2011 January/February

JANUARY / FEBRUARY 2011 | VolUmE 17 | NUmBER 1

Membership Directory iApp Arrives!

Get yours from the App Store today!

ALSO INSIDE: Member Benefits & Services Key Accomplishments in 2010 JANUARY / FEBRUARY 2011 | THE BULLETIN | 1

The Santa Clara County Medical Association and the Monterey County Medical Society are pleased to announce a new 10-year and 20-year Term Life program for members. You now have a choice of locking in your premium rate for the first 10 or 20 years of your policy,* enabling you to achieve dramatic premium savings. And you can apply for limits of up to $1,000,000!

Now is the time to take a good look at the SCCMA/MCMS plan if: • It has been more than one year since you last reviewed your life insurance protection • You had a change in lifestyle (e.g., married, had a child, adopted a child, taken out a mortgage or business loan or invested in a new practice) • The long-term assets that you once counted on for your financial planning no longer seem as secure as they once did Sponsored by:

• You think you may be paying too much • The amount of coverage provided by your medical group isn’t enough and you can’t take it with you if you leave

Call Marsh today at 800-842-3761 for information on this new program and to determine how you can save on your life insurance!

Underwritten by:

Administered by:

Insurance is provided by ReliaStar Life Insurance Company, a member of the ING family of companies.

*The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days advance written notice.

54723 (1/11) ©Seabury & Smith Insurance Program Management 2011 • d/b/a in CA Seabury & Smith Insurance Program Management 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com

CA Ins. Lic. #0633005 • AR Ins. Lic. #245544

2 | THE BULLETIN | JANUARY / FEBRUARY 2011

BULLETIN THE

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

700 Empey Way

•

San Jose, CA 95128

•

408/998-8850

•

www.sccma-mcms.org

MEMBER BENEFITS

6

From the Editor’s Desk

Legal Services/On-Call Library

7

Message From the MCMS President

Reimbursement Advocacy/ Coding Services Billing/Collections Discounted Insurance Referral Services With Membership Directory/Website Membership Directory iAPP for the iPhone Legislative Advocacy/MICRA House of Delegates Representation Practice Management Resources and Education Financial Services Professional Development Health Information Technology Resources Publications CME Tracking Physicians’ Confidential Line Verizon Discount Human Resources Services

Joseph Andresen, MD John T. Jameson, MD

8 It Pays to Be a Member 12 2011 Seminars & Events 15 Member Benefit: Reimbursement Advocacy 16 Key Accomplishments in 2010 22 Member Benefit: Professional Liability Insurance NORCAL Mutual Insurance Company

24 Member Benefit: Insurance Products and Services Marsh

26 Member Benefit: Human Resource Management TPO - The HR Experts

28 Member Benefit: Electronic Medical Records gloWest Alliance/gloStream 30 Member Benefit: Regulatory Compliance Partner EnviroMerica

Member Benefit: SCCMA/MCMS Directory 32 App

36 SCCMA Alliance News 42 MEDICO News 44 Classified Ads JANUARY / FEBRUARY 2011 | THE BULLETIN | 3

the sAntA clArA cOunty MeDicAl AssOciAtiOn Officers

AMA trustee - sccMA

cOuncilOrs

President Thomas Dailey, MD President-Elect William Lewis, MD Past President Howard Sutkin, MD VP-Community Health Cindy Russell, MD VP-External Affairs Rives Chalmers, MD VP-Member Services Scott Benninghoven, MD VP-Professional Conduct Eleanor Martinez, MD Secretary Sameer Awsare, MD Treasurer James Crotty, MD

James G. Hinsdale, MD

El Camino Hospital of Los Gatos: Art Basham, MD El Camino Hospital: Lynn Gretkowski, MD Good Samaritan Hospital: Jeff Kaplan, 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 Huang, MD Stanford Hospital & Clinics: Peter Cassini, MD Santa Clara Valley Medical Center: John Siegel, MD

Tanya W. Spirtos, MD (Alternate)

sccMA/cMA DelegAtiOn chAir James Crotty, MD (District VII)

cMA trustees - sccMA Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (President) Randal Pham, MD (Ethnic Member Organization Societies) Tanya Spirtos, MD (District VII)

chief executive Officer William C. Parrish, Jr.

Debbi Ricks (Alliance)

BULLETIN

the MOnterey cOunty MeDicAl sOciety

Editor

Officers

THE

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

Printed in U.S.A.

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 © Copyright 2011 by the Santa Clara County Medical Association.

4 | THE BULLETIN | JANUARY / FEBRUARY 2011

President John Jameson, MD President-Elect James Ramseur, MD Past President William Khieu, MD, MBA Secretary Eliot Light, MD Treasurer John Clark, MD

chief executive Officer William C. Parrish, Jr.

DirectOrs Paul Anderson, MD

Patricia Ruckle, MD

Valerie Barnes, MD

Scott Schneiderman, DO

Ronald Fuerstner, MD

Kurt Sliger, MD

David Holley, MD

Steven Vetter, MD

R. Kurt Lofgren, MD

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FROM THE EDITOR’S DESK

Joseph Andresen, Md Editor, The Bulletin

Physicians on the Front Line Handling witnessing the most horrendous human circumstances

By Joseph Andresen, MD

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.

The recent mass shootings in Arizona have brought forth an outpouring of grief, anger, shock, and soul-searching across our nation.

There is no doubt that this will be a topic of discussion for many months to come, as we all search for an understanding of why and how we may prevent such tragedies in the future.

What caught my attention in the first days after this horrific event was how the health care team at the University of Arizona Medical Center was thrust, unexpectedly, into the spotlight and rose to an incredible challenge. The nurses, hospital staff, and doctors working that January 8th shift could never have imagined or prepared for the near combat levels of casualties of civilians that would be received just hours into their workday. After several hours of surgery performed on Representative Giffords, Dr. Michael Lemole, Chief of Neurosurgery, was suddenly in front of a national press conference, delicately informing the public of his patient’s injuries and her prognosis. Just hours after losing nine-year-old Christine Taylor Green and five others, Dr. Peter Rhee faced the cameras to compliment the first responders, nurses, anesthesiologists, and staff who made the difference in all of the lives of those who did survive.

Despite the national attention toward this tragedy, we may need to be reminded that trauma victims are brought to emergency rooms for lifesaving treatment by doctors and staff continuously. “People are injured every single day. There’s nobody that’s more important than another,” said Dr. Rhee, when asked about the sudden media spotlight.

