February 2019

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HEALTHCARE DREAM TEAM CMA’s Economic Advocates Recoup $29 Million on Behalf of Physician Members

t hank you



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


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

Tracy Zweig & Associates (800) 919-9141 www.tracyzweig.com U.S. Air Force (707) 280-5178 michael.williams.94@us.af.mil Vista Community Clinic (760) 631-5000 www.vistacommunityclinic.org


Please contact these vendors for your business needs.

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

MAY 2017

The Doctors Company (800) 852-8872 www.thedoctors.com/SDCMS Cooperative of American Physicians, Inc. (800) 356-5672 www.CAPPhysicians.com


Medical Billing Strategies (619) 260-0999 askmbs.com


Bank of America 858.692.9698 billy.cafcules@bankofamerica.com mortgage.bankofamerica.com/ billycafcules


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


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


Champions for Health’s collaborative partner in diabetes prevention, Skinny Gene Project, has been providing their CDC evidencebased intervention in San Diego County with successful results: 5.2% - 10% sustained weight loss over 12 months. That is a 58% reduction in diabetes…a delay in the onset of diabetes by 4-10 years!


to start the process!


www.skinnygeneproject.org prevention@skinnygeneproject.org As of Jan 2019, this program is a covered benefit for both Medicare and Medi-Cal beneficiaries.

• • • •

Be at least 18 years old Be overweight (body mass index ≥ 25; ≥23 if Asian) Have no previous diagnosis of type 1 or type 2 diabetes Have a blood test result in these ranges within the past year: • Hemoglobin A1C: 5.7% -6.4% or • Fasting plasma glucose: 100-125mg/dl or • Two-hour plasma glucose (after a 75 gm glucose load): 140-199 mg/dl • Be previously diagnosed with gestational diabetes

Screen, Test, Refer to Skinny Gene Project’s Diabetes Prevention Program

When you screen, test, and refer patients to a CDC-twice recognized diabetes prevention program, your patients will receive the guidance, accountability, and support they need to reduce their risk of type 2 diabetes.

More about the program…

While your patients receive a minimum of 22 sessions during a year of support, you can remain informed with patient reports. Family and community support via walking buddies and dietary changes transforms communities with healthier patients and families. Workshop locations are near patients’ homes. Trained, peer-based, lifestyle coaches can become an extension of your care team. Let’s start 2019 right…let’s get healthy!




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



Office Manager Advocacy: Danielle Hoffman, Office Manger of the Year


15 CMA and AMA Urge Exemptions from Open Payments Reporting

Briefly Noted: Practice Management, Professional Development & Education/Chronic Diseases, Government, Drug Prescribing/ Dispensing, New and Returning SDCMS-CMA Members




Public-Private Partnership Begins Work to End Hepatitis C in San Diego County



12 SDCMS 30-Year Profile: Dr. Leonard Schulkind BY KARL E. STEINBERG, MD






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

feature Healthcare Dream Team: CMA’s Economic Advocates Recoup $29 Million on Behalf of Physician Members

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


16 Getting to the Heart of the Matter BY ADAMA DYONIZIAK

New California Healthcare Laws

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 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


26 Physician Classifieds

28 Avoiding the Trap of Comparison BY HELANE FRONEK, MD, FACP, FACPh

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.]





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

FEB 15–18: The 32nd Annual Practicing Physician’s Approach to the Difficult Headache Patient, in Carlsbad. APRIL 18: Physician Mixer; 5:30 pm-8:30 pm, Location TBD APRIL 28–May 1: AAPC HEALTHCON, Las Vegas


Save the Date for AAPC’s HEALTHCON 2019, April 28 to May 1 AAPC, a training and credentialing association for the business side of healthcare, is hosting its 26th annual HEALTHCON on April 28 to May 1, in Las Vegas. The conference is geared toward all levels of medical practice leadership and will offer attendees a multitude of tools and resources to help guide them to success, including: • More than 120 educational sessions featuring the industry’s hottest topics, including a presentation by Karen DeSalvo, MD, former President Obama’s Acting Assistant Secretary for Health. • 3,000 healthcare professionals to network with. • More than 75 exhibitors offering the chance to learn about the latest products and services in the industry. For more information or to register, visit www.healthcon.com. AAPC has long been the California Medical Association’s (CMA) partner in billing and coding education, providing CMA’s monthly “Coding Corner” column and offering key education for the ICD-10 transition.




On-Demand Webinar: Reporting Data to the California Parkinson’s Disease Registry ON JULY 1, 2018, the California Department of Public Health (CDPH) launched the California Parkinson’s Disease Registry (CDPR), a statewide, population-based registry that will be used to measure the incidence and prevalence of Parkinson’s disease. MDs, DOs, PAs, and NPs who diagnose or treat Parkinson’s disease patients are required to report. The first deadline for data submission is March 29, 2019, for cases encountered during the first quarter the law was in effect (July 1 to Sept. 30, 2018). Details on the reporting obligation can be found in the Implementation Guide, version 3.0. To provide an overview of the registry and

help mandated reporters understand how to submit data to CPDR, CDPH has posted an on-demand webinar (webinar password: CPDRdec2018), free to all interested parties. The webinar covers both manual data entry via secure web portal and automated electronic interface. The CDPR data collected will be used to measure the incidence and prevalence of Parkinson’s disease, with the goal of better understanding this disease to improve the lives of Parkinson’s patients. If you are a provider and need assistance submitting Parkinson’s disease case information to the registry, please contact CDPH at CPDRhelp@cdph.ca.gov or (916) 731-2500.


Gov. Newsom Signs Executive Order Expanding Healthcare Access WITHIN HOURS of being sworn in as California’s 40th governor, Gavin Newsom signed an executive order that will help control healthcare costs and expand access to care for millions of Californians. Gov. Newsom announced the creation of the nation’s first state-run purchasing program for prescription drugs to help bring down costs via bulk purchasing. He also announced his intention to expand Medi-Cal coverage to undocumented Californians up to age 26. (California currently allows anyone under age 19 to receive Medi-Cal benefits, regardless of immigration status.) The governor also plans to create a state mandate for all Californians to carry health insurance, and to expand subsidies for those purchasing health coverage through the state’s health exchange, Covered California. Currently, subsidies are available to individuals making up to $48,000 per year, or 400 percent of the federal poverty level. The Newsom administration plans to both increase the size of subsidies and to make them available to individuals making up to $72,840 (or families earning up to $150,060). More details are expected on Thursday when Newsom unveils his budget for the 2019– 2020 fiscal year, but many of the governor’s moves on Monday reflect longstanding priorities for the California Medical Association (CMA). “Gov. Newsom is backing up his words with action, helping make healthcare more affordable and available to all Californians,” says CMA President David H. Aizuss, MD “By making this his first act as governor, he is sending a clear signal that expanding access to care will be a top priority for his administration.”

////////////////////////////////////////////////////////////////////////////////////////////////// DRUG PRESCRIBING/DISPENSING

Pharmacy Board Says “Enforcement Not a Priority” for New Security Prescription Law ON JAN. 1, 2019, a new California law took effect that requires all security prescription forms to have a uniquely serialized number. This new law also requires California physicians who prescribe controlled substances to use updated controlled substance prescription forms effective Jan. 1, 2019. The legislation did not include any transition or grandfathering period to allow for continued use of old controlled substance security prescription forms on or after Jan. 1. And although this requirement went into effect Jan. 1, the California Department of Justice (DOJ) only very recently issued any implementation guidance to security prescription printers. The California Medical Association (CMA) has expressed concern to DOJ that this guidance was not given in timely enough manner for it to be implemented by physician prescribers and will result in a serious disruption of patient care. The California Board of Pharmacy recently said it would “not make enforcement a priority” if pharmacists choose to fill prescriptions written on security prescription forms that were compliant prior to Jan. 1, but are not compliant with the new serialization requirement. The pharmacy board has urged pharmacists and pharmacies to exercise their best professional judgement when handling these situations, to determine if it is in the best interest of the patient or public health or safety to nonetheless fill such prescriptions. Similarly, the Medical Board of California has also recently issued a memorandum emphasizing the pharmacy board’s decision not to aggressively enforce the new requirement. CMA understands that reordering security prescription forms presents a great expense for many physician practices and has urged DOJ to work with CMA and other stakeholders to ensure compliance with this new requirement in a way that does not adversely affect patient care. Physicians should make sure their security prescription vendors are ready to comply with the new requirements. CMA’s security prescription partner, RxSecurity, is now taking orders for the new uniquely serialized prescription forms. (The full list of DOJapproved security prescription printers is available here.) For more details, see CMA’s letter to DOJ on this issue. CMA will provide additional information as it becomes available. Contact the CMA legal information line at (800) 786-4262 or legalinfo@cmadocs.org.

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Welcome New and Returning SDCMS-CMA Members! Welcome New Members! Young Lee, MD Cardiovascular Disease North County (760) 743-0546 Vi Nguyen, MD Pediatrics North County (619) 442-2560

Aileen Ramgren, DO Pediatrics North County (858) 673-3340

Collete Grant, MD Pediatrics North County (760) 945-3434

Welcome Returning Members!

