February 2013

t H e n e W o f f i c i a L p u B L i c at i o n o f t H e Lo s a n G e L e s co u n t y M e d i c a L a s s o c i at i o n REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

NEW REVENUE STREAMS FeBrUary 2013

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feBr ua ry 2013 | ta BLe of cont ent s

Volume 144 Issue 02

FEATURES

18

NEW REVENUE STREAMS

Healthcare reform, with its focus on providing quality-driven and costconscious medical care and reimbursement issues, has led many doctors to contemplate ways to find new revenue streams.

18

PNN SPECIAL FEAtURE

departMents

14

The Year of Uncertainty

As California is positioning itself for the advent of healthcare reform, Southland physicians will be faced with many uncertainties in 2013 and beyond.

16

6 FRONT OFFICE | PRACTICE MANAGEMENT

News, tips, advice and resources

14

The Year of Opportunity

Uncertainties aside, the implementation of the Affordable Care Act offers unprecedented opportunities for practicing medicine by creating more efficiency, cutting waste, and promoting innovation.

8 BALANCE | LIFESTYLE & WELLNESS

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

10 TRANSITIONS | CAREER MANAGEMENT

16

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

12 PNN | NEWS IN REVIEW

The latest headlines impacting the economics of healthcare delivery in Southern California 22 UNITED WE STAND | AT WORK FOR YOU

Your LACMA and CMA membership at work for you.

froM your association 4 PRESIDENT’S LETTER | SAMUEL FINK, MD

26

24 CEO’s LETTER | ROCKY DELGADILLO 25 LACMA NEWS | ASSOCIATION HAPPENINGS

LACMA’s Political Action Commitee.

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.

f eb rua 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 AD SALES EDITORIAL ADVISORY 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 Network 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 benefi t 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.

p r es i d ent ’s Let t er | sa M u eL fi nk , M d

I h o Pe t h at the last month has gone well for you, and that you are enjoying the new format of our magazine! In this letter, I will update you on some new products that LACMA will be introducing, and keep you current on our activities. I will also let you know about my ongoing quest for Medicare recertification, a government-imposed hobby for both my biller and myself.

But first, let’s discuss the planned transition of the Los Angeles dual eligible Medicare/Medi-Cal population into managed care. I was on a conference call with CMS Director Marilyn Tavenner, and expressed my concern to her over the passive transition of thousands of poor, elderly, and non-English speaking patients into managed care programs that would disrupt their ongoing medical care, often without their knowledge. Ms. Tavenner explained that this so-called “pilot program” would transfer “only 370,000” patients, but was adamant that there are no plans to cancel this passive transfer.

However, there is still no agreement between the State of California and L.A. Care over reimbursement rates, and Governor Brown has delayed the implementation of the dual eligible program until September, 2013, with a phase-in period of eighteen months. It was clear from my conference call with Ms.Tavenner that we will need extensive political action to eliminate this ill-conceived plan...whether it occurs in 2013 or 2014, there is no right time to forcibly interfere with the healthcare of disadvantaged patients. LACMA strongly opposes this plan to passively transfer Medi-Medi patients to managed care organizations and will do everything in our power to hinder it. We will do our best to make sure that these patients understand just what their options are!

How serious are we? Our CEO, Rocky Delgadillo just travelled to Washington, D.C. with our Treasurer, Dr. Pedram Salimpour to express all of our concerns.

They met with Congress members Adam Schiff, Henry Waxman, Brad Sherman, Janice Hahn, Lucille Roybal Allard, Judy Chu, and Maxine Waters...all of whom expressed sympathy to our position, and gained new understanding of how this program undermines established physician-patient relationships.

As always though, we will need your help!

Please go to our redesigned web site at www.lac4 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

manet.org, and click on the large “Act Now” red button, so that we can give you the information you need to contact your legislator and express your strong opposition to this issue.

One good piece of Medi-Cal news is the fact that Medi-Cal reimbursement rates have increased to Medicare levels effective immediately (as of 1/1/13) for care rendered by primary care physicians. There was a risk that the “fiscal cliff” negotiations would eliminate these increases, but that did not happen.

There will be a delay in processing these increases (what a surprise) because a state health plan amendment has to receive federal approval, but you should be receiving these added dollars by this summer, and they will be retroactive to January 1.

LACMA continues to develop our “Best in Class” online marketplace, an exclusive member benefit that can be accessed from our website under “Practice Resources.”

We have obtained some terrific pricing for our members that need help with legal resources, billing services, medical waste services, as well as shipping costs...and there will be much more to follow. We are also actively pursuing affiliation with a purchasing group that will save our members even more money.

My ongoing goal is to try to save our members at least the cost of their membership. Also, don’t forget about our exclusive jury duty service. Contact us as soon as you receive your summons, and we can arrange for a one-time call in on a date of your choosing, up to one year from the original summons date. Additionally, we are able to transfer your court assignment to a location that is more convenient for you.

As you may remember from my last column, my biller and I have embarked upon the Medicare recertification process, which is actually a brand new application to Medicare, requiring the same amount of time that the first one took. After mailing in the initial application, and reassuring the government that Los Angeles, California was still in the United States, we finally received an email link. I was grateful that I could now complete the application on line... but no! The link directed us to print up additional forms which had to be completed by hand, and then “signed in blue ink” so that Medicare could ensure that it was my own unadulterated signature attesting to my same personal information that they have had on file for at least a decade. What fun!

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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front offi c e | p r ac t i c e M a naGeM ent

rISK TIP

drug-related adverse events on the rise:

protect yourseLf froM cLaiMs

Medication-related errors involving narcotic anal- were the most common class of medications identified gesics are not only a patient safety concern but are also (17.5% of claims).

The U.S. Food and Drug Administration (FDA) has a cause of significant professional liability for physicians mandated a Risk Evaluation and Mitigation Strategies and other prescribers.

Over the past decade, the number of adverse events (REMS) program for prescribing extended-release and related to inappropriate prescribing, misuse, and abuse long-acting opioid analgesics. The FDA will implement this voluntary program on of prescription painkillers has March 1, 2013. As part of the substantially increased in the otHer tips for avoidinG narcotic program, the FDA is requiring U.S. In 2010, 2 million people— anaLGesics cLaiMs incLude: opioid manufacturers to pronearly 5,500 a day—reported • Require office visits for obtaining convide grants to fund continuing first-time, nonmedical use of trolled medication prescriptions. medical education (CME) proprescription painkillers during • note actual amounts prescribed, and grams to advance prescriber unthe previous 12 months.1 Such give matching numerals to discourage derstanding and safe use of pain drugs cause more deaths than prescription alterations (e.g., thirty/#30). medications. heroin and cocaine combined,2 • attend seminars to educate yourself on In addition to completing and drug-related deaths exceed safe prescribing practices.

CME programs, doctors can deaths from traffic fatalities.3 reduce risk by incorporating Narcotic analgesics are the most common class of medications that can lead to a electronic prescribing, also known as e-prescriptions, medication-related error claim, according to a study into their practice. Electronic prescribing removes the

by The Doctors Company, the nation’s largest medical time-intensive process involved with tracking paper malpractice insurer. Some 5.8% of 2,646 closed claims prescriptions, voids opportunity for alterations, and alanalyzed by The Doctors Company in 2011 contained lows direct connection to pharmacists to ensure accumedication-related errors. Of these, narcotic analgesics rate prescriptions.

Contributed by The Doctors Company. Learn more about prescription security at www.thedoctors.com/prescribing or visit www.thedoctors.com/articles for more safety articles. References: 1. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16. 2. Centers for Disease Control and Prevention. Prescription painkiller overdoses in the U.S. Vital Signs. Published November 2011. http://cdc.gov/vitalsigns/PainkillerOverdoses. 3. Drug deaths now outnumber traffic fatalities in U.S., data show. Los Angeles Times. September 17, 2011. http://articles.latimes.com/2011/sep/17/local/la-me-drugs-epidemic-20110918.