These events brought home to me how our entire health care team and physicians are often on the front line. Whether we are caring for a victim of crime, an auto accident, or heart attack, we must respond quickly, decisively, and compassionately to events often out of our control. This is a tremendous responsibility and burden, yet is the essence of our

6 | THE BULLETIN | JANUARY / FEBRUARY 2011

profession. How do we handle witnessing the most horrendous human circumstances? Dr. Rhee emphasized the importance of the entire health care team for the successful outcomes accomplished. Yet there were six lives lost.

How do individual nurses, physicians, and staff cope with this? I can’t imagine the sorrow and emotional upheaval felt by those who cared for nine-year-old Christine in the final minutes of her life.

In a study of Israeli surgeons entitled, “Posttraumatic Stress Disorder Among Hospital Surgical Physicians Exposed to Victims of Terror: A Prospective Controlled Questionnaire Study” (Clin Psychiatry 67:6 June 2006), one of every six physicians (16%) was found to suffer from PTSD. This correlates with other similar studies of doctors working in trauma centers. However, surprisingly, the level of PTSD among physicians was found to be unrelated to the frequency of their exposure to victims of terror in the work environment.

Individual coping mechanisms and the level of exposure to terror outside the workplace appeared to be the most important factors in the prevalence of PTSD among these physicians.

Other studies have shown that “accommodation” or repetitive exposure to trauma in rescue workers and medical staff may be a protective mechanism against the development of PTSD. When asked how he and his colleagues dealt with patients who have been so severely injured, Dr. Lemole replied: “This is what we do and why we got into medicine. We each deal with the stress and emotions in our own way.”

And this brings to mind an ancient proverb: “Physician, heal thyself.”

As providers of health care, doctors and medical staff need to look after ourselves in all respects, so that we can continue to provide care for others. With the tremendous responsibility we bear, this is an important reminder, no matter what our specialty or position.

MESSAGE FROM THE MCMS PRESIDENT

John T. JAMeson, Md President, Monterey County Medical Society

Organized Advocacy Continues!

Check out new member benefit for Electronic Medical Records!

By John T. Jameson, MD 2010-2011 MCMS President Well, the lame duck Congress managed to pull its act together and nix the planned SGR cuts scheduled for December and January. While it remains to be seen whether our politicians will be able to accomplish anything resembling suitable reform of this continuing annoyance, I wish to thank everyone, MCMS/ CMA members and non-members alike, who telephoned or otherwise contacted their Congresspeople to encourage them to fix this problem. I especially want to thank MCMS board members, Drs. Lofgren and Sligar, who went with me on November 3 to talk to Sam Farr and his staff about this and the GPCI issue.

Whatever your political persuasion, Congressman Farr has been proactive in support of us and the seniors who depend on Medicare for their medical coverage; and accordingly, I wish also to thank Congressman Farr for his efforts on their and our behalf.

Nonetheless, storm clouds of a different and possibly more menacing kind are gathering on the horizon. Governor Brown has put forth a proposal to cut Medi-Cal fees to physicians by 10%, with restrictions on the number of office visits per year, an increase in co-pays, and reductions in reimbursements for durable medical equipment.

Possibly worse, there are reports that the trial lawyers are fixing to mess with MICRA, and undoubtedly not to our benefit. Given that victorious plaintiffs’ medical expenses are covered by malpractice verdicts, it’s not clear that plaintiffs will benefit much either from raising the cap on “pain and suffering” awards. It’s my opinion, and I have expressed it before, that we might have an opportunity to change the subject by promoting “no-fault” insurance, whereby injured patients would be recompensed without passing judgment on the doctors or other professionals involved. Ours has become a very complicated and even esoteric profession; care for patients has become

extraordinarily complex, in many instances, and in that light, it’s not surprising that some patients are harmed by unintentional mishaps that do not reflect badly on the doctors and other professionals who work in the system.

Particularly adversely affected by a raise in the cap would be community clinics and entities such as Planned Parenthood, which might not be able to serve as many Medi-Cal and other underserved patients, if the cost of malpractice insurance goes up. Medical students and residents might choose to practice in a more physician-friendly state, reducing access to medical care to California residents.

That being said, we might garnish support from the public by acknowledging that there are indeed some “bad actors” in our profession, as indeed there are in all professions; and we might do everyone a favor by supporting no more or less than firm and reasonably swift due process by our Medical Board for those of us who, for whatever reason, are unable or unwilling to live up to the high standards we have set for ourselves.

In the meantime, the CMA is planning a counter offense involving allies within and outside the legislature to try to prevent the issue from even coming to the floor. Those of us who can tell personal stories of how a raise in the cap would adversely affect their practices and patients are encouraged to pass them on to Ron Lopp at the CMA (start with cma.org).

And of course, this is all going to cost some money, on the order of millions; so those of us who are motivated and have the means are encouraged to donate to the CMA. Organized medical staffs can donate to the CMA Educa-

tion Fund without running afoul of state or federal rules on such donations.

Now for some better news for those of us in Monterey County. Our affiliate, the Bureau of Medical Economics, which is a non-profit medical billing and collection company, has made a deal with gloStream, a producer of medical practice software, to offer a uniform system of office electronic medical records that will enable physicians to keep abreast of the continuing evolution of state and federal requirements for electronic documentation of patient care and also qualify for stimulus funding, which could offset as much as 25% of the cost of the system. The catch – you have to belong to the Monterey County Medical Society.

To see if this will meet your needs, check out glostream.com or call 877/456-3671, 408/9985811 (BME), or 831/455-1008 (MCMS).

Until next time!

John T. Jameson, MD, is the 2010-2011 President of the Monterey County Medical Society. He is board certified in pathology and is currently practicing at Natividad Medical Center.

JANUARY / FEBRUARY 2011 | THE BULLETIN | 7

It Pays to Be a Member Take advantage of your member benefits and services!

SCCMA/MCMS members are entitled to a host of discounts from both local and national vendors that provide a wide range of products and services. Enhance your personal and professional life, while saving time and money, by being familiar with our member benefits and services. Listed below is a summary of the benefits and services currently available, as well as a list of the vendors (with contact information) who provide the special services and/or discounts to members.

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 Practice Management Software: Members receive 6% off athenahealth’s unique web-based practice management services, which include eligibility verification, claims submission, and insurance collection. athenahealth, 888/652-8200 or www.athenahealth.com/cma.

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 408/998-8850 or 831/455-1008 Ext. 3010.

Practice & Liability Consultants LLC: Members receive $10 off the regular hourly consulting fees. Since 1985, Practice & Liability Consultants have worked with over 1400 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 hourly basis and, where possible, a minimum and maximum fee is quoted. Please call 415/7644800, or csm@practiceconsultants.net.