Choll Kim, MD, PhD Orthopaedic Surgery of the Spine East County (619) 344-6918

Bernard Lichtenstein, MD Internal Medicine Hillcrest (619) 236-0111

Kimberly Bower, MD Hospice and Palliative Medicine Kearny Mesa (619) 822-8872

Endorsed by






DREAM TEAM CMA’s Economic Advocates Recoup $29 Million on Behalf of Physician Members CALIFORNIA PHYSICIANS have a powerful ally when it comes to dealing with problematic payers: the California Medical Association (CMA) Center for Economic Services (CES). Staffed by practice management experts with a combined experience of more than 125 years in medical practice operations, the CES team has recovered $29 million on behalf of its physician members over the past 10 years. Each member of the CES team brings something unique to the table, allowing them to bounce ideas off each other when trying to help practices. “We are the dream team of healthcare,” says Mark Lane, CES director of publications and resources. “There are few issues presented that we do not have experience dealing with in some capacity. We can also draw upon our vast network of contacts to find a resource or point person to help address almost any issue. No other organization, that I am aware of, can assist physicians or their practices on this level.” Lane began his career as a claims processor for plans such as Blue Shield of California and Health Net. Before long, he had moved up to a position in provider relations, allowing him to get a unique vantage point on the relationship between physicians and payers. Empowering Physician Practices CES also provides one-on-one practice management assistance to physician members and their staff on reimbursement, practice operations, and contract-related issues. The center’s goal is to empower physician practices by providing resources and guidance to improve practice success. Assistance ranges from coaching and education to direct intervention with payers or regulators.



When do I call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help: • Are your claims not being paid in a timely manner or according to your contract? • Do you need assistance regarding the new law on payment and billing for out-of-network services (AB 72)? • Are you receiving untimely requests for refunds or is a payer recouping money without first notifying you in writing of a refund request? • Do you need assistance creating a business case as to why a payer should consider contracting/ recontracting with your practice? • Do you need help with Medicarerelated issues? • Are your claims being denied after obtaining prior authorization? • Are you receiving unreasonable requests for medical records? • Do you need help identifying common practice mistakes costing you money? • Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law? • Have you done everything you can to resolve an issue with a payer, including appealing, and have been unsuccessful? Call CMA’s reimbursement helpline today at (888) 401-5911 and they will arm you with the knowledge you need to identify and fight unfair payment practices. Learn more about how CMA’s practice management experts can help you at cmadocs. org/ces.



“The ultimate goal is to empower practices to be able to advocate successfully for themselves,” says CES Vice President Jodi Black. “Sometimes processes fail, and that’s when we intervene on their behalf.” In the first three quarters of 2018, CES recovered more than $9 million on behalf of physician members, up from $3 million in all of 2017. One of the biggest successes this year was getting Anthem Blue Cross to agree not to pursue a $4.2 million recoupment from a member practice. Anthem had notified the practice it was planning to recoup more than $4 million due to problems with the renewal of a fictitious name permit. CMA escalated the issue to Anthem’s medical director, highlighting that upon renewal, the medical board showed no lapse in the permit. As a result, Anthem agreed not only to not pursue the recoupment, but also to release approximately $600,000 in pending claims for payment. Another success story was getting Medicare to agree to reinstate billing privileges and release almost $1 million in pending payments to another practice that had its billing privileges revoked when Medicare discovered an undisclosed criminal offense by a practice employee. CMA, the American Medical Association, and Noridian, California’s Medicare Administrative Contractor, worked together to get the practice’s appeal reviewed within three days rather than the normal 90 days as allowed by law. That helped get the practice’s billing privileges reinstated and avoid overpayments dating back nine years. “This is money that would have likely gone unrecouped if we didn’t step in,” says Black, who has been with CMA for 14 years, building relationships with both physicians and payers on behalf of CMA. Prior to joining CMA, she spent 15 years working with a group of emergency physicians, a field she entered while still in college. She changed her major to healthcare

administration because she believed in the cause so much. CES is constantly developing resources and tools to assist practices with new laws, including its monthly CMA Practice Resources newsletter, webinars, seminars, and phone conversations. These services are free to all members. “It feels great to help our doctors so they can get back to work helping their patients,” says Juli Reavis, CES associate director, who focuses largely on helping physicians with California’s new out-of-network billing and payment law (AB 72). The law, which went into effect July 1, 2017, placed limits on what physicians can bill patients for using an out-of-network physician at in-network facility. CES has created more than 10 new resources to help practices succeed and comply with these new requirements. You Are Not Alone In just the first eight months of 2018, CES assisted physicians and their office staff with nearly 900 calls from 555 different practices within 30 different component medical societies. Seventeen percent of those calls were from first-time callers. Often the only way CES finds out about an issue is by members contacting the call center. Typically, if an issue is affecting one practice, it’s impacting others. Small errors — sometimes on the part of the payer, sometimes on the part of the physician — can have a snowball effect. “Our goal is to take the noise out of the system so doctors can get back to treating patients,” says Black. “I always felt a need to help others and prevent pain and suffering wherever I could,” says Lane. “The role I serve at CMA, assisting physicians and their practice staff, has given me the opportunity to fulfill my mission. It’s the most rewarding role I have ever had in my 25 years of healthcare.” Tina Tedesco is a freelance writer in Sacramento.

Jodi Black, Vice President Jodi is the vice president of CMA’s Center for Economic Services. She has spent the past 14 years working through practice operational issues and advocating on behalf of members of CMA and its county medical societies. Prior to her time at CMA, Jodi spent 15 years working with a group of emergency physicians. “Our team not only provides oneon-one assistance when needed, but we also work hard to educate and empower practices to be able to advocate successfully for themselves,” she says. Cheryl Bradley, Physician Advocate Cheryl specializes in Medicare issues. Before joining CMA, Cheryl served as a provider outreach and education specialist for Noridian Healthcare Solutions, California’s Medicare contractor. She came to CMA with more than seven years of Medicare experience. “Our goal is to empower CMA member physicians and their staffs to use tools and resources that increase their understanding of the healthcare topics at hand — and their bottom lines,” she says. Mark Lane, Director of Publications and Resources For more than a decade and a half before joining the CMA team in 2010, Mark had a career as a claims processor for plans such as Blue Shield and Health Net. Before long, he had moved up to a position in provider relations, giving him a unique vantage point on the relationship between physicians and payers. “Communication really is the answer to a lot of payer issues. CMA has the contacts and the relationships to cut through the red tape and get things done,” he says. Kris Marck, Physician Advocate Before joining CMA in 2011, Kris spent 23 years working on the payer side of the healthcare industry. This previous experience makes her a very effective and approachable advocate for physicians in need of reimbursement and contracting assistance. “Working with payers is challenging and the reimbursement process is complex,” she says. “Don’t hesitate to call us. It’s easy to give the easy answer, but it’s difficult to go and find the right answer. We’ll get you the right answer.”

Meet Your Advocates Juli Reavis, Physician Advocate Juli primarily focuses on helping members navigate the new AB 72 billing restrictions for out-of-network services at in-network facilities. “We are fighting to ensure that payers do not game the system to set artificially low physician payment rates,” she says. “If you’re being negatively impacted by AB 72’s new billing and payment restrictions, call me. I can help.” Learn more at cmadocs.org/ab-72. Jennifer Williams, Executive Assistant Jennifer, who has spent the last 12 years with CMA, is often the first point of contact for practices in need of reimbursement assistance or practice management advice. “A lot of practices think we’re too busy to answer questions or don’t want to ‘bother’ us with what they think is a ‘silly’ question,” she says. “Please don’t wait to call us. We’re here to help our members; it’s our job.” Mitzi Young, Physician Advocate Mitzi has spent more than 20 years in healthcare settings, including county organized health programs, surgery centers, and specialty healthcare practices, and brings a variety of skills suited to help CMA members tackle their practice management questions. “With more than 125 years of practice management experience on the CES team, we can help medical practices work smarter, not harder,” she says. The CES team can be reached at (888) 401-5911 or economicservices@cmadocs.org.



P U B L I C H E A LT H / I N F E C T I O U S D I S E A S E S

Public-Private Partnership Begins Work to End Hepatitis C in San Diego County By Christian B. Ramers, MD, MPH, and Sayone Thihalolipavan, MD

THE GOAL IS LOFTY. But the work has begun. This past November, the steering committee of the Eliminate Hepatitis C San Diego County Initiative met for the first time, an initial step in the effort to eliminate hepatitis C (HCV) as a public health threat, defined by the World Health Organization (WHO) as reducing new infections by 80% and deaths by 65% in the next 11 years. Over the next year, the steering and other committees of the Eliminate Hepatitis C San Diego County Initiative will develop recommendations on how to end hepatitis C in the region and present its plan to the County Board of Supervisors at the end of 2019. Spearheaded by the County Health and Human Services Agency and the American



Liver Foundation-Pacific Coast Division, the committee, comprising members from the public and private medical community, met to begin developing recommendations to accomplish this ambitious goal. Hepatitis C is a chronic infection caused by the hepatitis C virus. Unlike hepatitis A and B, there is no vaccine, and because clinical symptoms are often absent, it may go unnoticed until they develop long-term complications. Acute hepatitis C typically occurs within six months of exposure and symptoms may include fever, fatigue, dark urine, nausea, vomiting, and jaundice. However, most cases are asymptomatic. Over time, most people (75 to 85 percent) infected with hepatitis C will develop chronic infection, characterized by low-

grade but persistent liver inflammation. Complications begin to appear 20 to 30 years later, with roughly 20 percent of people going on to develop cirrhosis and, in some cases, hepatocellular carcinoma (HCC). According to the Centers for Disease Control and Prevention, approximately 3.5 million people in the United States are estimated to have chronic hepatitis C and approximately 18,000 people died in 2016 from hepatitis C-related liver disease, a figure the CDC believes is an underestimate. Models estimate that roughly half of the cases in the U.S. are undiagnosed, and rates of hepatitis C–related complications (cirrhosis, HCC) are expected to increase over the next several years.

