser, database, and the like, to function in an electronic healthcare environment; (3) support requiring health information technology (HIT) software vendors to fully disclose whether their product meets industry standards for functionality and interoperability; and (4) reaffirm the position that any new EHR system should, to the extent possible, be interoperable with legacy systems. (Res. 719)

Other Key Action

1. Assuring Patients’ Continued Access to Physician Services: Adopted a substitute resolution that asks AMA to immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule and in a manner that does not forfeit benefits otherwise available to the patient. This legislative language shall be available to AMA members no later than Sept. 30, 2010. (Res. 204)

The next AMA Interim Meeting will be held Nov. 6–9, 2010, in San Diego. august 2010 SAN  DIEGO  P HY SICIA N. o rg


healthcarefinancing By Arthur L. Gruen, MD

Note: This article continues a series of occasional articles from San Diego County’s medical directors.

EA Health On-call Management in San Diego County Fairly Reimbursing Doctors for Their Call Panel Participation


Taking call for your medical practice is hard work. Taking call for a hospital’s ED call panel is even tougher. A call-panel physician is obligated by law to respond to and provide specialty physician care to any patient in need, regardless of insurance status. Not surprisingly, call panel physicians feel an untenable burden of responsibility. As managed care expanded in the ’80s and ’90s and impacted physician compensation, EA Health and Sharp Memorial Hospital in San Diego worked collaboratively to create an


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

innovative physician call panel. EA designed a plan that could fairly reimburse doctors for their call panel participation by joining hospital subsidy monies with actual collections to guarantee fair payments for their professional services and on-call availability. EA has designed custom solutions providing consulting services to at least 170 health systems, and now currently maintains on-call management programs at more than 60 hospitals nationwide. EA Health manages, supports, licenses, credentials, privileges, staffs,

schedules, codes, bills, collects, and pays physicians for their on-call services. In developing EA’s core competencies, a sophisticated operations and IT platform was developed to support the ever-growing EA Health medical group, now 6,700 physicians strong. In San Diego County, EA Health is contracted with more than 1,800 physicians from all specialties, and these physicians take care of 50,000 unassigned patients annually. EA Health helps many healthcare systems as well as individual hospitals nationwide to solve their on-call problems by implementing payment methodologies to encourage physicians to be available and provide oncall services. EA Health also assists hospitals in managing their on-call programs through a variety of means, including consulting services. In solving their on-call needs for reliable physician availability, hospitals have achieved positive results in promoting physicians to be on-call through EA’s best-practice payment methodologies. This has generally been in the form of fee-for-service payments to doctors for professional services provided.

Reimbursement based on fee-for-service is physician-friendly as it encourages physicians to provide services and allows them to maintain their autonomy. In the long term, the fee-for-service pay-for-productivity model may prove to be the continued best practice, but we may see variations in the methodologies and/or a complete paradigm shift in the model because of changes in the healthcare market as related to national insurance reform, the HITECH initiative, and the trend toward hospital-physician integration. Currently, EA Health brings value to healthcare systems and hospitals, to physicians, and to the community of patients they serve:

Support for Life.

For Healthcare Systems and Hospitals: • customizable on-call management programs • nationwide coverage and experience • cost containment • legal expertise with Stark, anti-kickback, and anti-supplementation statutes • relevant and timely with national healthcare insurance reform For Physicians: • physician-friendly fee-for-service model • quick payment for services rendered • EA assumes coding and billing responsibilities • enrollment and easy program orientation For Patients: • quality ER care • availability of on-call physician specialists The fee-for-service pay-for-productivity payment methodology has been a good formula to successfully encourage and promote on-call participation by physicians on staff at hospitals throughout the country. EA Health programs generally promote cost savings to client hospitals by installing effective and sustainable call-panel programs that pay doctors well and to their satisfaction and at fair market value, all the while staying within hospital budgets and goals. There are numerous benefits to doctors in addition to guaranteed and fair payments, including improving documentation practices, coding reviews, detailed payment summaries, provision of tax summaries, and a full line of physician support services. Hospitals also experience

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healthcarefinancing As managed care expanded in the ’80s and ’90s and impacted physician compensation, EA Health and Sharp Memorial Hospital in San Diego worked collaboratively to create an innovative physician call panel. EA designed a plan that could fairly reimburse doctors for their call panel participation by joining hospital subsidy monies with actual collections to guarantee fair payments for their professional services and oncall availability.


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

significant benefits, in addition to having their call panels filled, including call-panel sustainability through cost containment, legal compliance, and data empowerment, as well as having satisfied physicians. With hospitals and physicians having a similar goal in mind — namely, to take care of emergency/unscheduled patients — the fee-for-service payment methodology, in conjunction with steering committee meetings that bring hospital and physicians to the same table, has been successful in aligning hospital and physician goals. At EA Health, we think that national healthcare insurance reform and the HITECH initiative will drive hospitals and physicians to align to a greater extent. There are and will continue to be incentives and even possibly future mandates to electronify healthcare information such that electronic medical records (EMRs) and healthcare information exchanges (HIEs) will drive a convergence of goals for hospitals and physicians. Moreover, we may be moving toward lump-sum hospital-physician payments such that hospitals and physicians will need to share payments, and this will certainly further align hospitals and physicians. The challenge will be to create hospitalphysician aligned payment methodologies that allow hospitals to develop costeffective on-call strategies while covering their ERs with specialty physicians who can still maintain their autonomy. Effective physician-compensation structures will be metric-based management that balances productivity incentives with goals that support the hospital organization’s vision. The landscape will most likely incentivize physicians to promote and be guided by hospital goals such as patient satisfaction, quality of care, response times, reducing length of stay and avoidable days, and cost-effective best practices that minimize direct expense and use other key indicators to reduce hospital organization overhead; and the models may even go so far as risk sharing by hospitals and

