2009 September/October

SEPTEMBER / OCTOBER 2009 | Volume 16 | Number 5

Membership Has Its Benefits

Now, more than ever.

Becoming disabled could stop your income. Do you have a reliable financial source to help replace it?

Three in ten entering the workforce today will become disabled before retiring1. A disabling injury will sideline one in five Americans for at least a year before they reach age 652; one in seven for five years or more3.

Santa Clara County Medical Association members can turn to the SCCMA-sponsored Long Term Disability Insurance Plan. This plan is designed to provide a monthly benefit of up to $10,000 if you become Totally Disabled. Members age 50–59 are eligible to apply for up to $6,000 per month.

Visit www.MarshAffinity.com/ cmadownload.html for more information and an enrollment kit.

Administered by:

Please call a Client Service Representative at 800-842-3761 or visit www.MarshAffinity.com/ cmadownload.html to download an enrollment kit.

Let us show you how your membership in the Association can save you money.

Social Security Administration, Fact Sheet January 31, 2007 Life and Health Insurance Foundation for Education, November 2005 3 ”Commissioners Disability Table, 1998,” Health Insurance Association of America, the New York Times, February 2000 1 2

Underwritten by:

Sponsored by:

43391 (9/09) ©Seabury & Smith Insurance Program Management 2009 d/b/a in CA Seabury & Smith Insurance Program Management • CA License #0633005 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • 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).

Hartford Life and Accident Insurance Company, Simsbury, CT 06089. The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. (AGP-5719) • #3-924

BULLETIN THE

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

From the Editor’s Desk.................................................................................5 Joseph S. Andresen, MD

America’s Affordable Health Care Choices Act of 2009 (H.R. 3200) in 1,000 Words or Less...................................................................................6 Joseph S. Andresen, MD America’s Affordable Health Care Choices Act of 2009 (H.R. 3200) in 1,000 Words or Less

MCMS/SCCMA Member Benefits and Services..........................................8 2009-2010 MCMS/SCCMA Seminars & Events.........................................12

More on page 6

Your MCMS/SCCMA Staff is Here to Help!................................................14 CMA’s Legislative Accomplishments & On-Call Library..........................16 A Look at the Financial Challenges of Practicing Medicine...................20 NORCAL Mutual Insurance Company

MEMBER BENEFIT: Insurance Products and Services..............................22 Marsh

Member Benefit: Reimbursement Advocacy Program........................24 MCMS and SCCMA members are entitled to a host of discounts from both local and national vendors that provide a range of products and services.

More on page 8

Do It Yourself or Seek Help With Your Collections and Billing...............25 Mark Christiansen, BME General Manager

Member Benefit: TPO Human Resource Management........................26 Legacy Wealth Advisors, LLC – Q & A.......................................................28 Edwin K.S. Ryu

Bridging to the Eventual EHR....................................................................32 Sourcecorp Deliverex

Time to Explore Options in Your Practice’s Banking and Check Processing Activities...............................................................................34 Conomikes Associates, Inc.

Are You Compliant With the New HIPAA Regulations?..........................36 Physicians should become familiar with what to embrace and what to shun when taking steps to automate records and improve work flow prior to taking the EHR plunge.

More on page 32

PrivaPlan

Alliance News.............................................................................................38 Classified Ads..............................................................................................40 Welcome 34 New Members!......................................................................43 Member Benefit: Regulatory Compliance Partner...............................44 EnviroMerica Q & A

PAGE 3 | THE BULLETIN | SEPTEMBER / OCTOBER 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.

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

THE MONTEREY COUNTY MEDICAL SOCIETY OFFICERS 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 Valerie Barnes, MD

© Copyright 2009 by the Santa Clara County Medical Association.

PAGE 4 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

FROM THE EDITOR’S DESK

health care reform

By Joseph Andresen, MD After 1,017 pages, we all breathed a sigh of relief. Our ambitious task of reading through, summarizing, and taping a television presentation of America’s Affordable Health Choices Act of 2009 (H.R. 3200) was accomplished in advance of legislators reconvening in Washington, D.C. on September 7, 2009.

Nancy Farber, CEO of Washington Hospital Health System in Fremont, California, organized a panel of physician leaders to participate in this task.

Dr. Anmol Mahal, former CMA President and internist; Dr. Dan Morgan, retired orthopedist and former co-chair of the Bioethics Committee; and I joined together in this challenge. The objective was to read through H.R. 3200 in its entirety and give a public presentation of what is actually written in the bill. Hopefully, this would provide the opportunity for more informed and constructive discussion within and among our community members.

It is clear that H.R. 3200 is only one of five separate bills under consideration that is concerned with health care reform. It will inevitably go through multiple amendments. However, H.R. 3200, to date, has the most detailed description of proposed changes to our health care delivery system that will potentially affect every American. Many of the key elements may well be incorporated into a final bill that reaches the President’s desk and is ultimately signed into law.

With the level of media attention, misinformation, and controversy raised, it

was apparent that a thoughtful and factual discussion was needed.

What did I discover? There are no “death panels.” An “essential benefits package” would create a uniform safety net of health insurance coverage for all consumers. Pre-existing conditions exclusions and rescissions of coverage would no longer be permitted. The public option is just that, an option. Primary care doctors will see their reimbursement rise. Medicare is predicted to go broke in eight years. There is an attempt to fix this.

Medicaid will have national standards by 2013 and direct funding from the federal government. There is a marked increase in graduate medical education support, residency slots, and nursing programs.

This is in response to the increasing and alarming shortage of primary care doctors and nurses. This is good news for all of us aging baby boomers, who will undoubtedly see our need for quality medical care rise in the years to come.

Is it perfect? Far from it. The public option remains controversial.

(If it had just been named the optional public plan.) The Health Choices Commissioner will yield significant power under the executive branch of government. Introduction of Accountable Care Organizations (ACOs) bring up some of the same fears of HMOs with financial incentives for potentially less care. Cutbacks in Medicare and Medicaid disproportionate share hospital (DSH) payments worry hospital administrators, who now are treading water to meet the costs of keeping their doors open.

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.

However, for the most part, H.R. 3200 is an ambitious and forward-thinking piece of legislation with two primary goals: 1) to provide affordable, quality health care for all Americans, and 2) to reduce the growth in health care spending.

H.R. 3200 is divided into three broad sections: Division A entitled “Affordable Health Care Choices,” Division B “Medicare and Medicaid Improvements,” and Division C “Public Health and Workforce Development.”

I have attempted to summarize the key points in an accompanying article entitled “America’s Affordable Health Care Choices Act of 2009 in 1,000 Words or Less” with a list of informative references. The television broadcast, “InHealth,” discussion can be viewed directly online at www.whhs.com or by contacting Washington Hospital Community Relations Department at 510/791-3417.

I encourage you to study these important issues carefully. Form your own opinions. Talk with your patients, colleagues, CMA, and legislative representatives. Ensuring that your voice is heard will give us all the best opportunity to see that wise and viable solutions prevail in health care reform.

PAGE 5 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

health care reform

America’s Affordable Health Care Choices Act of 2009 (H.R. 3200) in 1,000 Words or Less

By Joseph Andresen, MD

Division A is entitled “Affordable Health Care Choices.”

This section is concerned with health insurance market reform, whereby a uniform standard of health care benefits is defined. A Health Insurance Exchange would regulate this process giving consumers the option to keep their current policy, obtain a different policy through their employer, or purchase insurance directly through the Exchange. As mentioned earlier, there would be an elimination of pre-existing condition exclusions and limitations on rate adjustments of premiums. All citizens would be required to enroll in coverage or pay a tax. Employers would be required to offer insurance to employees through the Exchange or contribute 8% of the employee’s salary in lieu of coverage. Small businesses would be exempt and would receive a 50% tax credit for any funds spent insuring employees. Rules would prohibit employers from steering employees away from employer-based coverage and into the Exchange. Affordability credits would be available for those who do not qualify for Medicaid and have an income up to 400% of the federal poverty level ($22,050 for a family of 4), to ensure that all citizens receive coverage. The public option is a plan that is designed to promote competition in the health insurance marketplace by acting as a nonprofit alternative. It would receive startup funding from the federal government

providing a reserve for the first 90 days that would be paid back through premiums over time. Thereafter, the plan would be required to compete on a level playing field with private insurance providers. All physicians who are Medicare participants would be included in the network, but would have the option to opt out. A health care surcharge tax is also included on highincome earners to partially fund the Health Insurance Exchange.

Division B is entitled “Medicare and Medicaid Improvements.”

Medicare Part A is projected to be insolvent in 2017. This portion of the bill attempts to meet this budgetary challenge in a number of areas. This includes refinement of Medicare payment reimbursement to better recognize improvements in productivity and incentives to reduce preventable hospital readmissions. There is also phasing out Medicare DSH (disproportionate share hospital) payments, as the number of uninsured is reduced. The Medicare Advantage (HMO) program that has been costly, compared to fee-for-service care, will be phased out. This alone will save about $150 billion over ten years (nearly 30% of total savings) as estimated by the Congressional Budget Office. Permanent reform of the sustainable growth rate reimbursement for physicians will occur with its repeal. A new system of rates will raise reimbursement at a faster rate of

growth for primary care physicians and maintain current Medicare support for all others. Encouragement of physicians to form Accountable Care Organizations (ACOs) is made. Reform of Medicare Part D includes elimination of the “donut hole” or co-pay currently required of enrollees.

Preventative services will be covered.

Perhaps the most controversial and fear-inspired debate is centered on the added benefit of advance care planning consultation, Section 1233, page 424. The intent here is to help patients discuss their views regarding end-of-life care with their families and doctors before the need for such care arises and to learn what they must do to ensure their wishes are carried out if they become incapacitated. The end result will be an increase in each patient’s autonomy in his or her medical care.

Division B continues with establishment of an Agency of Comparative Effectiveness Research that will promote work in the area of evidence-based medicine. Tele-health services are an additional area of development to aid in the quality and access of medical care in rural areas. A significant section is devoted

PAGE 6 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

to program integrity to fight waste, fraud, and abuse. Lastly, there is a significant section devoted to Medicaid and CHIP reform.

Preventative services will be covered. There are broad changes to bring Medicaid under a national standard with federal funding by 2013. This would include matching the essential benefits package offered through the Health Insurance Exchange, elimination of eligibility hurtles for those with incomes under 133% of the federal poverty level, and an increase of primary care physician reimbursement to 100% of Medicare within three years.

Division C is entitled “Public Health and Workforce Development.”

This final section focuses on strengthening our health care system by establishing a Public Health Investment Fund with $89 billion dollars for use over the next 10 years. This would support community health centers, Nation Health Service Corporation programs, and the promotion of primary care and dentistry. Emphasis on adapting the workforce to evolving health system needs is made with scholarships for disadvantaged students, cultural and linguistic training for health care professionals, and interdisciplinary care training such as medical home models. A $35 billion Prevention and Wellness Trust is created from the Public Health Investment Fund mentioned above. This will be responsible for developing a national strategy to improve the nation’s health through evidence-based clinical and communitybased prevention and wellness activities. There is establishment of a Center for Quality Improvement to focus on quality improvement by identifying best practices and new innovation. An assistant to the Secretary of HHW will be responsible for gathering information of key health indicators and facilitate improved data sharing.

There is also a provision for creation of a National Medical Device Registry for all class III medical devices and class II devices that are permanently implantable, life supporting, or life sustaining. This would be linked to provide safety and outcome data.

comparative effectiveness research, graduate medical education support, CHIP. Division C: Preventative services and access, Public Health Investment Fund, National Health Services Corporation, promotion of primary care and dentistry, nursing program support, Prevention and Wellness Trust, National Medical Device.

References 1. Full version of H.R. 3200 http://energycommerce.house.gov/ Press_111/20090714/aahca.pdf 2. Defining Key Terms of the Health Care Debate http://www. latimes.com/news/nationworld/nation/healthcare/la-na-healthglossary6-2009sep06,0,2720250.story 3. For Many Consumers, Few Insurance Choices http:// prescriptions.blogs.nytimes.com/2009/08/19/how-muchcompetition-among-insurers/?nl=pol&emc=pola1 4. Private Health Insurance: Number and Market Share of Carriers in the Small Group Health Insurance Market http:// www.gao.gov/new.items/d02536r.pdf 5. The Unwitting Birthplace of the “Death Panel” Myth http:// www.washingtonpost.com/wp-dyn/content/article/2009/09/03/ AR2009090303833.html 6. T.R. Reid: Looking Overseas for the Healing of America http://www.npr.org/templates/story/story. php?storyId=112172939 7. AMA Supports H.R. 3200 http://www.ama-assn.org/ama/pub/ news/news/ama-supports-hr-3200.shtml

Some terms and concepts: Division A: Protecting choice of existing policy holders, Health Benefits Advisory Committee, Health Insurance Exchange, Health Choices Commissioner, medical loss ratio, essential benefits package, basic, enhanced, premium and premium plus, public health insurance option, individual affordability credits, shared responsibility including individual and employer, health care surcharge tax.

Division B: Market basket updates, skilled nursing facility transparency, Medicare DSH (disproportionate share hospital) payments, sustainable growth rate reforms, Accountable Care Organizations (ACO), preventable hospital readmissions, Medicare Advantage reforms, advance care planning consultation, promotion of primary care, mental health services, prevention of fraud, waste and abuse, Part D donut hole, Tele-health,

PAGE 7 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

COVER STORY

MCMS/SCCMA MEMBER BENEFITS & SERVICES Practice Management CMA’s Reimbursement Help Line: Trouble getting paid? Call CMA’s Reimbursement Help Line for personal assistance with contracting or reimbursement issues. Not available to nonmembers.

888/401-5911.

Amerinet: Members are eligible for a variety of discount programs, including a 22% discount at Verizon Wireless, after joining Amerinet. As a leading group purchasing organization, Amerinet strategically partners with health care providers to reduce costs and improve quality. Health care providers can access contract information, purchasing history, and financial information, all online! To learn more about the available web-based practice management tools, visit www.amerinet-gpo.com. To sign-up, call MCMS/SCCMA Membership Department today at 831/455-1008 or 408/998-8850 Ext. 3010.

Conomikes: Members offered 10% discount on their on-site practice management consultation. The nationally-recognized practice consultants at Conomikes Associates have undertaken over 1,500 assignments with medical practices – showing them ways to improve their performance and profitability.

Most of the assignments of the San Diego-based firm are in the range of $5,000 to $10,000, depending on your practice size.

Contact: Regina Reading, Admin. Assistant, Conomikes Associates, 800/421-6512 or email: rreading@conomikes.com. Please visit conomikes.com.

