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ALL THE RIGHT MOVES PRACTICE MANAGEMENT TIPS, TRICKS & STRATEGIES
SEPTEMBER 2016
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S EPT EMB ER 2016 | TA B LE OF CONT ENT S
Volume 147 Issue 9
8
12 ON THE INSIDE 8 Five Ways to Add Time to Your Life
FEATURE
14
All the Right Moves
Good practice management is critical for a physician’s practice to be successful, and it has become even more important in today’s challenging healthcare environment. In this issue, we offer ideas that can help your practice run safely and efficiently.
12 Physician Spotlight | Dr. Nhat Tran
FROM YOUR ASSOCIATION 4 President’s Letter | Vito Imbasciani, MD 6 Do More With Less | Gustavo Friederichsen
Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, 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,801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request.
S EP T E M B ER 2016 | 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
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The Los Angeles County Medi-
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Physicians News Network Los Angeles County Medical Association 801 S. Grand Avenue, Suite 425 Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.physiciansnewsnetwork.com
specialty and practice setting
LACMA OFFICERS
cal Association is a professional association representing
as well as medical students, interns and residents. For more than 100 years, LACMA has
PRESIDENT
PRESIDENT-ELECT
TREASURER SECRETARY
IMMEDIATE PAST PRESIDENT
LACMA BOARD OF DIRECTORS
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 County and with the statewide California Medical Association, your physician leaders and staff strive toward a common goal— that you might spend more time treating your patients and less time worrying about the chal-
Vito Imbasciani, MD William Averill, MD C. Freeman, MD Sion Roy, MD Peter Richman, MD
RESIDENT/FELLOW COUNCILOR
CMA TRUSTEE
COUNCILOR – DISTRICT 2
ALTERNATE RESIDENT/FELLOW COUNCILOR COUNCILOR – SSGPF
COUNCILOR – DISTRICT 3
ALT. MEDICAL STUDENT COUNCILOR/UCLA
COUNCILOR – DISTRICT 5
COUNCILOR-AT-LARGE
ETHNIC PHYSICIANS COMMITTEE REP
COUNCILOR – DISTRICT 17 COUNCILOR – USC
YOUNG PHYSICIAN COUNCILOR
COUNCILOR – DISTRICT 7
CHAIR OF LACMA DELEGATION
COUNCILOR – DISTRICT 6
COUNCILOR-AT-LARGE
COUNCILOR – ALLIED ALLIED PACIFIC COUNCILOR-AT-LARGE COUNCILOR – SCPMG
COUNCILOR – DISTRICT 14
COUNCILOR – DISTRICT 10
MEDICAL STUDENT COUNCILOR/USC
COUNCILOR – SSGPF
VLGPF TRUSTEE
COUNCILOR-AT-LARGE
Jerry Abraham, MD David Aizuss, MD Emil Avanes, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Amanda de la Cerda Troy Elander, MD Samuel Fink, MD Hector Flores, MD Sidney Gold, MD Stephanie Hall, MD Po-Yin Samuel Huang, MD David Hopp, MD Marvin Kaplan, MD Kambiz Kosari, MD Jeffery Lee, MD Paul Liu, MD Maria Lymberis, MD Ashish Parekh, MD Jinha Park, MD Anantjit Singh, MD Stacy Songco Heather Silverman, MD Diana Shiba, MD Nhat Tran, MD
lenges of managing a practice.
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, Director of Governance, 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, 801 S. Grand Avenue, Suite 425, 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. PM is not responsible for unsolicited manuscripts.
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P RES IDEN T ’S LET T ER | VIT O IM B AS C IANI, M D
T H E B A L L O T T H A T A L L C A L I F O R N I A N S will face this November 8 will rival some of
Many of the initiatives this year will affect physicians’ personal finances as much as public health.
the longest ballots in state history. And as in the past, voters will have to do substantial research on each initiative to know which choice – Yes or No – corresponds to their personal choice. Many of the initiatives this year will affect physicians’ personal finances as much as public health. Many physicians will have strong opinions on many, if not all, of the issues, and may insist that the profession weigh in to inform the public about the implications, medical and financial, of the choices they face. The short list includes Proposition 55, which extends Proposition 30’s income tax increase for those earning more than $250,000 for another 12 years (till 2030) in order to fund K-12 education and community colleges. Proposition 64 will add a $2-a-pack tax increase on cigarettes. The California Healthcare, Research and Prevention Tobacco Tax Amendment is supported by the CMA, since it directs the tax dollars to medical and dental research, prevention programs, physician training and law enforcement. Equally controversial will be Proposition 64, the Marijuana Legalization Initiative, which will establish a 15% tax on all sales and cultivation taxes for flowers and leaves (different rates!). It allows for criminal resentencing and obliteration of prior convictions, and comes with the expectation of an increase to the state’s coffers of hundreds of millions to a billion dollars. Proposition 61, the Drug Price Standards Initiative, will limit the amount any state agency (such as the one I head – the Department of Veterans Affairs) can pay for medications, tying it to the price paid by the United States Department of Veterans Affairs. Part of the incentive behind this item is a federal report from 2005 that the VA pays 42% of market rates, while the California Medicare system pays 51%. How the average citizen can calculate the reactions of the pharmaceutical industry to this ballot initiative, when even physicians cannot, is beyond me. Proposition 52, the California Medi-Cal Hospital Reimbursement initiative, will, if passed, make it harder for the Legislature to divert dollars to the General Fund that are supposed to support hospitals in caring for Medi-Cal patients and to help cover healthcare costs for low-income children. I saw my first pro-Prop. 52 ads on CNN on August 15. Other initiatives on the ballot touch on public health and policy issues, such as repealing the death penalty (Proposition 62) and mandating background checks around the sale of ammunition and largecapacity magazines. The larger point, besides the Encyclopedia Britannica like scale of the upcoming November ballot, is that it behooves physicians to pay heed to what happens in Sacramento, since government, and the democratic process as practiced in California, has the ability to impact your practice, your patients and your finances. Whether it’s unfunded CME mandates, expansion of scope of practice by non-physicians, or Death with Dignity (which, signed into law by Governor Brown in October 2015, went into effect this June), the law as it relates to physicians is not static. It is the job of LACMA (and the CMA) to continually gauge the opinions of its member physicians, and to translate those opinions into advocacy at the highest level. Many physicians have strong, informed opinions on ballot initiatives and new legislation, but they lack the time or determination to call their local elected officials. That is where your medical society can help.
