July 2018

JULY 2018 OFFICIAL PUBLICATION OF SDCMS

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CONTENTS

VOLUME 105, NUMBER 7

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Jamie M. Jordan, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO

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AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher

feature

18 All Together Now to Save Lives

BY CHRISTINE THORNE, MD, MPH

departments 4 Briefly Noted • Calendar • NEPO Conference • Public Health • Reimbursement Help • Volunteer Opportunities • Advocacy

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CMA Expands Program to Cultivate Equality in the Medical Profession

BY CALIFORNIA MEDICAL ASSOCIATION STAFF

14 Welcome to the Next Generation of CMA

BY CALIFORNIA MEDICAL ASSOCIATION STAFF

Promote Health in San Diego as a Physician Speaker

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BY CHAMPIONS FOR HEALTH STAFF

Physician Marketplace Classifieds

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Sexual Harassment Allegations in Healthcare

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BY RICHARD CAHILL, JD

BY HELANE FRONEK, MD, FACP, FACPh

JULY 2018

The Opposite Is Also True

ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org.

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

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CONFERENCE

CALENDAR Aug. 1–4: Metabolic & Endocrine Disease Summit (MEDS) for NPs and PAs. Physicians welcome.

More information: www. globalacademycme.com Aug. 11: Integrated Care Across the Lifespan at AMN Healthcare San Diego. More information: https://cme.ucsd. edu/ical Sept. 13–15: 2018 NEPO Summit at the Westin Pasadena. More information: www.phcdocs.org Oct. 12–14: UCSD School of Medicine marks its 50th anniversary with Alumni Reunion Weekend. More information: medalumni@ ucsd.edu Oct. 19: Save The Date! 2018 Top Doctors Gala at Farmer and the Seahorse Oct. 25: SDCMS Physician Mixer at the Rock Bottom Brewery. More information: JOhmstede@sdcms.org Nov. 8-10: Cardiovascular, Allergy & Respiratory Summit (CARPS) at the Wyndham San Diego Bayside.

Optional workshops Nov. 7. More information: www. globalacademycme.com.

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JULY 2018

NEPO Building Healthy Communities Summit, Sept. 13–15 in Pasadena Registration is now open for the 2018 Network of Ethnic Physician Organizations (NEPO) Summit. This year’s theme, Building the Best You: Celebrating the Joy of Medicine, will address issues of physician burnout and provide solutions to create a culture of wellness and physician wellbeing.

The 2018 NEPO Summit is a unique and exciting educational event for physicians, medical students, public health professionals, and community leaders. The NEPO Summit will provide you with opportunities to learn about key health policy issues, building diversity in the workforce, and increasing cultural competency in clinical care.

To register visit www.phcdocs.org PUBLIC HEALTH

Public Health Services Resources The Public Health Services (PHS) Division in the County of San Diego Health and Human Services Agency (HHSA) provides health services and information in multiple languages, both online and at County Public Health Centers. To make information available in the languages of the clients that the County serves, PHS is increasing the availability of materials in different languages beyond English, especially the five most spoken languages in San Diego County. These languages include Spanish, Vietnamese, Tagalog, Chinese, and Arabic. More information: https://www.sandiegocounty. gov/content/sdc/hhsa/programs/phs/phswritten-materials.html

SDCMS President Dr. Bazzo attending the UCSD’s School of Medicine Commencement Ceremony on June 3.

REIMBURSEMENT HELP

Blue Shield implements system fix for AB 72 claims Last year, the California Medical Association (CMA) worked with Blue Shield of California to correct two issues affecting accurate payment of claims subject to the state’s new out-of-network billing and payment law (AB 72). The issues were identified as being due to manual claim processing errors, because the payer had not yet updated its system to allow automated processing of claims subject to AB 72.

Blue Shield recently announced it implemented a system update on June 28 that allows claims subject to AB 72 to be processed automatically. The payer reports it is conducting regular audits of these claims post-automation to ensure accuracy.

Practices with additional questions or concerns can contact CMA’s Reimbursement Helpline at (800) 786-4262 or economicservices@cmanet.org.

////////////////////////////////////////////////////////////////////////////////////////////////// ADVOCACY

State budget includes 10 new CPT codes eligible for supplemental tobacco tax payments

GIVING BACK

VOLUNTEER OPPORTUNITIES Email Your Volunteer Opportunity Ads to Editor@SDCMS.org Short-Term Medical Volunteers Needed for Haiti Global Health Teams is looking for physicians, mid-level providers and nurses for one week, primary care medical clinics in rural Haiti every February, June and October. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically underserved area. Global Health Teams is an experienced, U.S.-based nonprofit and has been operating these clinics since 1998.

We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or bob@ globalhealthteam.org if you are interested in applying. Visit www. globalhealthteam.org for further information.

Physicians: Help us help improve the health literacy of our San Diego County Communities by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and

help improve the health literacy of those with limited access to care.

For further details on how you can get involved, please email Andrew.

Gonzalez@ChampionsFH.org.

Champions for Health Project Access: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal to receive short term specialty care. Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism.

Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or Andrew.Gonzalez@ ChampionsFH.org, or visit www.

ChampionsforHealth.org.

Governor Jerry Brown recently signed a $139 billion California budget for the 2018–2019 fiscal year. The budget continues the Administration’s commitment to using the Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers, with $500 million in tobacco tax funds allocated to improve provider reimbursement through supplemental payments. The total funding for provider payments is approximately $1.3 billion.

DHCS plans to allocate the tobacco tax funds to increase payments for a total of 23 CPT codes, which includes 10 new preventive CPT codes. The supplemental rate proposal is contingent on federal approval, and is effective July 1, 2018.

DHCS has proposed increasing the supplemental payment for the currently eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017–2018 payment levels). The 10 newly added preventive CPT codes would be paid at 100 percent of Medicare.

The supplemental payments would apply to both fee-for-service and managed care delivery systems.

The supplemental rate proposals are effective July 1, 2018, contingent on receipt of federal approval, which was requested through a State Plan Amendment on June 29, 2018.

