The new LaCMa
Top Ideas for Running Your Practice Balance Billing for Medi-Medi Patients
MAGAZINE of the
los angeles county MeDical association
You create a brighter future. We work to protect it.
Let us help find the right Long-Term Care insurance plan for you, so you can spend time on things that matter the most. People are living longer these days, but as life expectancies increase, so does the risk of serious health problems that could require long-term care. In fact, at retirement age, 70% of Americans will need long-term care and 40% will enter a nursing home.1 And with the average cost for nursing home care in a
Long-Term Care Resources LACMA is pleased that members have access to an interactive and educational Long-Term Care evaluation tool to help you make the best decisions for your specific situation. To learn more, visit: www.myltcplan.com/lacma.
semiprivate room equating to more than $82,855 per year, that could literally cost most or all of your life’s savings.2
Long-Term Care insurance may not be for everyone. But with soaring healthcare costs, insurance restrictions and the need to stretch retirement savings through more years . . . it’s a good idea to seriously consider this valuable coverage while receiving a member premium discount.
To learn more about how LACMA members can help protect their assets from the rising cost of long-term care, call us or go online today.
Call 800.616.8759 or visit www.myltcplan.com/lacma. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, October 2008, www.longtermcare.gov. Genworth 2010 Cost of Care Survey, April 2010, www.genworth.com/content/genworth/us/en/products/long_term_care/long_term_care/cost_of_care.html. The Long-Term Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in all states. 1 2
CA Ins. Lic. #0633005, AR Ins. Lic. #245544, d/b/a in CA Seabury & Smith Insurance Program Management 58461 (8/12) ©Seabury & Smith, Inc. 2012 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance.com
Volume 143 issue 08
FeaTUReS 16 The new LaCMa With a history-making lawsuit against aetna for illegal practices, lacMa takes a step into its bright, new future. 22 Top Tips for Managing Your Practice in our annual feature on running the business side of medicine, we offer a laundry list of best practices. 24 an evening to Remember our annual officers’ installation dinner sets new precedences.
eVeRY ISSUe 6 Front office tips, hints, advice and resources to make your practice run more smoothly. 12 CMa the latest update on regulations. 36 Just the Facts this month we focus on breast feeding.
FRoM YoUR aSSoCIaTIon 2 Ceo’s Letter an update on how your association works for you from rocky Delgadillo. 4 President’s Letter Monthly musings from samuel fink, MD. 26 Member Benefits find out how to get the absolute most from your membership. 30 association Happenings latino physicians empowerment Dinner • a day at the beach • expressing their viewpoints • talking to the media • august events • Welcome to our new members!
Southern California Physician (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. 08 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 Southern California Physician, 707 Wilshire Boulevard, suite 3800, los angeles, ca 9001 7. advertising rates and information sent upon request.
au g u s t 20 1 2 | W W W. s o c a l p h ys i c i a n . n e t 1
CeO’ s l e t t e r | rOCk Y d e lGad i l lO
The Time For a New LaCMa is Here
n a H I S To RY making move, the Los Angeles County Medical Association along with the California Medical Association, Santa Clara County Medical Association, Ventura County Medical Association and individual physicians filed a lawsuit on July 3 in Los Angeles County Superior Court against Aetna Health of California. The lawsuit charges that Aetna routinely and illegally denies patients access to out-of-network doctors after selling them costly insurance policies that promise patients the right to chose their own physicians. The suit also alleges that Aetna threatens doctors with having their Aetna contracts terminated if those doctors continue to refer patients outside the network even though their policy provides this benefit. Clearly, Aetna puts profits ahead of a patient’s health and safety. That’s immoral, and it is also illegal. Aetna’s reimbursement refusal harms the ability of physicians to get patients the care they need in a professional and timely manner. The suit seeks an end to Aetna’s unlawful practices, compensation for patients and physicians, and punitive damages. The response from doctors, patients and medical societies across the country has been tremendous. LACMA received a deluge of calls and emails from supporters who want to join the lawsuit. LACMA is encouraging patients, physicians and employers to share their experiences with Aetna at www.lacma.md. The new LACMA won’t sit idly by while insurers find loopholes to deny care to patients or while the government saddles physicians with more and more bureaucratic red tape. We are on the warpath to help physicians and their patients take back control of health care from insurers, government or anyone else who impedes access to quality health care. It is this type of momentum that you can expect from LACMA moving forward. Join the new LACMA. Together we can take bold steps to make sure that the insurers and others take us seriously when we say “enough is enough.” With every good wish,
PU BLISH ER /EDITOR
213-226-0335 | firstname.lastname@example.org
aRT & eDIToRIaL ART DIR EC TOR
@thruform | thruform.com CO N T R I BU TI N G WR IT E R S
Russell A. Jackson, David Reynolds
aDVeRTISIng SaLeS D I S P L AY A D S A L E S / D I R E C T O R O F S A L E S
213-226-0325 | email@example.com C L A S S I F I E D / D I S P L AY A D S A L E S
858-231-1231 | firstname.lastname@example.org
eDIToRIaL aDVISoRY BoaRD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD
LoS angeLeS CoUnTY MeDICaL aSSoCIaTIon oFFICeRS CEO
Rocky Delgadillo PRESIDENT
Samuel I. Fink, MD P R E S I D E N T- E L E C T
Marshall Morgan, MD TREASURER
Pedram Salimpour, MD S E C R E TA R Y
Peter Richman, MD I M M E D I AT E P A S T P R E S I D E N T
Troy Elander, MD
HeaDQUaRTeRS Southern California Physician los angeles county Medical association 707 Wilshire Boulevard, suite 3800 los angeles, ca 90017 tel 213-683-9900 | fax 213-226-0350
Chief Executive Officer SUBSCRIPTIonS Members of the los angeles county Medical association: Southern California Physician 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 Southern California Physician, 707 Wilshire Boulevard, suite 3800, los angeles, ca 90017. to inform us of a delivery problem, call 213683-9900. acceptance of advertising in Southern California Physician 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 Southern California Physician, lacMa services inc. or the los angeles county Medical association. Southern California Physician 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.
2 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
pr e si d e n t ’ s l e t t e r | sa m u e l fi n k , MD
The New LACMA
n e w e e k ag o, I took over as the new president of the Los Angeles County Medical Association… and what a week it has been! But first, I’ll tell you a little bit about myself. I am a Los Angeles native, and have been practicing internal medicine in Tarzana for 24 years, and am currently in solo practice. I still love what I do, and despite the changes and paradigm shifts we have all endured, I believe that medicine is a great profession that hopefully will continue to attract the best and the brightest. At night I figure out what my kids have been up to all day, and try to ensure that they get their homework done—correctly! (That’s a proposition that is sometimes tougher than patient care). When not coaching one of my kids in a sport, I still play league basketball, and can still hit the “3” on occasion! But, what I really want to discuss with you is the “new LACMA.” We have assembled quite a team this year, led by our CEO, Rocky Delgadillo, a former Los Angeles city attorney. We will be very visible, assertively representing you and your patients, and ensuring that your membership brings pride and value. Just two days after I took office, I had the honor of representing you before the media, as LACMA, the California Medical Association, and sixty other plaintiffs sued Aetna Health of California. We alleged that Aetna routinely and illegally denied patients access to out-of-network doctors after selling them costly insurance policies that promised them the right to choose their own physicians. This was a very proud moment for LACMA and the physicians and patients we care about, because filing this lawsuit defended one of the core values of American medicine—the right of patients to determine along with their doctors what is best for their health, not insurance companies, not Wall Street investors, and certainly not Aetna’s CEO with his 10 million dollar yearly compensation package. Aetna has embarked on a campaign to increase premiums (30 percent in the small business market over the past two years), cut dollars spent on patient care, and pack on profits! LACMA members have had their relationship with their patients threatened, and their contracts illegally breached. Their patients have been illegally denied
coverage, and saddled with costs that Aetna should rightfully be covering under the terms of its own contract. Aetna’s health insurance division in California made a 27 percent profit in 2011—how about you? Enough is enough! I’d like to invite you to go to our website, www.lacmanet.org, click on the Stop Aetna button, and learn how you can help us fight back. Over the past few months, LACMA, along with the CMA, successfully blocked in court Governor Brown’s proposal to cut Medi-Cal reimbursement by 10 percent. We are currently working hard on your behalf to prevent the State of California from forcing dual eligible “Medi-Medi” patients in Los Angeles from being coerced into managed care plans, which would disrupt long-established doctor patient relationships and adversely affect continuity of care for thousands of our citizens. Health care savings cannot be built upon the backs of sick patients. We cannot state emphatically enough that we are not your father’s LACMA. In coming issues I will be discussing practice resources we are developing for members
4 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
only—resources that will save you significant money and time. And don’t be at all surprised if you hear about additional legal advocacy on behalf of you and your patients. If you like what we are doing, then spread the word. It’s your membership dues that allow us to represent and support the best interests of your practice. If each of you recruited just one new member over the next few months, I cannot stress enough how significant that would be to our efforts. Please let me know what LACMA can do to assist you and your practice. What are we doing well? What needs work? Would you like to be more involved? Please feel free to call our main office at 213-683-9900. You can also reach me at email@example.com. I’ll either reply to your email, give you a call, or perhaps address your issue in a future column. 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.
“When it comes to Meaningful Use, athenahealth did all the legwork… and then they made it easy for me to do.” –Dr. Reavis Eubanks
This is how Dr. Eubanks
got paid for Meaningful Use.
fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months. With guidance every step of the way and proven, cloud-based services. Best in KLAS EHR* Free coaching and attestation
Seamless clinical workflow Guaranteed Medicare payments**
85% of eligible athenhealth providers attested to Stage 1 Meaningful Use. And we’re ready for Stage 2.
Visit www.athenahealth.com/SCA or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians ** If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply.
Cloud-based practice management, EHR and care coordination services
F RO N t O F Fi CE | PR aC ti CE ti Ps
Big Challenges Ahead t H E M O S t A P P L I C A B L E and intense challenges of running a group practice are, according to respondents to the fifth annual Medical group Management association/american college of Medical practice executives report “Medical practice today: what Members have to say” research: 1. Managing finances with the uncertainty of Medicare reimbursement rates. 2. preparing for reimbursement models that place a greater share of financial risk on the practice. 3. preparing for the transition to icD-10 diagnosis coding. 4. Dealing with rising operating costs 5. participating in the centers for Medicare and Medicaid services’ ehr meaningful use incentive program. “the threat of a significant cut in Medicare reimbursement continues to plague physician practices and severely hinders their ability to properly plan and assess their financial situations,” comments susan turney, MD, president and ceo at MgMaacMpe. “the increased regulatory burden brought on by unfunded federal mandates only exacerbates the uncertainly caused by the flawed Medicare sustainable growth rate physician payment formula.” challenges for physician-owned medical groups and groups owned by hospitals or integrated delivery systems differed slightly. “not surprisingly,” a statement from the association says, “merging with another practice posed a bigger challenge for respondents in physician-owned groups than it did for those in hospitalowned or iDs-owned practices. Being acquired by another practice was also more likely to be a challenge for physician-owned medical groups.” Medical practice professionals in hospital- or iDs-owned medical groups found preparing for the icD-10 diagnosis codes more challenging than those in physician-owned groups. Managing finances, implementing and/or optimizing a patient-centered medical home and dealing with the commercial payer physician credentialing process were also cited as a greater challenge for hospital-owned groups. Visit www.mgma.com.
tracking Patients’ Skin Changes Free app also provides reminders for patients to perform skin checks
N E W F R E E A P P developed at the University of Michigan Health System allows your patients to create a photographic baseline of their skin and photograph suspicious moles or other skin lesions, walking them stepby-step through a skin self-exam. The app, called UMSkinCheck, sends automatic reminders so patients can monitor changes to a skin lesion over time, and provides pictures of various types of skin cancers for comparisons. The app is designed for the iPhone and iPad and is available for download on iTunes. “Whole body photography is a well-established resource for following patients at risk for melanoma,” says Michael Sabel, MD, associate professor of surgery at the U-M Medical School and the lead physician involved in developing the app. “However, it requires a professional photographer, is not always covered by insurance and can be an inconvenience. Now that many people have digital cameras on their phones, it’s more feasible to do this at home.” More than 2 million Americans are diagnosed with skin cancer each year, and some 50,000 will be diagnosed with melanoma, the most serious kind. Regular skin checks can help people discover melanoma in its earliest stages. The new app, a collaboration of the University of Michigan’s technology and clinical expertise, guides users through a series of 23 photos, covering the body from head to toe. Photos are stored within the app and serve as a baseline for future comparisons. The app will create a reminder to repeat a skin selfexam on a regular basis. If a mole appears to be changing or growing, the photos can then be shared with a dermatologist to help determine whether a biopsy is necessary. The app also includes a risk calculator that allows patients to input their personal data to calculate their individual risk.
