December 2018

DECEMBER 2018 OFFICIAL PUBLICATION OF SDCMS

CMA OUTLINES BOLD HEALTHCARE AGENDA Improving affordability, access, and quality

HIGH RATE OF RETURN LEGISLATIVE WRAP-UP

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DECEMBER

CONTENTS

VOLUME 105, NUMBER 12

On the cover: Lase Ajayi, MD, member of SDCMS Executive Committee, chair of CMA Council on Medical Service, which produced all the reports considered during this House of Delegates

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

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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

features

6 CMA Outlines Bold Healthcare Agenda: 2018 House of Delegates Recap

BY LEE T. SNOOK JR., MD, AND TANYA W. SPIRTOS, MD

11 High Rate of Return: CMA’s 2017–18 Legislative Wrap-Up , Part 1

BY JANUS L. NORMAN

departments 4

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22 Seeing Is Believing

BY ADAMA DYONIZIAK

24 Growing Your Practice With Millennials and Real Estate Decisions

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Got Passion?

DECEMBER 2018

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

BY CHRIS ROSS

Briefly Noted: Public Payer • Practice Management • Advocacy • Member Engagement

San Diego Celebrates 2018 Top Docs

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

Physician Classifieds

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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.]

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/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// PUBLIC PAYER

Last Day to Change Your Medicare Participation Status for 2019 is Dec. 31

BY C M A S TA F F

ONCE AGAIN, IT’S TIME for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until Dec. 31, 2018, to make changes for the 2019 participation year.

As always, physicians have three choices regarding Medicare: Be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely. Details on each of the three participations options are as follows: • A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients.

• A non-participating provider can make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims. Nonparticipating physician fees are 95% of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25% more than the amounts allowed in the participating physician fee schedule (which equates to 15% of the non-participating fees).

• Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare

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beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. As a result of the Medicare Access and CHIP Reauthorization Action of 2015 (MACRA), validated opt-out affidavits signed on or after June 16, 2015, will automatically renew two years after the effective date.

Physicians who want to change their participation status for 2019 must send a letter to Noridian, California’s Medicare contractor, postmarked by Dec. 31, 2018.

The California Medical Association (CMA) also has information on physicians’ Medicare participation options in CMA’s health law library document #7209, “Medicare Participation (and Nonparticipation) Options.”

Health law library documents are free to members at www. cmadocs.org/health-law-library.

Nonmembers can purchase documents for $2 per page.

Physicians can also visit CMA’s MACRA resource center at www. cmadocs.org/macra to better understand the payment reforms, how they may impact physician practices, and access resources to help with the transition. The center is a one-stop shop with tools, checklists, and information from CMA, the Centers for Medicare and Medicaid Services, the American Medical Association, and national specialty society clinical data registries.

PRACTICE MANAGEMENT

CMA Publishes Prop 56 Payment Monitoring Worksheet THE CALIFORNIA HEALTH CARE,

Research and Prevention Tobacco Tax Act of 2016 (Prop. 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and MediCal managed care when providing Medi-Cal services under certain CPT codes. A total of $325 million was allocated for physician payments in the budget for 2017–18, with $488 million proposed for 2018–19.

To help physician practices monitor their Prop 56 supplemental payments, the California Medical Association (CMA) has published a Prop. 56 Payment Monitoring Worksheet. The worksheet will automatically calculate the supplemental payment amount by CPT code so you can ensure that you are receiving your share of the supplemental tobacco tax money.

The worksheet is available free to CMA members at cmadocs.org/ prop56.

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

CMA Launches New Mobile App THE CALIFORNIA MEDICAL ASSOCIATION (CMA) is thrilled to announce that our new, members-only mobile app is now available. Free and available for Android and iOS, our CMAdocs app will keep you up to date and informed on issues critical to the practice of medicine in California.

Check out a few of the app features: My CMA: Access your membership dashboard for your custom news and event feeds, discussion groups, calls to action, and more.

Take Action: When we need to mobilize our physician grassroots advocates, you will be instantly notified so you can take action and help protect the practice of medicine. Other action alerts could include membership renewal notices, fast and easy webinar registration, and notification of new member benefits.

Events: Attending a CMA event? CMA’s mobile app will connect you with event schedules, facility maps, speaker bios, and more.

To download the app, simply search “CMAdocs” in the Apple App Store or the Google Play Store. To log in, use your CMA/county website credentials. In most cases, your username will be your medical license number. If you do not know your login credentials, use the username and password reset to retrieve them.

Once you’ve logged in, you can turn on “Touch ID” (click on the menu in the top right corner and look for the fingerprint icon) and you will be able to log in with the touch of a finger on devices that support biometric login.

Have ideas or want to provide feedback? Email communications@cmadocs.org

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SDCMS Hosts Successful “Physician Social” at Rock Bottom Brewery Dozens of physicians were able to spend time with their colleagues and network during the October 25th “Physician Social” hosted by the San Diego County Medical Society at Rock Bottom Brewery in La Jolla. The event was considered a rousing success by attendees and the next one is scheduled for Feb. 7, 2019. Thank you to our event sponsor, Cooperative of American Physicians.

Endorsed by

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2018 H O U S E O F DE L E G AT E S

CMA Outlines Bold Healthcare Agenda Improving Patient Affordability, Access, and Quality

BY LEE T. SNOOK JR., MD, A ND TA N YA W. SPIRTOS, MD

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IN OCTOBER, the California Medical Association (CMA) convened its 147th annual House of Delegates (HOD) meeting in Sacramento. More than 500 California physicians convened to debate on the most critical issues affecting members, the association, and the practice of medicine.

The major focus of HOD was the creation of an initial framework for a bold agenda to increase healthcare affordability, improve healthcare delivery, create efficiencies throughout the healthcare system, and improve health outcomes, which includes addressing social determinants of health and expanding telehealth services.

Virtually all of us have directly witnessed the impacts on our patients, but the following statistics bear repeating because they reinforce the critical nature of CMA’s charge: • Prescription drug prices have increased 25% since 2012 (Health Care Cost Institute).

• Health insurance deductibles have more than doubled since 2008, and half of all workers now have a deductible of at least $1,000 for an individual, up from 22% in 2009 (Kaiser Family Foundation).

• Employer-sponsored insurance premiums have risen from $6,000 in

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4 1999 to more than $18,000 in 2016, and out-of-pocket costs have increased by more than 53% between 2006 and 2016 (Economic Policy Institute).

• The average American spent $10,345 on healthcare in 2016, yet roughly 41% of Americans say they can’t pay a $400 emergency expense without borrowing or selling something (Centers for Medicare and Medicaid Services, Federal Reserve).

• Thirty-three percent of Americans with health insurance said they or a family member had problems affording care in the last year (Kaiser Family Foundation survey).

