2009 July/August

JULy / AUGUST 2009 | Volume 15 | Number 4

Now, more than ever.

In the current economic climate, spending more than you have to for workers’ compensation insurance doesn’t make sense. Workers’ compensation premiums are on the rise again, right at a time when reducing practice expenses must be a priority for every physician.

The Association sponsored Workers’ Compensation program, with its 5% member discount (15% depending upon where you place your group health insurance) will be even more important to members this year.

When you place your coverage with Employers Compensation Insurance Company, the sponsored program insurer, chances are your savings will exceed the 5% program discount.

Rather than guess what your savings can be, take a moment to contact Marsh and let us show you how your membership in the Association can deliver a quality insurance program and exceptional savings to you.

Underwritten by:

Administered by:

Please call a client service representative at 800-842-3761 today.

The process is simple and fast. Just ask for a premium indication form, complete and fax back to Marsh.

Let us show you how your Membership in the Santa Clara County Medical Association can save you money.

Sponsored by:

Seabury is a subsidiary of Marsh Risk and Insurance Services, CA License No. 0633005 ©2009 Seabury & Smith Insurance Program Management • 43351 (3/09) 777 South Figueroa Street, Los Angeles, CA 90017 • (800) 775-2020 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com Marsh is part of the family of MMC companies, including Kroll, Guy Carpenter, Mercer and the Oliver Wyman Group (including Lippincott and NERA Economic Consulting).

BULLETIN THE

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

Message From the SCCMA President..........................................................5 Howard Sutkin, MD, FACS

Message From the MCMS President...........................................................6 The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF). There are currently 28 Never Events, which are grouped into six categories…

More on page 10

William Khieu, MD, MBA

Coding & Reimbursement: Coding Q’s.......................................................7 Sandie Becker, CMC

From the Editor’s Desk.................................................................................8 Joseph Andresen, MD

Never Events...............................................................................................10 NORCAL Mutual Insurance Company

Employee Satisfaction & Retention in Today’s Medical Practice...........12 NORCAL Mutual Insurance Company Many physicians and office managers wrongly assume that the key to effective employee retention and satisfaction is money.

More on page 12

Employment Practices Lawsuits: Are You at Risk?..................................14 Malpractice Lawsuits Are ‘Red Herring’ in Obama Plan........................16 Alex Nussbaum

A Silver Lining: Strategies in a Bear Market.............................................18 Robert M. Cheney, CFA, CFP®

Well-Being of Physicians............................................................................21 Depressed values for stocks and real estate make this a great opportunity for estate planning by transferring assets to the next generation…

More on page 18

SCCMA Physicians Well-Being Committee

MEDICO NEWS............................................................................................24 2009 Santa Clara County Medical Association Award Honorees..........26 Classified Ads..............................................................................................34 PAGE 3 | THE BULLETIN | JULY / AUGUST 2009

The Santa Clara County Medical Association Officers

House Officer Representative

Councilors

President Howard Sutkin, MD President-Elect Thomas Dailey, MD VP-Community Health Cindy Russell, MD VP-External Affairs William Lewis, MD VP-Member Services Judith Dethlefs, MD VP-Professional Conduct Jim Crotty, MD Secretary Sameer Awsare, MD Treasurer Martin L. Fishman, MD

Jacob Ballon, MD

El Camino Hospital of Los Gatos: Rives Chalmers, MD El Camino Hospital: Michael Curtis, MD Good Samaritan Hospital: Eleanor Martinez, MD Kaiser Foundation Hospital - San Jose: Efren Rosas, MD Kaiser Permanente Hospital: Allison Schwanda, MD O’Connor Hospital: Jay Raju, MD Regional Med. Center of San Jose: Emiro Burbano, MD Saint Louise Regional Hospital: John Saranto, MD Stanford Hospital & Clinics: Peter Cassini, MD Santa Clara Valley Medical Center: Patrick Kearns, MD

AMA Trustee - SCCMA James G. Hinsdale, MD Tanya W. Spirtos, MD (Alternate)

SCCMA/CMA Delegation Chair Tanya W. Spirtos, MD

CMA Trustees - SCCMA Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (District VII)

Chief Executive Officer

John D. Longwell, MD (Hospital Based Physician)

William C. Parrish, Jr.

BULLETIN THE

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

Printed in U.S.A.

THE MONTEREY COUNTY MEDICAL SOCIETY OFFICERS

Editor

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Opinions expressed by authors are their own, and not necessarily those of The Bulletin or the Santa Clara County Medical Association and the Monterey County Medical Society. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by the Santa Clara County Medical Association or the Monterey County Medical Society of products or services advertised.

Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org

President William Khieu, MD, MBA Secretary Eliot Light, MD Treasurer John Clark, MD

CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.

DIRECTORS Valerie Barnes, MD Ronald Fuerstner, MD David Holley, MD R. Kurt Lofgren, MD Oguchi Nkwocha, MD James Ramseur, Jr., MD Scott Schneiderman, DO

CMA TRUSTEE – MCMS

© Copyright 2009 by the Santa Clara County Medical Association.

PAGE 4 | THE BULLETIN | JULY / AUGUST 2009

Valerie Barnes, MD

MESSAGE FROM THE SCCMA PRESIDENT

change is all around us

By Howard Sutkin, MD, FACS President, Santa Clara County Medical Association Dear Santa Clara County Medical Association Members: Here we are now at the verge of some significant changes for medicine, both locally and nationally. El Camino Hospital in Los Gatos is organizing to bring services online with limited surgery, followed by expanded medical and surgical departments including an active emergency room. They seem excited about the unique opportunity which is before them, and from what I have heard, the medical community is happy to hear about the plans, and see the new paint on the building and cars in the lot.

The national debate on health care reform has begun with a recognition that the details matter. Many doctors sense a lot of pitfalls to a new national

plan, if the exact mechanisms are not well understood and tuned. Middle-of-thenight amendments and rush-job legislation are the trademarks of a disaster for patients, physicians, hospitals, and health care (in your author’s humble opinion). We watch with keen eyes the outcome of the federal government reform and health care expansion measures.

We at SCCMA kicked off June with a very successful Awards Banquet. It was truly a special evening of entertainment, great conversations, and super awards for some of our own very talented physicians, as well as the gracious Peggy Fleming-Jenkins for her work benefiting breast cancer awareness.

A special thanks is in order to the staff at SCCMA for putting together such a terrific and professional evening. You really won’t want to miss it next year, so get your tickets early next spring!

PAGE 5 | THE BULLETIN | JULY / AUGUST 2009

Howard Sutkin, MD is the 20082010 President of the Santa Clara County Medical Association. He is board certified in plastic and reconstructive surgery and is currently practicing in the Los Gatos/San Jose area.

Your member benefits department is working on some new programs which will roll out over the summer. Member services is looking at discount programs and improved communication regarding benefits. This fall, an entire issue of The Bulletin will be dedicated to member services. Of course, if you have any ideas about ways we can serve you better, we would absolutely love to hear from you.

Have a great summer!

MESSAGE FROM THE MCMS PRESIDENT

change is all around us have the ability to assist you to take the insurance company to small claims court so that you will get paid. The experience from the Santa Clara County Medical Association has been encouraging, and we can now expect the same for the Monterey County Medical Society.

By William Khieu, MD, MBA President, Monterey County Medical Society Dear Monterey County Medical Society Members: I am pleased to let you know that Monterey County Medical Society has gone through a significant transformation that we have not done for the last 30-40 years. With the bleak economy and poor reimbursements, it has been difficult for our physicians and the Medical Society. We were unable to keep up with the expensive overhead while improving services for our physicians, until June 2009…

No more!

Starting in June 2009, we have retained the administrative know-how of our sister organization, Santa Clara County Medical Association, to help us run our administrative functions better and to better serve our members. It was a challenging transition, but it is 100% behind us. I look forward to regroup with many more resources to meet or exceed the expectations of our members. Our Board is 100% in charge of the organization as when it was founded.

The following are a few important added benefits that we will be able to provide: • •

Timely response to your questions and specific needs.

Balance Billing – There has been a lot of debate regarding legislation that will ensure you will get paid for unregistered patients you saw in the emergency department for consultation. Although no meaningful legislation became a reality, we now

•

•

Dues reduction – We have not heard of many organizations that have reduced dues (yes, we do and will continue to watch our expenses closely so that we can save you money as much as possible).

Verizon Wireless – 22% discount off services and products for both members and their staff.

•

CMA – Learn about the HITECH Stimulus Act – FREE HIT webinars.

•

TPO Human Resource Management – FREE seminar to MCMS members ($100 value), plus a FREE HR phone consultation ($50 value), and a 10% discount off purchase of any of their HR products, such as an employee handbook.

•

BME (Bureau of Medical Economics) – 5% discount off billing and collections services.

•

Enviro Merica – FREE CAL/OSHA inspection/assessment ($175 Value).

•

OfficeWorksRX – 10% off the standard rates for hiring experienced temporary and/or long-term medical professionals.

•

On-staff economic advocacy specialist, Sandie Becker, CMC (if you have a problem with billing or reimbursement, you have an advocate

PAGE 6 | THE BULLETIN | JULY / AUGUST 2009

William Khieu, MD is the 20082010 President of the Monterey County Medical Society. He is board certified in Obstetrics & Gynecology and is currently practicing in Salinas. to stand with you against the insurance companies).

The next issue of The Bulletin will highlight more of the membership benefits and services to which you are entitled.

I look forward to having your input to make us better and more relevant to the practice of medicine in Monterey County. Please call us during business hours at our familiar number, 831/4551008, or email me directly at wkhieu@ obdocs.org.

I sincerely hope that you will have an opportunity to attend our next membership appreciation meeting (“Meet and Greet” Social) on August 11, 2009 at the Corral de Tierra Country Club at 6:00 p.m. Please join us and meet Mr. Bill Parrish, CEO, the medical association staff, and partners that will be supporting you. To RSVP, please call 831/455-1008 by August 4, 2009.

If you feel that your voice is not loudly heard, please join me to be a part of our Board of Directors so that we can together achieve better health care delivery in Monterey County.

CODING & REIMBURSEMENT NEWS

CODING Q’s

By Sandie Becker, CMC SCCMA/MCMS Coding & Reimbursement Specialist Q: I billed Medicare for an office visit and two other procedure codes. I used modifier 59, but Medicare denied them. What am I doing wrong?

A: It’s important to understand, if you are billing procedure codes that are bundled under the CCI (Correct Coding Initiative) edits, modifier 59 may be appropriate to use depending on whether the documentation supports it. CPT modifier 59 signifies that a procedure or service was distinct or independent from other non-E/M services performed on the same day. It’s also important to know that effective for dates of service on and after July 1, 2008, if documentation in the patient’s medical record supports the use of CPT modifier 59 for your code pair (containing a Column I and Column II code), CPT modifier must be submitted with the Column II code only. Previously, Palmetto GBA (the Medicare contractor for California) accepted claims submitted with modifier 59 on either code, but no more.

Q: I submitted code S0605 to a Secure Horizons Medicare Direct Plan, but they denied it as an invalid procedure code. What code should I use for Digital Rectal Exam?

A: The code to use for DRE (digital rectal exam for prostate cancer screening) is HCPCS G0102 with ICD-9 code V76.44. All male Medicare beneficiaries 50 or older are covered annually for this exam.

Q: Is it legal for our office to use patient sign-in sheets under HIPAA? A: Yes. Covered entities, such as physicians’ offices, may use patient sign-in sheets or call out patient names in waiting rooms, so long as the information disclosed is appropriately limited. The HIPAA Privacy Rule explicitly permits the incidental disclosures that may result from this practice, for example, when other patients in a waiting room hear the identity of the person whose name is called, or see other patient names on a sign-in sheet.

However, these incidental disclosures are permitted only when the covered entity has implemented reasonable safeguards and the minimum necessary standard, where appropriate. The sign-in sheet may not display medical information that is not necessary for the purpose of signing-in (e.g., the medical problem for which the patient is being seen, address, date of birth,

Would you like to receive updated coding & reimbursement news by email? If so, please call the SCCMA office to provide your email address at: 408/998-8850 ext. 3007 or email: sandie@sccma.org.