physicians driven by or even forced by lumpsum hospital-physician payments by payers. EA Health envisions the possibility of a collaborative partnership with EA and its clients to develop and support hospital-physician aligned payment methodologies that bonus physicians for compliantly promoting hospital objectives and improving market share. In addition this hospital-physician integration model might develop entities that are co-managed by hospital and physician representatives. Payments to doctors may ultimately transition from traditional fee-for-service to Medicare Severity Diagnosis Related Group-driven patient capitation rates such that payments are shared by hospitals and physicians taking care of a particular patient; and the physician payments might give way to straight fee-for-service methodology and transition in some way to a capped payment on a given patient and divided among physicians based on the productivity of the physicians participating in the care of that patient. What will on-call management models look like tomorrow? EA Health foresees that the answer will not be the same for every hospital and physician. For some hospitals and physicians, the best choice will be new payment methodologies or even different entity models; other hospitals and physicians may continue with fee-for-service, or find better ways to apply fee-for-service payment methodologies. It is certain, however, that sustainability of on-call programs will be most successful if hospital and physician goals become better aligned. The top three challenges that EA Health faces in San Diego are as follows: 1. Aligning hospitals’ and physicians’ goals while allowing doctors to maintain their autonomy. 2. Containing costs for hospitals and yet providing physicians with a fee-for-service platform. 3. Positioning EA programs to anticipate the changes that might be precipitated by healthcare reform, such as increasing patient volumes and decreasing reimbursements to hospitals. In summary, EA Health’s vision is that the current fee-for-service model will continue to thrive and will likely include performancedriven bonuses for patient satisfaction, qualityof-care core measures, and market share.

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Office Man 22

S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

o v d A

e nager

y c co a

august 2010 SAN  DIEGO  P HY SICIA N. o rg


Office Manager

A dv o c a c y SDCMS Medical Office Manager By Sonia Gonzales, Your Office Manager Advocate

S Medical Hello SDCMn Office Ma agers!

into your community these Thank you for welcoming me of ing me to help you with all past few months and allow er mb me r ou hard to support your questions as you work be to how excited I continue physicians. I can’t tell you nity as your medical office to serve our medical commu manager advocate! rth-annual Office ManI hope you enjoy this, our fou of San Diego Physician. I ager Advocacy August issue nk Sylvia Aldama, Christina would like to personally tha n, , Maria Marin, Debbie Morga Binkowski, Tammy Haupert , an lliv Su a Lis Kimberly Riley, Vicky Morgan, Alex Rader, Villa, and Carmen Williams Renee Thompson, Stephen busy schedules to help me for taking time out of their l s issue. Along with their vita put together content for thi d an , als go frustrations, insights into the challenges, office manager today, we’ve al successes of being a medic on how long to keep paper collected here information er g to an EHR system, wheth documents after convertin n tio ipa rtic able, what pa “collections fees” are accept



S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

options are av ailable to phys icians with re Medicare, how spect to much physicia n s are obligated reimburse pat to ients in cash-p ractices, our te seminar/web ntative inar calendar for 2010–11, in on two great formation certification co urses offered (Certified Med at SDCMS ical Coder and Certified Med ance Specialis ical Insurt), and finally, information o tions for our se n nominacond-annual “Outstandin Office Manag g Medical er” contest. Thank you ag ain for allowin g us at SDCM port you and S to supyour member p h ys icians — as a cal office man mediager myself I remember thin important it w king how as for me, my staff, and my to have an org physician anization like SDCMS to ad all of our coun vo cate for ty physicians and their staff SDCMS is to h . My job at elp you get th e job done mo and more quic re easily kly by ensurin g you’re levera of the resourc ging all es we make av ailable to our and their staff m embers ! If we haven’t yet met or sp oken or emaile please feel free d, to give me a ca ll or shoot me email if only to an introduce you rself and find we can help yo o u t how u and your pra ctice. I look fo meeting each rward to and every one of you in the co months and ye ming ars, and to co ntinuing to le you how best arn from to grow my ro le at SDCMS vocate so that as your adyou can bette r serve your p and staff. We hysicians will have man y exciting opp ahead of us to ortunities work together and to help ea You are not al ch other. one — pick u p the phone o me an email at r se nd (858) 300-278 2 or at SGonza Ta les@ lk to you soon !


SDCMS seminars/webinars/courses

✓ Sept. 16: Palmetto /

Medicare Updates ✓ Sept. 30: The Art of the Appeal ✓ Oct. 1–29 (Five Fridays): Certified Medical Coder Course ✓ Oct. 7: Economic Survival

Get Your Questions Answered!

keep paper length of time to What is the proper EHR system? ile converting to an wh er/ aft ts en m copy docu with your d that you check It is recommende rule: What sic ba e Th eir guidelines. th r fo st fir ers rri ld liability ca per chart and is he art stays in the pa for OR s; ar was in the paper ch ye n ve (se te of limitations tu sta te ria op pr for the ap less they are seen s + seven years un ar ye 18 s, nt tie ole pa pediatric tice scans the wh en years). If a prac sev st ju is it es m en th eti after 18, but that som the paper charts, red sh n ca e ce on on en e, chart, th ming into a practic far as new paper co d. de red sh isn’t practical. As be n ca d to the record it he ac att d an ed it is scann s, we want tients to collection When we send pa d to our collection if they are assigne ” fee ns tio ec oll “c to add a to pay the collecr any fees we have ve co ll wi fee is Th agency. ed to us. Is this monies that are ow ng eri ov rec r fo cy tion agen le? practice acceptab arge a collecis reasonable to ch In certain cases it any u need to consult rstanding that yo de un e th s. th wi tion fee and/or restriction racts for limitations nt co r yo pa ty al ar tu third-p ould reflect the ac passed on, they sh ing subbe ks ris If those fees can be an ici ys on; otherwise, a ph cti lle co e th ubtful of e do expens it. However, it is ess practice lawsu sin bu r fai un en an ject to charges giv their al would allow such i-C ed M or re ed apica ed that M terest and/or miss beneficiaries for in g in arg ch on s position

Question: Answer:

Question: Answer:

pointments. For furthe r information, consult CM A’s ON-CALL document #0112, “Colle cting from Patients/Exte nd ing Credit” — available free to SDCMS-C MA members at CMAN


My physician is consid ering opting out as a Medicare provider. I wo uld like to know the opt ions we have with making this change.