6 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/25/12 6:46 PM
PR aC ti CE ti Ps | F RO N t O F Fi CE
Risk tip Informed consent: Fostering a dialogue
I P P O C R At E S once promoted the beneficence model of medicine, which encouraged minimal communication with patients about their condition. Like Hippocrates, those days are long gone, and guidance now supports the idea that patients need to understand planned medical procedures adequately so they can make informed decisions about their treatment. Effective informed consent requires a dialogue with the patient wherein they feel comfortable fully participating by asking clarifying questions and offering personal concerns. Requirements for informed consent have not changed in modern health care, but the delivery has seen strong consumer momentum to encourage a better exchange of information. Traditionally, informed consent was limited to operative procedures, but in recognition of the high-tech nature of medicine and the potent medications that have been developed, it must now encompass a broader range of medical care, including:
• Surgical procedures • Significant medical treatments • Prescriptions with severe side effects Physicians are bound, in advance of this medical care, to provide the patient with detailed information on the risks, benefits, and alternatives, including the option to not perform the procedure or treatment regimen and the effect that doing nothing would have on that patient’s health status. They are also required to inform the patient about any potential clinically significant adverse drug reactions or other concerns when a new medication is ordered. Patients can be overwhelmed by medical jargon and may be medically naïve, so it is imperative for the physician to foster an open dialogue with the patient and allow adequate time for discussion, translating key terms to common language and providing commonly asked questions that may put the patient at ease and stimulate further questions. It is important to base information not only on personal experience, but on broader
sources, as well. Verify understanding by asking patients to restate or recall key elements so the patient has an accurate understanding and does not develop unrealistic expectations, which often result in unfair complaints about the practitioner’s care. An area often minimized prior to medical care is the recovery period. Prior to treatment, the physician should discuss any limitations or unwelcome surprises that may arise. Often the focus is on early medical issues (e.g., pain, possible infection, drainage), but it is valuable for the patient to also understand what life will be like for a longer period of time. Perhaps they will require readily accessible restrooms or will be not be able to perform household activities. Finally, physicians will strengthen understanding and reduce potential complaints by including family members or friends in the discussions. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com.
Balance Billing for Dual Eligibles Don’t do it! By CMA StAFF
Q: CAN I BALANCE BILL My MEDI-MEDI PAtIENt? A: The California Medical Association frequently receives calls from practices with similar questions regarding their patients who have Medicare as their primary insurance and Medi-Cal as secondary, commonly referred to as Medi-Medi patients: Can I bill my Medi-Medi patient for the 20 percent co-pay after Medicare pays? Generally speaking, the answer is no. A physician who bills the Medicare program for services provided to a patient also eligible for benefits under the Medic-
aid program must do so on an assignment basis. Additionally, Section 1902(n)(3)(B) of the Social Security Act, as modified by section 4714 of the Balanced Budget Act of 1997, prohibits Medicare providers from “balance billing” Medicare beneficiaries who have secondary coverage under a state Medicaid plan. If a physician knowingly and willfully violates the law, he or she faces the possibility of exclusion for five years from all programs that receive federal funding. That means physicians could lose their ability see patients covered under Medicare, TRICARE, Medi-Cal, Medicare Advantage programs and federal workers’ compensation. In addition to exclusion, the federal government may impose civil monetary penalties.
Physicians who are not currently enrolled in the Medi-Cal program may enroll as Medi-Medi-only providers. More information about Medi-Cal provider enrollment and applications can be found at www.medi-cal.ca.gov. For more information on billing Medi-Cal and Medi-Cal managed care patients, see CMA On-Call Document #0150, “Side Agreements with MediCal Patients,” which is available free to members at www.cmanet.org. Or contact CMA’s reimbursement helpline at 888-401-5911 or economicservices@ cmanet.org. Reprinted with permission from the CMA online newsletter CMA Practice Resources. Visit www.cmanet.org/cpr/ current-issue. au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 7
7/25/12 6:46 PM
F RO N t O F Fi CE | PR aC ti CE ti Ps
Responding to Negative Online Comments Proactive and reactive steps to take when you’ve been flamed
I t H t H E advent of social media and online marketing outlets, physicians, health care practitioners and facilities are experiencing, in a new medium, a not-so-new phenomenon—bad publicity. There are many online sites that allow patients to rate their physicians on various scales, and oftentimes they can leave narratives about their experiences. As these websites increase in popularity, so does the significance of the ratings. Many patients are using the sites to report negative comments about physicians, and physicians often feel unable to defend themselves due to HIPAA and other privacy regulations. Negative reviews can come from angry patients, disgruntled employees, and sometimes even members of the public just trying to create unsubstantiated problems. When these attacks occur, sometimes the physician wants to go into a defensive mode to preserve both integrity and reputation. But impulsive responses may do more harm than good. Because negative online reviews can affect a physician and his or her practice, the issue warrants a two-fold plan of action that is both proactive and reactive in nature.
Proactive Steps • Set up your own practice web page
where you can control the content and message you want to share with the community. Work with your group administrator or medical director as necessary. Develop a social media plan for your practice. This could include Facebook or Twitter accounts where postings can be controlled. Periodically check websites for yourself or your practice to identify any specific issue or trends. You may want to explore setting up online alerts that advise when comments have been posted about you as a physician. Ask patients to go online and rate your services. Positive ratings will help to counter balance negative comments. Provide a patient complaint process so disgruntled patients can receive timely resolution.
Reactive Steps • Don’t panic. • Do not respond immediately or impulsively. Take time to consider the comment, to ref lect on why the individual felt compelled to post, and to decide if it warrants a response. Not all negative comments are worthy of your time to respond. A response may start a chain reaction of negative slurs and comments, potentially leading to litigation.
By JOSH HyAtt
• If you feel the information is clearly false, inappropriate and solely inf lammatory, contact the Internet site administrator. Legitimate sites have content guidelines and will probably remove information that violates them. • If you are considering suing a reviewer, there are many potential issues you need to be aware of to avoid pitfalls and countersuits. Consult with your attorney as soon as possible before taking any steps in that direction. • Periodically follow up with positive information about your practice on the sites. Never post fake consumer reviews, as this may result in significant fines and penalties. • If you choose to respond in writing, limit the response to general information. Never use patient identifiers or reveal any protected health information, and do not directly or personally attack the individual posting the comment. This article has been adapted from “Responding to Online Negative Comments,” one of 100+ risk management articles, sample forms and sample policies available online to NORCAL Mutual Insurance Company policyholders. Josh Hyatt is a Risk Management Specialist with NORCAL Mutual.
LA Children’s Hospital is Honored U.S. News & World Report ranks it No. 5 C H I L D R E N ’ S H O S PI tA L Los Angeles has made the honor roll in the most recent ranking of the Nation’s Best Children’s Hospitals by U.S. News & World Report. The hospital ranked No. 5 out of nine hospitals nationwide on the publication’s Best Children’s Hospitals Honor Roll, up three places from last year’s survey of Best Children’s Hospitals.
The new rankings recognize the top 50 children’s hospitals in 10 pediatric specialties. To make the roll, Hospitals had to excel in at least three medical specialties. Children’s Hospital Los Angeles ranked in the top 10 in a number of specialties: No. 5 in cancer, No. 6 in orthopedics, No. 7 in diabetes and endocrinology, gastroenterology and neonatology and
No. 9 in cardiology and heart surgery. The 286-bed Children’s Hospital Los Angeles has been affiliated with the Keck School of Medicine of the University of Southern California since 1932. Sourced from the Physicians News Network at www.physiciansnewsnetwork.com.
8 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/25/12 6:46 PM
• Fast implementation • Free setup and unlimited training • Customizable design for all specialties • Capture pay-for-performance monies • Order and receive lab results online • Eligibility verification* • ePrescribing* • Real Time clinical messages from health plans • “Real time” results reporting • Auto store common phrases • Dictation and scanning • Customizable SOAP note guidelines • Patient follow up alerts • Secure message center ...and much more!
Say goodbye to complicated, Expensive EHR packages... Oﬃce Ally oﬀers the ﬁrst ever, easy to use and aﬀordable EHR solution that fully integrates with our FREE Practice Management System, Practice Mate™, and our FREE Patient Health Registry, Patient Ally™. EHR 24/7 allows providers to spend more time with patients and less time on paperwork. We believe an EHR system should empower physicians to be more eﬀective, allowing for a more streamlined oﬃce workﬂow. Best of all, since its web-based you can access patient records anytime, anywhere!
for ONLY $29.95 (per month/provider)
(866) 575-4120 www.officeally.com
EHR 24/7™, version 3.6.0 CC-1112-490300-1 Learn More: www.officeally.com/certification
*additional fee applies *additional fee applies
7/25/12 6:46 PM
F RO N t O F Fi CE | PR aC ti CE ti Ps
Medical Claims Errors Cut by Half AMA efforts save $8 billion annually in the health care system
F F O Rt S By the American Medical Association to lead, as it calls it, “a transformation in the chaotic health insurance billing and payment system” have cut the number of medical claims paid incorrectly by large health insurance companies in half, according to the findings released for the AMA’s fifth annual National Health Insurer Report Card. Error rates for private health insurers on paid medical claims dropped from 19.3 percent in 2011 to 9.5 percent in 2012, the association says. That improvement “resulted in $8 billion in health system savings due to a reduction in unnecessary administrative work to reconcile errors,” the AMA adds. “While dramatic improvements were made this year, the commercial health insurance industry still paid the wrong amount for nearly one in 10 medical claims.” The AMA estimates an additional $7 billion could be saved if insurers consistently paid claims correctly. All the health insurers measured by the AMA improved their accuracy ratings since last year. For the second year in a row, UnitedHealthcare came out on top of seven large commercial health insurers, with an accuracy rating of 98.3 percent. Anthem Blue Cross Blue Shield, which had last year’s worst accuracy rating, 61.0 percent, made the largest improvement, with an accuracy
17% amount of improvement from 2008 to 2012 in private insurers’ response times to medical claims. among them, health care service corp. and humana had the fastest median response time, at six days. aetna was the slowest, with a median response time of 14 days. 33% amount by which health insurers have increased, since 2008, the transparency of rules they use to edit medical claims. reducing the use of undisclosed proprietary edits “unlocks the flow of transparent information to physicians and reduces the administrative costs of reconciling medical claims,” the aMa points out. 69% how much private health insurers’ overall denial rate rose since last year, reversing a downward trend that occurred between 2008 and 2011. the upward trend is continuing: in 2011 the figure was 2.10% but in 2012 it is 3.48%. every private health insurer except humana increased denials this year. anthem Blue cross Blue shield had the highest denial rate, at 5.07%, while regence had the lowest denial rate, at 1.38%. rating this year of 88.6 percent. Humana rounded out this year’s list with an accuracy rating of 87.4 percent.