ICD-10: Preparing Your Practice for the Big Changeover The healthcare industry, which is still in the throes of adapting to the HITECH Act and Meaningful Use, faces another significant change to its way of doing business between now and October 1, 2013. That change is the adoption of the new ICD-10 code set for reporting diagnoses and procedures to payers. While the current ICD9 code set includes 13,800 three-to-five-digit, primarily numeric diagnostic codes, the ICD-10 code set includes approximately 69,000 threeto-seven-digit, alphanumeric codes. Needless to say, a change this dramatic will bring a whole new set of challenges along with it.

The first thing to recognize is that, despite the fact that the cutover to ICD-10 won’t take place until October 1, 2013, you should begin to

prepare for it now. Think about how ICD codes are used by your practice and by your payers.

Now think about what it will mean when those codes change dramatically.

Education is the first step. Learn exactly what the transition to ICD-10 will mean for your practice and for the industry. Your billing, practice management and EHR vendor should be able to provide you with helpful information. In addition, a comprehensive list of ICD-10 resources for providers can be found at the Centers for ICD-10: Preparing Your Practice for the Big Changeover, athenahealth.com. Also Medicare and Medicaid Services (CMS) website, as well as the AAPC’s ICD-10 Provider Office Changes and the HIMSS ICD-10 Playbook.

Read more at visit http://www.athenahealth.com/our-services/resource-library.php

6 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

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Ba L a nc e | Li fest yLe & WeLLnes s

a Physician’s Guide to Personal health aMa STaFF

are challenging times, with studies suggesting - and physicians reporting - that they are under tremendous stress to see more patients in less time, and with less support, than in the past. Written for physicians by physicians, the AMA has provided these practical steps for resilience to remind physicians of two important points: (1) that mental health is the cornerstone to a healthy and productive life, and (2) recognizing periods of difficulty with mental health issues and seeking help can truly make a difference personally and professionally. If you identify a particular emotional health challenge in yourself or a colleague, let this information help you take steps toward assistance and resilience.

Fo r Ph ys I c I a n s t h e s e

anXieTy

Physicians have anxiety disorders with the same frequency as non-physicians, characterized by uneasiness and worry without relief If you or a colleague are experiencing anxiety on a regular basis, here are options to explore: Treatment with psychotherapy, primarily cognitive behavior therapy (CBT), is the cornerstone of treatment for anxiety disorders such as generalized anxiety disorder, social phobia and post-traumatic stress disorder, with or without medication.

Medications for anxiety disorders often are used in conjunction with psychotherapy in order to achieve the best results.

BUrnoUT

Experienced by ~50% of physicians at some point in their career; characterized by fatigue, depersonalization and mental exhaustion. Burnout can happen to anyone in any specialty. To distinguish between burnout and depression, consider that burnout symptoms are almost always relieved after adequate rest, vacation time,and positive changes made in the work environment and/ or work and life balance.

These changes do not alleviate symptoms of depression. In fact, depressed physicians often take time off with the hope their symptoms will remit—but the symptoms remain, or even worsen, on the vacation.

A hallmark of burnout is feeling detached and distant from one’s work and patients. It is best to prevent burnout, however, to combat it, taking time off and changing work priorities can help. Consider the following: Get at least eight hours of sleep per night Practice good nutrition Regular mobility and/or mindfullness or yoga Cultivate close relationships Take regular breaks and/or vacations

DePreSSion

Three times more prevalent in physicians than with age-matched cohorts, depression can be mistaken for burnout; however, one difference is the length of symptoms. Burnout symptoms can be relieved by time away from work, whereas depression symptoms persist beyond a vacation or break from work. The good news is that depression, even recurrent depression, is usually very responsive to treatment.

There are many effective treatments for depression, including various psychotherapies.

Mild to moderate depression: cognitive behavioral therapy (CBT) or supportive psychotherapy.

Moderate to severe depression: there is a wide range of effective antidepressant medications with different modes of action and side effect profiles (see page 2—anxiety/antidepressants).

For severe and life-threatening depressions, electroconvulsive therapy (ECT) may be indicated. Transcranial magnetic stimulation (TMS) is another effective therapy for treatment-resistant depression.

SUiCiDe

Physicians who are referred, or self-refer, for suicidal thoughts, should be seen by a psychiatrist immediately—the same day, if possible.

Most importantly, the suicidal physician must receive the same standard of care as any other suicidal patient. Physician patients tend to understate and minimize their symptoms and sucidal intent, and their treating physicians are often influenced by their own reluctance to insist on an inpatient hospitalization, more intensive treatment, or a mandatory leave from practice for their patient.

This companion piece to the Physician’s Guide to Personal Health is designed to provide information and resources on mental and emotional health, particularly anxiety, burnout, depression and suicide. 0.50 AMA PRA Category 1 Credit™ available. http://www.ama-assn.org 8 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

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Opportunities for Retired Physicians

By Marion Webb

are nearing retirement age, but are not quite ready to hang up their stethoscopes, will find that their medical training make them ideal candidates for other careers. Here are nine jobs for doctors to consider—whether they are already in retirement or looking to reinvent themselves post-retirement.

Many doctors who

Reentry Program For doctors who let their license expire and have been inactive for an extended period of time, reentering as a physician in the United States may involve continuing education and passing the Special Purpose Examination (SPEX). With the changing emphasis on technology, doctors also need to be prepared to brush up on such know-how as electronic medical records. Several reentry programs nationwide can help doctors get up to speed. The cost, however, could be upward of $20,000.

With all the changes that will come with healthcare reform, there will be even more opportunities for physicians - retired or not - to explore, including a wide variety of new business ventures.

Locum Tenens For doctors with an active license and looking to work part-time and through a staffing agency, being a substitute doctor for others is a great opportunity to work on your own terms. This often requires travel and working off-hours.

Healthcare Administrator Knowing how medicine is delivered and having clinical experience can work in your favor as a healthcare administrator.The real challenge, however, is being trained in business.

According to the U.S. Department of Labor, the demand for healthcare administrators is on the rise.

Consultant Consulting is a great way for doctors to create income. Medical consultants have many options, including at companies that make medical devices, law firms looking for expertise or testimony in cases, and publications.

Writer and Editor Providing medical expertise for magazines, online publications and Websites can be a great freelance opportunity for doctors, which can be done from home.With health news exploding on the Internet, there is no shortage of Websites looking for scientifically backed information on health issues.

1 0 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

Hospitalist A hospitalist, or doctor who specializes in the care of hospitalized patients, is seeing rising demand. Some studies have shown that hospitalists reduce the length of a patient’s stay and the likelihood of readmission. A large majority of hospitalists (about 78%) had their training in general internal medicine. Internists make excellent candidates for hospitalists.

Telemedicine Often meaning simply treating patients by talking to them over the phone or via internet, telemedicine can often be done part-time, from home. Services like AmeriDoc.com even suggest that the majority of doctors visits can be done via phone.

Teacher Retired doctors often enjoy teaching undergraduate health sciences like biology, anatomy and physiology as a low-stress alternative to clinical work. The University of Texas Health Science Center at Houston has gained attention and praise for its nursing program, which brings in retired doctors to help train nurses.

Volunteer For doctors who simply want to give back to the community, volunteering their time in free clinics can be personally rewarding and refreshing. This allows doctors to stay in the medical loop without having to deal with red tape. However, they may need to buy malpractice insurance.

Another opportunity is to volunteer your services in underprivileged countries. Health Volunteers Overseas (HVO) is one nonprofit organization dedicated to bringing healthcare volunteers to developing countries. Some doctors say that these opportunities are often easier for more experienced doctors who remember life without technologies vs. younger doctors who rely on computers to assist them.

As we move forward with healthcare reform, there will be even more opportunities for physicians to explore, retired or not, including a wide variety of new business ventures.

