January 2018

JANUARY 2018 OFFICIAL PUBLICATION OF SDCMS

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JANUARY

CONTENTS

VOLUME 105, NUMBER 1 EDITOR: James Santiago Grisolía, MD EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: Mark W. Sornson, MD, PhD President-elect: David E.J. Bazzo, MD Secretary: James H. Schultz Jr., MD Treasurer: Holly B. Yang, MD Immediate Past President: Mihir Y. Parikh, MD 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: Sergio R. Flores, MD (Board Representative to Executive Committee) Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Geva E. Mannor, MD, MPH 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: Michael A. Lobatz, MD South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, 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: Neelima V. Chu, MD South Bay: Paul Manos, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Karrar H. Ali, DO, MPH; #3: Alexexandra E. Page, MD; #4: Nicholas J. Yphantides, MD; #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

6 8 Disaster Preparedness for Your Medical Practice

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BY JULIE BRIGHTWELL, JD, RN, THE DOCTORS COMPANY

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feature

18 A Culture of Health: Making Wellness a Priority for Physicians

BY TRISH BEALL

departments

BY CHRIS ROSS, JONES LANG LASALLE

12 CMA On-Call, the California Medical Association’s Online Health Law Library

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Briefly Noted: Calendar • Volunteer Opportunities • New & Returning Members

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ADDITIONAL NON-VOTING MEMBERS Alternate Young Physician Director: Heidi M. Meyer, MD 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 TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MP

AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Vacant At-large AMA Delegate: Albert Ray, MD (appointed by CMA) At-large AMA Delegate: Robert E. Hertzka, MD (appointed by CMA) At-large AMA Alternate Delegate: Theodore M. Mazer, MD (appointed by CMA)

Physician Marketplace Classifieds

Have Yourself a Meaningful 2018

New Laws 2018: Significant New California Laws of Interest to Physicians

BY HELANE FRONEK, MD, FACP, FACPh

BY CALIFORNIA MEDICAL ASSOCIATION

JANUARY 2018

ADDITIONAL VOTING DIRECTORS Communications Chair: J. Steven Poceta, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Meghana Pagadala

BY CALIFORNIA MEDICAL ASSOCIATION

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San Diego County Medical Office Snapshot

AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Erin L. Whitaker, 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

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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/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// CALENDAR

Multimodality Breast Imaging, International Institute for Continuing Medical Education (IICME), Inc. Feb 09 11, 2018 Manchester Grand Hyatt Hotel 31st Annual State-of-the-Art Echocardiography, American Society of Echocardiography (ASE). Feb 17 - 20, 2018 Paradise Point Resort & Spa Scripps Cancer Center’s 38th Annual Conference: Clinical Hematology & Oncology. Feb 17 - 20 2018 Hyatt Regency La Jolla at Aventine 9th Annual SBP Rare Disease Day Symposium & CDG Family Conference.

Feb 23 - 25, 2018 The Dana Hotel on Mission Bay 13th Annual Brain Injury Rehabilitation Conference, Scripps. Mar 02 - 03, 2018 San Diego Marriott Del Mar Mayo Clinic Gastrointestinal Cancers, Mar 01 - 03, 2018. Hyatt Regency La Jolla at Aventine.

Endocrinology for Primary Care, Medical Education Resources (MER). Mar 09 - 11, 2018 Hotel del Coronado American College of Osteopathic Emergency Physicians Spring Seminar, American College of Osteopathic Emergency Physicians (ACOEP). Apr 03 - 07, 2018 Loews Coronado Bay Resort The American Society of Addiction Medicine (ASAM) 49th Annual Conference - Innovations in Addiction Medicine and Science. Apr 12 - 15, 2018 Hilton San Diego Bayfront

SDCMS Social Events 2018

GIVING BACK

VOLUNTEER OPPORTUNITIES Email Your Volunteer Opportunity Ads to Editor@SDCMS.org 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 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 at Andrew.

Gonzalez@ChampionsFH.org, or visit www.ChampionsforHealth.org.

SHORT-TERM MEDICAL VOLUNTEERS NEEDED FOR HAITI: We are looking for physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti in February, June, and October 2018. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically under served area. Seattle-King County Disaster Team (a U.S.-based nonprofit) has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@earthlink. net if you are interested in applying.

Visit www.skcdteam.org for further information

Mark your calendars for next year!

March 27 (Tues) Private Film Screening and Reception July 14 (Sat) Family Pool Party Oct 25 (Thurs) Physician Networking Mixer *dates subject to change.

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JANUARY 2018

“

QUOTE OF THE MONTH

In nothing do men more nearly approach the gods than in giving health to men.

— Cicero (106 B.C. - 43 B.C.)

”

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

Welcome New and Returning SDCMS-CMA Members!

Welcome New Members!

Rachel Abbott, MD Mohammed Ahmed, MD Brain Injury Medicine La Jolla (866) 277-2659 Mariah Baughn, MD Pathology La Jolla (858) 626-6006 Joon Choi, MD Anesthesiology Kearny Mesa (858) 673-6100 Zachary Cohen, MD Anesthesiology Kearny Mesa (858) 673-6100 David Coon, MD Pathology East County (619) 297-4900 Trung Dang, MD Hospice and Palliatative Medicine HIllcrest (858) 939-3400 James Fontaine, MD Physical Medicine and Rehabilitation North County (510) 356-0028

Adrian Ionescu, MD Anesthesiology Kearny Mesa (858) 673-6100

Keith Reid, MD Anesthesiology Kearny Mesa (858) 673-6100

Paul Jacobs, DO Anesthesiology Kearny Mesa (858) 565-9666

Alaa Saghbini, MD Anesthesiology Kearny Mesa (858) 673-6100

Rishi Jindal, MD Plastic Surgery Kearny Mesa (858) 715-9200

William Schoenfeld, MD Anesthesiology Kearny Mesa (858) 565-9666

Arun Kalra, MD Hematology Oncology Kearny Mesa (760) 346-7655

Scott Tanaka, MD Orthopaedic Surgery Hillcrest (619) 299-8500

Jeanette Lee, MD Anesthesiology Kearny Mesa (858) 565-9666

Jens Thiele, MD Dermatology North County (760) 757-7546

David Liu, MD Anesthesiology Kearny Mesa (858) 565-9666

Christopher Urband, MD Orthopaedic Sports Medicine La Jolla (858) 535-1075

Roshni Vora, MD Anesthesiology Kearny Mesa (858) 565-9666

Tyler Maly, MD Dermatology North County (760) 758-5340 Jeremy Mccandless, MD Orthopaedic Surgery Hillcrest (619) 299-8500

Welcome Returning Members Donald Fithian, MD Orthopaedic Surgery East County (866) 459-2912

Shannon Granger, DO Anesthesiology Kearny Mesa (559) 449-4350

Karen McGowen, MD Pediatrics East County (619) 583-6133

Susannah Graves, MD Internal Medicine Hillcrest (619) 692-5565

Sophonie Noel, MD Anesthesiology Kearny Mesa (858) 565-9666

Lawrence Eisenhauer, MD Obstetrics and Gynecology North County (760) 753-8413

Marie Denise Green, MD Pediatrics Kearny Mesa (619) 528-4000

Joseph Palma, DO Anesthesiology Kearny Mesa (858) 673-6100

Martin Rajsbaum, MD Ophthalmology South County (619) 426-3400

Carly Guthrie, MD Anesthesiology Kearny Mesa (858) 565-9666

Grace Park, MD Anesthesiology Kearny Mesa (858) 565-9666

Sanjay Rao, MD Psychiatry Hillcrest (619) 500-6202

Nathan Hammel, MD Orthopaedic Surgery North County (619) 532-6400

Visal Patel, MD Anesthesiology Kearny Mesa (858) 565-9666

Kristen Rice, MD Hematology Oncology Kearny Mesa (858) 637-7888

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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