Physicians have two cho ices: 1) They may elect to be a nonparticipating ph ysician; or 2) They may opt out of the program entirely (for two -year periods) and privat ely contract with their Medicare patients. A nonparticipating pro vid er can choose to accept or not accept ass ignment on Medicare cla im s on a claimby-claim basis, meaning that on a claim-by-claim bas is they can choose to get reimburse d at the Medicare rate (i.e ., par ticipating provider rate) or at a no nparticipating rate. Physi cia ns who opt out of Medicare are bound only by their private con tra cts wit h their patients. Medicare’s lim iting charges do not app ly to the se contracts, but Medicare do es specify that these con tra cts mu st contain certain limits. When a physician enters into a pri vat e con tra ct with a Medicare benefic iary, both the physician and the patient agree not to bill Medicare for services provided un der the contract. For more informatio n regarding acceptable sta tus change dates and further clarifi cation on these option s, ple ase consult CMA’s ON-CALL docum ent #0151, “Medicare Par tici pat ion (and Nonparticipation)” — ava ilable free to SDCMS-C MA me mb ers at

Special Focus Item:

S seminar Check out the SDCM and fax 34 ge pa calendar on our for n tio tra gis in your re ns. If upcoming presentatio pic you don’t there’s a seminar to ow! see listed, let me kn

Special F ocus Item :

Please share this issue w and encoura it ge his or he h your physician r participati tering YOU on in enin SDC Year” conte MS’ “Office Manager of st. See page th 38 for details e .

august 2010 SAN  DIEGO  P HY SICIA N. o rg


Office Manager

A dv o c a c y

A Medical Office Manager’s Job Is

Never Done SDCMS Member Office Managers Sound Off on Their Challenges, Frustrations, Goals, and Successes By Sonia Gonzales


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

Christina Binkowski

Sylvia Aldama and Maria Marin

SDP: How long have you been working in healthcare? Maria: Thirty years. Sylvia: Twenty-three years. We’ve worked together six years at this office. SDP: What do you love most about your job? Maria: It’s a challenge. It’s interesting. It’s new each day. Especially in our specialty, it’s not your typical office visit. Sylvia: There’s so many changes, and it’s always evolving, keeping up with changes in medications and Medicare. It’s not boring! SDP: What has been your biggest challenge this past year? Maria: Having to deal with each insurance company’s and HMO group’s unique requirements. Every time we figure it out, it changes! Sylvia: More and more medications that need prior authorizations. Also, getting assistance for patients for medications so they can get treatment. SDP: What has been your biggest success this past year? Maria: Having the billing portion of the practice completely automated. We are less hands-on with paper and much more online, so we can give the patients more time and attention. SDP: How has SDCMS helped you do your job better? Maria/Sylvia: Marisol Gonzalez, SDCMS’ physician advocate, was able to get to the appropriate people at Palmetto when we were having such difficulty with our claims. We were getting tossed around at Palmetto, but when Marisol got involved, the issues were resolved quickly and smoothly. SDP: What is your goal for the next year? Maria/Sylvia: To be fully EHR.

SDP: How long have you worked in healthcare? Christina: Thirty-five years. SDP: What do you love most about your job? Christina: We’ve seen so many advances, both administratively and medically. I came back to the healthcare field after six years in law enforcement and everything was new! It’s exciting and challenging.

“Every time we figure it out, it changes!”

SDP: What’s been the biggest challenge for you this past year? Christina: Finding new physicians to come into our practice … basically to come into California because of the economy here, coupled with the doctors who don’t want to be on-call at the hospital, it’s a challenge. SDP: What has been your biggest success in your job this past year? Christina: Finally establishing a cohesive, consistent staff. All the current staff members have been here for more than three years. Until four years ago we were going through people every six months. I had to find people with a strong work ethic and accountability. SDP: How would the staff describe you? Christina: I have high expectations because I’m older and I have an old-fashioned work ethic. They would say I am fair and flexible and that I’m loyal. SDP:Describe your technique for hiring. Christina: I am at an advantage because I have been in law enforcement, so I can interview people very well. I am able to sit back and be an active listener. Be personable so the candidate relaxes and you can see a little more of their personality and their real skills.

Sylvia Aldama and Mari

a Marin

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SDP: What are your goals for the next year as an office manager? Christina: We just hired two new physicians, so the goal is to get the office running with the new additions and to get Dr. Silver back on the lecture circuit.

“Up until four years ago we were going through people every six months. I had to find people with a strong work ethic and accountability.”

Debbie Morgan SDP: How has SDCMS helped you be a better office manager? Christina: I’ve attended seminars and webinars. It’s nice because I can pull up webinars online and have access to information on the website. I recently called SDCMS regarding guidelines for the use of a sign language interpreter and was given assistance with the requirements and CMA guidelines.

Tammy Haupert

SDP: How long have you worked for Medical Group of North County? Tammy: Twenty years. It started out as a single-employee practice, and, as it grew, I grew with it. SDP: What do you love most about your job? Tammy: The doctors and the staff. It takes more than one person to manage an office like ours, and it’s nice to have the doctors’ support.

Tammy Haupert

SDP: What has been the biggest challenge for you this past year? Tammy: Keeping it a win-win for the staff and the patients with all the healthcare changes. SDP: What has been your biggest success? Tammy: The growth of the company. It has gone through all the challenges and has come out of all of it with quality healthcare still being the goal. SDP: What resources are you most interested in from SDCMS? Tammy: I am very excited about the seminars and the website. SDP: What is your goal for the upcoming months and years?