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JULY 2018

ADVOCACY

Leading Health Organizations Announce Filing of Statewide Soda Tax Measure for 2020 This month a ballot measure to protect public health through a state soda tax was filed for the 2020 ballot by two of California’s leading healthcare provider organizations: the California Medical Association (CMA), representing 43,000 California physicians, and the California Dental Association (CDA), representing 27,000 California dentists.

The filing comes after the multibilliondollar soda industry had proposed a ballot measure that jeopardized the fiscal outlook of local governments, forcing the state to preempt local authority and pass an unprecedented 12-year moratorium on any local soda tax.

Specifically, the soda industry’s proposal would have required cities and counties achieve a two-thirds vote instead of the current 50 percent vote threshold to raise taxes. The soda industry’s strategy was to effectively hold the state of California hostage with this dangerous ballot threat.

This 2020 ballot initiative would implement a statewide tax on sugar-sweetened drinks, providing at least $1.7 billion in revenue for critical health programs and constitutionally preserving the ability of California’s local communities to make their own decisions regarding future soda taxes.

Dustin Corcoran, CMA chief executive

officer, and Carrie Gordon, CDA chief strategy officer, issued the following statement: “In the face of growing public support for local health taxes on sugar-sweetened beverages, the billion-dollar global soda industry last week put corporate profits ahead of public health and forced an ultimatum upon the leadership of California’s state government.

“Big Soda may have won a cynical short-term victory but, for the sake of our children’s health, we cannot and will not allow them to undermine California’s long-term commitment to healthcare and disease prevention.

“There is overwhelming evidence of the link between obesity, diabetes, tooth decay, and heart disease and the consumption of sugary-sweetened beverages such as soft drinks, energy drinks, sweet teas and sports drinks.

“Around the world and in local communities, reasonable soda taxes have been proven effective in dramatically reducing consumption of sugary drinks and improving the public health, especially among children.

“California’s healthcare provider community is united behind ensuring that California voters have the opportunity to protect our children’s wellbeing — not the profit margins of soda conglomerates.”

////////////////////////////////////////////////////////////////////////////////////////////////// MEMBERSHIP

Welcome New and Returning SDCMS-CMA Members!

Welcome New Members!

Hellen Chiao, MD Internal Medicine North County (858) 554-3200 Bryon Chow, MD Pediatrics North County (760) 520-8100 Neelima Doshi, MD Pediatrics North County (760) 520-8372 Christopher Gordon, MD Family Medicine Hillcrest (619) 906-4609 Mason Harrell, MD Occupational Medicine South County (619) 545-4556 Mark Howard, MD Family Medicine North County (760) 520-8372 Nishwan Jibri, MD Family Medicine East County (619) 440-2751

Taib Rawi, DO, MBA Geriatric Medicine (Internal Medicine) La Jolla (619) 497-8476 David Ries, MD Internal Medicine Pediatrics Hillcrest (858) 657-7000 Patricia Rose, MD Family Medicine North County (858) 499-2600 Karla Strazicich, MD Pediatrics North County (760) 737-2030

Welcome Returning Members!

Mark Yamanaka, MD Pulmonary Critical Care Medicine North County (760) 941-0221 Julian Anthony, MD Urology North County (760) 747-8935

Robert Mcauley, MD Psychiatry North County

Minhthy Meineke, MD Anesthesiology Hillcrest (619) 471-0670

Archana Narayan, MD Internal Medicine North County (619) 528-5000

Katherine Francis, MD Pediatrics East Country (619) 440-2751

Alejandra Postlethwaite, MD Child and Adolescent Psychiatry North County (858) 966-5832

Ahmed Ghouri, MD Anesthesiology North County (858) 795-1914

TrusT

Michael O’Leary Otolaryngology Hillcrest (619) 229-4903 Tawny Sauriol, MD Family Medicine North County (858) 458-4382 Laura Petrovich, MD Pediatrics South County (619) 435-2234 Kelly Keefe, MD Ophthalmology Hillcrest (619) 291-6191 James Veltmeyer, MD Family Medicine East County (888) 833-7922 Lindsey Yourman, MD Internal Medicine Hillcrest (858) 657-7000 Jean Mullenax, MD Pediatrics East County (619) 445-1188 Dorothy Liu-Barbaro, MD Psychiatry East County (760) 520-8372

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C O M M U N I T Y E N G AG E M E N T

Promote Health in San Diego as a Physician Speaker!

IN A WORLD INCREASINGLY going virtual, a live presentation continues to have impact. Particularly on topics of health and wellness, the veritas of a physician further enhances the value. San Diego turns to Champions for Health Live Well Speakers Bureau to connect physicians with organizations requesting that human touch.

By recruiting physicians across the spectrum of specialties and career stages, the Bureau finds matches for equally diverse audiences. SDCMS member Karl Steinberg highlights his geriatric, hospice, and palliative care specialty through topics including advanced care planning, POLST, and

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JULY 2018

diseases of aging such as diabetes, delirium, and dementia. Speaking at a Salvation Army senior home, Dr. Steinberg says “the attendees were very engaged, and I know what I had to say caused some of them to take action to ensure that they discussed their goals of care with family and their personal physicians.”

Led by recent SDCMS President Mihir Parikh (pictured), ophthalmologists developed a cutting-edge presentation on the growing problem of myopia. “It is easy and very gratifying to talk about a topic I have expertise on to the general public,” Dr. Parikh says. Through a one-hour talk

to parents and policy makers in county schools, these eye docs impact lives.

Through a partnership with Live Well San Diego, Live Well Speakers Bureau works with organizations including SDUSD Wellness Council, South Eastern SD Cardiac Disparities Project, Heal Zone Lemon Grove, and more than 130 other partners.

The goal is to meet at least seven speaking engagements per month, but requests can reach many times that number. The Bureau has hopes of expanding outreach even further through virtual presentations.

For retired cardiologist and SDCMS member Harris Effron, participation allows him to interact with a diverse population from high school to active military to retirement. Most memorable was his audience at the Archie Moore Center, addressing kids who might otherwise have been out on the streets. For Dr. Effron, the Live Well Speakers Bureau provides a way to meet the community needs for basic medical information and encourage youth to stay focused on education and good living habits.