You may also visit our website at: www.sccma.org.

PAGE 7 | THE BULLETIN | JULY / AUGUST 2009

For coding questions and reimbursement issues, contact Sandie @ 408/9988850 or MCMS 831/455-1008 or email sandie@ sccma.org.

or any unnecessary information). The signin sheet should be limited to essential data, like name and time of appointment.

Q: I am an ophthalmologist. I billed a claim with a visit and procedure using diagnosis code 362.02 and Blue Shield rejected it because of the ICD-9 code.

I don’t get it.

A: 362.02 (Proliferative diabetic retinopathy) is a manifestation code of an underlying disease. In the 2009 ICD9-CM book, you will notice under the beginning of the code set 362.0 Diabetic retinopathy, there is an instruction that reads Code first diabetes (249.5, 250.5).

Likewise, if you look at either of these codes, they instruct you to additionally code to identify the manifestation. This is one of the reasons it is so important to consult your ICD-9 codebook, when selecting a code. If there are special instructions on how to report a diagnosis, it will be outlined for you.

FROM THE EDITOR’S DESK

Surrounded by the history of “Age of Discovery”

By Joseph Andresen, MD For the past two weeks, I have been far away from the hospital, clinic, and my medical practice. After a long flight from San Francisco to Munich, and a connecting flight to Lisbon, I found myself in a city filled with history, proud traditions, and warm and welcoming people. Long walks through the bustling downtown marketplace, narrow corridors, and cobblestone streets filled my days.

Surrounded by the history of “Age of Discovery” were majestic churches, castles, and monuments honoring Vasco da Gama and Henry the Navigator, among others.

In the evening, I dined in Clube de Fado, drinking Vinho Verde, and sampled a wide variety of seafood including polvo (octopus). Several singers filled the intimate restaurant atmosphere with their soulful and blues-like ballads.

After several days in “Old” Lisbon, it was time to venture south to the Algarve region. Chevrolets and American autos were surprisingly commonplace on the roads and I ended up renting a Ford Focus diesel station wagon with manual transmission. This car was comfortably snug, very fuel efficient, and handled well at 140 km per hour on the expressway.

Hopefully, our auto industry leaders are looking here for answers to our energy crises and slumping domestic sales.

found myself surrounded by many Brits on holiday. Only a two-hour flight from London, this area has become a popular vacation destination spot. A dermatologist would be quite busy here tending to the shockingly reddened bodies of the many sunbathers and beachgoers. After several lazy days of swimming in the very blue Atlantic Ocean, it was time to move on.

A visit to this area would not be complete without driving to the most southeastern tip of the European continent at Sagres and Cape St. Vincent. An incredible vista facing west is found at land’s end, with dramatic cliffs meeting the ocean’s edge hundreds of feet below. Centuries ago, it was here that explorers ventured out to prove that the world was not flat and found trade routes to Africa, India, and the New World.

Driving east toward the Spanish border, I briefly stopped in Tavira, a city well past its prime as a major seaport

Salema is a small fishing village still clinging to its simple way of life, but undergoing a rapid transformation.

There seemed to be relatively few Englishspeaking tourists in Lisbon, but I now Drs. Andresen and Morais PAGE 8 | THE BULLETIN | JULY / AUGUST 2009

Joseph Andresen, MD is the editor of The Bulletin.

He is board certified in anesthesiology and is currently practicing in the Santa Clara valley area. several centuries ago. It stood out with its Roman arched bridge that spanned the river, which divided and ran adjacent to the town square and plaza where both young and old gathered to escape the hot afternoon sun.

Evora was several hours to the north, by car. It is in the central high plains of Portugal surrounded by national forest, and olive and cork orchards. Romans, Moors, a Portuguese king, and the Inquisition are all part of this city’s history.

Portugal’s senior citizens seemed to be ever present, frequenting the markets, city parks, and town squares where the social fabric of daily life was most closely woven.

My last day in Portugal was a special treat. A family friend put me in touch with a relative who resided in Sintra, a beautiful town just to the north of Lisbon with a presidential palace, Moorish castle ruins, and a historic central village.

I met Dr. Ze Morais, a cardiologist at a community hospital, who graciously spent a day sharing his country with me. We drove along the waterfront near Lisbon’s harbor and northward to the coastal resort area of Cascais, and then through the rugged cliffs of Cabo da Roca overlooking the Atlantic Ocean. Of particular interest was

learning about Dr. Morais’s medical practice, where he works within the public health system that provides care for all of Portugal’s citizens. He is a non-invasive cardiologist in a large community public hospital, working in a 14-member specialty group. His wife is a pediatrician in the same hospital. We shared our many common experiences as physicians in both Portugal and the United States.

These past two weeks of travel have provided me with an opportunity to see my personal and professional life in a new and enriched way. When the opportunity arises, I encourage you to venture beyond your familiar surroundings and gain a new perspective from outside in. What better way to appreciate what we often overlook or take for granted.

Lisbon Square

Salema

Dr. Andresen in Lisbon

When faced with an illness such as my husband Paul’s, some seek to travel to far away places to fulfill personal dreams. Paul had traveled and experienced many wonderful adventures in his 44 years. In the end with the love, compassion, and guidance from our Hospice of the Valley “family,” we as a family met our goal and were exactly where we needed and wanted to be... at home.

— Mary S. Brad Leary, director social services and counseling Pam Nates, chaplain

Deni

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For more information please contact us.

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PAGE 9 | THE BULLETIN | JULY / AUGUST 2009

RISK MANAGEMENT

NEVER EVENTS The topic of Never Events is an important development within the health care industry, bringing changes to the hospital environment in which many physicians practice. Those changes are a result of many hospitals’ efforts to reduce these events. Physicians should find value in being able to identify Never Events, and in understanding the impact of recent state and federal regulations on Never Event reporting and reimbursement, and preparing for coming changes in inpatient care.

The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF).1 There are currently 28 Never Events, which are grouped into six categories: Surgical 1. Surgery performed on the wrong body part 2. Surgery performed on the wrong patient 3. Wrong surgical procedure performed on a patient 4. Unintended retention of a foreign object in a patient after surgery or other procedure 5. Intraoperative or immediately postoperative death in an ASA Class 1 patient Product or Device 6. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the health care facility 7. Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended

8. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a health care facility Patient Protection 9. Infant discharged to the wrong person 10. Patient death or serious disability associated with patient elopement (disappearance) 11. Patient suicide, or attempted suicide, resulting in serious disability while being cared for in a health care facility Care Management 12. Patient death or serious disability associated with a medication error (for example, errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration) 13. Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/ HLA-incompatible blood or blood products 14. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a health care facility 15. Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility 16. Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates 17. Stage 3 or 4 pressure ulcers acquired after admission to a health care facility 18. Patient death or serious disability due to spinal manipulative therapy PAGE 10 | THE BULLETIN | JULY / AUGUST 2009

19. Artificial insemination with the wrong donor sperm or wrong egg Environmental 20. Patient death or serious disability associated with an electric shock while being cared for in a health care facility 21. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances 22. Patient death or serious disability associated with a burn incurred from any source while being cared for in a health care facility 23. Patient death or serious disability associated with a fall while being cared for in a health care facility 24. Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a health care facility Criminal 25. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider 26. Sexual assault on a patient within or on the grounds of a health care facility 27. Abduction of a patient 28. Death or significant injury of a patient or staff member resulting from a physical assault that occurs within or on the grounds of a health care facility1 In general, Never Events are difficult to defend in medical liability litigation, mostly due to the alarm associated with their occurrence and the tendency for them to occur as a result of failed patient-safety systems or substandard medical care. That is not to say, however,

that these events cannot occur when a patient’s care has been appropriate.

Health care providers should also be aware of Never Event reporting laws.

For example, in September of 2006, the California legislature adopted legislation that directs hospitals to report Never Events (referred to in the legislation as “adverse events”).2 Rhode Island and Alaska have not passed Never Event reporting legislation.

The Joint Commission considers all of the NQF Never Events to be “Sentinel Events.” Accredited organizations are expected to identify and “respond appropriately” to all sentinel events, according to the Joint Commission. An appropriate response includes “conducting a timely, thorough, and credible root cause analysis; developing an action plan designed to implement improvements to reduce risk; implementing the improvements; and monitoring the effectiveness of those improvements.”

Although the Joint Commission does not mandate reporting, the organization encourages it.3 More information on sentinel event policies and requirements can be accessed on the Joint Commission website, www.jointcommission.org.

In addition to professional liability concerns, Joint Commission requirements and reporting mandates, hospitals will also experience increased difficulty obtaining reimbursement for treatment rendered as a result of a Never Event. For example, in August 2007, the Centers for Medicare and Medicaid Services (CMS) announced that beginning October 1, 2008, Medicare will no longer pay at a higher weighted MS-DRG for eleven conditions (some are on the Never Events list) when acquired during a hospital stay. These conditions are referred to as “Hospital-acquired Conditions” (HACs). As anticipated, private health insurers are following CMS’s lead in refusing to reimburse for care rendered as a result of a Never Event/HAC. For example, Aetna and WellPoint have started to include reimbursement refusal provisions in some of their contracts.4,5

Although Never Event rules, regulations, and guidelines are currently directed towards hospitals, individual health care providers will feel their effects.

Hospitals, if they haven’t already, will begin developing new policies and procedures to deal with these changes, and providers will be expected to comply with them.

Furthermore, it is anticipated that Never Event legislation and reimbursement limitations will be used in malpractice claims against individual providers to support allegations of medical negligence.

Finally, some commentators suggest that the Medicare and private health insurer reimbursement limitations will be extended to individual providers.6 Keeping a Never Event from occurring is an appropriate goal for any health care provider. Consistently adhering to policies and procedures designed to guard against the occurrence of Never Events can protect patients, reduce liability exposure, reduce reporting burdens, and preserve reimbursement rates. NORCAL has provided risk management advice via the monthly Claims Rx and CME courses related to many of the 28 Never Events and CMS’s HACs. Providers are encouraged to review the following publications, available at www.norcalmutual.com: •

Wrong patient, wrong site, wrong surgery, surgical site infections—The July 2008 Claims Rx entitled: “Risk Management and Patient Safety Strategies for Surgeons”

•

Medication errors, contaminated devices—The June 2008 Claims Rx entitled: “Strategies for Making the Medication Delivery Process Safer”

•

Hypoglycemia—The November 2006 NORCAL CME course entitled: “Diabetes: Managing Comorbidities”

•

Hyperbilirubinemia/Kernicterus—The May 2008 Claims Rx entitled: “Focus on Newborn Patients: Strategies for Reducing the Incidence of Kernicterus as a Result of Hyperbilirubinemia and Vision Deficits as a Result of Retinopathy of Prematurity”

PAGE 11 | THE BULLETIN | JULY / AUGUST 2009

•

Surgical Fires—The December 2007 Claims Rx entitled: “Reducing the Risk of Surgical Fires”

•

Deep Vein Thrombosis/Pulmonary Embolism—The March 2008 Claims Rx entitled: “Deep Vein Thrombosis Prophylaxis”

To learn more about new Medicare rules on reimbursement for hospital-acquired conditions (HACs), see “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates,” in the Federal Register/Vol. 72, No. 162, August 22, 2007/Rules and Regulations.

To learn more about proposed 2009 rule changes on HACs, see “CMS Proposes Additions to List of HospitalAcquired Conditions for Fiscal Year 2009” at the CMS website at www.cms.hhs.gov.

To learn more about California’s new rules on reporting adverse events, see the California Health and Safety Code, Sections 1279.1-1279.3 and 1280.4.

As physicians interface with hospital staff and administrators, they will hear more about Never Events. As hospitals face the lack of reimbursement for patients who experience these events, physicians will be witnessing policy and procedure changes, discussions at medical quality and peer review committees, and other measures aimed at the prevention of these events. By understanding the history and the reimbursement factors associated with Never Events, physicians will be better prepared to be involved in these activities and offer support and input.