8 | THE BULLETIN | JANUARY / FEBRUARY 2011

EnviroMerica, Inc. is a 12-year-old Northern California-based consulting firm that now also has a Medical Waste Management Division with extremely competitive rates. They have helped hundreds of medical and dental professionals to comply with their federal, state, county, and city regulations, such as OSHA, HIPAA, EPA, DTSC, Department of Health, facility accreditation, board requirements, etc. EnviroMerica assures their clients full compliance with all standards, keeping their offices, patients, and staff safe and clear from any potential fines and liabilities that are often imposed by the regulatory agencies.

Their compliance services include annual training, up-to-date and customized safety manuals, regulatory documentations, complete MSDS books, all employees’ labor posters, and full implementation of all safety plans including a thorough inspection, labeling, and signage. Via an insurance policy, EnviroMerica guarantees all of their clients against fines they may receive from any of the regulatory agencies.

Their Medical Waste Division transports all of your medical waste, including contaminated sharps, red bags, pathological/microbiological waste, chemo, pharmaceutical, radioactive waste, and all hazardous material used in medical/dental facilities, as well as alkaline batteries, fluorescent bulbs, and electronic monitors.

MCMS and SCCMA members receive a complimentary regulatory compliance inspection given by EnviroMerica (valued at $275), as well as a 20% discount off their regular prices.

To set your free evaluation and quote, call 888/323-0583 or 650/6552045.

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 thirdpart 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 TP. Contact Melissa Irwin, Sr. Consultant: 831/6884196 or cmelissai@tpohr.com.

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 fullor part-time 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 2448 hours. Call Kristen Biernat at 408/452-1125 for more information.

LegaL ServiceS

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.

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.

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.

live customer service team. Heartland Payment Systems, 866.941.1477 or www.heartlandpaymentsystems.com.

ComericA Bank: Comerica has supported the SCCMA’s offices and members banking needs for over 20 years and now supports the MCMS. For more information, please contact Jo Matheson, VP of Banking at 408/556-5261.

Legacy Wealth Advisors, LLC: Provides financial planning, retirement planning, professional money management, and more! Members receive a onehour complimentary consultation (over a $300-dollar savings). For more information, call Michelle Hamilton at 408/452-7700.

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 services, call Karen Jorgenson at 408/998-5811, Ext. 3034.

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.

inSurance

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.

Medical, Workers’ Comp, Life, Disability, Long-Term Care and More: Marsh serves as the insurance advisor for the Santa Clara County Medical Association, Monterey County Medical Society and its members. 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. CONTACT: Call 1-800-842-3761; e-mail: member.insurance@marsh.com; website: www.marshaffinity.com.

CMA Credit Card: Physicians can show their CMA pride with CMA-branded credit cards from Bank of America. Bank of America, 800/7896701.

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

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 AssurePay, 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

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

FinanciaL ServiceS

Continued on page 10 JANUARY / FEBRUARY 2011 | THE BULLETIN | 9

Member Benefits and Services, from page 9 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.

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)

gloStream: Members receive 25% off of their electronic medical record software purchase! gloStream provides doctors with certified, voice-enabled electronic medical record and practice management solutions delivered and supported through a nationwide community of local technology Partners. gloStream products are secure, easy-to-use applications and the only solutions on the market with Microsoft Office built right in. gloStream Partners leverage gloDNA (“gloStream Detailed Needs Analysis”), a proprietary implementation process that has given gloStream a 100 percent success rate. For more information, call 866-456-7995 or email info@proficientEMR.com.

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.

10 | THE BULLETIN | JANUARY / FEBRUARY 2011

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 point-of-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 Hotlist: 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.

The Bulletin: Members receive a FREE subscription to the voice of Monterey and Santa Clara County physicians. This bi-monthly 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 831/4551008 or 408/998-8850 Ext. 3001 for details. All physician member directory listings/photos are also now available on an iPhone, iPad App.

autoMotive ServiceS

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 408/3565985 to set up your appointment today.

Car Rentals: Save up to 25% on car rentals for business or personal travel. Membersonly coupon codes are required to access this benefit. Get your code at www.cmanet.org/benefits or call CMA’s Member Help Line 800.786.4262. Avis, 800/3311212; Hertz, 800/654-2200.

MeMber SuPPLieS

otHer SuPPLieS anD reSourceS

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

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.

curity.com/cma.php.

Security Prescriptions: Get 15% off tamper-resistant security prescription pads and printer paper. RX Security, www.rxse-

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.

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

Physician Referral Service: Our physician referral service handles around 1200 calls per month. Patients can select a physician by city, specialty, language, Medicare, or Medi-Cal, and gender. Call Jean Cassetta, MCMS/SCCMA, at 831/455-1008 or 408/998-8850 ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today.

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.

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 Sharon Jensen, MCMS/SCCMA at 831/455-1008 or 408/998-8850 Ext. 3008.

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, & national projects, close support for the medical family. For more information, call Mary Hayashi at 408/395-4661, or Debbi Ricks at 408/354-5613, or visit www.sccmaa.org.

HiDEF Audio Video: Members receive discounts, up to $1,000 off on packages, and free shipping on orders over $1,300. Provides security camera systems, hi-fidelity music systems, simple one touch system control, new ultra resolution 3D LED TV’s, and 7.1 DTS surround sound. A portion of all proceeds will go to your local SCCMA Alliance to help fund various local medical and health education projects in our community. Call 408/294-6632. Located at 1610 Monterey Road, San Jose.

JANUARY / FEBRUARY 2011 | THE BULLETIN | 11

2011 Seminars & Events Happenings for MCMS/SCCMA members Note: All members may attend events held in Monterey or Santa Clara counties, regardless of location of membership. (Please RSVP prior to event.) For more details about each event, visit sccma-mcms.org and visit our website prior to each event to check for cancellations.

MONTH

DATE

DAY

TIME

DESCRIPTION

February

16

Wednesday

12:00pm - 1:30pm

SCCMA “Bring Your Own HR Questions” Presented by TPO HR

February

23

Wednesday

11:30am - 1:00pm

MCMS “Bring Your Own HR Questions” Presented by TPO HR

February

25

Friday

12:00pm - 1:30pm

SCCMA SACPAC - Assemblymember Jim Beall, Jr AD 24

March

1

Tuesday

6:45pm - 8:30pm

SCCMA Town Hall Council Mtg. Guest Speaker: Dustin Corcoran, CMA CEO

March

9

Wednesday

12:00pm - 1:30pm

SCCMA “Take the Mystery and Frustration Out of Implementing and Using an EMR” Presented by gloStream

March

10

Thursday

12:00pm - 1:30pm

MCMS “Take the Mystery and Frustration Out of Implementing and Using an EMR” Presented by gloStream