• Twenty-seven percent of our time is spent with patients, while nearly half is spent on electronic health records or other desk work. Spending three hours a day on administrative tasks equals a loss of 2,200 patient visits per physician per year (Annals of Internal Medicine).

CMA President David H. Aizuss, MD, put it best: “Healthcare costs continue to grow, with patients paying more and getting less — except for more runarounds, fine print, and larger medical bills. This is our current reality and the battle we must fight, because it’s hurting our patients’ ability to access

needed care, treatment, and medications.

No family should have to forgo medical care to pay household bills or take on debt, yet that is exactly the situation more Californians are facing. If healthcare isn’t affordable, then it isn’t accessible, and the California healthcare system must do better for our patients.”

With physicians at the center of healthcare delivery, CMA has long advocated on behalf of our patients to ensure they are receiving affordable, timely, and quality care, and we doubled down on that commitment at HOD. After hearing expert testimony, CMA debated and identified four critical issues that California must address to make

CAPTIONS 1. Orange County Medical Association Past President Sudeep Kukreja, MD, with SDCMS Past President Al Ray, MD. 2. Former SDCMS President and new CALPAC Chair Susan Kaweski, MD, working with Delegation Chair Steve Hayden, MD, to ensure all delegation members donate to CMA’s Political Action Committee. San Diego again had 100% participation and the highest total donations in the House. 3. Incoming CMA President David Aizuss, MD, of Los Angeles with CMA CEO Dustin Corcoran at the CALPAC major donor reception.

4. Marin County physician Peter Bretan, MD, accepting election as President-elect of CMA. 5. SDCMS Executive Committee member Lase Ajayi, MD, presiding as chair of the Council on Medical Service, responsible for all the reports considered during this House. 6. Former SDCMS President Bob Wailes, MD, looks down from the dais as chair of CMA’s Board of Trustees.

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2018 H O U S E O F DE L E G AT E S

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healthcare affordable while improving quality and access: • Reform healthcare delivery and utilization by making payment and delivery more efficient, as well as expand telehealth.

• Expand patient choice and affordability by increasing competition throughout healthcare with market-based solutions.

• Maximize physicians’ time spent with patients by reducing administrative burdens and eliminating duplicative tasks that add unnecessary costs without improving health outcomes. CMA also remains committed to ensuring that all modes of medical practices are financially vibrant.

• Ensure patients have access to necessary treatment and medications by addressing pharmaceutical costs.

In the coming months, CMA will develop targeted, pragmatic, and workable solutions, and continue to work with our members, healthcare stakeholders, and policymakers to ensure patients can access quality care in an affordable and timely manner.

As a physician-led organization, CMA’s

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collective strength is derived from the dedication and passion of its membership.

We thank the HOD delegates, and we thank you for your continued commitment to patients and the profession.

On the following pages you will find more highlights from this year’s House of Delegates.

Los Angeles ophthalmologist installed as 151st president of CMA CMA installed Los Angeles ophthalmologist David H. Aizuss, MD, as its 151st president during the organization’s annual House of Delegates meeting in Sacramento.

In his address to the delegates, Dr. Aizuss said that physician satisfaction and practice sustainability would be among his top priorities in the upcoming year.

“The presence of third parties in clinical decision-making is corrosive to our relationship with patients,” said Dr. Aizuss.

“We must protect both our patients and professional prerogatives, independence, and authority.”

Dr. Aizuss also noted that heavy administrative demands and emerging payment

CAPTIONS 7. Past presidents of the California Medical Association, at their annual luncheon. 8. CMA staffmembers Jennifer Williams and Rebecca Paplanus, among the most important resources for members. 9. SDCMS CEO Paul Hegyi with Orange County & CMA Past President Brennan Cassidy, MD. 10. The always compelling Janus Norman, CMA Senior Vice President and head lobbyist, updating the delegates on the past year in the legislature. 11. Jane Lyons, MD, with Robert Hertzka, MD, at the CALPAC reception. 12. SDCMS members Drs. Mihir Parikh, Kosala Samarasinghe, Alex Quick, and Venu Prabaker listening intently during House. 13. State Senator Richard Pan, MD, regaling a group of medical students and CMA CEO Dustin Corcoran with stories of his time in the legislature.

14. SDCMS delegates Will Tseng, MD, and Wayne Sun, MD. 15. SDCMS delegates Kyle Edmonds, MD and Steven Chen, MD, with Preeti Mehta, MD, looking on from behind. 16. State Senator Richard Pan, MD, addressing the house. 17. The 2018 candidates for President-elect, Drs. Ken Blumenfeld, James Strebig, and Peter Bretan. 18. Vice Speaker and Speaker of the House, Drs. Tanya Spirtos and Lee Snook. 19. Lase Ajayi, MD, and Kyle Edmonds, MD, listening intently to one of the educational sessions.

is a former president of LACMA and the California Academy of Eye Physicians and Surgeons.

Through the David H. Aizuss, MD, Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He is a medical staff member at Tarzana Hospital and West Hills Hospital in Los Angeles County, and serves as an assistant clinical professor of ophthalmology at the David Geffen School of Medicine at UCLA. He received his medical degree from Northwestern University Medical School and completed his residency and fellowship in ophthalmology at the Jules Stein Eye Institute in Los Angeles.

Urologist and transplant surgeon named CMA president-elect Urologist and kidney transplant surgeon Peter N. Bretan Jr., MD, was elected by the CMA House of Delegates as the association’s new president-elect. He assumed office at the close of this year’s meeting

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2018 H O U S E O F DE L E G AT E S

The full 2018-2019 CMA Executive Committee includes:

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President David H. Aizuss, MD, Los Angeles

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President-Elect Peter N. Bretan Jr., MD, Watsonville Chair of the Board Robert E. Wailes, MD, Oceanside/ Encinitas Vice-Chair of the Board Shannon L. Udovic-Constant, MD, San Francisco Speaker of the House Lee T. Snook Jr., MD, Sacramento

CAPTIONS 20. Chair of the Board of Directors of the American Medical Association Jack Resneck Jr., MD, is a San Francisco dermatologist.

21. Los Angles President-elect and newly elected Santa Monica Community College Board Member Sion Roy, MD, in discussion with CMA Federal Lobbyist Elizabeth McNeil. 22.

CMA’s new President, David Aizuss, MD, with his wife, Felicia. 23. SDCMS Resident delegates Trisha Morshed, MD, and Obi Chidi, MD, en route to their next meeting.

systems have forced physicians to spend increasing amounts of time on computer work at the expense of patient care, leading to physician dissatisfaction and burnout.

“CMA recognizes the urgent need for additional programming to mitigate physician burnout. … Good care includes caring for us, the physicians,” Dr. Aizuss said.