Keeping a Never Event from happening is optimal. However, they continue to occur at a significant rate.

Having appropriate policies and procedures in place to guard against the occurrence of Never Events can increase patient safety, reduce liability exposure, reduce reporting burdens, and preserve reimbursement rates. When those policies and procedures do not work and a Never Event occurs, in addition to analyzing those policies and procedures to Continued on page 36

RISK MANAGEMENT

Employee Satisfaction & Retention in Today’s Medical Practice Labor shortages have long been a problem within the medical community, posing a constant threat to the delivery of quality patient care in the U.S. The Healthcare Financial Management Association, a leading membership organization for medical executives and leaders, places the average national health care employee turnover rate at 20%. According to retention consultant John B. Izzo, “The current health care labor shortage has underscored the importance of attracting and retaining good employees.

Although recruitment efforts often focus on clinical professionals such as

pharmacists and registered nurses, employees of all kinds are becoming increasingly difficult to find and keep.”

As the Baby Boomer generation reaches retirement age, the need to hire and retain skilled employees—whether they are physicians, nurses, front- and back-office staff, or virtually any other type of health care employee—only becomes more urgent. What’s more, the emerging generation of workers has a markedly different work ethic from those of their parents and grandparents. Employees in their 20s and 30s are, on the average, much more willing to leave jobs that don’t meet their needs and expectations.

The Value of Retention Although retention is important within any company or organization, it is particularly vital to the success of a medical practice. First and foremost, retention can directly affect the quality of care a practice’s patients receive. According to Quint Studer, a health care thought leader, greater employee satisfaction directly correlates to higher patient satisfaction and safety.1 Employee retention also affects a practice’s bottom line. Studies have shown that the outlay for replacing a lost employee can be as much as 200% of that employee’s annual salary, once the costs of hiring, recruiting, training, lost productivity during the first six months of employment and the use of temporary employees have been factored in.2, 3 In addition, any medical practice that experiences a high rate of physician turnover can end up spending an enormous amount on tail coverage.

PAGE 12 | THE BULLETIN | JULY / AUGUST 2009

Finally, employee retention can strongly influence a practice’s productivity and longevity. Long-term, seasoned employees can help define and streamline processes and operations, thereby contributing to the overall success of the practice.4 However, if there is frequent turnover, day-to-day operations will necessarily suffer.

Examining the Obstacles to Retention In order to diminish high attrition rates within a medical practice, managers and physicians must begin by considering some of the most common barriers to retention. Fortunately for today’s practice managers, recent retention studies have helped to uncover some of the systemic problems that typically send employees packing: Miscommunication In a busy medical practice, the amount of time devoted to open communication between staff and management can be compromised.

However, effective communication is widely considered to be the very foundation of a successful medical practice, especially when one considers that the proper care of patients may depend on it.

Lack of Cultural Integration Today’s workforce is more diverse than ever before. Not only does the average medical practice contain employees of different genders, races, ethnicities, cultures and religions, it also contains workers of different generations. If the diversity of a workforce is ignored, tensions among different cultures and subcultures can arise.

Ineffective Recruitment Often, physicians and office managers leap to replace a departed clinician or staff member without carefully evaluating the practice’s staffing needs.

But knee-jerk recruitment is ineffective recruitment, and it can have an adverse impact on the medical practice.

Lack of Training One of the leading causes of high staff turnover is ineffective or nonexistent training. If a medical practice routinely uses out-of-date training materials or does not take the time to train new staff members properly, errors and miscommunication can occur, leading to employee and patient dissatisfaction.5

Solving the Retention Problem Many physicians and office managers wrongly assume that the key to effective employee retention and satisfaction is money. Although adequate, competitive compensation is indeed important, most research indicates that it is not one of the top factors affecting employee satisfaction and longevity. 8,9 In order to keep employees happy and fulfilled on the job, experts suggest the following time-tested strategies: Recruit the Right People Evaluate practice needs before beginning the hiring process, then thoroughly screen new candidates during interviews in order to ensure the right fit.

Successful retention begins with effective recruitment.4 Offer Job Flexibility Practices that are willing to offer their employees flexible work hours, job sharing, telecommuting, sabbaticals, time off for good work and other “quality of life” incentives retain employees far longer than their peers.3 Provide Feedback on Performance Frequent and constructive feedback, especially with new generations of health care workers, has a direct correlation to staff retention. One study

found that “71% of top performers receiving regular feedback stayed on the job compared with 43% who did not.”10

7. Moore, Pamela. “The Art and Science of Physician Recruitment.” Physicians Practice, 2002.

Assign Meaningful, Challenging Work

8. Numerof, Rita E. “What Works…

And What Doesn’t?” Nursing Management, March 2004.

Today’s employees want to make a difference and have a positive effect on the world around them. Practice managers should make an effort to communicate to every employee that his or her contribution has a direct impact on the health and wellbeing of patients.3 Provide Opportunities for Training and Professional Growth Studies show that a lack of opportunities to learn and grow within a position frequently causes staff members to become restless and unsatisfied. Experts suggest that physicians and office managers offer employees opportunities for “outof-the-box learning,” i.e., opportunities wherein they can learn new duties and functions beyond the scope of their current job descriptions.3 Endnotes 1. Studer, Quint. “The Value of Employee Retention.” Healthcare Financial Management, January 2004.

2. Kaye, Beverly. “Retention: Tag, You’re It!” Training and Development, April 2000.

3. Izzo, John B. “Winning Employee Retention Strategies for Today’s Healthcare Organizations.”

Healthcare Financial Management, June 2002.

4. Alexander, Gary. “Finders and Keepers.” MGMA Connexion, March 2005.

5. Redling, Robert. “How to Get—and Keep— Employees’ Trust.”

MGMA Connexion, January 2004.

6. Gatzke, Karen. “A Satisfied Staff Pays Off: What You Can Do to Keep the Good Ones.” Physicians Practice, July/August 2002.

PAGE 13 | THE BULLETIN | JULY / AUGUST 2009

9. Kursmark, Louise. “Strategies for Healthcare Retention.” Available at hr.monster.com/articles/healthcare_ retention/. Accessed April 21, 2006 10. Webster, Lee Ann H. “Sharpen Your Communication Skills.” MGMA Connexion, September 2005.

Printed by permission of NORCAL Mutual Insurance Company. NORCAL is the premier provider of professional liability insurance for physicians, medical groups, community clinics, hospitals and medical facilities. To access additional articles published by NORCAL, visit www. norcalmutual.com.

RISK MANAGEMENT

Employment Practices Lawsuits: Are You at Risk?

Open any newspaper or look on any news website and you’re bound to notice an article about another business being sued by an employee or former employee alleging discrimination or wrongful termination.

These stories always make headlines. But are businesses truly being sued more often? Is your practice at risk? If it is, how much could you be forced to pay in such a situation?

When an employee brings a complaint against a business, or a suit involves misadventure by a key employee, the trend is unmistakable: the business pays more.

The number of resolved lawsuits alleging breach of the Fair Labor Standards Act more than doubled in 2005 (the last year that statistics are available) to almost 3,600 compared with the 1,596 cases in 2000.1 A survey found that complaints from disgruntled employees in 2007 cost businesses an average $63,114, including judgments, settlements, fines, and legal fees.2 The survey also reported that two out of three U.S. private companies experienced some type of event related to management liability within the past five years, costing an average $393,017. The number of

incidents ballooned more than 25% from 2005.3 The survey results mirrored government statistics. The total number of charges filed with the U.S. Equal Employment Opportunities Commission (EEOC) rose 26% from fiscal years 2006–2008.4 And the total amount of money awarded in those complaints during that span nearly tripled, from $44.3 million to $102.2 million.5 Even if a case goes to EEOC mediation, the average period it takes for it to be settled is 84 days—almost four business months.6 The question a responsible business owner should ask is: Am I covered for this increasing eventuality?

Workers’ compensation and general and professional liability insurance policies generally do not cover the vast majority of complaints filed against employers. For this reason, Employment Practices Liability insurance (EPL) has grown in popularity. “Generally, purchasing EPL insurance is a wise investment,” write lawyers Robert Hoffer and Kelly Schoening in the Business Courier of Cincinnati, “but not all plans are created equal.”

When considering EPL insurance, they recommend asking the same questions as you would about any insurance: •

what is covered;

•

what is the deductible;

•

which attorneys can you engage; and

PAGE 14 | THE BULLETIN | JULY / AUGUST 2009

•

how are claims settled.

The Santa Clara County Medical Association and Monterey County Medical Society offers its members EPL insurance. This coverage also includes risk-management tools that can lower your risk, as well as access to a legal information hotline staffed by employment practices attorneys. And if you never had coverage before, ask about the simplified First Time Buyers program. You can contact a Marsh client service representative toll-free at 800/842-3761 today for more details and a no obligation premium indication.

1. Kris Maher, “Workers Are Filing More Lawsuits Against Employers Over Wages,” The Wall Street Journal, Monday June 5th, 2006. page A2.

2. Chubb Private Company Risk Survey, www.chubb.com/corporate/ chubb8596.html 3. Chubb Private Company Risk Survey, www.chubb.com/corporate/ chubb8596.html 4. w ww.eeoc.gov/stats/charges.html 5. www.eeoc.gov/stats/litigation.html 6. www.eeoc.gov/employers/ investigations.html CA License #SL0633005 d/b/a in CA Seabury & Smith Insurance Program Management 42534 (5/09) ©Seabury & Smith Insurance Program Management 2009

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Available on Bloomberg.com

Malpractice Lawsuits Are ‘Red Herring’ in Obama Plan

By Alex Nussbaum June 16 (Bloomberg) -- Protecting doctors from lawsuits may do more to gain political cover for President Barack Obama’s health care overhaul than to rein in medical costs.

While Obama vowed to address physicians’ malpractice worries in a speech yesterday, annual jury awards and legal settlements involving doctors amount to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, said Amitabh Chandra, a Harvard University economist. Chandra estimated the cost at $12 per person in the U.S., or about $3.6 billion, in a 2005 study. Insurer WellPoint, Inc. said last month that liability wasn’t driving premiums.

Obama told an American Medical Association meeting in Chicago yesterday that his efforts to cut costs and increase coverage couldn’t succeed without freeing doctors from the fear of lawsuits. While that may be what his audience needed to hear, the evidence that malpractice drives up health care costs is “debatable,” said Robert Laszewski, an Alexandria, Virginia, consultant to health insurers and other companies.

“Medical malpractice dollars are a red herring,” Chandra said in a telephone interview. “No serious economist thinks that saving money in med mal is the way to improve productivity in the system. There’s so many other sources of inefficiency.”

Obama, appealing for doctors’ support for health care legislation, said he would “explore a range of ideas,” to

reduce the effect of lawsuits, without giving specifics. While he opposes caps on jury malpractice awards, Obama said he recognized the legal threat spurs doctors to perform unnecessary tests and procedures—so-called defensive medicine.

‘Fear of Lawsuits’ Making U.S. care more efficient will be harder “if doctors feel like they are constantly looking over their shoulder for fear of lawsuits,” the president said.

One possibility the Democratic administration has mentioned is shielding

“Exorbitant” malpractice premiums are making it harder for doctors to stay in the business, and hurting taxpayers whose money goes for publicly-funded clinics, said William C. Parrish, Jr., chief executive officer… doctors from liability if they follow “best practice” guidelines developed by physicians’ groups, said J. James Rohack, incoming president of the 250,000-member AMA, in a news conference after the speech. Doctors were “thrilled” to hear Obama acknowledge the issue, even with

PAGE 16 | THE BULLETIN | JULY / AUGUST 2009

the lack of specifics, said Nancy Nielsen, the outgoing president.

“What we heard we were very pleased with,” Nielsen said. “He is open to considering options that will lower the cost of defensive medicine.” While stating opposition to caps, the president “has not taken that off the table,” she said.

In a letter to Obama on June 1, the doctors suggested Congress fund pilot projects for state courts or administrative agencies specializing in malpractice. They also recommended experimenting with predetermined schedules for injury awards and “early offer initiatives” designed to speed settlements.

