January 2013

T h e N e w O f f i c i a l P u b l i c at i on o f t h e Lo s An g e l e s Co u nt y M e d i c a l A s s o c i at i on REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

INTRODUCING

THE NEW LACMA

JANUARY 2013

J A NUARY 2013 | TABLE OF CONT E NT S

Volume 144 Issue 01

FEATURES

16

the new lacma

The many challenges surrounding healthcare reform and physicians advocating for patients’ rights, while looking for their own representation and support, will require strong leadership and doctors who stand united.

10

16

Overprescribing: How to Avoid Discipline

DEPARTMENTS

Important insight into to taking appropriate steps to protect yourself from mistakes that can lead to overprescribing enforcement actions by the Medical Board.

6 Front Office | Practice Management

News, tips, advice and resources

9 Balance | Lifestyle & Wellness

Tips, hints, advice and resources to make your practice run more smoothly.

10

12 Transitions | Career Management

Questions and challenges associated with various phases of your medical career.

14 PNN | NEWS IN REVIEW

The latest headlines impacting the economics of healthcare delivery in Southern California 20 United We Stand | AT WORK FOR YOU

Your LACMA and CMA membership at work for you.

From Your Association

12

4 President’s Letter | Samuel Fink, MD 24 CEOs Letter | Rocky Delgadillo 25 LACMA News | Association Happenings

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.

j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1

editor

Sheri Carr 559-250-5942 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

display ad sales / director of sales display ad sales editorial advosory board

The Los Angeles County Medi-

Christina Correia 213-226-0325 | christinac@lacmanet.org Dari Pebdani 858-231-1231 | dpebdani@gmail.com David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD Headquarters

cal Association is a profes-

Physicians News N Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 Tel 213-683-9900 | Fax 213-226-0350 www.physiciansnewsnetwork.com

sional association representing physicians from every medical specialty and practice setting

LACMA Officers

as well as medical students, interns and residents. For more than 100 years, LACMA has

CEO President President-elect Treasurer Secretary Immediate Past President

been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, government relations and community relations. Through its advocacy efforts in both Los Angeles

LACMA BOARD OF DIRECTORS CMA Trustee Councilor med student Councilor/usc keck Councilor-at-large young physician counsilor cma trustee ethnic physicians commitee representative Councilor Councilor med student Councilor/ucla david geffen Councilor Chair of LACMA Delegation

County and with the statewide

Councilor-at-large Councilor

California Medical Association,

Councilor Councilor

your physician leaders and staff

Councilor

strive toward a common goal–

Councilor-at-large

Councilor

that you might spend more time treating your patients and less time worrying about the challenges of managing a practice.

Rocky Delgadillo Samuel I. Fink, MD Marshall Morgan, MD Pedram Salimpour, MD Peter Richman, MD Troy Elander, MD

RESIDENT/FELLOW Councilor Councilor RESIDENT/FELLOW Councilor Councilor Councilor-at-large cma trustee (resident)

David Aizuss, MD William Averill, MD Erik Berg Stephanie Booth, MD Steven Chen, MD Jack Chou, MD Hector Flores, MD Sidney Gold, MD William Hale, MD Shelley Han Vito Imbasciani, MD Paul Kirz, MD Lawrence Kneisley Howard Krauss, MD Gideon Lowe, MD Carlos E. Martinez, MD Nassim Moradi, MD Ashish Parekh, MD Jeffrey Penso, MD Heidi Reich, MD Bob Rogers, MD Sion Roy, MD Pejman Salimpour, MD Robert Bitonte, MD Erin Wilkes, MD

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Executive Assistant, at lisa@lacmanet.org or 213-226-0304.

Subscriptions Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900.

Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. SCP is not responsible for unsolicited manuscripts.

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P R ESIDE NT ’S LE T T ER | SA M UEL FINK , M D

I H O PE T H AT, all of you had exactly the kind of holiday you were hoping for...I asked Santa for the eradication of the SGR, and the elimination of the Independent Payment Advisory Board. He just laughed Ho, Ho, Ho, and handed me a twenty page government form to fill out, driving away in a low-emission hybrid sleigh. As have many of you, I just received notice from Medicare that I had to “reapply” to continue seeing patients within the Medicare program. And yes, this is a complete “from scratch” new application. They requested all original IRS paperwork from when I formed my corporation fourteen years ago, which, of course, necessitated several conversations with the IRS, since the original paperwork is buried deep somewhere within a long-forgotten box. I personally had to get on the phone with Medicare to initiate the application...when I told them (despite the fact that they already have this information) that I was born in Los Angeles, California I was asked what country that was in. I replied that I thought it was on Mars, and was told that was not the information they had on file for me. To this point, my biller and I have spent five hours of unnecessary time, and have only progressed to where, hopefully, we will be mailed an internet link at which point we can begin to fill out the actual online “reapplication.”

I was under the impression that the eighth amendment to the Constitution prohibits cruel and unusual punishment...obviously that doesn’t apply to physicians.

The issue that appears to be most critical to doctors in Los Angeles right now is the potential for the forced enrollment of the dual-eligible population (Medi-Medi) into managed care plans as of June, 2013, unless these patients opt-out with a form that has yet to be distributed, or even created! Here is where we stand: As of right now, there is no contract between the State of California and L.A. Care to provide for the care of these dual-eligible patients, as reimbursement rates have not been agreed upon. In the absence of these rates, no provider network can be formed. I have seen applications being sent to physicians around the county for the formation of new IPAs, ostensibly to care 4 PHYSICIAN MA G A Z INE | JANUARY 2013

for this group of patients...but such formation is premature, and purely speculative. I would advise all of you to be very careful before committing your dollars or time to such ventures. Also, remember that LACMA is strongly advocating for the preservation of the current physician-patient relationships that so many of our members have established. It is possible that all or part of Los Angeles County will be excluded from this pilot program! Stay tuned, and we will try to keep you up to date with our weekly Physicians News Network, which all of you should be receiving via email...if you are not receiving this new member benefit please let us know, and we will get you on our list!

LACMA has also been hard at work forming Physicians Advisory Committees, to better represent our members...one month ago the Latino Physicians Advisory Committee met for the first time, chaired by Dr. Hector Flores. Dr. Flores has been a member of LACMA for a long time, and has always been a strong advocate for Latino physicians. I was very impressed by the passion and energy displayed at this meeting. Dr. Flores and his committee will be working on several initiatives, including the effort to recruit more Latino medical students, as well as Latino physicians that wish to practice in underserved areas of Los Angeles County. I am also happy to welcome Dr. Flores as the newest member of the LACMA Board of Directors! The Women’s Physicians Advisory Committee, an African-American Physicians Advisory Committee, and an Asian Physicians Advisory Committee are all in the planning stages, and we welcome your participation, as well as suggestions for other advisory groups that we should consider forming.

In my last column, I discussed our plan to revitalize the LACMA Districts, and I am happy to welcome Margaret Vieira to the LACMA team, where she will serve in the capacity of our new District Manager. Margaret just moved to Los Angeles from Washington, D.C., and she will be working hard on ensuring that every LACMA district has an elected president and board. We are actively recruiting for our district boards, and this would be an excellent way for you to become involved in the New LACMA! Please contact Margaret immediately at 213-226-0393 if you’d like to be involved in the leadership of our dynamic organization!

I will update you soon on the status of my Medicare reapplication, and was glad that I could assist our government office with the knowledge that Los Angeles, California is in the United States! Until next month....

Samuel Fink, MD, is an internist in private practice in Tarzana. He is the 141st president of the Los Angeles County Medical Association.