HAVE YOURSELF A MEANINGFUL 2018

by Helane Fronek, MD, FACP, FACPh

AFTER READING Paul Kalanithi’s beautiful book When Breath Becomes Air, I find my thoughts drifting to the question: What makes a meaningful life? Kalanithi’s need to find the answer became acute when he was diagnosed with metastatic lung cancer at the age of 36. As we begin a new year, we each consider how to make our life meaningful and imagine the joy and fun we might experience, the accomplishments we might have, the impact we might make. From this vantage point, our year is full of promise and we envision feeling contented and fulfilled next December. Yet, if we remember our intentions at the beginning of 2017, we regret that many did not materialize.

As John Lennon reminded us, “Life is what

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JANUARY 2018

happens to you while you’re busy making other plans.”

To have a meaningful life, we are advised to “live as if this were your last day” and to “cherish every moment.” When I am mindful of these suggestions, they help me recognize the bounty of my life, engage authentically with whatever is happening, and feel grateful. But I also recall coming home after a long day of seeing patients to care for two small children while I had a URI; I can assure you I was not following either of these admonitions. I simply wanted to take care of everyone’s needs so I could crawl back into bed and sleep. Sometimes, just getting through a day is all we can muster.

So, how can we structure, or even conceptualize, our life to enhance its meaning?

During a program on work-life balance, I asked the participants to list all of the priorities — interests, activities, people — they intended to spend time on in the coming year. The lists were long. We each have full lives, with overflowing plates, some of which we’re juggling in the air. “What if you only had a year to live? “ I asked. I directed the group to cross five things off their lists that they wouldn’t bother with if they only had a year to live. I repeated this with decreasing amounts of time left in their

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lives; the tension in the room rose as people confronted this uncomfortable possibility.

The point of the exercise is to become clear about what is most precious to each of us. As Kalanithi’s oncologist repeatedly encouraged him when he wondered about his life’s meaning, “You’ve got to find what matters most to you.”

As an intern, I cared for a patient experiencing an MI, who lamented from his ER bed that he hadn’t spent more time with his family. At his first clinic visit, he had forgotten that conversation and was again working 80 hours a week. With this exercise, we have an opportunity to insure that everything on our “short list” features prominently throughout our year, in addition to the many other things we will do.

In this way, 2018 will truly be a year full of meaning for us.

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.

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SAN DIEGO PHYSICIAN.ORG

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

DISASTER PREPAREDNESS FOR YOUR MEDICAL PRACTICE

by Julie Brightwell, JD, RN

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JANUARY 2018

RECENT FIRES, hurricanes, and floods nationwide have highlighted the importance of planning for disasters. Wildfires in California forced several physicians to quickly relocate their practices — some permanently — and to move scheduled procedures to different facilities. Hurricane and flood damage in Texas and Florida left practices without power for days or even weeks. Is your practice prepared for this type of situation?

A disaster can overwhelm a medical practice, with damage that can include shattered windows, flood debris, power outages, disrupted telephone systems, computer and system outages, unsafe drinking water, destroyed medical records, medication expo-

Physicians are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted. specific types of disasters, can provide the framework for a comprehensive plan. The checklist should include these elements: • A full-circle call tree that outlines who contacts whom.

• Instructions for setting up instant messaging technology that enables staff to communicate without a wireless network or cellular data connection.

• Instructions for securing records of patients undergoing diagnostic testing and a list of outstanding diagnostic studies.

• Guidelines for maintaining Health Insurance Portability and Accountability Act (HIPAA) compliance. Although the HIPAA Privacy Rule is not suspended during a natural disaster or other emergency, the Secretary of Health and Human Services may waive certain provisions of the Privacy Rule.

• A Certificate of Insurance for your medical malpractice coverage, or instructions for contacting your agent or insurer directly to obtain proof of coverage. This document will be necessary if you are forced to temporarily relocate your practice or procedures.

• Verification that home health agencies caring for your patients have plans in place to provide adequate services in a disaster.

• Steps to follow upon returning from evacuation.

sure to temperature and humidity extremes, contaminated instruments, and building structure failure.

Disaster preparedness requires a continuous cycle of planning, organizing, training, equipping, rehearsing, and evaluating. Physicians are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted—especially for at-risk individuals who may have special medical needs.

Plan Ahead Now Before the next disaster strikes, make sure your practice has a plan in place. A checklist, ordered by priority and customized to

When Disaster Strikes Planning today makes accomplishing the following tasks more feasible during a disaster: Communication • Contact staff immediately to determine realistic return-to-work time frames.

• Notify external vendors and business associates of your practice interruption and targeted resumption of operation.

• Implement staff briefings at the beginning and end of each day.

• Create temporary phone, fax, and answering services.

• Establish patient telephone triage.

• Implement temporary controls to ensure HIPAA compliance.

Computers and systems • Contact computer service vendors to ensure integrity and recovery.

• Verify insurance coverage for repair or replacement costs and losses.

• Evaluate applicable warranties and consider an information technology restoration service contract.

• Inventory and document hardware and software.

• Document the type and extent of both lost electronic and paper data.

• Ensure data back-up and periodically test compliance.

• Reestablish filing systems and internal programs.

Medical records • Determine the extent of damage to, or loss of, patient records and filing systems.

• Attempt to restore all damaged charts and document inventory findings.

• Notify the state medical board for specific guidance pertaining to lost or damaged records.

• Document all efforts to restore and protect existing records.

• Reconstruct lost charts at the next patient encounter.

• Contact your insurance carrier for restorative services and/or claim procedures.

• Reestablish a filing system and temporary storage if necessary.

• Obtain legal guidance for patient notification during recovery efforts.

• Contemporaneously date and initial all late entries and duplicate information in context of recovery efforts.

In addition, create an inventory of all equipment and medications that may have been exposed to water or extremes in temperature. Repair, replace, or discard damaged items appropriately.

Once your plan is in place, regularly reevaluate its steps and update all contact information. Practice and rehearse the plan’s protocols. An effective disaster preparedness plan will help keep your practice focused on delivering care during an emergency.

Ms. Brightwell is director of Healthcare System Patient Safety at The Doctors Company.

SAN DIEGO PHYSICIAN.ORG

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R E A L E S TAT E T R E N D S

SAN DIEGO COUNTY MEDICAL OFFICE SNAPSHOT San Diego medical office occupancy flat in the third quarter by Chris Ross

6.8%

Countywide Direct Vacancy

3,555

Q3 net absorption (s.f.)

2.6%

12-month rent growth $3.20 FS Average Asking

Market Conditions and Trends San Diego medical office occupancy was essentially flat in the third quarter of the year, posting an increase of 3,555 square feet of positive net absorption. The current overall San Diego County direct vacancy rate of 6.8% has dropped by half (680 basis points) since its 13.6% peak in 2009.