4 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2016
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I ’M NOT MUCH O F A BOXI NG FAN. For those of you who might be casual fans or simply follow the folly of sports, Roberto Duran’s “No Mas fight” against Sugar Ray Leonard was epic and draws parallels to physicians facing MACRA. In 1980, Leonard was clearly ahead in the welterweight battle of the ages. Then, inexplicably, Duran shouted, “No mas. No mas. No more box.” Duran quit. He’d had enough pounding for eight excruciating rounds. But we’re not Duran.
“... we need to work quickly because MACRA is around the corner, and a significant number of physicians don’t even know what I’m talking about when I say MACRA. We need this thing postponed ASAP.”
CMS’ recently released MACRA (Medicare Access and CHIP Reauthorization Act of 2015) regulation proposes the most significant changes to physician reimbursement we’ve seen in decades. But with the regulation now scheduled to hit physician groups across the country in a matter of months (January 1, 2017), a recent report from Deloitte indicates that 50% of physicians have never heard of MACRA, while another 32% of physicians know of it, but by name only. There is little doubt that we are at a critical crossroads as MACRA, other government reforms, and market forces are set to make value-based reimbursement mandatory for not only Medicare, but also Medicaid and commercial payers. As a result, physician groups are being forced to do more with less: to deliver high-quality, cost-effective care with fewer dollars and more risk. So, should physicians simply throw in the proverbial towel? Or, should physicians engage, share their voice, perhaps like never before, to ensure there is some logic in this current equation? CMS issued its proposed rule on April 27, 2016, and received many comments from interested stakeholders, including CMA. The final rule is expected this fall. CMA encourages practices to get ready, but to remember that the details are subject to change. Check out this month’s article on MACRA (“Prepping for MACRA,” Page 20) for more about CMA’s comprehensive comments to CMS. They outline constructive improvements to MACRA. On the CMA website, you’ll also find a link to AMA’s extensive comments. Our members need to stay up-to-date on everything and anything MACRA. As Dr. Emil Avanes stated recently, “I think we need to work quickly because MACRA is around the corner, and a significant number of physicians don’t even know what I’m talking about when I say MACRA. We need this thing postponed ASAP. We need thousands of petitions signed. We cannot have a 9% cut in 2022 from something they spring on us in the last 2 months of 2016. The mature way to do this is roll out the plan in 2016, and start in 2018. We have now seen some of the catastrophic repercussions of hasty health policy decisions enacted over the past few years. CMS has the responsibility to patients to evaluate the feasibility of MACRA prior to ramming through yet another arbitrary set of unvalidated statutes.” The essential physician to-do list: • Sign up to receive CMS MACRA email updates; • Sign up to receive Medicare news directly from CMA through content update alerts. • To do so, just activate your web account (if you haven’t already done so) and sign up for custom content alerts on the topics that are of interest to you. You will then be notified any time there is new content posted in one of your interest areas. • Check CMA’s MACRA Resource Center at www.cmanet.org/. It’s not time to give up; it’s time to champion our collective points of view. Share your opinions on MACRA with me. To be silent would be like saying “no mas.”
Gustavo Friederichsen Chief Executive Officer
6 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2016
Staying ahead of the curve is a matter of degree. Master the analytical, financial, and business tools you need to lead today’s healthcare enterprises.
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Five Ways to Add Time to Your Life
By Deborah Stambler, Communications Consultant, Los Angeles County Medical Association
A
RECENT
ARTICLE
ON
TIME
M A N A G E M E N T for physicians laid out a
comprehensive strategy for helping doctors with TM and used alphabetical coding to set priorities and evaluate each daily activity on a specially constructed chart. From there, charted activities were entered on the appropriate calendar and shared with the appropriate people. It was noted that after 168 days of strict usage of this method, you’ll have joined those legendary creatures who have conquered TM. It wasn’t clear why 168 was the magic number of days. The article took way too long to read. However, there was a small takeaway from that article—it makes sense to use the shorthand TM for time management. And the reminder, for efficiency’s sake, that you probably know why you’re busy, late and/or overworked, so here are five ways to add a little time to your life.