Last year, 3,112 new cases of hepatitis C cases were reported in San Diego County. Hepatitis C is listed as an underlying cause of death annually in 70 to 100 deaths in the region. How is hepatitis C contracted? Most cases of hepatitis C transmission occur through exposure to small quantities of blood, primarily among people who inject drugs, although some studies have implicated inhaled or intranasal drug use as well. While the virus is not typically transmitted through sexual practices, recent studies have shown that sexual transmission does occur, particularly among HIV-positive people. Additionally, hepatitis C has been detected in people from other countries who contracted it through unsafe injection practices or healthcare. Large epidemiologic surveys have found that baby boomers have a 3- to 5-fold higher risk of having hepatitis C, especially those born between 1945 and 1965. Some of these people may have been infected through contaminated blood and blood products before widespread screening of the blood supply for hepatitis C began in 1992. Because these individuals are likely to have carried the virus for several decades, they are at high risk for liver-related complications. In order to eliminate hepatitis C, we will need to increase prevention efforts, expand testing in clinics and other settings, and provide access to treatment across primary care settings. In the past five years, HCV treatment with a new class of drugs called Direct Acting Antivirals (DAAs) has drastically improved the tolerability and effectiveness of therapy. Who should be tested for hepatitis C? The Centers for Disease Control and Prevention recommends that the following groups of people be tested for hepatitis C: • Everyone born between 1945 and 1965. • Current or former injection drug users, including those who injected only once many years ago. • Recipients of clotting factor concentrates made before 1987, when less advanced methods for manufacturing those products were used.

• People who got blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donations became available. • Chronic hemodialysis patients. • People with known exposures to hepatitis C, such as healthcare workers after needle sticks involving hepatitis Cpositive blood and recipients of blood or organs from a donor who tested positive for the hepatitis C virus. • People with HIV infection. • Children born to mothers with hepatitis C. Testing for hepatitis C is also recommended for incarcerated people, those who use intranasal drugs, and people who got body art from an unlicensed tattoo parlor. In 2016, the World Health Organization issued a proposal to eliminate hepatitis C by 2030, specifically reducing new cases of chronic hepatitis C cases by 80 percent. Last year, the United States Department of Health and Human Services published the National Viral Hepatitis Action Plan, which provides a framework for eliminating hepatitis C in the U.S. Additionally, since July 1, 2018, the California Department of Health Care Services issued a new Treatment Policy for the Management of Chronic Hepatitis C, which will result in more individuals diagnosed with hepatitis C receiving treatment immediately. Although when the DAAs initially became available their price was prohibitive, costs have been drastically reduced, and insurance restrictions to treatment are now rare. The Initiative is funded by unrestricted educational grants/support provided to the American Liver Foundation — the facilitating agency — by a coalition of organizations, including the Alliance Healthcare Foundation, AbbVie Inc., and Gilead Sciences. Dr. Ramers (top left) is an infectious diseases specialist and assistant medical director of Family Health Centers of San Diego who co-chairs the Elimination steering committee. Dr. Thihalolipavan (bottom left) is deputy public health officer for the County of San Diego Health and Human Services Agency who co-chairs the Elimination steering committee. SAN DIEGO PHYSICIAN.ORG




Leonard Schulkind, MD By Karl E. Steinberg, MD

DR. LEONARD SCHULKIND is celebrating his 30th anniversary as a member of SDCMS. He had a somewhat nontraditional path to medicine, starting his career as a full-time lifeguard for the city of Los Angeles, then becoming a paramedic in L.A. County. Observing trauma in the field and appreciating the tangible ways that the medical system helped people, Dr. Schulkind made the decision to apply to medical school in his late 20s and matriculated to the Universidad Autonoma de Guadalajara at age 27. For his Fifth Pathway training, Dr. Schulkind worked in Baltimore at Prince George’s Hospital Center. This was a large, busy, urban medical center with a shock/ trauma unit — and a great opportunity to learn procedures and care for complex



patients. Dr. Schulkind got his medical license and board certification in family medicine in the early 1980s and decided to return to California to be near home, but not in the crowded L.A. scene where he had lived previously. So, Dr. Schulkind landed briefly in Alpine, practicing family medicine in a local multispecialty group where a friend of his was working. Before long, he decided to practice in emergency medicine and came to San Diego at the old Villa View Hospital; he also worked in the emergency rooms at Mercy, Fallbrook, and Coronado hospitals. Around this time, Dr. Schulkind joined SDCMS. He had been a member of the local medical society in Maryland and felt that joining SDCMS was the appropriate thing

for a young physician practicing emergency medicine to do. While Dr. Schulkind has not been active in governance within the society, he is nonetheless appreciative for some of the perks SDCMS offers. Reading San Diego Physician as a source of information has been one of the services Dr. Schulkind appreciates most, and over the years he has placed advertisements for physicians and other employees on numerous occasions, often finding excellent applicants that way. He also appreciates the information and discounts he has received on other services through SDCMS membership, notably insurance. Since his years running the Emergency Department at Villa View, Dr. Schulkind’s practice has changed somewhat. He still works a few shifts a month in the ED at Paradise Valley Hospital, but also owns several specialty clinics (weight loss, skin care) in Hesperia, San Bernardino and San Diego. Dr. Schulkind also has a Hawaii medical license and a home on Kauai; he goes there for a month at a time and works in the local ED there. He feels very fortunate to have a job that he loves, and he says the best thing about practicing medicine is still “that I get to wake up in the morning and go to work.” Dr. Schulkind believes that having a calling that is truly enjoyable and meaningful makes for a great life. As to the changes in the field of medicine Dr. Schulkind has observed in his 30 years as a SDCMS member, his main conclusion is that there has been an incursion of various non-medical, corporate type entities who are now largely in charge of some aspects of medical decision-making, such as insurance issues and productivity. More and more physicians are employed rather than independent, and it has made the practice of medicine quite different from the days of the solo practitioner or small practice. “Doctors have given up so much control,” he observes. Dr. Schulkind has no regrets about his career choice, though. He loves his practice and plans to continue working for at least several more years, although he could retire sooner. To the young physicians in medical school and residency today, Dr. Schulkind says, “God bless those kids coming up now; it’s not an easy field to be in. But for someone who’s committed to being a doctor, it’s still a great way to be of service to others in a tangible and important way.”

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YOU’RE A DOCTOR, NOT A COLLECTION AGENCY CAP’s FREE New Guide Lets You Focus More on Medicine and Less on Billing Request your free copy today: 800-356-5672 CAPphysicians.com/SDBG1 The Cooperative of American Physicians (CAP) provides California’s finest physicians with superior medical malpractice coverage and supplemental benefits. The Physician’s Action Guide to Smarter Billing is just one of the many benefits.

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.




Congratulations, Danielle Hoffman, SDCMS’s 2018 Office Manager of the Year! NOMINATED BY Dr. Brooke Sateesh, 14-year member of SDCMS-CMA, Danielle Hoffman was awarded the 2018 Office Manager of the Year for her exemplary work at San Diego Family Dermatology. From Dr. Sateesh: “Danielle Hoffman joined San Diego Family Dermatology in 2016, and in a short time she has transformed our practice. She is an extremely hard worker who prioritizes patient care and overall staff happiness. She came from a completely different role, coordinating



volunteers at hospice, and in a short time has learned the ins and outs of running a private medical practice. She has tackled such obstacles as Medi-Cal credentialing and improving our phone/email capabilities, enabling patients’ better access to care. She has made our practice more efficient by taking over the challenge of ordering medical and office supplies, always guaranteeing us the best prices. Additionally, she has scaled our ability to provide Mohs surgery to more patients

sooner and closer to their homes by taking on the responsibility for coordinating the entire operation from scheduling Mohs assistants, Mohs technicians, patients, and the surgeon, to ensuring each patient gets adequate communication both before and after the procedure, to keeping our CLIA license active. Additionally, she has created the means necessary for our clinic to serve as an urgent care clinic, providing same-day access to patients with urgent dermatological issues. She also helped set up a regular feedback system so we can ensure patients are satisfied with their care. Her detail-oriented nature, hard work, and dedication to this practice are evident in these accomplishments. Danielle helped create our two practice values, which she emulates daily: “(1) We treat each other and our patients like family. (2) Patient care is our first priority.” For any negative feedback we receive, she is the first to speak to the patient, never shirking this often difficult responsibility. She has a way with people that is calming and reassuring. Her dedication to patient care is evident as she acts with compassion and love when people need it the most, and is courteous and patient in 100% of patient interactions. She goes out of her way to get people the care they need to improve their quality of life. She is a kind, caring, and compassionate person. She goes out of her way to assist others whenever possible without being asked. She performs her job consistently, and in an efficient and quality manner. She follows through and ensures things don’t slip through the cracks. She is self-motivated, and eager to learn and grow professionally. She gives 100% to the job and is entirely honest. Danielle is constantly going above and beyond, allowing us doctors to provide efficient, effective care that is benefiting patients’ quality of life. She has freed up my time, allowing me to focus on patient care, and she has created a more fun, relaxed, and happy working environment for the staff, while ensuring patient care is always the top priority.” Congratulations, Danielle, on being SDCMS’s 2018 Office Manager of the Year and for all you have accomplished with San Diego Family Dermatology!


CMA and AMA Urge Exemptions From Open Payments Reporting By California Medical Association Staff

THE AMERICAN MEDICAL Association, the California Medical Association (CMA), and more than 80 other healthcare organizations recently submitted a joint letter in response to a request from the Centers for Medicare and Medicaid Services (CMS) for feedback on the Open Payments Program reporting requirements. Under the Open Payments program, drug and medical device manufacturers are required to report their financial interactions with licensed physicians — including consulting fees, travel reimbursements, research grants, and other gifts. The joint letter urges CMS to exempt journal reprints and medical textbooks from “Open Payments” reporting using a preexisting statutory exclusion for “educational materials that directly benefit patients.” The letter also urges the agency to play a more proactive role in the reporting process by working with stakeholders on a common set of defini-

tions of what is reportable. “We have long believed that the agency’s decision to include educational materials and CME programs as reportable transfers of value is contrary to both the statute and congressional intent,” states the letter. “[It] has harmed patient care by impeding ongoing efforts to improve the quality of care through timely medical education.” The organizations that signed on to the letter agree that CMS’s decision to require reporting of medical textbooks and journal reprints makes it more difficult for busy physicians to stay abreast of the latest advances in medical care, therefore and ultimately compromising patient care. They also state the reporting guidance pertaining to CME continues to be misinterpreted with many manufacturers overreporting. As previously reported by CMA, less than 6% of physicians who received payments actually looked at their records. Physicians who are not already registered

should be aware that there is a two-step process to register for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Identity Management System portal, a step many physicians may have already completed as the gateway enables access to some other CMS programs. Step two is to register in CMS’s Open Payments system. Physicians who have already registered but who have not accessed their account in the past 60 days will need to unlock their account by going to the CMS Enterprise Portal. It will prompt you to enter your user ID and correctly answer all challenge questions, then you will be prompted to enter a new password. Users who registered last year but who have been inactive for more than 180 days will need to reactivate their account by contacting the Open Payments Help Desk at openpayments@cms.hhs.gov or (855) 326-8366.