Exorbitant Premiums “Exorbitant” malpractice premiums are making it harder for doctors to stay in the business, and hurting taxpayers whose money goes for publiclyfunded clinics, said William C. Parrish, Jr., chief executive officer of the Santa Clara County Medical Association, based in San Jose, California. The group represents 3,600 physicians.

Capping awards is “going to ruffle the feathers of trial bar attorneys,” he said by phone. “They are going to say it’s affecting these poor victims. But if we could provide 5,000 more free visits at the county hospital for indigent care, as opposed to giving a huge settlement for one person for non-economic damages, socially that’s a good trade-off.”

About 10% of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing

due to defensive medicine, according to a January 2006 report prepared

by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans.

2% of Spending The figures were taken from a March 2003 study by the U.S. Department of Health and Human Services that estimated the direct cost of medical malpractice was 2% of the nation’s health care spending and said defensive medical practices accounted for 5% to 9% of the overall expense.

A 2004 report by the Congressional Budget Office also pegged medical malpractice costs at 2% of U.S. health spending and “even significant reductions” would do little to reduce the growth of health care expenses.

The proportion of medical malpractice verdicts among the top jury awards in the U.S. has declined during the past 20 years, according to data compiled

by Bloomberg. Of the top 25 awards so far this year, only one was a malpractice case.

At least 30 states cap damages in medical suits, primarily for “pain and suffering” awards.

‘Completely Broken’ The medical malpractice system is “completely broken,” said Chandra, a public policy professor at Harvard in Cambridge, Massachusetts. It rewards plaintiffs who are undeserving while leaving others with real injuries unpaid, prompts some doctors to perform needless tests, and encourages others to refuse to care for patients deemed a higher legal risk, he said.

The development of new drugs and medical procedures, and their growth in price, has been a bigger factor in costs, said Chandra, citing his research and that of other economists. Studies haven’t found a link between increasing procedures, such

as cesarean-section births, and areas with rising malpractice damages, he said.

The U.S. Institute of Medicine found a decade ago that medical errors kill 98,000 Americans a year, said Les Weisbrod, president of the lawyers’ association. “By taking away the rights of people to hold wrongdoers accountable, the quality of health care will suffer tremendously,” he said.

Medical malpractice is “not a major driver” of spending trends in recent years, Indianapolis-based WellPoint, the largest U.S. insurer by enrollment, said in a May 27 report. The report cited advances in medical technology, increasing regulation, and rising obesity as more significant reasons for rising costs.

Without more details of Obama’s plan, it’s too soon to say how reforming malpractice insurance will affect companies providing insurance to doctors, said Michael Nannizzi, an analyst at Oppenheimer & Co. in New York.

Issue for Doctors Malpractice is “a big issue for doctors, but whether it’s a big issue for the American health care system is another question,” Laszewski, the consultant, said in a telephone interview. “There are studies that indicate that medical malpractice reform would not have a huge impact on costs, but that is not what doctors think.”

“The insurance companies that are in the business, now, don’t want medical malpractice to suddenly become an easy business to write, because that takes away the expertise they’ve built over the years,” he said by telephone. “But they do want to have some predictability for their own financials. It’s a very fine line.”

A Washington-based trial lawyers’ group, the American Association of Justice, opposes curbing malpractice lawsuits.

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RISK MANAGEMENT

A Silver Lining: Strategies in a Bear Market

By Robert M. Cheney, CFA, CFP® Using these bear market strategies will help you efficiently achieve and maintain financial independence. Doctors have the luxury of fairly recession-proof income streams not enjoyed by other professionals. The question is how efficiently they use those practice revenues to achieve their financial goals. There are many aspects to a bear market that are well beyond our control. It is important for us to focus on the silver lining; the opportunities in a bear market that we can control and capitalize upon: Maximize Your Qualified Plan Opportunities! Recent regulations allow opportunities in qualified retirement plans not seen for decades. Using this legislation, a 45-year-old doctor in private practice can save up to $170K annually before taxes and a 55-year-old can save up to $270K annually before taxes, all using government qualified plans, with protection from creditors and lawsuits. An increased contribution to retirement plans, and the resulting tax savings, can do a lot to offset recent negative investment performance. If you are only maximizing a profit sharing plan at $46,000 yearly, but you have the ability to fund a Defined Benefit Plan at $146,000 yearly, then you are being unnecessarily taxed on the $100,000 difference and losing approximately half ($50,000) to Uncle Sam. That additional $50,000 annual tax savings to your retirement account goes a long way to replenish retirement funding.

If you are an associate in a large practice or at an HMO, make sure you max out your 401(k) and ensure that you are

receiving all possible matching from your employer – matching helps to replenish retirement accounts, too. The stock market should give us some wind at our backs in capital appreciation, in the long term of five to ten years or more, on these increased retirement plan contributions.

Recent regulations also loosened restrictions for funding Defined Benefit Plans at the same time as funding 401(k) Profit Sharing plans, enhancing the ability to increase total deductible contributions.

High income doctors have historically been unable to fund Roth accounts, while recent legislation made Roth provisions

Depressed values for stocks and real estate make this a great opportunity for estate planning by transferring assets to the next generation… for 401(k) plans permanent. Roth 401(k) accounts allow doctors to pay taxes on contributions now and get tax-deferred growth and tax-free distributions. These accounts are very advantageous because participants should be poised to receive appreciation in the stock market and, if income tax rates increase in the future, participants are able to pay only current tax rates on contributions, avoiding the higher rates in the future. As opposed to other qualified plans and traditional IRAs, Roth 401(k)s do not face required minimum PAGE 18 | THE BULLETIN | JULY / AUGUST 2009

distributions at age 70.5, so they can be allowed to compound tax-deferred longer.

Include Non-correlated Assets in Your Portfolio. Portfolios built with Exchange Traded Funds (ETFs) can allow for institutional-caliber risk management by investing in asset classes often omitted from the portfolios of individual investors. ETFs can efficiently gain exposure to alternative asset classes such as commodities, currencies, and inverse funds which increase in value when markets decline. Many traditional asset classes have recently been increasing in correlation, moving together at the same time when we desire for them to move separately, which diminishes their diversification benefits. The increasing correlation of foreign and domestic stocks over recent decades is an example of diminishing diversification benefits and the need to include non-correlated assets in a portfolio.

The alternative asset classes represented by ETFs offer diversification benefits and can minimize risk in volatile and down markets.

If inflation rears its ugly head in coming years, then utilizing these alternative asset classes will become even more important.

Furthermore, ETFs are very cost and tax efficient.

Long Term Care Insurance (LTC) is a risk management tool that I term “retirement savings insurance” that can keep you from having to deplete your diminished retirement savings in the event of an LTC need. Doctors in certain practice structures can deduct 100% of LTC premiums for themselves and their spouse over 10 years and then have that coverage in place for life, unlike traditional

disability income insurance which usually ceases at age 65.

Life Insurance in Qualified Plans. Use of whole life insurance as an asset in qualified retirement plans purchases permanent death benefits with pre-tax dollars, increases the deductible contribution to a defined benefit plan, and gives the ability to take tax-free loan distributions at retirement, hedging the risk of higher taxes in the future. Doctors with life insurance in their qualified plans and still in the guarantee period have been very happy recently because their policy cash values have continued to increase with the contractually-obligated interest rate of the policy, while traditional pension investments have dropped.

Estate Planning. Depressed values for stocks and real estate make this a great opportunity for estate planning by transferring assets to the next generation and removing them along with any future appreciation from your estate at the lower value. The annual gift exemption for 2009 has just increased to $13,000 annually from $12,000 last year, meaning that between you and your spouse, you can get $26,000 of a consolidated stock position or real estate out of your estate each year. Intrafamily loans that currently are required to have interest rates of 0.6% to 2.7%, depending on term, are also very attractive when children are unable to qualify for mortgages at commercial banks. $13,000 of the loan principle can be forgiven each year using the previously mentioned gift exemption. Grantor Retained Annuity Trusts (GRATs) are also attractive with historic low 2.0% current threshold rates, meaning that all appreciation of substantial assets above 2.0% can be retained by the beneficiary of the GRAT.

IRAs will be lifted. This is a great time to be accumulating a traditional IRA or rollover (from 401(k), 403(b), or 457(b)) accounts, even if you are using nondeductible contributions ($5,000 for under 50, $6,000 for 50 or older). Consider making an IRA contribution for you and your spouse in 2009 and 2010. Aim to convert that IRA to a Roth IRA in 2010 and you even have the opportunity to delay the taxes on the conversion to half the taxes in 2011 and half in 2012. Roth IRA funds can then grow tax-deferred and distribute tax-free (when five years have elapsed since first contribution and you are 59 1/2). Roth IRA sponsors should be poised to get appreciation from the stock market and if we believe income tax rates will increase in the future, then these Roth IRA accounts will be valuable and will offer tax diversification in retirement. This tax-free nest egg can supplement your tax-deferred retirement funds at your practice. Again, we should have some wind at our back from the stock market in the long run, helping these account values.

Investing With Guarantees.

A benefit of having a highly dependable practice revenue stream means that a doctor can be highly certain of when they will meet their

retirement savings objective. If a doctor can be sure that they will meet their savings requirement in X number of years receiving 5.0% interest, then they need to ask why they assume risk of principal in the equity and bond markets. Carriers with high financial strength offer 5.0% for 10-year fixed annuity contracts for those doctors still accumulating savings and offer 5.0% to 6.0% lifetime income guarantees for doctors age 65 and desiring to take income.

Particularly during these challenging economic times, the guaranteed return or guaranteed income of annuities for older doctors who have reached their retirement savings requirement or doctors who are close to meeting their retirement savings requirement have given those doctors significant peace of mind during these challenging times. Keeping in mind that economic downturns are a part of our recurring economic cycles, it can be useful for all of us to consider guaranteed return or guaranteed income annuities as part of a comprehensive retirement strategy.

These are some of the wealth management tools available during a bear market to help you to efficiently achieve and maintain financial independence. You have the luxury of stable practice revenues in a recessionary economy. Even better, there are many tools at your disposal to make efficient use of those revenues!

Robert M. Cheney, CFA, CFP®, is a Wealth Advisor and Founder of Westridge Wealth Strategies and helps doctors from his offices in Portola Valley and Palo Alto. He was named to Medical Economics Mmagazine’s 20082009 list of “150 Best Financial Advisers for Doctors.” ** Not to be distributed or reproduced without express permission from the author. **

Roth IRA Conversions. In 2010, the income cap on conversions of traditional IRAs to Roth

PAGE 19 | THE BULLETIN | JULY / AUGUST 2009

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PAGE 20 | THE BULLETIN | JULY / AUGUST 2009

RISK MANAGEMENT

Well-Being of Physicians

By SCCMA Physicians Well-Being Committee Since the beginning of the Physicians Well-Being Committee of the Medical Association, our main focus has been on physicians impaired through alcohol or drug dependencies or psychiatric diagnosis. Recently, however, many more factors seem to be affecting the health and well-being of physicians. We hear some subtle and some not-so-subtle complaints about the satisfaction of being a physician. At the very least, the energy that once was expended in caring for patients is now directed into struggles with insurance companies for authorization or reimbursement, or many other bureaucratic wars.

The complexities of dealing with financial aspects often overwhelm the medical complexities. Many of us feel we have lost control to the multiple bureaucratic levels. We have become an interface between our patients and thirdparty payors—rather than providers of health care.

Historically, we have a profession with higher incidents of alcohol and drug abuse—higher incidence of depression and marital discord, and a higher rate of suicide.

These new stressors will certainly have an impact on those statistics. Burnout—as a syndrome—is present in many individuals under constant pressure. It has been associated with impaired job performance and poor health. It may also contribute to alcoholism and drug addiction. Symptoms of burnout can lead to physician error, and these errors can, in turn, contribute to burnout. This vicious circle underlies the potential human costs of medical mistakes, which can be devastating for a physician.

Our committee would like to enlist all of our colleagues and their spouses to bring forth those issues they feel are significantly impacting their well-being. By bringing up the issues, solutions can evolve.