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reporting on the economics of healthcare delivery

Expanding and Aging Population Creates Greater Need for Doctors

Health Net Ends Contract with Lakewood Regional Medical Center

A new study found that a growing and aging population, along with increased access to health insurance, will create the need for 52,000 more primary care doctors within the U.S. by the year 2025, according to a Reuters news report.

Health Net Inc. recently announced that it ended contracts with Tenet Healthcare Corp.’s Lakewood Regional Medical Center and five other hospitals in Southern California.

READ MORE ON PAGE 22

Higher Medi-Cal Payments Delayed Los Angeles County primary care doctors and others in California who expected to receive more than twice their current reimbursement rate for treating Medi-Cal patients this month will be disappointed to learn those higher payments will be delayed.

Critics Say New Tax will Slow Research and Development in LA County Makers of medical devices in Los Angeles and elsewhere are warning that a new tax on their products, which went into effect on Dec. 31, will stifle research and development and cause industry-wide layoffs. The 2.3% tax, which will be levied on revenues, not company profits, is expected to raise nearly $3 billion over the next decade, according to the Obama administration.

New Program by Rock Health Turns Physicians into Angel Investors Los Angeles physicians who have contemplated investing in life sciences start-ups, but didn’t feel they had enough know-how, now can enter a program to learn what it takes. San Francisco-based digital health incubator Rock Health is launching a new program to create a new class of physician angel investors.

Providers Treating Medicare Patients Should Prepare for More Service Cuts Healthcare providers treating Medicare patients should expect additional cuts to Medicare services in the coming months, as members of Congress continue to grapple with deficit reduction as part of sequestration policies that will go into effect in two months, according to published reports. Medicare faces a program cut of up to 2%, which is likely to lead to further uncertainty in the healthcare sector.

1 2 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

New Coalition Seeks to Elevate Primary Care Profession A newly formed California-based coalition, which aims to elevate primary care as a career choice and improve the performance of primary care teams, plans to hold its first plenary steering council committee this month.

Palliative Care Conference to Address Continuum of Care This year’s upcoming 5th annual Hospital Association of Southern California’s Palliative Care conference will cover such critical issues as providing continuum of care and improving the transitioning of patients from hospitals to other facilities, according to a top manager at the association.

Notices Coming for Physicians Who Have Not Reenrolled in Medi-Cal Los Angeles physicians who have not yet reenrolled in Medi-Cal, as one of the provisions of the Affordable Care Act (ACA), can expect to receive notices of revalidation this coming week.

Anyone receiving a notice must complete and return the requested forms and required attachments within 35 working days of the date of the notice to avoid payment delays, according to the California Medical Association.

LOCAL event

Local Physicians Invited to Attend Discussion on Managing Medicare LACMA’s District 5 invites doctors to an interactive discussion of “Managing Medicare in 2013” with speaker Dr. Arthur Lurvey, a board-certified internist and endocrinologist who has been a Medicare contractor for 16 years. The event will be held Feb. 5 at the New Center for Psychoanalysis at 2014 Sawtelle Blvd. in Los Angeles from 6:30 p.m. to 9 p.m

Dual eligibles Project could Begin in september LACMA’s meeting with key legislators to remove Los Angeles County from the healthcare project known as “dual eligibles” follows news on Jan. 16 that the demonstration project, if implemented, could begin as early as Sept. 1.

Bodega clinicas Described as Parallel healthcare system While an understanding of the operations behind the so-called bodega clinicas in Los Angeles’ immigrant neighborhoods often eludes officials, some see them as an opportunity to strengthen the county’s strained medical safety net.

UcLa health system and cedars-sinai chosen as acos UCLA Health System and Cedars-Sinai announced on Jan. 10 they were chosen among 106 new “accountable care organizations” (ACO’s) in Medicare.

UCLA’s chief medical officer told PNN that in the case of UCLA the implementation will affect only doctors employed by UCLA and health professionals working at its two hospitals—the Ronald Reagan UCLA Medical Center and UCLA Medical Center, Santa Monica.

Lawmaker introduces Bill to combat Prescribing errors Sen. Curren Price (D-Culver City) on Jan. 8 introduced SB 62, a bill to ensure that state licensing boards quickly receive the information they need to determine the role doctors and pharmacists may have played in prescription drug deaths.

LOCAL EvENt

healthcare Forecast conference to Feature top industry Officials The upcoming University of California, Irvine’s 22nd annual Healthcare Forecast Conference promises doctors in Los Angeles and Orange County a unique opportunity to listen to some of the nation’s top decisionmakers. These insiders will provide economic forecasts and discuss critical issues affecting doctors under the Affordable Care Act.

consumer-driven healthcare Plan created by manufacturer During this time of uncertainty surrounding healthcare reform, the CEO of a Wisconsin-based manufacturing company has taken matters into his own hands by creating a consumer-driven healthcare plan.

Implementation of the plan is drawing national attention. Its costs, however, remains an issue, according to a local doctor.

INFRAStRUCtURE AND INvEStMENt New Medical Facility Opens in Los Altos MarketCenter The MemorialCare Medical Group’s new 30,000-square-foot medical center/urgent facility located in the Los Altos MarketCenter is officially open to the public.

The center is located between MemorialCare’s Long Beach Memorial Medical Center to the west and Community Hospital of Long Beach to the East.

“We’re starting with nine primary care physicians and hope to grow to 20,” said Dr. David Kim, the center’s medical director. The urgent care will be fully staffed and open from 9 to 9 on weekdays, and 9 to 5 on holidays and weekends.”

Merger of two Medical Facilities Falls Behind Schedule The planned merger of Verdugo Hills Hospital and USC’s Keck Medical Center now is expected to be done by February.

The merger, which was expected to be completed by the end of last year, fell behind because both parties still are working on “due diligence” reviews of transaction, with no strict timeline for completion, according to news reports.

Partnership Aims to Improve Pediatric Services Providence Tarzana Medical Center and Children’s Hospital Los Angeles announced a partnership to broaden the medical services provided by the pediatric unit and the Mozilo Family Foundation Pediatric Intensive Care Unit at Providence Tarzana, according to news reports.

The units will be operated jointly by both hospitals with Children’s Hospital, providing further pediatric clinical expertise to Providence Tarzana.

Under the agreement, a nurse manager from Children’s Hospital will oversee the pediatrics partnership at Providence Tarzana, working closely with hospital administration, physician and nursing leadership.

thousand Oaks Company Buys deCode Genetics Thousand Oaks-based pharmaceutical giant Amgen announced it bought Iceland-based deCode Genetics for $415 million to gain critical genetic information to treat disease.

A few months ago deCode Genetics said it found a gene that might be linked to Alzheimer’s disease. The firm also found genetic risk factors for dozens of other diseases, including heart disease and cancer, which makes it valuable to Amgen.

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Year of uncertaintY

a s c a L I Fo r n I a I s positioning itself for the advent of healthcare reform, Southland physicians will be faced with many uncertainties in 2013 and beyond. Given the expected severe shortage of primary care doctors and changing reimbursement rates, patients’ access to healthcare and services are among physicians’ biggest concerns.

Health reform will give an estimated 34 million more Americans access to health insurance. A recent study found that the growing and aging population, along with hundreds of thousands of people obtaining health coverage in California alone, will create the need for 52,000 primary care doctors within the U.S. by the year 2025.

With many primary care doctors entering retirement age and not enough young doctors to follow in their footsteps, some organizations, including the Association of American Medical Colleges, predict a severe doctor shortage.

The Affordable Care Act, which puts a lot of focus on primary care doctors, includes some provisions, such as offering additional money to encourage medical school students to become primary care

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doctors instead of specialists, who tend to get paid more.

Those provisions, however, are only expected to provide 500 additional doctors per year.