By AMA StAFF Savings generated by improved insurer accuracy were partially offset by administrative costs associated with “a resurgence of intrusive managed care policies on clinical decisions,” the AMA says. Medical services requiring prior authorization from a commercial health insurer were reported on 4.7 percent of all claims, a 23 percent increase since last year. The AMA estimates that “burdensome prior authorization policies” will add up to $728 million in unnecessary administrative costs to the health system in 2012. The National Health Insurer Report Card “provides an annual check-up on the nation’s largest health insurers and diagnoses the strengths and weaknesses of the systems they use to manage, process and pay medical claims,” the AMA adds. It’s the cornerstone of the association’s Heal the Claims Process campaign, launched in 2008 to lead the charge against administrative waste by improving the health care billing and payment system. The AMA is urging a streamlined approach that allows medical claims to be submitted and settled in real time at the patient’s point of care. To learn more about Heal the Claims Process campaign or how AMA tools and resources can help you better manage the process of preparing and submitting medical claims, visit the AMA’s Practice Management Center at www.ama-assn.org/go/pmc.
Making Reports Easier to Read Alliance aims to standardize reports used in physician profiling programs t H E A M E R I C A N Medical Association reports that more than 60 organizations have pledged their support to an AMA effort designed to help physicians better use health insurer-provided data reports as tools to enhance the quality and value of patient care. “Almost every public and private health insurer presents physicians with practice profile reports to support data-driven decisionmaking,” says Jeremy A. Lazarus, MD, president at the AMA. “This feedback has been ineffective because the complex reports vary from plan to plan and are difficult to read and interpret.”
To help create data reports that physicians can easily understand and use, the AMA created the “Guidelines for Reporting Physician Data” with input from public and private health insurers, state and specialty medical societies, health standard organizations and employer and consumer coalitions. The new guidelines provide a roadmap for improving the usefulness of physician data reports by encouraging greater format standardization, process transparency and level of detail. “Encouraging industry-wide standardization of practice data reports will help physi-
cians double check the information and use accurate data as a tool to identify opportunities for practice improvement,” says Dr. Lazarus. Last March the AMA introduced a new teaching guide to help physicians review insurer-provided practice data and use the information for practice improvement. “Take Charge of Your Data” is designed to help physicians understand and verify the accuracy of profile reports provided by public and private health insurers. For more information on the new guidelines, visit the AMA website at www.ama-assn.org/go/physiciandata.
1 0 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/25/12 6:46 PM
LOS ANGELES COUNTY
Sheriff’s Department Leroy D. Baca, Sheriff
Medical Services Bureau
WEAR THE BADGE! Now Hiring
• Physician Specialist (Family Practice/Internists) • Registered Nurses • Licensed Vocational Nurses • Ancillary Staff
• Job Stability • Competitive Salary • Excellent Retirement Plans • Shift Differentials • Free Parking and Meals • Full Benefits Package Including: Medical, Dental, Life and Deferred Compensation Plan
Now Hiring Board Certified Family Practice and Internal Medicine Physicians Like us on Facebook and follow us on Twitter, and Text: 424242 to LASDMED for more information about our job opportunities.
Now Hiring Medical Professionals!
Exceptional employer support program for reservists and guardsmen
866-806-8773 • 213-893-5445
www.LASD.org LAS_0512_3tm.indd 06-15_7ce.indd 11 1
5/9/12 6:46 6:44 PM PM 7/25/12
Cm a | qu i ck list
Regulations Quick List The latest news on medical regulations
By CMA Staff
Loss Ratio Regulation for Individual Health Insurance Policies Department of Insurance This regulation conforms state law to the 80 percent medical loss ratio requirement under the federal Patient Protection and Affordable Care Act. The CMA supports the regulation because it will ensure that consumers receive the maximum health benefit value for their premium. The CMA submitted comments generally supporting conformity to federal law, but raised concerns about misleading health plan information regarding premium rate increases. Currently, the DOI and Department of Managed Health Care are accepting pre-notice comments regarding their implementation of Senate Bill 51, which would bring California in conformity with the federal 85 percent MLR requirement for large group insurers in addition to the 80 percent MLR requirement. The CMA submitted pre-notice comments reflecting concerns similar to those on the initial DOI regulation, as well as calling for an application of the MLR rule that would not result in excessive administrative burdens. Status: Pre-notice comments submitted 2/9/12.
Requirements for Preceptors Physician Assistant Committee
use lasers for ablation or surgery. It also states that they may not treat allergies where there is a known risk of anaphylaxis. The CMA submitted comments calling for no chiropractic laser treatment of allergies under any circumstances, clarifying that cosmetic medical laser procedures, including ablative and nonablative procedures are also prohibited, and declaring that the only lasers appropriate for chiropractors use are FDAapproved devices available over-the-counter. The BCE accepted the amendment that prohibits chiropractic use of lasers to treat allergies under any circumstances, but did not accept the other changes. The CMA reiterated the unaddressed issues in a letter submitted during the 15-day comment period. The BCE made no further changes before submitting the regulation to the Office of Administrative Law. The BCE made no further changes before submitting the proposed regulation to the OAL. Status: OAL decision expected 6/17/12.
Federal Regulations Coverage of Preventative Services: Group Health Plans and Health Insurance Issuers Department of Health and Human Services
Existing regulations permit only physicians to act as preceptors for the training and education of physician assistant preceptees. This proposal would expand the type of licensed health care providers who may act as preceptors to include physicians and surgeons, PAs, registered nurses who have been certified in advanced practice, certified nurse midwives, licensed clinical social workers, marriage and family therapists, licensed educational psychologists, and licensed psychologists. The CMA submitted comments and substitute language that would maintain the requirement that PAs receive supervised clinical training from physicians, but allow other health care providers to serve as supplemental preceptors. The changes were not made at the February 6 hearing, but the CMA and the California Academy of Physician Assistants were encouraged to submit additional language changes for future consideration. The CMA and CAPA sent a joint letter with agreed upon language changes for the PAC to consider at their May 7 meeting. At the May meeting, the PAC accepted and approved the language recommended by the CMA and CAPA and will be updating the proposed regulation’s language to maintain the requirement that preceptees receive supervised clinical training from physicians. At the May meeting, the PAC accepted and approved the language recommended by the CMA and CAPA and will be updating the proposed regulation’s language to maintain the requirement that preceptees receive supervised clinical training from physicians. Status: CMA/CAPA letter sent 4/10/12.
The Department of Health and Human Services issued an interim final rule implementing coverage for preventive services such as immunizations, obesity screening, and tobacco cessation counseling. CMA comments supported the proposed standards as a means to provide more Americans with basic preventive services that are covered by their health insurance, but cautioned that adequate provider reimbursement must be provided for these services to ensure access to care. Status: Still pending as of 2/18/12.
Chiropractic Use of Lasers Board of Chiropractic Examiners
Nutrition Labeling of Standard Menu Items in Restaurants Food and Drug Administration
The proposed regulation allows chiropractors to use lasers that have been approved by the FDA and indicates that they may not
The ACA requires restaurants with 20 or more locations to list calorie content information for standard menu items. The ACA
Medicare Physician Value-Based Payment Modifier Centers for Medicare and Medicaid Services The ACA establishes a new Medicare payment methodology called the “Physician Value-Based Payment Modifier,” which would pay physicians a higher rate if they successfully spend less than the national average per Medicare beneficiary. It reduces payments to physicians who do not successfully report on quality measures and spend more than the national per capita average. The Value Index takes effect January 1, 2015. The CMA generally opposes the value index because it is not workable under CMS’ current systems and will not produce accurate individual physician quality information. While the CMA won amendments in the ACA to ensure that the new formula adjusts physician payments based on geographic practice expenses (rent and wages) and the socioeconomic and health status of the patients, the CMA is concerned about its implementation and impact on access to care. Status: Long term ACA payment reform still pending.
1 2 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/25/12 6:46 PM
qu i ck list | cm a also requires vending machine operators who operate 20 or more vending machines to disclose calorie content for certain items. These regulations provide further direction on what is required to comply with the standards. The CMA submitted comments in support of the standards. Status: Still pending as of 1/23/12.
Medicare and Medicaid: Opportunities for Alignment Under Medicaid and Medicare Centers for Medicare and Medicaid Services Under the provisions of the ACA, the CMS will work with state Medicaid (Medi-Cal) programs to redesign the care and treatment of Medicare-Medicaid “dual eligibles.” In this request for information, the CMS solicited comments from all stakeholders about how best to coordinate benefits for the dual eligibles, and what opportunities are available to better align the two programs. The CMA filed a formal response highlighting the need for adequate physician and patient protections and the importance of coordinating care for this vulnerable population. Status: CMA comments submitted 7/11/11.
ments by 4 percent. The 2012 proposed rule includes the CMA’s advocate position to increase the geographic adjustment by 3 percent to truly reflect the geographic differences in the cost to practice medicine. The CMA opposed the proposed dates for applying penalties for e-prescribing and the value modifier. The CMA urged the CMS to coordinate the PQRS and EHR programs, and provide more guidance to physicians and patients about the new Annual Wellness Visit. The CMA provided detailed comments on the physician confidential feedback report program, the PQRS, e-prescribing, and the Value Modifier. The CMS continues to ignore the Geographic Payment Locality problems. Status: Final rule published 11/28/11. Long term ACA payment reform still pending.
Medicare and Medicaid: Reform of Hospital and Critical Access Hospital Conditions of Participation Centers for Medicare and Medicaid Services
Medicare Physician Fee Schedule for 2012 Centers for Medicare and Medicaid Services
The CMS published an updated set of requirements that hospitals must meet in order to participate in the Medicare and Medicaid programs. The major changes to the requirements, known as conditions of participation, that could impact medical staffs and scope of practice within hospitals include:
The CMS published the 2012 Medicare physician payment rule and asked for preliminary comments on provisions of the ACA that take effect in future years, including the Value Modifier and the Physician Compare Website. Most significant for California physicians, in last year’s proposed rule, the CMA successfully killed the CMS’ plan to reduce geographic adjust-
• Creating an option that allows a single governing body in a multi-hospital system to oversee multiple hospitals. • Allowing hospitals to broaden the definition of “medical staff” to include other practitioners as eligible candidates for privileges required by the state to practice in a hospital.
It’s never been easier to enjoy menu choices from McDonald’s® that fit your lifestyle! Calories provide the fuel you need to work and play. A 2,000 calorie daily diet is used as the basis for general nutrition advice; however, individual calorie needs may vary. With our FAVORITES UNDER 400 CALORIES menu, you’ll be surprised how easy it is to make choices that are right for you!