1. Say No. One surprising suggestion on time management for physicians is to say No. A District 2 physician shared his own experience: “We don’t say no when patients don’t have their co-pays; we don’t say no when patients want to talk on the phone for 15 minutes; we don’t say no when insurance companies make us spend 25 minutes on a phone tree in order to get hold of someone to discuss why a test was not approved.” Setting boundaries and sticking to them helps in keeping to your schedule and lowering stress. It takes a bit of practice for many people to get comfortable saying no and setting boundaries. Start small by noticing times when you agree to take on an extra task and feelings of stress or resentment crop up.
2. Say Yes. What is on your calendar? Probably work appointments and staff meetings. But is date night with your spouse penciled in anywhere? How about time to work out? Say yes to your personal life by adding it to your calendar.
One suggestion from the The Happy MD website is to each week create a calendar with personal appointments on an actual paper calendar and take a photo of it on your phone so you have it with you. Try putting your personal events and activities on your calendar and see if you don’t just stick to date night a bit more often.
3. Set Your Sights on Time. Staying on schedule is easier if you can see what time it is. Don’t just count on your phone or computer. Make sure you have clocks in the exam rooms and at the nurses’ station. Is this too simple to work? Maybe. But let us know if it helps.
4. Physician, Know Thyself. Taking time for personal reflection to look at your values, short- and long-term goals and priorities helps with setting daily boundaries. Physicians are generally more concerned (and even more comfortable) with action, rather than reflection. But taking time to set goals can motivate you or re-energize you around the things you really do want to accomplish. Use the self-reflective time to evaluate your strengths and weaknesses as well. Are you great with people, lousy with paperwork? It helps to know yourself and how you work best. We all tend to put off the tasks we don’t enjoy. Try switching things up and see if breaking old patterns unexpectedly frees up some time in your schedule. (continued)
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5. Delegate. Initially, it may seem like more work to train personnel on certain tasks than just doing things yourself, but over time having trusted, competent staff is a worthy, measurable investment. Here’s a recommendation from Laura Palmer, FACMPE, senior industry analyst for the Medical Group Management Association (MGMA): “There are simply some tasks in the office that physicians should no longer be doing, including managing incoming and outgoing documents, refilling prescriptions, and contacting patients about negative test results. Physicians should also leave financial aspects of the business to practice management professionals.” She went on to note that “Financial discussions with patients are best handled by competent, trained business office staff rather than physicians. This allows physicians to focus their attention on the clinical relationship with the patient and maximize their time with them.” Please know that we recognize the struggles most physicians face can’t be resolved in five quick tips. The current culture in healthcare is far too complex to tackle in one article. At LACMA, we want to engage in a long-term conversation that will yield deep changes, the kinds of changes that will not only prevent burnout, but help physicians thrive.
“The current culture in healthcare is far too complex to tackle in one article. At LACMA, we want to engage in a long-term conversation that will yield deep changes.
We also know that you have to start somewhere. There are issues within the larger culture to address, but taking control over the personal sphere and making small changes matters too. Please join the conversation on our website and through social media and events as we continue to explore the issue of physician wellness. Your voice matters.
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The EMPH Program’s curriculum is developed by faculty that includes renowned researchers, practitioner-scholars, and top tier Los Angeles healthcare executives using competency-based educational standards. Content and coursework are developed so that graduates achieve exemplary competence in areas such as analytical thinking, creativity and problem-solving, written and oral communication, team leadership, and business planning and execution. In addition to improved business acumen, an understanding of healthcare policy and strong advocacy techniques are critical in improving healthcare delivery and population health and play a role in the education of working professionals. From patient rights to antitrust legislation, bioethics to resource allocation, and social justice and sustainable competitive advantage – the EMPH students understand how these issues must weave together if they are to improve health and health service delivery. Not ready for a full Masters’ Program with your busy schedule? UCLA’s Executive Programs also offers professional development series in Health Law, Lean & Six Sigma certification, and Health System Analytics for gaining skills right now, when you need them. UCLA’s Executive Programs in Health Policy & Management brings programmatic innovation and technological advancements that create a more relevant degree for many busy physicians and healthcare professionals. The Executive Programs office is interested in helping each individual find the career path that best fits your needs. For more information on the EMPH degree program and our non-degree programs please visit www.emph.ucla.edu or call (310) 206-6885.
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Physician Spotlight:
Dr. Nhat Tran
By Deborah Stambler, Communications Consultant, Los Angeles County Medical Association
I N C O N T I N U I N G T O R E C O G N I Z E some of our LACMA leaders, we’re casting the spotlight on Nhat Tran, MD, for this issue of Physician Magazine. Of his involvement with LACMA, Dr. Tran had this to say: “It has been an honor for me to serve on the Los Angeles County Medical Association Board of Directors…I helped establish the Young Physicians Advisory Committee. Our committee aims to encourage more participation of young and future physicians who will be practicing in Los Angeles County. With the unprecedented change in the healthcare delivery system in the United States, we need more physician involvement to help shape this new landscape. That is why it is essential for young physicians to get involved, because they will be the ones who will inherit the privilege of being doctors to care for those in need.”