Dr. Joshua Hedaya, a retina specialist at the Retina Institute of California at Encino and Thousand Oaks, is among the physicians who fears real consequences.

“With 30 million more people obtaining health insurance, it will put a lot of stress on the healthcare system, primarily at the primary care level,” Dr. Hedaya said.

Dr. George Ma, past president of Los Angeles County Medical Association and an internist in Los Angeles, echoed Hedaya’s view. “Primary care doctors are most essential under healthcare reform, because they emphasize preventive care,” Dr. Ma said.

Under healthcare reform, the way physicians are paid is also changing, creating more uncertainty. Rather than being paid for services, physicians are being paid based on results, which marks a radical departure even from a decade ago.

Financial rewards will be based on clinical performance and that goes for hospitals too. Once independent, financial analysts predict that more doctors will become employees of hospitals, and hospitals will become chains, according to published reports.

“Physicians will not be paid per doctor visits, but rather based on patient outcomes,” Dr. Ma said. “If the patient is readmitted to the hospital within 30 days, doctors and hospitals won’t get paid, so it’s not business as usual, where if you see a patient, you’ll get paid.”

Under the Centers for Medicare & Medicaid Services’ newly released 2013 physician payment rule, primary care doctors’ pay is expected to increase whereas specialists will see a pay cut.

fordable care,” Dr. Hedaya said.

He hopes that under the Affordable Care Act, there will be a provision for smarter allocation where doctors are rewarded for providing efficient and cost-effective care.

“In other industries you get paid when you do a good job,” he said. “In medicine, you get paid when you do more. There just can’t be cuts across the board.”

Dr. Standiford Helm, president of the Orange County Medical Association and medical director at the Helm Center for Pain Management in Laguna Hills, said he’s concerned about the rapid implementation of certain guidelines in the state of California, especially when they seem to contradict federal guidelines.

“There will be a lot of confusion and concerns among patients and physicians,” Dr. Helm said. “We will experience confusion regarding the rapid implementation.”

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Under the rule, family physicians’ pay will go up 7%. Other primary care providers will also likely see a 3% to 5% increase in pay, in part from the “transitional care” CPT codes, which reimburse doctors for coordinating care in the 30 days after a patient is discharged from a hospital or skilled nursing facility, CMS reported.

Cardiologists, nuclear medicine specialists, ophthalmologists, pathologists, physical medicine specialists and vascular surgeons can expect a 2% to 6% pay cut in Medicare fees.

Specialists say the changing reimbursement rates will provide major challenges in terms of providing care for patients as well as their own financial health.

“This will make it challenging for some specialists to stay afloat,” Dr. Hedaya predicted.

The Affordable Care Act included a temporary rate increase for certain primary care physicians in the state Medicaid programs.

This 100% federally funded increase was intended to recruit more physicians to treat the rising number of low-income patients joining the healthcare system. According to the California Medical Association, 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 higher rates.

At the same time, the recent appeals court decision, which allows the state of California to cut the reimbursement rate for Medi-Cal patients by 10% spells trouble for many California physicians, given that an estimated 2 million new patients could become eligible for Medi-Cal under the new law.

Surveys show that less than half of all primary doctors in California treat Medi-Cal patients, and less than one-third of specialists do, because the reimbursement rate is among the lowest in the country.

Dr. Hedaya said when reimbursement rates dip too low, more doctors will likely opt out of treating Medi-Cal and Medicare patients.

“My biggest concern is with all these new patients coming into the system and cuts in reimbursement, patients will have a more difficult time to gain access and get af-

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Year of oPPortunitY

PU t t I n g U n c e r ta I n t I e s aside, most healthcare experts and physicians agree the implementation of the Affordable Care Act offers unprecedented opportunities for practicing medicine by creating more efficiency, cutting waste, and promoting innovation.

Some experts interviewed by Physicians News Network (PNN) suggest that the future of medicine lies in transforming primary care practices into centers where every patient is cared for by a team of health professionals. Adopting this preventive and comprehensive approach, supporters say, has two major benefits: Better quality of care and lower healthcare costs.

“Integrated medical groups who can offer patients increased function at a lower cost that can be documented will be in a position to thrive,” said Dr. Standiford Helm, president of the Orange County Medical Association and medical director at the Helm Center for Pain Management in Laguna Hills. “The mantra is being able to get outcomes that are better, faster and cheaper.”

“I think it’s an opportunity primarily to practice better medicine,” said Dr. Joshua Hedaya, a retina specialist at the Retina Institute of California in Encino 1 6 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

and Thousand Oaks. “Medicine today is, in part, fragmented and lacks communication. As a result, we provide unnecessary testing, sometimes unnecessary treatments, which puts a burden on patients and the system.”

The rising number of Accountable Care Organization (ACO) networks, where hospitals and doctors share responsibility of providing care for patients with the goal of saving costs by avoiding unneeded testing and procedures, is well underway in Southern California.

Just last month, Anthem Blue Cross announced it expanded its ACO network with a program focusing on managing patients with chronic disease at Cedars-Sinai Medical Care Foundation and Torrance Memorial Center/ Torrance Memorial Integrated Physicians.

The team-based approach to providing patient care has shown early successes, according to Torrance Memorial.

The hospital said a new triage system they have implemented, where physicians, nurses and other staff work together to improve operations in the emergency department, has led to improved waiting times and streamlined the process for providing patient care. Under the model, an ER doctor tries to see every patient who walks into the ER within 60 minutes at the busiest time, and determines who most urgently needs to be moved into an ER bed.

Other hospitals report similar outcomes.

At Brigham and Women’s Hospital in Boston, Dr. Atul Gawande, a surgeon, a writer, and a public-health researcher, whose work currently focuses on systems innovations to transform safety and performance in surgery, childbirth, and care of the terminally ill, said he helped the hospital save significant dollars and improve patient’s healing time by making the knee replacement surgeries and recovery process more efficient, as he described in a recent article in The New Yorker magazine.

The doctor achieved this goal by gathering the

doctors and hospital associations to come to the negotiation table.“Doctors and hospitals will be paid together as a bundle for hospital admission,� Dr. Ma noted.

As medical care is being reinvented, more innovation will follow, experts agree.This, in turn, also leaves the window of opportunity wide open.

This could mean giving patients access to clinicians via email and online support to provide timelier advice and reduce the need for emergency room visits.

Smartphone apps could be used to coach the chronically ill on managing disease. IT experts and healthcare will come together to develop ever more sophisticated methods to track outcomes and costs and bring medical care into patient’s homes and into their hands, such as tracking data on their Smartphones.

Most everyone agrees that the potential for opportunities and problems will be created along the path of healthcare reform. “I’m sure there will be other opportunities besides the team approach, but a lot depends on how things unfold,� Dr. Hedaya said. “The bill won’t be fully implemented until 2020. It’s still in its early stages and will just have to wait and see.�

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best people in their expert fields, standardizing processes, and then having others follow suit. For example, as part of the streamlining process, surgeons had to choose a single implant manufacturer, which cut the hospital’s knee-implant costs in half.

The trend will be toward finding consensus and towards physicians working together with hospitals to find better solutions. According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed today. More doctors are becoming employees and health systems are becoming chains.

The future of healthcare means that doctors and hospitals are both being paid based on clinical performance and outcomes. The more hospitals exceed its cost-reduction and quality improvement targets, the more money they can keep, Dr. Atul Gawande wrote in The New Yorker. “If it misses its target, it loses tens of millions of dollars. With doctors no longer being independent, the care they provide becomes the business of the hospitals too.�

For Dr. George Ma, past president of the Los Angeles County Medical Association and an internist in Los Angeles, this development represents an opportunity for

EW REVENUE STREAM EW REVENUE STREAM EW REVENUE STREAM

By Marion WeBB

Healthcare reform, with its focus on providing quality-driven and cost-conscious medical care and reimbursement issues, has led many doctors to contemplate ways to find new revenue streams.