Most all of the San Diego medical office submarkets recorded minor movement in their total occupancy
in the third quarter, with only two submarkets recording positive movement greater than 10,000 square feet. The Oceanside/Vista submarket

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JANUARY 2018

posted 17,074 square feet of positive net absorption, and La Jolla/UTC/ Sorrento saw 12,543 square feet of positive net absorption. Both of these submarkets have accounted for a significant portion of the demand in the San Diego office market with a total of 92,944 square feet of positive absorption in the last 12 months.

The weighted average asking rental rate for medical office space continues to rise, with a current year-over-year increase of 2.6% countywide overall. The submarket with the largest year-over-year increase was Kearny Mesa/Mission Valley, which

240,800

Total under construction (s.f.)

(3 projects in total)

rose 12.4%, while North County Coastal posted the highest average asking rental rate in the county at $4.33 per square foot per month, fully serviced.

Tip of the Quarter: Utility Costs With the cost of electricity rising at such a rapid pace, landlords and tenants should be evaluating their utility usage and how they stack up against industry norms. Explore ways to reduce these costs, such as raising awareness among staff, implementing new policies to reduce usage, installing solar, retrofitting light fixtures, or installing motion sensors. Subsidy programs are often available. And if you are planning for a remodel or new construction, closely monitoring the electrical design and Title 24 process can result in substantial upfront and long-term savings.

News, Facts & Updates Alvarado Hospital Medical Center is expanding its emergency department with a 21,000-square-foot, newly renovated,

state-of-the-art facility. Completion is scheduled for early 2018.

In July, the 82,024-square-foot Fletcher Parkway Medical Center, located at 8881 Fletcher Parkway in La Mesa, sold for $33M ($402/SF) to Anchor Health Properties.

The building is situated adjacent to Sharp Grossmont Hospital. Sharp Healthcare and United Health Group anchor the center.

In August, Anchor Health Properties acquired 625 W Citracado Parkway in Escondido. The 49,000-square-foot building sold for $21.85M ($458/SF). The building is anchored by Rady Children’s Hospital.

Chris Ross is co-leader of JLL San Diego’s Healthcare Practice Group, a brokerage team that has been specializing exclusively in healthcare real estate leasing and sales since 1991. His primary specialty is tenant representation and owner-user sales. To receive more comprehensive JLL Healthcare Practice Group market reports, contact Mr. Ross at (858) 410-6377 or chris.ross@am.jll.com.

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H E A LT H L AW L I B R A R Y

Termination of the Physician-Patient Relationship Once a physician-patient relationship is established, the physician has an ongoing responsibility to the patient until the relationship is terminated. To help physicians understand their legal and ethical obligations related to terminating the physician-patient relationship, CMA OnCall document #3503, “Termination of the Physician-Patient Relationship” discusses how a physician-patient relationship can be terminated in a way that will not create liability for patient abandonment. CMA has also published On-Call document #3500, “Establishment of the Physician-Patient Relationship,” which discusses a physician’s right to select or reject patients.

CMA ON-CALL the California Medical Association’s Online Health Law Library

Did you know CMA’s online health law library is FREE to members?

CMA On-Call, the California Medical Association’s (CMA) online health law library, is fully updated for 2018. One of CMA’s most valuable member benefits, On-Call contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. The searchable online library contains all the information available in the California Physician’s Legal Handbook (CPLH), an annual publication from CMA’s Center for Legal Affairs.

CMA On-Call documents are available free to members at www.cmanet.org/cmaon-call. Nonmembers can purchase documents for $2 per page. The complete health law library is also available for purchase in an 8-volume print set or annual online subscription service. To order your copy, visit the CMA resource library or call (800) 882-1262.

On the following pages we feature some of the most commonly accessed documents from the CMA On-Call library.

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JANUARY 2018

Retention of Medical Records California regulations regarding retention of medical records in a physician’s office are a perennial hot topic in CMA’s On-Call health law library. To ensure physicians understand their rights and obligations under the law, CMA On-Call document #4005, “Retention of Medical Records,” discusses major issues raised by the retention, abandonment, theft and destruction of medical or health insurance information and physician practice business records. Issues covered include statutory record retention requirements, the rules applicable to records abandoned in bankruptcy or otherwise, recommended retention periods, options for record management on the sale or closing of a medical practice, record destruction requirements, obligations for safeguarding patients’ personal information, and for responding when records containing identifying information are stolen or otherwise breached.

Contract Termination by Physicians and Continuity of Care Provisions Physicians may decide to terminate their payor contracts for various reasons, including non-payment. This has been particularly true in recent years with the insolvencies of health plans, IPAs and other entities that contract with health plans. Contract termination should, however, be executed by physicians with caution and in a legally appropriate manner.

To help physicians understand how to terminate managed care contracts, and the resulting continuity of care obligations that may apply, CMA published On-Call document #7051, “Contract Termination by Physicians and Continuity of Care Provisions.”

This document discusses the usual ways that contracts provides for termination and the laws regarding managed care contract termination.

Patient Access to Medical Records Patients (or their legal representatives) generally have a right to inspect and copy their medical records. In addition to California law, the federal HIPAA regulations provide additional patients’ rights with regard to their medical records. To help physicians understand patients’ rights to access their medical records, see CMA On-Call document #4205, “Patient Access to Medical Records.”

Medical Records: Most Commonly Asked Questions CMA published On-Call document #4000, Medical Records: Most Commonly Asked Questions, to provide physicians with answers and resources for the most commonly

asked questions regarding medical records received by the CMA legal information line.

The document includes the following information, along with references to relevant CMA On-Call documents: • How to respond to requests for medical information • Requirements for a valid authorization of medical record release • HIPAA privacy and security rules • Contents, retention and destruction of medical records • Reporting obligations Medical Records: Allowable Copying Charges Physicians are often asked to provide copies of medical records to patients and third parties, which may be costly for their practices.

CMA On-Call document #4002, Medical Records: Allowable Copying Charges, discusses the allowable amounts that a physician may charge for copies of medical records under various circumstances. These amounts depend on whether the records are

requested by patients, patients’ attorneys, health plans and insurers, or government agencies. The document also describes what costs can be included in a copying charge in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA Privacy Rule).

California’s Prescription Drug Monitoring Program California’s prescription drug monitoring program—the Controlled Substance Utilization Review and Evaluation System (CURES)—helps health care practitioners make appropriate prescribing decisions and assists law enforcement and regulatory agencies in their efforts to control the abuse and diversion of controlled substances.

To help physicians understand their obligations and requirements when prescribing controlled substances, CMA published On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).”

This document provides an overview of California’s prescription drug monitoring program and discusses legal requirements related to CURES, including a new law that that requires physicians to consult the CURES database prior to prescribing a Schedule II through IV controlled substance.

It also includes details on how to register, what data physicians must provide, what information they will have access to and any relevant liabilities.

Practice Promotion through Third-Party Coupons Some physicians may choose to offer discounts for their medical services through Internet-based e-commerce marketplaces, such as Groupon or Living Social, which allow consumers to purchase coupons and vouchers for discounted services. Using these third-party ecommerce platforms may help the physician’s practice gain exposure and help the physician build a patient base.

Until recently, however, such arrangements put physicians at risk of scruty as a

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violation of state and federal fee-splitting prohibitions, since California law prohibits physicians from paying for patient referrals. In 2017, a new law took effect (AB 2744) to more clearly distinguish referrals from advertising. The legislation permits California healthcare providers to advertise their services through third-party companies that sell discounted coupons and vouchers to consumers in exchange for a fee.