Practice & Liability Consultants, LLC: Members receive $10 off the regular hourly consulting fees. Since 1985, Practice & Liability Consultants have worked with over 1,400 practices as practice management and malpractice prevention specialists. Services include practice assessments, valuations, benchmarking, mergers, operations/personnel issues, partnership/ group formation/improvements, and seminars. Benefits include greater productivity, increased gross and net income, greater patient satisfaction, and a more pleasant work environment. Fees are based on either a flat fee or an hourly basis and, where possible, a

minimum and maximum fee is quoted. Please call 415/764-4800 or csm@practiceconsultants.net.

EnviroMerica: Bay Area-based private company that has helped hundreds of medical and dental offices in Northern California with all of their regulatory compliance issues for the past 12 years.

They assure their clients are up to all standards, keeping their offices, patients, and staff safe and keeping them clear from hefty fines that are often levied by the regulatory agencies – such as CAL/OSHA, the Department of Health, the EPA, as well as the Medical Board of California. Services include annual training, up-to-date and customized safety manuals, all appropriate office documentation including complete and compliant MSDS books, plus complete physical compliance of the office. Via an insurance policy, EnviroMerica guarantees all of their clients against any and all fines they may receive from any of the regulatory agencies.

MCMS/SCCMA members receive a complimentary CAL/OSHA inspection given by EnviroMerica (valued at $275). Call 888/3230583 for more details.

The Personnel Office (TPO): TPO is an award-winning HR consulting firm serving primarily the Bay Area. Typical services include, general HR consulting, employee handbook development, neutral third-party investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices. How we work with SCCMA and MCMS members: Over the past 15 years, TPO has provided HR support to SCCMA as well as the members of SCCMA and MCMS. TPO has facilitated numerous HR training programs for members to attend and has provided many articles throughout the years. MCMS/SCCMA members receive a free initial consulting call ($50 Savings) and then 10% off the initial work, products, and services with TPO. Contact Melissa Irwin, Sr. Consultant: 831/688-4196 or cmelissai@tpohr.com.

PAGE 8 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

OfficeWorksRX: Members receive preferred pricing and FREE working interview. When your office is short staffed, are you getting the help you really need? OfficeWorksRX is your employment remedy! They specialize in placing medical assistants, receptionists, transcriptionists, and records clerks, as well as biller/collectors, coders, and office managers. Whether you require full- or parttime employees, permanent or temporary placement, vacation or maternity leave coverage—THEY CAN HELP! OfficeWorksRX provides pre-screened candidates, that have a health care background, within 24-48 hours. Call Kristen Biernat at 408/4521125 for more information.

Legal Services

4262. Banc of America (subsidiary of Bank of America), 800/4976076.

Merchant Services/Payroll Services/ Check Management: Members receive exclusive discounts and a three-year rate guarantee on Heartland Payment System’s suite of financial services, which includes credit card processing, payroll processing, and check management. Heartland offers a full suite of services to meet the needs of the health care market, including ConfirmPay, a PC-based tool that processes credit card and ACH transactions with real time insurance verification and patient responsibility estimator for over 400 insurance carriers. Heartland Payment Systems also has local sales and service professionals who specialize in the health care industry and a 24/7/365 live customer service team. Heartland Payment Systems, 866.941.1477 or www.heartlandpaymentsystems. com

CMA On-Call: CMA On-Call is an online library with over 4,500 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. Free to CMA members ($2 per page for nonmembers). Accessible online at www.cmanet.org/member or by calling CMA Member Help Line, 800/786-4262.

ComericA Bank: •

$500 credit towards nonrecurring closing costs at close of escrow.

•

1/4% higher than posted CD rate over $50,000.

•

1/2% discount off posted rate along with no fee.

Legal Help Line: CMA legal help line provides immediate assistance for HR, medical, regulatory, or legal questions. Free to CMA members. Not available to nonmembers. 800/786-4262.

•

For more information, call Jo Matheson, vice president of banking, at 408/556-5261.

PrivaPlan: Receive discount on a complete do-it-yourself HIPAA privacy and security compliance toolkit (CD-ROM). Call David Ginsberg at PrivaPlan at 877/218-7707.

•

Provides financial planning, retirement planning, professional money management, and more.

•

One-hour complimentary consultation for MCMS/SCCMA members (over a $300-dollar savings).

•

For more information, call Lisa Goss at 408/452-7700.

Financial Services Financial Planning: Members get a free portfolio checkup (a $250 value) and $500 off Mercer’s “Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning. Mercer Advisors, 800/898-4642.

CMA Credit Card: Physicians can show their CMA pride with CMA-branded credit cards from Bank of America. Bank of America, 800/789-6701.

Practice Financing: Members get reduced loan administration fees from Banc of America Practice Solutions (a subsidiary of Bank of America) for software upgrades, practice expansion, and equipment purchasing. A members-only coupon code is required to access this benefit. Get your code at www. cmanet.org/benefits or call CMA’s Member Help Line, 800/786-

Legacy Wealth Advisors, LLC:

Bureau of Medical Economics (BME): Receive a 5% discount off the basic rate for collections. (Rate based on volume—you only pay if they collect.)

The billing rate is based on provider productivity. For more information regarding BME’s collection and billing services, call Karen Jorgenson for Collections, Ext. 3034, and Yolanda Rubio, CMC, for Billing, Ext. 3002. 408/998-5811.

Coding and Reimbursement Hotline: Access a wealth of coding and billing information by calling Sandie Becker, CMC, MCMS/ SCCMA’s coding/reimbursement specialist at 831/455-1008 or 408/998-8850 Ext. 3007 or email: sandie@sccma.org. This service is FREE-of-charge to our members and their staff.

PAGE 9 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Continued on next page

MCMS/SCCMA MEMBER BENEFITS & SERVICES, from page 9 Insurance Medical, Workers’ Comp, Life, Disability, Long-Term Care and More: Members receive discounted rates on insurance products for solo, small, medium, and large groups. Marsh Affinity Group Services, 800/842-3761 or www. marshaffinity.com/assoc/cma.html.

Auto and Homeowners Insurance: Discounted auto and homeowners insurance for CMA members. Mercury Insurance Group, 888/637-2431 or www. mercuryinsurance.com/cma.

MCMS/SCCMA Seminar/Webinar Series: Member physicians and their office staff often attend FREE-of-charge seminars (including office managers) covering legal issues, HIPAA, risk management issues, contract negotiations, reimbursement, billing, OSHA compliance, how to open/close/how to determine the value of a medical practice, HR requirements/guidelines, and much more.

Check out www.sccma.org or www.montereymedicine.com or The Bulletin for more information.

Health Information Technology (HIT)

NORCAL Mutual Insurance Company: Formed by physicians in 1975 to provide the highest quality medical professional liability insurance products and services to its policyholder-owners. NORCAL Mutual insures nearly 20,000 physicians and other health care professionals in solo practice, medical groups, hospitals, clinics, and allied health care facilities in California, Alaska, and Rhode Island. More than three-quarters of NORCAL Mutual policyholders have been with the company longer than five years. They stay with NORCAL Mutual because it stands with them, providing vigorous defense to the standard of care, unparalleled risk management, and personalized local service.

In 1984, NORCAL received their first “A+” rating from A.M. Best.

They have maintained an “A” or better rating every single year since then. NORCAL offers a variety of FREE on-line CME courses for members of NORCAL. For more information, visit www. norcalmutual.com or call Jeanne Zosky at 800/652-1051.

Professional Development CME Tracking/Credentialing: CMA’s Institute for Medical Quality certifies CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others. CME certification is $29 a year for members, $49 for nonmembers. IMQ, 415/882-5151 or www.imq.org.

CMA Webinar Series: CMA’s webinar series gives physicians the opportunity to watch live presentations on important topics of interest and interact with legal and financial experts from the comfort of their homes or offices. The webinars are free to CMA members and their staff. www.cmanet.org/calendar.

HIT Resource Center: CMA is closely monitoring the standards development process, and will be updating this resource center as new information becomes available. www.cmanet.org/hit.

EHR Webinar Series: To help members begin to assess their HIT needs, CMA has partnered with Maxwell IT to provide members with complimentary registration to the EHR Best Practices Series webinars. Maxwell IT is a national education/ consulting program endorsed by state medical associations to help physician practices learn how to select and implement EHRs. A members-only coupon code is required to access this benefit. Get your code at www.cmanet.org/benefits or call CMA’s Member Help Line, 800/786-4262.

Epocrates: CMA members save 30 to 50% on Epocrates, which provides pointof-care access (via the Web, PDA, or smartphone) to information on drugs, diseases, and diagnostics. Visit www.cmanet.org/benefits to access the members-only discount link.

Publications CMA Alert Newsletter: CMA’s biweekly e-newsletter provides up-to-date information on many issues of critical importance to California physicians. Advertising opportunities available.

Distributed via email or fax to all CMA members. Subscribe online at www.cmanet.org/news/alert_sub.asp or call 800/786-4262.

CMA’s Legislative Hot list: CMA’s Legislative Hot List, distributed weekly during the legislative session, follows the progress of CMA-sponsored bills and other bills of interest to physicians as they move through the legislative process. Subscribe online at www. cmanet.org/news/hotlist.asp or call 916/551-2887.

CMA’s In the News: CMA’s daily news roundup, “In the News” provides a quick, but meaningful, overview of the day’s health care news. Subscribe online at www.cmanet.org/news/press_clips.asp or call 916/551-2072.

PAGE 10 | THE BULLETIN | JULY / AUGUST 2009

The Bulletin: Members receive a FREE subscription to the voice of Monterey and Santa Clara County physicians. This bimonthly publication includes medical articles, classifieds, new member benefits, coding/billing/collection advice, CME classes and webinars, seminars, new members listing, and more!

MCMS/SCCMA Pictorial Membership Directory: Appear in MCMS/SCCMA’s annual pictorial membership directory! Receive a FREE directory each year ($60.00 value) and receive a 50% discount off each additional directory purchase by member. Contact Maureen at 831/455-1008 or 408/998-8850 Ext. 3001 for details.

Automotive Services

The Alliance: Members of the Alliance work together to promote quality health in Santa Clara County through education, community service programs, and legislative advocacy. Benefits of membership include advocacy for quality health care, legislative awareness and action, lifelong friendships, active local, state, and national projects, and close support for the medical family. For more information, call Debbi Ricks at 408/358-0855, or Siggie Stillman at siggiestillman@aol.com, or visit www.sccma.org.

Other Supplies and Resources

Autobahn Los Gatos: Members, family, and staff receive a 10% discount on labor. Specializing in BMW and Mercedes Benz repair. Call Dave or Gary at 408/356-5985 to set up your appointment today.

Staples: Save up to 80% on office supplies and equipment from Staples, Inc. Visit www.cmanet.org/benefits to access the members-only discount link.

Car Rentals: Save up to 25% on car rentals for business or personal travel.

Members-only coupon codes are required to access this benefit. Get your code at www.cmanet.org/benefits or call CMA’s Member Help Line, 800/7864262. Avis, 800/331-1212; Hertz, 800/654-2200.

MedicAlert: MedicAlert is a nonprofit foundation with over 50 years of lifesaving experience identifying and providing vital medical information to emergency personnel for over 4 million members worldwide. CMA members and their patients save $10 on new adult enrollments and $2.95 on Kid Smart enrollments. MedicAlert, www.medicalert.org/cma or 800/253-7880.

Member Resources Mailing Lists/Labels: To send new practice announcements, inform your colleagues of a particular legislation or upcoming event. Members can order mailing labels by specialty, zip code, or total membership. Members receive a 50% discount by calling Pam Jensen, MCMS/SCCMA, at 831/455-1008 or 408/998-8850 Ext. 3012.

Physician Referral Service: Our physician referral service handles around 1,200 calls per month. Patients can select a physician by city, specialty, language, Medicare or Medi-Cal, and gender. Call Jean Cassetta, MCMS/SCCMA, at 831/4551008 or 408/998-8850 ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today.

Discounted Tickets & See’s Candies Certificates: Discounted tickets available for members, their staff, and families to: California Great America, Gilroy Gardens, Monterey Bay Aquarium, Raging Waters, and Six Flags Discovery Kingdom. Gift certificates also available for See’s Candies. For more information, call Jacquelyn Mentz, MCMS/SCCMA, at 831/455-1008 or 408/998-8850 Ext. 3008.

Security Prescriptions: Get 15% off tamper-resistant security prescription pads and printer paper. RX Security, www.rxsecurity.com/cma.php.

Magazine Subscriptions: 50% off subscriptions to hundreds of popular magazines. Subscription Services Inc, www.buymags.com/ cma or 800/289-6247.

Breveon: The leader in developing and marketing the most accurate medical speech-recognition tools for health care professionals use in dictation, transcription, and clinical data management. Discount given to members. For more information, call 650/691-2061.

Copyland/Zip 2 Print: Members receive excellent quality service with a 10% discount on all printing needs, from prescription pads, new practice announcements, brochures, etc. FREE shipping or delivery depending on your office location. Call Frank at 408/971-9800.

PAGE 11 | THE BULLETIN | JULY / AUGUST 2009

mcms/sccma member benefits & services

2009-2010 mcms/sccma seminars & events Note: All members may attend events held in Monterey and Santa Clara counties regardless of location of membership.