March

23

Wednesday

12:00pm - 2:00pm

SCCMA HIPAA and OSHA Presented by Enviromerica

March

24

Thursday

12:00pm - 2:00pm

MCMS HIPAA and OSHA Presented by Enviromerica

March

25

Friday

12:00pm - 1:30pm

SCCMA Congresswoman Zoe Lofgren 16 District of CA

April

5

Tuesday

All Day 6:00am - 6:30pm

MCMS/SCCMA CMA’s 38th Annual Legislative Day-Sacramento (Chartered Bus Trip)

April

12

Tuesday

6:00pm - 8:00pm

SCCMA Avoiding Burn-Out Practice Liability & Consultants (Physicians Only)

April

13

Wednesday

6:00pm - 8:00pm

MCMS Avoiding Burn-Out Practice Liability & Consultants (Physicians Only)

April

15

Friday

6:00pm - 8:30pm

MCMS/SCCMA CMA’s Leadership Academy Indian Wells, CA (Physicians Only)

12 | THE BULLETIN | JANUARY / FEBRUARY 2011

MONTH

DATE

DAY

TIME

DESCRIPTION

May

3

Tuesday

6:45pm - 8:30pm

SCCMA Town Hall Council Mtg. Guest Speaker: Jim Hay, MD, CMA Pres-Elect

May

11

Wednesday

12:00pm - 1:30pm

SCCMA (Repeat) “Take the Mystery and Frustration Out of Implementing and Using an EMR” Presented by gloStream

May

12

Thursday

12:00pm - 1:30pm

MCMS (Repeat) “Take the Mystery and Frustration Out of Implementing and Using an EMR” Presented by gloStream

May

18

Wednesday

12:00pm - 2:00pm

SCCMA Case-Based General Malpractice Scenarios and Ways to Minimize Risk Presented by NORCAL (Office Managers Only)

May

18

Wednesday

6:00pm - 8:00pm

SCCMA Case-Based General Malpractice Scenarios and Ways to Minimize Risk Presented by NORCAL (Physicians Only) CME units offered.

May

25

Wednesday

12:00pm - 2:00pm

MCMS Case-Based General Malpractice Scenarios and Ways to Minimize Risk Presented by NORCAL (Office Managers Only)

May

25

Wednesday

6:00pm - 8:00pm

MCMS Case-Based General Malpractice Scenarios and Ways to Minimize Risk Presented by NORCAL (Physicians Only) CME units will be offered.

June

7

Tuesday

6:30pm - 8:00pm

SCCMA Awards Banquet San Jose, Fairmont

June

22

Wednesday

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 (Practice Managers Only)

June

22

Wednesday

6:00pm - 8:00pm

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

June

23

Thursday

12:00pm - 2:00pm

MCMS “What Every Office Manager Should Know About Running a Practice (ARs, Collections, Billing)” Frank Navarro/CMA’s Center for Economic Services (Office Managers Only)

June

23

Thursday

6:00pm - 8:00pm

MCMS “What Every Physician Should Know About Running a Practice (ARs, Collections, Billing)” Frank Navarro/CMA’s Center for Economic Services (Physicians Only)

June

28

Tuesday

6:00pm - 8:30pm

MCMS Installation Dinner

JANUARY / FEBRUARY 2011 | THE BULLETIN | 13

CMA Center for Economic Services 2011 Webinars at-a-glance Mar 2: E&M Coding - Don’t Leave Money on the Table

Aug 3: Surviving Medicare and Medi-Cal Audits

Mar 16: Key Financial Ratios to Increase Profitability

Aug 17: HIPAA Update 2011

Practice Management Institute • 12:15 - 1:15pm

Debra Phairas • 12:15 – 1:15pm

Apr 6: Coding for Medical Necessity and Quality Care

Mary Jean Sage • 12:15-1:15pm & 6:00-7:00pm

Apr 20: Implementing a Compliance Program

Mary Jean Sage • 12:15-1:15pm & 6:00-7:00pm

May 4: Dealing With Sensitive Personnel Issues Debra Phairas • 12:15-1:15pm & 6:00-7:00pm

Mary Jean Sage, Sage Associates • 12:15 - 1:15pm Lisa Matsubara, CMA • 12:15 - 1:15pm

Aug 24: Legislative Update

Jodi Hicks, CMA • 12:15 - 1:15pm

Sep 7: How to Grow Your Practice

Practice Management Institute • 12:15 - 1:15pm

Sep 21: Know Your Rights About Unfair Payment Practices Aileen Wetzel, CMA • 12:15 - 1:15pm

Oct 5: Providing Extraordinary Customer Service Debra Phairas • 12:15 – 1:15pm

May 18: A Guide to CMA’s Amazing Legal Library

Oct 19: EOBs: Fact or Fiction

Jun 1: ICD-10

Nov 2: EMR / EHR Update

Jun 15: Best Practices for Accounts Receivables

Nov 16: Top Ten Ways to Save Your Practice Money

Jul 6: Collections – Get Paid Now!

Dec 7: Medicare 2012: Final Rules

Samantha Pellon, CMA • 12:15 – 1:15pm

Practice Management Institute • 12:15 – 1:15pm

Mary Jean Sage • 12:15-1:15pm & 6:00-7:00pm Mary Jean Sage • 12:15-1:15pm & 6:00-7:00pm

Jul 20: Writing Effective Appeals

PMI and Frank Navarro, CMA • 12:15 - 1:15pm

14 | THE BULLETIN | JANUARY / FEBRUARY 2011

Mary Jean Sage, Sage Associates • 12:15 - 1:15pm David Ford, CMA • 12:15 - 1:15pm

Debra Phairas • 12:15-1:15pm & 6:00-7:00pm Michele Kelly, CMA • 12:15 - 1:15pm

MEMBER BENEFITS

Reimbursement Advocacy Another benefit for SCCMA/MCMS members 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 billing-related 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 attentiongetting 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-mcms.org Mail See above address

JANUARY / FEBRUARY 2011 | THE BULLETIN | 15

Key Accomplishments in 2010 SCCMA/MCMS/CMA advocacy HeaLtH reForM

SCCMA/MCMS and CMA were engaged at all levels of the health reform debate throughout 2009 and 2010. We supported elements to enhance health care coverage, adequate funding for services, and health insurance industry reforms. We opposed elements that would interfere in the relationship between physicians and patients, create a monolithic health care system, or impose additional regulatory burdens on physicians. Equally important, we continue to be engaged as health care reform is implemented. We held several meetings with South Bay members of Congress to express concerns and make recommendations. $450 billion in Medicare reimbursement fixes in the House bill were, unfortunately, stripped from the Senate version and did not get enacted. We are actively working on these issues to ensure Medicare payment reform remains front and center.