Visit www.mcdonalds.com for information on our variety of menu choices. ©2012 McDonald’s.
au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 1 3
7/25/12 6:46 PM
Cm a | qu i ck list • Allowing for drugs and biologicals to be prepared and administered on the orders of practitioners (other than a doctor), in accordance with hospital policy and State law. The amendment also allows orders for drugs and biologicals to be documented and signed by practitioners in accordance with hospital policy and State law (which is specified to include medical staff bylaws, rules and regulations). • Eliminating the requirement for authentication of verbal orders within 48-hours and have deferred to applicable State law to establish authentications timeframes. Late last year, the CMA submitted comments objecting to several amendments in the proposed regulations. The CMA supported the elimination of the federal requirement that verbal orders be authenticated within 48 hours. With regard to authentication of verbal orders, California law still requires such authentication to take place within 48 hours, but the elimination of the federal requirement on this issue could potentially lead to changes in state law. The CMA review the final rule in further detail and will take the appropriate legislative and regulatory action to ensure that state laws continue to protect patients and ensure quality of care. Status: Final rule published 5/16/2012. Effective 7/16/12.
Smoking of Electronic Cigarettes on Aircraft Department of Transportation This rule would amend existing airline smoking regulations to explicitly ban the use of electronic cigarettes on all aircraft in scheduled passenger interstate, intrastate and foreign air transportation. The CMA submitted comments in support of the rule. Status: Still pending as of 6/11/12.
Medicare, Medicaid, SCHIP: Transparency Reports and Reporting of Physician Ownership or Investment Interests Centers for Medicare and Medicaid Services This rule requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children’s Health Insurance Program to report annually certain payments or transfers of value provided to physicians or teaching hospitals. In addition, applicable manufacturers and group purchasing organizations are required to report annually certain physician ownership or investment interests. The Secretary must publish applicable manufacturers’ and GPOs’ submitted payment and ownership information on a public website. While the CMA supports the disclosure of financial relationships between physicians, pharmaceutical interests, and medical device manufacturers, the CMA co-signed a letter with the AMA that expresses concern with the lack of due process for physicians who dispute the accuracy of information, the record-keeping burden, and the scope of the value that must be reported. Without significant modifications, the regulation will result in the publication of misleading information and impose burdensome paperwork requirements on physicians while shedding very little light on actual physician-industry interactions. Status: CMA/AMA comments submitted 2/17/12.
Medicare: Emergency Medical Treatment and Labor Act: Applicability to Hospital Inpatients and Hospitals with Specialized Capabilities Centers for Medicare and Medicaid Services EMTALA was passed to ensure that any individual with an
emergency medical condition, regardless of insurance coverage, is not denied essential lifesaving services. This request for comments addresses the applicability of EMTALA to hospital inpatients. The CMS states that it is maintaining its current policy that EMTALA does not extend to inpatients or to the transfer of inpatients to hospitals with specialized capabilities. The CMS says it will continue to monitor whether it may be appropriate later to reconsider the inapplicability of EMTALA to the transfer of inpatients to hospitals with specialized capabilities. The AMA and CMA determined there was no need for comment. Status: Comment period 2/2/12 – 4/2/12.
Medicaid: Covered Outpatient Drugs Centers for Medicare and Medicaid Services This rule implements several sections of the ACA related to prescription drug pricing in the Medicaid (Medi-Cal) program. The regulations would increase minimum drug rebates paid by manufacturers, add new reporting requirements on pharmaceutical companies, and review upper payment limits allowed under federal law. The CMA reviewed the regulations to ensure that they do not hamper access to, for example, vaccinations and chemotherapy. Physician administered drugs are not addressed, and there is no apparent connection to the practice of medicine, so the CMA will not comment. Status: Comment period 2/2/12 – 4/2/12.
Medicare and Medicaid EHR Incentives – Stage 2 Centers for Medicare and Medicaid Services This rule defines “Stage 2” of meaningful use, which many physicians would have to demonstrate in the EHR incentive programs beginning in 2014. As drafted, the rule would require physicians to report on 17 required objectives, and 3 selected from a menu of 5. It would further require physicians to report on as many as 12 clinical quality measures. The CMA Information Technology Council is reviewing the rule, and the CMA will submit formal comments requesting that the CMS not impose any new requirements that would be overly burdensome on physicians, or which involve infrastructure physicians cannot control (such as public health registries). Status: CMA comments submitted 5/7/12. Final rule expected in late 2012.
ACA: Certain Preventive Services Under the ACA Department of Labor The DOL intends to amend federal preventive services regulations around the mandated provision of contraceptive services coverage in employee health insurance. Specifically, the proposed amendments would shift the requirement to provide such coverage from the employer to the insurer, leaving the religious exemption largely unchanged. The CMA submitted comments supporting the federal position that such preventive services provisions serve as a floor so as to not reduce the current level of access to contraceptive services coverage in states. Status: CMA comments submitted 6/5/12.
Medicare: Reporting and Returning of Overpayments Centers for Medicare and Medicaid Services Physicians are currently obligated to return overpayments to Medicare. The CMS recently issued further guidance on how physicians may comply. However, the rule fails to clarify key elements of the obligation and contradicts other existing CMS
1 4 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/25/12 6:46 PM
qu i ck list | cm a overpayment rules. The CMA and AMA opposed the 10-year look back period for overpayments and requested a three year look back starting in 2010; the CMA/AMA also asked for these clarifications: Asked CMS to clarify that physicians are not obliged to search for overpayments; Requested that the CMS provide the same due process and appeal rights to physicians for overpayments as apply for other payment related issues. Status: CMA/AMA comments submitted 4/16/12.
Medicare ICD -10 Coding System Implementation Regulations Centers for Medicare and Medicaid Services In response to organized medicine’s advocacy, the CMS’ regulations delay the implementation of the ICD-10 coding system until October 1, 2014. The regulation also simplifies administrative processes for physicians by proposing that health plans have a unique identifier of a standard length and format. In a letter to the CMS, the CMA expressed strong support of the decision to delay the implementation of ICD-10 and asked for further delays. Status: CMA Comments submitted 5/10/12.
State Regulations Rule Making Process The executive rulemaking process is governed by the Administrative Procedures Act. Once the appropriate state agency has published the regulatory text and notified the public of its availability, regulations are said to have been officially “noticed.” This commences a 45-day minimum comment period during which written public comments may be submitted. In many cases, a public hearing will be held at the close of the comment period through which the agency may receive oral testimony.
The agency will then consider the comments and make appropriate changes to the regulatory text. Major changes require that the regulations be noticed and published for a second 45-day minimum comment period and public hearing. Substantial and sufficiently-related changes only require a 15-day comment period. If no substantial changes are made, the agency will issue a Final Statement of Reasons responding to all comments. The agency then officially adopts the regulations and files them with the Office of Administrative Law within one year of the official notice date. If the OAL approves the regulations, they are filed with the Secretary of State and effective within 30 days. If the OAL rejects the regulations, the OAL can either return them to the agency for revisions or publish a final notice of disapproval. The federal rulemaking process is governed by the Administrative Procedure Act. Federal agencies must publish all proposed rulemaking files in the Federal Register at least 30 days before they take effect in order to allow for public comment. Additionally, some rulemaking agencies allow for an optional Advance Notice of Proposed Rulemaking which asks for public input prior to the official rulemaking notice. Certain regulations only require publication and an opportunity for comment, while others require publication and one or more public hearings. Once all comments have been considered by the rulemaking agency, the language is issued as a Final Rule. In some cases, members of the public and other interested parties may file a lawsuit against the regulatory action, thus requiring further judicial review. The Congressional Review Act also provides Congress with 60 in-session days in order to review and possibly reject new federal regulations issued by these regulatory agencies.
No down payment for home mortgages up to $1 million Our special home financing is designed to meet your needs as a physician for the purchase of your primary residence. • Financing available with no down payment – up to $1,000,000. Expansion of loan-to-value ratios for loan amounts up to $1,750,000. • Private mortgage insurance is not required – save thousands over the life of the loan
• Single family homes, townhomes, lofts, and condominiums are eligible • Student loans that are deferred for 12 months are not counted in qualifying ratios. Refinances with high loan-to-values are also available.
For information on this special home financing program from BBVA Compass, give us a call today. Bryan Yaninek, Mortgage Banking Officer 719-329-3256 • firstname.lastname@example.org apply online at: www.bbvacompass.com/mortgages/byaninek
All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC.
7/25/12 6:46 PM
The neW 1 6 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
t h e n e w l acm a | f e at u r e
With its recent lawsuit against aetna for illegal—and immoral— practices, the los angeles County Medical association proves once and for all that it is not afraid to take on the big boys. BY CherYl england
h e n a California resident bought a Preferred Provider Organization plan from Aetna that offered medical coverage for services by in-network and out-of-network health care providers, he didn’t realize that Aetna wasn’t going to uphold the contract. After the patient had a medically necessary surgery performed by an out-of-network physician that his primary physician chose, however, Aetna refused to pay up. The patient appealed the insurance company’s decision three times, but Aetna only reimbursed $9,000 of $70,000 in medical bills. At about the same time, Rocky Delgadillo, CEO of the Los Angeles County Medical Association, started hearing from physician members that they were receiving letters from Aetna threatening them with the loss of their contracts if they continued to refer patients to out-of-network physicians and facilities even though the patient’s policy provided that benefit. “I consulted with Francisco Silva, the California Medical Association’s Vice President and General Counsel, and he said he had heard the same stories from physicians and patients,” says Delgadillo. “He also said he’d be happy if LACMA would take the lead in stopping Aetna from these illegal practices.” So on July 3, the Los Angeles County Medical Association along with the California Medical Association, Santa Clara County Medical Association,
Ventura County Medical Association, four surgery centers, more than 60 physicians and a California patient filed a lawsuit, LACMA, CMA, et al vs. Aetna, in Los Angeles County Superior Court against Aetna Health of California. The lawsuit charges that Aetna routinely and illegally denies patients access to out-ofnetwork doctors after selling them costly PPO insurance policies that promise patients the right to choose their own physicians. The suit also alleges that Aetna threatens doctors with having their Aetna contracts terminated if those doctors continue to refer patients outside the network even though their policy provides this benefit. It is Aetna’s best financial interests to keep procedures within the network, since out-of-network medical centers charge more for procedures than Aetna pays its contracted providers. In the lawsuit, the physicians also claim that Aetna has violated the terms of a 9-year-old settlement. Despite a 2003 settlement in a national classaction lawsuit brought by physicians, “Aetna has continued its illegal practice of restricting its members’ rights to use out-of-network providers, has continued to threaten physicians who refer to out-of-network facilities, and has refused to pay for out-of-network benefits for which its members expressly contracted,” the lawsuit says. The lawsuit seeks an injunction prohibiting Aetna from engaging in unfair business practices and false advertising, compensation for the
patients and physicians who have been harmed, triple damages under the federal Lanham Act and punitive damages.
Stepping up to the Plate
The lawsuit comes just three months after California Insurance Commissioner Dave Jones criticized Aetna’s quarterly health insurance rate increases as “unreasonable” and “in excess” of the U.S. Bureau of Labor’s medical cost inflation index. According to the Commissioner, the department also determined that the Aetna subsidiary selling health insurance in California made a 27.7 percent profit in 2011 and paid $1.7 billion in dividends to its parent company, Aetna Health Management, which is based in Hartford, CT. Aetna Health Management reported $33.8 billion in revenue last year—certainly not chump change. “With its most recent increase, Aetna is hitting its California small business customers with an average increase of 30.3 percent over the last 24 months,” said the Commissioner. Yet, it took LACMA to step up to the plate and begin to do something about the problem. Delgadillo worked with his law firm, Liner Grode Stein Yankelevitz Sunshine Regenstreif & Taylor LLP, to find physicians and patients that were willing to speak up and file a lawsuit. (Hooper, Lundy & Bookman, P.C. is the other law firm representing the plaintiffs in the suit). “This isn’t a class action suit,” says Delgadillo, “but a mass action.”
au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 1 7
f e at u r e | t h e n e w l acm a best for someone’s health.” Delgadillo echoed Dr. Fink’s sentiment that the lawsuit is unprecedented. “It struck me at one moment just before press conference when Dr. Fink was being interviewed by a local newspaper reporter and he started off by saying this is the new LACMA,” says Delgadillo. “It’s not just another lawsuit about putting profits ahead of patients--it’s a historic event since LACMA has never sued a health plan before.” Even more than a historic event, the lawsuit will help change the way physicians are perceived by the public—it proves that physicians are here to help their patients and will put everything aside for that, including their time and possibly even their livelihood.
a b o v e : New LACMA President Dr. Samuel Fink and Gerry Daley representing the California Nurses Association both spoke passionately about the lawsuit. b e l o w : Numerous news outlets picked up the story including major papers such as the Los Angeles Times, the San Jose Mercury News and the Los Angeles Business Journal as well news wires such as Reuter’s and PR Newswire, thus getting LACMA’s name into the public eye.