Month

Date

Day

Time

Description

October

6

Tuesday

9:00am – 10:30am

MONTEREY: Employment in Today’s Economy… Options to Reduce Employment-Related Expenses in Medical Offices TPO

October

7

Wednesday

6:30pm – 8:30pm

SCCMA: FREE Investment Symposium @ DoubleTree Hotel Legacy Wealth Advisors Dinner Provided (MDs only)

October

14

Wednesday

12:30pm – 1:30pm

SCCMA/MCMS: FREE Webinar: “Avoiding Embezzlement” Practice Liability & Consultants

October

17 - 19

Saturday – Monday

All Day

House of Delegates @ Disneyland Hotel

October

21

Wednesday

12:30pm – 1:30pm

MCMS/SCCMA: FREE Webinar: “Avoiding Embezzlement” Practice Liability & Consultants

October

28

Wednesday

9:00am – 12:00pm

SCCMA: “MBA in 3 Days” (Finance) Physicians and Practice Managers Practice Liability & Consultants

November

4

Wednesday

9:00am – 12:00pm

SCCMA: “MBA in 3 Days” (Operations) Physicians and Practice Managers Practice Liability & Consultants

November

11

Wednesday

9:00am – 12:00pm

SCCMA: “MBA in 3 Days” (Human Resource Management) Physicians and Practice Managers Practice Liability & Consultants

November

12

Thursday

12:00pm – 2:00pm

SCCMA: What Every Office Manager Should Know About Running a Practice (ARs, Collections, Billing) Frank Navarro/CMA’s Center for Economic Services

November

12

Thursday

6:00pm – 8:30pm

SCCMA: What Every Physician Should Know About Running a Practice (ARs, Collections, Billing) Frank Navarro /CMA’s Center for Economic Services

November

12

Thursday

9:00am – 12:00pm

MONTEREY: Telephone Techniques, Patient Relations, Customer Service Practice Managers Practice Liability & Consultants

December

3

Thursday

12:00pm – 2:00pm

MONTEREY: OSHA Refresher Seminar (Office Managers Forum) EnviroMerica

December

10

Thursday

6:00pm – 8:00pm

Young Physicians Mixer

PAGE 12 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Month

Date

Day

Time

Description

January

27

Wednesday

9:00am – 4:00pm

SCCMA: Repairing Leaks in Your Practice “Strategies to Boost Profits in 2010 thru Better Billing & Coding” Practice Liability & Consultants

January

29

Friday

10:00am – 12:00pm

MONTEREY: Managing Up! Practice Managers Practice Liability & Consultants

January

29

Friday

12:15pm – 1:30pm

MONTEREY: Magnificently Managing Your Manager Practice Managers Practice Liability & Consultants

February

4

Thursday

12:00pm – 2:00pm

MONTEREY: What Every Office Manager Should Know About Running a Practice (ARs, Collections, Billing) Frank Navarro/CMA’s Center for Economic Services

February

4

Thursday

6:00pm – 8:30pm

MONTEREY: What Every Physician Should Know About Running a Practice (ARs, Collections, Billing) Frank Navarro/CMA’s Center for Economic Services

February

10

Wednesday

1:00pm – 4:00pm

MONTEREY: Webinar MOJO Management & “Learn Management Magic” for Workplace/Workforce

February

17

Wednesday

12:30pm – 1:30pm

SCCMA: Diversity in Today’s Medical Practices… Beyond the Prevention of Harassment and Discrimination TPO

March

8

Monday

6:00pm – 8:30pm

MONTEREY: Retirement, Recruiting, Buying, Selling & Transitioning Your Practice (Physicians only) Practice Liability & Consultants

March

15

Monday

6:00pm – 8:30pm

SCCMA: Retirement, Recruiting, Buying, Selling & Transitioning Your Practice (Physicians Only) Practice Liability & Consultants

April

TBD

6:00am – 6:30pm

CMA’s 37th Annual Legislative Day @ Sacramento (Bus Trip)

May

12

Wednesday

10:00am – 12:00pm

MONTEREY: Diversity in Today’s Medical Practices… Beyond the Prevention of Harassment and Discrimination TPO

May

13

Thursday

12:30pm 1:30pm

Webinar Mojo Management Practice Liability & Consultants

PAGE 13 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

ANSWERS FOR YOU AND YOUR STAFF

YOUR SCCMA/MCMS STAFF IS HERE TO HELP! We are available to help you with everything important about your profession and your practice, as well as with services and discount programs for your home and personal use. Whatever you need – be it legal information, help with a problematic payor, or details about your member discounts and services – just call!

William C. Parrish, Jr.

Sheila Foley

Maureen Yrigoyen

Chief Executive Officer Executive Director T: 408/998-8850, ext. 3006 or 831/455-1008, ext. 3006 E: bill@sccma.org

Executive Assistant T: 408/998-8850, ext. 3024 or 831/455-1008, ext. 3024 E: sfoley@sccma.org

Administrative Assistant Catering Coordinator T: 408/998-8850, ext. 3001 or 831/455-1008, ext. 3001 E: maureen@sccma.org

Contact Bill should you have questions about what SCCMA or MCMS are doing locally, in Sacramento, and in Washington, DC, on the political advocacy front, or with questions about finances and operations. You may also contact Bill if you have general questions, complaints, or concerns about what SCCMA or MCMS are doing or can do for you as a Santa Clara County or Monterey County physician.

Contact Sheila should you have questions about the House of Delegates, Executive Committee, Nominating Committee, or Monterey County activities. Also, provides high-level administrative support and scheduling for the CEO.

Contact Maureen for physician referrals, to order additional copies of the membership directory, or should you need any information regarding SCCMA’s meeting facilities/conference room rental or catering.

Jean Cassetta

Pam Jensen

Sandie Becker, CMC

Membership Director T: 408/998-8850, ext. 3010 or 831/455-1008, ext. 3010 E: jean@sccma.org

Managing Editor Peer Review Committees Coordinator T: 408/998-8850, ext. 3012 or 831/455-1008, ext. 3012 E: pjensen@sccma.org

Coding/Reimbursement Specialist T: 408/998-8850, ext. 3007 or 831/455-1008, ext. 3007 E: sandie@sccma.org

Contact Jean to enroll a physician, resident, or student to membership, or for information regarding the SCCMA/ MCMS Young Physician Program, Resident Section, Medical Student Section, or member benefits. Also, contact Jean if you have ideas or suggestions as to how we can increase the value of your membership and thus serve you better, or if you need assistance with external affairs, SCCMA’s Political Action Committee, or SCCMA Council business.

Contact Pam should you have questions about The Bulletin magazine, our website, the annual pictorial membership directory, or if you need to change or update your contact information. Also, contact Pam should you like to place a classified ad, display ad, or order a database mailing list (all discounted for member physicians).You may also contact Pam for any business related to physician or patient complaint referrals, Annual Awards Banquet, Physician Well-Being issues, History Committee, and Peer Review Committees.

Contact Sandie should you need assistance with coding, billing, compliance, or for any economic advocacy issue you’re facing. Also, contact Sandie if you would like to receive the advocacy e-newsletter or for business pertaining to the Bioethics Committee.

Jacquelyn Mentz

Steven Brazeau

Shannon Landers

Membership Coordinator T: 408/998-8850, ext. 3008 or 831/455-1008, ext. 3008 E: jmentz@sccma.org

Administrative Assistant T: 408/998-8850, ext. 3009 E: sbrazeau@sccma.org

Lead Bookkeeper T: 408/998-8850, ext. 3026 or 831/455-1008, ext. 3026 E: slanders@sccma.org

Contact Jackie should you have questions about your membership status or dues, or for entertainment discount tickets.

Contact Steven for any business related to the Environmental Health Committee.

Contact Shannon should you have questions about invoices, statements, or accounting business.

PAGE 14 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

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Deal directly with me, Dr Santucci DC, and save about $100K in broker’s fees. I bought this building from Dr Prolo and want to sell it directly to the next buyer. Please call my office at (408) 261-7767 to set up a tour on a Tuesday or Thursday morning.

PAGE 15 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

GOVERNING MEDICINE

CMA’s legislative accomplishments CMA is the unifying voice of doctors. When decisions affecting health care are being made at the state and federal levels, we are at the table to represent all California doctors.

Your membership strengthens our representation and advocacy efforts at the table to create and

maintain a physician-led, patient-centered health care system in California. The following legislation is just a small, albeit noteworthy, portion of CMA’s advocacy efforts. The victories were achieved despite an often-hostile environment for physicians and medicine; victories made possible by CMA, you, and your dues dollars.

Aggressive Advocacy AB 1324 (De La Torre) Sponsored by CMA and signed by the Governor, this bill protects patients and physicians by prohibiting HMOs and insurance companies from retroactively rescinding or modifying authorizations after the treatment has been provided by the physician in good faith.

Professional Liability Rate Protection Defending MICRA: The trial lawyers will never give up in their attacks to

overturn MICRA – the Medical Injury Compensation Reform Act that keeps professional liability rates affordable for California doctors. Recently, the trial lawyers tried to overturn the non-economic damages award in MICRA ($250,000 cap).

CMA’s arguments and amicus filing before the 5th District Court of Appeal were validated when the court agreed with CMA and rejected each of the trial attorneys’ constitutional arguments.

State Can’t Cut Medi-Cal Fees A federal court has ruled that California acted illegally by trying to cut Medi-Cal fees by 10% last year for doctors and others who treat 7.1 million poor people. The ruling means that doctors will be retroactively paid in-full for claims that were paid at 90% during the 6 weeks that the 10% cut was in effect. CMA’s legal efforts last year helped reverse the cuts and restore more than $1 billion to California’s health care system, including the $121 million to California physicians who provide care to the poor. CMA attorneys are already consulting and working with Supreme Court experts to prepare for any challenge that could be mounted by the state to overturn this ruling.

Streamlining Medi-Cal Medi-Cal’s costly Treatment Authorization Request (TAR) process is set for an audit, thanks to CMA. The TAR program costs the state $1.5 billion to administer and creates considerable added paperwork for physicians serving Medi-Cal patients. Since 92% of TARs are granted, the process does little PAGE 16 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

more than delay treatment and increase administrative costs in nine out of ten cases. CMA is advocating that those funds be spent on providing actual health care, like maintaining the state’s Healthy Families program, rather than wasteful administration, particularly given the state’s budget situation.

Stopping Health Insurance Company Abuses AB 2 (De La Torre) Sponsored

by CMA, this bill will protect patients from losing health insurance when they get sick by preventing the outrageous industrywide practice of health plans wrongfully rescinding coverage for patients through requirements that health insurers obtain final approval for an independent reviewer before they can rescind a health plan or insurance policy.

Protecting Against Fraud CMA has filed a class action lawsuit against health insurance company WellPoint, Inc. The lawsuit alleges that WellPoint colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. WellPoint – which operates as Blue Cross in California – is legally bound to pay the usual and customary amount for care provided to their enrollees by an out-of-network physician.

Other CMA Sponsored Legislation AB 526 (Fuentes) This bill will create the Patient Protection and Physician Health Program in California. The bill will allow physicians with mental health or addiction problems to seek help, leading to appropriate treatment and monitoring, prior to harming a patient. With the closure of the Medical Board Diversion Program, there is not a sufficient program available for physicians seeking help.

AB 583 (Hayashi) CMA is co-sponsoring this bill with the California Society of Plastic Surgeons. It is becoming increasingly difficult for the public to identify the license, education, and training of health care professionals who practice in the state and many are unable to distinguish between physicians and non-physicians. To protect the public’s health and safety, this “truth in advertising” legislation will require a health care professional to disclose information in various health care settings to help patients understand who will be helping them with their health care, such as information about

A federal court has ruled that California acted illegally by trying to cut Medi-Cal fees by 10% last year for doctors and others who treat 7.1 million poor people.

their license, education, and recognized board certification.

AB 1201 (M. Perez) CMA is co-sponsoring this bill with the American Academy of Pediatrics and the California Academy of Family Physicians. The bill requires plans/insurers to adequately reimburse for both the acquisition and administrative costs of giving shots, such as purchasing the vaccine, storage, inventory, staff time, supplies, etc. This bill also prohibits plans from applying copays, deductibles and other cost-sharing mechanisms to immunizations.

CMA Opposed Corporate Bar Legislation - DEFEATED SB 726 (Ashburn) This bill, as amended in the Assembly Health Committee, will allow virtually all health

care districts and rural hospitals to directly employ up to five physicians in a pilot program. The CEO of a facility must show they have been unsuccessful in recruiting a physician for 12 months, that no currently contracted physician or physician with privileges will be supplanted, and the physician was not recruited from an FQHC. Employment contracts can be up to 10 years, but may be renewed if signed prior to December 31, 2017. (This bill was defeated).

AB 646 (Swanson) This bill would authorize a health care district that is located in a rural area, or a public or nonprofit hospital or clinic located in a health care district serving medically underserved urban populations and communities, to employ physicians. (This bill was defeated).

AB 648 (Chesbro) This bill will allow rural general acute care hospitals to employ an unlimited number of physicians and surgeons. The bill requires an employed physician and surgeon to sign a contract to exercise independent medical judgment and to notify the Medical Board of any action or event that compromises that independent medical judgment. (This bill was defeated).

Legislation to Watch AB 542 (Feuer) In the face of strong CMA opposition, this bill was dramatically narrowed by the author before its first committee hearing. The bill now applies only to hospitals and merely requires the state to adopt regulations establishing uniform policies and practices governing the nonpayment to and reporting by hospitals of substantiated adverse events by public and private payers, consistent with those developed by the federal Centers for Medicare and Medicaid Services (CMS). CMA will continue to provide suggestions to further improve this bill and will stay engaged in the discussion.

PAGE 17 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER BENEFIT: PRACTICE RESOURCES

CMA ON-CALL The California Medical Association’s FREE Information-on-Demand Service Access the answers to all your medical-legal questions — free of charge — with CMA’s ON-CALL documents.

CMA ON-CALL is the California Medical Association’s 24hour information-on-demand service for physicians. All CMA ON-CALL documents are available free to MCMSSCCMA-CMA members. Members may access CMA ON-CALL documents on CMA’s website as follows: Go to www.cmanet.org. In the upper right-hand corner, click on the blue box that reads “CMA Members Enter Here.” Enter your username and password.

If you are entering the “Members’ Section” for the first time, you will need to register by clicking on the words “Click here” inside the “Sign In” box. Fill in the three blank fields with: Your California medical license number (make sure to leave out the leading zeroes in your license number, e.g., if your license number is “AOOO12345,” enter

corner. Under step one, check the box next to CMA ON-CALL. Under step two, select “Enter Search Criteria.” To search by document number: If you know the specific document for which you are searching, enter the document number into the search box. Click on the document title and number and follow the prompts to download the document. To search by keyword search: Type a keyword(s) search into the search box. When searching for two or more words, use “and” or “or” (e.g., needles or syringes, point and of and service). Do not use “and/or.”

A12345”); your six-digit CMA ID number; your last name. Click “Register.” Next, follow the prompts to personalize your username and password, and record this information for future use. Be sure to give CMA your preferred email address when registering, so that they can send you your username and password via email should you misplace them.

Once in the “Members’ Section,” slide your cursor over the words “CMA ON-CALL” on the left side of the homepage, and click on the link that says “CMA’s online medical-legal information library.” From this page, you can search by general topic headings, which parallel the chapters included in CMA’s California Physician’s Legal Handbook. To see a list of documents by topic, simply select that topic.

To view the documents, you will need the Adobe Acrobat program. If you do not have Adobe Acrobat on your computer, you may download the program at no charge by clicking on the Adobe icon to the right of your screen before you click on the blue “Download PDF” button.

If you have questions about CMA ONCALL or how to access documents, please call CMA’s Legal Information Line at 800/786-4262.