(Sign up for our 4.5 hour CME accredited program “The Medical Family: More Fun and Less Stress”—see page 22.)

Some main ways physicians can take care of themselves include spending time with family and friends, religious or spiritual activities, finding meaning in their work, setting limits at work, and adopting a healthy philosophical outlook.

The following are some suggestions you can use to stay well and avoid burnout: 1. Take care of your own body.

Physicians are always caring for others’ bodies. But when was the last time you had a physical? When was the last time that you took the time to remember what a joy it is “to be?” A regular regimen of exercise, relaxation, adequate sleep, and good nutrition is essential to achieve physical well-being.

Meditation or breathing exercises, and even something as simple as yawning or taking a deep breath, allows the body to relax.

2. Be your own best friend.

If you made a mistake or things didn’t quite turn out as you planned, your best friend wouldn’t give you a hard time. But many doctors treat themselves in ways no friend ever would. In medicine, perfectionism is pursued and rewarded. However, perfectionism makes it harder to cope with the reality of being a caregiver.

Some things are not within your control. You must learn to base your

PAGE 21 | THE BULLETIN | JULY / AUGUST 2009

self-esteem on what you do have control over—your efforts.

3. Listen and communicate.

Physicians’ training often leads them to look for and demand solutions to every problem. It’s ingrained in the culture to rush in and make everything all right, but this can interfere with empathetic communication. Many physicians can work on “listening without having to fix things.” Conversely, you can learn to describe your feelings to other people without the expectation that they will do something about it.

4. Don’t be afraid of change. Be flexible.

Physicians often react to stress by working harder, a solution that only makes the problem worse. Another common response is to accept change with resentment. Change is a necessary part of life and people typically experience a tremendous sense of relief when they finally accept its inevitability. Yet, like many of the suggestions above, this ability to accept change and to be more flexible is difficult for many physicians to embrace. Change forces you out of your comfort zone and makes you reassess what you really want out of life. A creative response to change can restore your sense of mission and purpose.

Our committee continues to assist individual physicians as their advocate.

We also work with the local hospitals and their well-being committees, in an effort to effectively respond to the complexities and stresses that being a physician can incur. Hopefully, our response to these challenging issues will be beneficial to the medical profession at-large.

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Risk Management CME TheAMedical Family: More FunPresentation and Less Stress Presented by NORCAL Mutual Insurance Company Santa Clara County Medical Association and NORCAL Mutual Insurance Company invite you Are your expectations ofSaturday medicine met? and your spouse/significant other to attend this special morning activity featuring Dr. A jointly-sponsored CME activity with Santa Clara County Medical Association and NORCAL Mutual Insurance Company invite you Ron Hofeldt, a psychiatrist from Salem, Oregon, who specializes in wellness issues pertaining to What issues contribute most to stress in your practice? and your spouse/significant other to attend this special Saturday morning activity featuring Dr. Santa Clara County Medical Association physicians and their families. This CME workshop will combine didactic teaching elements and Ron Hofeldt, a psychiatrist from Salem, Oregon, who specializes in wellness issues pertaining to interactive discussion.

Breakfast andthere lunch will provided.

Would you agree is be room for improvement inelements your and physicians and their families.

This CME workshop will combine didactic teaching When + Where communication with spouse/partner? interactive discussion.

Breakfast and lunch will be your provided.

Saturday, September 19, 2009, 8:00 am – 2:00 pm When + Medical Where Santa Clara County Medical Association and NORCAL Mutual Insurance Company invite you Palo Alto Foundation Saturday, September 8:00 – 2:00 andE. your spouse/significant other to am attend thispm special Saturday morning activity featuring Dr. 701 El Camino Real 19, 2009, Palo Alto Medical Foundation Ron Hofeldt, a psychiatrist from Salem, Oregon, who specializes in wellness issues pertaining to Mountain View 701 E. El Camino Real physicians and their families. This CME workshop will combine didactic teaching elements and How to Sign Up Mountain View interactive discussion. Breakfast and lunch will be provided. $25 per couple for SCCMA members and NORCAL Mutual Insurance Company policyholders.

How to+couple Sign Up When Where $50 per for non-members. $25 per couple for SCCMA members and NORCAL Saturday, September 19, 2009, 8:00 am – 2:00 pm Mutual Insurance Company policyholders.

Faculty $50 per couple for non-members.

Palo Alto Medical Ron Hofeldt, MD isFoundation a psychiatrist in Salem, Oregon with a private practice specializing in the Faculty 701 E. El Camino Real since 1976. He consults with physicians, physician organizations, and treatment of physicians Ron Hofeldt, MD is a psychiatrist in Salem, Oregon with private practice specializing in the Mountain View malpractice insurance companies on issues relevant toaphysicians.

Over the last several years, treatment of physicians since 1976.

He consults with physicians, physician organizations, and Dr. Hofeldt has conducted lectures and seminars on the topics of litigation stress, physician How to Signinsurance Up malpractice companies on issues physician-physician relevant to physicians.

Over the last several years, burnout, physician-patient communication, communication, boundary $25 per couple for SCCMAlectures members and NORCAL Mutual Insurance Company policyholders.

Dr. Hofeldt has conducted and seminars on the topics of litigation stress, physician violations, medical error, and coping with the current changes in medicine. $50 per couple for non-members. burnout, physician-patient communication, physician-physician communication, boundary Faculty medical error, and coping with the current changes in medicine. violations, Ron Hofeldt, MD is a psychiatrist in Salem, Oregon with a private practice specializing in the Educational Objectives treatment of physicians 1976.

He consults physician organizations, and At the conclusion of this since activity, you should be with ablephysicians, to: Educational Objectives malpractice insurance companies on issues relevant to physicians.

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• Analyze anderror, mitigate risk with for burnout utilizing primary prevention (e.g., education, professionalism, and malpractice riskprioritizing). exposure. re-inventory, limitpatient setting,safety, trust building, organizing, Analyze and mitigate your risk for primary prevention (e.g., education, •• Minimize the negative impacts of burnout burnout utilizing by utilizing secondary prevention (e.g., early Educational Objectives re-inventory, limit setting, trust building, organizing, prioritizing). detection, identifying sources of stress, commitment to change, intervention).

At the of this activity, you should be able Minimize the negative ofcommunication burnout by to: utilizing secondary (e.g., early •• conclusion Implement strategies toimpacts improve at work and atprevention home.

• detection, Articulate the medicalsources definition of burnout, its stages, well as intervention). the impact of identifying of stress, commitment to as change, unaddressed burnoutto onimprove physician mental health,at physician work/life balance, • Implement strategies communication work and at home.

CME Information and Disclosure professionalism, patient safety, and malpractice risk exposure.

This activity has been planned and implemented in accordance with the Essential Areas and • Information Analyze and and mitigate your risk for burnout utilizing primary prevention (e.g., education, CME Disclosure Policies of the Accreditation Council for Continuing Medical Education through the joint re-inventory, limit setting, trust building, organizing, prioritizing).

This activity has been planned implemented in accordance with County the Essential Areas and sponsorship of NORCAL Mutualand Insurance Company and Santa Clara Medical • Minimize the negative impacts of burnout by utilizing secondary prevention (e.g., Policies of the Accreditation Council for Continuing Medical Education through the joint early Association. NORCAL Mutual Insurance Company is accredited by the ACCME to provide detection, identifying sources of stress, commitment to change, intervention). sponsorship of NORCAL Mutual Insurance Company and Santa Clara County Medical continuing medical education for physicians.

NORCAL Mutual Insurance Company designates • Implement strategies improve Company communication at work by and atACCME home. to provide Association.

NORCAL Mutualto Insurance is accredited the

The Medical Family: More Fun and Less Stress

continuing medical education for physicians. NORCAL Mutual Insurance Company designates

*If you require reasonableand accommodation in accordance with the Americans with Disabilities Act (ADA), please make CME Information Disclosure arrangements when you enroll.

This activity has beenaccommodation planned and in implemented in the accordance with the Essential Areas and *If you require reasonable accordance with Americans with Disabilities Act (ADA), please make Policies of the Accreditation Council for Continuing Medical Education through the joint arrangements when you enroll.

sponsorship of NORCAL Mutual Insurance Company and Santa Clara County Medical

• •

Minimize the negative impacts of burnout by utilizing secondary prevention (e.g., early detection, identifying sources of stress, commitment to change, intervention).

Implement strategies to improve communication at work and at home.

CME Information and Disclosure This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of NORCAL Mutual Insurance Company and Santa Clara County Medical Association. NORCAL Mutual Insurance Company is accredited by the ACCME to provide continuing medical education for physicians. NORCAL Mutual Insurance Company designates this educational activity for a maximum of 4.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. *If you require reasonable accommodation in accordance with the Americans with Disabilities Act (ADA), please make arrangements when you enroll.

The faculty member—Ron Hofeldt, MD—has no relevant financial relationships to disclose. The planners for this activity are listed below, and have no financial relationships to disclose: Rebecca Powers, MD (Chair, SCCMA Physicians Well-Being Committee) William Berquist, MD (Chair, Stanford & Lucile Packard’s WBC) Jerry Callaway, MD (Chair, Good Samaritan Hospital’s WBC) Ramon Jimenez, MD (Chair, O’Connor Hospital’s WBC) Gene Kansky, MD (El Camino Hospital’s WBC) Jyoti Rau, MD (Chair, Kaiser’s WBC) Simran Singh, MD (Chair, Santa Clara Valley Medical Center’s WBC) Howard Sutkin, MD (Chair, Regional Medical Center’s WBC) Siggie Stillman (SCCMA Alliance) Jo Townson (NORCAL Mutual Insurance Co) Pam Jensen (Santa Clara County Medical Association) Special thanks to Dr. Stuart Menaker, Palo Alto Medical Foundation for use of their conference room.

Seating is Limited ☞ Register Today!

To attend, please complete the information below and mail with credit card number or a check made payable to “SCCMA” to 700 Empey Way, San Jose 95128, or fax to 408/289-1064, Attn: Pam. 1. Name of Physician: ____________________________________ Phone: _______________________ 2. Name of Spouse/S.O.: __________________________________Phone: _______________________ 3. Fax: ________________________________________________ Email: ________________________ $25.00 per couple for SCCMA Members OR NORCAL Policy holders $50.00 per couple for Non-Members Visa or Master Card # __________________________________ Exp. Date________________________ Amount of payment _________________ Signature _________________________________ Name on card________________________________

Deadline is September 11, 2009

MEDICO NEWS

MEDICONEWS

House Health Reform Proposal Would Eliminate Medicare SGR; Physicians Urged to Tell Congress Not to Make Empty Promises Last month, the three House Committees with Health Reform jurisdiction jointly released a general outline of their health reform proposal. Most significantly for physicians, the House proposal would eliminate the sustainable growth rate (SGR) payment formula, which has been an enormous hurdle in our fight to raise Medicare physician payment rates.

The proposal would, also, among other things: • Increase reimbursement for primary care E&M services by up to 15% (3% to 5% per year for three years); • Allow physicians to organize into virtual or real groups to coordinate care and receive bonus payments for reducing unnecessary hospitalizations; • Expand the Medicaid program to cover more low-income families; • Increase Medicaid rates to Medicare levels for primary care services; • Require everyone to have health coverage. It also provides tax credits and subsidies to families up to 400% of the federal poverty level to help them purchase insurance; • Require medium and large employers to offer health insurance to their employees or pay into a fund on behalf of their uncovered workers; and • Create a national health insurance exchange.

Although CMA strongly supports health coverage expansion and insurance market reforms (such as limits on medical loss

ratios) called for in this proposal, the association is concerned that these reforms will be illusory if they don’t also guarantee meaningful access to doctors. CMA is urging physicians to contact their representatives in Congress and tell them that they must increase all Medicare and Medicaid reimbursement rates. Without these important rate increases, the promise of access to care for California’s uninsured will be a false one. The uninsured may be given health insurance coverage, but they may not be able to find a doctor to care for them.