The good news is that, with a little creativity and commitment, doctors have ample opportunity to create new revenue streams by going outside of their practice.

Experts believe that healthcare reform, with its focus on consumercentric healthcare, technology-driven platforms, including electronic medical records, social media and telemedicine, as well as medical innovations at life sciences and pharmaceutical companies, all create new windows of opportunities for doctors.

“Now is a great time for medical entrepreneurs to begin exploring alternate ways of income, because medicine is changing so quickly that many needs arise,” said Dr. Max Lebow, medical director at the Reliant Immediate Care Medical Group, Inc., located at the LAX International Airport.

Dr. Lebow, an emergency medical doctor and entrepreneur, seized two business opportunities in the last year. Last March, he founded Insight Practice Partners, an electronic medical records and billing service for medical groups. Last December, he also started Healthy@Work, a partnership with employers to bring mobile wellness and health screenings to employees at the workplace.

Providing Electronic Billing Services Dr. Lebow started both business ventures, because he realized that it provided solutions to problems doctors and employers were dealing with.

An early adopter of electronic medical records, Dr. Lebow said that when he adopted the system in his clinic, he never thought of selling it as a service to other doctor groups. It wasn’t until

doctors started touring his facility to learn how the system worked that he starting contemplating the earnings potential.

“It took us two years to develop the expertise and become good enough to sell our knowledge and templates to other practices,” Dr. Lebow recalled.

Altogether, he invested about $75,000 to start Insight Practice Partners, with $25,000 a year paying for his own medical records system.

While his business started officially in March, following negotiations with different practices, he landed a first client in July.

Today, the firm serves seven clients and keeps growing, he said.

Mobile Wellness Program Last December, Dr. Lebow also created a second business, dubbed Healthy@Work, out of his clinic at LAX. He developed the pilot program when he saw an unmet need in Los Angeles for providing preventive care and wellness at the workplace, focusing on low-income workers.

His first client, the hotel chain Shutters on the Beach in Santa Monica, had long referred their workers to Lebow’s LAX clinic for work-

t He neW L ac M a | feat u r e

related problems.

He sold Shutters on the idea of bringing a mobile clinic to the workplace by convincing management that a healthier workforce equals greater productivity, less absenteeism, and healthcare savings.

Dr. Lebow said by providing employers’ workforce with health risk assessments, preventive care screenings and healthy lifestyle information, it saves them money in the long-term.

Under the agreement, Shutters pays Lebow’s Healthy@Work—whose team is comprised a primary care doctor, nurse and medical assistant— an undisclosed flat fee per employee taking part in the program.

At the inaugural visit at Shutters two months ago, Healthy@Work saw 40 out of 540 employees who volunteered to participate in the program.

Of the 40 people, many had health issues: Obesity, high-cholesterol, high blood pressure and Type 2 diabetes. Lebow said the clinic doesn’t treat patients’ diseases, but refers sick patients to doctors.

With tens of thousands of uninsured low-income workers becoming insured under the Affordable Care Act in Los Angeles County alone, and given the shortage of primary care doctors, Dr. Lebow bets on his mobile wellness service to fill a rising need for this population.

Dr. Lebow is already working on expanding the program to other firms.

To get the word out about Healthy@Work, Dr. Lebow gave away T-shirts, with his company name prominently displayed, to his own employees and Shutters’ workers to wear during a walk at the beach.

“We think that will be great advertisement for us,” he said.

Consulting.

Medical consultants have many options, from advising companies that make medical devices and pharmaceutical companies that run clinif eb rua 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

EW REVENUE STREAM EW REVENUE STREAM EW REVENUE STREAM

Public Health, there will cal trials to weight loss be as many as 250,000 companies and law ...the Affordable Care Act unfilled public health firms looking for expertise or testimony in will create chaotic times at jobs by 2020 as demand for this expertise is on court cases. first, but also shake up the the rise.

Other doctors have Shubha Kumar, disuccessfully started their healthcare system enough rector of the Keck own consulting businesses, such as teachfor everyone to want to play a School of Medicine at the University of Southing people how to lose role in building a better one. ern California’s new weight or being experts online master of public for media outlets, such health program and asas news segments on sistant professor of clinical preventive medicine making healthier dietary choices.

According to published sources, physicians in Los Angeles, said she is seeing a strong intercan earn an additional $160,000 doing consult- est from doctors.

“Doctors would benefit from this program, ing work. because they would learn how to work in this changing era of health reform and learn about Telemedicine Another great way for physicians to earn extra healthcare from the population perspective,” Kuincome is through part-time telecommunication mar said.

Health administrators earn on average salajobs from home.

Physicians have done this successfully by us- ries higher than $90,000.

Kumar describes the program’s benefits for ing their medical training and expertise to find teaching jobs online and review or write medical physicians.

“What they learn in medical school is in clinicontent for companies, such as insurers and recal training. This is about community-based presearch companies. vention and health programs. (Here) they are not learning how to treat malaria, but how to prevent Medical Illustrator Doctors’ knowledge of anatomy and the hu- it on a large scale.” man body also makes them ideal candidates for a second career as a medical illustrator and pho- Writer and Editor tographer.

Another great opportunity for doctors to Both of these professions require an under- supplement their income is to pursue writing and standing and ability to use a variety of media, in- editing opportunities. cluding drawing and photography, videography, Dr. Richard Foullon, owner and medical direcsculpting and modeling, graphical design and tor at Verdugo Hills Urgent Care Medical Group, computer-aided processes.

Inc., said that doctors are uniquely positioned for There are several accredited schools that of- writing and editing jobs, because they have the fer degrees in medical illustration. medical know-how to provide accurate and scientifically backed information to media outlets.

He agrees with experts who say that patients Healthcare Administrator Knowing how medicine is delivered and hav- will not only play a more active role in their own ing clinical experience is also a huge plus for a health, but also “shop” around for quality and service, according to Healthleadermedia.com. career as a healthcare administrator.

This in turn, will lead to a rising demand for According to the Association of Schools of

accurate health news, which doctors can provide.

Find Your Entrepreneurial Passion.

Dr. Foullon said the advent of healthcare reform may also push many doctors to pursue their passion. Others will likely take on a more active role in implementing changes in the healthcare sector.

He did so himself in the 1980s.

After having worked for several years as an emergency care physician, he noticed that a vast number of patients came to the hospital’s emergency department for nonemergency issues.

“I felt strongly enough that there needed to be a lower cost and better patient experience alternative to the hospital-based emergency department,” Dr. Foullon said. “It was then already clear (in the 80s) that so many patients wanted or needed to be seen by a physician sooner than their doctor could fit them into their office schedule.”

When he presented his idea of starting an urgent care clinic as a lower cost alternative to nonemergency ER visit to the hospital board, they not only rejected the idea, but viewed it as competition. Other doctors also didn’t see the idea as viable.

Back in the 80s, Dr. Foullon recalled, the concept of urgent care centers was in its infancy.

After meeting with owners of an urgent care clinic in New York, he decided to open up a clinic in Los Angeles. Back in 1984, he invested $1.3 million to open up Verdugo Hills Urgent Medical Care Group Inc. Nearly three decades later, he said, the clinic has seen 1 million patients.

“Although I took a significant professional and financial risk at the time, I have never regretted my decision or what I have done,” said Dr. Foullon.

He feels the time is ripe again for doctors to unite, embrace change and take on a more active role.

He feels that the Affordable Care Act will create chaotic times at first, but also shake up the healthcare system enough for everyone to want to play a role in building a better one.

“You need to have a passion,” Dr. Foullon said. “That’s when you take the risk and do whatever it takes to make your passion come true.”

Dr. Lebow said that doctors often don’t realize that finding solutions to problems can create tremendous business opportunities.

“Most businesses in medicine are arising to solve problems that are coming, because of the changes in medicine or people’s awareness of medicine,” Dr. Lebow said.