CMA On-Call document #0104, “Practice Promotion through Third-Party Coupons,” further explains the provisions of AB 2744, the services that physicians can legally advertise and payment with third-party involvement.

HIPAA Overview and Enforcement The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes six rules to improve the efficiency and effectiveness of the health care system while protecting patient privacy: • Privacy Rule • Security Rule • Breach Notification Rule • Uniform National Standards for Electronic Transactions and Code Sets • Unique Health Identifier Standards • Enforcement Rule These rules are outlined in CMA On-Call document #4100, HIPAA Overview & Enforcement. The document describes the provisions of HIPAA and the Health Information Technology for Economic and Clinical Health (HITECH) Act. It also provides information and resources for physicians to ensure that their practices are HIPAA-compliant.

Business Associate Agreements The HIPAA Privacy and Security rules permit covered physicians to disclose “protected health information” (PHI) to business associates. These business associates are authorized to create, receive, maintain or transmit PHI so long as safeguarding assurances are obtained through a business associate agreement. CMA On-Call document #4103, Business Associate Agreements, provides physicians with a better understanding of these agreements. The document discusses: • HIPAA requirements • The California Confidentiality of Medical Information Act • Additional privacy and security obligations under the HITECH Act • Business associate agreement requirements and enforcement • Business associates defined • CMA as a business associate

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MACRA Overview The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) restructures reporting of health care quality and reforms the way physicians and other clinicians are paid under Medicare Part B. MACRA aims to provide stable payment updates, reduce the quality reporting program burdens, reinstate bonus payments, and incentivize innovative, physician-led alternative payment models.

To provide physicians with an overview of the new payment models, the California Medical Association has published On-Call document #7210, “MACRA Overview.” The document outlines the following MACRA programs: • Quality Payment Program • Merit-Based Incentive Payment System • Alternative Payment Models • Advanced Alternative Payment Models • Medical Home Models • Physician-Focused Payment Models

Non-Contracting Physicians On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

While patients with out-of-network benefits can consent to treatment from outof-network providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate. The interim rate is the greater of 125 percent of Medicare or the plan/insurer’s average contracted rate.

CMA On-Call document #7508, “NonContracting Physicians,” has been updated to explain the circumstances under which the law applies and how to dispute the payment amount.

The California End of Life Option Act On Oct. 5, 2015, California passed the “End of Life Option Act,” which permits physicians to prescribe aid-in-dying medication to terminally ill adult patients with the capacity to make medical decisions.

To help physicians understand their rights and responsibilities regarding this legislation, CMA published On-Call document #3459, “The California End of Life Option Act.” This document discusses the requirements of the “End of Life Option Act,” describing circumstances that qualify a

patient to receive aid-in-dying medication, necessary documentation for the procedure and protections for physicians that choose to provide this service.

The Corporate Practice of Medicine Bar California law prohibits lay individuals, organizations and corporations from practicing medicine. This prohibition, known as the “corporate bar,” generally prohibits lay entities from hiring or employing physicians or other health care practitioners, or from otherwise interfering with a physician or other healthcare practitioner’s practice of medicine.

It also prohibits most lay individuals, organizations and corporations from engaging in the business of providing healthcare services indirectly by contracting with healthcare professionals to render such services.

CMA steadfastly supports our state’s corporate bar, and strongly believes medical decision makers should be insulated from influence by laypersons who may not have patients’ best interests at heart.

For more information on California’s corporate bar, see CMA On-Call document #0200, “Corporate Practice of Medicine Bar.” Confidentiality of Medical Information: CMIA, IIPPA and the HIPAA Privacy Rule There are protections under both California and federal law for the confidentiality of medical information. As a general rule, medical information may not be disclosed absent the written consent of the patient or a legal representative.

Regulations and exceptions regarding access to medical information are detailed in the Confidentiality of Medical Information Act (CMIA), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and Insurance Information and Privacy Protection Act (IIPPA). CMA has summarized these laws in On-Call document #4207, Requests

by Other Third Parties: CMIA, IIPPA and the HIPAA Privacy Rule.

The document describes the information protected under each law, prohibited actions and requirements for a valid authorization of medical information release. It also explains to whom these laws apply and relevant physician obligations.

All of the documents referenced in this article are available through CMA On-Call, the California Medical Association’s online health law library. CMA On-Call is free to members at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2/page

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ENHANCING PATIENT EXPERIENCE,

A Culture of Health: Making Wellness a Priority for Physicians Southern California Permanente Medical Group’s “Five Pillars” Fosters a Culture of Wellness That Is Helping Turn the Tide of Physician Burnout. By Trish Beall

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improving population health and reducing costs are the central tenets of medical practice that the Cambridge, Mass.-based Institute for Healthcare Improvement promulgated in 2007. It’s known as the “Triple Aim,” and healthcare organizations nationwide, including the 9,000-physican, 4.3-million patient Southern California Permanente Medical Group (SCPMG), have implemented it in their systems.

In 2014, as the national epidemic of physician burnout continued to spread and more and more physicians were leaving the profession, many physician leaders determined that burnout might well make the Triple Aim untenable.

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Frustrated by bureaucracy of modern medicine, 1 in 5 physicians wants to reduce clinical work hours

They proposed, in the Annals of Family Medicine, adding another aim, which was “the goal of improving the work life of healthcare providers, including clinicians and staff.”

This was just about the time that SCPMG was rolling out its Physician Wellness Program, which received the California Medical Association (CMA) 2017 Gary S. Nye, M.D., Award for Physician Health and Well-Being. What is now called the “Quadruple Aim” is the overriding mantra of the organization, its wellness endeavors, and its commitment to fostering a culture of wellness.

CMA recently interviewed Edward Ellison, M.D., who is SCPMG’s Executive Medical Director and Chairman of

Nearly one in five U.S. physicians intends to reduce clinical work hours in the next year, and roughly one in 50 intends to leave medicine altogether in the next two years to pursue a different career. If physicians follow through on these intentions, it could profoundly worsen the projected physician shortage in the U.S. This was the alarming conclusion of new research by experts at the American Medical Association (AMA), Mayo Clinic and Stanford University.

The research, published in the November 2017 issue of Mayo Clinic Proceedings, sheds light on a troubling correlation between the career plans of U.S. physicians and the growing problem of burnout, technology dissatisfaction and administrative fatigue among physicians. Physicians who were burned out, dissatisfied with work-life integration, and dissatisfied with electronic health records (EHRs) were more likely to intend to reduce clinical work in the next 12 months. Burnout is the largest factor influencing physicians who intend to leave medicine in the next two years.

Attrition in the physician workforce results in diminished access to care for patients. If just 30 percent of physicians follow through on their intention to leave medicine in the next two years, the study estimates approximately 4,759 physicians would leave the workforce — a loss roughly equivalent to eliminating the graduating classes of 19 U.S. medical schools in each of the next two years.

“Our findings have profound implications for healthcare organizations,” notes the study. “Replacing physicians is costly to institutions, with one recent analysis suggesting costs of $800,000 or more per physician. In addition, turnover is disruptive to patients, staff, and organizational culture.”

To help physicians succeed in their life’s work of caring for patients, the California Medical Association (CMA) and AMA have made physician wellness and the prevention of burnout a core priority. The CMA Board of Trustees earlier this year established a new subcommittee on physician wellness, which will explore strategies and resources to address issues of professional burnout in collaboration with relevant stakeholders.