Debbie Morgan

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Tammy: EMR! Our second conversion — hopefully we learned a lot from the first one. Definitely EMR, and then the growth of the practice.

There are many challenges today in the role of practice manager, far more than there were 10 years ago. I have been a practice manager for more than 25 years, and the changes that have occurred in the past 10 years have been innumerable. We as practice managers find ourselves working longer days and taking less time off to accomplish the day-to-day responsibilities associated with the job. One of the many challenges I face as a practice manager is dealing with the employees’ behaviors and personalities and keeping cohesiveness within the practice. I have learned over the years to listen to employees’ concerns and issues, to be open, and to encourage communication. Problems are not always “black and white.” I ask my employees what they’re willing to do to resolve an issue and what they aren’t willing to do. I strive to approach a problem this way because I feel it will lead to relationships based on trust, accountability, and mutual respect. Another challenge I face is keeping up with and understanding the many state and federal regulatory issues, e.g., PQRI initiative, HIPAA, HR, Red Flags Rule, OIG compliance program, etc., and the list gets larger each year. We now have a bigger responsibility of obtaining the knowledge, and doing this takes a significant amount of time, educating yourself to understand and implement the changes into the practice. This of course cannot all be accomplished during regular working hours, so you find yourself educating yourself on your “own” time. I guess my biggest fear is letting my physicians and staff down because there are just not enough hours in a day, days in a week, and weeks in a year to accomplish all that needs to be accomplished to assure that we have a successful and profitable practice, as well as happy and motivated employees and satisfied patients.

I do want to take this moment to thank SDCMS for all of their help and valuable resources. I frequently use their website for answers to many of my questions and feel that their resources are invaluable. I would hope that every member would use the available resources to answer any questions or address any issues you may have in the dayto-day operations of a medical practice. Thank you, SDCMS!

Vicky Morgan

SDP: How long have you been doing your job? Vicky: I have been in the medical field for 19 years and with Dr. Wilson for more than 17 years now. SDP: What do you love about your job?

Vicky: I love working with the patients. We have a lot of long-term, chronic-pain patients who have been coming in for years. They are like family to me, and it is always great to catch up with them and their families. SDP: Biggest challenges? Vicky: As our office got busier, we transitioned job duties among the staff. This was challenging at first, but we worked out a system, and things are running really smoothly now. I also have had to share and transition some of my job duties with Nathan Hughes. He is running the day-today operations at the office now, and this has allowed me to concentrate exclusively on the billing management and collection side of the practice. Having a strong dual management team for Dr. Wilson has definitely helped our practice through all of our growth.

Vicky Morgan

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Secondly, I think another big challenge is dealing with the insurance carriers. There is a lot more follow-up and numerous phone calls on the physician’s end than ever before to get any claim issues, prior authorizations, or appeals through their systems.

“It takes more than one person to manage an office like ours, and it’s nice to have the doctors’ support.”

Alex Rader


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SDP: Biggest successes? Vicky: One of our biggest successes, I would say, is that we stay on the cutting edge of all of the new resources available for our staff to get their jobs done more efficiently. We use Navinet for insurance benefits checks, they use all of the insurance websites available, we e-prescribe, and they upload authorization requests online. They all use the scanner, and we also have an automated appointment call reminder system tied to our schedule. We have also been billing our workers’ comp claims electronically with the carriers that are currently accepting these claims. This has allowed us to get prompt payments in from these carriers. SDP: How has SDCMS helped you do your job better? Vicky: I have been coming to the mangers meetings for years and years. We actually used to bring our own sack lunches way back when! All of the topics and speakers have definitely helped us run our office more efficiently. It’s always good to be on top of all of the current changes and having the resources with just a phone call or email to SDCMS. The staff is always fast and efficient in getting me the information I need or directing me to the right resources. I also like the fact that coming to the meetings, I get to meet other practice managers. I think it’s great that we have a forum that we can share ideas and problemsolve together. SDP: What are some of your goals for the next few years? Vicky: We are currently looking into EMR software for our office and all of the changes that will have to be made. Since we are a solo practice, we also have to look at the expense and all of the EMR incentives available. Personally? I am hiking Mt. Whitney on

the 31st of August! We have our permit, and I am hiking with a group of 15. We have been training for this hike for the past six months!

Alex Rader

SDP: How long have you been an office manager? Alex: Almost 20 years off and on. SDP: What do you love most about your job? Alex: There is no getting bored! There’s always something going on. SDP: What was your biggest challenge this year? Alex: The Medicare rollercoaster … it’s a hard one. It’s so volatile and emotional. One of our doctors had to retire. All costs to do business are going up, and reimbursement is all over the place. SDP: What did you accomplish this past year that you are most proud of? Alex: Converting doctors to e-prescribing through iPads! SDP: How has SDCMS helped you do your job better? Alex: SDCMS has provided wonderful resources. For example, we have had an ongoing issue with Medicare for more than two years, and SDCMS has helped us whenever we needed it. The training provided is valuable, and SDCMS truly recognizes the required ongoing training for compliance purposes. If my doctors had to pay for these training seminars, they’d be paying hundreds of dollars, but the seminars are free because of their membership. SDP: What is your goal for the next year as an office manager? Alex: To go “live” with an EHR system, provided that we can still afford to stay in business with that cost.