You can also search CMA ON-CALL by document number or by keyword search. To do this, scroll down to the bottom of the page and click on the “Search” button in the lower left-hand

General Topic Headings: • • • • • • • • • • • • • • • •

ADA/Discrimination Adverse Events Advertising AIDS and HIV Allied Health Professionals Ancillary Services Antitrust Business Prohibitions/Disclosure Requirements Clinical Laboratories Consent Death/Organ Donation Decisions Regarding Life-Sustaining Treatment Drug Prescribing/Dispensing Drug Testing eMedicine/HIPAA Emergency Transfer

• • • • • • • • • • • • • •

Expert Witness Issues Fraud and Abuse Fraud and Abuse: Referral Issues Managed Care: Overview Managed Care: Contract Termination/ Exclusion Managed Care: Risk Arrangements Managed Care: Utilization Review and Management Medical Board: Discipline and Licensing Medical Board: Reporting To Medical Practice: Employment Issues Medical Practice: Groups, IPAs, MSOs Medical Records: Management Medical Records: Requests for Access Medical Records: Special Confidentiality Rules

• • • • • • • • • • • • • • •

Medical Staffs Medicare and Medi-Cal OSHA/Office Safety Outpatient Facilities/Surgicenters Peer Review Physician/Patient Relationship Professional Liability Reimbursement: From HMOs and Other Private Payers Reimbursement: From Patients Reimbursement: Other Issues Reporting Abuse/Violence Reporting Diseases, Conditions, & Events Reproductive Issues Warning Obligations Workers’ Compensation

PAGE 18 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

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(408) 282-3848 • pdelorey@colliersparrish.com   

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CA License No. 01706987

   

MEMBER BENEFIT: PROFESSIONAL LIABILITY INSURANCE

Strapped: A Look at the Financial Challenges of Practicing Medicine Reprinted by permission of NORCAL Mutual Insurance Company Since the mid-1990s, physicians’ annual incomes have declined steadily.

According to researchers at the Center for Studying Health System Change, “between 1995 and 2003, average physician net income from the practice of medicine declined about 7%.”1 Although many factors have contributed to the drop in physician incomes over the past decade, three trends in particular appear to be the primary drivers: the nationwide growth in managed care, cuts in public program payments to physicians, and the rise in practice costs brought about by the increase in medical malpractice suits.

The ever-changing health care climate is yet another factor contributing to physicians’ financial pressures.

Many physicians cite high overhead as one of their most pressing problems, particularly the prohibitive cost of hiring and maintaining a staff to manage daily operations. According to one study, 60% of physicians surveyed reported that they spend between 40% and 70% of their revenue on overhead alone.2 Add to this the fact that as the health care climate has changed, so too have consumer attitudes. The high cost of American health care has an impact on the consumer as well as the physician, leading many consumers to seek more affordable ways to access care. More and more health care consumers are seeing health care extenders (HCEs), visiting the

ER, or seeking out alternative medicine practitioners, in an attempt to minimize the drain on their own wallets. As consumers seek alternative health care options, many physicians, especially primary care doctors and other generalists, find themselves in a position where they must compete with more aggressive, better-funded providers for insured patients.

Grasping at Solutions Because more and more physicians are forced to compete for insured patients, some have begun to avoid treating low-income and/or uninsured patients altogether. Others are increasing their patients’ fees, refusing to take call in hospital EDs, or are demanding extra pay from hospitals for taking call.3 Some physicians are even declining to participate in the Medicare and Medicaid programs due to low reimbursement rates, leaving many elderly and disabled patients with limited health care options.4 Conversely, some physicians have attempted to enhance revenue by taking on greater patient loads, increasing the volume and prices of services, investing

in ancillary services, and/or marketing products directly to consumers. Though these strategies have in many cases proven to be effective revenue generators, they can also be problematic. Larger patient loads often equate to less time spent with each individual patient and can lead to patient dissatisfaction. Investing in nontraditional services can be profitable, but only if the physician or practice can afford the initial capital outlay and additional staff that is required.

Clearly, today’s physicians need a wider variety of solutions to help them deal with the financial challenges they’re facing—solutions that are less likely to jeopardize the standard of care, pose liability concerns, or put them at even greater financial risk.

Experts’ Suggested Remedies Health care researchers have proposed a number of solutions to physicians’ escalating revenue crisis, ranging from the personal to the institutional, the simple to the complex.

Many experts suggest that financially strapped physicians can begin to improve

COMPANY: NORCAL Mutual Insurance Company MCMS/SCCMA MEMBER BENEFIT: MCMS/SCCMA has partnered with NORCAL Mutual Insurance Company, premier provider of professional liability insurance for physicians, medical groups, community clinics, hospitals, and medical facilities. In 1984, NORCAL received their first “A+” rating from A.M. Best. They have maintained an “A” or better rating every single year since then. NORCAL offers a variety of FREE on-line CME courses for members of NORCAL. CONTACT: Call Jeanne Zosky at 800/652-1051.

PAGE 20 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

the bottom line by simply taking the time to write business plans and develop budgets. According to health care consultant Paul Angotti, a well-thoughtout budget can be the key to maintaining a financially sound practice. “Think of your practice’s budget as a mini business plan covering this year and next,” counsels Angotti. “This helps you establish a plan and adds a level of discipline to operations and spending.”5 Physicians may also improve practice finances by examining ways to cut basic operating costs. Experts’ suggestions include revisiting costly business contracts, addressing delinquent patient accounts, offering staff time off instead of cash bonuses, cross-training staff to perform a variety of duties, and buying in bulk rather than retail.

Endnotes 1. Tu, Ha T. and Paul B. Ginsburg.

“Losing Ground: Physician Income, 1995 – 2003.” Issue Brief, Center for Studying Health System Change.

Available at http://hschange. org/CONTENT/851/. Accessed September 20, 2006.

2. Moore, Pamela. “Finance: What’s in Your Wallet?” Physicians Practice, July 1, 2006. Available at http:// www.physicianspractice.com/ index.cfm?fuseaction=articles. details&articleID=859. Accessed August 30, 2006.

3. Health Affairs, “New Studies Show Financial Challenges Lead Physicians to Cut Back in Services and Increase Costs, Making it More Difficult for Patients to Obtain Care.” Press release, March 9, 2004.

4. Reinberg, Steven. “AMA Seeks Delay in Medicare Payment Cuts.”

Yahoo! Health, September 6, 2006.

Available at http://health.yahoo.com/ news/166301;_ylt=AqxTCNvz4s9 d6gTTZbahmXBLvs8F. Accessed September 20, 2006.

5. Angotti, Paul. “Budgeting 101.” Physicians Practice, May 2005. Available at http://www. physicianspractice.com/index. cfm?Fuse action=articles. details&articleID=658. Accessed August 30, 2006.

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.

PAGE 21 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Member Benefit: Insurance Products and Services

Insurance Products and Services Workers’ Compensation Special Discount for Association Members!

As workers’ compensation rates begin to increase, membership in MCMS/SCCMA provides savings through lower rates for workers’ compensation insurance.

• Members receive a 5% discount on their Workers’ Compensation premiums through the association-sponsored program.

• Depending on where you place your group health insurance, groups of 2-250 employees may qualify for a 15% discount.

• Check your policy renewal date and contact Marsh for a premium indication.

Medical Insurance Reduce Your Expenses!

•

•

•

5% premium discount for groups of 2-50 If you are currently insured with Blue Shield, or are considering them, MCMS/SCCMA membership can earn you a 5% premium reduction on any small group plan.

Mercer Select HRKnowHow If you play a role in your medical group’s health care and benefit plan decisions, you know that staying current on the issues is challenging, especially with today’s increasingly complex marketplace and regulatory conditions. Mercer Select HRKnowHow may be the perfect solution for you. Access is included at no charge for members who purchase group health insurance through Marsh: • Mercer Alerts provide timely news and analysis of important benefit issues.

• Compliance Link tool to assist with health care and group benefit plan administration on topics such as: Cafeteria Plans, ERISA, COBRA, FMLA, Domestic Partnership and HIPAA. • Notices and Forms Connection for the topics above to help you complete employer requirements.

Health Savings Accounts With a high deductible health plan, you can reduce premiums significantly and use the savings to contribute to a health savings account that belongs to you. Contribute up to $3,000

•

as an individual or $5,950 with family coverage. Add another $1,000 if you are between the ages of 55-64. Unused funds rollover from year to year.

Investigate RAF Sales Health plans are still very interested in growing enrollment.

They offer incentives through discounts off their rate adjustment factors (RAFs) for you to change health plans.

Instead of your medical rates increasing this year, we might be able to help you lower them.

Group Dental Program Open Enrollment for January 1 This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money: • Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers).

• During Open Enrollment only, members may join as an individual or as a group with your employees.

• Low calendar year deductible of $50 per person ($100 per calendar year maximum for families).

• Pay no deductible on oral exams, x-rays, and routine cleanings.

• A Rollover Benefit that allows for the unused portion of the maximum benefit amount from one year to roll over and be used in the following calendar year.

The open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period that ends on December 31, 2009.

Employment Practices Liability - $750 minimum premium Risk management plus Insurance Employment-related claims tend to increase during difficult economic times. Smaller employers generally do not have coverage for claims related to wrongful termination, sexual harassment and discrimination claims under their business owners, general liability, or professional liability policies. If they do, it provides limited coverage for defense costs only.

PAGE 22 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Highlights: • Limits of up to $1,000,000 available.

• Low minimum premiums start at $750.

• Coverage for defense costs and judgments.

• On-line training.

My Marsh advisor - www.marshaffinity.com New Marsh website features resources for all members on a generational basis.

Not only does My Marsh Advisor provide helpful information about the MCMS/SCCMA-sponsored insurance programs with examples of how members save everyday, it contains many other useful resources that may assist you in your every day business and personal life. Look for guidance on issues involving: Life events - such as what to consider when moving a loved one into an assisted living facility or getting married; career planning; savings and finance and buying a home; or planning for retirement.

Health Savings Account Limits for 2010: • • •

Individual coverage: federally tax-deductible contributions up to $3,050.

Family coverage: federally tax-deductible contributions up to $6,150.

Catch-up between the ages of 55-64: an additional $1,000 to the above amounts.

COMPANY: Marsh serves as the insurance advisor for members of the Monterey County Medical Society, the Santa Clara County Medical Association and the California Medical Association. They design, develop, and implement insurance plans available only to members – with discounted pricing, enhanced coverage, or both. They assist members and their office managers by providing information, programs, and guidance to assist with insurance buying decisions.

MCMS-SCCMA-CMA MEMBER BENEFIT: MCMS-SCCMA-CMA has partnered with Marsh to provide members with discounts or enhanced coverages on a comprehensive portfolio of insurance products and services.

CONTACT: Call 1-800/842-3761

We are Wealth Advisors and Financial Planners to high net worth individuals, families and institutions. By Managing Wealth by Design™, we create a unique financial plan for each client, addressing their retirement, estate and investment planning needs.

LWA is proud to announce Edwin K.S. Ryu’s has been again named to the Medical Economics list of The Top 150 Best Financial Advisors for Doctors.

(September 2009 Issue, www.memag.com)

The LWA team includes Lisa Goss, CFP as a specialist in financial planning and portfolio administration.

PAGE 23 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Member Benefit: REIMBURSEMENT ADVOCACY PROGRAM

Reimbursement Advocacy Program For coding questions and reimbursement issues, contact Sandie at 408/998-8850 or MCMS 831/455-1008 or email sandie@sccma.org. Also, contact Sandie if you would like to receive the Economic Advocacy newsletter by email.

Reimbursement Advocacy Program (RAP) is a benefit available only to members of the Monterey County Medical Society and Santa Clara County Medical Association. Through RAP, association members gain leverage in collecting payments from managed care plans (and other payers) slow in honoring claims.

The RAP program also provides physicians, their office managers, and/or billing staff with coding and billing guidance.

Contact RAP for Assistance With: Carrier Failure to Process “Clean Claims” in Accordance With State Law (30 days for PPO plans and 45 days for HMOs) • Habitual Downcoding • Treatment Authorization and Subsequent Denial • Payment Inconsistent With the Physician’s Contract and CPT Guidelines • Coding Guidance

Follow These Steps To Expedite In-Office Collection: Step #1: Collect Accurate Data Remember—collection of accurate data is vital to your practice.

Verify the information below at every patient encounter: • • •

HMO or IPA affiliation Name of insurance company Name of Primary Care Physician (PCP)—with some plans this information can change monthly

• • • •

Patient’s home address. Do not accept a P.O. Box, in lieu of a home address Patient’s phone number Address and phone number of patient’s current employer If the patient visit requires a referral from a PCP, secure the referral number prior to the patient visit

Step #2: Discuss Fees and Billing Procedures With Your Patients It is very important to inform new patients about billing policies, when they call for an appointment. Place a sign at the check-in area advising patients that co-pays and deductibles are due at the time of service. Also, incorporate these policies in your patient registration form. Collect any applicable co-pays and/or unmet deductibles at patient checkout. Strict adherence to the foregoing will eliminate the additional expense of follow-up billing.

Consistent observance of the “pay at time of service” policy not only reduces overhead, but reinforces the custom with patients, resulting in their readiness to pay prior to leaving the office.

Step #3: Electronic Billing Claims should be filed electronically, whenever possible. This practice will significantly expedite payments and save resources, i.e. staff time, supplies, postage. In order to ensure timely reimbursement, whether billing electronically or via submission of paper claims, it is imperative that claims are “clean” and accurate, i.e. employ proper use of CPT procedure codes, modifiers, and ICD-9 diagnosis codes. The

availability of up-to-date coding manuals, familiarity with current coding literature, augmented with attendance at billingrelated seminars, are essential tools for precise billing.

Step #4: Obtain “Physician Claims Inquiry” Forms From MCMS/ SCCMA These bright green forms, identified with the MCMS/SCCMA logo, garner excellent results when affixed to claims that seem to be “hung-up” in the system. Attach this attention-getting form to a copy of the original claim(s) and resubmit to the carrier—30 days after the first submission for PPOs and 45 days for HMOs. Step #5: Request Help From MCMS/ SCCMA RAP After 30-45 days, if there is no response to the “Physician Claims Inquiry,” complete and sign an RAP form, and attach a copy of the claim, the patient’s insurance card, along with any related correspondence, and mail to: Monterey County Medical Society or Santa Clara County Medical Association 700 Empey Way San Jose, CA 95128 To request “Claims Inquiry” & “Reimbursement Advocacy” forms, Please contact one of the following: Fax 408/289-1064 Call 408/998-8850 Ext. 3007 Web www.sccma.org or www.montereymedicine.com Mail See above address

PAGE 24 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Member Benefit: Medical Billing, Collections, & Office Management Services

Do It Yourself or Seek Help With Your Collections and Billing

By Mark Christiansen, BME General Manager

More Patient Accounts Are Going Delinquent Uncompensated care, which is made up of charity care and unpaid patient bills, cost U.S. hospitals $34 billion in 2007, according to the American Hospital Association. In addition, in 2007, 41% of working-age adults had trouble paying medical bills or medical debt, up from 34% in 2005, according to a Commonwealth Fund Biennial Health Insurance Survey.

The volume of delinquent health care debt has undoubtedly increased in the last few years. When it comes to the number of patients that are either unable or unwilling to pay their medical bills, the pond has grown larger, and in terms of patient ability to pay, the pond has also grown shallower.