Here’s some of what makes Dr. Tran such a special part of the LACMA team: Dr. Tran has the enthusiasm and passion to lead young physicians and medical students toward a direction of collaboration, innovation, and leadership. In my interactions with him through the LACMA Young Physicians Committee, he has proven to be a competent leader and mentor to us all! - Stacey Songco, Medical Student Dr. Tran is a “visionary based on his work with the young physician section and passionate about his work.” - Dr. Kelechi Abanobi “Dr. Tran has been a champion for medical students in LA County. While working with him on the Young Physicians Committee, he has always led the efforts to better engage with and provide resources for medical school students, residents and young physicians. With so much of his own experience to share, Dr. Tran has worked tirelessly to mentor young physiciansin-training, making sure to plan events and projects that would best benefit them. For example, during this year’s inaugural Anti-Childhood Obesity Medical School Challenge, it was Dr. Tran’s unwavering and hands-on support that helped propel the competition to its success, giving students a wonderful opportunity to learn about the state of childhood obesity in LA County and to utilize their own creativity to propose programs/policies that could help alleviate it.” -Annie Wang, Medical Student “He always steps up and is available with fresh ideas. He leads the Young Physicians Advisory Committee in a great way. Truly, he is a physician who answered his calling and is passing that passion on to a new group of physicians. He wants to be a role model, and since my start here at LACMA, I’ve had the pleasure to see a true servant-leader at work in Dr. Tran. Thank you, Nhat, for all you’ve shared with LACMA and our doctors.” Gustavo Friederichsen, LACMA CEO
1 2 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2016
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Practice Management
All The Right Moves
GOOD
PRACTICE
MANAGEMENT
IS
By Marion Webb
C R I T I C A L for a physician’s practice
to be successful, and it has become even more important in today’s challenging healthcare environment. In this issue, we offer ideas that can help your practice run safely and efficiently. You’ll find recommendations on how to prepare for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). You’ll learn about the new HIPAA rule in regard to who bears burden of proof in the event of a ransomware attack and steps you can take to protect your practice. You’ll also learn about how you can prepare for the new guidelines, expected this month, for communicating with patients via text messaging. And when it comes to the day-to-day operations of a practice, there is always room for increasing efficiency, so we offer 10 tips on how to improve the overall flow of your practice. Finally, we offer some strategies on what to do when your practice finds itself the target of a not-soflattering online patient review.
1 4 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2016
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) shifts Medicare away from a fee-for-service payment system that incentivized volume of services to a system that rewards physicians for quality of care, yet some experts believe that many physicians have yet to get ready for this major change in regulations. With its final rules due in November and its implementation set to start Jan. 1, 2017, now is the time for physicians to learn about MACRA and its implications to avoid a financial hit, Modern Healthcare reported in August. The radical change in the Centers for Medicare and Medicaid Services’ (CMS) physician reimbursement policy dictated by MACRA leaves practices and hospital systems facing complex choices as they prepare to begin collecting 2017 quality and outcomes data that could affect as much as 4% of their Medicare pay in 2019. MACRA includes more than 200 quality measures doctors need to review and more than 90 Clinical Improvement Activities from the Merit-based Incentive Payment System to choose from. Experts recommend that all individual physicians, group physicians, registered nurses, advanced practice nurses and physician assistants need to learn about MACRA and the changes ahead.
The three major changes in Medicare payments follow: • The end of the sustainable growth-rate formula, which over the past decade mandated substantial cuts in physician pay based on productivity. • A new framework for rewarding doctors for quality of care, not just quantity. • The combining of existing quality reporting programs, including meaningful use of electronic health records, into one new system called the Quality Payment Program.
According to Medicare, most physician groups will fall into the Merit-based Incentive Payment System, or MIPS, while a minority of larger groups will follow Advanced Alternative Payment Models, or APMs. One expert told Modern Healthcare that with MIPS, there are “heavy quality of value reporting efforts,” while APMs have “upside risk and downside risk.” With APMs, doctors provide care to a group of people and have to estimate costs; if the costs are higher than estimated, the group needs to share in those expenses. The good news is that while the MIPS portion of the law is designed to be budget-neutral in general, there are more opportunities for bonuses, said Acting CMS Administrator Andy Slavitt in his address to the annual meeting of the American Medical Association on June 13. “Medicare will still pay for services as it always has, but
every physician and other participating clinicians will have the opportunity to be paid more for better care and for making investments that support patients — like having a staff member follow up with patients at home,” Slavitt was quoted in Modern Healthcare. “In MIPS, in addition to the 4% positive payment adjustment, there is the potential for much higher payments through $500 million in funding over six years. Physicians earn a 5% lump sum bonus for participating in an Advanced Alternative Payment Model.” However, because MACRA is designed to be budgetneutral, some groups will receive bonuses while others will be penalized to pay for the bonuses, another expert commented. The prediction is that this may lead some doctors to retire early or stop seeing Medicare patients because they don’t want to deal with MACRA. To succeed, small group practices and larger multispecialty medical groups or high-performing integrated delivery systems must make significant investments to succeed in the new environment. It begins with certified electronic medical records, required by MIPS and APM tracks.