ICD-9, CPT, OSHA, HIPAA, OIG, MSP, RAC, EOB, ABN … OMG! Kimberly Riley

Some of you might remember the Leave It to Beaver episode where the Beav climbs up onto a billboard and ends up falling into the giant coffee cup. Well, change that to a bowl full of alphabet soup and that’s how I was feeling shortly after joining my first office. Dip your spoon in and you will lift out many, if not all, of the abbreviations listed above, and more are appearing every time you turn around. Twenty years ago I chose a profession that I thought was challenging and rewarding: healthcare. I started my career in the prehospital world as an emergency medical

technician, and, over the years, I made the transition into the medical office. Like many others at the time, my medical insurance knowledge and office management knowledge came from hands-on experience. My first office position came with all of 30 minutes of actual in-office training from the person I was replacing; fortunately, the physician was very understanding and helped me through those first few weeks of adjustment, as did the medical biller, whom we outsourced to. While I was grateful for their patience, I knew that I needed to find someone with greater resources to whom I could ask questions and who was willing to answer them no matter how many times I had to ask the same thing. I looked into local training programs and schools; however, those were either too expensive or the courses were during work hours. I was about to give up until one day, I

Kimberly right, with Dr.RBiluney,yak

Take a at San Diego Physician magazine. Reach all 8,500 doctors in San Diego County. august 2010 SAN  DIEGO  P HY SICIA N. o rg


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was going through the faxes and ran across a flyer from SDCMS; it was offering a seminar for physicians and office staff on HIPAA. At this seminar I was relieved to find that I was not the only one drowning in the soup bowl. That day I left knowing I had found the answer to my prayers. Since that fateful day, I have regularly attended seminars and webinars that SDCMS has offered, including the certified office manager course and the certified medical coder courses offered in conjunction with Practice Management Institute. I encourage all medical office managers and office staff to use the resources that are offered by the San Diego County Medical Society.

Lisa Sullivan

SDP: How long have you been an office manager? Lisa: Twenty-two years. SDP: What do you love most about your job? Lisa: The variety of tasks. It’s always interesting!

Renee Thompson

SDP: What has been the biggest challenge in your job this past year? Lisa: Keeping costs down. We gave no salary increases to the staff for the first time. SDP: What has been your biggest success in your job this past year? Lisa: Being able to keep up with reimbursement issues and staying up-to-date. SDP: How has SDCMS helped you do your job better? Lisa: By keeping me informed of the updates. One of the best and most helpful seminars was Catherine Sherman’s [with TSC Accounts Receivable Solutions] billing/ collections seminar.

Stephen Villa 32

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SDP: What do you hope to

accomplish next year? Lisa: Same thing as last year: Search for solutions to navigate the changes in healthcare.

Renee Thompson

SDP: How long have you worked for Dr. Ansari? Renee: Nine years. SDP: What do you love most about your job? Renee: Being able to help patients get care. I do authorizations that are very hard, and being able to get authorizations or resources for treatment that the patients may not have been able to afford otherwise is very rewarding. SDP: What did you accomplish this past year that you are most proud of? Renee: Being able to manage my job and cover for a staff member who was out on maternity leave. SDP: How has SDCMS helped you be a better office manager? Renee: By offering all the classes and the invaluable “News You Can Use.” SDP: What is your goal for the next year as an office manager? Renee: To be more versed in human resources.

Stephen Villa

SDP: How long have you worked in healthcare? Stephen: Eighteen years. I started in healthcare when I was 17; I joined the Air Force and was a med tech. SDP: What do you love about your job? Stephen: It’s so diversified — there’s a little bit of everything, from patient care, to business development, to strategic planning, to human resources, to counseling staff, to government

interactions, to legal, to accounting, to networking, to financing, to remodeling … and the list never ends. SDP: What was your biggest challenge this past year? Stephen: Strategic planning because of the Medicare cuts and the economy. SDP: What are you most proud of having accomplished this past year? Stephen: Communication has improved throughout the office due to honest and sincere listening and honest feedback. SDP: How has SDCMS helped you? Stephen: Seminars are great! From the workers’ compensation seminar to the EMR trunk shows, to contract negotiations and the certified medical coder course. One of our physicians attended the coder course, and it was excellent. “News You Can Use” is great! We also use the website for the calendar of events. SDP: What is your goal as office manager for the next year? Stephen: To maximize function in the leanest possible way. To keep the staff we have, but to continue growing. To get our doctors out there more to have a bigger presence in the community.

Carmen Williams

SDP: What do you love about your job? Carmen: I love my boss! He is passionate about his work and caring for his patients. It is so inspiring that ever since I started I have not called in sick once. I am compelled to come here each day! SDP: What was your biggest challenge this past year? Carmen: How to financially manage this practice with the Medicare cuts. SDP: What are you most proud that you accomplished this past year? Carmen: Achieving 10 years working with Dr. Thota and obtaining six successful contract negotiations for our surgical center. Also, creating a very strong employee team. SDP: How has SDCMS helped you? Carmen: I love the seminars! The information available through SDCMS is so handy. I attended the certified medical office manager course offered at a significantly discounted rate through SDCMS, such excellent training. Also, the terrific resources on the website help me out a lot. I love to be part of something in our community that allows us to provide a better level of care.

Carmen Williams with Dr.Naga Thota

SDP: What is your goal for the next year as an office manager? Carmen: To continue to give the best care we can while keeping up with the financial changes.

SDP: How long have you been working for Dr. Thota? Carmen: Eleven years.

“I guess my biggest fear is letting my physicians and staff down because there are just not enough hours in a day, days in a week, and weeks in a year to accomplish all that needs to be accomplished to assure that we have a successful and profitable practice, as well as happy and motivated employees and satisfied patients.” august 2010 SAN  DIEGO  P HY SICIA N. o rg


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A dv o c a c y Seminar Calendar 2010-11 Office Mangers: Please put a check next to those seminars you are interested in attending, fill in the below contact information, tear this sheet out, and fax it back to SDCMS at (858) 569-1334. Thank you!