At a well-attended press conference about the lawsuit, posters filled with letters from Aetna to physicians and patients made an extremely compelling point that Aetna is routinely denying out-of-network coverage even when its policies explicitly offer that benefit. In his remarks at the press conference, LACMA President and Chairman of the Board, Samuel Fink, MD, stated “This lawsuit is an unprecedented action--the first of its kind--and an
enormously proud moment for LACMA, and the physicians and patients we care about. I say proud, because filing this lawsuit defends the very core values of American medicine—the right of patients to determine along with their doctors what is best for their health. It should not be insurance companies, Wall Street investors and Aetna’s CEO who, by the way, has a compensation package of over $10 million including a corporate jet that determine what is
1 8 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
The response from doctors, patients and medical associations across the country has been tremendous. LACMA has received a deluge of calls and emails from supporters who want to join the lawsuit. LACMA is encouraging patients, physicians and employers to share their experiences with Aetna at www.lacma.md. Aetna, of course, denies any wrongdoing, insisting the company only takes action against physicians who try to drive up patient costs by referring them to out-of-network facilities owned by the physicians themselves. In addition, according to an Aetna statement, the company contends it sued some of the physicians and surgery centers named in the complaint “for their egregious billing practices” in February in the Santa Clara County Superior Court. But LACMA’s chances of winning the lawsuit look good. Yes, the coalition of supporters know they are fighting an economic giant, but in the end, they believe the courts will agree with them that Aetna engages in unfair business practices. As any physician knows, the most critical relationship of trust in entire health care delivery system is that between a physician and a patient. Actions taken in name of profit such as Aetna’s start to erode that trust. The plaintiffs in the suit firmly believe that they can convince a jury that if Aetna is allowed to continue its illegal and profit-seeking actions it will, in the end, destroy the trust between the physician and patient and without that trust, we simply do not have health care in America.
If you are not a member of LACMA, then this is your last issue of Southern California Physician magazine unless you opt to subscribe. As a courtesy to our Southern California partners, we are offering a one-year subscription for the discounted rate of $25â€”a 64% discount! COMPanY:
MC, ViSa Or aMeX:
Mail or fax your completed form with credit card number or check to:
Southern California Physician Subscriptions 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 213-683-9900 t 213-226-0350 f au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 1 9
Top Tips for Mana
2 0 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
pr ac ti ce m anag e m e n t | f e at u r e
aging Your Practice Tips from the experts for running your business By Cheryl England
e rta i n ly Yo u r pa ss i o n lies in practicing medicine, not running a business. But often you have to do both. To help you out, we’ve gathered some top tips for managing your practice efficiently from the experts. You’ll find them grouped into these categories: Patient management, marketing, personnel management, reimbursement, and time management.
1 To help reduce peak hour phone call loads, add this note to your patient correspondence: “For fastest service, the best time to call is between 2:00 p.m. and 4:00 p.m.” Put the same information on your website and patient brochures. 2 Compile a list of the most frequently asked questions and educate patients about those issues while they are in the office. 3 Ethnic medical societies often have patient literature in other languages. Often you can visit their websites and download handouts. 4 The steps to take when terminating a patient relationship are: • Send a certified letter, return receipt requested. Keep a copy of the letter and attach it to the patient’s medical record. • Give no reason or a general reason for the termination. • Offer routine medical care for the first 15 days from the date of the letter. • Offer emergency care for the second 15 days from the date of the letter. • Offer to send copies of the patient’s medical records to a new physician. • State that the relationship will be terminated 30 days from the date of the letter. • Note any subsequent communication you have with the patient. • Never take a terminated patient back into your practice.
5 Pay attention to the ambience in your waiting room. Furnishings need to be attractive, and they should be updated every seven to 10 years. You should have adequate seating, good
lighting and a broad array of current reading material. If your patients have children—or your patients are children, be sure to have safe, hygienic toys for them. 6 Make self-introduction a priority for everyone on your staff. “Hi, I’m Sarah” goes a long way toward making a patient feel like a part of the practice. 7 When using an EHR system, avoid turning your back to the patient. Position the monitor so the patient can see the screen and tell them what you are doing. 8 The best practices for emailing patients are: • Only put in writing what you would say to a patient in person. • Be concise in your communication. • Incorporate your contact information. • Check your spelling and grammar before clicking “send.” • Never use all caps. • Use emoticons sparingly, if at all. • Never use abbreviations. • Include a disclaimer. A standard one might read: “Email is not secure, may not be read every day and should not be used for urgent or sensitive issues.” • Pick up the phone. If you cross emails with another party two or three times or if there is an emotionally charged issue involved in what you want to communicate, stop emailing and place a phone call instead.
9 Tips for dealing with patient complaints include: • Listen to what the patient says. Ask them to explain what went wrong. Don’t interrupt and if they are angry, let them vent. • Take notes about the complaint. • Be sincere. Tell patients that you understand. It gives them encouragement to give you the information you need to solve their problem. • Explain what caused the problem. Do your best to describe what caused the problem. If you don’t know, promise to find out and keep your word. • Compensate the patient for the inconvenience. Offer helpful alternatives for what au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 2 1
f e at u r e | pr ac ti ce m anag e m e n t you can do such as “I’m sorry, we don’t participate with that plan. But let me give you a blank claim form and preaddressed envelope to make it easy for you to submit your own claim.” • Set a deadline. Explain how long it will take to correct the problem and then stick to it. • Stay in touch. Keep in close contact with the patient while the problem is being corrected. That assures the patient that you haven’t forgotten or ignored his or her complaint.
10 Do not look at your watch until you are out of the patient’s sight. Don’t leave the patient thinking that you might have spent more time if you weren’t so concerned about the hour.
6 The most effective word of mouth is what your staff says about your practice. After all, they know the inside story. Do they understand how important they are in creating positive impressions? You have less to fear from competitors than from indifference or negativity on the part of your staff. 7 When using a website to market your practice, identify and use the keywords of your audience to improve a Google search. Prospective patients don’t always know or search using medical terms. (“Otolaryngologist” vs. “ear ache” for example.) Think about the words that a layman would use to do a Google search. In fact, one of the most accurate means to develop a list of search terms over time is to ask patients.
“Set up a system for timely review of aging reports. Unpaid claims and unapplied credits can get out of hand quickly.” Marketing
1 Build name recognition by writing letters to the editor on health care topics.
2 In medical procedures that involve a pharmaceutical product or medical device, advertise the physician or group, not the device. 3 The steps to take to prepare for a TV interview: • Know the information you are being interviewed about in depth. • Be conscious of your mannerisms while on camera. • Look your very best. • Have your clothes laundered and pressed.
4 At a gathering, assume everyone you meet is your patient and dole out free advice. Make recommendations. Be helpful. Seize opportunities to set new patient appointments. 5 Easy ways to capture email addresses for patients are: • Include a permission request and multiple spaces for email addresses as part of your standard office form. • Ask for email addresses when you routinely update records on file. • Invite people to subscribe to your e-newsletter or updates via a simple form on your website. Sites can be programmed to acpture the data submitted and automatically update your master list. • If you have Facebook page or Twitter account, you can invite people to register or subscribe by email. • Offer a prize to submit an email address. Be clear that you’re asking permission to use their email address subsequent to the contest. • Create a loyalty program that includes special offers or early promotional announcements that are available via email. The idea of exclusivity has a built-in appeal factor. 2 2 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
1 When making decisions that affect your staff, be sure to get their input first. Without their input, you will not have their buy-in, which will almost guarantee that the change process will not succeed. 2 If you have more than one employee at the front desk, separate the “hello” and “goodbye” functions to make workflow smoother. 3 Batch clerical work such as preparing bank deposits or entering patient demographics into times when there is a lull in the office worker’s schedule instead of when patients are waiting. 4 Transfer responsibility for answering the telephone away from the reception desk, where patients are welcomed. Make sure the area where the phone is answered is quiet, with minimal distractions. 5 To help prevent employment related claims, use these procedures: • Create an up-to-date employee handbook. • Create formal, written anti-harassment and anti-discrimination policies. • Make sure that you and any other managers have formal training in employment practices. • Create written employee job descriptions. • Document all hiring, promotional, disciplinary and discharge decisions. • Perform background and reference checks on all employees. • Provide accurate written evaluations to employees on a regular basis. • Provide written offers of employment to prospective new hires.
6 Audio- or videotape yourself conducting meetings, then sit back and review them objectively. Put yourself in your team members’ position and imagine what it felt like to be in that meeting with you. If you find it difficult to assess the recordings, ask a trusted colleague for honest feedback. 7 Remove the emotion factor when making a hiring decision by using a consistent strategy that carefully examines the candidate. Include these factors: • Rate the candidates’ past job history and accomplishments as presented on the resume. • Compare how well the candidates’ skill set matches your written job description. • Conduct the interview and note objectively what I reveals about the candidates’ attitudes, values and professionalism. • Complete past employment reference phone calls—be a good sleuth.
pr ac ti ce m anag e m e n t | f e at u r e
1 Front office staffers need to be aware of co-payments and collect them at each and every visit.
2 Emphasize to front office staff that obtaining accurate demographics—address, phone number, birth date and sex, for example—is very important because claims will be denied if the information is incorrect. 3 Make sure that front office staff verifies insurance information for patients at each and every visit. 4 Information needed in every appeal letter includes: • Patient name • Date of birth • Patient insurance identification • Claim number • Date of service • Total charges and/or balance due • A copy of the original CMS 1500 form • A clear and concise explanation of why the claim is being disputed and the outcome desired
5 Monitor accounts receivable reports monthly. Look for payers that have a pattern of slow payment. For any claims over 40 days old, staff should provide an explanation. If the delays are payer-related, a meeting or contract review with the payer is in order. 6 Perform an Explanation of Benefits audit. Monitor more closely those payers who are not reimbursing at contracted rates, and work with them to resolve inconsistencies. Setting up your practice management system to host each payer’s fee schedule is a great way to alert the payment poster if the payment received was not as expected. Train staff not to ignore practice management alerts. Setting up your system for the first time will be time consuming, but systems are easy to maintain once established. 7 Be sure that billing and coding staff have a current list of payers with whom you are contracted, and that contractual adjustments are not made for payers with whom you are not contracted. 8 Develop a “denial tracking system” that categorizes each denial. This will help you and your staff pinpoint areas that need to be improved. You can project the amount of money uncollected because of incorrect patient demographics, posting errors, etc. 9 Set up a system for timely review of aging reports. Unpaid claims and unapplied credits can get out of hand quickly. Setting up a timeline to monitor and review all accounts over 60 days old will help keep your accounts receivable under control. 10 Avoid sending statements for pending charges. Do not send patients statements of charges pending payment from their insurance company. This is often confusing to patients who mistake it for an actual bill. And it ends up being a waste of money to the practice that just spent 50 cents to communicate no actionable information to the patient. Instead send bills to patients only after you have collected the insurance portion of the claim. This way the statement only includes the patient’s owed portion. 11 Pay attention to missed appointments—those patients who cancel at the last minute or simply don’t show up at all. If you have three missed appointments a day—which is not uncommon for many physicians—and your average
per patient revenue is $150 that adds up to more than $100,000 per year. Make sure those patients show up by communicating how important the appointment is, confirming appointments 48 hours in advance and respecting the schedule so that you see patients on time. After all, if you value their time, chances are good that they will value yours. 12 Having specific written documentation is crucial when contacting a payer about reimbursement issues. Details should include: • The patient name, date of service and date and time of call. • The name, title and phone number of the payer contact as well as the name of the person in your practice making the call. • The tracking or reference number, if appropriate. • Requests for follow up calls or actions, including date and time. • Any resolution or outcome. • Record the details of all follow-up calls made on the same form. • An outline of the main elements of the conversation including commitments and agreements made by you and the payer. Then be sure to follow up with an email to that person to confirm your understanding of the next steps. Keep that email in your Sent items folder.