Dr. Aizuss officially took over from Immediate Past President Theodore M. Mazer, M.D., at the end of HOD, and will serve a term of one year.

“Our CMA brand has strength, effectiveness, power, and influence,” Dr. Aizuss said. “My goal as your president is to be an effective spokesman and to communicate your concerns, desires, needs, and hopes for a professionally satisfying medical practice and effective patient care.”

Dr. Aizuss has been a CMA and Los Angeles County Medical Association (LACMA) member for 37 years. He has been a member of the CMA Board of Trustees since 2010 — serving as vicechair and chair of the board before being named president-elect at last year’s HOD. Dr. Aizuss has also represented the physicians of California as a delegate to the American Medical Association (AMA), and is currently serving on the AMA Council on Legislation. Dr. Aizuss

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Vice Speaker of the House Tanya W. Spirtos, MD, Redwood City Immediate Past President Theodore M. Mazer, MD, San Diego

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and will serve as on the CMA Executive Committee as president-elect for one year.

Dr. Bretan will be installed as president at the close of the 2019 House of Delegates.

He will be the first Filipino-American physician to serve as CMA president.

Dr. Bretan practices in Marin, Sonoma, and Santa Cruz counties. He has served as a CMA trustee and delegate, and is a threetime county medical society president. He is the current president of the California Urological Association and serves as an adjunct clinical professor at Touro University, where he has taught classes in healthcare policy for the past 15 years.

Dr. Bretan is also the founder and CEO of Life Plant International, a charitable organization that promotes disaster preparedness, organ donation and early disease screening worldwide. He has provided care around the world on medical missions.

“My greatest motivation is in service to give back to society for my good fortune. I grew up as a child farm laborer, and I know what it is to be without adequate healthcare,” Dr. Bretan says.

Dr. Bretan earned his B.S. in physiology from UC Berkeley and his medical degree from UC San Francisco, where he completed residencies in general surgery and urology, as well as a fellowship in radiology. He also completed a fellowship at

23 The Cleveland Clinic Foundation in transplantation and renovascular surgery.

To view photos of this year’s HOD, visit flickr.com/californiamedicalassociation.

Get Involved Do you want to help establish CMA policies on major issues that affect the practice of medicine? Physicians interested in influencing CMA’s advocacy agenda can serve in the House of Delegates or on one of CMA’s councils and committees. For more information, contact Paul Hegyi at the San Diego County Medical Society.

Save the Date: 2019 House of Delegates The 2019 House of Delegates will take place Oct. 26–27, 2019, in Anaheim, at the Disneyland Hotel.

Dr. Snook Jr. is CMA’s Speaker of the House. Dr. Spirtos is CMA’s Vice Speaker of the House.

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HIGH RATE OF RETURN CMA’s 2017–2018 Legislative Wrap-Up, Part 1

BY JA NUS L. NORM A N

IT HAS BEEN SAID THAT “diligence makes the difference between all-time greats and one-hit wonders.” For more than 160 years, the physician leadership of the California Medical Association (CMA) has practiced unmatched devotion to its members and the entirety of the physician community. CMA’s physician leaders care for their individual patients at all hours of the day or night and are stewards of the profession in their limited time off. This investment of sacrificed family and personal time has powered the state’s largest medical association forward. Innovations in the association’s governance structure have increased CMA’s ability to maintain its vaulted position within the Golden State’s political Game of Thrones.

Success in the legislative process is sometimes difficult to measure. Insiders often refer to published lists of powerful special-interest groups or individuals, articles listing interest groups that have spent the most money on lobbying and/ or campaign activities, or the number of mentions an association receives in news articles. If those are the measurements of success, CMA is at the top of the class: Staff are consistently included in the Capitol Weekly Top 100; CMA is routinely recognized by news outlets as one of the most effective lobbying organizations in the

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state; and rarely does an article regarding healthcare legislation not include a quote from the CMA president.

Prominence is significant; it aids in the creation of political capitol. But distinction itself is not the goal. Physician leaders want to ensure CMA improves the healthcare delivery system by obtaining state budgetary appropriations to increase patient access and protect against illconceived legislation that would directly threaten their ability to financially maintain a practice and provide the best care.

“The 2018–2019 state budget included more than $1 billion in new funding to support supplemental payments for physicians participating in the Medi-Cal program.”

RETURN ON INVESTMENT In 2016, CMA, the California Dental Association, the Service Employees International Union (SEIU), and their coalition partners beat the odds. Together, we convinced voters to increase the state’s tobacco tax by $2 in order to invest a

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majority of the revenue into increasing access to care. CMA contributed $1 million to the statewide Proposition 56 campaign.

Now that the tax is being collected and distributed, the physician community sees the impact.

The 2018–2019 State Budget included: • More than $1 billion in new funding to support supplemental payments for physicians participating in the MediCal program • An expansion of the number of CPT codes that are eligible for those supplemental payments • $190 million for medical student loan repayment • $40 million in new funds for graduate medical education, which will be administered by Physicians for a Healthy California (formerly known as the CMA Foundation) In the 2017–2018 legislative session, two detrimental proposals were introduced that would have upended the state’s healthcare delivery system. SB 562 (Lara, Los Angeles) would have required California to implement an extremely flawed single-

payer proposal. AB 3087 (Kalra, San Jose) would have empowered a politically appointed committee to price-fix physician services. In both instances, the healthcare community looked to CMA for leadership and expertise.

“The Legislature now looks to our House of Delegates for a solution to improve access and increase the affordability of healthcare in California.”

On a weekly basis, opposition coalitions met at CMA headquarters to execute a substantial grassroots program, earned media strategy, Capitol lobbying strategy, and a digital media campaign. The defeat of SB 562 and AB 3087 once again showcased CMA as an unapologetic leader in healthcare policy. As a result of defeating both bills, the Legislature now looks to our House of Delegates for a solution to improve access and increase the affordability of healthcare in California.

During the first quarter of the year, the CMA Board of Trustees adopted CMA’s sponsored bill package. The bills focused on:

//////////////////////////// • Improving state oversight and regulation of predatory behavior by health plans (AB 2674 by Assemblymember Aguiar-Curry and AB 2427 by Assemblymember Wood) • Improving access to medicationassisted treatments for individuals fighting opioid addiction (AB 2384 by Assemblymember Arambula) • Improving the medical board disciplinary process (AB 505 by Assemblymember Caballero) • Increasing transparency and oversight in the pharmaceutical supply chain (AB 315 by Assemblymember Wood) • Protecting medical independence for physicians working in county sheriff’s departments (SB 1303 by Senator Pan) “All sponsored legislation made it through both houses of the Legislature and were sent to the governor for consideration.”