Palmetto and Medicare The Art of the Appeal (Billing) Certified Medical Coder Course Economic Survival Scope / Allied Health Professionals (Legal Issues) Expert Witness, Medical Board Interactions (Legal Issues) Emerging Patient Safety Issues (Risk Management) Emerging Patient Safety Issues (Risk Management) Collections / Procedures Medicare Online Provider Services Rollout Risk Management Certified Medical Insurance Specialist Course Treating Patients Right Contract Negotiations Updated Back to Basics Legalities of Hiring Medicare Updates Certified Medical Office Manager Course Coding Seminar Disciplinary Actions / Employee Terminations Preparing to Practice Risk Management Best Practices in Revenue Cycle Medi-Cal Updates Information Technology Overview Coding — General Practice and Specialties Legal Issues for Physicians Focus on Payer Contracts Risk Management EMR Follow Up HIPAA OSHA Microsoft for Busy Docs Changes to Medicare Regulations Seminar Depositions (Physicians) The “How To’s” of Appeals

Sept. 16, 2010 Sept. 30, 2010 Oct. 1–29, 2010 Oct. 7, 2010 Oct. 27, 2010 Nov. 4, 2010 Nov. 17, 2010 Nov. 18, 2010 January 2011 January 2011 January 2011 February 2011 February 2011 February 2011 February 2011 March 2011 March 2011 March 2011 April 2011 April 2011 April 2011 April 2011 May 2011 May 2011 May 2011 May 2011 June 2011 June 2011 July 2011 July 2011 August 2011 August 2011 August 2011 September 2011 September 2011 September 2011

CHECK IF INTERESTED o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o

SDCMS Member Physician’s Full Name

Seminar Attendee Name(s)




S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010



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 today!

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Two Great Certification Courses Offered at SDCMS! Become a Certified Medical Insurance Specialist in February 2011! Attention Physicians and Office Managers: Every medical office needs an expert in dealing with third-party payors. Securing correct and consistent reimbursement revenue goes well beyond simply coding. Our Certified Medical Insurance Specialist (CMIS) course is for those individuals seeking to master the complete reimbursement process, form information gathering, through coding, to challenging and prevailing in claim denial situations. Questions to ask: Are your aging reports under control? Are your claim follow-up procedures effective? Are ABNs and authorizations being processed correctly? Has your ratio of outstanding claims decreased in the last two years? Do you know how to bill for third-party subrogation or


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

second-injury fund? Today more than ever your entire team must be trained to focus on getting every dollar rightfully owed to the practice. Through the CMIS program, you can acquire the skills to master the entire process, better train those around you, and enhance your professional skills and value. Key Course Objectives*: • The Insurance Billing Specialist: Role and Responsibilities • Compliance • Basics of Health Insurance • Medical Documentation • Electronic Data Interchange: Transactions and Security • Receiving Payments and Insurance

• Problem Solving • Office and Insurance Collection Strategies • Managed Care Plans • Medicare • Medicaid and Other State Programs • Workers’ Compensation • Disability Income Insurance and Disability Benefit Programs *For a detailed description of the key course objectives, visit the August issue of San Diego Physician at Registration will begin winter 2010. Watch your communications from SDCMS.

Become a Certified Medical Coder in Five Days (October 2010)! Attention Office Managers/Practice Administrators: Certified medical coders (CMC) are the fact-checkers in the reimbursement process. They have mastered the intricacies of procedural and diagnostic outpatient coding systems, and understand the implications for over- or under-coding. CMCs have the skills to address complex problem sets, make proper code selections to the highest degree of specificity, and clarify advanced coding issues with physicians and business associates.

Fridays beginning Oct. 1, 2010, and running through Oct. 29, 2010. Registration is limited to 30 participants. SDCMS members and their staff may attend for the discounted rate of $599 each (nonmembers pay $999), which includes the certification exam. For more information, contact Sonia Gonzales, your SDCMS office manager advocate, at (858) 300-2782 or at To register today, simply fill in the information requested below and fax this form to SDCMS at (858) 569-1334.

Attention Physicians: Lack of adequate training can cost any medical practice dearly in terms of lost revenue due to inaccurate reimbursement. Erroneous claims may even trigger a carrier audit, which is why it makes good business sense to employ certified professionals to handle your reimbursement process. Accredited professionals are more confident in their abilities and able to use that heightened knowledge to train others in the practice. Other benefits include enhanced efficiency and productivity, and a higher level of financial security for the practice.

Course Curriculum*: • Medical Terminology as Applied to Diagnostic and Procedural Coding • ICD-9-CM Diagnostic Coding • CPT Procedural Coding • Ancillary Services and Advanced Coding *For a detailed description of the course curriculum, visit the August issue of San Diego Physician at

Course Details:

SDCMS will host the Practice Management Institute (PMI) Certified Medical Coder preparatory course at our offices at 5575 Ruffin Road, Suite 250. The class meets on five

• When: Oct. 1, 8, 15, 22, 29 (five Fridays) from 8 a.m. to 4 p.m. each day (sign in 15 minutes prior to program). • Where: San Diego County Medical Society’s meeting room, 5575 Ruffin Road, Suite 250, San Diego, CA 92123.

• cost: SDCMS member physicians and their staff pay the discounted rate of $599. Only SDCMS member physicians and their staff may attend. Registration fee includes breaks, lunch, instructional materials, and certification exam. Required materials include CPT, ICD-9 CM Volume 1 and 2, HCPCS manual, and a medical dictionary. • presented by: The Practice Management Institute (PMI), and hosted by the San Diego County Medical Society (SDCMS) and the California Medical Association (CMA). • cancellation policy: A full refund less a $20 processing fee is given if cancellation is received seven-plus days prior to program start date. A 50 percent refund is given if cancellation is received six days to 48 hours prior to start date. No refund is given if cancellation is received less than 48 hours in advance. Upon registration, custom materials are printed, refreshments are ordered and seating is reserved, and, as a result, PMI strictly adheres to this policy. • to register: Fax this page to SDCMS at (858) 569-1334 • Questions? Contact Sonia Gonzales, your SDCMS office manager advocate, at (858) 569-1334

participant Information • FAX COMPLETED FORM TO SDCMS AT (858) 569-1334 Attendee Name

Member Physician Name

Address city / state / zip



Payment Information

o Visa

o MasterCard

o AmEx


o Check

(Make check payable to “Practice Management Institute” and mail to: SDCMS, Attn., Sonia Gonzales, 5575 Ruffin Road, Suite 250, San Diego, CA 92123.)