Binational Health Month blood pressure screening at the Mexican Consulate

Getting to the Heart of the Matter By Adama Dyoniziak

THE HEART SYMBOLIZES love, passion, commitment … life itself. When our heart beats faster at the sight of a loved one, or skips a beat during stressful times, we take it for granted that it will always be there and working at its best. But what have you done for your heart lately? Champions for Health mobilizes more than 290 volunteer nurses and nursing students to provide free blood pressure screenings throughout San Diego County as part of our Community Wellness programming. During the past year, more than 7,000 San Diegans found out their numbers: diastolic, systolic, and what it means for them. These screenings occurred at 228 locations, most of which were part of Love



Your Heart (LYH), an annual event started by the County of San Diego. LYH is usually held on Valentine’s Day, the most celebrated heart holiday, where organizations around the U.S. and Mexico provide free blood pressure screenings to the public. This year’s Love Your Heart event will take place on Feb. 14, with some sites offering screenings the prior weekend. Last year the County and its partners, including Champions for Health, provided more than 36,000 blood pressure checks at nearly 400 sites! This year’s goal is to provide 50,000 screenings. Healthcare organizations can participate by providing blood pressure screenings to existing clients and patients during their visit, as well as to your

employees! Register your clinic, medical office, facility or hospital by visiting loveyourheartsd.org. Another Champions for Health program that goes hand in hand with our blood pressure screenings is the Live Well San Diego Speaker’s Bureau. Our volunteer physicians and healthcare professionals provide customizable presentations on a variety of health topics. One of these physicians is Dr. Harris Effron (pictured top left with Nancy Effron), a retired cardiologist with 40 years experience in matters of the heart. When he was choosing cardiology as his specialty, it was a field in its infancy, transitioning from ultrasound diagnostics and oxygen, morphine, and Coumadin for treatment to more invasive arterial procedures. “Cardiology provided longevity with patient care in hospitals and clinics, and I could use my hands in a peri-surgical manner,” Dr. Effron says. The transition from practitioner to retired professional was made smoother with teaching UC San Diego Medical School’s first- and second-year students who were eager and enthusiastic to learn. Additionally, giving back to the community in a relevant way is what drew Dr Effron to volunteer for the Speaker’s Bureau. “It is a large opportunity to educate people of all ages and backgrounds,” he says. “I enjoy establishing what a person can do to maintain a healthy lifestyle by making moderate changes to improve their health and longevity.” Participants are amazed how easy the healthy tips are: know your numbers (blood pressure, blood sugar, cholesterol), know your body (if something changes, bring it to the attention of your physician), and make changes in moderation (stop smoking, read labels, become more active). Dr. Effron practices what he preaches: he hikes 4 to 6 miles per day, and plays golf and racquet sports twice a week. His family has traveled together throughout the U.S. and other countries, hiking in scenic places: the Rockies, the Inca trail in Peru, the Pyrenees mountains, Milford and Routeburn in New Zealand, Darjeeling in northern India, Tiger’s Nest viewpoint in Bhutan, and the Kenyan bush. Physicians and community members having meaningful conversations helps

Get the mortgage benefits you deserve with the Bank of America® Doctor Loan1 people understand that healthcare providers are part of their team, and each person can work with all levels of healthcare providers to improve their own health. Providers have just such an opportunity with Target BP. In response to the rising incidence of uncontrolled blood pressure (BP), a national initiative was formed by the American Heart Association (AHA) and the American Medical Association called Target: BP. Through this no-cost program, healthcare organizations can improve BP control rates through an evidence-based quality improvement program that recognizes organizations committed to improving BP control. Community members can also step up to take control of their blood pressure. Champions for Health has worked closely with the American Heart Association and the San Diego Black Nurses Association to provide blood pressure screenings for faithbased communities in Southeast San Diego. Ethel Weekly-Avant, who is a CFH and AHA volunteer, AHA board member, and immediate past president of the San Diego Black Nurses Association, championed the implementation of AHA’s Check. Change. Control, an evidence-based hypertension management program. “This program empowers participants to take ownership of their cardiovascular health by tracking their blood pressure results,” Weekly-Avant says. “The program incorporates the concepts of remote monitoring, online tracking, and recruiting local volunteer health mentors to encourage participants.” During the month of February and especially on Valentine’s Day, think of your heart and that of your loved ones. After the flowers, chocolates, wine, and dinner, take your loved one by the hand and show them how much you love them: go for a romantic walk, hike, bike ride, or swim so you can get to the heart of the matter! If you would like to volunteer with Champions for Health to provide blood pressure screenings and immunizations, be a presenter in our Speaker’s Bureau, or provide pro bono specialty care for Project Access San Diego, please contact Adama Dyoniziak at (858) 300-2780 or adama.dyoniziak@championsfh.org. Ms. Dyoniziak is executive director of Champions for Health.

Low down payments. As little as 5% down on a mortgage up to $1 million and 10% down on a mortgage up to $1.5 million.2 Flexible options. Student loan debt may be excluded from the total debt calculation.3

Call me to learn more. Billy Cafcules Senior Lending Officer NMLS ID: 1485046 858.692.9698 Mobile billy.cafcules@bankofamerica.com mortgage.bankofamerica.com/billycafcules

An applicant must have, or open prior to closing, a checking or savings account with Bank of America. Applicants with an existing account with Merrill Edge®, Merrill Lynch® or U. S. Trust prior to application also satisfy this requirement. Eligible medical professionals include: (1) medical doctors who are actively practicing, (MD, DDS, DMD, OD, DPM, DO), (2) medical fellows and residents who are currently employed, in residency/fellowship, or (3) applicants who are medical students or doctors and are about to begin their new employment/residency or fellowship within 90 days of closing. Must be actively practicing in their field of expertise. Those employed in research or as professors are not eligible. For qualified borrowers with excellent credit. PITIA (Principal, Interest, Taxes, Insurance, Assessments) reserves of 4 – 6 months are required, depending on loan amount. 2 Minimum down payment requirements vary by property type and location; ask for details. 3 Additional documentation is required. Credit and collateral are subject to approval. Terms and conditions apply. This is not a commitment to lend. Programs, rates, terms and conditions are subject to change without notice. Bank of America, N.A., Member FDIC. Equal Housing Lender. ©2018 Bank of America Corporation. ARY89JD7 | AD-07-18-0108 | HL-112-AD | 02-2018 1

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



New California Healthcare Laws By California Medical Association Staff



The California Legislature had an active year, passing many new laws affecting healthcare. In particular, there was a strong focus on healthcare coverage, drug prescribing, public health, and mental health issues. On the following pages you will find highlights of the most significant health laws of interest to physicians. ALLIED HEALTH PROFESSIONALS AB 2281 (Irwin) – Clinical laboratories: licensed medical laboratory technicians CMA Position: Support Exempts blood smear reviews other than manual leukocyte differentials, microscopic urinalysis, and blood typing of moderate complexity such as automated ABO/ Rh testing and antibody screen testing from the prohibition of licensed medical laboratory technicians from performing microscopic analysis or immunohematology procedures. AB 2423 (Holden) – Physical therapists: direct access to services CMA Position: Neutral Provides physical therapists with an exemption from the provision in the Physical Therapy Practice Act that prohibits the physical therapist from continuing treatment beyond 45 calendar days or 12 visits, whichever occurs first, without receiving specified doctor approval of the physical therapist’s plan of care to enable them to provide services within their scope of practice under the federal Individuals with Disabilities Act (IDEA) under a school-developed Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP). AB 2589 (Bigelow) – Controlled substances: human chorionic gonadotropin Current law lists human chorionic gonadotropin (hCG) as a Schedule III controlled substance under the California Uniform Controlled Substances Act. This bill exempts hCG from being subject to the reagent regulations of the Controlled Substances Act when possessed by, sold to, purchased by, transferred to, or administered by a licensed veterinarian, or a licensed veterinarian’s designated agent, exclusively for veterinary use.

SB 762 (Hernandez) – Optometry: administration of immunizations Requires training programs for certification of optometrists to administer immunizations to be endorsed by the Accreditation Council for Pharmacy Education in addition to the federal Centers for Disease Control and Prevention. SB 1003 (Roth) – Respiratory therapy CMA Position: Neutral Prohibits any state agency, as defined, except for the Respiratory Care Board of California, from defining or interpreting respiratory care for those licensed under the Respiratory Care Practice Act, or from developing standardized procedures or protocols, unless authorized by these provisions or specifically required by state or federal statute. CONSENT AB 3189 (Cooper) – Consent by minors to treatment for intimate partner violence Authorizes a minor who is 12 years of age or older and who states he or she is injured as a result of intimate partner violence, as defined, to consent to medical care related to the diagnosis or treatment of the injury and the collection of medical evidence with regard to the alleged intimate partner violence. DEATH AND ORGAN DONATION AB 2096 (Frazier) – Personal income taxes: voluntary contributions: Organ and Tissue Donor Registry Voluntary Tax Contribution Fund Allows a taxpayer to designate an amount in excess of personal income tax liability to be transferred into the Organ and Tissue Donor Registry Voluntary Tax Contribution Fund, which the bill creates.