I am pleased to report that all sponsored legislation made it through both houses of the Legislature and were sent to the governor for consideration. While the fate of each bill will vary, it is important to note this year the Legislature agreed with each of the policy principles of our sponsored legislation. A full description and status of each measure is provided on the following pages.

The call for leadership is once again before us. Guided by our grand history, we must continue to exercise our diligence, provide solutions, and construct the development of the next iteration of California’s healthcare delivery. Let’s do it again!

CMA-SPONSORED LEGISLATION AB 315 (WOOD) PHARMACY BENEFIT MANAGEMENT This bill requires pharmacy benefit managers (PBM) to register with the Department of Managed Health Care (DMHC), to exercise good faith and fair dealing, 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, if the customer pays the retail price, to submit the claim to the health plan or health insurer in the same manner as if the customer had purchased the prescription drug by paying the cost-sharing amount,

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

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HIGH RATE OF RETURN

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requires the payment to apply to the deductible and the maximum out-ofpocket limit in the same manner as if the enrollee had purchased the prescription drug by paying the cost-sharing amount.

The bill also requires DMHC to convene a task force on PBM reporting to determine what information related to pharmaceutical costs it should require to be reported by healthcare service plans or their contracted PBMs. The bill also establishes a pilot project in Riverside and Sonoma counties to assess the impact of health plan and PBM prohibitions that prohibit the dispensing of particular quantities of prescription drugs by network retail pharmacies.

Status: Signed by the Governor (Chapter 905, Statutes of 2018).

AB 505 (CABALLERO) MEDICAL BOARD OF CALIFORNIA: ADJUDICATION: EXPERT TESTIMONY Current law prohibits the use of expert testimony in matters brought by the Medical Board of California unless specified information is exchanged with counsel for the other party and requires the exchange of the information to be completed 30 calendar days prior to the commencement date of the hearing or as specified. This bill would authorize the administrative law judge to extend the time for the exchange of information, upon a motion based on a showing of good cause, for a period not to exceed 100 calendar days, and at least 30 days before the hearing date.

Status: Signed by the Governor (Chapter 469, Statutes of 2018).

AB 1976 (LIMÓN) EMPLOYMENT: LACTATION ACCOMMODATION This bill extends the lactation accommodation protections within the federal Affordable Care Act (ACA) to all working mothers in California. Before this bill, California law only required employers to provide a lactation space for nursing mothers outside of a toilet stall.

The ACA required employers with 50 or more employees to provide a nursing mother a lactation space outside of a

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bathroom. With certain exemptions, AB 1976 requires all employers to provide a nursing mother with a place to express milk outside of a bathroom; thereby ensuring that a mother employed by an employer with less than 50 employees has a sanitary space to breastfeed upon returning to work.

Status: Signed by the Governor (Chapter 940, Statutes of 2018).

AB 2384 (ARAMBULA) MEDICATIONASSISTED TREATMENT This bill would require a healthcare service plan that provides prescription drug benefits to cover, at a minimum, at least one of each of the specified medicationassisted treatment and overdose reversal prescription drugs approved by the United States Food and Drug Administration for opioid use disorder, regardless of whether a drug is self-administered or administered by a healthcare provider. Prohibits the specified covered drugs from being subject to step therapy, prior authorization or other similar plan requirements.

Status: Vetoed by the Governor.

AB 2427 (WOOD) MEDI-CAL: ANTICOMPETITIVE CONDUCT This bill would require the Department of Health Care Services to include a contract provision in any extension, renewal, or

awarding of a new contract to a for-profit Medi-Cal Managed Care company if the attorney general determines that the for-profit health plan or insurer engaged or engages in anticompetitive conduct or practices, as defined, or if the department determines that the for-profit health plan or insurer has a pattern or practice of not complying with the medical loss ratio.

AB 2427 would ensure that for-profit companies are not gauging the Medi-Cal system by putting profits before patients.

Status: Vetoed by the Governor.

AB 2674 (AGUIAR-CURRY) HEALTHCARE SERVICE PLANS: DISCIPLINARY ACTIONS Would require the Department of Managed Health Care to review complaints filed by a provider who believes a plan is engaging in an unfair payment pattern, conduct an audit and an enforcement action pursuant to existing regulations, and if a final determination is made that a plan’s practice constitutes a “demonstrable and unjust payment pattern” or “unfair payment pattern,” assess and require the plan to pay an administrative penalty in an amount not less than the amount owed plus interest and to pay the provider what the provider is owed plus interest.

Status: Signed by the Governor (Chapter 303, Statutes of 2018).

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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 SB 1303 (PAN) CORONER: COUNTY OFFICE OF THE MEDICAL EXAMINER This bill would require that counties with a population of 500,000 or more, excluding charter counties, either replace the Sheriff-Coroner’s office with a Medical Examiner’s office or institute a policy where investigations involving conflicts of interest must be referred to a county with the Medical Examiner model. In a Medical Examiner model, a physician determines the type and manner (accident, homicide, natural causes, etc.) of death. In a SheriffCoroner model, a physician determines the type of death but the elected Sheriff, who has no medical training, retains the right to determine manner of death. Recent examples out of San Joaquin County have demonstrated the downside to the Sheriff-Coroner model. On April 25, the San Joaquin County Board of Supervisors, in a unanimous 5–0 vote, eliminated the office of the Sheriff-Coroner and adopted a Medical Examiner model. This was the main focus of SB 1303 and the pressure from this legislation clearly influenced the county’s decision.

Status: Vetoed by the Governor.

SUCCESSFULLY NEGOTIATED BILLS AB 1092 (COOLEY) HEALTHCARE SERVICE PLANS: VISION CARE SERVICES: PROVIDER CLAIMS: FRAUD This bill would specify that a specialized healthcare service plan that undertakes solely to arrange for the provision of vision care services may use a statistically reliable method to investigate suspected fraud and to recover overpayments made as a result of fraud for optometric services only.

The author accepted CMA’s amendments to exclude all medical services from application of the bill. The bill would require the healthcare service plan’s

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HIGH RATE OF RETURN

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statistically reliable method, and how the plan intends to utilize that method to determine recovery of overpayments for optometric services made as a result of fraud, to be submitted to, and approved by, the Department of Managed Health Care as elements of the plan’s antifraud plan.

Status: Signed by the Governor (Chapter 525, Statutes of 2018).

AB 1560 (FRIEDMAN) NURSE PRACTITIONERS: CERTIFIED NURSEMIDWIVES: PHYSICIAN ASSISTANTS: PHYSICIAN AND SURGEON SUPERVISION The Physician Assistance Practice Act authorizes a physician assistant licensed by the Physician Assistant Board to be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision. The act prohibits a physician and surgeon from supervising more than four physician assistants at any one time. This bill would prohibit a physician and surgeon from

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AB 1753 (LOW) CONTROLLED SUBSTANCES: CURES DATABASE Current law requires prescription forms for controlled substance prescriptions be obtained from security printers approved by the DOJ. This bill would authorize the DOJ to reduce or limit the number of approved printers to three. The bill would require prescription forms for controlled substance prescriptions to have a uniquely serialized number, in a manner prescribed by the DOJ, and would require a printer to submit specified information to the DOJ for all prescription forms delivered.