Protecting Patient Information
When it comes to electronic medical records, and any other web-based data transfers, including text messaging, it is important that doctor offices not only follow the new rules on recording and billing, but also protect patient information from cyber attacks. Moreover, in regard to ransomware attacks, a significant threat for doctors’ practices as well as hospitals, the rules have changed. According to The Doctors Company, the Department of Health and Human Services (HHS), under its recently released guidelines, “now presumes that a ransomware attack compromises electronic protected health information (ePHI) — unless the HIPAA-covered entity can prove otherwise.” Prior to the new guidelines, if a doctor’s office or hospital determined on its own that there was no breach, no action was needed. The burden was on HHS to prove the ransomware attack had compromised ePHI. But now, according to The Doctors Company, that burden of proof has changed. It is now the responsibility of the physician to prove that data was not compromised, including patient records, credit card data and employee records. Under the new guidelines, if you have a breach, or can’t prove that you did not, you must complete the HIPAA notification procedures or face fines. Doctors offices can also face fines if their practices weren’t HIPAA compliant prior to the attack. Ransomware attacks, which work by gaining access to a healthcare organization’s network and then denying the organization access to its own data unless they pay up, have risen in recent years. Unfortunately, healthcare groups rank among the highest targets, with more than 50% of all such attacks, according to The Doctors Company. There have been 4,000 daily ransomware attacks since early 2016, a 300% rise over the 1,000 daily attacks in 2015.
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So what can doctors do to prevent such attacks?
Day-to-Day Better Practice Management
Here are eight tips for keeping your systems safe:
The following 10 tips, reported in Medpage Today, could give you the edge you need to better manage your workflow:
Encryption used to be the standard method to prevent breaches and protect your practice, but in today’s sophisticated computer world, more steps are needed. Experts recommend that doctors’ practices migrate their software applications and data to the cloud. Cloud vendors have sophisticated security measures that most smaller practices can’t match.
1. Research the vendor to make sure the firm has a good reputation and solid security policies in place. 2. Ensure the vendor can handle the amount of data you use, since most vendors charge by the amount of storage you need. 3. Ensure data is encrypted when uploaded to or downloaded from the cloud. 4. Make sure data is encrypted when stored in the cloud.
When it comes to improving quality of care, managing an efficient doctor’s office will put you ahead of the game.
1. Take care of prescriptions at the time of the visit. Providing medications until the patient’s next follow-up visit reduces phone calls and faxes from pharmacies that pull nurses away from their other duties. 2. Assign nursing to staff the incoming nurse line instead of returning calls in between attending to patients. Studies have shown that 35% of calls are repeat calls that can easily be avoided.
5. Understand who has access to the cloud folder.
3. Stagger staffing support hours to avoid overtime and ensure coverage.
6. Understand the options if the cloud provider is hacked or data is lost.
4. Staff up for peak hours to have sufficient staff at critical times.
7. Train all employees and provide security awareness for them.
5. Use your telephone auto-attendant wisely to make it easy for patients to make an appointment, speak to a nurse/ doctor or choose “other.” Make it short and simple.
8. Perform regular backups and test to ensure it works properly.
Security and Texting
When it comes to sending text messages to patients, a rising trend in communicating with patients, doctors also need to be aware of new guidelines. Only two months after its May announcement that it would allow orders for care, treatment and services to be sent through secured text messaging platforms, the Joint Commission said it needed more time to “ensure safe implementation.” The new guidelines are expected to be released this month and will be developed with the help of CMS. In the original guidelines, the Joint Commission said healthcare groups may allow orders to be sent via text messages using a secure text messaging platform that included the following: a secure sign-on process, encrypted messaging, delivery and read receipts, data and time stamp, customized message retention time frames and specified contact lists for individuals authorized to receive and record orders. Tom Sullivan, MD, of DrFirst.com, advised doctors to prepare for the upcoming updates this fall by complying with Medication Management Standard MM.04.01.01, which states that medication orders must be “clear and accurate”; creating a system for monitoring frequency of texted orders; and training staff. For more information on the Medication Management Standard, visit the article on texting guidelines that appeared in physiciansnewsnetwork.com in July. Stay tuned for the follow-up story on the new guidelines on texting in PNN.
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6. Use your website to offload incoming phone calls. Encourage patients to use your website to schedule appointments, request prescription re-issues, get diagnostic test results, and complete their visit registration, including their medical history. 7. Clean up appointment scheduling templates by simply using a short appointment slot and a long appointment slot. 8. Verify the patient’s insurance eligibility and coverage before the patient presents to reduce the number of denied claims, which will save time and money. 9. Use your bank lockbox service to file Explanation of Medical Benefits to improve your accounts receivable status, which allows you to use the time needed to file and retrieve EOMBs for doing other tasks. 10. Track patients by using appointment scheduling tools, a much more efficient way to note the arrival of the patient and the room they are in than using lights, paper, intercoms and instant messaging.
Dealing with Negative Online Reviews
In this digital age, patients are increasingly turning to websites to research a doctor before a visit as well as to review a doctor after a visit. A negative rating on a review website such as Yelp could potentially steer away prospective patients, according to Physician Practice. But there are ways for doctors to address these issues.
Five tips for dealing with a negative review: 1. Communicate with the author Most authors post negative reviews because they are aggravated or feel unheard. Addressing some of these root causes with the author may prompt the author to voluntarily remove his or her post. 2. Respond carefully to the review Responding directly to a negative review publicly in a disparaging way isn’t only ineffective, but also could potentially expose a practitioner or practice to legal action. Practitioners should avoid the temptation to respond to negative posts with information that may be protected under HIPAA, even if the patient discloses medical information. Doctors can still be liable under HIPAA if they disclose, confirm or dispute any protected health information without the patient’s consent. 3. Be aware of review websites’ legal protection Review websites have immunity from slander, defamation and/or libel lawsuits under federal law, so threats of legal action are typically ignored. The immunity under the federal law, however, does not foreclose other avenues to remove negative posts, according to an article in Physician Practice. 4. Be aware of review website’s terms of service It is often difficult to convince a review website to remove a negative post, but carefully reviewing the review website’s terms of service may be helpful as the post in question may violate these provisions. For instance, most review websites don’t permit individuals with a conflict of interest, such as competitors, to leave negative posts. It is worth contacting the review website in question and explain the situation.