SB 1163 (Galgiani) – Postmortem examination or autopsy Makes various changes to provisions regarding postmortem examination or autopsies of unidentified bodies or remains, including to provisions regarding dental examinations, tomography scans, and retention of tissue and bone samples. Authorizes an agency tasked with the exhumation of a body or skeletal remains of a deceased person that has suffered significant deterioration or decomposition, where the circumstances surrounding the death afford a reasonable basis to suspect that the death was caused by or related to the criminal act of another, to perform the exhumation in consultation with a boardcertified forensic pathologist. Authorizes a board-certified forensic pathologist to suggest to the agency tasked with an exhumation to consider retaining the services of an anthropologist, as specified. DRUG PRESCRIBING AND DISPENSING AB 315 (Wood) Pharmacy benefit management CMA Position: Sponsor Requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the prescription drug unless the pharmacy automatically charges the customer the lower price. If the customer pays the retail price, the bill requires the pharmacy to submit the claim to the plan or insurer in the same manner as if the customer had purchased the prescription drug by paying the cost-sharing amount when submitted by the network pharmacy. AB 1751 (Low) – CURES database: Interstate data sharing CMA Position: Oppose Unless Amended SAN DIEGO PHYSICIAN.ORG



Requires the Department of Justice, no later than July 1, 2020, to adopt regulations regarding the access and use of the information within CURES by consulting with stakeholders, and addressing certain processes, purposes, and conditions in the regulations. Authorizes the department, once final regulations have been issued, to enter into an agreement with any entity operating an interstate data sharing hub, or any agency operating a prescription drug monitoring program in another state, for purposes of interstate data sharing of prescription drug monitoring program information, as specified. AB 1753 (Low) – Controlled substances: Security form CMA Position: Neutral Authorizes the Department of Justice to reduce or limit the number of approved security printers for controlled substance prescription forms to 3, as specified and requires prescription forms for controlled substance prescriptions to have a uniquely serialized number, in a manner prescribed by the department, and requires a printer to submit specified information to the department for all prescription forms delivered. AB 2037 (Bonta) – Pharmacy: automated patient dispensing systems Provides an alternative program to authorize a pharmacy located in the state to provide pharmacy services to the patients of covered entities, as defined, that are eligible for discount drug programs under federal law, as specified, through the use of an automated patient dispensing system, as defined. Provides that the responsibility of the operation, maintenance, and security of the automated patient dispensing system would be the responsibility of the pharmacy and requires that the drugs dispensed from the system be labeled in accordance to existing law. Requires the pharmacy to compete an annual self-assessment. AB 2086 (Gallagher) – Controlled substances: CURES database CMA Position: Support Allows prescribers to access the Controlled Substance Utilization Review and Evaluation System (CURES) database for a list of patients for whom that prescriber is listed as a prescriber in the CURES database.



AB 2256 (Santiago) – Law enforcement agencies: opioid antagonist CMA Position: Support Authorizes a pharmacy, wholesaler, or manufacturer to furnish naloxone hydrochloride or other opioid antagonists to a law enforcement agency, as provided. AB 2487 (McCarty) – Physicians and surgeons: continuing education: opiate-dependent patient treatment and management CMA Position: Neutral Authorizes a physician and surgeon to complete a one-time continuing education course of 12 credit hours on opiatedependent patient treatment and management, including eight hours of training in buprenorphine treatment as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients. AB 2760 (Wood) – Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs CMA Position: Neutral Requires a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another drug to the patient and specified others, except as specified. Subjects a prescriber to referral to the licensing board charged with regulating his or her license for the imposition of administrative sanctions, as that board deems appropriate, for violations of these provisions.

scriptions to have the capability to transmit electronic data transmission prescriptions and would require pharmacies to have the capability to receive those transmissions. Mandates electronic prescribing, unless specified exceptions are met. SB 212 (Jackson) – Solid waste: pharmaceutical and sharps waste stewardship CMA Position: Support Establishes a stewardship program, under which a manufacturer or distributor of covered drugs or sharps, or other entity defined to be covered by the bill, is required to establish and implement, either on its own or as part of a group of covered entities through membership in a stewardship organization, a stewardship program for covered drugs or for sharps, as applicable. Imposes various requirements on a covered entity or stewardship organization that operates a stewardship program, including submitting a proposed stewardship plan, an initial stewardship program budget, an annual budget, annual report, and other specified information to CalRecycle.

AB 2783 (O’Donnell) – Controlled substances: hydrocodone combination products Reclassifies specified hydrocodone combination products as Schedule II controlled substances under the California Uniform Controlled Substances Act.

SB 1021 (Wiener) – Prescription drugs Extends existing provisions related to formularies for outpatient prescription drugs by healthcare service plans or health insurers and cost-sharing for covered outpatient prescription drugs until Jan. 1, 2024. Prohibits, until January 1, 2024, a drug formulary maintained by a healthcare service plan or health insurer from containing more than 4 tiers, as specified. Requires a prescription drug benefit to provide that an enrollee or an insured is not required to pay more than the retail price for a prescription drug if a pharmacy’s retail price is less than the applicable copayment or coinsurance amount, and the payment rendered by an enrollee or insured would constitute the applicable cost-sharing. Extends until Jan. 1, 2023, coverage requirement to antiretroviral drug treatments that are medically necessary for the prevention of AIDS/HIV.

AB 2789 (Wood) – Prescriptions: electronic data transmission CMA Position: Oppose Requires, on and after Jan. 1, 2022, healthcare practitioners authorized to issue pre-

SB 1109 (Bates) – Controlled substances: Schedule II drugs: opioids CMA Position: Support Requires training and continuing education under the Medical Practice Act, Nursing

Practice Act, Physician Assistant Practice Act, Dental Practice Act, Osteopathic Act, and the Optometry Practice Act to include risks of addiction associated with the use of Schedule II drugs. Requires pharmacy or practitioner dispensing an opioid to a patient for outpatient use to display a notice on the label or container that warns of the risk of overdose and addiction as specified. Requires a prescriber to discuss specified information with the minor, the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. Requires youth sports organizations to distribute specified Opioid Factsheet for Patients to each athlete and requires each athlete and their parent to sign a document acknowledging receipt. SB 1254 (Stone) – Hospital pharmacies: medication profiles or lists for high-risk patients CMA Position: Neutral Requires a pharmacist at a hospital pharmacy to obtain an accurate medication profile or list for each high-risk patient upon admission of the patient under specified circumstances. Authorizes an intern pharmacist or a pharmacy technician to perform the task of obtaining an accurate medication profile or list for a high-risk patient if certain conditions are satisfied. Requires the hospital to establish criteria regarding who is a highrisk patient for purposes of the bill’s provisions and determine a timeframe for completion of the medication profile or list, based on the populations served by the hospital. EMERGENCY SERVICES AB 2576 (Aguiar-Curry) – Emergencies: healthcare CMA Position: Support if Amended Authorizes a pharmacist or a community clinic to furnish a dangerous drug or device in reasonable quantities without a prescription during a declared emergency. Requires the Pharmacy Board to allow for the use of a mobile pharmacy or clinic during an emergency if certain conditions are met. Authorizes the Governor, during

a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including directing DHCS to seek federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.

END-OF-LIFE AB 282 (Jones-Sawyer) – Aiding, advising or encouraging suicide: exemption from prosecution Prohibits a person whose actions are compliant with the End of Life Option Act from being prosecuted for deliberately aiding, advising, or encouraging suicide. AB 3211 (Kalra) – Advance healthcare directives Revises the language of the form for written advance healthcare directives created under the Healthcare Decisions Law to allow a person to authorize an agent to consent to any temporary medical procedures necessary to maintain organs, tissues, and/ or parts for the purpose of donation. SAN DIEGO PHYSICIAN.ORG



HEALTHCARE COVERAGE AB 2674 (Aguiar-Curry) – Healthcare service plans: disciplinary actions CMA Position: Sponsor Under the Knox-Keene Healthcare Service Plan Act of 1975, a healthcare service plan is prohibited from engaging in an unfair payment pattern, as defined, and allows providers to report instances in which a plan is engaging in an unfair payment pattern to the department. Requires the Department of Managed Healthcare to review complaints of unfair payment patterns on or before July 1, 2019, and at least annually thereafter and permits the department to conduct an audit or enforcement action pursuant to existing authority if the review of the complaint data indicates a possible unfair payment pattern. AB 2863 (Nazarian) – Healthcare coverage: prescriptions Requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the cost-sharing amount for the drug unless the lower price is charged auto-



matically. Limits the amount a healthcare service plan or health insurer may require an enrollee or insured to pay at the point of sale for a covered prescription to the lesser of the applicable cost-sharing amount or the retail price. Prohibits a healthcare service plan or health insurer from requiring a pharmacist or pharmacy to charge or collect a cost-sharing amount from an enrollee or insured that exceeds the total retail price for the prescription drug. Provides that the payment rendered by an enrollee or insured constitutes the applicable cost sharing and shall apply to any deductible as well as to the maximum out-of-pocket limit, as specified. AB 2941 (Berman) – Healthcare coverage: state of emergency Requires a healthcare service plan or health insurer to provide its enrollees or insureds who have been displaced by a state of emergency, as defined, access to medically necessary healthcare services. Requires a healthcare service plan or health insurer, within 48 hours of a declaration of emergency by the Governor that displaces or has the immediate potential to displace enroll-

ees or insureds, to file a notification with the regulator containing specified information regarding how the plan or insurer is communicating with and addressing the needs of its enrollees or insureds during the state of emergency. SB 997 (Monning) – Healthcare service plans: physician to enrollee ratios Deletes the repeal date of existing law that would have sunset on Jan. 1, 2019 and requires a healthcare service plan to ensure that there is at least one full-time equivalent primary care physician for every 2,000 enrollees and authorizes the assignment of up to an additional 1,000 enrollees, as specified, to a primary care physician for each full-time equivalent non-physician medical practitioner, as defined, supervised by that physician. These provisions will operate indefinitely. SB 1034 (Mitchell) – Healthcare: mammograms CMA Position: Neutral Extends, until Jan. 1, 2025, the operation of existing law that requires a health facility at which a mammography examination is

performed to include a prescribed notice on breast density in the summary of the written report that is sent to a patient, if specified circumstances apply. Makes technical and conforming changes.

tures that are constructed prior to Jan. 1, 2017, and subject to subsequent modifications, renovations, or tenant improvements, as specified.

department and its contractors to update any specified materials to ensure the new medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials.