Status: Signed by the Governor (Chapter 479, Statutes of 2018).

supervising more than 12 nurse practitioners, certified nurse-midwives and physician assistants at any one time, as specified.

Status: Failed on the Senate Inactive File.

AB 1751 (LOW) CONTROLLED SUBSTANCES: CURES DATABASE This bill would authorize the Department of Justice (DOJ) to enter into an agreement with an entity operating an interstate data share hub for the purposes of participating in interjurisdictional information sharing between prescription drug monitoring programs across state lines. CMA worked with the author to ensure that any agreements or sharing of Controlled Substance Utilization Review and Evaluation System (CURES) information will not occur until DOJ has promulgated and approved regulations that detail who can access CURES data, to what extent and for what purposes it can be accessed, and what penalties are in place for any unauthorized use of the information contained within the database.

Status: Signed by the Governor (Chapter 478, Statutes of 2018).

AB 1787 (SALAS) REPORTING: VALLEY FEVER Would require the state Department of Public Health, when it receives a report of a case of coccidioidomycosis after the reporting deadline for a specified year, to include the case in its data collection for the next year and attribute it to the year of diagnosis in future data reporting. This bill would require the department to collect data on coccidioidomycosis cases by April 15 of each year.

Status: Signed by the Governor (Chapter 229, Statutes of 2018).

AB 1790 (SALAS) VALLEY FEVER EDUCATION, EARLY DIAGNOSIS, AND TREATMENT ACT This bill would require the state Department of Public Health and the California Conference of Local Health Officers, by July 1, 2019, to make available protocols and guidelines — developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional healthcare organizations — for educating physicians and other healthcare providers regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment.

Status: Signed by the Governor (Chapter 338, Statutes of 2018).

AB 1801 (NAZARIAN) NEWBORNS: CYTOMEGALOVIRUS PUBLIC EDUCATION AND TESTING This bill would, until Jan. 1, 2023, require the state Department of Health Care Services to establish a commission on

////////////////////////////////////////////////////////////////////////// Cytomegalovirus (CMV) Public Education and Testing. The bill would require the commission to examine research and data regarding congenital CMV and develop recommendations.

Status: Vetoed by the Governor.

AB 1880 (FONG) VALLEY FEVER REPORTING Current law requires the state Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. This bill would require the department to collect data on coccidioidomycosis cases on or before April 1 each year, as specified.

Status: Failed in the Assembly Health Committee.

AB 1881 (FONG) VALLEY FEVER TESTING This bill would require the department to develop standardized methodology for coccidioidomycosis tests to ensure comparable sensitivity and specificity among laboratories.

Status: Failed in the Assembly Health Committee.

AB 1998 (RODRIGUEZ) OPIOIDS: SAFE PRESCRIBING POLICY This bill would require, by July 1, 2019, every healthcare practitioner who prescribes, orders, administers, or furnishes opioids classified as Schedule II and Schedule III to adopt, review, and periodically update a safe opioid prescribing policy. The bill would prohibit the safe opioid prescribing policy from placing a limitation on the prescription, ordering, administration, or furnishing of opioids to patients with prescribed conditions.

Status: Failed in the Senate Appropriations Committee.

Assemblyman Brian Maienschein

AB 2193 (MAIENSCHEIN) MATERNAL MENTAL HEALTH This bill would require, by July 1, 2019, a licensed healthcare practitioner who provides prenatal or postpartum care for a patient, or pediatric care for an infant, to offer to screen a mother for maternal mental health conditions. The bill would require a licensed healthcare practitioner to appropriately screen for maternal mental health conditions during pregnancy and the postpartum period if the mother agrees to be screened.

Status: Signed by the Governor (Chapter 755, Statutes of 2018).

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////////////////////////////////////////////////////////////////////////// AB 2682 (BURKE) NURSE-MIDWIVES: NATUROPATHIC DOCTORS: ALTERNATIVE BIRTH CENTERS Current law authorizes the Board of Registered Nursing to appoint a committee of qualified physicians and nurses to develop standards for educational requirements, ratios of nurse midwives to supervising physicians, and associated matters. This bill would delete those provisions and would instead require the board to appoint a committee of physicians, surgeons, and nurses to make recommendations to the board on all matters relating to midwifery practice, including, but not limited to, education and appropriate standards of care.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

AB 2342 (BURKE) BREAST AND OVARIAN CANCER SUSCEPTIBILITY SCREENING This bill would require healthcare service plans, health insurers, and the state Department of Health Care Services to cover breast and ovarian cancer susceptibility screening as recommended by the United States Preventive Services Task Force.

Status: Vetoed by the Governor.

AB 2423 (HOLDEN) PHYSICAL THERAPISTS: DIRECT ACCESS TO SERVICES: PLAN OF CARE APPROVAL The federal Individuals with Disabilities Education Act is a law that is implemented by states and public agencies to ensure early intervention, special education and related services to eligible infants, toddlers, children, and youth with disabilities.

Its purpose is to ensure that all children with disabilities have available to them a public education that emphasizes special education and other services designed to meet their unique needs and to prepare them for further education and independent living. AB 2423 exempts physical therapy

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services that are part of an Individualized Education Program or Individualized Family Service Plan from the direct access limitation that prevents physical therapists from continuing treatment beyond 45 calendar days or 12 visits without receiving a physician’s signed approval of the physical therapist’s plan of care; thereby removing a barrier to federal compliance for California school districts.

Status: Signed by the Governor (Chapter 761, Statutes of 2018).

AB 2487 (MCCARTY) PHYSICIANS AND SURGEONS: CONTINUING EDUCATION: OPIATE-DEPENDENT PATIENT TREATMENT AND MANAGEMENT This bill allows a physician who seeks to prescribe medically assisted treatment pharmaceuticals to fulfill their annual continuing education requirement by completing the DATA-Waivered Physician course along with four additional credit hours on treating substance use disorders.

Status: Signed by the Governor (Chapter 301, Statutes of 2018).

AB 2760 (WOOD) PRESCRIPTION DRUGS: PRESCRIBERS: NALOXONE HYDROCHLORIDE AND OTHER FDAAPPROVED DRUGS This bill would require a prescriber 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.

Status: Signed by the Governor (Chapter 324, Statutes of 2018).