“The wellbeing of the nation’s physicians, clearly being harmed by factors causing burnout, is a critical factor in maintaining access to care and the quality of our healthcare system,” says CMA President Theodore Mazer, M.D. “CMA is committed to helping physicians and their practices conquer these issues, so they may do what they do best: treat patients.”

By advancing initiatives that enhance efficiency, professional satisfaction and the delivery of care, CMA is striving to help physicians navigate and succeed in a continually evolving healthcare environment. Throughout the month of December, CMA will be highlighting this critical issue and innovative approaches to solving the problem of physician burnout.

SAN DIEGO PHYSICIAN.ORG

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////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Healing Our Healers In a First for a U.S. Academic Medical Center, Stanford Medicine Hires Chief Physician Wellness Officer By Ruthann Richter Tait Shanafelt, M.D., a pioneer and nationally recognized expert in physician burnout, recently joined Stanford Medicine as its first chief wellness officer, leading the medical center’s pioneering physician wellness program.

His appointment makes Stanford the first academic medical center in the country to create a position of chief wellness officer at a time when physician burnout nationally has reached an all-time high. Dr. Shanafelt, whose clinical work and research focus on the treatment of patients with chronic lymphocytic leukemia, will direct the WellMD Center at Stanford Medicine and serve as associate dean of the School of Medicine.

the Board; ob-gyn Dawn Clark, M.D., who is the group’s Chief Wellness Officer and the creator of SCPMG’s three-yearold Physician Wellness Program; and Frank Flowers, M.D., medical director of SCPMG’s Riverside region. All three noted how crucial that fourth aim is.

As Dr. Clark explained, “My message to our senior leadership has been: every time you make a decision about patient experience or quality or reduction of cost, make sure that you add this fourth aim and think about how your decision and every aspect of our organization affects the health and wellness of the physicians and the staff.”

Dr. Ellison hardly needed convincing.

When he took on the position of executive medical director/chairman of the SCPMG board in 2012, he was well aware that survey after survey around the country showed more and more physicians reporting symptoms of burnout and an intention to leave the profession.

He very quickly began soliciting Permanente physicians to tell him what their concerns were. In April 2013, he posted a job listing for a brand new post within Southern California Permanente — chief

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Leading the way Since 2008, Dr. Shanafelt has overseen multiple national surveys that included more than 30,000 U.S. physicians and about 9,000 U.S. workers in other fields. These found increasing rates of burnout among doctors; in 2014, more than half of those surveyed were suffering from emotional exhaustion, loss of meaning in work, or a sense of ineffectiveness and a lack of engagement with patients. Moreover, his studies have found that as physicians suffer, so do patients: Burnout has been found to contribute to physician errors, higher mortality among hospitalized patients and less compassionate care.

“I think most healthcare leaders now realize this is a threat to their organization, but there is also uncertainty that they can do anything effective to address it,” Dr. Shanafelt said. “They say, ‘It’s a national epidemic, what can we do?’ My experience has shown that an individual organization that is committed to this at the highest level of leadership and that invests in well-designed interventions can move the needle and run counter to the national trend of physician distress and burnout. I hope that the Stanford WellMD Center becomes a paragon that other medical centers want to emulate.”

Declining burnout rates at Mayo In 2008, Dr. Shanafelt became the Mayo Clinic’s director of the Department of Medicine Program on Physician Well-Being and launched an effort to address physician distress through programs promoting physician autonomy, efficiency, collegiality and a sense of community. While many were focused on strategies to make individual physicians more resilient, Dr. Shanafelt and his team focused on systems, the practice environment, organizational culture, and leadership.

As a result, the absolute burnout rates among Mayo physicians declined 7 percent over two years, despite an 11 percent rise in the rate among physicians nationally.

Dr. Shanafelt will work in collaboration with his new colleagues at Stanford in building on its innovative WellMD Center, which was established in 2016. The center has engaged more than 200 physicians through programs focusing on peer support, stress reduction and ways to cultivate compassion and resilience, as well as a literature and a dinner series in which physicians explore the challenges and rewards of being a doctor.

Bryan Bohman, M.D., who served as WellMD’s interim director, said the WellMD team has worked closely with Dr. Shanafelt over the past year on projects of mutual interest.

“All of us at the center have been struck by Tait’s collaborative nature, his integrity, his warmth, his generosity of spirit, and his work ethic,” says Dr. Bohman, who also serves as chief medical officer for Stanford’s University Healthcare Alliance. “Both at Mayo and nationally — in the physician wellness community — Tait is seen as an inspiring and strong leader. We couldn’t be happier that he will be guiding our future wellness work at Stanford.”

Ruthann Richter is the director of media relations for the Stanford University School of Medicine Office of Communication & Public Affairs. This article was excerpted with permission from Stanford Medicine News.

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Alzheimer’s Care Conference

Saturday, February 10, 2018 Schaetzel Center Scripps Memorial Hospital La Jolla, California

In cooperation with the San Diego County Alzheimer’s Project Clinical Roundtable

The Scripps Health Alzheimer’s Care Conference is being offered to healthcare professionals and family members who care for the patient with or at risk for Alzheimer’s disease and related dementias, in order to support them with the best in advanced tools for screening, evaluating, diagnosing and treating.

Scripps Health designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™.

For more information or to register and pay please contact Scripps Conference Services & CME www.scripps.org/alzheimerscme 858-678-6400 SAN DIEGO PHYSICIAN.ORG

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////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// CMA Doc: Edward Ellison, M.D. Southern California Physician Sets Out to Teach Physicians That Their Wellness Matters wellness officer.

Dr. Clark says, “When I saw the posting I saw my opportunity to align my own personal journey of work-life integration with our organizational needs.”

And she got the job. She didn’t start out by simply creating feel-good programs.

She began by researching wellness programs at other medical organizations.

There were the physician-wellbeing programs that hospitals are required to have to address individual physicians’ substance abuse and mental health problems. Additionally, some academic centers were beginning to address wellness among their trainees, but “there weren’t really any wonderful examples out there,” she says.

And so she and Dr. Ellison researched SCPMG physicians’ needs by sending out a survey asking them what they wanted to see in a wellness program. That survey included questions about how they rated their medical environment as a “culture of health.” Dr. Clark says, “Our program was based on their feedback and external benchmarking.” The wellness program that she and Dr. Ellison presented to its physicians a year later is a “five-pillar model” that helps physicians maintain or regain their resilience.

The five pillars include (1) prevention— emphasizing to physicians the importance of taking care of their own health; (2) professionalism and continuing medical education, so physicians can learn to

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He wants the public to know about it and to thank their physicians, he wants governing bodies to understand the toll their reporting and oversight requirements are taking on physicians, and he wants the physicians who lead medical schools, residency programs and medical groups to change the nature of being a physician from one of suffering to one of health and wellbeing.

Dr. Ellison is in a position — or more accurately, many positions — to effect that change. Since 2012, he has been Executive Medical Director and board chair of the Southern California Permanente Medical Group. He is also board chair and CEO of the Southeast Permanente Medical Group, comprising 500 physicians in the cities of Atlanta and Athens, Ga., and surrounding areas. He is co-CEO of the nationwide Permanente Federation. And he is a member of the board of directors of the soon-to-be Kaiser Permanente School of Medicine, under construction in Pasadena. He was also part of an AMA consortium of 10 physician leaders of major medical groups, including the Mayo and Cleveland clinics and several academic medical centers, drawn together in 2016 to propose solutions to the physician burnout crisis, which jeopardizes the quality of care and is pushing more and more physicians to leave the profession.