7 TIPS FOR BECOMING A SUCCESSFUL ENTREPRENEUR

By Drs. Lebow and Foullon

1. Learn as much as you can about the product you’re trying to sell.

2. Do your research, put in the time and money to improve upon what you’re doing.

3. Find good people to help you, including nonphysicians.

4. Give your employees ownership in your company and they will work much harder.

5. Be passionate about what you do.

6. Think about your patients as your best customers.

7. Learn about new technologies.

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HIGHER MEDI-CAL PAYMENtS DELAYED CMA STAFF

Los Angeles County primary care doctors and others in California who expected to receive more than twice their current reimbursement rate for treating Medi-Cal patients this month will be disappointed to learn those higher payments will be delayed.

The change in reimbursement rate is part of President Barack Obama’s healthcare overhaul. Under the Affordable Care Act, primary care doctors who care for Medi-Cal patients will be reimbursed the same rate the federal government pays Medicare providers.

In California, which pays one of the lowest Medicaid rates in the country, primary care physicians can expect to receive 136% higher reimbursements, according to the Kaiser Family Foundation.

The state Department of Healthcare Services reported it intends to eventually give higher payments to doctors for treating Medi-Cal clients, including retroactive payments for treatment after Jan. 1. DHCS blamed the delay on bureaucratic reviews, according to news reports.

“Since the payment increase will be retroactive to January 1, 2013, any delay in implementation is not expected to impact a provider’s willingness to continue serving Medi-Cal members,” DHCS spokesman Norman Williams said in a prepared statement.

The exact date when retroactive payments will be made to doctors was not available prior to PNN’s publication date.

On the Medicare side, doctors received some welcome news. On Jan. 1, Congress passed HR 8, the American Taxpayer Relief Act, which includes a bill that freezes Medicare fee-for-services payment for one year, averting the 26.5% sustainable growth rate (SGR) cut. The 2% sequestration cuts have also been deferred for two months, the California Medical Association reported on Jan. 2.

The one-year freeze will be paid for with cuts to the Affordable Care Act’s new CO-OP program and other healthcare programs ($15 billion of the cuts impacting hospitals), CMA said.

The bill also lays the groundwork for an alternate Medicare payment system by creating data systems and a registry for reporting on quality that will help doctors.

Because federal law requires Medicare contractors to hold claims for 14 days before releasing payment, it should not affect doctors’ cash flow. Claims will likely be processed under the new 2013 fee schedule.

Palmetto, California’s Medicare contractor, will post the new fee schedule on its website, according to CMA.

California’s Exchange Receives Approval from Feds COV E R E D C A L I F O R N I A , the state’s recently named health benefit exchange, has received conditional approval from the federal Department of Health and Human Services, according to a statement released late Thursday.

The approval, which was also granted to six other states, comes as a result of significant progress made on the part of planning entities responsible for establishing state-run or federal partner exchanges across the nation.

Approval is contingent upon the states being able to meet deadlines coming before October 2014, when exchanges will begin pre-enrollment.

“States across the country are working to implement the healthcare law and build a marketplace that works for their residents,” wrote Kathleen Sebelius, federal secretary of health and human services. “In ten months, consumers in all fifty states will have access to

2 2 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

a new marketplace where they will be able to easily purchase affordable, high quality health insurance plans, and today’s guidance will provide the information states need to guide their continued work.”

To date, a total of 20 states have received conditional approval from the federal government.

While California has been a leader in implementation of the Affordable Care Act (ACA), several recent actions taken by Covered California’s Board of Directors have caused considerable concern for the California Medical Association (CMA) and the state’s physician workforce as a whole.

These actions include a flawed system of monitoring network adequacy, a continued favoring of two-tiered networks and failure to address major issues with the law’s “grace period” provision.

u ni t ed We sta nd | at Wor k for you

hhs makes sweeping changes to Hipaa rules The Department of Health and Human Services (HHS) Office for Civil Rights has released a final rule implementing a wide range of changes to the Health Information Portability and Accountability Act’s (HIPAA) privacy, security, enforcement and breach notification rules.

The long-awaited “omnibus” final rule is based on statutory changes mandated by the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the Genetic Information Nondiscrimination Act of 2008. The rule provides patients with increased protection and control of their protected health information, expands the HIPAA privacy and security requirements to business associates and increases enforcement authority and penalties.

“Much has changed in healthcare since HIPAA was enacted over fifteen years ago,” HHS Secretary Kathleen Sebelius said in a news release coordinated with the posting of the 563-page rule in the Federal Register. “The new rule will help protect patient privacy and safeguard patients’ health information in an ever-expanding digital age.”

The rule expands individuals’ rights to receive electronic copies of their medical records and provides patients the right to instruct healthcare providers to restrict disclosure of information to health plans in certain circumstances for treatment that is paid for out-ofpocket and in full. It also sets new limits on the use of patient information for marketing and fundraising purposes and prohibits the sale of health information without their permission.

Additionally, the final omnibus rule clarifies when breaches of unsecured health information must be reported to HHS, makes business associates directly liable under HIPAA and increases penalties for noncompliance to a maximum penalty of $1.5 million per violation.

“This final omnibus rule marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented,” said Leon Rodriguez, director of the Office for Civil Rights at HHS. To comply with the new rule, physician offices will need to make significant changes to their Notice of Privacy Practices, business associate agreements, as well as their privacy and security policies. The California Medical Association (CMA) will be developing and updating resources including model agreements and policies in the coming months to help physicians comply with the new rule.

Official publication of the new rule in the Federal Register was Jan. 25. The final HIPAA omnibus rule is effective March 26, 2013.

Covered entities, including most physicians and business associates must comply with applicable requirements by September 23, 2013.

The new omnibus rule will also be covered in CMA’s February 6 webinar, “HIPAA Compliance: The Final HITECH Rule.” The one-hour webinar is free to CMA members. For more information, or to register, visit www.cmanet.org/events.

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F E BRUA RY I S OU T R E AC H MON T H :

Calling on Doctors to Stand United W i T H T H e M a n y challenges ahead under health care reform doctors, more than ever, need a strong association to stand behind.

This February the NEW LACMA, under my leadership, will enhance our efforts to create an even stronger union that will advocate on behalf of patients and restore fairness to the Los Angeles health care system.

On January 31, I met with doctors in Beverly Hills to bring them up to date on the NEW LACMA. We are creating a whole new platform at LACMA, including Physicians News Network, a weekly breaking news online newsletter, and our revamped Southern California Physician magazine, covering all major health care issues.

I also reminded Beverly Hills physicians of the filing of our lawsuits against Health Net and Aetna, which showed a clear signal to the world of health care that we are going to fight on behalf of doctors and their patients. We will support the efforts of surgery centers in Beverly Hills in the dispute with the city of Beverly Hills and stand united.

On February 5th, LACMA will also meet with the Association of Black Women Physicians in Los Angeles, which presents an exciting opportunity to develop new relationships and continue our efforts to bring diversity and growth to our organization.

Our outreach effort continues on February 12th with a meeting with the City of Hope doctors, which I hope will lead to a reunion of our collective efforts. On February 21st, I will be meeting with Dr. Emil Avanes, who leads the Young Physicians Organization Los Angeles. The younger demographic, thus far, has been less represented at LACMA, but is critically important to us.

To provide even more benefits to our members, starting this month, our new purchasing group offers LACMA doctors the opportunity to start saving on key purchases from malpractice insurance, surgical gloves and other medical supplies to computers.

Doctors will also be able to take advantage of educational opportunities, such as gaining critical business skills for physicians who run their own businesses, at significant savings.

Finally, last month, I met with key legislators in Washington, D.C. to gain support in removing Los Angeles County from the “dual-eligibles” demonstration project and returned to Los Angeles knowing that doctors’ voices have been heard loud and clear.