1 Schedule your time with a daily to-do list. 2 Schedule your hospital rounds early in the morning. Early rounds catch the patients before they are taken for tests, eliminating return visits to the room. Plus, since patients are usually eager to see their physician, you will avoid dealing with numerous phone calls from patients wanting to know when you will be in to see them. 3 Batch your phone calls. Set specific time aside for placing required phone calls, rather than dealing with constant interruptions during the day. 4 Dedicate time for the Internet and e-mail. You can accomplish more in less time if you set certain periods to handle such communications. 5 Handle paper on a “once and done” method. 6 Delegate responsibility, as well as tasks. 7 Prescribe for efficiency. You may need to prescribe certain medications for no more than 30 or 60 days before additional follow-up; however, other prescriptions can be issued for six months or more to minimize refill calls. 8 Set a specific time for the business of your business. Schedule when you will be reviewing accounts payable and receivable, billing reports, etc. sources: The Doctors Company; Susan Keane Baker, www. susanbaker.com; Lonnie Hirsch and Stewart Gandolph, www.healthcaresuccess.com; Jeffrey J. Denning, Practice Performance Group in La Jolla; Judy Capko, www.capko.com; the American Academy of Professional Coders; Roy S. Lyons, Managing Director of Marsh, www.marshaffinity.com; Brenda Bence author of the How You Are Like Shampoo personal branding book series; ExecTech Management Consulting and Coaching, www.exectechweb.com; Dan Schwebach, Vice President of Practice Management for AAPC Physician Services, www.aapcps.com. au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 2 3
2 4 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
i n stal l ati o n | f e at u r e fa r l e f t , to p : Past president Dr. David Aizuss takes a moment with Dr. Samuel Fink. Immediate Past President Troy Elander is seen in the background. fa r l e f t , b ot to m : LACMA CEO Rocky Delgadillo, Beloria Fink, Dr. Samuel Fink and Jerome French from sponsor Mann, Urrutia, Nelson CPAs pose for the camera. left:
Officers from left to right are Immediate Past President Dr. Troy Elander, Secretary Dr. Peter Richman, Treasurer Dr. Pedram Salimpour; President-Elect Dr. Marshall Morgan, an President Dr. Samuel Fink.
An Evening to Remember Officers for 2012-2013 installed By Cheryl England
p h oto s by da n i e l s i g a l
n a b e au t i f u l Thursday, June 28, the Los Angeles County Medical Association installed its 141st president, Samuel Fink, MD. More than 200 friends, family and fellow physicians came to event, which was held at the Luxe Sunset Hotel, to congratulate Dr. Fink on his new leadership role. Other officers installed included Secretary Peter Richman, MD, Treasurer Pedram Salimpour, MD, and President-Elect Marshall Morgan, MD. Immediate Past President Troy Elander, MD, officially handed over the reins to Dr. Fink. Featured speakers included Assemblymember Bonnie Lowenthal from the 54th district and also a member of the Assembly Health Committee. Rabbi Yakov Vann, who leads the Calabasas Shul, which Dr. Fink and his family attend, gave a devotional. Comedian Wayne Cotter, who has appeared on talk shows numerous times with both David Letterman and Jay Leno gave a popular and funny performance. Cotter has previously been awarded “Best Standup Comedian” in the American Comedy Awards. As the star of the evening, Dr. Fink also spoke to those present regarding his plans for his all-too-short year as president. First and
foremost, Dr. Fink plans to focus on increasing membership and on communicating better with members. Beyond that goal, he also stated that he plans to use the combined purchasing power of member physicians as a leverage to get significant discounts for members on the products and services that really make a difference to them such as medical waste disposal services, office and medical supplies, phone systems, billing and IT services and more. Part of his discount strategy is to combat the common misconception that membership in LACMA is too expensive. In a first for LACMA, this year’s installation was completely paid for by sponsors: Marsh, The Doctors Company, NORCAL, Cooperative of American Physicians, Pacific Western Bank, Lilly, AstraZeneca, Providence Tarzana Hospital, the United States Army, Mann, Urrutia, Nelson CPAs and eight other gracious companies. Other companies such as Fenton Nelson law firm and OSO Homecare, a specialty home infusion services company Dr. Fink’s wife Beloria consults for, supported the event with advertisements in the installation program or by purchasing seats at the dinner. And the sponsors definitely came through—the venue was elegant, the entertainment top-notch and the food delicious. au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 2 5
m e m b e r b e n e fits | at wo r k fo r yo u
reimbursement Advocacy and Assistance t h E C M A established the center for economic services to support physicians—especially those in solo practice, partnership, or small group settings—who face increasing financial pressures due to ongoing changes in the health care delivery system. we recognize that physicians like you are under constant pressure to streamline your business operations while continuing to provide access and quality care to patients. it is often a struggle to implement changes in stringent federal and state regulations and grapple with health plans that employ confusing, inconsistent, and unfair payment practices. we offer hands-on support to physician members in a variety of areas relating to practice management and a healthy bottom line: • Reimbursement assistance, which can help you recoup thousands of dollars by showing you how to appropriately respond to health plans through efficient appeals processes and claims reconsideration. • Direct assistance with resolving reimbursement issues. • numerous workshops and seminars that teach physicians and their staffs how to maximize reimbursements. • Various toolkits to help you better manage your finances. • cMa payor contract analysis, which is a free guide to contracting with payors. the educational guide helps members thoughtfully consider whether and when to enter into agreements with payors and how to prepare for negotiations when a payor relationship is desired. • assistance with federal and state pre- and post-payment audits and compliance. • information on health care issues, mandates and new policies to keep members informed about day-to-day reimbursement issues. • work with public and private payors to prevent onerous provisions from getting into contracts in the first place. For more information, contact the CMA’s Center for Economic Services at 1-800-786-4262.
At Work for you
LACMA offers a wide array of benefits designed to enhance your practice and protect your autonomy By CAroL ChAKEr
h E r E h A S N E V E r been a more important time to be a member of the Los Angeles County Medical Association and the California Medical Association. When you join LACMA and the CMA, you join a dedicated network of over 6,000 Los Angeles County physicians and over 35,000 California physicians who are working together to achieve a unified health care front and fight against unfair insurer reimbursement practices, restrictions on physician autonomy and the erosion of valuable legislation that protects physicians’ practices. LACMA and the CMA can help enhance your practice, improve your bottom line and protect your autonomy as a physician. Read on to discover the many benefits of membership.
your Membership, your Benefits
Since 1871, the Los Angeles County Medical Association has been at the forefront of medicine in L.A. County, ensuring that our members are represented in the areas of public policy, government relations and community relations. Through our advocacy efforts in both Los Angeles County and with the statewide California Medical Association, our physician leaders and staff strive toward a common vision—that you might spend more time treating your patients and less time navigating the obstacles that threaten your autonomy and undermine your practice of medicine. When you join LACMA and the CMA, you have access to these member-only benefits: • legislative advocacy
• • • • • •
Reimbursement advocacy and assistance Free legal consulting Jury duty assistance Free publications hit resources Free access to educational events, webinars, and cMe programs • partnerships and discounts As a member of LACMA and CMA, these benefits can: • provide visibility with patients and the community. • help improve your bottom line. • provide access to networks of peer physicians and elected officials. • give you a powerful platform to advocate for meaningful reform of the health care system and to protect your rights as a physician. • put valuable resources on topics ranging form practice management to legal issues at your fingertips. Most importantly, your membership works for you. As a member, you get access to an equally committed professional staff that will stop at nothing to protect the way you practice medicine from legal, regulatory and legislative intrusions. Your membership lets you focus on what’s really important: providing exceptional care to your patients. Recognizing the diverse membership needs of our prospective members, we offer specialized memberships for physicians, practicing residents and medical students. For additional information on the benefits of membership or to apply, please visit www.lacmanet.org or call us at 213-226-0313.
Jury Duty W h E t h E r yo u P r AC t i C E in a solo/small group setting, a large hospital group, or anything in between, jury duty service can conflict with your important daily obligations and disrupt patient access to care. lacMa understands how valuable your time is and has developed a solution to provide you with maximum flexibility in scheduling jury duty service. our program even reduces the chance that you will have to report. please call 213-226-0304 if you need further assistance or have additional questions.
2 6 s o u t h e R n c a l i F o R n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
at wo r k fo r yo u | m e m b e r b e n e fit s
i t h o u r influential Government Affairs program, LACMA and the CMA build coalitions of engaged physicians and establish meaningful relationships with legislators and other decision makers to impact public policy for the benefit of physicians and their patients. Working in partnership with the CMA, LACMA is actively involved in legislation at the federal, state, and local levels. While the vision for our Government Affairs program is ambitious and sweeping, our work has a tangible impact on the day-to-day practices of our members.
Shaping Health Care Legislation
Critical issues affecting today’s physicians are being decided in the legislative arena at a fast and furious pace. The most powerful weapon in advancing the cause of physicians and their patients is you. Hearing from a physician with experience from the frontlines of medicine can
make all the difference for a legislator facing a complicated health care issue. As a physician, you are in a unique position to offer advice to lawmakers about specific legislation affecting the medical profession and to share the concerns and challenges you face in your everyday. You can also help increase patient access to the important services that physicians provide. It is not only the right thing to do so that your patients’ interests are best served, but it is also good for the stability of the medical profession.
LACMA PAC and the LA County Physicians Action Committee are LACMA’s political action committees. Their mutual goal is to support and elect pro-medicine candidates at the state level by directly contributing to candidates seeking election to the State Legislature and other local offices. Anybody can support LACPAC.
LACPAC has a powerful role to play in shaping state health care policy since about one-third of the California Legislature respresents L.A. County. Many of these legislators hold key leadership positions, including five past speakers of the State Assembly. Active participation in every election cycle ensures the election of candidates who share our philosophy toward the future of medicine.
Continual Protection of MICRA
The CMA and LACMA continue to defend against attacks by personal injury lawyers on the Medical Injury Compensation Reform Act of 1975, which is California’s landmark medical malpractice reform law that keeps doctors’ medical liability premiums low and thus also keeps health care costs in check. We continuously defend the constitutionality of MICRA in court. The CMA and LACMA also work to ensure that federal health care reform efforts do not undermine MICRA.