Cost Cutting by Doing It Yourself In these trying economic times, many providers are tempted to take on the jobs of collections and billing in-house, rather than “pay” someone else. Cost cutting is something all of us are doing.

As the attorney for the Bureau of Medical Economics (BME), physicians often ask what steps they can take to file suit in small claims court. Whether suing a patient for services rendered or suing for proper compensation from an HMO involving a balance billing issue, I believe time is better spent by our members creating wealth in the venue for which they trained.

Physicians are completely capable of successfully prosecuting their cases in small claims court. That is not the issue, but rather whether it is a good use of a physician’s time and resources. Aside from spending a morning or afternoon in court, once a judgment is rendered in favor of the physician, the judgment must then be enforced in order to collect monies owed and requires additional uncompensated time by the physician or his or her staff.

The results are not always an indicator of success. Only 30% of health care accounts yield 90% of cash collections.

Why Pay a Billing Company?

When it comes to billing, many are turning to practice management systems as the “cure all” for their billing needs. These systems are definitely useful, especially if set up and monitored by a competent biller who is also a certified medical coder (CMC). These systems do not replace the expertise of a qualified medical biller, preferably one that is also a CMC. According to a Standard and Poor’s Industry Survey dated March 27, 2008, of Hospital Net Revenue Collected,

a little over 90% came from insurance, 50% to 60% was recovered after insurance, and only 8% to 10% was recovered from the uninsured. These figures emphasize the importance of a qualified medical biller, who understands the ins and outs of the insurance industry, to identify issues in order to properly bill and appeal your claims for full reimbursement.

How Do I Choose a Collection Agency?

Physicians should look for a collection agency that has training and experience in medical collections. Health care debt is a type of debt people don’t choose to incur. A good collection agency should be able to empathize with the patients. It should be friendly and firm, but not a “friend” to the patient. After all, recovery for the physician is the goal. BME has been in the collections business for over 60 years and specializes in medical collections.

No physician should ever pay for services prior to results. Fees should only be charged after monies have been collected. Most collection agencies Continued on page 39

COMPANY: Bureau of Medical Economics (BME) MCMS/SCCMA MEMBER BENEFIT: An affiliate of SCCMA, BME has a recovery rate approximately twice the national average. Members receive a 5% discount off the basic rate for collections. (Rate based on volume—you only pay if they collect.) The billing rate is based on provider productivity.

CONTACT: For billing information, contact Yolonda Rubio, CMC at 408/9985811 Ext. 3002. For Collections, contact Karen Jorgenson at 408/998-5811 Ext. 3034.

PAGE 25 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER BENEFIT: TPO HUMAN RESOURCE MANAGEMENT

Who we are: TPO is an award-winning HR Consulting Firm serving primarily the Bay Area. Typical services include general HR consulting, employee handbook development, neutral third-party investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices.

How we work with SCCMA and MCMS Members: Over the past 15 years, TPO has provided HR support to SCCMA as well as the members of SCCMA and MCMS. TPO has facilitated numerous HR training programs for members to attend and has provided many articles throughout the years. SCCMA and MCMS members receive a free initial consulting call and then 10% off the initial work with TPO.

SCCMA/MCMS Members receive a FREE initial telephone consulting call (up to 15 minutes) with a qualified HR Consultant.

Examples of Common Consulting Calls: “An employee just told me she is pregnant and gets 7 months off…is that right?”

“I have an employee with poor performance…how do we get him ‘on-board?’”

“I want to terminate an employee, but am not sure if we can…help!”

“An employee is demanding back overtime pay…we paid him a salary to avoid this!”

-Contact Melissa Irwin, Sr. Consultant: 831/688-4196 or melissai@tpohr.comTwo Common Questions Medical Practice Management Ask:

Q: In light of the holidays that are just around the corner, what are my obligations as an employer?

A: There are two important points to remember: 1. Private employers are not required to be closed on holidays, nor are they required to provide premium pay to employees in non-exempt positions when employees work on holidays. The typical number of holidays provided ranges from 6-10 days.

2. Overtime is based on actual hours worked, therefore, hours paid as holiday pay where the employee was not working are not considered when calculating hours worked.

When determining holiday policies, TPO works with each client to help them consider a number of issues, including the following:

•

Will your business close on certain holidays or remain open?

•

Who is eligible for holiday pay? Only 40+ hours per week employees? Or, is it prorated to part-time workers? What about introductory status (typically those working less than 90 days) employees?

•

When an employee works on a holiday, what will the premium rate in addition to their regular rate be? None? A total of 1.5 times the regular rate? A total of 2.0 times the regular rate? Other?

•

When an employee is not working on a holiday, will the employee receive holiday pay? Will it be a flat amount? An average daily amount? The number of hours otherwise worked on that day?

•

Does it make sense to eliminate “holiday pay” and instead put extra days into vacation or Paid Time Off (PTO) that can then be “cashed-out” to receive extra compensation on a “holiday” of the employee’s own choosing? This is an especially important question if an employer provides “floating holidays,” since they may be considered the same as vacation by the State of California, which will be discussed in our next tip.

Remember that employees in exempt positions do not get holiday premium pay, rather, their salary continues uninterrupted on that day. An exempt employee who works on a holiday might be allowed to take another day off, if the employer chooses.

PAGE 26 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Welcome MCMS members!

With TPO’s main office in Monterey, we look forward to providing HR information to you!

Q: I know that in California, vacation is a vested benefit that must be paid upon separation of employment, but I am confused about PTO, floating holidays, and personal days: are these vested, too?

A: In California, when employers allow employees to take days off with pay and the employee can choose when and/or why they want to take that time off, the days off are an earned (vested) benefit and the accrued portion must be paid out upon separation of employment (vacation and paid time off (PTO) are the classic examples).

When employers require the paid time off to be taken for a specific reason and/or day, that time is not an earned (vested) benefit and, therefore, it need not be paid out upon separation of employment (sick leave and holidays are the classic examples).

How the company defines “floating holidays” and “personal days” will determine if such time is “vested” and if it must be paid upon separation of employment. √

Example 1 – Personal Days: Employees at XYZ Company each calendar year are given three “personal days” to take whenever they want in the year. On October 31, employment separates and the employee had not used any of the three days. In this situation, the final paycheck must include 2.5 days of the accrued, but unused floating holidays (10/12 of 3 days).

√

Example 2 – Birthday: Employees at ABC Company are given their birthday off with pay each calendar year (if the birthday falls on a day usually not worked, the employee can take the usual day worked before/after off). An employee whose birthday is December 10 separates employment on October 31. In this situation, the final paycheck does not need to include a prorated portion of the birthday day off.

√

Example 3 – Floating Holidays: Each calendar year, employees at LMN Company are given a sheet listing the dates of 12 holidays and employees are allowed to take any eight of the 12 off. On October 31, employment separates and the employee had not used all of the eight days. In this situation, the final paycheck does not need to include a prorated portion of the floating holidays not taken.

What “Vested” Means: Time that is “vested” has been earned by the employees and cannot be taken away.

However, you may institute a “reasonable cap” in compliance with California law. Such a cap is typically 1.5 – 2.0 times the current accrual rate. Once employees reach the cap, they do not earn any more time until they take time and reduce the bank below the cap. This is the most common option. Remember that the bank of time (up to the cap) must be paid out upon separation of employment.

TO DO: Make sure that your actual practices match your written policies! In today’s economic climate, many employers want to take a look at their benefit policies to make sure they are appropriate for today’s medical practice.

Use your “free consulting call” for being an SCCMA and MCMS member and contact TPO at: 831/647-7292. www.tpohr.com

2009

TPO – This information is designed to be accurate in content. TPO provides human resources support services and is not engaged in rendering legal, accounting, or other professional services. Readers are advised to consult legal counsel on matters involving employment law or important personnel policies and practices before adoption or implementation.

PAGE 27 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER BENEFIT: FINANCIAL PLANNING

Legacy Wealth Advisors Questions and Answers Is the current economic crisis over and the worst behind us?

the S&P from 1997 through June 2009, and as you can see, the index is back to late 1997 levels.

This has been the most popular question and of course, the most difficult to answer!

Back in early March investors and analysts were actively debating whether the US would fall into another Great Depression.

The financial system was seizing up, few had faith in our policy makers, and the markets continued to spiral lower. However, beginning in mid-March it became apparent that the authorities had the tools (and were willing to use them) to prevent a repeat of the Depression and the panic began to ebb. We came perilously close to a systemic breakdown.

Based on the opinions of economists and financial market analysts who we respect economic activity and credit conditions appear to be stabilizing, and even the national housing markets show some signs of bottoming.1 This is not to say that it is easy sailing from here on out. There are huge issues such as inflation/ deflation, fiscal policy against a backdrop of a $12 trillion national debt, deleveraging and more that remain unresolved.

At least historically, most decades in the U.S. have shown positive overall returns for stocks. Obviously, equities did very well during the decades of the 1980s and 1990s, but even during the turbulent 1970s, the S&P grew at an annualized 5.9% per year.

One has to go back to the Great Depression era of the 1930s to find another decade where stocks lost ground over the entire period.

During the 1930s, stocks lost an annualized 0.1% per year.

Nouriel Roubini, Professor of Economics of NYU, and an economist who correctly anticipated the Crash of 20072009, suggests that we may experience a “W” style or double-dip recession where we get to 2010 and then potentially undergo a second down-leg before getting back onto the road to recovery.2 Other analysts like Nobel Prize winner Paul Krugman think we are in for a long period of anemic growth, perhaps like Japan in the 1990’s.3 And then there are some highly pessimistic writers like Martin Weiss who suggest we are on the verge of a Second Great Depression. No matter what, this economic downturn is unlike any other we have experienced. Its advent was much quicker and the decline much deeper than anything we have seen before, so we need to be circumspect as to what shape the recovery will take this time.

We probably shouldn’t lose sight of the fact that even though the S&P hasn’t generated returns during this decade, other areas of the markets have performed reasonably well. The table below illustrates this point:

What is the “Lost Decade” financial writers refer to?

* Goldman Sachs Natural Resources ** Goldman Sachs Commodity Index

Some are referring to Japan during the 1990s; most are referring to the fact that the stock market in the United States lost money during the period between January 2000 and June 2009. On an annualized basis, the S&P 500 lost 3.2% per year over this entire period. The chart below illustrates this point quite clearly. It shows

Almost always the media focuses on the main domestic indexes with little coverage of the overseas or alternative asset classes. So, from the perspective of an investor in only S&P 500 index funds this has certainly been a lost decade. However, for those

Asset Class Returns – 1/1/2000 to 6/30/09 Index

Annualized Returns

S&P 500

-3.2%

Vanguard Emerging Mkts Index

+7.3%

Natural Resource Stocks*

+7.2%

Vanguard Intermediate Bond Index

+6.6%

Vanguard REIT Index

+6.4%

Commodities**

+4.6%

PAGE 28 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

invested in bonds, alternative assets, and other equity asset classes this decade has been far from a disaster.

What will the economic picture in the U.S. look like going forward?

Anyone attempting to answer this question must first acknowledge that we live in a highly uncertain global environment.

Certainly, the financial and economic crisis of the last couple years has highlighted a number of flaws in the U.S. and global economic structure that can help with predicting the future, but given the number of moving parts, any economic and market view must remain flexible. As we noted earlier, the second half of 2009 will show modest economic growth in the developed world, due in part to the massive fiscal and monetary stimulus of the last several months. However, by past standards, the recovery in the U.S. and the rest of the developed world will be subdued as unemployment rates are likely to stay unusually high for quite some time. This will continue to pressure wages and consumer spending just as consumers are being pressured to rebuild their savings.

Looking beyond the next 6-12 months, the developed world appears to be headed for a roller-coaster economic and financial environment that looks nothing like the last decade. A normal economy, as we used to know it, requires easily-available credit and, on the other side, a willingness of consumers and businesses to borrow. This decade’s boom was characterized by a massive credit overshoot, fueled by optimistic assumptions on the part of both borrowers and lenders. The pendulum has now swung the other way and the credit environment, the need to reduce debt, and almost certainly higher taxes will represent structural headwinds for the next several years. This doesn’t preclude a cyclical recovery over the next year, but it adds huge uncertainty to the magnitude and durability of any longer-term recovery.

We wouldn’t be shocked to see the continuation of what is called a Secular Bear Market in the U.S. and Europe. Looking back at history, there have been relatively long periods where equity COMPANY: Legacy Wealth Advisors, LLC SCCMA MEMBER BENEFIT: Legacy Wealth Advisors, LLC has been managing SCCMA’s and BME’s reserve investment accounts since 2000. Legacy, along with its predecessor organizations, has been endorsed for financial planning by the SCCMA since 1986. They provide financial planning, retirement planning, professional money management, and more.

They will be hosting a symposium (no cost to members) on tactical versus buy & hold investment strategies on Wednesday, October 7, 2009 at the Double Tree Hotel in San Jose from 6:30 PM-8:30 PM. Members also receive a one-hour complimentary consultation (over a $300-dollar savings).

CONTACT: Call Lisa Goss at 408/452-7700.

markets have trended sideways for long periods of time. The decade of the 1930s is one example, as is the period of 1966 to 1982, as you can see below.

What are some financial planning implications following the Crash of 2007-2009?

On a national level, this has been a sobering, thoughtprovoking experience with some lessons to take to heart.

In the years leading up to the 2007-2009 recession, many people found themselves adopting a get-rich-quick mentality, where homes were appreciating rapidly and jobs and income were plentiful. Many people leveraged themselves with abandon, used their homes and credit cards like ATM machines, and bought things they really couldn’t afford. Our national savings rate got close to zero, when the bubble burst.

However unpopular the message may be, now the mantra needs to be: consume a little less and set aside a little more for the retirement nest egg and other needs, including education funding and wants, such as charitable giving. In our opinion, what used to be viewed as enough to retire on, unfortunately, may not be sufficient. Thanks to continued advances in medicine, we’re living longer and our children and grandchildren will be living longer.

The downside is that our wealth has to last longer, as well. In the meanwhile, expenses will continue to go up, not down. Two of our primary national security blankets, Social Security and Medicare, are grossly underfunded. According to the Economist, the unfunded liabilities for these two systems total nearly $480,000 per household.4 Retirement planning projections that we run on behalf of clients are increasingly minimizing the likelihood of receiving full, inflation-adjusted benefits. These projected benefits will have to be pared back, as our national debt continues to spiral out of control. And on the tax front, the outlook is equally daunting, as we witness local sales taxes reaching 10% and federal and state income taxes heading towards 50% for top bracket earners.

The major lesson from this experience is that we should return to the basics and go forward with the credo that we need to

PAGE 29 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Legacy, continued from page 29 save more and spend less. Inflation wreaks havoc on fixed budgets and, whether we like it or not, we will all reach the age where that is the case. All of the federal deficits we are running will ultimately exact a dear price. Feathering the nest egg needs to be a top priority and that may include planning to work a few extra years.