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T R ANSIT IONS | CA R EE R M A NAGE M E NT

THE PRACTICE WAS JUST BEGINNING TO TAKE OFF…

F RONT OFFICE | P R AC T ICE M ANAGEM ENT

CMS to Release Quality Reports to Physician Groups

By CMA Staff

Medicare & Medicaid Services (CMS) are making available Medicare Quality and Resource Use Reports (QRUR) to California physician groups of 25 or more. These reports will allow physicians to measure the quality and costs of their care compared with other doctors treating Medicare patients.

T he C e n te r s fo r

The QRURs will give physicians a preview of how data will be used to adjust Medicare pay for some physicians under a value-based modifier that will take effect in 2015 for some physicians.

The Physician Resource Use Measurement and Re-

porting Program was originally created in 2008 by the Medicare Improvements for Patients and Providers Act. This was extended and enhanced by the Affordable Care Act of 2010. The program is now called the Physician Feedback Program.

QRUR feedback provides comparative information so that physicians can view examples of the clinical care their Medicare patients receive in relation to the average care and costs of other Medicare patients.The report data is based on claim submission data. QRURs help CMS share comparative indicators of quality and cost performance with physicians and to receive input prior to making changes in Medicare payment based on the value-based payment modifier.

The value-based payment modifier will be implemented in 2015 for physicians in groups of 100 or more. It is not an actual modifier but rather a methodology of modifying payments, and will be based on 2013 claims submission data.

Solo physicians and those in groups of 99 or fewer physicians will not be affected by the value-based modifier until 2017 when all physicians will be affected. In 2017 it will be based on 2015 claims data.

For more information about the value-based payment modifier program and the Physician Feedback Reports, visit the CMS website www.cms.gov.

The California Department of Healthcare Services launches a new

Medi-Cal Email News Service

Subscribers can sign up to receive monthly digest bulletins and/or as-it-happens “news flashes� for critical or time-sensitive issues. You can tailor your subscription to receive only information on subject matters of interest to you and your practice including: billing, payment and policy rule changes.

The California Medical Association has advocated for a service like this for a long time and we are pleased to see it coming about. It will allow physicians to have news delivered directly to their inboxes, rather than having to visit the Medi-Cal website to track down the latest information.

Subscriptions are free. To sign up, go to the Medi-Cal Subscription Services Subscriber Form on the Medi-Cal website (http://files.medi-cal.ca.gov/pubsdoco/mcss/mcss.asp#1) and click the subject matter areas of interest and fill in your email and zip code.

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F RONT OFFICE | P R AC T ICE M ANAGEM ENT

Risk Tip

Hurricane Sandy Underscores the Need for Physicians to Be Prepared for a Disaster C ata s t r ophe s s u ch a s the recent Hurricane “Superstorm” Sandy, the Japan earthquake, and Hurricane Katrina underscore the importance of proper planning for disasters by both physicians and healthcare systems. Preparedness is a continuous cycle of planning, organizing, training, equipping, rehearsing, and evaluating.

Physicians should be involved in disaster preparedness to ensure that the best care is delivered to patients and critical services are not interrupted, especially for at-risk individuals who may have special medical needs. Physicians also should be aware of the potential threat of medical malpractice liability when serving as a volunteer health professional during a natural disaster or other declared state of emergency.

Here are a few tips to help physicians with disaster preparedness:

A long-time staple of the magazine, the Front Office section is your resource for tips, strategies and trends for effective and efficient practice management.

For your office plan: • A checklist of to-do items in case of an emergency.

These steps should enable you to preserve your assets as well as communicate with your staff and patients.

The list should be ordered by priority and can be designed to match up with specific weather-related information, such as in a hurricane.

• A disaster recovery checklist with steps to follow upon your return from an evacuation.

• A full-circle calling tree that provides directions on who will contact whom in the event of a disaster.

• Instructions on setting up instant messaging groups to enable your staff to communicate when cell phones may not work.

• Regularly revisit your office plan and review it with your staff.

• Verify that home health agencies that are caring for your patients have plans to provide adequate services in case of a disaster.

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8 PHYSICIAN MA G A Z INE | JANUARY 2013

For your community’s plan: • Participate in the development of a community disaster plan.

• Provide input to local entities such as Emergency Management Authorities, hospitals that are accredited by The Joint Commission, and volunteer organizations such as the Red Cross and Salvation Army.

• Work in concert with the lead organization coordinating disaster relief when volunteering to assist during or after a disaster.

Contributed by The Doctors Company.

For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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For your hospital’s plan: • Ask hospitals to define or redefine your role and responsibilities as a medical staff member during an emergency.

• Understand your hospital’s incident/disaster command structure and participate in drills and exercises.

li fest yle & WELLNESS | BALANCE

Start The New Year With Your Own Prescription of Exercise

BY Marion web

With more doctors recommending exercise to their patients to help combat medical problems, including obesity, diabetes and heart disease, exercise may just be their own best-kept secret to relieve stress, fatigue and achieve a healthier lifestyle for themselves.

To gain health and wellness benefits, according to the U.S. Department of Health and Human Services exercise guidelines, healthy adults need to engage in 2½ hours of weekly moderate-intensity exercise, such as brisk walking or gardening.

For more physically fit adults, 75 minutes of vigorous physical activity, such as swimming laps, hiking uphill or racewalking can offer similar benefits in half the time.

A great option for exercise, as well as the environment, is to start cycling for pleasure or commuting to work.

But even 10-minute bouts of heart-pumping activity are better than none at all. To regain lost muscle mass and strengthen weakening bones, which is part of the typical aging process, the experts also recommend that adults lift weights twice a week.

Considering that two-thirds of American adults are overweight and obese, exercising combined with a healthy diet can be a lifesaver given the

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clear link between excessive weight gain and a heightened risk for serious chronic diseases, including heart disease, diabetes, cancer and high blood pressure.

For the first time, Americans are raising children who may grow up even less healthy than their parents, because many are even more inactive than adults, preferring playing videogames and online social networking over exercise.

Yet, scientific evidence has shown that regular physical activity can do much more than cut feelings of fatigue and bolster overall well-being.

An expert panel gathered by the U.S. Department of Health and Human Services found that regular physical activity can cut risk of heart attacks and stroke by at least 20% and reduce the chance of early death.

With only about 26% of U.S. adults engaging in vigorous leisure-time physical activity three or more times a week, there is no better time to make a positive change toward a more active lifestyle than now.

Exercise is great medicine and a great way to start spending time with your loved ones and friends.

This exciting new department delivers news, studies, tips and opportunities that encourage physicians to maintain the healthy, balanced lifestyle that is essential to career success and longevity.

We Encourage Our Valued Readers to Patronizie Our Advertisers - and When You Do, Tell Them We Sent You! - Physician Magazine, & PNN (physiciansnewsnetwork.com)

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PHYSICIANSNEWSNETWORK.COM EXPANDED COVERAGE

Overprescribing and Medical Board Enforcement: How to Avoid Discipline

by Nick Jurkowitz, fenton-nelson

T he M e d ica l B oa r d

takes the inappropriate overprescribing of controlled medication very seriously.

For this reason, it is important to take appropriate steps to protect yourself from mistakes that can lead to overprescribing enforcement actions by the Medical Board.

In addition, whereas many physicians may feel that it may be difficult for the Medical Board to monitor prescriptions, it is actually not the case.

California has a state database for drug prescribing known as Controlled Substance Utilization Review and Evaluation System, commonly called CURES. There are over 100 million entries on the CURES database.

One of the devices the Medical Board uses is a Patient Activity Report. The Patient Activity Report will contain an entire list of all Schedule IIIV prescription drugs that have been prescribed to an individual patient. The Patient Activity Report will include the name of the physician that prescribed the drug as well as the pharmacies where 1 0 PHYSICIAN MA G A Z INE | JANUARY 2013

the patient obtained the drugs.

This generally comes into play after a complaint has first been filed with the Medical Board.