Change is on the Horizon. Now is the time to gain your competitive edge. Learn the BUSINESS of health care while earning your Executive MBA at UC Irvine: • Convenient schedule: one weekend per month • Cohort of health care professionals and practitioners • Week-long residential on Federal Policy in Health Care in Washington D.C. • Ranked among the Top 25 Health Care Executive MBA programs • Up to 50 CME units may be earned
Apply Now for Fall 2012 – merage.uci.edu/go/HCEMBA Contact us to attend an Information Session or schedule a personal consultation.
Dr. Romilla Batra, HCEMBA ‘09
au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 2 7
7/26/12 6:55 PM
m e m b e r b e n e fits | at wo r k fo r yo u
Free Access to Events and Educational Programs L AC M A A N D t h E C M A regularly host seminars, cMe programs, webinars, conferences, meetings, and educational workshops on a variety of topics essential to running the business side of your practice. you’ll find seminars on: • implementing electronic medical records. • proper coding, billing and collection. • Managing Medicare. • practice management techniques. • understanding and implementing legislative and policy regulations. • and much, much more.
Benefits and Discounts
L AC M A A N D C M A membership offers you exclusive, time- and moneysaving benefits. By taking advantage of these discounts and services, you can earn back more than the investment of your dues dollars. Products include discounts on billing and collections services, malpractice insurance, group practice insurance and HSAs, investment services, auto insurance discounts and more. Highlighted programs include: • Bank of America Affinity Card: a member-only credit card that offers reduced rates, premium service and a generous rewards program. • Marsh insurance Services: Marsh offers members a variety of insurance programs including high deductible health plans and health savings accounts, employment practices liability insurance, workers’ compensation, term life, business owners package, long term care, long term disability, business overhead expense, dental and more. • AAA Auto insurance Discounts: save hundreds annually. • CME tracking/Credentialing: cMa’s institute for Medical Quality, certifies cMe activity for credentialing purposes to the Medical Board of california, as well as to hospitals, health plans, specialty societies, and others. • heartland Payment Systems: Members receive exclusive discounts and a three-year rate guarantee on heartland payment system’s suite of financial services, which includes credit card processing, payroll services, check management and real time health benefits eligibility verification. Other discounted resources for you include:
events are held throughout the county and state. please view the calendar at www.lacmanet.org.
hit resources A S o F 2 0 1 1 , the federal economic stimulus package provides approximately $19 billion over five years for health information technology, including direct bonus payments upwards of $44,000 for qualifying physicians who demonstrate “meaningful use” of electronic health records systems. since eligibility is based on usage, even physicians who already use ehR systems are eligible. whether you already use an ehR system or are just starting to survey the landscape, lacMa and the cMa are ready to help you navigate this process. as a lacMa-cMa member, you will receive free access to health information technology resources.
• Epocrates: cMa members get a discount on all epocrates mobile and online products. save 30 percent on subscriptions to epocrates products such as the #1 rated epocrates essentials. epocrates provides point-of-care access (via mobile devices and the web) to information on drugs, diseases and diagnostics. call 1-800-786-4262 to access this benefit. • Staples: save up to 80 percent on office supplies and equipment from staples, inc. call 1-800-786-4262 to access this benefit. • MedicAlert: Medicalert is a nonprofit foundation with over 50 years of lifesaving experience identifying and providing vital medical information to emergency personnel for over 4 million members worldwide. cMa members and their patients save $10 on new adult enrollments and $2.95 on Kid smart enrollments. call 1-800-253-7880 to access this benefit. • Magazine Subscriptions: 50 percent off subscriptions to hundreds of popular magazines, with a best price match guarantee. call 1-800-289-6247 to access this benefit. • Car rentals: save up to 25 percent on car rentals for business or personal travel. Membersonly coupon codes are required to access this benefit. get your code by calling the cMa’s Member help center 1-800-786-4262.
Legal Assistance t h E C M A’ S L E G A L help line provides immediate assistance for hR, medical, regulatory or legal questions. this resource is free to members. in addition, members have access to cMa on-call, the california Medical association’s online library of medical-legal and other information of importance to physicians. the library includes most of the center for legal affairs’ annual publication, the california physician’s legal handbook, as well as more specialized information on peer review and other topics, including information from the cMa’s center for Medical policy and economics. please call 1-800-786-4262 to access the legal help line. to access cMa on-call, please visit www.cmanet.org.
2 8 s o u t h e R n c a l i F o R n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
at wo r k fo r yo u | m e m b e r b e n e fit s
Benefit of the Month W h e t h e r yo u P r ac t i ce in a solo or small group setting or you are part of a large hospital group, jury duty service can pose major barriers to your daily obligations. LACMA understands how valuable your time is for you and your patients. Luckily, we have a solution to the crimp that jury duty can put in your schedule! We are happy to offer our members an exclusive service that greatly reduces your risk of having to report for service.
Description of the Service LACMA can arrange for physicians to meet their jury-duty service requirements by offering a one-time call-in on a date of their choice up to six months from the original summons date. Physicians can also transfer court locations so that if they are called in for jury duty service, they are able to report to a location that is the most convenient for them.
How to Use the Service • Simply fax the front page of your summons to 213-226-0353. • Indicate on the fax your preferred court location and the date you choose for your one-time call in. It can be any day of the week up to a year out from the original summons date. For example, if you would like to call in for a Friday, you will call in the Thursday evening before to see if you need to report. • Once we receive your fax, we will submit your request to the court right away. • The court will send LACMA a confirmation that your request has been granted within 5 business days. • We will then fax you a confirmation of your one-time call in along with new instructions. It is very important you thoroughly follow these new instructions.
Other Important Information • If your group is called to report, we cannot
guarantee a one day service time. You will need to report and proceed under the court’s direction. If you are called into the jury selection pool, it will be important for you to bring a written request to be excused from service. Emphasize that your patients are at risk if you are not available to see them. You will be able to present your case to the judge at this time. For court locations and additional information about the Los Angeles Superior Court, please visit www.lasuperiorcourt. org/jury. This service is only available for summons received from the Los Angeles County Superior Court. We, unfortunately, cannot assist you with summons received from other counties. This service is for LACMA members only. If you are not currently a member, please call 213-226-0313.
Please call 213-226-0304 if you need further assistance or have additional questions.
Meet Your Board! L AC M A’ 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 email@example.com or 213-226-0304. Officers Samuel Fink, MD
Lawrence Kneisley, MD
Heidi Reich, MD
Medical Student Councilor / USC Keck
Marshall Morgan, MD
Stephanie Booth, MD
Howard Krauss, MD
Susan Reynolds, MD
Pedram Salimpour, MD
Jack Chou, MD
Gideon Lowe, MD
Bob Rogers, MD
Peter Richman, MD
Sidney Gold, MD
Troy Elander, MD
William Hale, MD
Immediate Past President
Board of Directors David Aizuss, MD
Medical Student Councilor / UCLA David Geffen
William Averill, MD
Vito Imbasciani, MD
Paul Kirz, MD
Jonathan Macy, MD
Sion Roy, MD
Resident/Fellow Councilor (Alternate)
Carlos E. Martinez, MD Councilor
Nassim Moradi, MD Councilor
Ashish Parekh, MD Councilor
Jeffrey Penso, MD
Pejman Salimpour, MD Councilor
Shuo Steven Wang, MD Councilor-at-Large
Erin Wilkes, MD CMA Trustee (Resident)
Chair of LACMA Delegation au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 2 9
7/26/12 6:55 PM
asso ciati o n happe n i n gs | N e ws & e ve n ts
August Events 8 CMA and the Courts / Accessing CMA’s Legal Library Free webinar. Learn about the CMA’s role in important litigation in California and nationwide and learn how to navigate the CMA’s health law library. The Legal hotline staff will provide an overview of the wide array of topics covered in the CMA’s online library. 12:15 – 1:15 p.m. Contact 800-786-4262 or firstname.lastname@example.org.
15 Program Integrity in Medicare and Medi-Cal—The Physician’s Role Free webinar for members and staff; $99 for nonmembers. This session provides physicians with information about the risks of becoming a victim of fraud and how to take preventative action. It also covers compliance with Medicare and Medi-Cal documentation requirements. 1 CEU credit. 12:15 p.m. – 1:15 p.m. Contact 800786-4262 or email@example.com.
16 California Workers’ Comp eBill Part 1: Are You Ready? Free webinar. You’re invited to attend an extended three-part California eBill Webinar Educational Series, to be held August 16, 23 and 30, and hosted by Jopari Solutions with
speakers from the California Division of Workers’ Compensation. Part 1 will provide you with an overview of what eBill is, how it works, and the benefits and tools to help you evaluate your practice’s eBill readiness. Specific topics include an overview of eBilling and how it works, how eBilling can improve your practice’s metrics, how to evaluate your practice’s eBill readiness, how to get started and what resources are available. 12:15 p.m. – 1:45 p.m. Contact 800-786-4262 or firstname.lastname@example.org.
23 California Workers’ Comp eBill Part 2: Implementation Free webinar. You’re invited to attend an extended three-part California eBill Webinar Educational Series, to be held August 16, 23 and 30, and hosted by Jopari Solutions with speakers from the California Division of Workers’ Compensation. Part 2 will provide an overview of the eBill compliance requirements and focus on electronic claims and attachment submission requirements including acknowledgement transactions. Specific topics include an overview of compliance requirements, what you need to know about submitting
a complete bill to meet the 15 payment rule, electronic bill attachment rules, claim resubmission codes and submission timeline rules, and key claims, attachment submission requirements and eBill metric improvement tools. 12:15 p.m. – 1:45 p.m. Contact 800-786-4262 or email@example.com.
30 California Workers’ Comp eBill Part 3: Understanding Remittance Advice Rules Free webinar. You’re invited to attend an extended three-part California eBill Webinar Educational Series, to be held August 16, 23 and 30, and hosted by Jopari Solutions with speakers from the California Division of Workers’ Compensation. Part 3 will provide an overview of the eBill electronic remittance advice rules and how to use these rule as a tool to help automate your back office workflow processes. Specific topics include an overview of eBill electronic remittance advice rules, how to use the eBill rule specified CARC/RARC code set rules as a tool to help automate your back office workflow process and benchmarking for success. 12:15 p.m. – 1:45 p.m. Contact 800-786-4262 or firstname.lastname@example.org.
On J u ly 1 2 , the Los Angeles County Medical Association hosted its second Latino Physician’s Empowerment Dinner at Tamayo’s. The first dinner garnered excellent word-of-mouth and, as a result, the second dinner was packed with an audience of about 75 physicians. As before, the dinner focused on concerns that Latino physicians share in serving their communities. In addition, LACMA CEO Rocky Delgadillo spoke about the association’s vision and goals for becoming a more interactive player amongst the physicians within the Latino community. Pictured are Katherine Gilmer and Remi de la Rocha with Cope Health Solutions and Hector de la Rocha, MD.