The House proposal also establishes a national health insurance exchange, through which the uninsured (and only the uninsured) can purchase insurance. The exchange would include both private insurance plans and a new public government-run plan. While specific details were not provided, it appears that the House proposal may require all participating Medicare physicians to also participate in the new public plan. While CMA understands that House leaders are concerned about building an adequate physician network to compete with the private health plans, CMA vigorously opposes mandatory participation in any health insurance plan.

CMA also believes that any government plan must be adequately financed to ensure appropriate access to care.

More details, including talking points and representatives’ contact information, are available at http://www.cmaalert.org.

(CMA Alert, June 15, 2009 issue)

Don’t Forget: Red Flag Rules Take Effect August 1 The Federal Trade Commission (FTC) has implemented a new regulation known as the Red Flag Rule, which requires “creditors” – including many physicians – to develop and implement identity theft detection and prevention programs by August 1, 2009. CMA has published a toolkit to help physicians and their staff understand the scope and requirements of the Red Flag Rule.

The toolkit provides guidance on designing and implementing an identity theft detection and prevention program for the physician practice. It also explains how the Red Flag Rule interacts or overlaps with other legal requirements governing the safeguarding of patient information, particularly the federal Health Information Portability and Accountability Act (HIPAA).

PAGE 24 | THE BULLETIN | JULY / AUGUST 2009

CMA’s Red Flag Rules Toolkit is free to members at the members-only website.

Members can also view CMA’s Red Flag Rules webinar on-demand in the webinar archives at the members-only website.

(CMA Alert, July 13, 2009 issue)

MEDICO NEWS

CMA Stops Onerous Provisions in Blue Cross Healthy Families Contract Earlier this year, Anthem Blue Cross notified approximately 53,000 physicians statewide that they would have to sign a separate contract and accept reduced rates if they want to continue treating Blue Cross-insured Healthy Families and AIM patients. In addition to the rate cut, CMA identified a number of problematic provisions in the proposed contract and has been working with the insurer to remove these burdensome provisions from the physician contract.

Thanks to CMA advocacy, Blue Cross agreed to remove from the contract language that would have: • Allowed the insurer to unilaterally reject physicians’ termination notices. California law requires physicians be given the opportunity to terminate a contract any time there is a material change to the contract terms. The proposed contract contained language that would have allowed Blue Cross to “take back” proposed changes and reject any contract termination notices it received from physicians who decided that the contract terms were not acceptable. This provision would have given Blue Cross an unfair advantage when negotiating with physicians by allowing the insurer to feel out how much they could get away with before a physician terminates the contract.

• Dictated how many Healthy Families patients physicians must accept. In some cases, physicians would have been required to take on additional patients even if in their professional and clinical judgment doing so would negatively impact the overall quality of care they are able to provide. This requirement now only applies to physicians who choose to participate in the insurer’s voluntary Medical Home program.

Required physicians to post numerous notices in their waiting rooms. The original contract language would have required physicians to post in their waiting rooms, in multiple languages, information for patients on how to contact Anthem Blue Cross.

• Applied the contract terms to every tax ID number under which a physician bills. The contract terms are now limited only to the tax ID(s) specified on the contract.

Blue Cross has extended the deadline for recontracting from June 30 to August 31. The new contracts become effective September 1.

Physicians who have historically treated Blue Cross Healthy Family enrollees should already have received copies of the new contract in the mail. Before deciding whether to sign the contract, physicians are urged to carefully review all policies, procedures, and operations manuals referred to in the agreement to ensure that they can reasonably comply with the requirements. Physicians should also obtain a full and complete fee schedule and calculate the financial impact the fee cuts will have on their practice. (Use CMA’s financial impact worksheet, available at the members-only website).

Additionally, physicians should carefully review Blue Cross’s new Voluntary Medical Home contracting model and decide whether to opt-in or opt-out of the program. Physicians who opt-in will be reimbursed an additional set amount, per member per month, in return for taking on additional care coordination responsibilities.

If you have questions about the new contract terms, contact Anthem Blue Cross at 877/811-3113 or ssbrecruit@wellpoint.com.

•

(CMA Alert, July 13, 2009 issue)

CMA Publishes “Best Practices” for Physician Practices Toolkit A practice cannot provide quality medical care unless it can keep its doors open. Physicians who work in well-run practices can spend less time dealing with administrative hassles or worrying about making ends meet, which, in turn, affords them more time for patient care. CMA, with generous support from the Physicians’ Foundation, has published a 140-page toolkit to help physicians improve the

efficiency, and, in turn, the quality of their practices.

In this tool kit, you will learn: • What every physician needs to know about running a practice; • How to find and keep qualified staff; • Why your receptionist can make or break your business; • How to make sense of your revenue stream; PAGE 25 | THE BULLETIN | JULY / AUGUST 2009

•

When it makes sense to cancel a payor contract; • And much more.

The Best Practices toolkit, available free to all members, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the toolkit today at http://www.cmanet.org/ bestpractices.

(CMA Alert, June 15, 2009 issue)

JUNE 2, 2009

2009 Santa Clara County Medical Association Award Honorees Held on June 2, 2009, at The Fairmont in San Jose, the 2009 Annual Awards Banquet was a great success! SCCMA members enjoyed a fantastic meal, comraderie, and live entertainment by Dean Martin (impersonator). Howard Sutkin, MD was honored as SCCMA’s 2008-2010 President and talked about SCCMA’s past year’s accomplishments and what still needs to be pursued, with regard to continued dedication. Dr. Sutkin then went on to recognize the 2009 Award Honorees and presented the following awards:

Bernadette Loftus, MD Benjamin J. Cory, MD Award

This award is given to a physician member of the Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.

Bernadette Loftus, MD was born and raised on the East Coast and graduated from the University of Pennsylvania with a Bachelor of Arts degree in biochemistry before attending Case Western Reserve University School of Medicine. After earning her medical degree, she completed a six-year otolaryngology residency in New York City at Columbia University College of Physicians and Surgeons.

Dr. Loftus came West immediately after residency, and joined The Permanente Medical Group in 1991. She has served in a number of roles: assistant department chief; elected representative to the board of directors; physician-in-chief of the Santa Clara Medical Center, and now as associate executive director, working on the affiliation of the Mid-Atlantic Permanente Medical Group with TPMG. This role has Dr. Loftus immersed in the topsy-turvy

health care world of Washington, D.C., at one of the most exciting and important times in the history of American health care. Dr. Loftus said “Personally, I am strapping in for a wild Bernadette Loftus, MD accepts her commendation with her family ride.”

Dr. Loftus is board certified in otolaryngology/head and neck surgery, and serves on the Research Advisory Board of the American Academy of Otolaryngology. Her purely clinical interests include sinus disease and head and neck cancer, but her broader health care interests reside in technology-enabled health care and in health care reform that results in the coverage of all Americans for their basic health care needs.

Dr. Loftus’s personal passions are reading, particularly non-fiction (the history of Africa is a particular favorite right now), and travel, anywhere. She is also a wife and the mother of two sons, aged nineteen and fifteen, and has spent many weekends for the last several years being a parent judge at their many speech and debate tournaments. She said “Being their mom is the best job I’ve ever had.”

The following are some of Dr. Loftus’s professional experiences and accomplishments: 2008 – Present, Associate Executive Director, The Permanente Medical Group (TPMG), a 6000+ physician multispecialty medical group based in Oakland, CA •

•

Responsible for actualizing the affiliation of The Permanente Medical Group with the Mid-Atlantic Permanente Medical Group (MAPMG), a 800+ physician multi-specialty medical group in Baltimore, Washington, D.C., northern Virginia corridor Effected restructuring of MAPMG leadership structure, as well as the launching of broad-based and rapid operational improvement measures

1998 – 2008, Physician-in-Chief, Santa Clara Medical Center, The Permanente Medical Group

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Oversaw growth of medical staff from 250 to 600+ physicians in seven medical locations Led medical center through overall growth of membership from 250,000 to 298,000, overcoming a significant interim membership loss in 2003 - 2004 Developed business case and shepherded it to approval; planned, programmed, oversaw construction, and operationalized complete 1.4 million square foot replacement medical center campus Implemented a fully electronic medical record for 600+ physicians, along with PACS, e-prescribing, and eConsultation referral capability Planned, developed, operationalized new clinical services (radiation oncology, interventional cardiology, CV surgery, etc.)

Oversaw significant improvement in medical center Member Patient Satisfaction Scores, achieving the Medical Center’s highest-ever scores at year-end 2008 Oversaw significant improvement in HEDIS outpatient quality measures and inpatient Joint Commission Total Composite core measures, being a top regional performer in both Elicited and aligned leadership support at multiple levels, in both TPMG and KFH, resulting in Kaiser Foundation Health Plan/Hospitals donation of land for construction of the JW House on the Santa Clara Medical Center campus (housing for families of long-stay patients), a first-of-its-kind facility for Kaiser Permanente nationwide Interfaced with JW House Foundation to ensure appropriate fund raising and operational planning to bring JW House to fruition Educational seminar site sponsor for international visitors, KP Institute for Health Policy

procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.

Thomas M. Krummel, MD is currently the Emile Holman Professor and Chair, Department of Surgery at Stanford University and the first Susan B. Ford SurgeonAward Honoree Thomas Krummel, MD and in-Chief at Lucile family Packard Children’s Hospital. Dr. Krummel has served in leadership positions in the American College of Surgeons, the American Pediatric Surgical Association, the American Surgical, the American Board of Surgery, and the American Board of Pediatric Surgery. He has mentored over 100 students, residents, and post-docs.

Throughout his career, Tom has been a pioneer and an innovator.

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While just a surgical resident, he formed what was then the world’s second ECMO team. The success of that team served as a major impetus to more widespread adoption.

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He helped “jump start” the study of the cellular and biochemical mechanisms of scarless repair in the fetus; his work has been funded by the NIH for over 18 years. He is the recipient of over $3M in research funding over his career.

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Over the last 14 years, he has been a pioneer in the application of information technology to simulation-based surgical training and surgical robotics. Along with Dr. Kenneth Salisbury, professor of Surgery and Computer Science, Dr. Krummel is the recipient of one of the first NIH Phased Innovation R21/ R33 programs to develop collaborative simulation-based surgical training systems. For his work in this arena, he was awarded two Smithsonian Information Technology Innovators Awards.

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For the past six years, he has partnered with Dr. Paul Yock to direct the Biodesign Innovation Program. This program is designed to teach the invention and implementation of new surgical technologies through interdisciplinary education at the emerging frontiers of engineering and the biomedical sciences (http://innovation.stanford.edu).

•

Dr. Krummel has lectured throughout the world and is author or co-author of over 200 publications, chapters, and books.

He has served as a frequent consultant to the medical device industry.

Thomas M. Krummel, MD Outstanding Achievement in Medicine Award

This award is given to a physician member of the Association who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she has achieved widespread recognition. Consideration is given to research and/or the development of

PAGE 27 | THE BULLETIN | JULY / AUGUST 2009

2009 SCCMA Award Honorees, continued from page 27 Martin L. Fishman, MD, MPA

George P. Kent, MD

Outstanding Contribution to the Medical Association

Outstanding Contribution in Medical Education

This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more activities of the Association over and beyond that expected of the membership at-large.

Marty Fishman, MD has been an SCCMA, CMA, and AMA member since 1976. There is no SCCMA member who puts in more time on behalf of the association than Dr. Fishman. His passion and support for SCCMA and CMA are exemplary, as shown below in the many various Award Honoree Martin Fishman, MD and wife Barbara leadership positions he has held. Dr. Fishman also continues to put in valuable hours as the association’s current Treasurer. This honor is very well-deserved.

SCCMA POSITIONS: President, 2002-2003 President Elect, 2001-2002 Vice President for External Affairs, 1997-2000 PAC Chairman, 2000-2001 External Affairs Committee member,1995-1997 Chair, Mini-Internship Program, 2003, 2004 CMA POSITIONS: Board of Trustees, 2005-present CALPAC Board member, 2003-present CALPAC Executive Committee, 2007-2008 Chair, CMA Presidents’ Forum, 2003-2004 Vice Chair, CMA Presidents’ Forum, 2002-2003 Delegate, CMA, 2003-2005 Alternate Delegate, CMA, 1998-2002 Hearing Committee, CMA House of Delegates, 2004 Delegate, CMAOMS Annual Conference,1996,1997

This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large.