What are some of the lessons, investment-wise, from the 2007-2009 Bear Market?

What we experienced in October 2007 through March 2009, when the key benchmark S&P 500 fell nearly 57%, was unprecedented in so many ways.5 Balanced, diversified portfolios that were supposed to benefit from having low-correlating assets still went down in value. Historically, when stocks went down, bonds went up to some degree; when domestic stocks have gone down, internationals have gone up, etc. Outside of a few asset classes such as Treasuries and cash, most assets went straight down during this market correction. It was only an issue of how much, not if they went down in value, as there were few places to hide in the “perfect investment storm” of our lifetimes.

However, for those who held on through the recent rally, balanced, diversified portfolios, they weathered things fairly well.

And even those who couldn’t stomach it anymore because of their specific risk tolerance and lightened-up equity positions still came through the crisis. Also, if our outlook for a continuation of the Secular Bear Market is correct, investors should continue to add some tactical or active strategies to supplement core buy-and-hold portfolios. Even during flat markets there are asset classes that prosper, as the period from January 2000 to June 2009 can attest.

Complementing a buy-and-hold approach with other asset classes (bonds, high-yield, commodities, real estate, etc.) will lead to a much more diversified portfolio and one that can prosper over the coming decade.

Last of all, the addition of satellite strategies, including the selective addition of proven third-party tactical managers who avoided the ravages of the 2007-2009 and 2000-2002 bear markets and performed well during market upswings, should be considered.

References 1.

2.

3.

4.

5.

S&P/Case-Shiller Index, April 2009 Financial Times, August 23, 2009 Return of Depression Economics,Krugman The Economist, June 13, 2009 www2.standardandpoors.com

Note: This Q & A resulted from recent interviews with Medical Economics, Goldline Research, and other organizations. Thanks to Gemmer Asset Management with providing some key data.

PAGE 30 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MICRA: 65,389 REASONS WHY DR. JOHN IS A MEMBER Since 1975, the Medical Injury Compensation Reform Act (MICRA) has been California’s model professional liability law. MICRA works by compensatng injured patients and keeping our premiums stable. Every year, the trial attorneys try to undo MICRA. Every year CMA and its county medical socieities protects MICRA.

2009 MICRA SAVINGS CHART Specialty

Allergy

Monterey / Santa Clara

Dade County, FL

Long Island New York

Wayne County, MI

FL-NY-MI Average

MICRA Savings

$3,283

$20,963

$9,265

$16,909

$15,712

$12,429

Anesthesiology

$8,641

$48,913

$32,223

$41,697

$40,944

$32,303

Cardiology (Invasive)

$9,857

$96,079

$40,738

$66,711

$67,843

$57,986

Cardiovascular Surgery

$24,899

$174,690

$100,550

$174,918

$150,053

$125,154

Dermatology (Lipo/Cosmetic)

$23,031

$55,027

$31,472

$23,797

$36,765

$13,734

Emergency Medicine

$14,163

$96,079

$48,737

$87,121

$77,312

$63,149

Family Practice (Non-Surgical)

$8,284

$45,419

$22,948

$33,893

$34,087

$25,803

General Surgery

$23,031

$202,640

$150,824

$143,445

$165,636

$142,605

Internal Medicine (Non-Invasive)

$6,869

$50,660

$31,472

$34,350

$38,827

$31,958

Neurosurgery

$42,902

$251,554

$275,289

$201,512

$242,785

$199,883

OB/GYN

$30,463

$202,640

$167,812

$135,935

$168,796

$138,333

Ophthalmology (LASIK/Cosmetic)

$6,869

$50,660

$31,179

$37,955

$39,931

$33,062

Orthopaedics

$23,031

$148,486

$125,004

$144,667

$139,386

$116,355

Otolaryngology (Cosmetic)

$23,031

$61,141

$97,378

$81,556

$80,025

$56,994

Pathology

$4,781

$45,419

$22,311

$19,524

$29,085

$24,304

Pediatrics (Non-Surgical)

$6,869

$31,444

$22,948

$28,928

$27,773

$20,904

Plastic Surgery

$23,031

$96,079

$97,378

$91,565

$95,007

$71,976

Proctology

$23,031

$69,876

$55,005

$53,751

$59,544

$36,513

Psychiatry (Non-Shock)

$4,781

$24,457

$9,264

$17,853

$17,191

$12,410

Radiology (Non-Invasive)

$6,869

$96,079

$50,496

$45,293

$63,956

$57,087

Thoracic Surgery

$24,899

$174,690

$100,500

$154,089

$143,093

$118,194

Urology

$9,857

$61,141

$55,005

$55,655

$57,267

$47,410

Average - All Specialties

$16,021

$95,643

$71,718

$76,869

$81,410

$65,389

* This is not a weighted average.

Note: Comparison reflects mature annual premium costs for $1 million maximum per case/$3 million maximum for all cases in a given year.

Wayne County, MI rates are for $1 million/$4 million, coverage levels typically made available at no extra charge to the Michigan policyholders of American Physicians Assurance Corporation.

Sources: NORCAL Mutual Insurance Co. (San Francisco, CA) effective 1/1/2009; First Professionals Insurance Company (Dade County, FLeffective 3/1/2009-2/28/2010- includes both FIGA assessments totaling 3.61%); American Physicians Assurance Corporation (Wayne County, MI) - Rates effective January 1, 2009; Medical Liability Mutual Insurance Company (Long Island, NY) - policy year ends June 30, 2009.

PAGE 31 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Monterey / Santa Clara physicians are saving an average of $65,389 this year.

Are you a member?

MEMBER BENEFIT: DOCUMENT MANAGEMENT SERVICES

Bridging to the Eventual EHR In the May/June issue of The Bulletin, the article, “Electronic Health Record Buyers Beware” by Stephen H. Carson, MD, described current pitfalls to avoid and challenges to face with the purchase and installation of an EHR system. The following points should help physicians become familiar with what to embrace and what to shun when taking steps to automate records and improve work flow prior to taking the EHR plunge.

•

Develop a written retention schedule of records that meets the needs of patients and other legitimate users and complies with legal and regulatory requirements. The schedule should identify what information should be kept and for how long, and in what form (paper, optical disk, microfilm, data repository, etc.). When the

schedule calls for destruction, those records must be documented by date, method of destruction, description of the disposed records, a statement that records were destroyed in the normal course of business, and a certificate of destruction.

•

•

•

Except in certain circumstances, keep in mind the goal is to eventually migrate patient records to the EHR. Activity is the acid test. It need not be done at once, so begin with a section at a time. All or part of the process can be done in-house or outsourced. When doing the work in-house, factor in the cost of equipment and its maintenance, the cost of employee time, and completion date scheduled.

If outsourcing all or part of the conversion process, cost-savings can be achieved by having your office staff do document preparation such as staple removal, repair of torn edges, un-pronging sheets, etc. Staff can even perform the scanning itself, outsourcing to the records management vendor only the important detail of indexing. If using an outside records management company to do some or all of the process, records that are off-site at the center should be easily retrieved, as necessary.

scan. Here’s how: at a typical cost range between $0.06 and $0.13 per image to prep and scan a page – and a page printed on both sides equals two images – scanning records that are seldom, if ever, accessed can quickly eat into the operations budget. Heavily detailed indexing can drive costs even higher.

•

When total divestiture of business obligations is sought due to retirement or the sale of a practice, and after records which can be destroyed are no longer a part of the picture, scanning inactive files is something to consider.

Chances are that the physician buying the practice will find it more attractive to log onto than to wade through mounds of paper files. Other reasons to consider scanning old charts are if they are used for longitudinal studies or necessary in litigation.

•

Determine how the online chart is to be organized. The granularity of electronic chart organization can be as detailed as paper-based charts with sections for lab reports, notes, billing information, RX, and such. This is where work flow considerations come into play, since more than one set of eyes can be on a chart at any time.

•

Choose the electronic option.

Decide if the office will benefit best from charts scanned to CD, DVD, hard disk drive, FTP site, or to an outsourced secure data center. Will the scanned records be uploaded to the office share drive or kept solely on media? Will both billing and clinical

Scanning years and years of inactive records is more costly than storing paper. The same 40 patient charts in a standard storage box housed at a record center for under $5.00 a year could cost fifty times that amount to

PAGE 32 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

staff benefit from simultaneous access to the records? The electronic solution should integrate well with users’ current work styles and require the shortest learning curve. Whichever deliverable option is chosen, the importance of user friendliness is second only to information security.

•

•

A security checklist for CDs, DVDs, and hard disk drives is short: make sure the disk is encrypted and requires strong password login. Once the information is downloaded to the office system, however, data must be protected via internal controls. If charts are to be uploaded to an FTP site, the conversion vendor should use Secure Sockets Layer (SSL) 256-bit encryption to transmit via the internet.

Providing for redundancy is part of making sure that records are secure.

Backup media needs to be securely

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

stored off-site. If archiving to a thirdparty data center fits best with your practice’s business model, make sure the vendor manages its own security infrastructure elements, such as firewalls and system management which involve daily security validation.

Records archived to a data center are only as secure as the viewer used to display the images. Not all data viewers are created equal, so make sure the data center’s viewer is HIPAA compliant.

•

An ideal data repository archival option requires no user licenses and

offers a low monthly cost for stored images. Migration of records from the data center to the chosen EHR system is a cooperative effort between the data center’s IT team and the EHR vendor.

There are hurtles to clear before installing an EHR and solutions to bridge the gap between now and then. The takeaway from all this is that until your fully integrated and interoperable EHR goes live, take time to examine your current records management processes and make the basic decisions that pave the way to an EHR. Then begin a conversion program that improves work flow and pay as you go.

COMPANY: SOURCECORP Deliverex MEMBER BENEFIT: SOURCECORP Deliverex has provided comprehensive document management services to the health care industry since 1973, including medical record imaging and electronic record conversion services for over 13 years.

CONTACT: Judy Chandler, CDIA+, at 800/957-5051 x 137

Hospice of the Valley Celebrating 30 Years of Community Service When your patients are coping with advanced illness, they require expert care, compassion and personal attention. Whether it is spending time with loved ones, fulfilling dreams, or simply remaining comfortable and independent for as long as possible, Hospice of the Valley guides patients and their families to meet their goals.

• For those dealing with grief and loss, our Community • The hallmark of hospice care is that it serves Grief and Counseling Center provides families and your patient wherever they live—be it in their home, individuals with one-on-one counseling and lossnursing home, hospital or assisted living facility specific support groups to adults, teens and children • Our interdisciplinary team members consist of • Since 1979, Hospice of the Valley’s legacy physicians, nurses, social workers, chaplains, of compassionate care, community hospice aides, volunteers, and grief counselors education, advocacy and outreach who are experts in palliative and hospice care, has set the standard for quality and who are here to assist you in the Wingate, RN hospice care state-wide and management of your patient’s nationally, and we are a locally end-of-life care needs based, run, and supported non-profit organization Margarita Vizcaya, hospice aide

For more information please contact us.

Monique Kuo, MD, medical director

4850 Union Avenue, San Jose, CA 95124 408.559.5600 l hospicevalley.org

PAGE 33 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER BENEFIT: PRACTICE PLANNING & CONSULTING

TIME TO EXPLORE OPTIONS IN YOUR PRACTICE’S BANKING AND CHECK PROCESSING ACTIVITIES Reprinted with the permission of Conomikes. Contact conomikes@conomikes.com or 800/421-6512.

There are ways to save time and money with new services.

Many practices, after having all mailed-in checks recorded, and checks from that day’s scheduled patients, produce a bank deposit slip; effectively closing the day’s banking needs.

What happens at this point can vary: at some practices a key employee or manager takes either that day’s, or the prior day’s, deposit to the bank; some do it at the bank’s night depository on their way home from work. Add to this, dealing with checks presented by your patients, at the time of their office visits.

As a prelude to doing the daily deposit, most practices have received mailed-in checks from plans, Medi­care and Medicaid, Workers Comp, etc. This requires the daily tedium of opening the mail, sorting out the checks, endorsing the backs of the checks to the practice, and the preparation of the deposit slip – often preceded by someone making copies of all the checks.

Practices should be exploring ways to reduce all the effort just explained.

What follows are options that, singly, and in combination, could reduce your labor costs, your potential error factors, and the temptations of embezzlement by one of your staff.

Here are the options: • Direct deposit by plans • Lock-box service • Remote Deposit • Courier service A. Direct Deposit by Plans All practices should have Direct Deposit of payments from as many plans as possible. Medicare carri­ers were the first to offer this ser­vice a number of years past.

More recently the major plans, and a great

number of the smaller plans, are offering this service. Basically, you authorize the plan to make a direct deposit of their payments to your bank—instead of mailing you a check, with back-up documenta­t ion.

With Direct Deposit you still receive, via Internet, documenta­t ion to back up the deposit.

Advantages to your practice: • Im mediate deposit of funds to your account • Less mail to open, less work for your daily deposit slip • Security. No staff member can embezzle these high-ticket checks.

Lock-Box Service This is an option for receiving your payments securely.

A number of practices use a lockbox service and find it convenient, especially for group practices with a lot of checks coming in on a daily basis. They also like the fact that incoming checks no longer provide a temptation for embezzlement at the practice: instead, checks go to the bank lock-box.

Here are some highlights. Most banks provide lock-box services, so you want to talk with your bank representative about this service. The way it works is that the bank provides you with a P.O. Box at your local post office. Your pay­ers—patients and plans—send their payments to the P.O. Box, instead of your office. Your bank accesses your P.O. Box at least daily and retrieves all the checks and attach­ments (EOBs and Remittance Advices) that are addressed to your practice.

The bank processes the checks and provides you with copies of all the documents related to the mailing. In other words, they: (1) replace the work of opening any mail that has your checks and

documents; (2) they copy all documents and send them along to you, along with a receipt for your day’s deposits; and (3) they deposit all the checks to your account.

Obviously the banks are bonded and do this for thousands of clients throughout the U.S. Advantages to your practice • Less clerical work of opening all mailed in checks and segre­gating the paperwork.

• Less work creating the daily deposit slip for mailed-in trans­actions • Immediate credit of your checks that day to your account Costs The following are estimates and will vary from bank to bank: • Monthly fee—can range from $150– $250 • Transaction fees—30–40 cents per item • Copying fee—10 cents per item.

There is a new trend with banks. They will create an image file of your documents so that this data can be transmitted to you electroni­cally. This should reduce the costs somewhat.

Guidelines: Based on the costs charged for a lock-box service, it is probably not economical for the smaller practice that is processing less than 1,000 checks per month. But, when doing your cost analysis, ask your bank to provide you with copies of recent statements to lock-box clients based upon your pre­dicted volume of checks.