MEDI-CAL HEALTHCARE FACILITIES AND FINANCING AB 2983 (Arambula) – Healthcare facilities: voluntary psychiatric care CMA Position: Support Prohibits a general acute care hospital or an acute psychiatric hospital from requiring a person who voluntarily seeks care to be in custody as a danger to himself or herself or others or gravely disabled as a condition of accepting a transfer of that person after his or her written consent for treatment and transfer is documented or in the absence of evidence of probable cause for detention. SB 1152 (Hernandez) – Hospital patient discharge process: homeless patients CMA Position: Oppose Unless Amended Requires each hospital to include a written homeless patient discharge planning policy and process within the hospital discharge policy. Among other requirements, the policy shall require a hospital to inquire about a patient’s housing status; to connect the patient with available community resources and supportive services; and to identify a post discharge destination for the patient. Requires a hospital to document specified information before discharging a homeless patient, including that the patient has been offered a meal and weather-appropriate clothing. Requires, commencing on July 1, 2019, a hospital to develop a written plan for coordinating services and referrals for homeless patients with the county behavioral health agency, healthcare and social service agencies in the region, healthcare providers, and nonprofit social service providers, as available, to assist with ensuring appropriate homeless patient discharge. SB 1397 (Hill) – Automated external defibrillators: requirement: modifications to existing buildings CMA Position: Support Applies the automated external defibrillator (AED) requirements to certain struc-

AB 1785 (Nazarian) – Medi-Cal eligibility: assets Excludes the principal and interest of a 529 savings plan, as defined, from consideration for purposes of any asset or resources test to determine eligibility for certain Medi-Cal benefits, as specified. Excludes qualified distributions from a 529 savings account from consideration for purposes of any income test to determine eligibility for certain Medi-Cal benefits. AB 2861 (Salas) – Medi-Cal: telehealth: alcohol and drug use treatment CMA Position: Support Requires, to the extent federal financial participation is available and any necessary federal approvals have been obtained, that a Drug Medi-Cal certified provider receive reimbursement for individual counseling services provided through telehealth by a licensed practitioner of the healing arts or a registered or certified alcohol or other drug counselor, when medically necessary and in accordance with the Medicaid state plan. SB 849 (Committee on Budget and Fiscal Review) – Medi-Cal Establishes, until Jan. 1, 2026, the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program, to be developed by the State Department of Healthcare Services to provide loan assistance payments to qualifying, recent graduate physicians and dentists that serve beneficiaries of Medi-Cal and other specified healthcare programs as specified. Allows the department to authorize a dental integration pilot program in San Mateo County as a component of the Medi-Cal 2020 demonstration project. SB 1287 (Hernandez) – Medi-Cal: medically necessary services Revises the Medi-Cal definition of “medically necessary” for purposes of an individual under 21 years of age to incorporate federal standards related to Early and Periodic Screening Diagnostic, and Treatment (EPSDT) services and requires the

SB 1423 (Hernandez) – Medi-Cal: oral interpretation services Modifies the minimum qualifications that an interpreter is required to possess to provide oral interpretation services to limited English-proficient (LEP) Medi-Cal beneficiaries enrolled in either a managed care plan or a mental health plan. MEDICAL CANNABIS AB 710 (Wood) – Cannabidiol Provides that, if specified changes in federal law regarding the controlled substance cannabidiol occurs, a physician, pharmacist, or other authorized healing arts licensee who prescribes, furnishes, or dispenses a product composed of cannabidiol, in accordance with federal law, is deemed to be in compliance with state law governing those acts. Excludes from the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA), any medicinal product composed of cannabidiol approved by the federal Food and Drugs Administration and either classified as a Schedule II-V controlled substance or exempted by MAUCRSA. AB 1996 (Lackey) – The California Cannabis Research Program Conforms the name of the Cannabis Research Program as the California Marijuana Research Program hosted by the Center for Medicinal Cannabis Research, throughout the code. Authorizes the program to cultivate cannabis for its use in research, as specified and expands the program to in include the study of naturally occurring constituents of cannabis and synthetic compounds that have effects similar to naturally occurring cannabinoids. Authorizes controlled clinical trials on testing methods for detecting harmful contaminants in cannabis, including mold and bacteria. MEDICAL RECORDS AB 2088 (Santiago) – Patient records: addenda Requires a healthcare provider to allow SAN DIEGO PHYSICIAN.ORG



a patient, regardless of their age, who inspects their patient records to provide to the healthcare provider a written addendum with respect to any item or statement in their records that the patient believes to be incomplete or incorrect. MENTAL HEALTH AB 1968 (Low) – Mental health: firearms CMA Position: Neutral Prohibits a person who has been taken into custody, assessed, and admitted to a designated facility because he or she is a danger to himself, herself, or others, as a result of a mental health disorder and who was previously taken into custody, assessed, and admitted one or more times within a period of one year preceding the most recent admittance from owning a firearm for the remainder of his or her life, subject to existing notice and hearing procedures. AB 2099 (Gloria) – Mental health: detention and evaluation CMA Position: Support Requires that a facility accepting a person taken into custody and placed in a designated facility for up to 72 hours for evalu-

ation and treatment pursuant to existing law, treat a copy of the application stating the circumstances surrounding the event the same as the original. AB 2193 (Maienschein) – Maternal mental health CMA Position: Neutral Requires, by July 1, 2019, healthcare service plans and health insurers to develop a maternal mental health program, as specified. Requires a licensed healthcare practitioner who provides prenatal or postpartum care for a patient to offer to screen or to appropriately screen a mother for maternal mental health conditions, subject to specified exceptions. AB 2315 (Quirk-Silva) – Pupil health: mental and behavioral health services: telehealth technology: guidelines CMA Position: Support if Amended Requires the State Department of Education, in consultation with the State Department of Healthcare Services and stakeholders, to, on or before July 1, 2020, develop and post guidelines, as specified, for the use of telehealth technology in public schools, to provide mental health and behavioral health services to pupils on school campuses.

AB 2325 (Irwin) – County mental health services: veterans CMA Position: Support Prevents a county from denying an eligible veteran county mental or behavioral health services while the veteran is waiting for a determination of eligibility for, and availability of, mental or behavioral health services provided by the United States Department of Veterans Affairs. Makes specific findings and declarations about the county’s duty to provide mental and behavioral health services to veterans. AB 2639 (Berman) – Pupil suicide prevention policies: reviews: updates CMA Position: Support Requires the governing board or body of a local educational agency that serves pupils in grades 7 to 12 to review, at minimum every 5th year, its policy on pupil suicide prevention and, if necessary, update its policy. AB 3032 (Frazier) – Maternal mental health conditions Requires a general acute care hospital or special hospital that has a perinatal unit to develop and implement, a program as specified, relating to maternal mental health conditions including, but not limited to, postpartum depression. SB 1004 (Wiener) – Mental Health Services Act: prevention and early intervention CMA Position: Support Requires the Mental Health Services Oversight and Accountability Commission to establish priorities for the use of prevention and early intervention funds and to develop a statewide strategy for monitoring implementation of prevention and early intervention services, as specified. Requires the commission to establish a strategy for technical assistance, support, and evaluation to support the successful implementation of the objectives, metrics, data collection, and reporting strategy. Amends the Mental Health Services Act by requiring a portion of funds in the county plan relating to prevention and early intervention focus on the priorities established by the commission. Permits a county to include other priorities, as determined through a stakeholder process.




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SB 1113 (Monning) – Mental health in the workplace: voluntary standards CMA Position: Support Authorizes the Mental Health Services Oversight and Accountability Commission, in consultation with the Labor and Workforce Development Agency, to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and to provide guidance to California’s employer community to put in place strategies and programs, to support the mental health and wellness of employees. PROFESSIONAL LICENSING AND DISCIPLINE AB 505 (Caballero) – Medical Board of California: adjudication: expert testimony CMA Position: Sponsor Authorizes the administrative law judge to extend the time for the exchange of specified expert witness testimony information with counsel for the other party to be completed, upon a motion based on a showing of good cause, for a period not to exceed 100 calendar days from the current requirement that the exchange of the information to be completed 30 calendar days prior to the commencement date of the hearing or as specified.

As a U.S. Air Force flight surgeon, blasting off in a jet is just part of the job. When you use your talents to care for the heroes who fly for our country, it’s more than an honor. As a U.S. Air Force flight surgeon, blasting off in a jet is just part of the job. When AIRFORCE.COM It’s a thrill. you use your talents to care for the heroes who fly for our country, it’s more than an honor.

AIRFORCE.COM It’s a thrill. As a U.S. Air Force flight surgeon, blasting off in a jet is just part of the job. When you use your talents to care for the heroes who fly for our country, it’s more than an honor.


It’s a thrill.