What We Fought for and Won: • 85% of health plan revenues must be directed to patient care.

• Health plans must have physician networks.

• Two-thirds of low-income, uninsured Californians (2.3 million), will have access to subsidized private coverage, instead of Medicaid.

• Medicaid rates for primary care physicians will be increased to Medicare levels.

• 100% federally-funded Medicaid expansion that will cover roughly 1.7 million Californians.

• State-based health insurance exchanges, instead of one national exchange.

• 10% increase in Medicare rates to bolster primary care in California.

• Patient right to seek care from the physician of their choice outside of health plan networks.

• Requirements that physician quality reporting information be 16 | THE BULLETIN | JANUARY / FEBRUARY 2011

• • • • •

protected and accurate, statistically valid, with an attribution methodology that is correct, risk-adjusted, and with physician’s right to review data before it is finalized or made public.

Accountable care organizations need not include a hospital.

Current, unused residency slots will be redistributed for primary care and general surgery.

Uniformity established in Medicare prescription drug appeals.

Insurance companies cannot rescind insurance when a patient becomes ill.

CMA fought to equalize Medicare Advantage funding with Medicare private, fee-for-service funding. Medicare Advantage plan rates will be cut by $130 billion; however, plans that meet certain quality standards may qualify for bonuses.

What We Fought Against and Defeated: • A public option that would have mandated physician participation and paid Medicare rates.

• Adoption of a payment system that would have reduced payments to California physicians by up to 15% and transferred those funds to states in the Midwest.

• The reduction of Medicare payments in California for geographic practice costs by up to 8%.

• The provision allowing nurse practitioners to lead medical homes in California.

• A provision that would have banned existing physician-owned hospitals (new physician-owned hospitals were banned).

• A 5% Medicare penalty on physicians who are utilization outliers.

• A $350 Medicare participation fee for doctors.

• CMA worked with AMA to push back the penalties for nonparticipation in Medicare’s Physician Quality Reporting Initiative (PQRI) until 2014.

• •

A cosmetic surgery tax.

Delayed a Cadillac health plan tax on high-end benefits until 2018 because it disproportionately harms California’s employers and individual purchasing insurance.

What We Are Fighting for Now: • Stopping the 21% Medicare cut and repeal Medicare’s flawed payment formula, known as the Sustainable Growth Rate (SGR).

• Eliminating of the Independent Medicare Payment Advisory Board, a board created in the reform legislation that can cut funding independent of Congressional approval.

• Updating California’s geographic payment localities (GPCI).

• Expanding the increase in Medicaid payment rates to Medicare levels for all physician specialties.

• Improving quality reporting programs.

• Preventing additional physician liability exposure.

• Allowing patients to privately contract with physicians.

aDvocacy

Though we often think of legislation when we think of advocacy (and indeed, in 2010, there was plenty of it), advocacy really encompasses so much more: regulatory advocacy to ensure that legislation is properly implemented without interfering in physicians’ practices; legal advocacy to ensure that health insurers, government agencies, corporate entities, and others abide by the laws that protect the patient-physician relationship; economic advocacy to ensure you get paid what you are reasonably owed from health insurance companies without onerous requirements and burdensome requests; and individual advocacy on payment, practice management, medical-legal, and other professional issues.

We Supported Legislation That: • Gives osteopathic physicians access to the Steve Thompson Loan Repayment Program — signed by the governor. [SB 606] • Would require private health plans that provide coverage for vaccinations to fully reimburse physicians for the costs of both the vaccine and its administration — passed by the Assembly and Senate, but vetoed by the governor. [AB 2093] Would have protected patients from having their insurance policies rescinded — passed by the Assembly and Senate, but vetoed by the governor. [AB 2] • Would have strengthened the current peer review system — passed by the Assembly and Senate, but vetoed by the governor.

[AB 120] • Draws down federal funds to preserve the Healthy Families Program — signed by the governor. [AB 1422] • Would require the DHCS to improve and streamline the MediCal treatment authorization request process. [AB 613] • Would require the performance of an occupational analysis on any bill seeking to substantively expand the scope of a healing arts practice. [AB 877] We Opposed Legislation That: • Would have allowed virtually all health care districts and rural hospitals to directly employ up to five physicians. [SB 726, AB 646, AB 648] • Would have allowed physical therapists to evaluate and treat patients without a previous diagnosis or referral from a licensed physician. [AB 721] • Would have circumvented MBC’s fair hearing process by not allowing a physician to test the validity of charges prior to an 805 report’s being filed. [SB 700]

• • • • •

Would have required all physician-owned surgical clinics to be licensed by the state. [AB 832] Would have allowed pharmacists to independently initiate and administer immunizations to children and adults. [AB 977] Would have allowed nurse practitioners to admit patients and to be designated primary care providers. [SB 294] Would have allowed chiropractors to perform manipulation under anesthesia.

Would have expanded the scope of practice of psychologists and potentially all other health care facility health care practitioners.

We Took a Leadership Role in Opposing Faulty Quality Reporting Programs: • By writing a joint letter with local IPA leaders challenging the accuracy of the California Physician Performance Initiative (CPPI); as a result, only Blue Shield of California chose to use the performance data provided by CPPI. • By urging physicians to request their data from the California Physician Performance Initiative (CPPI) to verify its accuracy.

• By exposing CPPI flaws through publication of editorials in the news media.

• By requesting that the California Cooperative Healthcare Reporting Initiative (CCHRI) not publish the faulty and misleading 2009 CPPI results.

• By assisting the CMA in identifying physicians who were unfairly measured by CPPI, information that assisted the CMA in filing a lawsuit challenging Blue Shield’s use of the flawed data.

We Fought Against Health Plan Abuse: • By suing WellPoint for colluding with Ingenix on a price-fixing scheme.

• By getting the California DOI to sue PacifiCare for widespread and unfair payment processes in the wake of United Healthcare’s takeover of PacifiCare in 2005.

• By publishing a tool kit to help physicians understand the impact that Anthem Blue Cross’s 2009 contract changes would have on their practices.

We Fought for Physicians’ Rights With Health Plans: • To clarify Health Net’s new prepayment review requirements.

• To get Blue Shield to automatically reprocess claims after it delayed loading new 2009 CPT codes into its claims payment system.

• To remove a number of problematic provisions in a proposed contract.

• To allow physicians to opt out of Blue Cross’s paperless EOB program.

• To clarify how physicians would be paid for vaccines under Blue Cross’s new contract.

We Fought for Physicians’ Rights With Regulators: • To expedite the MBC review process of resident physician and other medical license applicants with time-specific needs.

• To stop the transfer of $6 million from the MBC’s Contingent Fund to the state’s General Fund.