Regular Bureau speaker K.B. Lim says, “We all went into Medicine with great ideals of changing the world for the better.” Retired from ob-gyn practice, he focuses on health and nutrition topics such as whole-food, plant-based diets, finding that through this outreach he has found a new way to impact

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Other regular speakers include Roopa Chari, M.D. an internal medicine physician who has been driven by a passion for educating the public on important health topics. She finds her varied audiences are receptive to her practical tips, natural remedies and dietary recommendations for common health conditions. Porchia Rich brings her practice in preventive medicine to her presentations. Her favorite group was the ABC Youth Foundation, where she shared her own story about growing up in

Over the next few years, the Live Well Speakers Bureau will need more physicians as engagement with other Live Well San Diego partners increases outreach to constituents. a low-income community of San Diego in the ’80s and ’90s, but went on to become a doctor. After asking, “Who wants to be a doctor when they grow up?” three hands raised in the group. Next she asked, “Who is planning on attending and graduating from college?” and all 10 children raised their hands. Dr. Rich believes that she brought a message of possibility and hope to an underserved San Diego community.

Over the next few years, the Live Well Speakers Bureau will need more physicians as engagement with other Live Well San Diego partners increases outreach to constituents. Topics are varied, and physicians are encouraged to bring their own interests and expertise to meet speaker requests.

Making it easier for volunteers to identify opportunities of interest, volunteer coordinator Andrew Gonzalez instituted an online sign-up this year.

For more information or to participate, contact Andrew Gonalez at Andrew.

Gonzalez@ChampionsFH.org or (858) 300-2787.

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R I S K M A N AG E M E N T

Sexual Harassment Allegations in Healthcare Rising Risks By Richard Cahill, JD

A SUCCESSFUL AND HIGHLY respected pediatrician with an unblemished record over decades of practice learns of a HIPAA breach by a member of his clerical staff.

After an investigation reveals the employee is a repeat offender, she is terminated.

Imagine the physician’s reaction when the employee’s attorney not only initiates a wrongful termination suit, but also alleges

retaliation, claiming the employee rebuffed sexual advances from the doctor.

To gain additional leverage, the former employee’s attorney submits a complaint of sexual harassment with the medical board and has the plaintiff file a criminal complaint for sexual battery. The attorney also sends a letter to the medical executive committee of the principal hospital where the

doctor admits patients, resulting in a peer review investigation. Finally, the former employee blankets social media with an aggressive smear campaign.

This example demonstrates that healthcare providers are not immune from the growing number of reported incidents of alleged sexual harassment in the workplace.

Accusers may be employees, patients, third-party venders, or visitors. Individuals alleged to have acted inappropriately may include co-workers — both supervisors and subordinates — professional staff, and even patients.

Repercussions of Harassment Claims Shortly after complaints are filed, costly and potentially embarrassing investigations are often conducted by law enforcement, human resources departments, and administrative agencies. Depending on the nature and scope of the findings, serious adverse consequences and often irreparable harm to a person’s reputation may follow, including: • criminal prosecution; • civil litigation with the potential for substantial damages; • licensing board actions that may impose limitations on an individual’s continued privilege to pursue his or her profession.

Adopt and Enforce Zero Tolerance Given the risks, heightened awareness, and increased scrutiny, healthcare practitioners and facilities are strongly encouraged to develop and consistently enforce a zerotolerance policy. Protocols must be written, periodically reviewed, and updated as necessary, detailing: • The types of conduct that will not be tolerated, regardless of the identity of the alleged perpetrator.

• A clear methodology for reporting claimed instances of wrongdoing.

• The process to be followed in investigating complaints, and rules that should be observed to help insure that confidentiality and due process are appropriately protected.

• Documentation to be completed and maintained.

• The range of sanctions, up to and including termination, for both employees and patients, should the allegations ultimately be determined to be true.

Staff should receive proper training as part of the on-boarding process of each new employee and on a regular basis thereafter.

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JULY 2018

Offices should develop and retain attendance sign-in sheets of such training in the regular course of business to demonstrate, in the event of a subsequent problem, the good faith and due diligence as continuing efforts of the clinic, provider, or facility to comply with federal and state requirements.

It is recommended that healthcare facilities, clinics, and other professional offices institute a process of publishing their zerotolerance policy toward harassment. This can be achieved in employee on-boarding documentation, professional employment contracts, conditions of treatment or admission, third-party vender agreements, website notices, and even office signage.

Be Sure You’re Covered Healthcare providers are also strongly encouraged to consult with their personal or corporate attorney to understand the potential financial risks of claims involv-

ing allegations of sexual harassment or misconduct. They should then confer with their insurance agent or broker to determine proactively what coverages might be available in their respective states to protect the provider in the event of such a claim.

Policy language and state regulatory requirements often vary from jurisdiction to jurisdiction. Most practitioners carry professional liability coverage in the event of a claim for medical malpractice. Not uncommonly, however, medical professional liability policies specifically exclude coverage for acts of sexual misconduct committed by a physician against a patient.

Depending upon the professional liability carrier, the physician may be provided with a courtesy defense covering the costs of legal fees and expenses, but no payment for any indemnity incurred in the event of an adverse jury verdict.

It’s also prudent to consult with insurance brokers and agents about the availability of Employment Practices Liability Insurance (EPLI). EPLI may provide coverage for certain types of workplace harassment, which may include sexual misconduct involving the policyholder and an employee.

Finally, claims of inappropriate sexual behavior against a physician or other licensed healthcare practitioner may result in administrative proceedings by a state medical board, or the privileges committee of a hospital or other facility regulated by The Joint Commission. Endorsements are widely available as part of medical professional liability policies to pay legal defense costs in the event of an investigation or subsequent disciplinary hearing.

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DIVERSIT Y IN MEDICINE

CMA Expands Program to Cultivate Equality in the Medical Profession

By The California Medical Association

THE CALIFORNIA MEDICAL Association (CMA) has long believed that diversity and inclusion strengthen the health of our profession and California’s communities.