3 0 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
N e ws & e ve n ts | associati o n happe n i n gs
Welcome to Our New Members! Please offer a warm welcome to our new members. Organized medicine is now 23 voices stronger thanks to them! Metropolitan District David Kim, MD
Lalitha Ramanna, MD Nuclear Medicine
Foothill and Pomona Districts 13 and 14 Gary Jensen, MD Diagnostic Radiology
Richard Smith, MD Bibiana Reiser, MD
Hyuk Kim, DO Obstetrics/Gynecology
Richard Sullivan, MD Jonathan Wada, MD
Gargi Upadhyaya, MD Hematology / Oncology
Srinivas Yanamadala, MD Pasadena / San Gabriel Vallley District 2 Mireille Hamparian, MD
East San Fernando Valley District 17 Moutasem Abaza, MD Dermatology
Alexander Sheng, MD
Southeast District 10 Andy Hong, MD
Luis Esparza, MD
Long Beach District 3 Nathaniel Neal, MD Rheumatology
West San Fernando Valley/ Santa Clarita Valley District 6 Mark Gerard, MD Internal Medicine
Kambiz Kosari, MD General Surgery
Maryam Mortezaiefard, DO Internist
John Whelan, MD Internal Medicine
Beverly Hills District 7 Kristine Hirschfield, MD Internal Medicine
Parviz Taheri, MD Radiology
Southwest District 9 Milton Miller, MD Ophthalmology au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 3 1
7/26/12 6:55 PM
asso ciati o n happe n i n gs | N e ws & e ve n ts
A Day at the Beach District 5 holds its annual family fun day
S o me d i s t r i c t s have all the fun! On Saturday, July 14 Los Angeles County Medical Association Bay District 5 hosted its third annual beach party at the Bel-Air Bay Club. About 75 member physicians and their families attended the event, which was hosted by member Richard Corlin, MD. As usual, the sunny day was perfect for mingling with colleagues, spending time with the family and, of course, eating barbecue fare
under shady canopies. The popular event was free for members and their families and included a full menu of hamburgers, hot dogs and chicken along a variety of beverages including iced tea, sodas, margaritas, beer and wine. The adults could partake in a game of volleyball while the kids had a special playground that included an inflatable jumping castle. Thereâ€™s sure to be a fourth annual beach party next summer!
From left to right, beach goers include Dr. Maria Lymberis, District 5 Past President; Charles DeCell; and Drs. Hooman Melamed, District 5 Member; Heather Silverman, District 5 President; and JoAnn Giaconi, District 5 Board Member.
b e l o w : Drs. Laurie Reynard, District 5 Immediate Past President; Heather Silverman, District 5 President; Maria Lymberis, District 5 Past President; and Lois Oâ€™Brien, District 5 member.
32 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
N e ws & e ve n ts | associati o n happe n i n gs
Expressing Their Viewpoints Media strategy strives to make female physician voices heard
h e Lo s A ngeles County Medical Association convened a group of its prominent female leaders to attend the OpEd Project’s Core Seminar on June 30. LACMA is pleased to partner with the Op-Ed Project, a one-day program that guides female professionals in developing their expertise and viewpoints into stories being sought by major publications for opinion editorial pieces. Currently, only about 15 percent of op-ed writers are female—even fewer are female physicians. LACMA wants to change that dynamic in Los Angeles County. Our partnership with the OpEd Project reflects one component of the media strategy of the leadership development program that we have launched to develop active voices that represent the diversity our physician population. If you are passionate about an issue or want to increase your professional standing by voicing yourself through national media outlets, the OpEd
From left to right seminar participants included Drs. Heather Silverman, Theresa Swida, Letrinh Hoang, Stephanie Booth, Van Nguyen, Susan Reynolds, and Nassim Moradi.
Project offers a one-day program and an ongoing mentoring program. For
Talking to the Media Physicians get professional training
additional information, please call 213226-0313.
A b o u t t en physicians gathered at the Los Angeles County Medical Association headquarters on a recent Saturday to get professional training from Fred Muir, a three-time Pulitzer Prize winning journalist, on how to speak to the press when representing the interests of the medical profession. The training was crucial since 2012 is a very important year for health care—physicians are being confronted with many regulatory changes and challenges. The goal of the training was to prepare LACMA physicians to be a key source of professional, reliable and relevant health information within the West Coast media market. Participating physicians received the tools necessary to effectively prepare for media interviews, learn strategies for working with reporters, understand how to communicate a clear and concise message, and learn the do’s and don’ts for interviews. The instructor, Fred Muir, is the CEO of Grayling / Rose & Kindel Los Angeles and has more than 35 years of combined experience as a journalist and public relations consultant. He provides senior counsel on media issues, crisis communications and public affairs strategies for leading corporations, nonprofit organizations and government agencies. As a journalist, Mr. Muir served in senior editing and reporting roles at The Wall Street Journal and the Los Angeles Times, where he was a member of three Pulitzer Prize winning teams. He also serves on the faculty of the University of Southern California where he lectures on crisis communications. au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 3 3
7/26/12 6:55 PM
cl assi fi e ds / jo b boar d To place a classifieds ad, contact Dari Pebdani at dpebdani@gmail .com or 858 -231-1231. 118
REDONDO BEACH ARTESIA CORRIDOR 144-2,382 sq. ft. Professional and medical offices, some views, near freeways, restaurants and shops. Parking + ADA elevator at 2512 Artesia Blvd. 310-5690384 Email: maryannejankovic@ hotmail.com or visit: http://pike. nsicorp.net.
REDONDO BEACH RIVIERA VILLAGE 145 – 2,017 sq. ft. Some views, balconies, impressively near restaurants, shops and beach! Medical parking + ADA elevator, at 1611 S. Catalina Ave. 310-5690384 Email: maryannejankovic@ hotmail.com or visit us at www. plazariviera.nsicorp.net. 610
medical practice for sale
Seeking Part Owner Opportunity for partial ownership in recently licensed compounding/ traditional pharmacy in West San Fernando Valley. Contact Steve Levin R.Ph. at (818) 522-2244 or email@example.com. 520
TRACY ZWEIG ASSOCIATES • Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: firstname.lastname@example.org www.tracyzweig.com
IMMEDIATE OPENINGS FOR EXPERIENCED PHYSICIANS Great opportunity for Family Physician, Neurologist, etc. Seeking specialists for expansion. The clinic is suitable for multispecialist or urgent care clinic. Call 310-273-6060, or fax: 310273-6097.
office for lease/ sublease/share
“I rely on the doctor-to-doctor ads for medical equipment and leasing space. It’s a great resource.” Wayne Gradman, MD 530
FILM READING Carl H. Boatright, MD, DABR, 30 years’ experience, rapid turnaround. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.
newport beach SUITES FOR LEASE 1,240 and 1,000 sq. ft. Ground or 2nd floor, 1 block to Hoag Hospital, plenty of parking, low rent. Call 949-645-6665. See: wrmorganmd.org/sfl.htm.
INTERPRETING RADIOLOGIST AVAILABLE To read your x-rays, mammos, ultrasounds, CT and MRI’s. Can also provide mobile mammography and ultrasound (including Echo and Cardiovascular) at your office. Remote access to Pacs Dicom Server, or can arrange courier. Reasonable Pricing. Call Mary Kay Shaver 888-346-3811 ext 153.
Josh Nyholt, CPA www.nyholtcpa.com
RADIOLOGIST Board certified. Have own malpractice insurance. Available for part-time position or film reading. Call 310-477-4257.
“Advertising in Southern California Physician magazine has had a positive impact on my Medical Professional focused practice. The readership is a great match with my client base and the services I provide.”
540 locum tenens available
TRACY ZWEIG ASSOCIATES
Family Practice Med. Group In LA County Looking for Full-Time/Part-Time NP or PA for Fam. Practice HMO, CHDP, Fam. Pact, exp. e-mail: email@example.com or phone 323-562-6182.
• Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: firstname.lastname@example.org www.tracyzweig.com
3 4 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
cm e / m ar ke t pl ace / aD i n D e X To place a cme lisTing, conTacT dari pebdani aT dpebdani@gmail .com or 858 -231-1231.
CME 5Th annual ciTy of hope conference on hemaTologic malignancies
12Th annual ciTy of hope conference on WOMEN’S CANCERS
September 13 – 15, 2012, Hotel Casa
October 25 to 27, 2012 Four Seasons Hotel Las Vegas, NV
Learn about recent advances in the treatment of multiple myeloma, lymphoma and leukemia in a highly interactive environment while engaging in one-on-one dialogue with renowned experts. Updates on improved curative and palliative treatments, evolving molecular and immunologically based systemic therapies, and important, completed or ongoing clinical trials will all be profiled.
REGISTER NOW for this exciting conference featuring prominent oncology experts who will address clinical and translational research, prevention, practical issues, current standards of care, controversies and evolving new treatment recommendations for women’s cancers. Attendees will learn new tools to optimize decision making to help improve patient outcomes.
Del Mar, Santa Monica, CA
REGISTER TODAY at www. cityofhope.org/hematologicconference2012
To learn more and to register, visit www.cityofhope.org/ womensconference2012
Advertiser index Athena Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 BBVA Compass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Cooperative of American Physicians . . . . . . . . . . . . . C3 Fenton Nelson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 McDonald’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Los Angeles County Sheriff’s Department . . . . . . . . . . 11
Inland Empire Health Plan . . . . . . . . . . . . . . . . . . . . . . . 3
September: Autism: Get the latest scoop on the state of autism in Los Angeles County and what steps are being taken to help patients.
Marsh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2
For advertising information, contact Christina Correia at 213-226-0325 or Dari Pebdani at 858-231-1231.
Office Ally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 The Doctors Company . . . . . . . . . . . . . . . . . . . . . . . . C4 UC Irvine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Get Noticed! For MAXiMuM visibility for your product and services that will reach thousands of readers monthly, contact Dari today! DAri PEBDANi Phone: 858-231-1231 Fax: 858-876-1839
e! R e h D a youR
to place a marketplace ad, contact Dari pebdani at email@example.com or 858-231-1231 au g u s t 20 1 2 | w w w. s o c a l p h ys i c i a n . n e t 3 5
7/26/12 6:55 PM
68%43% J ust t h e fac ts | b r e ast f e e d i n g
The number of states that have greater than half of their infants being breastfed at 6 months of age. 1
How many women who breastfed longer than one year returned to employment before their infant was 1 year old. (2)
22% How many infants were breastfed at 12 months. (1)
How many infants were breastfed at 6 months. (1)
The number of states that have greater than 75% of women breastfeeding at hospital discharge. (1)
How many infants were exclusively breastfed at 3 months. (1)
How many women who practice extended breastfeeding are doing so when the child is three years old. (3)
How many infants were breastfed at birth. (1)
13% How many infants were exclusively breastfed at 6 months. (1)
sources 1 National Immunization Survey 2010 for infants who were then 19-35 months of age. 2 Hills-Bonczyk SG, Tromiczak KR, Avery MD, Potter S, Savik K, Duckett LJ. Womenâ€™s experiences with breastfeeding longer than 12 months. Birth 1994. 3 Sugarman M, Kendall-Tackett KA. Weaning ages in a sample of American women who practice extended breastfeeding. Clin Pediatr (Phila). 1995. 3 6 s o u t h e r n c a l i f o r n i a p h ys i c i a n | au g u s t 2 0 1 2
7/26/12 6:55 PM
We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.
800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo
For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.
Superior Physicians. Superior Protection.
26-OBC_7tm.indd 37 1 CAP_1361_SCP.indd
7/26/12 3/19/12 6:55 1:58 PM PM
We do what no other medical liability insurer does. We reward loyalty at a level that is entirely unmatched. We honor years spent practicing good medicine with the TributeÂŽ Plan. We salute a great career with an unrivaled monetary award. We give a standing ovation. We are your biggest fans. We are The Doctors Company.
Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company
We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer thatâ€™s just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. The Doctors Company is a Silver Sponsor of the Los Angeles County Medical Association (LACMA). To learn more about our benefits for LACMA members, contact us at (800) 717-5333 or visit www.thedoctors.com/tribute. Silver Sponsor of
Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.
7/26/12 6:55 PM
Thank you for visiting our website. Southern California Physician magazine is the official publication for the Los Angeles County Medical So...