• To stop the imposing of three furlough days per month on the MBC. • To postpone (after vociferous objections from CMA and others) the “Red Flags Rule” for over a year and then convince the

Continued on page 18 JANUARY / FEBRUARY 2011 | THE BULLETIN | 17

Key Accomplishments in 2010, from page 17 federal government not to require physician compliance.

We Protected MICRA (Medical Injury Compensation Reform Act): • The 5th District Court of Appeal unanimously sided with CMA to uphold MICRA’s constitutionality, thereby keeping professional liability insurance premiums reasonable.

• The SCCMA/MCMS interviewed candidates for state office from Santa Clara and Monterey counties to ensure they understand the paramount importance and educated them on the role MICRA plays in preserving access to care by keeping malpractice insurance affordable.

• •

webinars on a wide range of topics for hundreds of members and their staffs.

Members receive major discounts on registration fees for these programs.

CMA webinars are recorded and are available 24/7 from any computer with an Internet connection and speakers.

We Fought for Physicians in the Courts: • We stopped lawmakers from taking $100 Million+ from MediCal reimbursements through litigation, while all other public health programs suffered cuts to balance the state budget.

Technology: • Held a three-part webinar series and published articles to assist physicians with the process of evaluating and selecting EMR/ EHR vendors.

• CMA created a robust HIT resource center online.

• CMA pursued federal stimulus funding to assist physicians with EHR implementation, which resulted in a formation of an organization that has received $32 million in federal grant funds to provide these services to physicians.

We Helped Hundreds of Physicians With Medicare: • SCCMA/MCMS and CMA continued to help members personally — many who hadn’t been paid in months — by unraveling payment and enrollment problems through our contacts with Medicare/Palmetto administrators.

• Thanks to CMA advocacy, Palmetto GBA agreed to repeal its overly restrictive “monitored anesthesia care” policy.

• In response to Congress’s failure to stop another SGR cut from occurring at the end of March, the SCCMA/MCMS conducted a membership survey that garnered a significant response in which the majority of members indicated that if Congress doesn’t address the SGR, it will result in reduced access to care for Medicare patients; these results will be used in advocacy efforts to secure a permanent fix to the SGR. • To help members understand Medicare, the SCCMA/MCMS arranged for Palmetto to present an in-person seminar on key claims processing requirements.

• SCCMA/MCMS provided members with updates on participation in the PQRI quality reporting program.

Opportunities for Involvement: • The SCCMA Annual Meeting and Dinner brought nearly 200 guests to the Fairmont Hotel for the installation of SCCMA President Thomas Dailey, MD, and to honor the outgoing President Howard Sutkin, MD and five outstanding physician members and one citizen with awards.

• The MCMS Annual Meeting was held at the Pasadera Country Club for the installation of MCMS President John Jameson, MD, and to hear guest speakers James Hinsdale, MD, CMA’s President-Elect, and Dustin Corcoran, CMA’s Chief Executive Officer, discuss what they are doing at CMA. They also honored outgoing President William Khieu, MD. • SCCMA and MCMS members attended CMA Legislative Day to learn about health care policy and meet face-to-face with South Bay legislators in the State Senate and the Assembly.

• The SCCMA/MCMS welcomes members who want to volunteer for a committee. A list of committees and their descriptions can be found online at www.sccma-mcms.org under “About Us”>”Committees.”

MeMberSHiP SCCMA/MCMS/CMA Membership Services Benefits: • Your SCCMA/MCMS staff resolved hundreds of issues for members and members’ office staff, including economic advocacy issues, legal issues, and member benefits requests.

• Your SCCMA/MCMS-endorsed liability insurance partner, NORCAL Mutual Insurance Company, continued to aggressively defend physicians declaring a $13.3 million dividend in 2011. This dividend is issued as a premium credit beginning with the 2011 renewal statement, saving physicians an average of 10% on their premiums.

• SCCMA/MCMS made available to you and your staff a treasure trove of answers to your practice management questions via SCCMA/MCMS staff and the CMA’s On-Call library of medical-legal information.

• The SCCMA/MCMS-endorsed partner, Marsh, continued to offer solid and extremely competitive long-term care, disability, and business overhead insurance policies to SCCMA/MCMS members, as well as guidance on finding affordable health care coverage.

Excellent Educational Programs: • SCCMA/MCMS and CMA conducted many seminars and 18 | THE BULLETIN | JANUARY / FEBRUARY 2011

Communicating to, From, and for Our Members: • The Bulletin magazine continued to give voice to the South Bay’s physician community in 2010, reaching our members on a bi-monthly basis.

• Our Reimbursement/Coding newsletter continued to keep our members and their office staff abreast of key information critical to billing, coding, and economic regulatory issues. We also launched electronic versions of The Bulletin magazine and E-News that members may receive by email, and refer to archived issues online.

• The Bay Area’s print and broadcast news media continued to turn to SCCMA/MCMS when seeking the opinion of physicians on medical, public health, and legislative issues.

• SCCMA-MCMS.org — We launched our new website and continued to expand our online resources to include the information and resources you are looking for in a convenient and easily accessible online format. Also provides convenient access to an enhanced online membership directory and dues payment processing. Stay tuned for more enhancements in 2011!

Thank you to Joseph Greaves at ACCMA for your support with this feature article.

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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.

2010 MICRA SAVINGS CHART Specialty

Monterey / Santa Clara

Dade County, FL

Long Island New York

Wayne County, MI

FL-NY-MI Average

MICRA Savings

Allergy

$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.

20 | THE BULLETIN | JANUARY / FEBRUARY 2011

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

Are you a member?

PH: (408) 452-7700 FAX: (408) 452-7470 Email: michelle@lwallc.com

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LWA is proud to announce Edwin K.S. Ryu has again been named to the Medical Economics 2010 Best Financial Advisers for Doctors list. He was also named one of their 150 Best Financial Advisers to Doctors in 2006 & 2008.

The LWA team includes Michelle Hamilton, MBA as a specialist in financial planning and portfolio administration.

Department of Counseling Psychology

JANUARY / FEBRUARY 2011 | THE BULLETIN | 21

MEMBER BENEFIT

Professional Liability Insurance 2011 policyholder dividend declared In California NORCAL Mutual has declared a dividend for eligible physician, medical group, and health care facility policyholders in California.

The 2011 declared dividend totals approximately $13.3 million and equates to approximately 10% of a policyholder’s 2010 premium — the same level as last year. The dividend will be returned in the form of a premium credit beginning with the 2011 renewal statement.

Given the nation’s slow recovery from the current recession, to once again declare a dividend reflects well on the collective performance of NORCAL Mutual policyholders in practicing safely and managing risk. It also validates NORCAL’s efforts to vigorously defend their insureds, invest wisely, and manage resources prudently.