5. Consider legal action If all else fails, a doctor may consider legal action to remove a post and seek damages against the author. While the Communications Decency Act of 1996 provides immunity for online review websites that publish review information provided by third parties, such as patients, such protections don’t necessarily extend to authors, according to the article. A strongly written letter from an attorney may compel an author to remove the post. By deploying these practice management strategies, doctors will be well-prepared for dealing with new guidelines and the rapidly changing healthcare environment while keeping the workflow of their practice humming efficiently and safely.
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Practice Management
Accounting Tips
from Mann, Urrutia, Nelson CPAs & Associates, LLP By Jerome French, CPA, CVA
A D A Y I N T H E L I F E O F A B U S I N E S S O W N E R can often be overwhelming. Not
only do you have a full load of patients to see, but you also find yourself performing other vital business functions such as ensuring the business is adequately insured, handling human resources issues as they arise, negotiating a new banking relationship, and keeping up with the company bookkeeping
and record keeping. So, your day often doesn’t end when the last patient leaves your office! Practice management duties can be even more time-consuming than your day job as a physician. To aid in your practice management efforts, we have put together a list of the common questions asked by our small to mid-size physician clients. These questions are: 1. Am I maximizing my retirement contributions? 2. What tax deductions do business owners most often overlook? 3. I’m struggling to keep my accounting records up-to-date AND run my business, what are my options?
Maximizing Retirement Contributions Saving for retirement is critical. Depending on the structure of your business, there are likely a few different options you can choose from to help reach your retirement goals. For example, a self-employed individual can easily set up a Simplified Employee Plan Individual Retirement Account (SEP IRA) and contribute up
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to 25% of earned income up to $53,000 per year. SEP IRAs are easy to set up and have very few reporting requirements. There are many options to help you and your employees save for retirement. To get started, find a proactive retirement advisor and make sure to connect them with your tax accountant so they can help you plan ahead and maximize your savings.
Overlooked Tax Deductions Often the most overlooked deductions we find when onboarding physcians as clients related to fixed asset purchases. To help avoid missing these deductions, make sure your accountant gets a list of all property and assets you purchase during the year. There are often favorable tax deductions and credits related to asset purchases, and you don’t want to miss out on accelerating your deductions when it makes sense to do so.
Accounting Solutions There are many options to consider with regard to your accounting records. If you are struggling to keep current while also trying to run your practice and tend to patients, here are some questions to consider: 1. Can I do more to automate my accounting processes? Chances are the answer is yes. Many software programs as well as online banking have increased the ability to automate accounting processes.
There are often favorable tax deductions and credits related to asset purchases, and you don’t want to miss out on accelerating your deductions when it makes sense to do so.
2. Are the savings I am realizing by doing the record keeping myself worth it? Only you can answer this question. Consider what you would be doing with your time otherwise, whether it is spending time with your family or networking with other practitioners, then decide what makes the most sense for you. 3. Do you have an organizational system that fosters efficiency? Being organized and keeping your files easy to follow can significantly reduce the amount of time it takes to keep up with your day-to-day accounting. As a final thought, remember that often the most successful people in business are those who surround themselves with a team of other smart, successful people. Make sure you are partnering with the best as you manage your practice.
Jerome French, CPA, CVA, is a Senior Manager at Mann, Urrutia, Nelson CPAs & Associates, LLP, a full service accounting firm. Jerome can be reached on www.muncpas.com at jwf@muncpas.com or (818) 956-1681.
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Prepping for
MACRA M A C R A . M I P S . A P M . P Q R S . These are acronyms that you’ll be seeing a lot in the coming months. We’re here to help make them meaningful for you and your practice. At the LACMA webinar in August, Cheryl Bradley, CMA Associate Director, Center of Economic Services, went through the basics of MACRA. She also gave physicians links to some key resources for sorting out what MACRA means for your practice and how to prepare. You can access a recording of the webinar on the LACMA website. One of the first things you should know is that MACRA isn’t completely set in stone yet. Later this fall, CMS will hand down its decision about whether MACRA will start in January or sometime later in 2017. There are also parts of the new rules that may change from the original iteration. Stay tuned. Between CMA, LACMA and the AMA, there will be information coming down the pipeline. Educating yourself about MACRA is important. It may seem daunting, but the checklist CMA has put together has some great information and resources. As a LAMCA member, you have access to that checklist. Read it over. If you have questions, you can call LACMA. We’re here to help. We’re not your only resource, though. Talk to your EHR provider to make sure your system is certified and to find out if it will support the transition to Medicare MIPS. Will there be any additional costs associated with the changes? You can also talk to your medical society. Most are getting well organized to help smooth this transition.