After receiving the complaint, the Medical Board will initiate an investigation into the validity of the complaint. During this process, Medical Board investigators will review the Patient Activity Report and look for patterns that indicate overprescribing of narcotics. Some of the patterns that will get the Medical Board’s attention, include the quantity of drugs being prescribed to particular patient, the patient’s location as compared to the location of

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OV ER P R ESC R IBING | P NN E XPA NDED COV E R AGE

the physician (presumably, if Likely red flags include, pa- physician can look up a new a patient travels a great deal tients who have had numerous patient who has raised certain to see a physician, he or she physicians in a short period red flags regarding pain medimay appear to be seeking il- of time, patients that refuse cation. Physicians should also licit drugs), how many past to try nonnarcotic treatments, perform complete examinaphysicians the patient has patients that request specific tions of patients and docuseen and how many different narcotics at the outset of treat- ment meticulous notes in the ment, and patients that appear patient’s charts. If a physician pharmacies the patient used to require refills too quickly. to fill out the prescription. does attract the attention of Many times, physicians the Medical Board, then he or are innocent parties and fall prey to a patient that she will have to justify the prescription. Well mainis “doctor shopping” for pain medication. These tained and documented patient charts are essential kinds of patients may go from one doctor to an- for that, especially if memory may be an issue based other looking for a physician to prescribe pain on the amount of time that has elapsed from when medications.To the physician, the patient may seem the physician treated the patient. In maintaining qualified for a prescription, but in reality the pa- proper documentation, the physician should keep tient is simply trying to obtain illegal drugs. This is a record of all drugs dispensed in the office and especially difficult for physicians because measuring all prescriptions filled out, detailed descriptions of pain in a patient is complicated and physicians reg- the tests or examination performed, and detailed ularly have to rely on patient testimonials to assess descriptions of the pain or symptoms of the patient. pain. Nonetheless, even innocent physicians can be Physicians should avoid prescribing pain medicaheld responsible for negligent overprescribing. tions without first performing a physical exam, It is not surprising, that many drug-related even if it is a recurring patient. types of misconduct are forbidden by California Physicians should also properly screen patients law, and subsequently will serve as the basis for seeking prescription drugs. Likely red flags include, Medical Board enforcement. Any conviction for patients who have had numerous physicians in a violating a federal or state statute regulating drugs, short period of time, patients that refuse to try nonconstitutes unprofessional conduct. A violation narcotic treatments, patients that request specific of one of these statutes, even without a conviction narcotics at the outset of treatment, and patients may serve as the basis for a finding of unprofes- that appear to require refills too quickly. Physisional conduct. Moreover, Business & Professions cians should use common sense and their trained Code section 2241.5(d) states “a physician and sur- medical instincts when screening patients for the geon shall exercise reasonable care in determining first time. whether a particular patient or condition, or the Investigations and Medical Board trials are complexity of a patient’s treatment, including, but costly. Even if the physician ultimately prevails, not limited to, a current or recent pattern of drug thousands of dollars may have been spent to prove abuse, requires consultation with, or referral to, a he or she was not negligent or did not engage in more qualified specialist.” unprofessional conduct. For this reason, it is essenSo what can a physician do to avoid the over- tial that physicians take appropriate steps to ensure prescribing traps?

Registering for access to the that pain medication prescriptions do not get the CURES database will allow physicians to obtain negative attention of the Medical Board. reports on patients, which will provide statistical Nicholas Jurkowitz is an associate at Fenton Nelson with a wide range information about prior drug prescriptions with of experience representing and advising healthcare providers on litigation regard to a particular patient. Once registered, a related matters

tr a n s i t i on s | ca reer M ANAGEM ENT

Considerations as You Navigate Medical School Debt Due

to

the

rising

cost of higher education, student loan debt for

medical

graduates

has

school more

than tripled in the last 15 years. The average debt level now exceeds $174,000.* Needless to say, these debt levels, in conjunction with low starting salaries, can result in an undue financial hardship on resident physicians.

This NEW section will take a look at the questions and challenges associated with various career phases of Southern California physicians, from student loans and applying for positions, to starting/buying/ selling a practice, switching careers and planning for retirement.

Concern regarding cash flow often leads residents to utilize forbearance in order to postpone student loan payments and attain the liquidity necessary to pay for living expenses such as rent and groceries.

While forbearance offers payment relief, it can be at a considerable cost, as interest continues to accrue and can substantially increase an already significant medical school debt burden.

This article provides an overview of the student loan repayment options and debt minimizing strategies that are available to medical school graduates.

Utilize Federal Student Debt Relief Programs

Federal student debt relief programs are available to help recent graduates obtain payment relief and savings on their federal student debt.The nuances of these programs must be fully understood in order to ensure eligibility and the maximization of potential benefits.

1 2 PHYSICIAN MA G A Z INE | JANUARY 2013

Income-Based Repayment

Income-Based Repayment (IBR) is a viable option for residents, as it was specifically designed for borrowers with high debt levels and low incomes. IBR limits monthly loan payments to 15% of a borrower’s prior year discretionary income.

Should the loans not be paid off within 25 years, the remaining balances will be forgiven. Additional benefits of IBR include no interest capitalization while enrolled in the program and, for up to three years, the government will pay any interest on subsidized loans not covered by the monthly payment.

It is extremely important to utilize the most accurate income documentation when applying for IBR in order to ensure the lowest possible monthly loan payment and the highest subsidy.

Income Contingent Repayment (ICR-A), commonly known as “Pay as You Earn,” is a new repayment plan that will soon be available to help borrowers further reduce the cost of debt. While the repayment plan is not yet available, it will be very similar to IBR but with monthly loan payments reduced to 10% of a borrower’s discretionary income.

Additionally, the remaining balance on a borrower’s loans would be forgiven after 20 years instead of 25.

Qualification requirements are still being finalized but borrowers must have no outstanding loans disbursed prior to October 2007 and at least one loan disbursed after October 2011.

Public Service Loan Forgiveness

Public Service Loan Forgiveness (PSLF) allows for tax-free loan forgiveness to federal loan borrowers who make 120 qualifying payments while working for an eligible nonprofit entity. The majority of hospitals are classified as nonprofit and, therefore, many medical school graduates can begin working towards forgiveness during the first year of their residency. The Department of Education also recently released the Employment Certification Form for PSLF to allow borrowers to easily track their progress towards forgiveness.

Only Direct Loans are eligible for PSLF, so many borrowers interested in pursuing PSLF will need to transfer federal loans issued through the Family Educational Loan Program (FELP) to the Direct Loan Program via the Federal Direct Loan Consolidation program.

Combine IBR and PSLF

In order to make a qualifying payment in pursuit of PSLF, one must be enrolled in IBR or another qualified repayment option. Assuming qualifying employment, once a borrower makes 10 years of IBR or other repayment option payments while working at a nonprofit facility, they will have their remaining federal debt forgiven. Keep in mind these payments need not be consecutive, and can be made while working at different nonprofit entities.

Federal Direct Loan Consolidation Program

As referenced above, federal consolidation with the Direct Loan program may be necessary to position loans for Public Service Loan Forgiveness. Con-

solidation can take months to complete, so timing is an important consideration. Additionally, structuring consolidations by grouping like interest rate loans together will preserve the ability to target higher rate debt if necessary in the future.

Additional Items to Consider Outside of Debt Relief Programs: Refinancing Opportunities

Due to improvements in the private loan marketplace, certain borrowers may be able to refinance their higher rate student loans. Lowering private loan interest rates can result in thousands of dollars of savings since none of this debt can be forgiven.

Careful analysis must be performed when evaluating the potential savings and costs associated with any refinancing decision.