Then, you also need to determine if some jobs will have to be redesigned. Those individuals currently involved in opening mail and preparing depos­its will now have the opportunity to perform other tasks. The manager’s job is to determine if the time saved can be put to other productive uses.

PAGE 34 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

C. Remotepassed DepositCongress and was quickly signed into by the President.

Checklaw 21 legislation, creating Remote Deposit services, resulted from the

Simply stated, the law requires 9-11 attacks, forced the temporary banks to which accept image replaceshut down of airline paper ment checks inflights. lieu Since of the origicheckscheck travel theissued airways en nal byroute theto the maker for payment.

This means thatvul­ any drawee bank, the attacks exposed this business, able to create an image nerability in our payments system. As a of an original check, can submit result Check 21 legislation quickly passed check images to its bank, instead Congress and was signed intothe law by the of having to deposit original President. themselves. This allowed checks banks, which were the willing to invest Simply stated, law requires in image technology, the ability banks to accept image replace­ment checks to do so—because all banks were now in lieu of thetoorigi­ nal check issuedabypicture the required accept at least maker for payment.

This means that any of the check printed on paper from business, able to create an image of an an electronic image.

two processing happens,There the are checks are no options longer with any bank’s Remote Deposit. a legal instrument, but now become electronic ACH payments andas fall 1. The checks are processed under the rules for ACH, which are digitized images of checks. 2. The second different than for checks. Also, with option is to convert the checks Automatic this option, certain typestoof checks Clearingbe House (ACH) payments. cannot converted: Postal Once Money this happens, the checks are no longer a Orders, Government checks, certain business checks, and thirdelectronic party legal instrument, but now become checks like those ACH payments and fallfrom under credit the rulescard for accounts. In any case, the choice is ACH, which are different than for checks. yours.

Also, with this option, certain types of PostalDeposit, Money Ifchecks you cannot decidebetoconverted: do Remote you would want tochecks, keep copies Orders, Government certain of the originals, at your practice, for a few business checks, and third party checks days, until you receive your like those from credit card accounts. Inbank any report verifying their deposit. case, the choice is yours.

original check, can submit check images to

Larger banksofwith stake its bank, instead havinga tohuge deposit the in the check clearing business quickly original checks themselves. This allowed saw the cost advantages of moving banks, which were willing to invest in image checks electronically rather than technology, the ability to do so—because all paying couriers and airlines to cart banks were now required to accept at least a paper to and fro across the country.

Soon large exchangpicturethe of the checkbanks printedwere on paper from ing checksimage. with one another elecan electronic tronically and more and more banks Larger banks a huge stake began to move to with electronic image in the check clearing processing both business to savequickly money as well preserve stakechecks in the saw theascost advantagestheir of moving clearing system.

As more and more electronically rather than paying couriers banks become image capable and airlines to cart paper to and fro acrossfor receiving as well as sending images, the country. the large banks were fewer andSoon fewer checks must be exchang­ing with one another elec­ printed forchecks clearing. tronically and more and more banks began Remote is theprocessing service both now to move to Deposit electronic image being offered by many banks.

This to save money as well as preserve their stake is a new andsystem. unique of making in the clearing As way more and more check deposits to your account at banks bank. becomeNo image capablewill for receiving your longer you need as well as sending images, fewer to make trips to the bankand tofewer make checks must be printed for clearing. your check deposits.

Remote Deposit is the service now

Here’s how it works. At your office, offered by many banks. This is a new abeing scanner is attached to your PC. and unique way of making to Checks are fed intocheck thedeposits scanner your account at your bank.

No longerimage will which captures a digitized of and youthe needcheck. to makeUpon trips to completion the bank to make balancing, you click on “transmit” your check deposits. and your deposit is made. Deposits works. your with can be Here’s madehow up itto 7:00At p.m. office, a scanner to your PC. on virtually nextis attached day availability Checks are fed into the scanner which the deposited funds. captures a digitized image of the check.

There are twoandprocessing Upon completion balancing, youoptions click with any bank’s Remote Deposit. on “transmit” and your deposit is made.

1. The checks are processed as Deposits can be made up of to 7:00 p.m. digitized images checks.

2. with virtually next day availability the The second option is to on convert the checks deposited funds.to Automatic Clearing House (ACH) payments. Once this

If you A decide to do Remote Fees. Exhibit displays the fees that Deposit, you would want to keep copies the banking chain, UMB, charges for their Remote Deposit of the originals, at your practice, services. for a few When investigating Remote Deposit days, until you receive your bank report with your bank, be sure to get simiverifying their deposit. lar itemization. Your scanner costs Exhibit Acheck displaysimaging the fees and yourFees. monthly that the banking chain, UMB, charges by costs will, of course, be dictated your volume checkservices. activity. for their RemoteofDeposit When investigating Remote Deposit with your

D.Courier Pick-Up at Your bank, be sure to get simi­lar itemization.

Office Your scannercould costs andconsider your monthly check Practices talking imagingtheir costs will, of course, be dictated by with bank representatives about a daily courier service. Your your volume of check activity. bank could provide this service or D. Courier Pick-Up at Your Office contract it out to a courier service, Practices could consider talking for a daily pick-up of your bank deposit your office. with theiratbank representatives about a daily courier service. Your bank could provide

Exhibit A Fees for Remote Deposit services: Set-Up Fees Scanner options: TS215 single feed . . $800 TS230-65 (65 items per minute) . . . . . .$1,215 TS230-100 (100 items per minute) . . . . . .$1,400 Scanner warranty: Year 1 included with price of scanner Year 2 . . . . . . . . . . . $172 Year 2 & 3 . . . . . . . . $275 Year 2, 3, & 4 . . . . . $395 Remote Deposit one time set up fee . . . . . . . . . $100 Processing Fees Remote Deposit monthly maintenance . . . . $75/mo Check image capture 0–500 per mo. . . . $.11/ea 01–2500 per mo. . $.09/ea Over 2500 . . . . . . $.07/ea ACH capture (if chosen) . . . . . $.06/ea Internet Image Access (up to 5 users) . . . . . . $25/mo Over 5 users . .$10/ea/mo CD ROM (optional). . . . . . . .$25/ea Source: UMB

This is an alternative to to consider, this service or contract it out a courier in the following situations: service, for a daily pick-up of your bank at your 1.deposit If the feesoffice. for a Lock-Box ser-

vice This and/or Deposit seris anRemote alternative to consider, vice are too daunting for your in the following situations: volume of activity.

1. If the fees for a Lock-Box ser­vice and/ 2. You do not want any of your or Remote Deposit ser­vice are too employees involved in the risk ofdaunting going for toyour the volume bank of onactivity. a daily 2. basis.

You do not want any of your employees involved in want the riskyour of going to the bank 3. You do not manager, or on a daily basis. key employee, taking time away 3. from You do not want your or key work to go tomanager, the bank. employee, taking time away from work go to the bank.

Fees:toOne bank quoted the follow-

ing feesFees: for One a daily pick the up follow­ by a bank quoted courier: ing fees for a daily pick up by a courier:

Monthly—$90–$100, $5 per Monthly—$90–$100, i.e.i.e.$5 per day.

Doesnot not pick up cash, day. Does pick up cash, courier—monthly—$250 Armed Armed courier—monthly—$250 –300, i.e. $15 per also Will pick upalso –300, i.e. $15 day. perWill day. cash. pick up cash.

Bank Charges Are Negotiable

Bank Charges Are In this feature article are quotes of Negotiable that some individual banks quoted us.

Infeesthis feature article are quotes ofYour fees that some bank charges will,individual typically, be banks in the quoted us. as Your charges same ranges thosebank quoted.

However,will, keep typically, be in the same ranges in mind that your fees will vary depending as those quoted. However, keep your activities with fees the bank. inupon mind that your willThevary larger your activities – borrowing, dailywith depending upon your activities deposit balances, etc – theyour less your bank the bank.

The larger activities –isborrowing, daily deposit balances, likely to charge.

It may pay to discuss etc – services the lesswith your bank these other banksisinlikely your to charge.

It may pay to discuss these community. They may be wiling to offer services with other banks in your you lower fees They to get you to change to theirto community. may be wiling bank. offer you lower fees to get you to change to their bank

PAGE 35 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER BENEFIT: HUMAN RESOURCE MANAGEMENT

Are You Compliant With the New HIPAA Regulations?

Many physicians and their

Many newer association

Monterey County Medical

staff are not aware of the changes to

members may be unaware of the value

Society and Santa Clara County

HIPAA created by the HITECH Act

and benefits of using PrivaPlan, so we

Medical Association will be sponsoring

(American Recovery and Reinvestment

encourage you to purchase the CD.

additional programs in the near future

Act of 2009). Among other things,

Existing members who have purchased

with PrivaPlan to ensure you have as

the Act strengthens requirements for

PrivaPlan, in the past can obtain

much education as possible.

business associates, creates new rules

updates for a very affordable price.

on how breaches of either paper or electronic protected health information must be handled, and even defines new obligations for providing patients access to their medical records if you

To purchase the CD or

PrivaPlan will be releasing an

multimedia training, please call

update in the next 45 days to cover the

PrivaPlan directly at 877/218-7707.

HITECH Act changes. All medical

Be sure to mention you are a CMA

practices should be sure to understand

member, so you can get your discount.

these changes and appropriately update

use an EMR!

policies and procedures.

For many years, the Monterey County Medical Society and Santa have worked with and endorsed

Tracy Zweig Associates

PrivaPlan Associates as official HIPAA

A

Clara County Medical Association

experts. Many association members use the CMA/PrivaPlan HIPAA Privacy and Security ToolKit on CD-ROM which is updated annually by PrivaPlan and CMA to reflect changes in HIPAA

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners ~ Physician Assistants

and California law. (For example, last year California passed new regulations governing handling of electronic medical information and responding to possible medical identity theft.)

PrivaPlan also produces a multimedia HIPAA training program that provides an affordable way to keep your practice

Locum Tenens ~ Permanent Placement

trained on HIPAA. PrivaPlan users who maintain their annual subscription also benefit from a regular newsletter with information, tips, and training, as well as a free hotline or email service to contact with your HIPAA questions.

V oice : 8 0 0 - 9 1 9 - 9 1 4 1 or 8 0 5 - 6 4 1 - 9 1 41 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tzw e ig@ tra cy zw e ig.com w w w.tra cy zw e ig.com

PAGE 36 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

We fight frivolous claims. We smash shady litigants. We over-prepare, and our lawyers do, too. We defend your good name. We face every claim like it’s the heavyweight championship.

We don’t give up. We are not just your insurer. We are your legal defense army. We are The Doctors Company.

The Doctors Company built its reputation on the aggressive defense of our member physicians’ good names and livelihoods.

And we do it well: Over 82 percent of all malpractice cases against our members are won without a settlement or trial, and we win 87 percent of the cases that do go to court. So what do you get for your money? More than a fighting chance, for starters.

To learn more about our medical professional liability program, call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293. You can also visit us at www.doctorsagency.com.

Robert D. Francis Chief Operating Officer The Doctors Company

PAGE 37 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

Santa Clara County Medical Association Alliance

SCCMA Alliance News September, 2009 The Santa Clara County Medical Association Alliance is the philanthropic and volunteer arm of SCCMA that consists of physicians, physician spouses, students in training, and friends of medicine.

Bettering the health in Santa Clara County is the main focus of the Alliance.

In collaboration with other community groups, the Alliance provides health education, underwriting of projects, and legislative support for medical issues. To join, please visit the website at http://www. sccmaa.clubexpress.com. You will also find the most current updates and contact information on that site.

rapid progress toward a 501(c)(3) nonprofit status for our organization and a 75Year Celebration Book, which will provide a visual and verbal summary to mark our 75th anniversary.

Although all future events are described in detail on the website, some upcoming events are listed below. Please join us! For more information, contact

Mary Hayashi, 408/395-4661 or Jean Cassetta, 408/998-8850 Ext. 3010.

October 16-19, 2009: Fall Leadership Conference, Anaheim.

November TBA: Holiday Tree Decorating, Valley Medical Center.

December 14, 2009: Holiday Luncheon, 11 AM-2 PM.

Santa Clara County Medical Association Alliance 2008-09

Highlights of 2008-2009: The year was an eventful one, beginning with the May 2008 installation of Debbi Ricks as two-year president of the statewide organization, the California Medical Association Alliance (CMAA). Highlighted state and county events included participation at the April State Legislative Day, the Gardner Family Health Fair, Sundaes on Sunday, the speakers’ series, the CMAA Fall Leadership Conference, the annual tree decorating event at Valley Medical Center, assistance of medical students at their career day workshop for high school students, and a trip to the DeYoung Museum. Dr. Madhur Bhatnagar received the CMAA’s Excellence Award at the CMA Foundation dinner (as well as the 2008 Dedicated County Alliance Member Award). Carolyn Miller was recognized as the 2009 Dedicated County Alliance Member of the Year at the June 2009 SCCMA Awards Banquet. Interspersed with these events were organizational meetings, coffee, and luncheon gatherings.

Dedicated County Alliance Member Dr. Madhur Bhatnagar

SCCMAA President Carolyn Miller’s Installation Kathleen Miller, Siggie Stillman, Mary Hayashi, Carolyn Miller, and Meg Giberson

Gardner Family Health Fair

Carolyn Miller, Jean Cassetta, Kathleen Miller, Debbi Ricks, Siggie Stillman

Sundaes on Sunday Joint Medical Association/Alliance Event Suzanne & Steve Jackson’s home

CMAA Fall Leadership Conference Committee

Jean Cassetta, Heather Goodman, Suzanne Jackson, Debbi Ricks, Kathleen Miller, Meg Giberson, Mary Hayashi

Upcoming Events: May 2009 brought the installation of the 2009-2010 officers: Mary Hayashi, President; Kathleen Miller, Secretary; Carolyn Miller, Treasurer; Siggie Stillman, Membership; Meg Giberson, Legislative Representative; and Jean Cassetta, Health Promotion. Two ongoing projects include

CMAA President Debbi Ricks’s Installation

Annual Tree Decorating at Valley Medical Center Wayne Miller, Courtney Lewis, Carolyn Miller, SCCMAA President

Dr. Bhatnagar Receives CMAA’s Excellence Award at the CMA Foundation Dinner

Ladies’ Day Out in San Francisco Limo Ride to Yves Saint Laurent at the DeYoung Museum Pat Baker, Sarah Stillman, Siggie Stillman, Kathleen Miller, Carolyn Miller, Mary Hayashi, Mila Mitchell

PAGE 38 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

!

Do It Yourself or Seek Help With Your Collections…, continued from page 25 will charge a percentage of the recovery. BME only charges a percentage on monies recovered and has discounts for members of the Santa Clara County Medical Association and the Monterey County Medical Society.

necessary, with appropriate appeals. Experience in dealing with insurance carriers and HMOs is a must. BME has this experience.