Dr. Ellison is so concerned about physicians’ unhappiness in a profession they once loved that he presented the grim picture to a public, nonmedical forum, the 2017 TEDxNaperville conference in the Chicago area this November. Among the causes of burnout, Dr. Ellison says, are that physicians, who are by nature perfectionists, feel they have lost control over their work and are “being measured on everything they do.” The electronic healthcare records and reporting requirements have created inefficient workflows and less time for patients, which “feel like a gigantic pile-on.” He noted that surveys of physicians conducted in 2011 and again in 2014 showed that numbers of physicians experiencing at least one symptom of burnout rose to 54.4 percent from 45.5 percent.

“But it gets darker,” Dr. Ellison says. “In the last two years, data show that the rate of suicide among male physicians is 40 percent higher than that of the general public,” with female physicians’ suicide rate “130 percent greater than the general public.” In fact, he says, “The rate of suicide among physicians is similar to that of combat veterans.”

Much of the problem, too, begins in medical school, with many physicians entering practice after residency training already “broken and beaten,” Dr. Ellison says. He noted that two of his medical school classmates killed themselves before beginning their internships. He described his early career within the traditional “lockstep” regimen of American medical education: “I did the training. I went without sleep.

I ate junk. And I learned and I suffered. But I was also inspired by the gratitude of my patients and the satisfaction of knowing I was making a difference in people’s lives. So I did more and I asked for more and took on more, as my colleagues do.”

Now, however, having been “called to leadership,” and being a “co-leader of one of the largest groups of physicians in the world —

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21,000 doctors taking care of almost 12 million patients,” he says, “I have gained perspective. I have heard the cries.” He says it is time that society “recognize and care about the lives of those who save lives.”

Within SCPMG, he spearheaded a physician wellness program focusing on physicians’ health and on burnout prevention. For the physicians of the future he wants a total transformation of the American medical culture. “We need to change our thinking,” Dr. Ellison says, “and change our culture inside and outside of the medical profession across society. … We have to declare our physicians’ humanity.”

Permanente, he says, has a “path forward,” beginning with its new medical school. As well as teaching students to be exceptional physicians, which is “nonnegotiable,” he says, “We are going to teach them that their wellness matters. We are going to provide support for them and connect them with each other and resources. We are going to teach them how to set healthy boundaries for their own wellness and about how prevention and nutrition work not just for their patients but for themselves.”

For whatever kind of medical system — small practice, large practice, academic institutions—that the students set their sights on, he says, “We’re going to teach them how to work within theses systems to change these systems so they’re not buffeted about [and] they can be advocates for change.”

“I still love my profession,” Dr. Ellison says, and he hopes young people, “those bright shining stars,” will continue to seek it out.

see their personal wellness as a critical component of providing quality patient care; (3) practice management, which Dr. Clark summarizes as “back-office efficiencies—how to get through our days in an easier, healthier, more productive way”; (4) collegiality and community service; and (5) healthy eating, healthy exercising and healthy weight. Regarding collegiality, both Drs. Clark and Ellison noted that their physicians had stopped eating lunch together because of such demands on their time as the morass of emails and reporting requirements.

Using these five pillars, SCPMG has shifted its culture in a meaningful way that makes wellness a priority for physicians. The program has been nationally recognized for its effective and innovative work in physician wellness.

On the Physician Wellness Program website, the five pillars appear as: My Health, My Education, My Practice, My Community, and Food and Fitness, with each pillar’s section offering, among many other things, a portal to a “total health assessment,” helpful articles to read, and schedules of upcoming events and of nonpractice getaways that may focus on meditation and mindfulness, or golf and tennis tournaments.

The website is just one component, however. SCPMG’s regional medical directors and their appointed “wellness champions” encourage their physicians to attend “Health Connect Essentials,” SAN DIEGO PHYSICIAN.ORG

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////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// which are how-to lessons in practice efficiencies, such as electronic health record entry shortcuts. In the Riverside region, Dr. Flowers said attending such programs is not mandatory, but at meetings of his 680 physicians he “invites and reinvites” such engagement — receiving very positive feedback from many who have attended.

When he spoke with CMA, Dr. Flowers was particularly excited about an upcoming SCPMG event for physicians, their significant others and their families. It was an educational half-day session on resilience, led by Wayne Sotile, Ph.D., a nationally known speaker who works closely with medical families.

SCPMG leaders are also instituting other significant wellness and antiburnout measures across the region. For example, physicians have new flexiblework-hour possibilities, and Dr. Ellison

described a new “concierge” office to help physicians manage their nonpractice lives. The concierges do such things as help physicians plan trips and find someone to look after their house when they are away. There is also a major initiative to address “second victim syndrome,” the emotional toll that can overwhelm a physician when a patient dies unexpectedly. “Compassion fatigue,” another common burnout factor the organization is addressing, seems to hit mostly women physicians, and there are gatherings and retreats just for those doctors.

Is SCPMG’s wellness program working? A second survey of SCPMG physicians in 2016 determined that physician ratings of key workplace “culture of health” measures improved by a range of 11–23%. However, “although we are making progress, there is more work to

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be done,” Dr. Ellison says.

“More work” may well require a sea change in medical education, medical training and medical practices, he proposes. SCPMG’s approach to fostering a culture of wellness is hardly proprietary, and they are willing to share and learn, he says. Many organizations are tracking each other, continually adopting new ideas. State and county medical associations are drawing physicians together to discuss what works. Leaders of major medical organizations and the American Medical Association have meetings to brainstorm the solutions to the burnout epidemic and the looming possible shortfall of physicians nationwide. The beginnings of that sea change are happening.

Trish Beall is a freelance writer and editor in Berkeley, Calif.

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CLASSIFIEDS CLINICAL TRIAL VOLUNTEERS NEEDED WE ARE LOOKING FOR VOLUNTEERS TO PARTICIPATE IN CLINICAL TRIALS: Currently enrolling volunteers who suffer from rheumatoid arthritis, lupus, psoriasis, and psoriatic arthritis. Qualified volunteers may receive: no-cost investigational study medication, no-cost study-related care from a study doctor.

There is compensation available for time and travel. All study-related care will be at no cost, and volunteers can continue seeing their primary care doctor during the study. Health insurance and doctor referrals are not required to participate.

Please email Joy at joy@rheumSD.com for more information. [607] PHYSICIAN POSITIONS AVAILABLE PER DIEM PHYSICIAN NEEDED: The County of San Diego Health and Human Services Agency is seeking a physician to work with California Children’s Services (CCS). Applicants (MD or DO) must hold a current California medical license.

Board certification in Pediatrics, Child Neurology, Orthopedic Surgery, Physical Medicine and Rehabilitation, Family Medicine or Preventive Medicine is desired, but not required. Applicants must have previous experience in providing medical care for children with disabilities and willing to work a minimum 60 hours per month.

If interested, please e-mail your CV to Dr. Marie Green, CCS Medical Director, at Marie.Green@ sdcounty.ca.gov or call (619) 528-4010.

PART TIME PHYSICIAN: Progressive Medical Specialists is an outpatient medication assisted treatment program located in San Diego, CA. We are currently in need of a part-time Physician to work 1 - 3 days per week. The Program Physician is responsible for providing the day-to-day medical care and treatment for all program patients. The Program Physician performs all duties in compliance with the California Code of Regulations for Narcotic Treatment Programs.