Financial Allocation Management

With high student debt levels and relatively low starting salaries, residents face a unique challenge in balancing the repayment of their student loans with living expenses, insurance coverage, saving for future purchases like a home and investing. When determining the appropriate allocation, one must consider liquidity needs, tax implications, risk tolerance and rate of return.

Understanding Your Options

Student loans and related federal programs can be overwhelming. Taking full advantage of available benefits requires an in-depth understanding of each program’s details. To begin formulating your optimal repayment strategy, CMA members can sign up for a free personalized student debt assessment from GL Advisor. GL Advisor offers a unique service designed to help medical professionals lower the cost of their debt, obtain payment relief as needed and save time so they can focus on their careers. After receiving a free assessment, CMA members can retain GL Advisor’s service at a discounted fee for their first 12 months of service. *Based on data collected by the AAMC, AMA and GL internal student database.

White paper was prepared for the California Medical Association by Todd Balsley of GL Advisor. GL Advisor is a financial advisory firm that specializes in helping physicians effectively manage their medical school debt and other financial matters. To learn more or sign up for an assessment, visit www.glAdvisor.com/CMA or call (877) 552-9907.GL Advisor is a division of Graduate Leverage, LLC. GL Advisor does not offer all services to residents of North Dakota at this time. j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1 3

ca reer ma nagement | tr a n s i t i on s

ICR-A (Pay As You Earn)

p hys i c i a n s n ews n et work .com | NEWS i n revi ew

Read Full Stories and Subscribe to the PNN WeekLY eNews Bulletin at www.PhysiciansNewsNetwork.com

A Service of the Physicians News Network and The LOS ANGELES County Medical Association PNN | LOCAL • TIMELY • RELEVANT

reporting on the economics of healthcare delivery

LA Officials Scramble to Comply with Affordable Care Act With California being an early adopter of health insurance exchanges, Los Angeles County officials are scrambling to overhaul the county’s outdated healthcare system to comply with the Affordable Care Act and compete against private health insurers by Jan. 1, 2014.

Huntington Hospital Exec Explains Physician Collaboration via Technology Rebecca Armato, executive director of physician and interoperability services at Huntington Memorial Hospital, recently addressed the annual World Healthcare Innovation and Technology Congress to outline plans on how to use technology systems to improve quality of care while cutting costs.

Apollo Medical Holdings Inks Pact for Physicians with California Hospital Medical Center

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PNN brings readers a look at the latest local and state headlines impacting the economics of healthcare delivery in Southern California. Local, timely and relevant. In this NEW section you will find a summary of the latest headlines from PNN’s most recent weekly eBulletins.

Apollo Medical Holdings Inc. recently signed an agreement with California Hospital Medical Center in Los Angeles to provide hospitalist services.

Under the terms of the contract, published on Nov. 21, Apollo will provide two daytime and one nighttime doctor at the hospital to respond to rapid response, emergency calls and provide internal medicine consultations on trauma patients.

Keck School Online Program Draws Interest The Keck School of Medicine at the University of Southern California is drawing interest from health professionals, including physicians, for its newly created online public health graduate program, according to the program director.

The program, which combines online coursework and a practicum, recently started accepting applications for the spring of 2013.

St. John Health Center Shakes Up Leadership Saint John’s Health Center in Santa Monica abruptly has ousted its top two executives and most of its governing board, as the hospital grapples with financial losses and rising competition, according to the Los Angeles Times.

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New Triage System Cuts ER Waiting Times Torrance Memorial’s new triage system has led to improved patients’ waiting times in the emergency room and streamlined the process for providing patient care, according to news reports.

Last June, a team of physicians, nurses and other staff joined forces to improve operations in the ER by using the “Lean Operating System,” Toyota’s model for process improvement.

La Salle Medical Physicians Get New Paperwork Guidelines Associated physicians with San Bernardino-based independent practice association, La Salle Medical Associates, Inc., now are required to submit claims and other paperwork electronically to a new managed care services organization, Network Medical Management, Inc.

Anthem Blue Cross Rate Hike Plan Draws Scrutiny News reports that California’s largest for-profit health insurer, Anthem Blue Cross, is seeking to raise rates an average of 18% for more than 630,000 individual policyholders, is drawing scrutiny from regulators and the ire of consumers and doctors here and elsewhere.

Low-income Children to be Transitioned to Medi-Cal On January 1st, the Department of Healthcare Services (DHCS) will start transitioning about 409,000 low-income children, including those living in Los Angeles County, from the Healthy Families program to Medi-Cal.This will be the first of four phases in the plan, which calls for transitioning more than 860,000 low-income children from the Healthy Families program to Medi-Cal, according to news reports.

New LA Program Provides Workforce Health Risk Assessments Dr. Max Lebow, medical director at the Reliant Immediate Care Medical Group, Inc., located at the LAX International Airport, recently rolled out Healthy@ Work, a program to provide employer workforces with health risk assessments, preventive health screenings, and health and lifestyle information.

LACMA’s chair of the political action committee, Dr. Tom Horowitz, said he is looking forward to working with Santa Monica Mayor Richard Bloom, who declared himself the winner in a tight Westside Assembly race recently.

On Nov. 28, Bloom declared victory in an email thanking supporters, after his lead over Assemblywoman Betsy Butler grew to 1,246 votes, according to news reports.

Anthem Blue Cross Announces ACO Network Expansion in LA County This month, Anthem Blue Cross announced the expansion of its Accountable Care Organization (ACO) network with a program focusing on managing patients with chronic disease at Cedars-Sinai Medical Care Foundation and Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians.

With ACOs, hospitals and a network of doctors share responsibility for providing care to patients with the goal of saving costs by avoiding unneeded tests and procedures. Several hospitals, insurers and physician practices are making plans to form ACOs for Medicare patients and those with private insurance.

LACMA Officials Lobby to Stop Medicare cuts LACMA’s top officials said a recent meeting with Congresswoman Karen Bass (CA-33) to gain support for stopping proposed Medicare cuts as well as remove Los Angeles County from the proposed dualeligible reform, was highly successful.

Physicians Earnings Remain Flat; Other Healthcare Professionals Taking on Larger Roles New research published in a letter in the Nov. 28 issue of the Journal of the American Medical Association suggests that although physicians remain important, other health professionals will take on greater roles as health benefits are expanded in the next 13 months, under the Affordable Care Act.

Growing Demand Anticipated for Los Angeles County 211 Helpline With hundreds of thousands of uninsured people joining the healthcare system under the Affordable Care Act in 2014, the 211 Los Angeles County helpline will likely play a more prominent role connecting patients with doctors and social service providers.

Infrastructure and Investment. LA County -- Los Angeles area healthcare answering service Medical Practice Solutions, Inc. has been acquired by nationwide call center 1-800 We Answer, according to news reports.

“Supporting doctors through English and Spanish language call center support and live telephone answering services is central to our business,” said Rob Porter, CEO and president of 1-800 We Answer.

-- WellCare Health Plans, Inc. completed the acquisition of Easy Choice Health Plan, Inc., which serves about 36,000 Medicare Advantage plan members in Los Angeles, Orange, Riverside and San Bernardino counties, according to news reports.

In addition, Easy Choice will increase its 2013 service area to 11 California counties, including the San Diego area, as well as five counties in Northern California.

-- Construction of a 190,000-square-foot medical office at Wilshire Blvd. and Witmer Street in City West, slated to be finished in the second quarter of 2014, will serve as home to Good Samaritan’s specialty medical clinics, including cardiology, orthopedics and primary care.

The $80 million project will create a facility with a pharmacy, an outpatient surgical center and five levels of physician offices.

-- MemorialCare Health System in Long Beach and Orange County said on Nov. 27 it would buy specific assets of Universal Care and file an application for its newly formed Seaside Health Plan to become a California licensed health plan.