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The AMA has developed a program called Steps Forward Transformation Series. This is a five-step learning module that helps you transition your practice to value-based healthcare. It includes vignettes around physicians making changes to their practices. It also includes Q & A to address some common concerns. Both CMA and AMA have filed comments with CMS with constructive improvements to the proposed rules. You can find those at the CMA and AMA websites. Links to these comments are found on the CMA checklist. The checklist is available on the LACMA website under the Toolkits and Additional Resources tab for members. We encourage you to print it out and visit the links provided. Finally, we recommend taking up yoga. Yoga not only enhances relaxation and reduces stress, but it’s training in flexibility. As physicians, you are being asked to absorb and adapt to yet another major change in the U.S. healthcare system. A little physical flexibility to accompany the mental resilience can only help.
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LACMA Honors LA’s Famed Forensic Pathologist
Dr. Thomas Noguchi
By Jayme Kusyk
M E M B E R S O F T HE LO S ANGELES COUNT Y MEDI CAL ASSOC I ATI ON ( L AC MA ) and the World Association for Medical Law (WAML) honored and celebrated the ongoing career of forensic pathologist Thomas Noguchi, MD, with an Aug. 8 reception at LACMA’s headquarters in Downtown LA. Dr. Noguchi’s ties to both LACMA and WAML (convened in LA for its 22nd Annual Congress) span many decades. He is a 55-year member of LACMA and has served WAML as its president since 2010 and on its Board of Governors since 1977. Guests who have collaborated and continue to work intimately with Dr. Noguchi needed no encouragement to share their personal experiences with the man whose career of more than 50 years in forensic pathology has earned him celebrity status both within and without the field of medicine, a position Robert Bitonte, MD, stressed in his introductory remarks. “No one in our organization exemplifies Los Angeles and LACMA better than our honoree tonight,” said Dr. Bitonte, a former president and current board member of LACMA. “Being an immigrant and rising to the top is always difficult. Achieving professional excellence is equally as hard. And achieving celebrity status in this town, as a professional, in one lifetime, is nearly impossible.” Dr. Noguchi served as chief medical examiner-coroner for the County of Los Angeles from 1967 to 1982 and came to be known as the “coroner to the stars,” performing autopsies on high-profile personalities such as Marilyn Monroe, Bobby Kennedy, Janis Joplin, John Belushi and Natalie Wood. And he himself was the real-life inspiration for “Quincy, M.E.” (19761983), NBC’s medical TV mystery-drama starring Jack Klugman. However,. “Tom doesn’t claim his celebrity status,” said Roy Beran, MD, of the University of New South Wales, Australia, and secretary-general of WAML. “He’s prepared to let other
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people step forward, and he remembers everybody’s name. Tom is totally a man of principle. He’s a luminous, honest, kind man and a decent human being.” While Dr. Noguchi may have little interest in notoriety, Takahisa Okuda, MD, shared that the forensic pathologist has always made himself accessible and has motivated many. Dr. Okuda was practicing plastic surgery in Japan when he read Dr. Noguchi’s best-selling memoir “Coroner” (1983) and immediately decided to switch to forensic pathology. “Dr. Noguchi invited me to the Department of Coroners in LA, where I saw many cases. I went to study forensic pathology in the U.S., and he introduced me to the Medical Examiner’s Office, where I stayed for two years because of his recommendation. . . . He gave me my opportunities in the U.S. That’s why I stay here. He’s my mentor; I’d like to become like him.” It’s a sentiment shared by many, including Andre Pereira, MD, from the University of Coimbra, Portugal, and treasurer of WAML. Dr. Pereira credits Dr. Noguchi’s achievements to his work ethic, a vigor that has not lessened with time. “Sometimes he’s very rude when he answers emails, because he wants people to always be 100% engaged,” said Dr. Pereira with a laugh. “I wanted to do more than just autopsies. I wanted to expand our service to do something good for society,” said Dr. Noguchi in his address at the reception. Many of his colleagues and attendees of the reception would agree that, as a progressive-minded pioneer whose legacy spans much of the 20th century and promises to endure well into the 21st, Dr. Noguchi has made many valuable contributions to society.
LACMA EVENT A Look at Narcotic Prescriptions, Compliance and the Law Opioid and other prescription drug abuse remains a hot button topic around the nation. The healthcare community is grappling with solutions to chronic pain management and compliance with new laws. On Sept. 8, attorney Steve Meister will present “Anatomy of a Doctor Prosecution: A Look at Narcotic Prescriptions, Compliance and the Law” in coordination with LACMA District 1 and the Cooperative of American Physicians. Meister will tell physicians right off the bat that compliance laws around narcotic prescriptions are complicated. Meister will translate his firsthand trial and consulting experience into a presentation designed for physicians. He said: “Healthcare legal compliance and defense is a big part of my criminal law practice, and I have lectured to national, regional and local groups, as well as advising doctors, hospitals and insurers on prescribing compliance. I would like to participate in the work of the LA County Prescription Drug Abuse Medical Task Force. I bring a unique perspective and experience to helping doctors comply with narcotics prescribing laws – I spotted the legal issues early, maybe even first. I have developed original curriculum, advised medical practices proactively, and have defended accused doctors in criminal court. In my close work with the Cooperative of American Physicians, for example, I have helped every doctor who comes to me early enough to avoid criminal prosecution, and that goes even for clients who were already under criminal investigation when I first met them.” Please join us for this important discussion. The event is free for LACMA members, but you must RSVP. The cost for the dinner event is $50 for non-members. Visit the Events page of the LACMA website for more information and to RSVP.