With the 2011 dividend, NORCAL has declared a dividend in 31 of the past 33 years.

Over their 35-year history, they have declared more than $400 million in dividends. As a mutual company that answers to its policyholders, NORCAL takes great pleasure in the responsible return of revenue.

How Is Eligibility Determined?

Eligibility for the 2011 dividend is based on the following criteria: • The policyholder was actively insured and in good standing with NORCAL Mutual on September 30, 2010. (The dividend amount is based on the premium written for each eligible policyholder on policies with effective dates beginning on or after October 1, 2009 through September 30, 2010.)

• The policyholder renews his or her NORCAL Mutual policy for 2011.

• The policyholder is a physician, a physician group, or a health care facility (excluding most emergency rooms) written on NORCAL Mutual’s Individual/Entity, Facility, or Group Policy Forms. ER groups written on the IE Form are eligible for the dividend.

Please note that the 2011 dividend will be paid only to those policyholders who meet all of the criteria listed above.

If the policyholder pays the premium in

quarterly installments, the dividend credit will be applied to the quarterly billing statements.

Each quarterly dividend credit will equate to approximately 25% of the policyholder’s total share of the dividend.

cHooSing tHe rigHt MeDicaL ProFeSSionaL LiabiLity coverage

Few decisions are as important as choosing the right medical professional liability coverage. Not being fully informed about the key differences between various types of coverage can result in surprises at inopportune times such as policy renewal or during the handling of a claim. Below are some key points to consider.

What is the total out-of-pocket cost for your choice?

In these tough economic times, it is easy to base the choice on the initial cost for the coverage. However, it is important to consider the total out-of-pocket cost.

For example, does the method being considered provide for sharing the results of good loss experience with the policyholders or members?

Does the method provide that you may have to pay additional funds if the loss experience is worse than expected?

Are the rates, underwriting rules, and policy forms required to be approved by the California Department of Insurance?

NORCAL has a reasonable initial cost, has paid policyholder dividends for 31 of the past 33 years, and has a policy that does not allow for assessments. As with all California domiciled medical professional liability insurance companies, its rates, underwriting rules, and policy forms must be approved by the California Department of Insurance.

What type of consent-to-settle clause does the method have and how good is the claims handling?

Many of the methods to protect against medical professional liability exposure require your consent before a payment is made on your behalf, but not all provisions are the same.

Some give you the absolute right to decide (a “pure consent” provision). You should check

22 | THE BULLETIN | JANUARY / FEBRUARY 2011

to see what happens if you refuse to consent.

Will you have some financial disincentive associated with your decision? For example, are you required to pay the difference between the verdict and the amount of the settlement offer?

These NORCAL are sometimes clauses.”

Mutual iscalled proud “hammer to be endorsed by the Santa C NORCAL has experienced profes-medical County Medical Association asclaims the preferred sionalsprofessional to provideliability a defense to for medical profesinsurer its members. sional liability claims made against you. It also uses experienced defense counsel from many firms to ensure the best defense possible.

NORCAL has a pure consent-to-settle clause giving you control over whether a medical professional liability claim is settled or not. This is just part of the superior claims handling you will get from NORCAL. What other items of value do I get for my premium?

Do you get only the basics with the method you are considering or do you have access to risk management activities focused on clinical outcomes to improve patient safety and reduce your medical liability risk? Are discounts available for the successful completion of risk management activities? Are category 1 CME credits available for risk management activities? Does the company provide excellent customer service and coverage for such things as administrative defense; information, computer and network risk; and professional office premises liability?

NORCAL has clinical-outcome-focused risk management activities, excellent customer service, and broad coverage for issues associated with the practice of medicine.

What is their relationship with organized medicine?

Organized medicine provides many benefits, including advocacy for the medical profession and an opportunity to stay current with the issues facing practicing physicians.

For more than three decades, NORCAL has relied on the guidance and counsel of their partners in organized medicine, including 31 endorsing medical and professional

Our passion protects your practice

societies.

How active is their support of MICRA and Federal tort reforms?

MICRA is recognized as the reform that brought stability and predictability to the medical professional liability exposure of physicians in California. MICRA faces unrelenting judicial and legislative challenges in an attempt to overturn or modify this vital reform.

NORCAL actively supports MICRA, including founding the MICRA California PAC and the MICRA Federal PAC. NORCAL routinely provides financial support to those legislators who are committed to maintaining MICRA. NORCAL also actively participates in activities to educate legislators and physicians about the importance of MICRA. What is the “right” answer?

We believe that NORCAL is the right answer because it provides a competitivelypriced product that does an excellent job of 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 online CME courses for members of NORCAL. CONTACT: Call Jeanne Zosky at 800/6521051.

protecting you through: • Superior claims handling • A broad coverage form • Clinically-focused risk management activities • A close relationship with organized medicine and strong support for MICRA

norcaL MutuaL introDuceS DataSHieLD™ — Free coverage For inForMation, coMPuter, anD netWork riSk

All medical practices maintain private information regarding their patients. While such information has always been subject to breaches, the increased use of computers and electronic data — especially electronic medical records — exposes practices to greater risk.

To better serve their policyholders, NORCAL Mutual has initiated a new, free coverage enhancement that will protect policyholders from information, computer, and network risk.

Effective January 1, 2011, DataShield™ provides substantial protection from the growing risks associated with information technology and patients’ personal health information. It will be added to the policies of all physician individual and medical group insureds (but not hospitals or those insured under the health care facilities policy).

The aggregate limit for a physician with separate limits is $50,000; for an entity with separate limits, $50,000 to $250,000, based on group size. DataShield™ covers costs for:

Information & network security liability — Protection against claims alleging unauthorized release of personal information, violations of information privacy law, or unauthorized use of/access to your computer system.

• Media liability — Protection against claims arising from material published on a Web site, in ads, etc., including allegations of libel, slander, copyright infringement, or patent violations.

• Regulatory privacy proceedings & regulatory fines & penalties — Coverage for defense of HIPAA violations, state information privacy law violations, etc; and for certain related fines and penalties.

• Customer notification & credit monitoring expenses — Coverage for expenses incurred through information breaches, including costs of notifying affected parties and providing them with credit monitoring services.

• Electronic data recovery & replacement expenses — Coverage for expenses incurred to recover or replace electronic data lost or damaged because of a computer virus, hacking, or other system invasion.

Each of the five areas of coverage has its own $50,000 aggregate limit, subject to a $50,000 total aggregate limit.