Seaside seeks to support managed MediCal members and prepare for the California Children’s Services (CCS) demonstration project, addressing children with certain diseases and ongoing conditions.

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n ews i n revi ew | physi c i a n s n ews n et work .com

LACMA Chair is Eager to Work with Santa Monica Mayor

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Times are changing. The many challenges surrounding healthcare reform and physicians advocating for patients’ rights, while looking for their own representation and support, will require strong leadership and doctors who stand united.

“As more doctors become employed physicians, more than ever do they need an association to support them,” said Dr. Samuel Fink, LACMA’s president and chairman of the board.

As we’re heading into the New Year, the NEW LACMA is ready to take on these challenges, advocate on behalf of doctors and patients, and restore some fairness to the Los Angeles healthcare system, vowed Rockard (Rocky) Delgadillo, LACMA’s CEO. LACMA has already laid much of the groundwork.

Welcome to the NEW

NEW LACMA

BY Marion web

Advocacy—Protecting Doctors’ and Patients’ Rights When it came to stopping the proposed 26.5% Medicare (SGR) physician cuts and 2% Medicare sequestration cuts, LACMA’s officials took swift action by asking doctors to call their congressional leaders, urging them to stop the cuts.

Meanwhile, LACMA’s top officials took the initiative to meet with political leaders, including Congresswoman Karen Bass (CA-33), to advocate for their members.

Luis Ayala, LACMA’s director of government affairs, said that after hearing doctors’ concerns, Bass, a former physician’s assistant, agreed to support them.

“She understands healthcare and understood the equation and basically committed herself to work with us and to make sure our voices are heard for the benefit of the patients,” Ayala said.

LACMA’s political action committee members have made it a point to meet with all state legislators in Los Angeles County to ensure physicians’ issues and voices are being heard, said Dr. Troy Elander, past president of LACMA. “We’ve been getting to know them and they know what issues are important to us,” said Dr. Elander, who is also the assistant clinical professor at Jules Stein Eye Institute in Westwood.

This type of political advocacy ultimately benefits not only LACMA’s members, but all Los Angeles County physicians and the patients they serve.

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featu re | the new l ac m a

“The political action committee had a great track re-

courtrooms. This year, Delgadillo said, the NEW LAC-

cord in terms of the candidates that were elected and we

MA also will not shy away from filing suits to fight for

talked to them about protecting our patients and other

patients’ and doctors’ rights.

issues that are important to doctors,” Dr. Elander said.

tention of doctors and patients across the nation when

“The new political action committee will support

it filed a lawsuit against Aetna, charging that the insurer

candidates that are beneficial and have the best interest

often refuses to reimburse policyholders who go out of

of doctors and patients in their hearts,” Dr. Fink said.

their networks when medically necessary, even though

The great vigilance LACMA provides its members

they have purchased policies that allow them to do so.

isn’t always apparent. But Dr. Fink, who has been a LAC-

This was followed by another lawsuit on September

MA member for more than 30 years, wants physicians

13, 2012 in the local Superior Court. At that time, LACMA

to know that his organization has and always will ensure

went up against Health Net for legally denying patients’

that members are well protected—financially, politi-

claims to important, even life-saving, medical treatments on a routine basis.

cally, and legally.

“There are many competing agencies out there, but we hardly see anyone who advocates for patients and physicians (like LACMA does). We try to advocate for both groups, because we know the doctor-patient relationship is critically important.”

Last July, LACMA made headlines, drawing the at-

This effort will continue.

One of the major benefits of being a LACMA member, he pointed out, is the money

“Our two lawsuits send a clear signal to the world of healthcare that LACMA is no longer go-

members save on such

ing to stand on the sidelines

critical issues as medical

in the world of policy, and, in fact, we have decided

malpractice insurance.

Though The Medi-

to step up into the ring on

cal Injury Compensation

behalf of doctors and their

Reform Act

patients,” Delgadillo said.

(MICRA)

was passed almost 40

Greater Diversification

years ago, California Trial Lawyers tried to overturn it virtually overnight with a bill that would have allowed plaintiff attorneys to sue based upon the retail price of the medical services provided, rather than upon the amount paid by the injured party.

Other LACMA physicians regard Delgadillo’s arrival at LACMA in 2012 as a major win for the organization. Under his leadership, the NEW LACMA is poised for even more growth and ethnic diversification.

“We are vigilant 24 hours a day against any at-

“With the arrival of Rocky last year, we outlined

tempt to overturn MICRA,” Dr. Fink wrote in an article

what we think would be the survival and growth of

informing members about MICRA. “Never underesti-

LACMA to represent our physicians and the patients

mate the hard work that your medical association does

they serve,” said Dr. Robert Bitonte, past president of

to make sure that you are protected!”

LACMA and chair of the legal affairs committee.

Not Afraid to Take Legal Action

ing on the fight against the big insurance companies.

Dr. Elander described Rocky as instrumental in takDr. Fink is passionate about LACMA. He and Delgadillo agree that The NEW LACMA requires even greater strength in numbers given the challenges ahead.

He’ll also open the doors wide to a more unified and diversified LACMA. Under Delgadillo’s watch, LACMA will represent

“There are many competing agencies out there,

the same ethnic diversity of the community it serves,

but we hardly see anyone who advocates for patients

starting with the creation of the first ever Latino Physi-

and physicians (like LACMA does),” Dr. Fink said. “We

cians Advisory Committee.

try to advocate for both groups, because we know the doctor-patient relationship is critically important.”

Last year, LACMA broke barriers by entering the 1 8 PHYSICIAN MA G A Z INE | JANUARY 2013

The Latino Physicians Advisory Committee, formed last November, will be the first of a new planned series of advisory committees to be launched by the NEW

and their patients.

“If you try to deliver care in underserved areas, it is key to pay physicians a higher differential in those

To reach an even more diverse population in Los

underserved areas,” he said. Dr. Bitonte said he would

Angeles County, the NEW LACMA also will create a

like to address the issue of better compensation or

Women’s Physicians Advisory Committee, an African-

debt forgiveness this coming year as an incentive, but

American Physicians Advisory Committee, and an

commented that “these are not easily solvable issues.”

Asian Physicians Advisory Committee.

He also said that allowing physicians to have au-

According to reported estimates, African-American

tonomy to make the best decisions for their patients

and Latino physicians in Los Angeles County represent

will be a cornerstone issue for the NEW LACMA. Fair

just over 6% of the county’s 26,940 physicians, despite

compensation for all doctors, regardless of where they

representing 48% of the population.

practice, also will be on the table.

“When I first came on board, we had very little representation of Latino physicians at LACMA, which

t he new l ac ma | featu r e

LACMA in an effort to expand the reach to physicians

LACMA Benefits

made it a priority for me to reach out to the Latino community,” Delgadillo said.

New Purchasing Group

Under the leadership of Dr. Hector Flores, the Latino

In its continued effort to provide even more ben-

Physicians Advisory Committee will work hard this year

efits to its members, the NEW LACMA will also form a

to increase the number of Latinos enrolling into medical

new purchasing group where doctors will save on key

school while attracting Latino physicians from all over

purchases from malpractice insurance, surgical gloves

the world to practice in Los Angeles County, he added.

and other medical supplies to computers.

With an estimated 34 million more Americans

“We will also offer educational opportunities to in-

gaining access to health insurance under the Afford-

crease the business acumen for doctors who run their

able Care Act, along with a rising aging population,

own businesses,” Delgadillo said.

researchers estimate a need for 52,000 more primary care doctors within the U.S. by the year 2025.

This should provide members with significant savings.

“Our goal is to save members money that is at least equivalent to the cost of their membership,” Dr. Fink said.