The department at the state, which is handling the demonstration project, has now agreed to meet with LACMA’s leaders to continue discussions pertaining to LACMA’s key issues.

We hope all of these efforts will inspire other physicians to come forward and join us—as doctors who are united are stronger than doctors on their own.

Rocky Delgadillo

Rocky Delgadillo Chief Executive Officer

2 4 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

LACMA’s meeting with key legislators to remove Los Angeles County from the healthcare project known as “dual eligibles” follows news on Jan. 16 that the demonstration project, if implemented, could begin as early as Sept. 1.

“Nothing is concrete, but as of today (Jan. 16), Sept. 1 would be the start date with full implementation taking 18 months,” said Dr. Thomas Horowitz, the chair of the political action committee of the Los Angeles County Medical Association and a family practitioner in Los Angeles.

The demonstration project however, is far from being approved and many questions remain. LACMA opposes the project, saying that the state is moving too quickly and that patients would suffer.

Rocky Delgadillo, LACMA’s CEO, on Jan. 15 met with key legislators and stakeholders in Washington, D.C. to gain support for removing Los Angeles County from the project. He said the legislators heard doctors’ concerns loud and clear.

He said that lawmakers “want to hear more from Los Angeles physicians and want them to provide suggestions on how to improve the situation in Los Angeles County.”

Delgadillo and LACMA board member Dr. Pedram Salimpour on Jan. 15 met with Congress members Adam Schiff (D, CA-29), Henry Waxman (D, CA-33), Brad Sherman (D, CA-30), Janice Hahn (D, CA-44), Lucille Roybal Allard (D, CA-40), Judy Chu (D, CA-32) and Maxine Waters (D-CA, 43).

He also met with Kerry Branick, who is the lead staff of the dual eligibles pilot project with CMS, and Edo Banach, who is with the division of program alignment at the CMS’ Federal Coordinated HealthCare Office.

“CMS was interested in hearing what doctors have to say,” Delgadillo said about his meeting with Branick and Banach.“They encouraged us to engage with them on a regular basis, and also with the state officials in California. .”

In addition, Delgadillo had a first meeting with Richard Deem, who is the senior vice president of advocacy at the American Medical Association.

Two years ago, legislators gave Medi-Cal the authority to do four pilot projects to redesign care for Medicare and Medi-Cal dual eligibles.

The centerpiece of these pilot projects requires patients who are eligible for both Medicare and Me-

di-Cal to enroll into Medi-Cal managed care plans, which LACMA opposes for various reasons.

A major concern is the size of the project, which according to figures provided by the Department of Healthcare Services, is too heavily tilted toward Southern California.

Los Angeles County is home to 60% of dual eligibles. With an estimated 500,000 residents in Los Angeles County qualifying for medical insurance under healthcare reform in 2014, it will add a significant burden on safety net clinics and medical providers caring for underserved populations.

Another concern for doctors is the proposed passive enrollment of seniors into the dual eligibles project. Though seniors have the right to opt out and stay in traditional Medicare, doctors worry that this will cause confu- Lawmakers want to hear more sion among patients. from Los Angeles physicians Disruption of care is a and want them to provide sugserious issue for doctors, given current healthcare gestions on how to improve the reform initiatives that situation in Los Angeles County. call for transitioning tens of thousands of patients.

They include moving 400,000 seniors and persons with disabilities into Medi-Cal managed care. Also, more than 800,000 children would move to MediCal from the Healthy Families program.

In total, Medi-Cal is proposing to shift more than 3 million beneficiaries between now and 2015, which doctors and LACMA leaders say is too soon.

Delgadillo said that legislators were sympathetic once they were made aware that the expansion would put too much of a burden on Los Angeles County physicians.

“Once they realized that an additional 500,000 Los Angeles County residents will qualify for medical insurance in 2014, and the number of doctors available to handle the significant expansion are far and few in between, and that the proposed MediMedi demonstration project might chase doctors out of the medical profession, they became very concerned,” Delgadillo said.

Physicians who want to voice their opposition to the project can do so by submitting a petition to their representative in Congress online at http:// www.lacmanet.org/Advocacy/TakeAction.aspx. f eb rua ry 2013 | w w w. physiciansne w sne t w o r k .c o m 2 5

a s s oc i at i on ha p p eni ng s | at wor k for you

Dual Eligibles Project Could Begin in September

a s s oc i at i on h a p p eni ngs | news & ev ent s

LACMA’s Political Action Committee

By Marion Webb

I n co mi n g a n d e x i s t i n g members of LACMA’s political action committees (PACs) will tackle pressing issues surrounding health care reform this year. They will continue the committee’s mission of supporting issues and electing political candidates that improve patient access to care, according to LACPAC’s executive director.

“The political action committee is there to support candidates and elected officials that support LACMA and our healthcare system that is there for the benefit of the doctor-patient relationship,” said Luis Ayala, LACPAC’s executive director.

The PACs members—who will be introduced in this article—are instrumental to LACMA’s advocacy efforts.

That is critical given that about one-third of the California Legislature resides in Los Angeles County—home of one of the largest healthcare budgets in the nation.

“With all the changes occurring at the federal and state level, specifically with the implementation of the Affordable Care Act, our goal is to ensure that all of these initiatives are implemented to ensure access to healthcare,” Ayala said.

Ayala noted several initiatives that will take center stage for PACs members.

The implementation of the Affordable Care Act, as it unfolds this year, will be on PACs’ radar.

With the Obama administration’s granted conditional approval last month to California to build and

2 6 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

operate statewide health insurance exchanges, PACs members will need to keep a watchful eye on how it will affect doctor-patient relationships, access to care, and reimbursement issues.

“Scope of Practice,” or how legislators will define proposed increases in scope of practice for nonphysicians, will be another hot-button issue for PACs members, Ayala said.

Legislative support to give the Medical Board of California more information to determine physicians’ role in patient prescription drug deaths will also be on the agenda.

“LACMA will work with state legislators to ensure the appropriate power of the medical board,” Ayala said. “Rather than taking a defense stance, we want to work with state legislators to figure out a proper way to stop the abuse of overprescribing of narcotics.”’

PACs members will also continue their efforts to remove Los Angeles County from the dual-eligibles project. Rocky Delgadillo, LACMA’s CEO, recently met with key legislators in Washington, D.C. and reported that ‘doctors concerns were heard loud and clear’—but LACMAs work continues.

Meet PACs doctors who will be working hard on behalf of all LACMA doctors, medical students and members: Dr. James Futrell is the CEO of Expert Medical Consultants Inc. in Los Angeles, and has served as an expert medical consultant in court cases. He works as an anesthesiologist at Cedars-Sinai Medical Center. Dr. Futrell graduated from medical school at Georgetown University in Washington D.C in 1975. He received his intern training at Martin King Jr. Hospital in Los Angeles and was a resident at UCLA Hospital.

Dr. Paul Kirz, a board-certified orthopedic surgeon, works in private practice in Fullerton. Dr. Kirz earned his medical degree at the University of Washington in Seattle, Wash. in 1974. He received his intern training in internal medicine at the University of Southern Illinois in Springfield, Ill and was a resident in orthopedic surgery at the University of Kansas in Wichita.

Dr. Vito Imbasciani, Ph.D., is a urologist at the Kaiser Foundation Medical Center in Los Angeles. He

Center in 1969. He did his internship, residency and fellowship at UCLA. He is an associate professor in pediatrics at UCLA. He was LACMA’s past president at the Bay district.

Dr. Thomas Horowitz, a board-certified family practitioner, works in private practice in Los Angeles.

Dr. Horowitz earned his medical degree at the College of Osteopathic Medicine of the Pacific, DO in 1982.

He conducted his intern training and residency at Pacific Hospital of Long Beach. He serves on the editorial board of LACMA’s Southern California Physician magazine and Rx for Prevention for the LA County Department of Health.