Training is provided. Please send your CV to tboylan@pms911.com or call 619-286-4600.

OB/GYN POSITION AVAILABLE: A MultiSpecialty Group is seeking a full-time OB/ GYN must be BC/BE to join a busy OB/GYN and Uro-gynecology practice, group of a physician and a nurse practitioner. Located in Southern California 1 ½ hours East of San Diego and Palm Springs; We offer a Competitive compensation, full benefits and opportunity for partnership. If interested, please e-mail CV to ekmoukarzel@aol. com or fax to : 760-352-6221. Visit our website: www.feminacareouro-gyn.com for additional information on our practice.

INTERNAL MEDICINE POSITION AVAILABLE: Unique opportunity to practice outpatient internal medicine in beautiful North San Diego County. Practice is part of a wellestablished internal medicine group with a long history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, small group environment, autonomy and very high quality patient care are among the many benefits of this opportunity. Office is located near San Diego coastal communities,

PART TIME OR FULL-TIME SUB-INVESTIGATOR Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures.

Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction.

Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multidisciplinary team. Send resume to: eliku@artemis-research.com accessible from all parts of San Diego County as well as Orange County. Seeking BC/BE applicants.

Please send CV to portofino3@aol.com or call 619-248-2324.

PRACTICE/INTERNAL MEDICINE PHYSICIAN wanted for established private office in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 28 years in the UTC/La Jolla area of San Diego, adjacent to the UCSD campus. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence based chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with healthy work/life balance. Friendly and upscale environment.

Cohesive team. This a real family practice. Boardcertified, California licensed MD and DO physicians interested in this opportunity should send CV to: triciaberkoff@gmail.com.

MULTI-ETHNIC GROSSMONT PEDIATRICS [private practice] in East San Diego seeks BC pediatrician, with 4+ years experience. Patientengaged and clinically-interested in Obesity, ADHD and Asthma, and in care continuity.

Grossmont Pediatrics has 20+ years reputation for family-oriented care and teaching parents.

Office schedule 3 days per week is ideal for dedicated pediatrician wishing to balance work and personal life, while still nurturing close physician-patient relationships. Salary $81,000 for BC pediatrician + $6,000 one hospital rounding and light after-hours call. Hospitals’ privileges, AAP, CME fees, tail-coverage included liability insurance included. Contactvenk@gpeds. sdcoxmail.com or 619-504-5830.

SEEKING A FULL/PART TIME DERMATOLOGIST to join a co-op situation at a brand new Medical and Day spa. Share space with two Licensed Massage Therapist and Esthetician in a new start up office on Miramar Rd/805. Opportunity to do Cosmetic, Cool sculpting, Botox, Fillers, and Laser procedures.

3,000 sq ft office with reception area, lobby,

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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kitchenette, bathroom. Free parking, handicap access. Short term or up to a 5-year lease available. $1,300/per month. Have 3 extra large offices available. Please call 760-815-3236 or email me at mpear4560@gmail.com FAMILY MEDICINE POSITION AVAILABLE: The Sycuan Medical Dental Center is a tribal health center, located on the Sycuan Indian Reservation in El Cajon, CA. This is a full-time position to provide outpatient care, no OB. Current CA and DEA licenses required. Student loan repayment possible. Must be BC/BE. Competitive compensation, full benefits. If interested, please e-mail CV to Amy Laughner (ALaughner@sycuan. com) or apply online at www.sycuan.com.

PRACTICES WANTED

PRIMARY CARE PRACTICE WANTED

I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base.

Please call 858-257-7050

PRACTICE FOR SALE FOR SALE. BUSY FAMILY PRACTICE POTENTIAL URGENT CARE: Established family practice for 27 years located in Chula Vista near H Street at 805 in upscale mall setting. Ideal location with free and easily accessible parking.

Spacious 2600 ft. office space with CLIA Certified Lab and X-ray. Practice accepts and experienced in billing: Medicare; Tricare, Immigration Exams, DOT Certification; Workers Comp. Contact: S.J.Anderson (858)736-5818 or Email: marva. winchi.garcia@gmail.com UNIQUE MEDICAL SPA FOR SALE-OWNER RETIRING Committed clientele, growing revenues/profits p lus expansion possibilities.

Bank pre-approved for SBA financing. Offered at $999,000 by Transworld Business Advisors of San Diego Central (CalBRE#02019152).

Contact Robert Cunio MBA, (888) 604-8221/ rmcunio@tworld.com OFFICE SPACE / REAL ESTATE AVAILABLE MEDICAL OFFICE SPACE, SUBLEASE HM POOLE BUILDING SCRIPPS LA JOLLA CAMPUS: Very attractive, comfortable suite with two offices, two exam rooms and two person receptionist area, and beautiful waiting room.

Excellent location on the campus of Scripps Memorial Hospital La Jolla. Large windows with open, peaceful garden views, available for full time rental with the option to rent time at the adjacent surgical suite. Rent also includes small kitchenette with sink, electricity, and janitorial service. Call- 858-344-7342 OFFICE SPACE/ REAL ESTATE AVAILABLE IN SOUTH BAY: Available for monthly sublease, 3 exam room, medical office, 5 days per week. Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista. If interested, please call 619-422-2000.

SOUTH BAY: Available for monthly sublease; pulmonary specialist for busy practice in South Bay. This is a great sublease opportunity for pulmonologist. If interested, call: 619-585-0476.

Ask for Judith.

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging from 1,300-5,000 SF with mix of exam rooms and offices. Will consider short-term & long-term leases.

For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org

MESA MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE: 1500 sq.ft Frost Street office with 2 exam rooms, 2 offices, front office area, bathroom, kitchenette and lobby. Easy access to Sharp Memorial Hospital and Rady Children’s Hospital and the 163 and 805 freeways. Up to 4 month lease with possible extension. Please call (858)467-1899.

POWAY OFFICE SPACE AVAILABLE PARTIME: Spacious 5 exam room office including large treatment room. Located across the street from Palomar Medical Centery Poway (aka Pomerado Hospital). Well suited for surgical or medical specialty. Contact bmorales@genhp.com.

MEDICAL EQUIPMENT / FURNITURE FOR SALE

CLASS “A” MEDICAL OFFICES, VISTA

Grow your business and upgrade to a new Class “A” medical office in TriCity’s leading outpatient health center.

Collegial environment with more than 40 physicians in 15+ specialities.

Strong primary care referral base. Fully renovated offices with today’s modern finishes. Close hospital proximity.

Multiple sizes available ranging from 1,200-6,800 SF. For more information, including floor plans, please call Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/leasing

SCRIPPS ENCINITAS CAMPUS OFFICE to share starting Jan.1. It is a beautifully decorated, 1600 sq.ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and 1/2 mile from Swami’s beach.

Contact Kristi or Myra 760-753-8413. View space on website: www.eisenhauerobgyn.com. Looking for compatible practice types.

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genessee Ave. – great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus. Please call (858) 4557535 or (858) 320-0525 and ask for the Sandy.

LA MESA OFFICE SPACE AVAILABLE. East County San Diego. Spacious 4,675 square foot office space to sub-let.Specialist suite.Recently updated.10 exam rooms. Two waiting rooms.

Main waiting area is newly renovated. Three in-suite restrooms. Diagnostic lab/service rooms.