To that end, CMA launched a Diversity and Inclusion Technical Advisory Committee (D&I TAC) in 2014 to usher in a new generation of policies and initiatives focused on: • developing resources and programs that demonstrate why diversity and inclusion is a business imperative; • implementing policies and practices that make diversity and inclusion goals a permanent strategic focus; • designing a strategic plan to achieve diversity and inclusion within CMA, including the Board of Trustees, component medical societies, CMA staff and leadership; • supporting efforts to achieve diversity and inclusion within the physician workforce and in California medical schools.

• CMA’s diversity and inclusion mission statement reinforces our dedication to “ensure that the work we do, how we carry out our work, and the issues we address all reflect the rich diversity of the patients and the physicians we serve and represent.”

Donaldo Hernandez, MD, chairs the D&I TAC and is joined by C. Freeman, MD; Dexter Louie, MD; Margaret Juarez, MD; Rafael Silva, MD; Vito Imbasciani, MD; Andrea Rudominer, MD; and medical students Pooja Desai and Allen Rodriguez.

“Diversity is the who and inclusion is the how — the behaviors and policies that welcome and embrace diversity,” Dr. Hernandez says. “One supports the other, and the D&I Tac is pursuing comprehensive external and internal strategies to cultivate equity in the medical profession.”

“Our research highlights current demographics and realities to explain why diversity and inclusion is imperative for advancing CMA’s mission, economic sustainability, and membership growth,” Dr. Juarez says. “Implementing strong policy and procedural changes will keep CMA at the forefront of Cali-

fornia’s evolving patient population and provider demographics.”

Ongoing D&I TAC activities include: • publishing demographic and educational resources; • expanding the pipeline for entry into medical schools for underrepresented populations; • sharing best practices that physicians can utilize in their employment practices; • identifying pathways to increase member engagement through the Network of Ethnic Physician Organization (NEPO) and Ethnic Medical Organization Section (EMOS); • reviewing policies and procedures on leadership development, staff hiring, and promotion practices for CMA and the county medical societies.

“California is facing a physician shortage and our current workforce doesn’t reflect the state’s patient population,” Dr. Silva says. “The D&I TAC is examining various strategies to support or expand mentoring programs and outreach to middle and high school students who show an interest in science and medicine. And we’re pursuing proactive ways to tackle the barriers to enter medical school, including financial aid assistance and promoting implicit bias training.”

“Our initial research has also discovered the need to support our physician colleagues serving ethnic and historically underrepresented communities,” Desai says. “From financial assistance programs and trained translators to culturally responsive care and succession planning support for retiring physicians, we’re exploring strategies to ensure California’s physician workforce can respond to the needs of its patient population.”

The D&I TAC will present research at the July 2018 Board of Trustees meeting highlighting the benefits of diversity and inclusion efforts toward clinical outcomes and demonstrating why it is a business imperative, as well as recommendations for new CMA policy and procedures, and joint engagement between NEPO and EMOS. This article is the first of an ongoing series to provide regular updates on D&I TAC’s mission and objectives. All interested physician members who want to learn more or get involved are encouraged to email communications@cmanet.org.

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JULY 2018

CURES Duty-to-Consult Mandate Takes Effect October 2 Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – before prescribing Schedule II, III or IV controlled substances.

When Must I Consult CURES?

Physicians must consult the database before prescribing controlled substances to a patient for the first time and at least once every four months thereafter.

Save the Date:

Free CURES webinar with the California Department of Justice on 8/22.

Register at cmanet.org/events.

For More Information CMA CURES webpage: cmanet.org/cures CURES website: oag.ca.gov/cures SAN DIEGO PHYSICIAN.ORG

13

CMA SERVICES FOR MEMBERS

Welcome to the Next Generation of CMA CMA Website Redesigned to Better Benefit Members

SINCE 1856, the California Medical Association (CMA) has supported physicians and the practice of medicine to keep the Golden State healthy and thriving. CMA’s success is rooted in our ability to effectively connect, communicate, and engage with members.

Because together, we are stronger.

“Diverse organizations like CMA need a bold brand and modern website to reinforce our mission through impactful design, messaging, and imagery,” says CMA Vice President of Strategic Communications Laura Braden Quigley. “Our website was last updated in 2011, and our brand family had been untouched since the early 1990s. Given that CMA’s family includes 37 county medical societies, a political action committee, a foundation, and other partners, it is critically important to demonstrate a cohesive and consistent brand across all communications channels, affiliates, and platforms.”

CMA’s website functionality, design and content strategy was reimagined with a focus on membership recruitment and engagement. Enhanced features of the new website include:

1

One Login: We’ve simplified the login process so you don’t have to keep track of multiple usernames and passwords. The joint CMA/county login means that your county medical society login now grants access to your CMA account.

2 3

My CMA: From public health to Medi-Cal, choose your preferences for custom content and personalized

alerts.

Mobile Responsive Design: CMA’s new site is optimized for mobile devices, so you can stay engaged from your phone or tablet.

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How to Log in to CMA’s New Website CMA and the county websites now share a single sign-on. If you’re a CMA member, that means you can login with your county website username and password. In most cases, your username will be your email address or your medical license number. If you do not know your county login credentials, simply use the username and/or password retrieval. If you have any problems accessing your account, please contact the CMA Member Resource Center at (800) 786-4262 or memberservice@ cmadocs.org.

PLEASE NOTE: Changing your password on the CMA website changes your password on the county website, and vice versa.

Have You Visited the Improved cmadocs.org?

My CMA

Choose your preferences for custom content and personalized alerts.

Grassroots Action Center The new hub for all of CMA’s advocacy efforts.

Simplified joint CMA/county login process so you don’t have to keep track of multiple usernames and passwords.

Mobile Responsive Design Optimized for mobile devices, so you can stay engaged from your phone or tablet.

Newsroom

In addition to press releases and breaking news, you can also join our Social Media Ambassador program or become a Media Surrogate.

Legislative Tracker

Real-time updates on legislation impacting the practice of medicine.