Addressing the Physician Shortage LACMA already has begun to address the doctor

Physicians News Network

shortage by reaching out to medical students, residents

The weekly Physicians News Network is an entirely new

and fellows, providing scholarships, career guidance

concept to keep members abreast of key developments

and networking opportunities.

in the industry, provide breaking news focusing directly on

In October, the California Medical Association House

Los Angeles County and to keep members involved. “Ev-

of Delegates passed a resolution to eliminate dues for

ery week we are communicating with our members,” Dr.

interns, residents and fellows who join the LA County

Elander noted. “You can get 1,000 emails, but not one will

Medical Association and CMA in the hope of attracting

have local medical news—PNN does just that.”

up-and-coming doctors.

PNN is the only source that provides every doctor

During that time, LACMA also invited physicians to

serving in Los Angeles County with the weekly custom-

its annual LA Healthcare Awards dinner to help raise

ized news they need to stay informed and abreast of

funds for a loan repayment and scholarship program

what matters to them.

to encourage newly graduated physicians to practice in underserved areas in the county.

“The foundation has been raising funds to provide

“Being a part of LACMA gives you prestige in the physician community and business community and the political arena and a presence. What LACMA can do is connect the dots—to influential people in Los Angeles County and for upward mobility”

“We believe that every doctor in Los Angeles should be a member of LACMA,” said Dr. Fink.

Why? The answer is clear.

medical school scholarships and we’ve been targeting

“Being a part of LACMA gives you prestige in the

those in disadvantaged neighborhoods,” Delgadillo said.

physician community and business community and the

Dr. Bitonte believes that the lack of fair compensa-

political arena and a presence,” Delgadillo said. “What

tion is partly to blame for the shortage of doctors in un-

LACMA can do is connect the dots—to influential people

derserved communities.

in Los Angeles County and for upward mobility.” j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1 9

u n i t ed we sta nd | at work for yo u

Medi-Cal primary care rate hikes delayed Medi-cal primary care physicians will have to wait to receive the higher reimbursement rates that were set to go into effect on Jan. 1 under the Affordable Care Act (ACA). The delay has been caused by a state health plan amendment that must receive federal approval. It is not yet known when the federal approval process will be completed, but the California Department of Healthcare Services (DHCS) has said the earliest it would be able to implement the increase is summer 2013. DHCS has been unable to provide any detailed information regarding the reason for the lengthy delay.

This 100% federally-funded increase was intended to recruit more physicians to treat lowincome patients who will be newly eligible for health coverage under the ACA. With the increase, primary care physicians should see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to the Centers for Medicare and Medicaid Services (CMS), states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.

California is not alone in this delay; several other states are in the same boat as well. The final federal regulations governing the two-year

United We Stand delivers the latest California Medical Association news and insight into CMA-supported and opposed legislation, as well as information on the results of healthcare-related bills to keep member physicians up-to-date on the latest from the policy makers in Sacramento.

primary care physician rate hike were released on November 1, which did not give state much time to write and submit the necessary plan amendments.

DHCS has indicated that regardless of when it is implemented, the increase will be retroactive to January 1, 2013. However, they have been unable to tell us exactly when we can expect the rate increase and exactly how retroactive payment will function, apart from saying that physicians will not be required to resubmit claims.

The California Medical Association will provide members with additional information as it becomes available.

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CMA President’s Message:

Shaping the Future of Healthcare in California Paul R. Phinney, MD, President, CMA

With 2 012 comi n g to a close and 2013

looming ahead, as the new President of the California Medical Association (CMA), I want to take this opportunity to outline what we may see unfold over the course of the next year.

When I assumed the role of president in October, I identified three imperatives critical to both our short and long-term success as an association: First – The importance of membership in organized medicine NOW, when healthcare delivery is rapidly changing, and how it is ON US to “connect the dots” and find linkages between the needs of potential members and the value CMA can provide.

Second – The vital role of physicians in leading change, moving toward a healthcare delivery system that is patient centric, physician-driven, high value, high quality, evidence-based and universally accessible. Without doctors leading the way toward that end, we will inevitably see a less desirable result.

Third – Mentorship. It is important that we provide guidance and experience to our medical students, residents and young physicians as they enter the workforce and grow in their practices, in order to help them succeed as they take the medical, social and political reins from our hands.

From almost the first years of practice, my professional life was a mix of clinical and non-clinical activity. At some point, it became clear to me that even a large integrated group cannot insulate itself from accelerating change in the economic, technological and political context for medicine. It was clear to me that joining an organization like CMA was the natural thing to do.

I had, at last, begun to understand the connection between organized medicine and what I wanted for my practice, my patients and the health of my community, as well as what I wanted to contribute to the profession.

Many physicians – overloaded with exploding regulation of their practices, decreasing reimburse-

it will be an area of my focus over the next year. It is something each one of us can and should do. A healthy future requires up-front investment.

As the New Year begins, I hope each of you will join me in bringing new energy to these three imperatives: membership, mentorship and the stewardship not just of our profession, but of the evolving system we use to provide care to our patients.

We live in turbulent and uncertain times that very likely will Look for ongoing coverage of this topic produce the most rapid in the PNN eNews Bulletin and on phychange in the delivery siciansnewsnetwork.com, your resource of healthcare in decades. for what’s to come in 2013: The Year of It is an incredible time Uncertainty, The Year of Opportunity to be part of the profession. As we navigate the waters and obstacles ahead, I encourage each of you to consider what an important role you play in creating a future we can delight in, and be proud of. The default – what will happen absent our effort – simply is not good enough for us – or for our patients.

j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 2 1

u ni ted we sta nd | at work for yo u

ment rates and an overwhelming flow of information and expectation – may make that same connection.

It is up to US – the members of CMA – to help find that connection for physicians who haven’t yet done so. It will not happen by itself. At a time when legal, regulatory and legislative agendas are continually shaping the way medicine is practiced in California, this is more important than ever.

With implementation of the Affordable Care Act just around the corner and with California leading the way in many respects, it is imperative that physicians proactively take a lead role in shaping the changes ahead.

Only physicians know how to balance medical care wisely as we figure out how to realign incentives toward a sustainable health system and stable fiscal future.

If we resign ourselves to a future in which economists and business executives lay out the rules for change, we are likely to end up with a system in which quality is measured in dollars, value is available only to those who can pay for it and physicians are controlled by payors and regulators.

But it doesn’t have to be that way. With proactive involvement and dedicated advocacy, physicians can be the ones leading the change, helping to invent a better future for our patients.

Each physician will approach that effort in his or her unique way. But the aggregate effort by CMA as a whole will be both potent and determinative.

Each of us in the profession has arrived where we are with the guidance and mentorship of someone who believed in us. It is this critical assist that is the third imperative as physicians of CMA. Medical students, residents and young physicians whom WE mentor today – here and in our offices – will not only provide our medical care, but will be the leading advocates in the social and political arenas that will affect the science and art of medicine, the care and well-being of patients, the protection of public health, and the betterment of the medical profession – the mission of our association.

Mentorship deserves our attention, and

2 2 PHYSICIAN MA G A Z INE | JANUARY 2013

u n i t ed we sta n d | at work for you

u n i t ed we sta nd | at work for yo u

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a s s o c i at i on ha pp eni ngs | news & events

ceo’s letter

As w e ’ r e h e a d i n g into the New Year, the Los Angeles County Medical Association is pleased to

offer existing and new members many more opportunities and benefits.

At the same time, such key issues as healthcare reform and advocacy for physicians’ and patients’ rights in our communities and courtrooms will continue to take a center stage role at LACMA. Today, we are far more poised than ever to take on these challenges.

We will look into building our political capabilities to advocate on behalf of physicians and restore some sense of fairness to the healthcare system in Los Angeles County.

Our new political action committee will connect even more dots with elected officials—not just in Los Angeles County, but in the state of California and across the nation—to deal with these issues and ensure that physicians’ voices are being heard.