Credit Card #

Exp Date

Total Amount

Cardholder Name

Cardholder Signature

Billing Address ZIP Code august 2010 SAN  DIEGO  P HY SICIA N. o rg


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acy A dv o cSDCMS Announces Its Second-annual

“Outstanding Medical Office Manager” Contest Nominate Your Office Manager Today! Does your physician think that you are the best office manager in San Diego County? We want to hear about it! SDCMS wants to recognize San Diego County’s most outstanding medical office manager, i.e., someone who goes above and beyond his or her job description, who anticipates problems before they arise, who works efficiently with the practice’s time and resources, and who strikes the right balance between exercising control and boosting morale when supervising staff. SDCMS member physicians can nominate their office managers by explaining in writing (up to approximately 600 words) why their office manager is the best in San Diego County. Nominations should be sent to SDCMS, Attn.: Sonia Gonzales, 5575 Ruffin Road, Suite 250, San Diego, CA 92123, or emailed to Sonia at The winner will receive a $250 gift card and recognition as SDCMS’ Outstanding Medical Office Manager for 2010! Nominations will be accepted until Oct. 1, 2010, and contest results will be published in the December issue of San Diego Physician. Contact Sonia with any questions at (858) 300- 2782 or at


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

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 to learn more and to sign up.

Sign up NOW at 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. august 2010 SAN  DIEGO  P HY SICIA N. o rg


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


classifieds office space CARMEL VALLEY OFFICE SPACE FOR SHARED LEASE OR SUBLEASING: 2,900 square feet located in the Scripps Medical Offices on El Camino Real and High Bluff. Busy women’s health office ideal for physician seeking exposure to new patients. Convenient practice ready space ideal for a solo physician. Possibility for shared staff and/or overhead. Contact Mrs. Kim at or at (858) 259-9821. [790]

Office space sublease in prime La Mesa location available immediately. Handicap accessible. Office is directly across from Grossmont Hospital. Its the only Grossmont medical office location with free parking. If interested contact Stacey Ruggles @ 619-994-3233 or 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 [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, 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 ( — 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] 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] PHYSICIAN POSITIONS AVAILABLE NORTH SAN DIEGO COUNTY FAMILY PRACTICE: We are a Joint Commission-accredited, federally qualified community health center, celebrating 40 years of service, and serving more than 60,000 patients in multiple locations in North San Diego County. We have opportunities for BC/BE physicians. Compensation includes attractive base, incentive, and great benefit programs, malpractice, reimbursement for CME/licensure. This is an opportunity to make a difference in the lives of patients who are under- or uninsured without having the expense of overhead or management concerns, and provides work-life balanced hours. NHSC loan repay may also be available. Email cynthia.bekdache@, call (760) 736-8632, or fax to (760) 736-8740. [794] ARE YOU STRUGGLING WITH YOUR PRIMARY CARE PRACTICE?: If you love your patients and you want to practice medicine the way you want, then Harmony Medical Group is a solution. We know the way to increase your productivity, cut expenses, and turn your practice from a nightmare to a joy. Please email us at harmonymedicalgroup@gmail. com and our business coordinator will meet and answer all your questions. [827] FAMILY MEDICINE PHYSICIANS — FULL AND PART TIME: SHARP Rees-Stealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking full-time or half-time job share BC/ BE family medicine physicians to join our staff. We

offer a first-year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Ave., San Diego, CA 92101. Fax: (619) 233-4730. Email: [825]

U.S. HealthWorks, headquartered in Valencia, is one of the nation’s largest employers in the field of Occupational Medicine and Urgent Care. Medical Directors San Diego County Clinic Physicians & Physician Assistants Per Diem San Diego Area Clinics We are an employee-focused organization! We offer outstanding compensation and a competitive benefits program! Please apply with a resume to: Email: Fax: 661-678-2472 Apply online at: EOE ORTHOPEDIST WANTED: Orthopedic office looking for an orthopedist, preferably a foot/ankle specialist. Please send CV and contact info to [824] PSYCHIATRIST NEEDED: Home Physicians ( is a fast-growing group of house-call doctors. Great pay ($140–$200+K), flexible hours, choose your own days (full or part time). No weekends or inpatient duties. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to [801] 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 or fax to (760) 414 3702. Visit our website at EOE/M/F/D/V [821] 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

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


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

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 For further information, visit us at [808] 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] PRACTICE FOR SALE

increase in three months. Please email your resume with business references to drkenstanley@yahoo. com. [829] LOOKING FOR EXPERIENCED / LICENSED NURSE PRACTITIONER: Part/full time for a busy private primary care practice. (Spanish helpful.) National certification required. Location: Oceanside/Tri-City area. Compensation: competitive. The nurse practitioner will provide general medical care and treatment to patients in the office. Under the direction of physician: performs physical examinations and preventive health measures within prescribed guidelines and instructions of physician. The nurse practitioner orders, interprets, and evaluates diagnostic tests to identify and assess patient’s clinical problems and healthcare needs. Records physical findings and formulates plan and prognosis based on patient’s condition. Discusses case with physician to prepare comprehensive patient care plan. Submits healthcare plan and goals of individual patients for periodic review and evaluation by physician. Prescribes or recommends drugs or other forms of treatment such as physical therapy, inhalation therapy, or related therapeutic procedures. May refer patients to physician for consultation or to specialized health resources for treatment. [826] 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 he-

matologies, 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 and Kathy Fisher (administrative assistant) at [812] 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]