One Login

Join CMA

Streamlined application process that is fully integrated with our membership database.

Search

Returns more relevant results, making it easier for you to find what you need.

Discussion Forums Easier and faster to connect with physician colleagues.

Policymaking

Submit and comment on resolutions through CMA’s year-round policymaking process.

Learn more about CMA’s next generation at cmadocs.org

Change Your Bookmarks: CMAdocs.org In addition to the new website, CMA is also moving to a new URL that is easier to remember and more representative of who we are: CMAdocs.org. We have also moved to @CMAdocs on Facebook, Twitter, YouTube, Instagram, and LinkedIn. CMA’s emails have been updated to email@cmadocs.org, and the staff directory remains the same: the first letter of the first name and last name (e.g.: dcorcoran@cmadocs.org).

For additional information and resources: • Customize Your Website Content: cmadocs.org/my-cma • Website How-to Webinar and Usage Guide: cmadocs. org/cma-next-generation • Contact the CMA Communications Team: communications@cmadocs.org.

4 5

Search: The new and improved search function returns more relevant results, making it easier for you to find what you need.

Grassroots Action Center: The Grassroots Action Center is the new hub for all of CMA’s advocacy efforts. Make your voice heard, join the Physician Advocate program, receive training from CMA experts, and more!

6 7 8 9

Policymaking: Submit and comment on resolutions through CMA’s year-round policymaking process.

Discussion Forums: With improved features, we’ve made it much easier and faster to connect with physician colleagues.

Legislative Hot List: Receive real-time updates on healthcare legislation impacting your patients and medical practice.

Newsroom: In addition to press releases and breaking news, CMA now has media training and other resources available, just for members. You can also join our Social Media Ambassador program or become a Media Surrogate!

10

Join CMA: We have streamlined the application process so it is fully integrated with our membership database. Join or renew today and immediately get full access to your “My CMA” dashboard and valuable member benefits.

“CMA’s brand and website serve as powerful recruitment and engagement tools to keep California’s physicians at the forefront of an ever-changing healthcare landscape,” says CMA President Theodore M. Mazer, MD. “It also sends a bold message to physicians that we continue to be ready to embrace tomorrow’s challenges and opportunities. Much has changed since 1856, but CMA’s mission remains constant: to promote the science and art of medicine, protect public health, and better the medical profession.”

CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

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ALL TOGETHER NOW TO SAVE LIVES Addressing Cardiovascular Disease Disparities: Be There San Diego Issues Recommendations to Control Hypertension

BY C H RI STI NE THORNE , M D, M PH

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B

e There San Diego, with funding from the Centers for Disease Control and Prevention (CDC) through the County of San Diego Health and Human Services Agency (HHSA), has spent the past four years tackling the problem of undiagnosed, untreated, and uncontrolled hypertension in San Diego County through its clinical quality collaborative and community-based initiatives.

Heart disease remains a persistent area of healthcare disparity, with AfricanAmericans experiencing increased rates of hypertension and associated cardiovascular morbidity and mortality compared to whites.1 Nationally, African-American men continue to have the highest overall cardiovascular disease death rate.2 Additionally, African-Americans are less likely to have their risk factors diagnosed and treated than white patients.3 Therefore, physicians need to remain vigilant, to not only ensure that they’re diagnosing hypertension and other cardiovascular disease risk factors, but to ensure that they’re doing so equitably, accounting for race, ethnicity, and gender disparities.

To specifically address racial disparities in hypertension awareness, management, and control in the community, Be There San Diego has had a four-year initiative in Southeastern San Diego partnering with 22 faith-based organizations to implement

heart-health action plans. These plans, developed by the churches and one mosque, have included education about hypertension, lifestyle programs for the communities, and nurse-supported blood pressure screening and monitoring programs.

These programs have been undertaken in partnership with the American Heart Association, United African American Ministerial Action Council (UAAMAC), Champions for Health, Kaiser Permanente, Multicultural Health Foundation, and the Black Nurses Association. This project has been so successful that it has garnered recognition from the CDC and Elizabeth Bustos, the project director at Be There San Diego, and Rev. Brown of UAAMAC received the prestigious Robert Wood Johnson Health Equity Award in December 2017.

As physicians, we all know that preventing disease is ideal and that treating hypertension is essential to preventing multiple chronic diseases, including heart attacks and stroke. However, translating knowledge into action remains a challenge. According to Hillary Wall’s paper, Patients with Undiagnosed Hypertension, from 2014, while one in three Americans has hypertension, only half of those patients have their hypertension under control, and one-third of them weren’t aware they had hypertension and weren’t being treated. It’s tempting to think that patients who have undiagnosed or untreated hypertension are not seeking care;

SAN DIEGO PHYSICIAN.ORG

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7 Recommendations for Better Management of Chronic Disease A Focus on Hypertension

however, her study showed that between 2009 and 2012, before the Affordable Care Act, more than 80% of these patients had health insurance and a usual source of care, and nearly 62% of them had been seen two or more times by their clinician in the past year.4 Clinically, Be There San Diego has been working with medical leadership from all of the major health systems, numerous federally qualified health clinics, and independent practices in San Diego with an audacious goal of making San Diego a heart attack and stroke-free zone. To achieve this, Be There has set a goal of achieving 80 percent hypertension control across all participating clinical groups. By the end of 2016, Be There San Diego had achieved this goal, putting the quality collaborative’s hypertension control within in the top 10 percent of clinics nationally.

This improvement was not limited to a specific sector but involved broad improvements in hypertension control across all areas of the county and all payers. To build on this achievement, Be There San Diego developed a comprehensive series of recommendations to address organizational approaches to improving hypertension control across all patient populations.

The recommendations were developed collaboratively with input from all of the major healthcare systems in the region and are the result of a years-long process that tapped the expertise of physicians, pharmacists, and healthcare professionals delivering patient care in a variety of clinical settings. The recommendations are grounded in evidence-based interventions and are in accord with all recent clinical guidelines. Medical directors of the leading

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Be There San Diego has developed a set of recommendations for organizations looking to improve their management of chronic disease, with a focus on hypertension. This began with a simplified approach to hypertension treatment, which was adopted in 2014. The approach outlined in this recommendation is based on JNC8 recommendations, but remains in accord with 2017 ACC/AHA Hypertension Treatment Guidelines.