We will continue to demonstrate our courage for physicians and stand up for their profession—whether it will be in the courts, legislature or at City Hall.

As we set out from the beginning, doctors need to be united.

The more we can get doctors to unite around issues and continue to do outreach to get them to unite with LACMA, the better we are equipped to take on these challenges.

We will provide ongoing training for physicians to help them accomplish their goals and continue our series of networking events with elected officials and others to make the presence of physicians tactile in the community.

This year, LACMA will offer media training and create op-eds by physicians to let our voices be heard. Networking events, speaking engagements at hospitals and other events will also be a part of this equation to connect more physicians.

We will provide members new benefits.

LACMA’s new purchasing group, for one, will allow physicians to buy insurance, medical supplies and equipment like computers at discounted rates. These savings should offset LACMA’s annual membership alone.

With the enhanced communication we have put into place via the Physicians News Network (PNN) newsletter, physicians receive weekly news that isn’t only informative, but relevant to them.

We can get more doctors involved in the leadership of organized medicine through our various advisory communities, including the first Latino Physicians Advisory Committee, which we kicked off late last year.

It will be an exciting year and we hope that existing members and the entire Los Angeles County community will rally behind LACMA and get involved.

As always the Los Angeles County Medical Association will share social and event highlights, as well as news and developments as they continue their work to advocate quality healthcare for all patients and serve the professional needs of its members.

Rocky Delgadillo Chief Executive Officer

2 4 PHYSICIAN MA G A Z INE | JANUARY 2013

LACMA’ s to p o ff i c i a l s said a recent meet-

ing with Congresswoman Karen Bass (CA-33) to gain support for stopping proposed Medicare cuts as well as remove Los Angeles County from the proposed dualeligible reform, was highly successful.

LACMA’s representatives, Rocky Delgadillo, Dr. Tom Horowitz, Dr. Marshall Morgan, and Luis Ayala, met with Bass last Monday.

Ayala, LACMA’s director of government affairs, said the one-hour meeting focused on preventing the scheduled 26.5% Medicare SGR physician cuts and the 2% Medicare sequestration cuts.

The officials also addressed concerns surrounding the planned dual-eligible project, which would put poor seniors who are eligible for both Medicare, the singlepayer system for retirees, and Medicaid, the program for low-income Americans, under the managed care of private insurers.

Ayala noted that 50% of Medi-Cal patients—low-income Californians—have a tough time finding a doctor. About 75% of doctors stopped taking qualified patients, because the reimbursements do not meet the cost of overhead and supplies to treat them.

Reform for dual eligibles is a hot-button issue for LA

doctors.

“We advocated for LA County to be removed from the dual-eligible project,” Ayala said, citing concerns that LA County simply does not have enough doctors to meet the rising demand for healthcare services. That is discounting the challenges patients would face under the proposed reform.

Dr. Samuel Fink, LACMA’s president and chairman of the board, echoed Ayala’s sentiments.

Forcing dual eligibles into managed care plans, he said, would be disruptive and provide a disservice to patients.

“Dual eligibles would be forced into managed care plans and away from the doctors they have been with for many years,” Fink said. “Patients should be given every opportunity to stay with their doctors.”

After meeting with LACMA’s officials, Congresswoman Bass, a former physician’s assistant, is expected to be supportive of LACMA. “She understands healthcare and understood the equation and basically committed herself to work with us and to make sure our voices are heard for the benefit of the patients,” Ayala noted.

SEEN ON www.PhysiciansNewsNetwork.com

LACMA Forms Latino Physicians Advisory Committee L AC M A h as a n n o u n ce d the formation of its first-ever Latino Physicians Advisory Committee with Dr. Hector Flores chairing the group.

Flores is chairman of the Family Practice Department at the White Memorial Medical Center and co-director of the hospital’s Family Practice Residency Program. He received his undergraduate degree from Stanford University and his medical degree from the University of California at Davis.

An advocate in cultural competency in healthcare, Dr. Flores is a frequent panelist and speaker on such topics as developing high-performing healthcare systems, payment innovation, family medicine, the need for culturally relevant care, and the effect of diversity on healthcare quality.

With the Affordable Care Act, an estimated additional 500,000 Los Angeles County residents, mostly Latinos, will qualify for medical insurance by the year 2014. This expansion, compounded with a shortage of physicians, will strain the capacity of the Los Angeles County healthcare system. One of the main goals of the new committee will be to increase the number of Latino physicians in Los Angeles County.

“I look forward to leading LACMA’s Latino Physicians Advisory Committee,” Flores said. “We will be a committee action-focused on addressing the needs of patients and improving the healthcare system to better serve disadvantaged communities.”

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a s s oc i ati on ha pp eni n g s | at work for yo u

LACMA Officials Lobby to Stop Medicare Cuts

a s s o c i at i on ha pp eni ngs | news & events

District 2 Harvest Moon Tradition Revival Ph ys i c i a n s o f n u m e r o us specialties shared camaraderie, fine food, and a delightful evening in a beautiful garden, thanks to the work of District 2 Alliance spouses. Seventy turned out to enjoy the 2012 version of a vaunted tradition, a respite from the rigors of modern medicine. Surgeon David Dahl and attorney wife Annabelle provided the olive and oak-framed setting. Excellent live music was contributed by orthopedic surgeon Steve Riffenburgh. Drs. Glenn Ehresmann and Robert Henderson, Chief of Staff of all 5 USC hospitals, took the microphone to applaud Halaine Rose for enthusiastically bringing us together against the odds! Halaine thanked her team--Marilyn Henderson, Jan Moritz, Joan Dietrick, Joyce Getzen, Dr. Holt A delightful evening of camaraderie, fine Rose--and heaven food, in a beautiful garden, thanks to for holding off rain. the work of District 2 Alliance spouses.

The 2012 party Seventy turned out to enjoy the 2012 participants included version of a vaunted tradition, a respite some new and potenfrom the rigors of modern medicine. tial members along with stalwarts. All Residents at Huntington Hospital were invited (at no cost, thanks to generosity of several docs). Mrs. Rose challenged all present to conjure ways to gain young physician involvement and send ideas to Dr. Amy Caton (D2 member; resident at UCLA). Halaine noted the importance of legislative advocacy and drew attention to impressive photo display boards depicting D2 work and fun at local, national, state CMAA, and western states levels.

Neurosurgeon Bill Caton (D2 Board; then president of D2 and his specialty society) challenged wife Cathy, Halaine, and Jan Moritz to recreate a fall tradition. Their success in October 2006 was the catalyst for revitalizing our District 2 Alliance.

Leading and continuing today, D2 is the largest and most active LACMA Alliance.We are in synch with LACMA President Sam Fink’s key goal of district revitalization.

2 6 PHYSICIAN MA G A Z INE | JANUARY 2013

Dr. Bill Caton and Cathy, Dr. Amy Caton and Lance Polverini.

Halaine Rose (right) with Dr. Steve Riffenburgh.

Halaine Rose , Janet Kadin, with officers Hollis Kim Bowles and Gloria DeOlarte,MD (LACMA & Alliance D2)

a s s oc i ati on ha pp eni n g s | at work for yo u

“When it comes to Meaningful Use, athenahealth did all the legwork… and then they made it easy for me to do.”

–Dr. Reavis Eubanks

This is how Dr. Eubanks

got paid for Meaningful Use.

A

fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months.

With guidance every step of the way and proven, cloud-based services.

 Best in KLAS EHR*

 Free coaching and attestation

 Seamless clinical workflow  Guaranteed Medicare payments**

85% of eligible athenhealth providers attested to Stage 1 Meaningful Use. And we’re ready for Stage 2.

Visit www.athenahealth.com/SCA or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians ** If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply.