Additionally, its CMC billers have resolved many Palmetto issues for its clients.

In previous issues of The Bulletin, you have seen changes in the Health Insurance Portability and Accountability Act (HIPAA), the recently enacted Health Information Technology for Economic and Clinical Health (HITECH) act, as well as the enactment of Red Flag rules for medical identity theft. Your collection agency should comply with all of these laws and regulations. BME is fully compliant with each.

Your collection agency and/or billing company should be knowledgeable of the Balance Billing Act and in identifying those accounts that fall within the purview of the act. The last thing a physician needs during these difficult times are issues with the Department of Managed Health Care. BME has had success in resolving balance billing issues for its clients.

You should be able to freely communicate with your collection agency. Your questions shouldn’t go unanswered. BME has a full-time dedicated client relations director to address the questions and concerns of its clients.

How Do I choose a Billing Company?

One should choose a billing company with qualified medical billers that are Certified Medical Coders (CMCs). Full reimbursement only comes after diligent follow-up and, when

Finally, the bottom line is return on your investment.

You have invested your time and resources in providing your patients with quality medical care. You are entitled to proper reimbursement.

BME is endorsed by the California Medical Association, the Santa Clara County Medical Association, and the Monterey County Medical Society. BME is a full-service collection agency and billing company meeting the needs of its clients for over 60 years.

RECORD MANAGEMENT SOLUTIONS Electronic Document Management • Application Services • Business Process Automation Solutions • Scanning & Conversion Services Record Retention Management & Confidential Destruction Secure Offsite Storage 1.800.957.5051 x137 www.srcpdeliverex.com

San Jose | San Francisco | Hayward | Sacramento PAGE 39 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

CLASSIFIED ADS office space for rent/lease FIRST VACANCY IN OVER 32 YEARS! • SALINAS Located on West Laurel Drive in Salinas.

This suite is approximately 4,000 sq. ft.

Ideal for a medical partnership or satellite facility. For information please call Dr. Paul Farrell at 831/424-9853.

SHARED MEDICAL SPACE AVAILABLE FOR LEASE • WEST SAN JOSE NEAR CUPERTINO Approximately 1,000 sq. ft., four rooms with shared reception area, waiting room area, and kitchen area. Great visibility on De Anza Blvd. Call brokers to tour: Alice Teng, 408/282-3808.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA 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.

OFFICE SPACE FOR LEASE • SAN JOSE

Two suites, ranging from 1,000 to 1,645 sq. ft., at gross lease cost. Excellent parking. Located next door to Los Gatos Community Hospital. 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.

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

600–1,900 sq. ft. in West Valley Medical Building, second floor, elevator, separate entrance. Call Helen at 408/243-6911.

One exam room plus one large office, shared waiting room and front office.

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

LOS GATOS OFFICE $1.99 GROSS/$2.30 FULL

PRIME MEDICAL SPACE • PRIME SAN JOSE LOCATION

1,500 – 9,000 sq. ft. of offices and/ or rehab in heart of Los Gatos. www.536NSantaCruz.com. 408/656-8265.

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.

OFFICE SPACE FOR SUBLEASE • MTN VIEW

MEDICAL SUITES • LOS GATOS – SARATOGA

OFFICE EXAM ROOMS TO LEASE

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.

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.

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

PAGE 40 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

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.

PRIVATE PRACTICE/ OFFICE for sale

A+ TRANSCRIPTION SERVICE

FOR SALE OR LEASE • MENLO PARK MEDICAL BUILDING

Providing Clinicians Quality Medical Transcription Since 1995

New construction high end medical building on Menlo Park/Atherton border.

11,885 sq. ft. building. Divisible into four condos (2,400 sq. ft.+). Great parking.

Contact Dan (agent) for pricing and additional information at 650/473-4773 or email: dskehan@ccarey.com.

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.

MEDICAL OFFICE FOR LEASE • LOS ALTOS

PRIVATE PRACTICE FOR SALE

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.

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 AVAILABLE FOR LEASE 2,045 RSF, Class A Medical Office.

Conveniently located near O’Connor and Good Samaritan Hospitals.

Easy access to Highway 17. Parking 5/1,000. For questions and touring information, call Colliers, Alice Teng, 408/282-3848.

Testimonials

PRIVATE PRACTICE FOR SALE

granite waiting room with comfortable seating for eight patients. Call Irene at 408/358-5757 to schedule your private showing. Price is negotiable.

408/282-3808 and Patrice DeLorey,

� Dictation Using 800 Phone System or Your Hand-Held Recorder � 24-Hr. TAT - STAT 2-Hrs. � HIPAA Compliant

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 provide either an employment relationship Continued on page 42

“ 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

PAGE 41 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

A+ Transcription Service 888 589-8283 e-mail: apluspat@aol.com

Classified Ads, continued from page 41 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.

condo/COTTAGE rentals HOUSE FOR RENT/SALE IN TAHOE Northstar at Tahoe house for rent, lease or for sale, walk to ski area, four bedroom, three bath. Call 408/348-0926.

OCEAN FRONT CONDO ON KONA COAST Beautiful setting on the big island of Hawaii. Sleeps four. Great Views. Call 408/354-3253 for more info.

FOR SALE

WANTED

BEAUTIFUL HAWAIIAN CONDO

PEDIATRIC PRACTICE

Poipu Beach, Kauai. Lovely 2 BR/2 BA condo, across street from ocean. Recently remodeled bathroom and kitchen with granite countertops, new 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.

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

OAK MEMORIAL PARK CEMETERY PLOTS 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.

Pajaro Dunes Beachfront Condo

MEDICAL BILLING PHYSICIAN NETWORK • MEDICAL BILLING AND CONSULTING SERVICES Over 18 years of experience managing medical and specialty billing; customized to fit the needs of your practice. Services include, but are not limited to, full medical billing (including patient statements), coding, authorization, insurance eligibility, monthly summaries, and financial counseling. Call us today and allow our professionals to reduce the frustration and time consumed processing medical claims and account follow-up, so you can focus your valuable time on patient care. Office: 408/998-8537, Email: physnet@sonic.net.

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 42 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

MEMBER NEWS & HAPPENINGS

Welcome 34 New Members!

Name Mary Abusief Joel Bronstein Peter Bui Elwyn Cabebe Charlie Deng Shane Dormady Peter Fay Ramesh Gopi Tobias Hays Bowen Jiang Wesley Kong Roger Lucero Van Mai Aditi Mallick Ingerlisa Mattoch Anjuli Mehrotra Vidya Mhamunkar Richa Misra Roberto Neisa Karen Purcell Christopher Quan Juan Rodriguez Ankur Sangoi

Specialty *REN [*OBG] US PSHN ON HEM EM ON HEM IM IM DR *PD US U FP GP US *ATP DMP PD AI OBG IM US *REN [*OBG] IM US PTH

City Palo Alto Stanford Santa Clara Mountain View Alhambra Mountain View Sunnyvale Cupertino San Jose Stanford Mountain View Gilroy Santa Clara Stanford San Jose San Jose Cupertino Campbell Stanford San Jose Mountain View Stanford Mountain View

Name Wendy Shelly Takudzwa Shumba Stephanie Smith Geoffrey Spencer Serena Tan Margo Thienemann Raymond Tsai Kevin Wang Byron Wilson Melissa Wu Calvin Yang

Specialty REN [*OBG] US US *GE [*IM] *PD *CHP *P US PMR ON HEM IM P

*Board Certified US -- Unspecified [ ] Not Practicing

In Memoriam Clyde Duane Larsen, MD *Pediatrics 2/20/35 – 6/8/09 SCCMA member since 1974

Perry A. Olsen, MD *Anesthesiology 5/8/24 – 5/16/09 SCCMA member since 1962

PAGE 43 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

City San Jose Stanford Stanford San Jose Los Gatos Palo Alto Stanford Santa Clara Castro Valley Los Gatos Saratoga

MEMBER BENEFIT: REGULATORY COMPLIANCE PARTNER

EnviroMerica Frequently Asked Questions Who are you? We are EnviroMerica. We are a Bay Area-based private company that helps hundreds of medical and dental offices in Northern California with all of their regulatory compliance issues. We insure our clients are up to all standards, keeping their offices safe and keeping them clear from hefty fines that are often levied by the regulatory agencies – such as CAL/ OSHA, Department of Health Services, Environmental Protection Agency, as well as the Medical Board of California.

EnviroMerica has been helping medical practices for more than 12 years.

and compliant material safety data sheets books, plus complete physical compliance of the office. Via an insurance policy, we guarantee all of our clients against any and all fines they may receive from any of the regulatory agencies.

Do you have a guarantee? Yes. We guarantee to cover any regulatory fine, up to a million dollars, incurred upon any of our clients.

How many medical offices do you work with? EnviroMerica concentrates its services solely in the Bay Area. We work with more than 300 different medical and dental offices.

Where are you located? Our offices are conveniently located in Belmont, California – just south of the San Francisco Airport.

What do you do? We provide comprehensive products and services to bring all of our client offices up to complete regulatory standards. Our services include annual training, up-to-date and customized safety manuals, all appropriate office documentation including complete

How much does it cost? The initial evaluation is being offered without charge, at this time, to all members of MCMS and SCCMA. EnviroMerica generally charges $275 for this service.

Our rates for ongoing service and protection vary depending on the number of employees at the practice. In total, we charge much less than most offices spend to take care of these issues on their own.

For members of the MCMS and SCCMA, we offer additional discounts.

How long does the evaluation take? A full evaluation can take up to one hour, if time permits. If less time is available, our compliance experts can provide a very thorough evaluation in less than 30 minutes. In each case, the EnviroMerica Compliance Expert needs at least 15 minutes to share his findings with the owner-doctor.

COMPANY: EnviroMerica MEMBER BENEFIT: Via an insurance policy, EnviroMerica guarantees all of their clients against any and all fines they may receive from any of the regulatory agencies. MCMS and SCCMA members receive a complimentary CAL/OSHA inspection given by EnviroMerica (valued at $275).

Why is this important? First and foremost, California’s regulations are in place to help assure safety and privacy for your office’s staff and patients. Our services help your office to abide by all of these safety and privacy regulations.

Secondly, the state regulatory associations have the authority to levy heavy fines upon medical offices. Recently, we have seen fines exceeding $50,000. EnviroMerica protects medical practices from heavy business-threatening fines.

Products/Services OSHA/DHS COMPLIANCE • Customized OSHA Manuals • Customized MSDS Manuals • NFPA Chemical Labeling • All Required Signs and Labels • In-Office OSHA Training • Employee Posters • Updates CAL/OSHA, DHS Forms • Customized Records Manual • Customized Evacuation Map • Updates and Maintenance • Surprise Inspection Protection • Appeal Support • Hearing Representation WASTE MANAGEMENT: EPA/ DTSC • Waste Pick-up (Red Bags) • Sharps Pick-up • Expired Pharmaceutical Pick-Up • Hazardous Material Pick-Up • Spore Testing (for Autoclave) • Mail Back Sharps Containers

CONTACT: Call 888/323-0583 for more details.

PAGE 44 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

CALL 1-888/323-0583

THE DIABETES SOCIETY IS THE ANSWER TO EFFECTIVELY MANAGING BLOOD GLUCOSE LEVELS IN YOUR DIABETIC PATIENTS The Diabetes Society is an independent non-profit organization founded in San Jose as a one-stop shop for diabetes education and support in the communities you serve!

Services Offered: • ADA certified 3-step diabetes self-management program • Nutrition education and counseling • Free meters and instruction • Group classes (English and Spanish) • Support Groups (English and Spanish) • Insulin start appointments and pump training • Weight loss consultation and carb counting • Children’s diabetes camps throughout California Easy referral process with a variety of fee options including most insurance plans, Medicare and local IPA’s

> If you never thought about us for your patients, now is the time < For more information or brochures: 1165 Lincoln Avenue, Suite 300, San Jose, CA 95125 (408) 287-3785 Fax: (408) 287-2701 Email: info@thediabetessociety.org

When you have questions about eating disorders...

Eating Disorders Resource Center

NEW Free Support Group

EDRC is pleased to annound a new support group and information session for family members and loved ones of individuals suffering from eating disorders. Please join us for support throughout the healing process.

WHERE: El Camino Hospital Meeting Room “DE” (on ground floor)

2500 Grant Road

Mountain View, CA 94040

...we’re here to help.

Awareness, Recovery, Advocacy www.edrcsv.org 408-559-5593

WHEN: Every 4th Saturday of the month

9:30 a.m. – 11:00 a.m.

For further information on this support group or any other EDRC services, please contact us at 408-559-5593 or katie@edrcsv.org.

PAGE 45 | THE BULLETIN | SEPTEMBER / OCTOBER 2009

The MLC Website has been designed to allow easy access to information for participating organizations, their members, and other health care professionals.

On the site you will find: • News and Information: MLC reports, meeting summaries, and an events calendar • Educational Tools: CME courses, tools, and patient education materials • Resource Center: Interpreter Services Database, MLC presentations, and links • About the MLC: Member organizations, participation agreements, and policies The Interpreter Resource Database is a county-by-county database providing information on interpretation and translation services. The database is updated regularly, and listings may be sent to the CAFP for inclusion.

The Interpreter Resource Database includes: • Interpretation Resources by Phone, VMI or On-Site • Language Lines • Community Resources • Interpretation Equipment • Training for Physicians and Staff Members • Websites in Languages Other Than English

When was the last time a doctor came to YOU?

I’m Dr. Jon Wack, Medical Director of the Vascular Institute at California Pacific Medical Center, a unique program with specialists from four disciplines—interventional radiology, cardiology, vascular surgery and neurosurgery —working together to provide the most sophisticated array of treatment options for all aspects of vascular disease.

Since the 1970’s, we’ve been on the forefront of new technologies —from aortic aneurysms to claudication; from uterine fibroids to neoplasms. Today, we are the only private California hospital using the Yttrium 90 treatment. We have the experience to know what works—and what doesn’t— in minimally invasive treatment.

I’d like to make an appointment to see you in your office. Why? I, or one of my team mates, would like to take just a few minutes to familiarize you with our facilities, equipment, staff —and discuss treatment options for your next complex patient.

The Vascular Institute offers: •

Board certified, fellowship trained vascular specialists

•

Unparalleled care for patients with vascular disease

•

Endovascular abdominal and thoracic aortic aneurysm repair

•

Minimally invasive lower extremity revascularization

•

Renal and visceral stenting procedures

•

Carotid stenting and endarterectomy

•

Endovascular and open options available and recommended without bias

•

Tumor embolization and radiofrequency ablation

•

Uterine fibroid embolization

•

In 2008, HealthGrades® ranked California Pacific “Best in the San Francisco Area for Cardiology and Overall Cardiac Services.”

Call me at 415-600-7459 • www.cpmc.org/services/heart

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