The concept for this original recommendation was to provide an evidence-based treatment approach that could be readily implemented across all systems and payers with affordable medications and an easy-to-access flow chart for advancing treatment in patients who are uncontrolled.

Since 2014, the organization has developed seven more recommendations, synthesizing evidence-based best-practice guidelines with real-world system-based implementation approaches that have been proven to work in the health systems and clinics represented within Be There. All recommendations were developed by the Data for Quality Project, by medical directors from all major health systems and multiple community health centers and IPAs in the San Diego region. After review and revision by these clinicians, the recommendations were then advanced to Be There’s Executive Committee, comprised of regional medical leadership in San Diego, which also provided their review and revisions before final approval.

Recommendations from Be There include approaches for diagnosing and managing hypertension, including the utilization of team-based care, using self-measured blood pressure monitoring, and addressing undiagnosed hypertension. Taken together, these recommendations can help to improve blood pressure management across a patient population.

Other recommendations for involving community health workers on the care team to address disparities and incorporating team-based and community pharmacists in the control and management of hypertension expand the management of hypertension beyond the clinic walls to ensure that all patients have their hypertension addressed at every point of clinical contact.

There’s also a recommendation for diagnosing and managing prediabetes, an important and growing area of healthcare. And later this summer, there will be three more recommendations released, addressing food insecurity and lifestyle considerations around cardiovascular disease, including diet and exercise.

Be There San Diego hopes that these recommendations will help to spread the knowledge and experience of our quality collaborative to other clinicians, clinics, and health systems looking to make systematic change to improve their hypertension control and clinical quality. The step-by-step approach of each recommendation is meant to address all areas necessary for a successful intervention, while allowing room for the variety of practice types, patient groups, and payers that affect the delivery of healthcare.

Clinicians can access the recommendations freely, for review and download, from the Be There San Diego website (betheresandiego.org), under the Healthcare Providers tab.

“We’re not going to let the patient leave the facility with untreated high blood pressure. It’s called the silent killer for a reason.”

- Dr. Anthony Chong, Chief Medical Officer, Scripps Coastal

healthcare organizations rigorously reviewed the data backing these recommendations and honed them with their practical knowledge of healthcare delivery and their daily experience providing patient care.

Specific care was taken to ensure that recommendations included approaches that addressed racial and ethnic disparities in healthcare delivery. For instance, a recommendation for incorporating community health workers into healthcare settings is included to address barriers that racial and ethnic minorities face in developing trusting relationships with their healthcare providers while also supporting culturally appropriate care.

In approaching undiagnosed hypertension, a key portion of the recommendations involve accounting for the racial and ethnic makeup of the patient population, to ensure diagnosing all hypertensive patients equitably. The hope is that through sharing knowledge of how to implement a

system-based method for addressing hypertension, gains can be made throughout the region and healthcare disparities will be decreased.

Anthony Chong, MD, chief medical officer for Scripps Coastal, which has about 200 doctors and physician assistants, is uniquely positioned to see the power the recommendations have to improve an individual patient’s health as well as the positive impact they can have on a health system. A member of Be There’s Executive Committee since 2014, Dr. Chong has participated in the development of the recommendations and sees the value in having a standard approach to diagnosing and treating hypertension, no matter the clinical setting. He understands that patients with hypertension go undiagnosed because they present to the clinic or emergency room for other issues and addressing their elevated blood pressure gets deferred to deal with more acute problems. When this happens,

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Be There San Diego Tackles Cardiovascular Disease Working to Make San Diego a Heart-Attack and Stroke-Free Zone Be There San Diego is a collaborative of multiple health systems, clinics, and communities working together to achieve the audacious goal of making the San Diego region the nation’s first heart-attack and stroke-free zone.

Integral to this work is raising awareness of the inequities that exist in cardiovascular disease risk factors.

On the clinical side, Be There has brought together the physician leaders of the healthcare providers in the region, often competitors in the marketplace, to work together toward preventing cardiovascular disease.

Be There holds monthly University of Best Practices meetings and an annual summit each summer to share regional successes, updates on clinical care, and nationally recognized innovations for improving the quality of

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healthcare delivery and management of chronic disease.

The organization’s Data for Quality project hosts monthly meetings where clinicians and health systems voluntarily share and compare unblinded, aggregate, quarterly data for improving management of cardiovascular disease. In that forum, the physician leaders share their successes and challenges, set goals for improving their organizations’ quality outcomes, and have developed a series of recommendations to capture and share their successful efforts to control hypertension and prevent cardiovascular disease morbidity and mortality.

Be There engages patients and community-based organizations to raise awareness of risk factors like hypertension, high cholesterol, and diabetes, and supports communitybased efforts to identify and control them. The Southeastern San Diego Cardiac Disparities Project, for instance, helps faith organizations to develop their own plans to improve and protect their members’ heart health.

Be There is led by an executive committee made up of the physician leaders of the region’s key health sectors who bring depth of experience, innovation, and commitment to improving the heart health of the San Diego community. And it is chaired

by Anthony DeMaria, MD, who is the Judith and Jack White Chair in Cardiology at UC San Diego and the previous editor of the Journal of the American College of Cardiology.

Funding has come from the Judith and Jack White Family Foundation, the County of San Diego HHSA, a Centers for Disease Control and Prevention Racial and Ethnic Approaches to Community Health award, and a Centers for Medicare and Medicaid Innovation Center Health Care Innovation Award.

Information about the organization is available at betheresandiego.org or by email at info@betheresandiego.org.

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Be There San Diego Executive Committee months can pass before the patient has their blood pressure evaluated again.

BTSD’s recommendations call for addressing hypertension across clinical settings, and raise the importance of treating the issue at all points of care and in all patients.

“We’re not going to let the patient leave the facility with untreated high blood pressure,” he says. “It’s called the silent killer for a reason.”