Dr. Kent has devoted his career to both clinical practice and teaching in the fields of family medicine and HIV/AIDS care, and is most deserving of recognition.

Dr. Kent came to San Jose in 1987 to serve as associate program director on the teaching faculty of the Family Medicine Residency Program at the former San Jose Medical Center, now located at O’Connor Hospital. For over twenty years, Dr. Kent has taught the clinical skills and humanistic art of family medicine to over 150 resident graduates of the program. He is a beloved educator, direct but gentle, in his Socratic hands-on teaching style.

He is a superb lecturer, mentor, and role model. As adjunct clinical professor at Stanford, he has also taught and inspired the many medical students and physician assistants that have been fortunate to train with him over the years.

After graduating from Case Western Reserve University School of Medicine (1980), George completed his residency in family medicine at Award Honoree George Kent, MD with his the UCSF-affiliated family Family Medicine Residency Program at Community Hospital in Santa Rosa (1983).

George then served as a medical epidemiologist and medical intelligence officer with the Centers for Disease Control in Atlanta, concurrently completing an additional residency in preventive

PAGE 28 | THE BULLETIN | JULY / AUGUST 2009

medicine. He is board certified in family medicine, and is certified as an HIV specialist with the American Academy of HIV Medicine.

Dr. Kent received the California Academy of Family Physicians Award for Educational Excellence in 1998, with special recognition given for his contribution to student and resident instruction, as well as his CME presentations on a local, state, and national level. He has shared his expertise on a wide range of topics, including talks on immunizations, hepatitis, antibiotics and resistance, bioterrorism, HIV/AIDS in primary care, emerging infections, care of the immigrant, and tuberculosis. At the residency, his clinical and teaching expertise extends beyond traditional primary care to include full HIV/AIDS care, clinical obstetrics, pediatrics, and the art of taking a sexual history.

To his residents, Dr. Kent is always there to teach, mentor, and nurture. One resident said about his teaching, “He makes information useable and practical. We all appreciate his ability to take us with him to the cutting edge.”

Seham F. El-Diwany, MD Outstanding Contribution in Community Service

funding for research and training of clinicians in the area of eating disorders.

Dr. El-Diwany’s involvements with community service Award Honoree Seham El-Diwany, MD with also include chairing, her family for several years, the Community Benefit Committee at KP San Jose. Among its achievements is an annual event organized in collaboration with San Jose State University, where physicians and nurses volunteer to provide free physical exams for many inner city youth for athletic participation. Other events include “The Heart Walk” to raise awareness and funds for AHA. Last summer, Dr. El-Diwany spent time at the Matibabu Clinic in rural Kenya as an international medical volunteer.

Dr. El-Diwany is a recipient of the Human Relations Special Merit Award of Santa Clara County, California State Recognition Award for all of her “valuable community services and advocacy,” and the YWCA “Twin Award,” honoring women in leadership roles.

Peggy Fleming Jenkins Citizen’s Award

This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large.

Seham El-Diwany, MD graduated from Ain Shams University Medical School in Cairo, Egypt. Upon completion of her residency training in pediatrics at UC Davis, she joined The Kaiser Permanente Medical Group of Northern California, where she currently serves as the director of The Teen Health Center. As a board member of EDRC (Eating Disorders Resource Center) of the Silicon Valley, she made numerous CME presentations to health care providers to raise awareness about eating disorders, especially among adolescents. She has also organized several community events with other volunteers to address eating disorders. She traveled recently to Washington, D.C. in lobby days for the passage of the FREED Act: a comprehensive bill that would increase

For an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field.

On the 30th anniversary of Peggy Fleming’s gold medal in Grenoble, France, she was diagnosed with breast cancer. Faced with what she called “another Olympics, a life Olympics,” she was granted a second great victory. Early detection saved her life,

PAGE 29 | THE BULLETIN | JULY / AUGUST 2009

2009 SCCMA Award Honorees, continued from page 29 and since then, she has looked for ways to help raise funds and awareness in the quest for a breast cancer cure.

Peggy decided to share her experience with the public, so that other women would be strengthened. Promoting breast cancer awareness has become extremely important to Peggy, and her appearances on “20/20,” “Oprah,” and “The Rosie O’Donnell Show” have given hope to millions of cancer patients.

Peggy and her husband, Dr. Greg Jenkins, dermatologist, also own Fleming Jenkins Vineyards & Winery in the Santa Cruz Mountains. They have created the wine “Victories” (a wonderful dry Rosé) specifically to raise funds for breast cancer research and awareness. Since the 2004 Greg Jenkins, MD and Award Honoree vintage, they have donated Peggy Fleming Jenkins over $20,000 to charities supporting the cause. In addition to The Lombardi Comprehensive Cancer Center at Georgetown University and The V Foundation for Cancer Research, they are supporting local organizations including the Community Health Breast Project and the VMC Foundation at Santa Clara Valley Medical Center for the Sobrato Cancer Center.

Peggy has always regarded her place in sports history as an honor and from this perspective she has made her career choices. Although Phil Hersch of Sports Illustrated called her “the face that launched a thousand zambonis,” she feels that glamorous image is only one side of her personality. Today, her interests are focused on health issues as well as fitness; balance, she feels, is the key to living a vital and satisfying life. Towards that end, she has served on several community project boards, such as San Jose’s Sports Authority and as honorary chairman for Easter Seals and the PTA. She was also the national spokesperson for the National Osteoporosis Foundation.

Carolyn Miller Dedicated County Alliance Member of the Year Carolyn Miller has been a member of the Santa Clara County Medical Association Alliance since she moved to the area in 1965 with her husband, the late Richard Miller, MD, pediatrician. Married in 1956, Carolyn has always been an active supporter of the Alliance, even when busy with her three children, Cheri Lewis, Wayne Miller, and Kim Merritt, and one grandchild, Courtney. She has served in almost every position on the board, and continued to support the activities when not assuming a board post. Carolyn has been in charge of mailing, served as secretary, worked as vice president of membership, and served as president from 1986-87 and then returned to serve again as president from 2007-09. If there were stamps to be licked or envelopes to be stuffed, Carolyn would be there to lend a hand or support those in charge. Most recently, she helped organize the La Rusticana wine tasting and fundraiser, handled the raffle booth at the Gardner Health Fair in east San Jose, and graciously hosted the Thursday night cocktail event at the CMA Fall Conference in 2008. Perhaps the most noticeable aspect of Carolyn is her uplifting cheerfulness and her ever-present smile.

She welcomes new and old members and is the picture of who we are as the SCCMA Alliance, giving support to medical families and health-related issues in Santa Clara County.

Of course, her primary source of balance and joy has always been her family. In 1970, she married dermatologist Dr. Greg Jenkins. They live in the Los Gatos hills and have two sons, Andy and Todd. Peggy is also a proud grandmother to three grandsons.

PAGE 30 | THE BULLETIN | JULY / AUGUST 2009

T H A N K

Y O U !

SCC

Our special thanks to the following sponsors for contributing to the success of this event:

GOLD

SILVER

BRONZE

Law Offices of Hinshaw, Draa, Marsh, Still & Hinshaw

Program09.indd 1

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Santa Clara County Medical Association

2009 Annual Awards Banquet

Dr. Fishman and the other Award Honorees were presented with a commendation from Senator Elaine Alquist. Dr. Fishman poses with his family.

Dean Martin, CMA Alliance President Debbi Ricks, and Award Honoree Peggy Fleming Jenkins

Award Honoree George Kent, MD with family and friends

Past SCCMA President Don Gartman, MD, SCCMA CEO Bill Parrish, Jr., Peggy Fleming Jenkins, Judy Gartman, Past SCCMA President Fred Armstrong, MD, and Gladys Armstrong

SCCMA President Howard Sutkin, MD and wife Erika

Dean Martin sings to the guests

PAGE 32 | THE BULLETIN | JULY / AUGUST 2009

Martin Fenstersheib, MD receives an appreciation plaque for serving on Council as Vice President for Community Health from 1995 - 2008

Award Honoree Martin Fishman, MD dines with family and friends Award Honoree Seham El-Diwany, MD dines with family and friends

Kathleen Miller, Phil Stillman, MD, Siggie Stillman, CMA Alliance President Debbi Ricks, Bill Ricks, MD, SCCMA Alliance President Mary Hayashi, and Roger Hayashi, MD

Greg Jenkins, MD, Award Honoree Peggy Fleming Jenkins, SCCMA CEO Bill Parrish, Jr., Luanne Parrish, Erika Sutkin, SCCMA President Howard Sutkin, MD, Sheila Foley, and Christopher Foley

SCCMA President Howard Sutkin, MD presents flowers to new SCCMA Alliance President Mary Hayashi

Award Honoree Thomas Krummel, MD dines with family and friends

Debora Sawyer, MD, Allison Schwanda, MD, Beth Robie, MD, Past SCCMA President Tanya Spirtos, MD, and County Health Officer Marty Fenstersheib, MD

SCCMA CEO Bill Parrish, Jr. presents SCCMA President Howard Sutkin, MD with gavel and thank you gift PAGE 33 | THE BULLETIN | JULY / AUGUST 2009

Rosemary Kamei and SCCMA PresidentElect Thomas Dailey, MD

CLASSIFIED ADS office space for rent/lease MEDICAL OFFICE AT SAMARITAN MEDICAL CENTER Available July 15, 600 sq. ft., reception, consult room, large procedure room, bathroom, and shower. $2,100/mo plus utilities. Call 408/358-2308.

OFFICE SPACE FOR LEASE Medical suite near O’Connor Hospital. 630 sq. ft., $2.30 per ft. Contact Dr. Michael Lambert at 408/296-2190 or toothtastic@ yahoo.com.

MEDICAL SUITES • LOS GATOS – SARATOGA Two suites, ranging from 1,000 to 1,645 sq. ft., at gross lease cost. Excellent parking.

Located next door to El Camino Hospital Los Gatos. Both units currently available.

Call 408/355-1519.

MEDICAL OFFICE FOR LEASE/ SUBLEASE/SALE Office in close proximity to O’Connor Hospital for lease/sublease/sale. Please call 408/923-8098 for more information.

MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.

OFFICE SPACE FOR LEASE • SAN JOSE 600–1,900 sq. ft. in West Valley Medical Building, second floor, elevator, separate entrance. Call Helen at 408/243-6911.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA

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Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500–4,000 sq. ft. Call Rick at 408/228-0454.

2,048 sq. ft. ready to occupy medical office, previously occupied by RAMBLC Pediatric Group. Located at 6140 Camino Verde Dr, San Jose, in the Santa Teresa Medical/Professional Center across from Kaiser Hospital. Call Virginia at 408/5280571.

LOS GATOS OFFICE $1.99 GROSS/$2.30 FULL 1,500 – 9,000 sq. ft. of offices and/ or rehab in heart of Los Gatos. www.536NSantaCruz.com. 408/656-8265.

OFFICE SPACE FOR SUBLEASE • MTN VIEW Two exam rooms and one doctor’s office, five days a week, shared waiting room, in Mountain View, on South Drive. Call 650/967-7471.

OFFICE TO SHARE • LOS ALTOS Options include two exam rooms plus office. Newly remodeled office space perfect for cosmetic dermatologist, facial plastic, or plastic surgeon. Near El Camino Hospital. Call 650/804-9270.

OFFICE EXAM ROOMS TO LEASE Two nice and large exam rooms (dedicated), shared waiting room. Available five days a week, 2585 Samaritan Drive, San Jose. Please call 408/356-7788 for more information.

MEDICAL OFFICE TO SHARE • SUNNYVALE One exam room plus one large office, shared waiting room and front office.

Newly built, 1,280 sq. ft. Call 408/4381593.