SB 1448 (Hill) – Healing arts licensees: probation status: disclosure CMA Position: Oppose Requires, on or after July 2, 2019, the licensing boards for podiatrists, naturopathic doctors, chiropractors, acupuncturists, physicians and surgeons, and osteopaths to provide, before the patient’s first visit, a specified disclosure to a patient or the patient’s representative if the licensee is on probation pursuant to a probationary order made on and after July 1, 2019. Also requires the licensing boards to post specified information related to licensees on probation on their website. These are just a sampling of the new laws impacting healthcare in 2019 and beyond. For a comprehensive list, see “Significant New California Laws of Interest to Physicians for 2019,” at cmadocs.org/new-laws-2019.

TSgt Michael W. Williams Jr. ( 707) 280-5178 michael.williams.94@us.af.mil



CLASSIFIEDS PHYSICIAN OPPORTUNITIES FAMILY MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. We currently have full-time openings in our Ramona and Valley Center locations (solo practices). Current CA and DEA licenses required. Must be BC/BE. Conduct medical diagnosis and treatment of patients in an outpatient setting. Bilingual in English/Spanish helpful. We offer a competitive compensation and benefit package including malpractice coverage and shareholder opportunity. Check out a full list of our benefits under Careers at www.graybill.org. Send CVs to ssnodgrass@ graybill.org, apply online, or fax (760)738-7101. FAMILY PRACTICE DOCTOR: Family Practice doctor for part- time position. Competitive compensation. Well established clientele, great staff, comfortable environment. Looking for a semi-retired physician to work one day a week and one month a year for vacation coverage. Must have excellent professional and interpersonal skills. Email to gboonemd@aol.com FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Our company is looking for a board certified primary care physician. Time will be split between our La Mesa and National City locations. Hours are 8-5 Monday – Friday no night calls or weekend. Please email your CV to lara. encompass@gmail.com. (Posted 11/19/2018) CARDIOLOGIST POSITION AVAILABLE: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County. Practice opportunities from Mon.-Friday. Hours are from 8 to 5 p.m. There is no night calls, or holidays work days. The contracted cardiologist would decide from the days available which days to work. Please fax resume to 760.510.1811 or via e-mail at evelynochoa2013@yahoo.com. FAMILY PRACTICE MD/DO: Family Practice MD/DO wanted for urgent care and family practice office in Carlsbad, CA. Flexible weekday and weekend shifts available for family practice physician at busy, well-established office. FAX or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net

OUTPATIENT PRIMARY CARE OPPORTUNITY San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared.Kowerski@SDIMA.com.

PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCareaffiliated practice, is looking for physicians for our San Diego County practice sites. SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients. Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement. For more info visit www.sharp.com/sharpcare/ or email interest and CV to glenn.chong@sharp.com. PART-TIME MEDICAL DOCTOR WANTED - IMPERIAL RADIOLOGY: Our company is an outpatient diagnostic radiology facility in search of a part-time Medical Doctor to help cover contrast administration. All Candidates must have an active California Medical License. Please contact via email info@carlsbadimaging.com with your resume if this position is of interest to you. (Posted 8/16/2018) FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Primary care physician wanted for established private practice in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 29 years in the UTC/La Jolla area of San Diego. 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 a healthy work/life balance. Our office is modern, clean, and well appointed. Our staff is supportive, cohesive, and friendly. This a real family practice. Board-certified, California licensed MD and DO physicians who are passionate about medicine and interested in this



opportunity should send their CV and cover letter addressed to Tricia at officemanager@ljvfmg.com. Let us grow your practice according to your unique specialty interests and style. Responsibilities include: Provide excellent care, become part of a cohesive team, light call, maintain accurate and detailed medical records using EHR, comply with all laws applicable to family practice/internal medicine, including HIPAA, recommend lifestyle changes as appropriate to improve quality of life, Full-time, Part-time. (Posted 8/16/2018)

SURGEONS NEEDED FOR EXPANDING NATIONWIDE SURGICAL PRACTICE FT/PT positions available. Competitive pay and flexible schedule with complete autonomy. Add revenue to your current practice. For more information, contact us: P: 1-877-878-3289 F: 1-877-817-3227 or email CV to: JOBS@ADVANTAGEWOUNDCARE.ORG www.AdvantageWoundCare.org

MEDICAL DIRECTOR, CALIFORNIA CHILDREN’S SERVICES: The County of San Diego invites qualified individuals to apply for the position of MEDICAL DIRECTOR, CALIFORNIA CHILDREN’S SERVICES (Job Classification: Public Health Medical Officer). Under the direction of the Deputy Public Health Officer or designee, this unclassified management position will be responsible for the medical oversight of County of San Diego, Health & Human Services Agency, California Children’s Services Division. Residency in Pediatrics or Family Medicine is highly desirable. Please view the detailed brochure for information regarding the position, duties, and benefits. | Job Number 18412807CCSU | CLICK HERE to apply. (Posted 7/27/18) PHYSICIAN NEEDED: Family Practice MD. San Ysidro Health is looking for an MD for our Family Practice center. The Family Practice MD manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, prenatal OB/GYN, pediatrics and internal medicine. Bilingual preferred but not required. Medical school graduate, CPR, CA MD and DEA License, board certified or eligible in primary care specialty. For more info on San Ysidro Health, visit: http://www.syhealth.org/ If interested, please email CV to Meagan.underwood@syhealth.org. DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at (858) 761-7362 or email jmaas12@ hotmail.com for more information. OUTPATIENT PRIMARY CARE OPPORTUNITY: San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared. Kowerski@SDIMA.com. PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE OPPORTUNITY: Internal Medicine practice in North San Diego County, Tri-City community, established for over forty years, available for full or part-time physician. This practice has an established EMR system, exceptional office staff and shares overhead with five other Internists. Inpatient activity available at your option. Please email: jalafata@aol.com, or call North County Internal Medicine at 760-726-2180. RHEUMATOLOGY SOUTH SAN DIEGO MEDICAL PRACTICE FOR SALE: Located in Chula Vista and has been in existence for >30 years. Established patient base and excellent insurance contracts including HMOs, PPOs, and Medicare with rates that have been negotiated over years. Gross collections >$450,000 with low overhead. Asking for $10,000 for medical records to be transferred and equipment. Would also ask that lease be taken until June 4, 2020 or you can negotiate longer with the manager of the building. Long

term trained staff and Electronic Medical Record, which could be kept in place if needed. For immediate consideration, forward your details including your contact phone or email to: info@sdrheumatology.com. Run your own practice with potential earnings above and beyond an employed position without the bureaucracy and make your own schedule! (Posted 11/15/2018) 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. Experienced staff plans to stay, and protects current physician/owner at 30 hours/week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: (208) 762-3451. doug.miller@goexio.com. 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 PRACTICE AVAILABLE IN EL CAJON: Mature board certified Family physicians grossing $ 1 million per year are selling this practice in El Cajon, California. This is a busy practice , on the Allscripts EHR in a busy neighborhood and contracted with local IPAs. I will lease the 1500 sqft office condo to you as well. Send an inquiry to Dennis O Dominguez dd489583@gmail.com or send text to 619 2464548 and I will call you. 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. 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. OFFICE SPACE / REAL ESTATE AVAILABLE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals. Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org ENCINITAS OFFICE SPACE TO SHARE/SUBLEASE: Longstanding (38 years) allergist in Encinitas has a 3000 square foot office space available to share/sublease. Six exam rooms and a permanent private office/consultation room. Office is available Tuesday morning and all day Wednesdays and Fridays. Office located on El Camino Real in Encinitas.Please contact wwpleskow@sbcglobal.net or call 760-436-3988. MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located close to Moonlight Beach in Encinitas. First floor with 570 square feet and peek ocean views. Available February 1st. Physician/Dentist parking spot comes with lease and lease would be until December 31, 2020. Sinks in 2 exam rooms, office space for physician/dentist and laboratory storage area in addition to lobby/reception area. Asking: $2,000/month. Terms are negotiable. This will rent fast so hurry! Please contact: dana@sdrheumatology.com | (858) 603-2068.

SHARED OFFICE SPACE: Office Space, beautifully decordated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-6063046. OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4 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 ½ mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website:www.eisenhauerobgyn.com. Looking for compatible practice types. SHARED OFFICE SPACE AVAILABLE:: Shared Office Space: Very attractive 1 or 2 exam rooms available, medical spa office ‘Exquisite Md Spa’ in Bankers Hill near Balboa Park. Available 5 days per week. Reasonable rates. Call Claudia at 619-5014758. (Posted 8/16/2018)

Dentist, Physician, Surgeon. Any dental or medical related occupation welcom. Located in medical/dental building. Come join these great practices. Classy second floor suite with elevator. Perfect for entrepeneur. Partially equipped for dental or surgical practice. Terrific Opportunity. 612 square fee. $4.90/sq ft per month. Triple net lease. Contact Kevin Gott: dynamold@aol.com MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in an office space with other medical offices located in downtown Chula Vista close to Scripps Chula Vista hospital. First floor with ~1000 square feet. Available January 1st. 2 physician/dentist parking spots comes with lease and lease would be until June 4, 2020 or longer should you negotiate with the building manager. Sinks in 3 exam rooms, office space for physician/ dentist, bathroom, and laboratory area or additional exam room in addition to lobby/reception area. There is a long term subleasor on Fridays, so rent could be lower if you are willing to keep the subleasor, but asking: $2,000/month. Terms are negotiable. Please contact: dana@sdrheumatology.com | (858) 603-2068. OFFICE SPACE / REAL ESTATE WANTED

OFFICE SPACE AVAILABLE: La Jolla (Near UTC) office for sublease or to share: Scripps Memorial medical office building, 9834 Genesee Ave-great location by the front of the main entrance of the hospital between 1-5 and 1-805. 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) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 344-9024. (Posted 8/10/2018)

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: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on useage. Contact Jo Turner (619) 733-4068 or jo@siosd.com.