Scripps Coastal adopted a similar approach several years ago, he notes, and has seen a 15% improvement in the control of patients’ hypertension since then.

“If adopted system-wide — at primary care offices, clinics, urgent care centers, emergency departments, and specialty clinics — the recommendations would make the San Diego region a heathier place, improve patients’ lives, and reduce healthcare costs,” Dr. Chong says.

The seven recommendations are titled: “Organizational Approach to Hypertension Management Using Team-Based Care,” “Organizational Approach to Undiagnosed Hypertension,” “Organizational Approach to Self-Measured Blood Pressure Monitoring,” “Organizational Approach to Pharmacy Integration for Hypertension Control,” “Linking with Community

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JULY 2018

Pharmacists to Improve Hypertension Management,” “Organizational Approach to Diagnosing and Managing Prediabetes,” and “Approach for Integrating Community Health Workers on the Care Team.”

Parag Agnihotri, MD Sharp Rees-Stealy Medical Group

Brian Bronson, MD Kaiser Permanente

Anthony Chong, MD Scripps Coastal Medical Group

Dr. Thorne, clinical director of Be There San Diego, is a Preventive Medicine physician at the UCSD Department of Family Medicine and Public Health.

Anthony DeMaria, MD

References: 1 Lackland DT. Racial Differences in Hypertension: Implications for High Blood Pressure Management. The American Journal of the Medical Sciences. 2014;348(2):135-138. doi:10.1097/MAJ.0000000000000308.

2 Murphy SL, Xu JQ, Kochanek KD, Curtin SC, Arias E. Deaths: Final data for 2015.

National Vital Statistics Reports; vol 66 no 6. Hyattsville, MD: National Center for Health Statistics. 2017.

3 Graham G. Population-based approaches to understanding disparities in cardiovascular disease risk in the United States. International Journal of General Medicine.

2014;7:393-400. doi:10.2147/IJGM.S65528.

4 Wall HK, Hannan JA, Wright JS. Patients with Undiagnosed Hypertension: Hiding in Plain Sight. JAMA. 2014;312(19):1973–1974. doi:10.1001/jama.2014.15388

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DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/part-time BC or BE eligible Dermatologist to join our team.

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INTERNAL MEDICINE POSITION AVAILABLE: Unique opportunity to practice outpatient internal medicine in beautiful North San Diego County. Practice is part of a well-established internal medicine group with a long history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized

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PHYSICIANS WANTED: Premier Medical Group is seeking to establish a family practice at the Kearny Mesa Medical Center in San Diego, CA. Part-time or full-time family practice or internal medicine physicians needed, M.D. or D.O. Physicians must be PPO contracted with most major insurance companies. Most overhead expenses covered and flexible hours available. Compensation is 100% of collected revenues. Premier Medical Group is located in the Kearny Mesa Medical Center (858-715-1822).

PRACTICE FOR SALE HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN: Southern California | Asking Price: $1,050,000 | Cash Flow: $410,419 | This profitable and expandable company performs non-invasive cosmetic procedures, including dermal fillers, Botox, and laser treatments.

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OB/GYN PRACTICE FOR SALE IN SAN DIEGO: ASKING $480,000,00. FY 2017 Gross $1,445,688,00. Established practice for 38 years. Suburban district. Easy freeway access. Dedicated and experienced staff able to stay on board through sale. Situated within a modern, high-end building. The region’s fast-growing population assures for an expanding client base. Features 3200 sq. ft. of working space; 6 fully equipped patient rooms (5 exam & 1 surgery rooms with surgical lighting and fully adjustable treatment tables). Furnished waiting room and reception area; doctor’s private office, sterilization area, staff lounge and storage. ADA compliant. Contact: dixon@ cwmc4women.com

PRACTICES WANTED PRIMARY OR URGENT CARE PRACTICE WANTED: Looking for independent primary or urgent care practices interested in joining or selling to a larger group. We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call 858-832-2007.

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KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals.

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NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista, CA 92083. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, décor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: Digital X-ray suite, multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is NOT included. Contact Harish Hosalkar at hhorthomd@gmail.com or call/text (858) 243-6883 (Posted 6/11/2018)

TO SUBMIT A CLASSIFIED AD, email Editor@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

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SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity.

Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps.

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DENTIST, PHYSICIAN, SURGEON, ANY DENTAL OR MEDICAL RELATED OCCUPATION WELCOME. LOCATED IN MEDICAL DENTAL BUILDING. COME JOIN THESE GREAT PRACTICES. 612 SQ FEET, CLASSY SECOND FLOOR SUITE WITH ELEVATOR. PARTIALLY EQUIPPED FOR DENTAL PRACTICE, SURGICAL PRACTICE. $4.90 PER SQ/FT PER MONTH TRIPLE NET LEASE. CONTACT: Kevin Gott : dynamold@aol.com

MEDICAL OR DENTAL BUSINESS SPACE AVAILABLE: FOR LEASE A MEDICAL OR DENTAL RELATED PRACTICE OR BUSINESS IN A SMALL BOUTIQUE OFFICE SPACE LOCATED IN THE CENTER OF “HILLCREST/ BANKERS HILL” Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom.

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Separate address. Wood floors, refinished windows, natural light, quiet street, walkable to restaurants. On-site parking with up to 8 parking spaces available! Asking: $3,000/ month. Terms are negotiable. This will rent fast so hurry! Click For Photos. Please contact: hillcrestofficerental@gmail.com 858.775.5075

MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time. Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com.