SB 1003 (ROTH) RESPIRATORY THERAPY This bill would prohibit any state agency, except for the Respiratory Care Board of California, from defining or interpreting respiratory care for those licensed pursuant to these provisions, or from developing standardized procedures or protocols, unless authorized by these provisions or specifically required by state or federal statute. The bill would also authorize the board to adopt regulations to define, interpret, or identify basic respiratory tasks and services, intermediate respiratory tasks, services and procedures that require formal training, and advanced respiratory tasks, services, and procedures that require advanced training.

////////////////////////////////////////////////////////////////////////// Status: Signed by the Governor (Chapter 180, Statutes of 2018).

SB 1034 (MITCHELL) HEALTH CARE: MAMMOGRAMS Current law requires, until January 1, 2019, 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. This bill would extend the operation of that provision until January 1, 2025.

Status: Signed by the Governor (Chapter 332, Statutes of 2018).

SB 1121 (DODD) CALIFORNIA CONSUMER PRIVACY ACT OF 2018 This bill amends the recently enacted California Consumer Privacy Act of 2018, AB 375 (Chau), which beginning January 1, 2020, provides consumers with certain rights over their personal information collected by businesses. The changes it makes include properly exempting medical providers from AB 375 provisions.

Specifically, those amendments exclude: 1) providers governed by the Confidentiality of Medical Information Act (CMIA), Health Insurance Portability and Accountability Act of 1996 (HIPAA) covered providers and entities; 2) information that is collected and treated as private medical information; and 3) information collected pursuant to clinical trials from application of AB 375.

Status: Signed by the Governor (Chapter 735, Statutes of 2018).

SB 1152 (HERNANDEZ) HOSPITAL PATIENT DISCHARGE PROCESS: HOMELESS PATIENTS Current law requires each hospital to have a written discharge planning policy and process that requires that the appropriate arrangements for posthospital care are made prior to discharge for those patients likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning. This bill would require each hospital to include a written homeless patient discharge planning policy and process within the hospital discharge policy as well as provide non-medically necessary care in the hospital’s emergency department.

Status: Signed by the Governor (Chapter 981, Statutes of 2018).

SB 1254 (STONE) HOSPITAL PHARMACIES: MEDICATION PROFILES OR LISTS FOR HIGH-RISK PATIENTS This bill would require a pharmacist at a hospital pharmacy to obtain an accurate medication profile or list for each highrisk patient upon admission of the patient under specified circumstances. The bill would authorize 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. The bill would require the hospital to establish criteria regarding who is a high-risk 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.

Status: Signed by the Governor (Chapter 697, Statutes of 2018).

SB 1264 (STONE) MEDI-CAL: HYPERTENSION MEDICATION MANAGEMENT SERVICES This bill would include hypertension medication management services as a covered pharmacist service under the Medi-Cal program.

Status: Failed in the Assembly Appropriations Committee.

SB 1336 (MORRELL) PUBLIC HEALTH: END OF LIFE OPTION ACT Existing law requires the state Department of Public Health to create a report with information collected from attending physician follow-up forms and to post that report to its website. This bill would require the report described above to further include the areas of practice of each physician who wrote a prescription for an aid-in-dying drug, the motivating reason or reasons behind a patient’s decision to request the aid-in-dying drug, and the number of patients who received a mental health specialist assessment prior to receiving the aid-in-dying drug. The bill would require the Medical Board of California to make any necessary changes to the applicable forms to conform with these requirements.

Status: Failed in the Senate Health Committee.

SB 1343 (MITCHELL) EMPLOYERS: SEXUAL HARASSMENT TRAINING:

REQUIREMENTS This bill would require an employer who employs five or more employees, including temporary or seasonal employees, to provide at least two hours of sexual harassment training to all supervisory employees and at least one hour of sexual harassment training to all nonsupervisory employees by Jan. 1, 2020, and once every two years thereafter.

Status: Signed by the Governor (Chapter 956, Statutes of 2018) SB 1448 (HILL) HEALING ARTS LICENSEES: PROBATION STATUS: DISCLOSURE This bill would, on and after July 1, 2019, require the California Board of Podiatric Medicine, the Naturopathic Medicine Committee, the State Board of Chiropractic Examiners, and the Acupuncture Board to require a licensee to provide a separate disclosure to a patient or a patient’s guardian or healthcare surrogate before the patient’s first visit if the licensee is on probation pursuant to a probationary order made on and after July 1, 2019. The bill, on and after July 1, 2019, would require the Medical Board of California and the Osteopathic Medical Board of California to require a licensee to provide a separate disclosure to a patient or a patient’s guardian or healthcare surrogate before the patient’s first visit if the licensee is on probation pursuant to a probationary order made on and after July 1, 2019, under specified circumstances.

Status: Signed by the Governor (Chapter 570, Statutes of 2018).

SCR 110 (WIENER) SEX CHARACTERISTICS This resolution makes various legislative declarations regarding intersex individuals and calls upon stakeholders in the health professions to protect intersex children from nonconsensual, medically unnecessary surgeries and to enact procedures that would delay interventions to determine gender assignment until an individual can participate in the decision.

Status: Signed by the Governor (Chapter 225, Statutes of 2018).

Mr. Norman is CMA senior vice president, Centers for Government Relations and Political Operations.

SAN DIEGO PHYSICIAN.ORG

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M E M B E R E N G AG E M E N T

San Diego Celebrates 2018 Top Docs San Diego County Medical Society and San Diego Magazine Team Up to Honor Local Physicians

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Produced in partnership with the San Diego County Medical Society, San Diego Magazine’s Top Doctors Celebration honored the 2018 Top Doctors featured in the October issue. The evening event consisted of a farm-to-fork menu showcasing local ingredients and the culinary talents of celebrity chef Brian Malarkey at his restaurant Farmer & The Seahorse. Guests enjoyed a walkabout dining experience paired with craft cocktails, San Diego beers, and fine wine. Live music and dancing followed.

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CAPTIONS 1. Dr. Jane Lyons and Jeremy Lyons. 2.

Dr. Alan Bier with Liz Alan and Dr. David Ostrander. 3. Dr. Jeremy Hogan and his wife, Shannon Hogan. 4. Dr. William Tseng and his wife, Angela Shiau. 5. Dr. Caroline Thornton and Dr. Mark Sornson.

6. Dr. David Bazzo and his wife, Sabrina, enjoying the evening. 7. (L-R) UCSD Medical Students Jonathan Cunha, Sophie You, Mary Gamboa, Athena Hsu, Tori Speck, and Brendan Berenger. 8.