HIGH TECH FACIAL IMAGING FOR SALE: New Reveal® Imager for sale. Ideal for MedSpa or cosmetic practice. The Reveal® Imager clearly demonstrates sun damage, brown spots, red areas and more. Create a personalized printed treatment record for the patient. Contact info@ restoresdplasticsurgery.com or 858-224-2281 if interested.

OFFICE SPACE AVAILABLE IN MISSION VALLEY: Unique space for lease in Mission Valley. 1300 sq. ft office space in medical/surgical office building, single story, ample free parking. Is currently in use as physical therapy suite with reception area, small waiting room, private treatment room, separate office, bathroom in suite and hook ups for washer/ dryer. Easy access to all freeways. Available approximately August 1, 2018. Please contact Joan McComb, Executive Director, CA Orthopaedic Institute. (619) 291-8930 or cell (619) 840-0624. 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) 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. Extensive referral base, EMR/”paper-light” office, experienced MA/surgery scheduler/referral coordinator. Please call Terry Sanchez, practice administrator, at (858) 278-8300 or email tsanchez@synergysmg.com. (posted 11/19/2018) SCRIPPS ENCINITAS CAMPUS OFFICE: 320 Santa Fe Drive, Suite LL4 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 ½ mile from Swami’s Beach. Contact Kristi or Myra (760) 753-8413. View Space on Website: www.eisenhauerobgyn.com. Looking for compatible practice types. (Posted 4/4/2018) MEDICAL OR DENTAL 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. Additional security gate and mailbox. 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! Please contact: hillcrestofficerental@gmail.com | (858) 775-5075 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,


MEDICAL EQUIPMENT AVAILABLE FOR DONATION: Carlsbad Imaging has medical equipment available for donation. Afinion HbA1c-Used, Siemens clinitek status+-Used, FastPack-Used. Please contact info@carlsbadimaging.com if interested. (Posted 8/16/2018) NON-PHYSICIAN POSITIONS AVAILABLE SEEKING CARDIOLOGY PHYSICIAN ASSISTANT / NURSE PRACTITIONERS: Graybill Medical Group is one of North San Diego County’s largest independent multispecialty groups with over 80+ physicians and advanced practitioners. We are looking for a Cardiology PA/NP to provide direct, in office patient care M-F, 8am-5pm in our Escondido office. Requirements will include examination and treatment of patients and completion of all necessary paperwork. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Prior experience in Cardiology highly preferred. Bilingual in English/Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www. graybill.org, or fax (760)738-7101. SEEKING PART-TIME FM AND UROLOGY PHYSICIAN ASSISTANT / NURSE PRACTITIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork. We currently have a FM part-time opening in our Ramona office and a part-time Urology opening in Escondido. The Urology position is 2 days per week; preferably Mondays & Thursdays 8 am - 5 pm. Prior Urology experience highly preferred. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently. Bilingual in English/ Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www.graybill.org, or fax (760)738-7101. POSITION AVAILABLE: This patient centered medical practice requires a skilled and professional individual with exceptional empathy, integrity, maturity and passion for patient care. You must have 5+ years of experience in the field as either an MA or LVN and be comfortable with front and back office work, be able to perform blood draws and injections, understand how to verify insurance, obtain prior authorizations, collect copays and balances. You are driven, diligent, organized, efficient, a clear communicator, honest and constantly wanting to improve. Please submit a detailed resume and 3 references from your last three positions to 92024medical@gmail.com. (Posted 11/19/18) PART-TIME, REMOTE MEDICAL CODING AND DATA ENTRY POSITION: Part-time, remote medical coding and data entry position available. All work is done remotely by logging into our EMR eclinical works. ICD-10 medical coding experience and familiarity with risk-adjusted diagnosis codes required. Experience with eclinical works a plus. Potential to increase work to full-time possible. Please submit a letter of interest and your resume to docpaul@sdmedgroup.com. (Posted 11/19/18) NON-MEDICAL PROVIDER WANTED: San Diego Medical Group is a well-established and busy Internal Medicine

practice. We seek an experienced NP to work independently as a primary care provider for our current NP’s patient panel who plans to leave the practice after 10 years for family needs. Work hours are Monday through Friday 7:30/8:30 AM to 4:30/5:30 PM. There is no call. After hours remote preparation for clinics and maintaining desktop duties (labs, imaging reports, consult notes, patient emessages, etc.) is required. Applicants must have prior experience in this capacity and be able to assume responsibility for patient care immediately. Patients range from healthy adults to medically complex seniors. You must have experience providing medical care in Internal Medicine. In addition you need a DEA number, have familiarity prescribing Schedule II-V medications, be able to provide office gynecology, provide Tehehealth visits and perform basic dermatology procedures. Other duties may apply as deemed necessary. Spanish and/or experience with eClinicalWorks is a plus. Benefits include vesting into a 401k profit sharing retirement plan. Our office is located directly across the street from Scripps Mercy Hospital in the prestigious Mercy Building and we are staffed by two Internists and 8 additional staff. Salary $95,000-$120,000 annually. Contact docpaul@sdmedgroup.com. (Posted 11/19/18) PUBLIC HEALTH NURSE. COUNTY OF SAN DIEGO. FLUENCY IN THE SPANISH LANGUAGE IS REQUIRED: The County of San Diego invites qualified individuals to apply for the position of Public Health Nurse. Salary is $70,470.40 - $86,632.00 Annually. Public Health Nurse is the journey level class in the Public Health Nurse series. Under general supervision, a Public Health Nurse performs the full range of public health nursing duties in homes, public health centers, and other community settings. (Posted 10/30/18) POSITION FOR A PHYSICIAN ASSISTANT (PA-C) OR NURSE PRACTITIONER FOR ENDOCRINOLOGY PRACTICE IN CHULA VISTA: This is a very rewarding practice managing patients from teenagers to nonagenarians, from a spectrum of ethnic groups and socioeconomic levels. It is also rewarding due to the opportunity for consultations as well as fostering a relationship with many of the patients who continue with the practice for years. Salary is competitive and commensurate with experience with benefits including Health (Kaiser), dental, vision, 6 days PTO per year, major holidays and the opportunity to participate in a Simple IRA retirement plan. Please send resume and references to g@ sd-endo.com or call 619-606-3046 (Posted 10/23/2018) PLASTIC SURGERY AND FRONT DESK COORDINATOR: The ideal position for someone with a background in plastic surgery, dermatology, ophthalmology, or medical spa. Will consider those with a background in a high-end hospitality setting. The Coordinator is primarily responsible for the day-to-day creation of an office environment that fosters highly personalized customer service. Responsible for the front/back office daily operations including patient care, scheduling, and optimizing surgical closure rates and sale of skin care lines. Contact info@restoresdplasticsurgery.com with resume. Salary commensurate with experience. (Posted 9/4/2018) 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 CLASSICS OF MEDICINE LIBRARY AVAILABLE: The Friends of the San Diego Public Library are in search of a good home for a Classics of Medicine Library [Gryphon Edition]. These collectible volumes are leather bound, facsimile reprints of classics from Hippocrates and Galen, through Virchow, Lister, and Jenner. The books are BEAUTIFUL! This particular collection contains 60 titles in total, all in like-new condition. A full list is available upon request. We are asking $550 and would prefer to sell them as a complete set. 100% of proceeds from our book sales support the programs and collections of the San Diego Public Library. Please call Lisa Heinz at (619) 572-1274 or email lis_heinz@hotmail.com for more information. 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 A VALUABLE EDUCATIONAL RESOURCE: Extensive Medical Articles File for sale. Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes. Will accept offers for 30 days after the publication of this newsletter. View in person at a North County location by appointment. (858) 451-6517.



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

Avoiding the Trap of Comparison By Helane Fronek, MD, FACP, FACPh

YOGA IS CONSIDERED a gentle form of exercise — so I was frustrated when my back muscles cramped and I found myself in bed, unable to stand or walk after a class. A wise bodyworker asked me to describe what I had done during the class. “Well, I saw someone move deeper into a pose, so I thought I could go deeper too,” I replied. Laughing, she said, “That’s not yoga you’re doing. It’s competitive stretching!” I had to admit she was right. How much of our behavior is driven by comparisons to others? How often do we feel compelled to purchase a new car, accessory, or electronic device after someone else buys one? How many of us suffer from



FOMO — the fear of missing out — which prompts us to take on a new activity or role we don’t have time for, say yes to an event we don’t want to go to, or volunteer for something we have no interest in in order to “keep up” or not miss out? How much time is consumed by self-doubt as we worry we’re not “as good as” another person at work or in our life? My parents’ typical response when I reported a test grade was, “What did everyone else get?” It instilled the belief that it was important to come out on top of any comparison. The days I spent in bed gave me ample time to reflect on this impulse to compare. Comparisons are setups. While striving

to do as well as or better than others can motivate us to study, practice, or improve, it tricks us into reaching for the wrong goal. Yes, winning is usually more fun than losing. But winning alone, without also doing our best, enjoying the fun, or achieving some growth through the experience, is often hollow and unfulfilling. And if our sole trophy is the sense of being better than someone else, the joy we might feel is easily overshadowed by the anxiety that we may not come out on top next time. The pressure to continue to triumph may even undermine our further attempts to succeed. Freeing ourselves from the trap of comparison is simple — although not as easy as we might hope. The hard part is challenging the belief that our worth or importance is tied to being equal to or better than someone else. The first step in changing this pattern is to recognize when we’re comparing. This gives us the opportunity to ask some important questions: What feels joyful, interesting, or meaningful in doing this? In what ways will I learn and grow through this experience or effort?” We can then refocus our attention on this. We can set a new personal goal and agree to allow ourselves to feel successful if we meet that. In this way, our efforts are never eclipsed by another’s and we remain focused on the right goals: following our passion, learning and growing, and experiencing the adventure and exhilaration of living an authentic life. 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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