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] NONPHYSICIAN POSITIONS AVAILABLE Office Manager Wanted: Mature, responsible adult with experience as office manager in cosmetic dermatology and surgery. Would also need to have experience in reception/front office and be willing to fill in there as needed. Sales experience helpful. Position would start part time and grow into full time. Would need to be available to cover vacations and sick call. We are a growing cosmetic dermatology/primary care practice with some minor officebased surgery. Duties would be primarily office managerial but would require occasional filling in when other employees are out. You would need to be able to manage employees, inventory, and be second point of contact for patients with questions or complaints. Good people skills are a must as well as a personable, sunny disposition. Starting pay $18 with performance increase in three months. Please email your resume with business references to [828] Receptionist Wanted: Mature, responsible adult with friendly, outgoing disposition for reception/front-office position. Experience in cosmetic dermatology preferred. Sales experience a must. Responsibilities include answering the phone, making appointments, collecting payments, selling products, and answering questions about services and products. You will be the primary point of contact for patients and potential patients. Must be willing and prepared to perform multiple roles as needed. Pay starts at $12/hour with a performance

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

august 2010 SAN  DIEGO  P HY SICIA N. o rg


publichealth By Marshall E. Lewis, MD

It’s Up to Us


Addressing Mental Health in San Diego County

Do you have a family member or friend with a psychiatric illness? Most of us do, and all of us have patients with mental illness, often not recognized or treated. As you may know, the Health and Human Services Agency, as part of our new Health Strategy Agenda, is committed to increasing our focus on prevention and early intervention and to working with community partners to improve the overall level of health of our entire population. As a significant part of that effort, I’m pleased to let you know that our agency is launching It’s Up to Us, a major media campaign designed to help people recognize symptoms of mental disorders in themselves, friends, and family members; to reassure them that mental illness is both common and treatable; and to encourage them to seek help. It’s especially up to us as physicians to listen carefully and to respond appropriately when patients ask questions or express concerns about emotional and cognitive issues. Most of us are not experts on mental illness, but when a patient feels comfortable enough to approach the topic, don’t we all want to be able to address their concerns to the best of


S AN  D I E G O  P HY S I CI A N . or g a u gu st 2010

our abilities? It’s every doctor’s goal to provide patients with good options for getting help. It’s Up to Us will provide resources specifically for physicians. The website — UP2SD. org/medical — offers tips for talking with patients about their concerns, information on recognizing warning signs of mental illness, helpful fact sheets, and a host of other resources to provide patients the guidance they need. Modeled after Big Pharma’s detailing approach, experts from our new Ambassador Program will visit physician offices throughout San Diego County to deliver materials, including screening kits, a resource list, and posters and flyers that can be displayed in waiting areas and exam rooms. If an ambassador hasn’t visited your office yet, or if you need additional information or materials, please visit to make a request. An ambassador will respond within 72 business hours, delivering materials to your office manager, or speaking with you directly if you prefer. Please ask your office staff to welcome our ambassadors, to engage them with any questions, and to take and use the resources that will be made available. This is also an oppor-

tunity for all of us to become more aware of the warning signs of mental disorders and to assure that they are on our radar screens when we see our patients. Regardless of our specialties, as physicians we all want to reduce suffering and contribute to our patients’ overall health. There are many opportunities to detect significant psychiatric illnesses in a wide variety of medical practices, and to make appropriate referrals. Our ambassadors want to make this as easy for you as possible. Physicians can help in specific ways: • Display It’s Up to Us posters and flyers prominently in waiting areas and exam rooms. This will desensitize patients and show them that you are open to discussing psychiatric symptoms without embarrassment or discomfort. • Visit the physician portal at medical to access other resources. • Review the primary warning signs of mental disorders and watch for them when you can. • Listen attentively and ask questions when mental health symptoms are broached. Mental illness might not be your specialty, but it is your concern. • Be prepared to have your office provide active assistance when a patient needs help: • Starting Sept. 1, 2010, refer patients to the It’s Up to Us line at (800) 479-3339. It’s easy! • When appropriate, refer your patients to a qualified psychiatrist or psychologist for assessment. • Encourage patients to access the It’s Up to Us website at for further information. • If you suspect that a patient might be suicidal, urge him or her to call the Access and Crisis Line at (800) 479-3339, which is available 24/7. As this important mental health campaign proceeds, an increasing number of San Diegans will become aware of the signs of mental illness and the importance of asking for help. Many of them will — appropriately — look to us for guidance. Let’s be certain that we’re prepared to listen, ask questions of our own, and point them toward the resources they need for further information and treatment. Together, we have enormous potential to help the patients we serve. Thank you in advance for your participation.






MENU SDCMS Is at the Table! By choosing toSDCMS join the San Diego County Medical (SDCMS), over 3,000 practicing physicians, Is atSocietythe Table! and medical students in San Diego(SDCMS), County have voice to our patients Byresident choosingphysicians, to join the San Diego County Medical Society overgiven 3,000 practicing physicians, and to physicians, our communities in the healthcare discussions everyvoice single resident and medical students inreform San Diego County and haveingiven tohealthcare our patients issue being debated locally, inreform Sacramento, and inand Washington, DC. healthcare and to our communities in the healthcare discussions in every single issue being debated locally, in Sacramento, and in Washington, DC. Ask your colleagues: “Are You a Member of SDCMS?”

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San Diego County Medical Society (SDCMS) | 5575 Ruffin Road, Suite 250 San Diego | 858.565.8888 | San Diego County Medical Society (SDCMS) | 5575 Ruffin Road, Suite 250 San Diego | 858.565.8888 |

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San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA  92123 [ RETURN SERVICE REQUESTED ]

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August 2010  

Office Manager Advocacy

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