(L-R) Reema Batra, MD; Vishakha Modi Sharma, MD; Monali Patel, MD; Reena Patel; Preeti Tuladhar, MD; Shila Patel; and Hetal Hosalkar, MD

SAN DIEGO PHYSICIAN.ORG

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C H A M P I O N S F O R H E A LT H

Seeing Is Believing

By Adama Dyoniziak

MIX ONE AVID CYCLIST and photographer, one drum guru and world traveler, and one great white shark diver and wake surfer, and what do you get? The dedicated ophthalmologists at Greider Eye Associates (GEA). Since 2013, 42 Project Access San Diego (PASD) patients have received pro bono consultations and vision restoring surgery from GEA. “I always enjoy sharing my skills and talents through Project Access,” says Dr. Bradley Greider, who has 35 years of caring under his wing. “The most important sense is sight … in order to see the world and interact. My universal reward is a patient’s smile — that says everything.”

GEA has expanded from a practice with two people to a team of 45 who reflect the diversity of the patients GEA serves.

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North Coast Surgery Center (NCSC), a proud member of Surgical Care Affiliates, partners with Greider Eye Associates for PASD ophthalmology patients. NCSC has provided 42 surgeries pro bono since 2010, which also includes otorhinolaryngology (ENT) patients with other physicians.

When asked why these physicians chose ophthalmology, Dr. Peter Krall said he was introduced to the field by viewing cataract surgery. “I was amazed and knew that this was the field for me,” Dr. Krall says. “The immediate gratification of a patient’s face lighting up after cataract surgery had a huge impact on me. Project Access patients are a joy to see — they have an amazing attitude. One gentleman was having his second pterygium surgery and he was so

thankful and grateful, didn’t complain at all. I am grateful to be in a position where I can help and enjoy the work.”

It takes a team to create these daily transformations. The pre-op preparation and education by assistants and nurses; the technicians, nurses, surgeons, and anesthesiologists in the operating room; the post-op care by nurses; and the administrative glue that holds it all together from beginning to end at GEA and NCSC. The team creates an environment where everyone enjoys what they do, which is helping to restore sight. “Better vision is essential in a visual world, especially for a better quality of life,” Dr. Maulik Zaveri says. “The results of a 20-minute surgery can last a lifetime. This work has made me learn more about myself. Everyone has a story or a struggle, and loss of vision ties into that. I enjoy getting to know Project Access patients. You feel the love from the patients. I feel privileged to be part of their transformation.”

Innovations in the field of ophthalmology, such as laser-assisted cataract surgery, minimally invasive glaucoma surgery (MIGS), and less invasive corneal surgery, add to this excitement of restoring vision, preventing further sight loss, and reducing spectacle dependency. “All the physicians and staff really care about the patient and their outcome,” Dr. Greider says. “This is a great responsibility, but with it comes a great reward.”

Photographing volcanoes, the underwater world, and the Milky Way… creating harmonious tones on Tabla drums … riding waves while wakeboarding … these physicians have a creative vision at play and at work, reaching the best outcomes for their patients. Seeing is believing.

If you, your practice, or your facility would like to become a member of the Project Access San Diego volunteer network of physicians and surgical centers, please contact Adama Dyoniziak at (858) 300-2780 or Adama.Dyoniziak@championsfh.org.

Ms. Dyoniziak is executive director of Champions For Health.

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P R AC T I C E M A N AG E M E N T

Growing Your Practice With Millennials and Real Estate Decisions

By Chris Ross

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DECEMBER 2018

WITH EACH NEW GENERATION (Baby Boomers, Gen X, Millennials) comes a new set of opportunities for healthcare organizations and private practices. Since the early 2000s there has been a heightened focus on the aging Baby Boomer population and its effect on healthcare and medical office space — the motto being, a rapidly aging elderly population means increased demand for healthcare.

For the past couple of years, however, healthcare professionals have new dynamics to consider with the Millennial generation — the population born between 1981 and 1996. In 2019, the last of the Millennials will have reached the age of 22, which many deem to be the adult age when an individual begins to make his or her own healthcare decisions, and this adult population of Millennials will have surpassed that of Baby Boomers. Millennials are also steadily reaching the point in their lives where they experience an uptick in healthcare demand: entering their 30s, thinking about starting a family, and beginning to

and doctors, and business-savvy providers are appealing to them and taking advantage of these trends.

LOCATION

Location can be the key to the success (or failure) of any business, and now more than ever that includes medical practices.

With technology and a skilled commercial real estate adviser, healthcare practices can make location decisions based on where clusters of Millennials and other targeted populations work, reside, travel, dine, entertain, or frequent. Valuable tools and information are readily available to help physicians understand population trends, traffic patterns, scheduling habits, underserved or saturated healthcare services, etc., and how the access to and demographics surrounding one location measure up to that of another … or that of your competition.

Millennials are a huge segment of business for healthcare organizations and doctors, and business-savvy providers are appealing to them and taking advantage of these trends. show normal signs of aging … perhaps tearing their first ACL or rotator cuff.

There are clear trends that every practice should recognize in Millennials. They value flexibility in their work-life balance and consider technology being “king” in the way they gather information, communicate, and operate in their daily lives. They value immediate gratification — which, in terms of healthcare needs, means quick and convenience access — and many are dropping their primary care providers in favor of smaller, quickly accessible facilities such as express care and urgent care centers. It’s no secret that Millennials are a huge segment of business for healthcare organizations

OFFICE DESIGN

When it comes to visiting offices, Millennials are concerned with access and convenience of care. They want proactive, holistic, and preventive care, and not just reactive treatment. “Healthcare organizations are starting to implement and integrate services that support the overall wellness of an individual,” says Darci Hernandez, principal at Boulder Associates Architects, a firm specializing in designing healthcare facilities. “We have seen providers shift toward the needs of Millennials by offering nutrition, yoga, wellness, and social programs. Within the clinic, we are designing for small consults or phone-booth-type rooms that support technology and allow providers to better inform and educate patients.” Hernandez adds that “more consideration is being spent on branding medical offices through graphics, design elements, and lighting to create an experience for this audience.”

Many organizations are reengineering their intake process, turning to a concierge, and experimenting with electronic kiosk check-in stations to provide patients a high level of customer service.

ANALYTICS

As the industry works toward efficiency, analytics are playing a big part, not only in where your patients are coming from and going but their experience in the office.

Today doctors and medical organizations

are using tools to analyze everything from patient wait times to patient exam durations to checkout time. Today’s patient is typically taken through seven steps from the time they make the appointment to the point where they check out. The goal of these tools is to create an efficient system, minimizing these steps, where the doctors provide optimal care to the largest number of patients each day.