Conference/ lunch room. Lots of storage space.

Large patient parking lot (free) with ample space.

Walking distance to Grossmont Hospital. Centrally located in East County. Please contact Jennifer Hansen at lamesacardiac@yahoo.com or cell 619249-8154. 10/10 SHARED OFFICE SPACE: Very attractive 3 exam room, medical office near Alvarado Hospital.

Available for 1, 2 or 3 days per week. Reasonable rates. Call Pat at 858-344-5020.

USED OFFICE FURNITURE FOR SALE: Exam tables, stools, chairs, x-ray view boxes, executive desk, waiting room chairs, tables, filing shelves and cabinets. Please call (858)467-1899.

NONPHYSICIAN POSITIONS AVAILABLE PART TIME PHYSICIAN ASSISTANT: Looking for a part time Physician Assistant for a rheumatology office in Escondido. 20-30 hrs a week. Spanish desired. To start as soon as possible. Please send resume and references to info@rheumSD.com.

MEDICAL ASSISTANT IN BUSY RHEUMATOLOGY OFFICE. FULL TIME. Wonderful opportunity for learning and growth.

We are looking for someone who is organized, capable of multi tasking, takes instruction well, and has a positive helpful attitude. Tasks include, but are not limited to: Front desk - answering phones, make calls to patients, collect fees, set appointments and filing. Back office: Rooming patients and taking vitals, helping with therapy, keeping things organized and running smoothly, and cleanup. Spanish desired. Salary is based on experience. Please email info@rheumSD.com SEEKING A DYNAMIC BUSINESS OFFICE MANAGER for a busy medical practice located on Convoy Street, close proximity to the 163/805 freeway. Responsible for the overall operations of the medical practice and reports directly to the CEO. This position ensures that the medical practice is running smoothly,

effectively and efficiently rendering a high standard of quality and customer service.

Accountable for operational systems, processes and policies in support of the organization’s mission. Required Education and Experience: Requires at minimum 3 years of significant work related experience in a private or group medical practice setting; supervised at least 10 F.T.E.’s and ability to collaborate with a minimum of 4 physicians in a practice setting. Preferred Education and Experience: AA or higher in Health Management or Business Administration education; Familiarity with health care laws, regulations and standards; Proficient in Excel and Word. We are offering a competitive salary, excellent benefits. Please email resume to businessofficemanager2017@gmail.com.

POSITION AVAILABLE FOR DYNAMIC NURSE PRACTIONER OR PHYSICIAN ASSISTANT to join our team of Women Healthcare providers specializing in Reproductive Medicine. We are offering a competitive salary, excellent benefits and a flexible schedule.

Requirements: Obtain detailed medical history, review medical records, and collaborate with physician in developing a thorough infertility evaluation and treatment plan.

Perform transvaginal sonograms for follicular measurements and collect data to monitor IVF cycles. Perform early OB ultrasounds and monitor early preganancy lab values. Master’s in Nursing or equivalent. 2-4 years experience in OB/GYN. Fertility experience preferred. Please email klopez@cacrm.com or call 760-274-2000.

Visit our website at cacrm.com.

PRODUCTS / SERVICES OFFERED 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 Medi-Cal 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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N E W L AW S 2 0 1 8

SIGNIFICANT NEW CALIFORNIA LAWS OF INTEREST TO PHYSICIANS The California Legislature had an active year, passing many new laws affecting health care. These are just a sampling of the new laws. For a comprehensive list, see “Significant New California Laws of Interest to Physicians for 2018,” in the California Medical Association’s online resource library at www.cmanet.org/ resource-library.

AB 242 (Arambula) – Certificates of death: veterans

ALLIED HEALTH PROFESSIONALS

HEALTH CARE COVERAGE

AB 89 (Levine) – Psychologists: suicide prevention training AB 1153 (Low) – Podiatry SB 554 (Stone) – Nurse practitioners: physician assistants: buprenorphine

SB 133 (Hernandez) – Health care coverage: continuity of care SB 223 (Atkins) – Health care language assistance services

HEALTH CARE FACILITIES AND FINANCING

ANCILLARY SERVICES SB 512 (Hernandez) – Health care practitioners: stem cell therapy CONFIDENTIAL INFORMATION AB 210 (Santiago) – Homeless multidisciplinary personnel team AB 1119 (Limón) – Developmental and mental health services: confidentiality SB 241 (Monning) – Medical records: access SB 575 (Leyva) – Patient access to health records

DRUG PRESCRIBING AND DISPENSING AB 40 (Santiago) – CURES database: health information technology system AB 265 (Wood) – Prescription drugs: prohibition on price discount AB 720 (Eggman) – Inmates: psychiatric medication: informed consent AB 1048 (Arambula) – Health care:

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pain management and Schedule II drug prescriptions SB 17 (Hernandez) – Health care: prescription drug costs.

END-OF-LIFE ISSUES

AB 395 (Bocanegra) – Substance use treatment providers AB 658 (Waldron) – Clinical laboratories AB 1102 (Rodriguez) – Health facilities: whistleblower protections SB 54 (De León) – Law enforcement: sharing data SB 219 (Wiener) – Long-term care facilities: rights of residents

MENTAL HEALTH AB 1315 (Mullin) – Mental health: early psychosis and mood disorder detection and intervention SB 565 (Portantino) – Mental health: involuntary commitment PROFESSIONAL LICENSING AND DISCIPLINE AB 508 (Santiago) – Health care practitioners: student loans AB 1340 (Maienschein) – Continuing medical education: mental and physical health care integration SB 798 (Hill) – Healing arts: boards

PUBLIC HEALTH AB 643 (Frazier) – Pupil instruction: abusive relationships AB 841 (Weber) – Pupil nutrition: food and beverages: advertising AB 1221 (Gonzalez Fletcher) – Responsible Beverage Service Training Program Act of 2017 SB 239 (Wiener) – HIV and AIDS: criminal penalties SB 536 (Pan) – Firearm Violence Research Center: gun violence restraining orders WORKERS’ COMPENSATION SB 189 (Bradford) – Workers’ compensation: definition of employee SB 489 (Bradford) – Workers’ compensation: change of physician

MEDI-CAL AB 205 (Wood) – Medi-Cal: Medi-Cal managed care plans AB 340 (Arambula) – Childhood trauma screening SB 171 (Hernandez) – Medi-Cal: Medi-Cal managed care plans MEDICAL CANNABIS AB 133 (Committee on Budget) – Cannabis Regulation SB 94 (Committee on Budget and Fiscal Review) – Cannabis: medicinal and adult use

WORKFORCE & OFFICE SAFETY ISSUES AB 461 (Muratsuchi) – Personal income taxes: exclusion: forgiven student loan debt SB 63 (Jackson) – Unlawful employment practice: parental leave SB 179 (Atkins) – Gender identity: female, male, or nonbinary SB 396 (Lara) – Employment: gender identity, gender expression, and sexual orientation

Litigated Cases That All Physicians Can Learn From As a leading California medical professional liability provider, CAP is committed to protecting our physician members with not only superior coverage, but also valuable resources, including our most-requested risk management publication, Medicine on Trial: Risk Management Lessons from Litigated Cases.

We are pleased to offer this updated edition to all California physicians for a limited time, free for the asking. Each vignette serves to demonstrate how the adoption of simple policies, procedures, and personal practices can help keep you out of the courtroom.

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