Dr. Daniel Stone is a physician in internal medicine at Cedars-Sinai Medical Group in Beverly Hills and medical director at Cedars-Sinai Health Associates.

Dr. Stone is also an assistant clinical professor of internal medicine at UCLA School of Medicine. He earned his medical degree at the Chicago Medical School in 1983.

Dr. Stone conducted his intern training and residency at the LA County Harbor-UCLA Medical Center. He earned his master’s degree in public health from UCLA and master’s in business administration from Pepperdine University.

Dr. Brian Johnston works in internal medicine at the White Memorial Medical Center. He earned his medical degree from the University of California, San Francisco School of Medicine and trained in internal medicine at Marina Del Rey, CA.

DISTRICT 2

ScholarshipWon by Future Physician

Two thousand dollars was recently awarded to an excellent medical student, based on evaluation of top candidates presented to the District 2 Alliance Board. Given this special opportunity, all fifteen officers participated in the selection process. After the fascinating discovery of a loan fund begun decades earlier (when tuition was $8,000), we converted into the ‘LACMA Alliance District 2 Scholarship Fund.’

Our balance grew over time at the USC Keck School of Medicine, enabling 5 medical student scholar awards.

District 2 is honored to renew a tradition fostered by our organization of physician spouses and MDs. We promote collaborative health education projects, advocacy on behalf of physicians (and the patients they serve) across the full medical specialty spectrum, social connections, and health-related philanthropy. 2014 will be our 75th year!

The scholarship is sparking keen interest to expand the fund enabling worthy future physicians to benefit. We look forward to working with LACMA District 2 doctors to promote this rewarding effort!

Pictured: LACMA Alli D2 President Halaine Rose was invited to the ceremony marking scholarship awards at Keck. VP Marilyn Henderson joined Halaine; both are seen in a photograph with our scholar winner.

f eb rua 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 7

a s s oc i at i on Ha p p eni nG s | at Wor k for you

serves on the board of directors of the Southern California Permanente Medical Group. He is also a member on the board of trustees at the California Medical Association and a member of the board of directors at the California Association of Physician Groups. Dr. Imbasciani earned his medical degree at the University of Vermont College of Medicine in 1985 and Ph.D. at Cornell University, Ithaca, NY in 1979.

Dr. Paul Urrea, a board-certified ophthalmologist, works at Monterey Park Medical Plaza in Monterey Park and White Memorial Medical Plaza II in Los Angeles. Dr. Urrea is a clinical associate professor of ophthalmology at the Keck School of Medicine at the University of Southern California. He earned his medical degree at the UCLA School of Medicine in 1982 and received his intern training and residency training at the LAC and USC Medical Center.

Dr. Patrick Wade is a neurological surgeon in private practice in Glendale. He earned his medical degree at the University of Southern California School of Medicine in 1967 and conducted his intern training at the USC Medical Center in Los Angeles. He was an officer in the Navy. Dr. Wade is past president of the California Association of Neurological Surgeons; Los Angeles Academy of Medicine; and LACMA District IV. Dr. Jeffrey Penso works as a pediatrician in Culver City. Dr. Penso earned his medical degree at the State University of New York, Downstate Medical

a s s oc i at i on Ha p p eni nGs | neWs & ev ent s

HAVE YOU RENEWED YOUR 2013 MEMBERSHIP?

IF NOT, GO TO WWW.LACMANET.ORG AND RENEW YOUR MEMBERSHIP ONLINE OR CALL 213-226-0313!

YOUR DUES DOLLARS HARD AT WORK! In 2012, LACMA: filed major lawsuits against aetna and Healthnet for abusive business practices against physicians and patients.

Implemented a vendor vetting program, offering you exclusive discounts on best in class products and services. Vendors include uPS, Tredway, Lumsdaine and Doyle, and Los angeles Collection Service.

Launched an all new www.lacmanet.org with greater functionality to keep you informed and involved.

Launched Physicians News Network (PNN), written and edited by professional healthcare journalists offering breaking local news, information, and data about the economics of healthcare delivery. reestablished legitimacy in local policy matters.

Supported candidates elected to serve in the Congress and State Legislatures. Those candidates ensure that LaCMa’s mission of enhancing patients’ health and physician’s ability to practice medicine is protected.

In 2013, LACMA will also: Offer exclusive members-only access to a Group Purchasing Organization to streamline your supply chain operations and save you valuable dollars on your everyday products and services.

Work with Congress members to remove La County from the Dual eligibles Demonstration Pilot Project.

Work to initiate free membership for your office managers to become a member of PaHCOM, the Professional association of Healthcare Office Management.

Host a series of informative and educational seminars to keep you updated on the most recent changes in California’s healthcare delivery system.

Host a series of mixers for effective networking and fun interaction amongst your local peers.

Your physician leaders work tirelessly to ensure that LACMA continues to serve physicians in LA County!

BE PART OF THEIR EFFORTS AND RENEW TODAY! 2 8 P H Y S I C I A N M A G A Z I N E | f eb rua ry 2013

LACMA Adds New Best In Class Vendors!

The LACMA Member Discounts Program is here to provide you with special offers and savings on the products and services you need most. To take advantage of these offers visit www.lacmanet.org/PracticeResources/PartnersandMarketplace.aspx

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Medelita offers LaCMa Members: · 15 % off Medelita lab coats & scrubs · Exquisite custom embroidery with faderesistant, top quality thread

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To access your discount, please send us an email to inquiries@medelita.com with your full name and affiliation. Once we verifiy your record we will respond with the appropriate coupon code for you to use within 48 hours.

SHIPPING: Looking to save even more money on shipping?

Through your LaCMa membership you can now save up to 37% on shipping through UPS. Savings on shipping increases the more packages or letters you send and your savings begin immediately once your enrollment is complete (check your confirmation date). So enroll now at www. savewithups.com/lacma or by calling 1-800-325-7000

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.

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CME 81st annUaL PoSTGraDUaTe ConVenTion

Sponsored by the SM Alumni Association Loma Linda University March 1-4, 2013 Special focus on both the new role of primary care in healthcare reform and ethics in medicine, plus specialty symposiums in Ophthalmology, Orthopaedic Surgery, Otolaryngology, Plastic Surgery & Surgery. LLUSM designates this Live Activity for a maximum of 21.25 AMA PRA Category 1 Credit(s) For more information: www.llusmaa.org/apc email: apc@llusmaa.org (909) 558-4633

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Advertiser Index Athena Health .................................................................11 California Wine Club ........................................................3 City National Bank............................................................7 Cooperative of American Physicians ............................... 23 The Doctors Company ................................................. C4 Fenton Nelson ............................................................... 15 Los Angeles County Sheriff ’s Department ..........................9 Marsh ................................................................................5 NORCAL .....................................................................C2 Office Ally .................................................................... C3 Telephone Connection ....................................................29 UC Irvine .......................................................................17

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of residents (48%) said they are unprepared to handle the business side of medicine. including career management. Only 9% of residents felt they were “very prepared.”

56% of residents said they received no formal instruction during medical training around medical business issues such as contracts or compensation arrangements.

222,000

$

of the nation’s physicians will be employed by hospitals in 2014 (estimated).

75%

SiXtY eiGHt

% of residents would prefer to practice in communities of 50,000 people or more.

Thirty Two

hospital-based physicians have annual incentive plans or pay-for-performance programs

Ninety Four

6 in10

%of residents said they would prefer to be employed in a hospital more than any other setting

By t He nu M Ber s | eM p LoyM ent t r end s

ONE HALF

Solo-practice owners median income, while employed physicians earned a median income of $194,000.

% of general surgeons and surgical subspecialists are employed.

From 2006 to 2011, the number of surgeons in a full-time employment arrangement jumped by nearly a third at 32%.

http://www.medscape.com/features/slideshow/compensation/2012/public; http://www.merritthawkins.com/pdf/ mha2011residentsurvpdf.pdf

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