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5
Things You May Not Know About the Alliance
1. The LACMA Alliance was started in 1929 and was called the Woman’s Auxilliary. So yes, the Alliance has come a long way in the past 87 years, and over that time has changed to meet the needs of physicians and their families. Let’s face it – no one understands what it’s like to have a doctor in the family as well as another physician family member. Making connections among physician family members for socializing and support is one function of the Alliance. Alliance President Elizabeth Ting is a Marriage and Family Therapist. She shared that her professional work is all about relationships, and one thing she’s heard over the years from the spouses of physicians is that “it can be lonely.” Alliance members have also told her, “It’s nice to meet other people who understand your life.”
2. The Alliance has shifted its focus recently to serve LA area physician families. Physicians and the entire family can join the Alliance and benefit from the network, attend events and work on social causes relevant to the immediate community.
3. According to the LA County Department of Public Health, 42% of children are obese or overweight. What does this have to do with the Alliance? Members of the Alliance are teaming with local physicians to tackle the problem head on. The Alliance has a rich history of taking on public health issues and making a difference. They were part of campaigns against bullying, awareness about leaving children in the car and banning smoking in restaurants. You can find updates on their Facebook page and websites about their social justice and public health work.
4. The Alliance sponsors membership for physicians in training and residents by offering a reduced fee of just $10 for the whole year.
5. The Alliance is taking strides to re-imagine their role in the community of physician families. They’re asking, “What can we do for you?” Alliance Communications Chair Debbi Ricks said that it’s an exciting time to be part of the organization as they find ways to be of service to both old and new members. For information on how to join, go to www.lacmaalliance.com.
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CALIFORNIA MEDICAL ASSOCIATION
PRACTICE MANAGEMENT:
TIP OF THE MONTH
Make sure your billing staff are aware of the prohibitions on balance billing Medi-Medi patients. Both state and federal law provide broad protections to such individuals, and prohibit billing a Medi-Cal patient in most circumstances. Running afoul of these laws can put you at risk of a CMS audit and sanctions. For more information on this topic, see “Ask the Expert: Billing Medi-Medi patients,” free to members at www.cmanet.org/ces.
CMA’s online health law library contains thousands of pages of On-Call documents in hundreds of chapters containing valuable information for physicians and their staff. Access to the library is free to members in the resource library at www.cmanet.org/cma-on-call or by calling CMA’s member help center, (800) 786-4262. Nonmembers can purchase documents for $2 per page.
TROUBLE GETTING PAID? WE CAN HELP! CMA’s Center for Economic Services (CES) is staffed by a team of practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Access to our reimbursement experts is a FREE, members-only benefit. Call (800) 786-4262 or email economicservices@cmanet.org. Meet Your Advocate: Jennifer Williams
Jennifer Williams, who has spent the last 12 years with CMA, currently serves as the Center for Economic Services’ executive assistant, meaning that she’s the first point of contact for practices in need of reimbursement assistance or practice management advice.
A lot of practices think we’re too busy to answer questions or don’t want to ‘bother’ us with what they think is a ‘silly’ question. Please don’t wait to call us. We’re here to Jennifer Williams, CES Executive Assistant help our members; it’s our job.” TO OPT OUT OF FUTURE NOTICES, EMAIL MEMBERSERVICE@CMANET.ORG OR FAX (916) 551-2036. BE SURE TO INCLUDE THE FAX NUMBER YOU WANT REMOVED. S EP T E M B ER 2016 | 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 5
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• SBS loan; 68k down, mortgage 4k a month per MD (12MD’s) • CLUSTER: 10,000 SF - 36 car parking + 4 unit apt. bldg, 2nd 30 car lot Contact Dr. Brown • 562-618-6912 for PACKET
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American Lung Association .................................................................................... 9 Cooperative of American Physicians .................................................................... 3 The Doctors Company ......................................................................................... C4 Fenton Law Group .................................................................................................. 17 miVIPSurgical .......................................................................................................... 13 Norcal ....................................................................................................................... 21 Office Ally ............................................................................................................... C3 Prime Clinical Systems .......................................................................................... 11 Regal Lakeside......................................................................................................... 19 UCI Paul Merage School of Business ................................................................. 23 UCLA School of Public Health ............................................................................... 7 U.S. Army.................................................................................................................... 5 Wells Fargo ............................................................................................................. C2
EPTTEEM MBBER ER 2016 2016 || W WW WW. W.PPH HYYSSIICCIIAAN NSSN NEEW WSSN NEETTW WO ORRKK.C .CO OM M 2179 SSEP
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TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231.
LACMA CALENDAR OF EVENTs www.lacmanet.org/events.aspx
Event Networking Social and Painkiller Law Presentation
Date 2016
Time
09/08 - 09/08
6:30 PM - 8:30 PM C
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You Don’t Have Time for This Webinar? Tips on Work-Life Balance.
09/14 - 09/14
12:15 PM - 12:55 PM
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Building Healthy Communities 09/16 - 09/18 Summit
9:00 AM - 5:00 PM
Women Physicians Action Committee Board Retreat
10/01
9:00 AM - 1:00 PM
10/05
7:00 PM - 9:00 PM
Protecting Your Practice
10/12 - 10/12
12:15 PM - 12:55 PM
CMA House of Delegates
10/15 - 10/16
8:00 AM - 6:00 PM
2 8 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2016
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