Cloud-based practice management, EHR and care coordination services

a s s o c i at i on ha pp eni ngs | news & events

attention lacma/cma members

RENEW TODAY By now, all LACMA and CMA Members have received their 2013 dues statements.

Dues were due by December 31, 2012.

Please be sure to renew your membership to ensure continuation of your benefits.

Dues can be renewed conveniently online at www.lacmanet.org

Thank you for supporting your profession and your patients by supporting organized medicine! memeber exclusives

New Online Marketplace Offers Discounts on Products and Services For Your Practice!

LACMA is pleased to designate a “best-in-class� designation for any vendor who meets the criteria outlined in our vendor vetting process so they may become a partner in our exclusive online marketplace. The online marketplace is a new and growing program designed to help your practice grow! Please call 213-226-0313 to access the discounts and learn more!

Featured Vendors Include:

LOS ANGELES

Collection Service Inc.

2 8 PHYSICIAN MA G A Z INE | JANUARY 2013

T w o year s ago, the Legislature gave Medi-Cal the authority to do four “pilot projects” to redesign care for Medicare/Medi-Cal dual eligibles. The centerpiece of these pilot projects is requiring dual eligibles to enroll into Medi-Cal managed care plans.

LACMA is opposing this proposal.

TAKE ACTION IMMEDIATELY

Urge the DHCS to withdraw this ambitious proposal to the Federal Government!

PLEASE VISIT THE SITE BELOW TO SUBMIT A LETTER TO YOUR LEGISLATOR

http://www.lacmanet.org/Advocacy/TakeAction.aspx Legislators need to hear from LA County Physicians to know the true impact these cuts would have in their districts.

WWW.LACMANET.ORG

LACMA LAUNCHES CAMPAIGN TO URGE LEGISLATORS to HELP REMOVE LOS ANGELES COUNTY FROM THE COORDINATED CARE INITIATIVE: DUAL ELIGIBLES DEMONSTRATION PROJECT

New Tools to Take Action, Get Involved, and Manage Your Practice New features include Members-only portals

Physician community networks Office manager online forums Physician directories

New online marketplace showcasing vendors offering exclusive money-saving discounts on products and services geared towards efficient practice management operations.

c l a ssi fi ed | jo b boa r d

To place a classifieds ad, contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.

135

520

legal services

openings—Physicians

LEGAL REPRESENTATION FOR PHYSICIANS

Former Deputy Attorney General, Law Professor & Administrative Law Judge specializing in Administrative & Medical Board matters.

Free initial consultation RONALD S. MARKS A Professional Law Corporation 21900 Burbank Blvd., Suite 300 Woodland Hills, CA 91367

(818) 347-8112

RonMarks@prodigy.net ww.ronmarks-law.com

205

office for lease/ sublease/share

MEDICAL SPACE IN MANHATTAN BEACH

Fully outfitted Medical space available in Manhattan Beach (borders Hawthorne and El Segundo). 700-2,000 square Feet available in existing Physical Therapy office. Freeway accessible, plenty of parking. Call 310-725-8505

Medical office for lease

South Gate Medical office for lease with ample parking. Please contact 714-833-7573.

Advantage Wound Care Surgeons Needed for Expanding Nationwide Wound Care Practice: *Full or part-time positions *Add revenue to your current practice *Flexible schedule, complete autonomy *No Call *Competitive Pay Please contact us for more information: Phone: 1-877-878-3289 Fax: 1-877-817-3227 or email CV to: Jobs@AdvantageWoundCare.org

www.AdvantageWoundCare.org SEEKING OFFSITE MEDICAL DIRECTOR

Passive income opportunity $24k/year.

Fallbrook Medical Center is seeking an offsite medical director board certified Family Practice/ Internal Medicine to serve as supervising physician. Malpractice covered by group. Contact 951-7515593 karenberrios@fallbrookmedicacenter.comexaminations. 866-723-2081.

Full-time Family Practice and Pediatrician

Garfield Health Center (GHC), operating as a Federally Qualified Health Center Look-Alike, is located in Monterey Park, California. GHC’s mission is to provide comprehensive, culturally competent, quality primary health care to medically underserved and vulnerable individuals and families, including the Asian immigrant community, in the San Gabriel Valley.

We are seeking full-time California licensed Family Practice Physician and Pediatrician to join our clinic.

to place an ad

Contact DARI DPEBDANI@GMAIL.COM

or

858-231-1231

Classified • Job Board CME • Marketplace

3 0 PHYSICIAN MA G A Z INE | JANUARY 2013

Job requirements: • Board Certification in Family Practice and Pediatrics • California Medical License • Bilingual – English/Chinese Mandarin or Cantonese highly preferred • Ability to be flexible Contact Information: • Jamie Thai • Phone: (626) 307 – 7397 • Fax: (626) 307-1807 • Email: garfieldhealthcenter@ gmail.com

TRACY ZWEIG ASSOCIATES • Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

530

opportunity wanted

FILM READING

PM

Marketplace

Get Noticed! for maximum visibility for your product and services that will reach thousands of readers monthly, contact Dari today!

Dari Pebdani Phone: 858-231-1231 | dpebdani@gmail.com

www.PhysiciansNewsNetwork.net

Carl H. Boatright, MD, DABR, 30 years’ experience, rapid turn-around. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.

540

locum tenens available

TRACY ZWEIG ASSOCIATES • Physicians • Nurse Practitioners • Physician Assistants

LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

610

medical practice for sale

MEDICAL OFFICE FOR SALE

In Sunny California, just North of LA, a medical office is available for sale, all ready for the doctor to move in. Current tenant, retiring Board Certified General Surgeon will help with transition. The office is walking distance of main hospital and surrounded by multiple medical offices. May accommodate easily 2 MD’s. Current personnel will stay. It may be sold alone or together with the building it is in. Interested, please call 661-942-6565.

NEWS NETWORK www.PhysiciansNewsNetwork.com

To place a marketplace ad, contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231

Advertiser Index Athena Health..................................................................27 California Wine Club.........................................................3 Cooperative of American Physicians .............................. C3 The Doctors Company .................................................. C4 Fenton Nelson ................................................................ 21 Marsh.................................................................................5 Mitochon ..........................................................................7 Office Ally ..................................................................... C2 Telephone Conneciton.....................................................29

j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 3 1

c l a s s i fi ed | jo b boa rd

To place a CME listing, contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.

% of California Doctors are concerned healthcare reform is eroding their earning power physicians are unwilling to recommend healthcare as a profession

doctors believe that healthcare reform will negatively impact patient care.

65%

% of physicians would choose the same career if they had it to do over again

Nine in Ten

6 in 10

66.5

physicians are unwilling to recommend heathcare as a profession

by t he n u m ber s | hea lthca re reform

Seventy-six

of doctors do not think that healthcare reform will reduce defensive medicine.

25,000

$

the amount 62% of physicians estimate they provide in uncompensated care each year.

of doctors believe that healthcare reform will negatively impact their relationship with patients.

51% forty

% of physicians feel that liability/ defensive medicine are the least satisfying about medical practice

Sources: The Future of Healthcare: A National Survey of Physicians. www.thedoctors.com A Survey of America’s Physicians: Practice Patterns and Perspectives http://www.physiciansfoundation.org

3 2 PHYSICIAN MA G A Z INE | JANUARY 2013

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection. j a n ua ry 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 3 3

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head.

We make CME easy, free, and online. We do extra homework.

We protect good medicine. We are your guardian angels. We are The Doctors Company.

Donald J. Palmisano, MD, JD, FACS Board of Governors, The Doctors Company Former President, American Medical Association

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer. And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient. To learn more about our medical malpractice insurance program, contact us at (800) 717-5333 or visit us at www.thedoctors.com.

www.thedoctors.com