PAGE 34 | THE BULLETIN | JULY / AUGUST 2009

OFFICE SUITE AVAILABLE Location is highway 85 at De Anza. One suite available. Currently configured with 6 tx rooms/offices, entry, large master office with balcony. Street signage to 100,000 cars a day. Marble entry. Zoned medical/ office. No variance required. Looking for established business/practice that values prime location in beautiful building.

Please be qualified. No start ups. Contact Dr. Newman at 408/996-8717. Brokers welcome if you have a client. Compare with space by Good Sam at $2.00 sq. ft. + 3 N.

ELEGANT AND SPACIOUS LOS GATOS MEDICAL OFFICE Available to share with prominent aesthetic dermatologist. This upscale office has seven exam rooms, a lab, two large administrative offices, and a marble and granite waiting room with comfortable seating for eight patients. Call Irene at 408/358-5757 to schedule your private showing. Price is negotiable.

BRAND NEW HIGH END MEDICAL CONDOS– DOWNTOWN LOS GATOS Design/build-to-suit opportunities for sale/lease. On-site parking. In the heart of prestigious downtown Los Gatos. Unit sizes 1,400 sq. ft. and up.

Contact Matt–408/282-3835. www. colliersparrish.com/losgatos.

ATHERTON SQUARE MEDICAL/ DENTAL BUILDING A newly upgraded Class A building offers a variety of spaces from 1,166 sq. ft. and up for medical/dental use at 3301-3351 El Camino Real, Atherton. Tenant improvement allowances available to design suite to meet your needs. Excellent onsite parking, close to Stanford and Sequoia. Trask Leonard, Bayside Realty Partners, 650/282-4620 or Alice Teng, Colliers, 408/282-3808.

MEDICAL OFFICE FOR LEASE • LOS ALTOS Fantastic location. The unit is 1,050 sq. ft. Four + exam rooms, plus an additional doctor’s office. Large reception and waiting room. Includes basement for storage.

Located on Altos Oaks near El Camino Hospital. Two private parking spaces. Call 650/575-6889.

OFFICE FOR RENT • MORGAN HILL 10 minutes from South San Jose. 1,150 sq. ft., excellent location, next to MDs and lab. $1,500 per month. Call or fax 408/7797349. Agent welcome.

MEDICAL OFFICE BUILDING FOR LEASE • SAN JOSE 4,370 sq. ft., at gross lease cost. Located at 55 N. 13th St. Available for single tenant or multi-tenant use. Abundant parking available. Easy access to Highways 101, 280, and 87. Call Patrice DeLorey, Colliers, 408/282-3848.

MEDICAL OFFICE • O’CONNOR HOSPITAL AREA Office in elegant medical office building with ample parking, within one block of O’Connor Hospital. 1,600 sq. ft. to share, 800 sq. ft. per physician. Common bathroom and waiting room, no triple net, $2.75 per square foot. Call 408/292-3609 and leave a message.

MEDICAL OFFICE SPACE FOR LEASE • SAN JOSE 2211 Moorpark Ave. Suites available from 482 sq. ft. – 3,758 sq. ft. Professionally managed medical office building with an onsite building manager. Across the street from Santa Clara Valley Medical Center.

Easy access to Highways 280 and 17. Call Patrice DeLorey, Colliers, 408/282-3848.

PRIVATE PRACTICE/ OFFICE for sale

A+ TRANSCRIPTION SERVICE Providing Clinicians Quality Medical Transcription Since 1995 � Dictation Using 800 Phone System or Your Hand-Held Recorder � 24-Hr. TAT - STAT 2-Hrs. � HIPAA Compliant Testimonials

PRIVATE PRACTICE FOR SALE IM/FP/GP. Primary care practice for sale, including inventory and equipment. Close to O’Connor Hospital. If interested, please call Stacy at 408/297-2910.

PRIVATE PRACTICE FOR SALE Available immediately. Urgent Care/Family Practice in West Valley area. Established 30 years, $0 down. Contact Helen at 408/4763450.

LOS GATOS OFFICE FOR SALE Luxurious 9,000 sq. ft. office with seven offices, full kitchen, 3,700 ft.

Physical Therapy floor, lockers, showers. www.536NSantaCruz.com or 408/6568265.

EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can Continued on page 36 PAGE 35 | THE BULLETIN | JULY / AUGUST 2009

“ A+ Transcription makes us feel like we are their only client. Great work in terms of accuracy and rapid turnaround time.”

Wendy Perston, Administrator – Cardiovascular Institute of Southern Oregon “A+ Transcription has provided my Physiatry and Pain Medicine practice with prompt, accurate transcription for many years. I strongly recommend this service to any clinician.” Mark J. Sontag, M.D. “Transition was seamless, prompt, accurate and very easy to work with. All my doctors are completely satisfied with A+ Transcription Service!” Ilona Garton, Administrator – Altos Oaks Medical Group “A+ Transcription Service has good turnaround time. Their team is accurate in transcribing what we dictate and most importantly, A+ is reliable!”Anthony DuBose, M.D. – Director, Workforce Medical Center A+ Transcription Service 888 589-8283 e-mail: apluspat@aol.com

Classified Ads, continued from page 35 provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Dan R. Azar MD, MPH at 408/790-2907 or e-mail dazar@allianceoccmed.com for additional information.

carpeting throughout. Three lanais with ocean and mountain views, and the tropical gardens which make the Nihi Kai complex so special. Price reduced to $785,000. Call 650/949-3353.

OAK MEMORIAL PARK CEMETERY PLOTS

condo/COTTAGE rentals

Oak Hill Memorial Park--single plots for sale by owner in sold-out hillside section.

Selling two for $10,000 or all four for $18,000 (transfer fees included). No brokers involved. Contact Joyce at 408/3772459.

BEACH HOME • RIO DEL MAR/ APTOS Two story, three bedroom, remodeled home, 1½ blocks from beach, available for weekend or weekly rental. Email bystrong@yahoo.com for details.

WANTED PEDIATRIC PRACTICE

FOR SALE

Will buy Pediatric practice in South Bay. Call 408/455-2959.

BEAUTIFUL HAWAIIAN CONDO Poipu Beach, Kauai.

Lovely 2 BR/2 BA condo, across street from ocean.

Recently remodeled bathroom and kitchen with granite countertops, new

Pajaro Dunes Beachfront Condo Shorebirds #58 2 Bedroom -- 2 Bath Top Level -- Great Ocean View Great for Families Owners Bill & Debbi Ricks 408-354-5613

Rental Agent Pajaro Dunes Company 1-800-564-1771

PAGE 36 | THE BULLETIN | JULY / AUGUST 2009

Never Events, continued from page 11 determine what has gone wrong, hospitals must follow adverse event reporting laws and be prepared for limitations in Medicare and private insurance reimbursement.

Endnotes 1. Patient Safety Primer: Never Events.

Available on the AHRQ Patient Safety Network website.

2. California Health and Safety Code §§ 1279.1-1279.3 and 1280.4.

3. Sentinel Events. Available on the Joint Commission website.

4. CMS proposes additions to list of hospital-acquired conditions for fiscal year 2009. April 14, 2008. Available on the CMS website.

5. Report of the board of trustees.

Presented by: Edward L. Langston, MD, Chair. Available on the AMA website.

6. Medicare’s no-pay conditions: not always preventable. July 14, 2008.

Available on the American Medical News website.

Printed by permission of NORCAL Mutual Insurance Company. NORCAL is the premier provider of professional liability insurance for physicians, medical groups, community clinics, hospitals, and medical facilities. To access additional articles published by NORCAL, visit www. norcalmutual.com.

ANNOUNCEMENT A new textbook titled “Clinical Emergency Medicine Casebook” (Cambridge University Press, 2009) was authored by Drs. Joel T. Levis and Gus M. Garmel, emergency physicians at Kaiser Santa Clara hospital. Congrats to them both on their hard work and contribution to medical education.

Thinking about electronic medical records?

What about your paper records?

If you are planning going to do with all those records into records to a CD alternative:

to move to an electronic medical record system, what are you your paper patient charts and billing files? Consider scanning a digital database with deliverExchange™. Let us scan your or DVD, and realize the benefits of this cost-effective

Safe secure storage that you control • Records are accessible 24/7 Files can be printed out or electronically transmitted • Save time spent filing and retrieving records • Eliminate lost or misfiled records • Save space and storage costs • Keep a copy for backup, security •

•

We pick up your records, scan them at our imaging unit in San Jose, produce quality images on CDs or DVDs, and handle the destruction of the paper records.

2054 Zanker Road San Jose, CA 95131 Contact: Liz Allan phone 408.436.1701 ext.131 fax 408.436.1625

You may not know our name, but if you practice in Santa Clara county you know our service. For over 30 years, SOURCECORP Deliverex has been the vendor of choice for record management in the Bay Area.

PAGE 37 | THE BULLETIN | JULY / AUGUST 2009

Monterey County Medical Society and Santa Clara County Medical Association present

September 26, 2009 10:30am – 8:00pm

Join fellow association members and their guests for a day of family fun on September 26, 2009 at Six Flags Discovery Kingdom in Vallejo!

Only $24.99 per person for all-day admission to the park and all of its attractions.

Lunch provided in one of Discovery Kingdom’s beautiful picnic groves from 2pm to 4pm.

This All-You-Can-Eat meal includes: BBQ Hamburgers and Hot Dogs Garden Green Salad Homestyle Potato Salad Coca Cola Soft Drinks Ice Cream Sandwiches Tickets are $24.99 per person, and must be ordered and paid for before September 15, 2009.

To order, please call Jacquelyn Mentz at 408/998-8850 or 831/455-1008, ext. 3008.

Please refer to your county below for ordering information and details.

Santa Clara County: With a purchase of 4 or more tickets, SCCMA will deliver to your office for a $5 delivery fee on Fridays only. Tickets must be pre-paid via credit card prior to delivery, or remit payment with exact cash. NO CHECKS. Monterey County: Tickets will be delivered via certified mail for an additional fee of $5 per order. MCMS is not liable for tickets once they have been mailed. Tickets must be pre-paid via credit card prior to delivery. You can also pick them up from our office at 700 Empey Way, San Jose, CA 95128. For pick-up orders, MCMS also accepts exact cash.

NO CHECKS.

PAGE 38 | THE BULLETIN | JULY / AUGUST 2009

When was the last time a doctor came to YOU?

At California Pacific Medical Center’s Heart Failure and Transplant Program we are committed to working with referring physicians to provide comprehensive patient care, focused on improved survival and quality of life for patients with advanced heart failure.

We are heart failure cardiologist Ernest Haeusslein, M.D. and cardiothoracic surgeons James Avery, M.D. and Donald Hill, M.D.—and we would like to make an appointment to see you in your office. We’d like the opportunity to acquaint you with our facilities, staff and specialized therapies. We’d also like to review referral indicators to help identify your patients who may benefit from these advanced therapies.

Our program offers: •

Expert evaluation and treatment of patients with NYHA functional class III/IV heart failure and AHA/ACC stages C & D heart failure.

•

Unparalleled experience—with over 385 transplants and 200 ventricular assist device implantations since our program began.

•

Access to the most current mechanical assist devices available, each offering a different interface designed to most successfully match the patient’s pathophysiology.

•

Urgent outpatient consultations and evaluations of your patients—within 48 hours. We can also accommodate same-day hospital transfers.

•

An experienced, highly-trained cardiac care team, comprised of Board certified, fellowship trained cardiologists, cardiovascular and thoracic surgeons, physician assistants, nurse coordinators, a dietician, licensed clinical social worker, psychologist, financial counselors and rehabilitation specialists.

Call us at 415-600-1051 • www.cpmc.org/services/heart PAGE 39 | THE BULLETIN | JULY / AUGUST 2009

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CME courses at your convenience. Submit Attestation Form NORCAL. Your commitment deserves nothing less.

Visit www.norcalmutual.com today,your or call 800.652.1051. online. Print transcripts and certificates…everything from one NORCAL is proud to be endorsed by the Santa Clara County Medical Association Our passion protects your practice. easy-to-navigate website. as the preferred professional liability insurer for its members.

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