OFFICE SPACE FOR RENT: LA JOLLA -- LEASE - MEDICAL OR DENTAL RELATED PRACTICE OR BUSINESS IN A SMALL BOUTIQUE OFFICE SPACE LOCATED IN THE CENTER OF BEAUTIFUL LA JOLLA CALIFORNIA. PERFECT OPPORTUNITY FOR PSYCHIATRIST, PSYCHOLOGIST, COUNSELOR, DENTIST, PHYSICIAN, SURGEON, ANY DENTAL OR MEDICAL RELATED OCCUPATION WELCOME. LOCATED IN MEDICAL DENTAL BUILDING. COME JOIN THESE GREAT PRACTICES. 612 SQ FEET, CLASSY SECOND FLOOR SUITE WITH ELEVATOR. PERFECT FOR ENTREPRENEUR. PARTIALLY EQUIPPED FOR DENTAL PRACTICE, SURGICAL PRACTICE. TERRIFIC OPPORTUNITY. $4.90 PER SQ/FT PER MONTH TRIPLE NET LEASE CONTACT KEVIN GOTT : dynamold@aol.com (Posted 3/22/18) OFFICE SPACE FOR RENT: Office space for rent, multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU Convenient freeway access and ample parking.

Price based on usage. Contact Jo Turner 619 733 4068 or jo@siosd.com MEDICAL OR DENTAL BUSINESS SPACE AVAILABLE: FOR LEASE A MEDICAL OR DENTAL RELATED PRACTICE OR BUSINESS IN A SMALL BOUTIQUE OFFICE SPACE LOCATED IN THE CENTER OF BEAUTIFUL LA JOLLA CALIFORNIA. PERFECT OPPORTUNITY FOR PSYCHIATRIST, PSYCHOLOGIST, COUNSELOR,

OFFICE SPACE / REAL ESTATE WANTED

NONPHYSICIAN POSITIONS AVAILABLE MEDICAL OFFICE MANAGER/ CONTRACTS/BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work.

PRODUCTS / SERVICES OFFERED

DATA MANAGEMENT, ANALYTICS AND REPORTING Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries.

Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and process-related outcomes and establish benchmarks, and the production of automated reporting.

(619) 913-7568 | info@rudolphia. consulting | www.rudolphia.consulting PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to MediCal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara.Mandel@ChampionsFH.org or call (858) 300-2780. [559]

PLACE YOUR AD HERE Contact Dari Pebdani at 858-231-1231 or DPebdani@SDCMS.org

SAN DIEGO PHYSICIAN.ORG

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P E R S O N A L & P R O F E S S I O N A L D E V E LO P M E N T

The Opposite Is Also True

By Helane Fronek, MD, FACP, FACPh

I’M INTRIGUED BY oxymoronic phrases that challenge my assumptions, like the bumper sticker that reads, “The Opposite Is Also True.” I love how that simple concept opens up new perspectives. We are frequently so confident that our ideas are right and the only way of thinking about something. But what if the opposite were also true?

In dealing with patients, this perspective might offer us a window into their thinking, and an opportunity to communicate and intervene more effectively. For example, we know that our patients should take their

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JULY 2018

medications regularly. But if the opposite is also true, why might it be possible that they shouldn’t do those things?

Maybe the medications have unpleasant side effects, cost too much, are a nuisance to take, or make our patient feel unhealthy because they associate taking medications with sick people. If so, our patients should not take their medications, from their point of view. Unfortunately, when patients don’t follow our treatment plan we frequently become frustrated and angry, labeling them “noncompliant.” Sometimes we give up on them because we decide that they must not

care about their health.

In The Spirit Catches You and You Fall Down, Anne Fadiman describes a Hmong family whose infant daughter had a seizure disorder. Because they believed the etiology of her condition was spiritual, the parents did not give their daughter her medication; her seizures raged out of control. In response, the physicians considered the parents neglectful and treated them poorly.

After the child suffered brain damage and her seizures stopped, the family continued to care for her in their same loving way, but now the physicians viewed the parents as saintly. Clearly, each side had a different view of the situation. Could these physicians have provided more effective care if they had seen that, while they believed the medications were essential, the parents believed the opposite was true?

When dealing with friends, relatives, or colleagues who hold different opinions, encouraging ourselves to consider how the opposite is also true helps us see a different perspective, allowing us to expand our vision of the world. Holding onto judgments that the other person is wrong deprives us of meaningful discussion, learning and a true relationship with that individual.

In considering our own ideas, wondering how the opposite stance might also be true gives us an opportunity to get closer to the truth of any matter, rather than remaining walled off in our own, usually self-serving, thoughts. Given the extreme polarization in our country, each of us, and our society at large, might benefit from this approach.

Try it for a while. Whenever you have a thought that you are absolutely sure is correct, ask yourself in what ways the opposite is also true. You might be surprised at what insights you gain, how different the world and other people begin to seem, and how much less stressed you feel.

Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.com.

t hank you

TO OUR ADVERTISERS WHO HAVE SUPPORTED SAN DIEGO PHYSICIAN MAGAZINE THIS YEAR.

INSURANCE

The Doctors Company (800) 852-8872 www.thedoctors.com/SDCMS Cooperative of American Physicians, Inc. (800) 356-5672 www.CAPPhysicians.com Norcal Mutual Insurance Company (844) 4NORCAL www.norcalmutual.com

BANKING

First Republic Bank (855) 886-4824 www.firstrepublic.com

COMMERCIALREAL ESTATE

JLL Healthcare Practice Group (858) 410-6377 www.sdmedicalrealestate.com North Coast Medical Plaza northcoastmedicalplaza.com

DATA MANAGEMENT

Rudolphia Consulting (619) 913-7568 www.rudolphia.consulting

EMPLOYMENT



Please contact these vendors for your business needs.

Advantage Surgical & Wound Care (877) 878-3289 www.AdvantageWoundCare.org

MEDICAL BILLING

Medical Billing Strategies (619) 260-0999 askmbs.com Valley Medical Billing Services (800) 807-9843 valleybillingservices.com

MORTGAGE BANKING

Bank of America billy.cafcules@bankofamerica.com ed.woolery@bankofamerica.com

OFFICE SPACE

WeShareMD (832) 937-4273 www.wesharemd.com

TECHNOLOGY

Soundoff Computing (858) 569-0300 www.soundoffcomputing.com

Tracy Zweig & Associates (800) 919-9141 www.tracyzweig.com Vista Community Clinic (760) 631-5000 www.vistacommunityclinic.org

Additional information can be found at the Practice Management Resources page at www.SDCMS.org.

SAN DIEGO PHYSICIAN.ORG

29

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