SOCIAL MEDIA

Social media and branding is extremely important to Millennials, as most rely on them to make decisions. Having a presence on LinkedIn, Facebook, Twitter, and numerous other platforms has recently become a priority in marketing to Millennials. Doctors with a succinct social media branding strategy are having success growing their business with Millennials. It is important to be proactive in monitoring and responding on review sites like Yelp to maintain a strong image. In this age of technology, patient decisions are being made by looking at reviews of organizations or doctors. Poor overall reviews can be detrimental to the success of a medical organization and its individual doctors. New apps and other patient tools are also rolling out, which allow patients to more easily compare not only quality (ratings) between healthcare providers, but also costs, and Millennials are leading the charge in the utilization of such tools.

THE FUTURE

With the growth of technology and the ever-evolving patient habits, the future is a vast, open sea. Many expect that how medicine is delivered and how it is administered will see significant growth and change beyond what most of us can even comprehend. Will drones be delivering our prescriptions 10 years from now? Will we schedule all of our appointments via “Uber Health” and have driverless vehicles take us to and from the doctor’s office, where physicians and patients are walking into the exam room at nearly the exact same time?

The future is here, and we will continue to see innovations every day, every month, every year, and healthcare real estate and the analytics around it will be situated in the middle of the evolution.

Mr. Ross is executive vice president of JLL Healthcare Practice Group.

SAN DIEGO PHYSICIAN.ORG

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CLASSIFIEDS VOLUNTEER OPPORTUNITIES PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.

Gonzalez@ChampionsFH.org.

CHAMPIONS FOR HEALTH PROJECT ACCESS: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for MediCal receive short term specialty care. Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.Gonzalez@ChampionsFH.org, or visit www.ChampionsforHealth.org. [282] SHORT-TERM MEDICAL VOLUNTEERS NEEDED FOR HAITI: Global Health Teams is looking for physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti every February, June, and October. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically under served area. GHT is an experienced U.S.-based nonprofit and has been operating these clinics since 1998. We coordinate all in-country travel and logistics.

Please contact Bob Downey at (619) 905-7157 or at bob@ globalhealthteam.org if you are interested in applying. Visit www.globalhealthteam.org to see what we do and learn about the clinics and volunteer experience.

PHYSICIAN OPPORTUNITIES 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)

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

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.

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, evidencebased 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 HER, 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) 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.

PRACTICE FOR SALE RHEUMATOLOGY SOUTH SAN DIEGO MEDICAL PRACTICE FOR SALE:Close to US-Mexico border that 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 $50K to be paid after credentialing is completed and asking $5000/month for 10 months. Possibility to salary a physician the first 1-2 years as well through one of the insurance contracts. Long term trained staff and Electronic Medical Record. For immediate consideration, forward your details including your contact phone, your specialty and current professional status 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 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 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 December 1st or January 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. (Posted 11/18/2018) SHARED OFFICE SPACE: Office Space, beautifully decordated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046.

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

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

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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 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 619-501-4758. (Posted 8/16/2018) 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) 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.

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! CLICK HERE for photos. 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, 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 OFFICE SPACE / REAL ESTATE WANTED 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.

MEDICAL EQUIPMENT/FURNITURE FOR SALE 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.

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 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.

For more information and to apply CLICK HERE (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 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.

SAN DIEGO PHYSICIAN.ORG

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

If you care about providing optimum care, perhaps it’s time to ask yourself: Where do I feel passion?”

Got Passion?

By Helane Fronek, MD, FACP, FACPh

ONE MIGHT CALL ME a serially passionate person. When connected to a passion, we feel boundless enthusiasm and longing for the object of our passion. Passions provide excitement; they reflect and satisfy our inner desires. For 30 years, my passion was to understand and treat patients with venous disorders, to discern the extent and impact of my patients’ condition, and help them find relief. Exploring and contributing to this undeveloped field of medicine fed my need for discovery, love of teaching, and yearning to help the underserved.

Riding horses was once my top passion.

Creating partnership with an animal so different than I am was an exhilarating way of connecting with nature and my own body.

Last year, the bass guitar entered my life, reconnecting me with the soulfulness and spirituality of music that had long been part

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of my experience. Each passion nourished a part of me, satisfied a desire that was languishing, and added aliveness, which is essential for a healthy life.

Many physicians’ passion for medicine has eroded. We feel devalued by the menial, unfulfilling tasks, exemplified by the label “provider,” and disrespected when insurance company employees overrule our decisions. We mourn the loss of close, fulfilling relationships with patients, diminishing the joy of medicine. Even if we maintain a love for our work, a career lasts for decades, numbing us to the delight and fulfillment we wish to feel each working day.

In a long career and your current practice of medicine, where can you find passion?

Incorporating former passions can revive the spark in our work lives. If art, music, or sports excite you, discussing these topics

with patients and staff can enliven your day.

As a cooking buff, I delighted each November in trading Thanksgiving recipes with patients. Bringing our interests into work relationships also creates personal connection and congruence that can prevent burnout.

Finding the meaning in our work is a potent way to rekindle passion. The Remen Institute for the Study of Health and Illness offers a three-question journal to focus our attention on what touches us each day.

Spending a few moments each evening recalling what surprised us, moved us and inspired us will refresh our memories and highlight these positive experiences each day.

What if your passions don’t fit within the context of your medical work? Adding even small increments of activities that light you up can reenergize your life. This renewed connection with parts of you that have been ignored can change your outlook toward your work, as each part of our lives affects the others.

We are never encouraged to prioritize passion. It doesn’t provide CME credits or a tangible benefit to our patients. Yet if enlivening our lives balances the challenges of medicine or helps us feel inspired by our work, it may be even more important. When doctors leave medical practice prematurely due to burnout, they offer no benefit to patients. If you care about providing optimum care, perhaps it’s time to ask yourself: Where do I feel passion?

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

t hank you

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

INSURANCE

The Doctors Company (800) 852-8872 www.thedoctors.com/SDCMS

BANKING

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

COMMERCIALREAL ESTATE

JLL Healthcare Practice Group (858) 410-6377 www.sdmedicalrealestate.com

EMPLOYMENT

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

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



Cooperative of American Physicians, Inc. (800) 356-5672 www.CAPPhysicians.com Norcal Mutual Insurance Company (844) 4NORCAL www.norcalmutual.com

MEDICAL BILLING

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

MORTGAGE BANKING

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

OFFICE SPACE

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

TECHNOLOGY

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

Please contact these vendors for your business needs.

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

SAN DIEGO PHYSICIAN.ORG

29

$5.95 | www.SANDIEGOPHYSICIAN.org

San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, Ca 92123

PRSRT STD U.S. POSTAGE

PAID DENVER, CO PERMIT NO. 5377

[ Return Service Requested ] 6316_ACC_Cardiology_PD_Feb2017 FP 4C Final Trim: 8.187” x 8.615” Bleed:0.25” deliver to jrohr@sdcms.org NO BORDER, WITH BLEED

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GOOD MEDICINE. We’re taking the mal out of malpractice insurance.

By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal.

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