•

JANUARY / FEBRUARY 2011 | THE BULLETIN | 23

and to determine how you can sav on your life insurance!

e counted on for your

MEMBER BENEFIT

s secure as they once did

Insurance Products and Services Underwritten by:

Insurance advice for SCCMA/MCMS members

Administered by:

WorkerS’ coMPenSation

Each plan also includes a travel asSpecial discount for Association members! sistance service and a As workers’ compensation rates begin to increase, membership in funeral planning and SCCMA/MCMS provides savings through lower rates for workers’ comInsurance is provided by ReliaStar Life Insurance concierge service at no pensation insurance.

Company, a member of the ING family of additional charge.

You may also insure your spouse or domestic partner • Members receive a 5% discount on Workers’ Compensation and your eligible employees may apply for coverage as well. companies. premiums through the association-endorsed program.

• Depending on where you place your group health insurance, eMPLoyMent PracticeS LiabiLity groups may qualify a 15% discount. e for the first 10ofor2-250 20 employees years unless theforinsurance company exercises its right to change premium rates Risk management protection plus insurance • Call Marsh today with your policy renewal date and payroll for ureds covered under the group policy with 60 days advance written notice.

Employment-related suits usually involve one or more of the fola premium indication to determine your savings. lowing: discrimination, sexual harassment, or wrongful terminaurance Program Management • d/b/a in CA Seabury & Smith Insurance Program Management Long terM DiSabiLity2011 PrograM tion. This program provides members with the needed tools to manApply for up to $10,000 per month age risk properly and the protection generally missing from other ngeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com Becoming totally disabled could stop your ability to earn an in- insurance policies. Ask about the special First Time Buyers program. come in a split second. Make sure you have a reliable financial plan in Risk Management • Web-based training for members, office managers, and place that includes long term disability income protection. The SCCMA/ employees to help minimize exposure to employment practices MCMS-endorsed Group Long Term Disability Insurance Plan protects lawsuits. members in their medical specialty. Features include: • Access to a legal information hotline staffed by employment • A 10-year Medical Specialty Definition of Disability defined practices attorneys. as the inability to work in your own medical specialty as a • Review of employee handbooks and employment applications. physician for the first 10 years after the waiting period (a very Insurance important distinction vs. many plans with a broad “inability to • Choice of policy limits of $250,000, $500,000, or $1,000,000. do ANY job” definition).

• Low minimum premium of $750.

• Your monthly benefit payments are not taxable when you don’t • Low per claim retention of $2,500. take your premium as a tax deduction under current tax law.

• Provides for defense costs and losses you become legally That’s not necessarily the case for employer-provided plans obligated to pay as a result of a covered claim. where you could lose up to 40% of your benefit to taxation.

(Always consult your tax advisor.)

CA Ins. Lic. #0633005 • AR Ins. Lic. #245544

Optional Benefits Catastrophic Benefit – If a benefit for total disability becomes payable, and you become cognitively impaired or unable to perform two or more Activities of Daily Living (ADLs), you will be eligible to receive an additional monthly benefit of $1,000, $2,500 or $5,000 per month for up to two years subject to meeting qualifying criteria.

LeveL terM LiFe

10- and 20-year term plans available Members may apply for a 10- or 20-year term life policy with face amounts up to $1,000,000. Rates for the first 10 or 20 years of your coverage are locked in, so you do not experience increases in premium as you get older. This results in substantial premium savings during the life of the coverage. After the initial 10- or 20-year term period, you can reapply for coverage at your then attained age or transfer to the regular term life program if you no longer qualify through underwriting.

24 | THE BULLETIN | JANUARY / FEBRUARY 2011

MARSH

Duration of Benefits For disabilities occurring prior to age 60, the plan provides benefits for total disability until your normal retirement age from either covered injury or sickness.

54723 SCCMA/MCMS (1/11) Full Size: 8.5" x 11" Bleed: 8.75" x 1 Live: 7.5" x 10" Colors: 4C=(CMYK) MeDicaL inSurance Stock: N/A It’s still a long road ahead Postage: N/A Health insurance is not a “one size fits all” proposition. That’s why SCCMA/MCMS,Misc: togetherN/A with Marsh, provides a wide range of health insurance options to its members. Odds are you can find a plan that’s right for you.

• 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 $3,050 as an individual or $6,150 with family coverage. Add another $1,000, if you are between the ages of 55-64. Unused funds rollover from year to year. marsh serves as the insurance advisor for the Santa Clara County Medical Association, Monterey County Medical Society, and its members. 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.

CONTACT: Call 1-800/842-3761; e-mail: member.insurance@ marsh.com; website: www.marshaffinity.com.

•

•

•

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

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

Groups of 2 - 50 members and employees have access to Blue Shield of California, Blue Cross, Aetna, Kaiser, and Health Net. Participating members receive complimentary enrollment in HRKnowhow (see below).

Individual Health Insurance Looking for individual or family health coverage? Aetna, Anthem Blue Cross, and Blue Shield offer a wide choice of plans and doctors and hospitals.

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 like health care reform.

• 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.

buSineSS oWner’S PoLicy

Your professional liability policy doesn’t cover this This policy provides property and general liability protection (nonprofessional) for your practice. Coverages include replacement cost for buildings and business personal property, theft, computer equipment/ software, loss of business income and extra expense, tenant’s legal liability, and umbrella limits. Most landlords require this coverage.

grouP univerSaL LiFe

Earn 4% on your deposits This policy provides the life coverage you may need to help protect your family. What’s more, it offers a tax deferred, interest earning cash fund that can also help you build cash value to help meet your short- or long-term financial goals. For 2011, all deposits earn an interest guarantee of 4%. You may apply for up to $1,000,000 of life insurance and then choose the additional amount you wish to contribute to the cash account. You may withdraw some or all of your cash tax and penalty free.

grouP DentaL PrograM

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. Member and Employee groups may enroll throughout the year.

• 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. * Please Note: Marsh and SCCMA/MCMS do not render tax or legal advice. You should consult your advisors regarding applicable tax or legal consideration. The summary above is only provided as a general overview and should not be used to make decisions on coverage. In the event of any conflict between the information above and the policy, the policy will govern.

JANUARY / FEBRUARY 2011 | THE BULLETIN | 25

MEMBER BENEFIT

Human Resource Management Common questions from medical practice management Q: Our practice is so busy that we like to have our staff meetings during lunch when the office is closed, and we even provide a free meal. Now an employee mentioned that she should get “an extra hour of pay” for missing her meal period. What is that about?

“Working Lunches” and Non-Exempt (hourly) Employees A: The provisions of meal periods can be one of the more complicated areas of employment! While many employers have required occasional paid “working lunches” (for example a lunchtime office meeting) for their nonexempt hourly staff (often even providing the food), at question is whether such a requirement runs afoul of any California wage and hour requirements.

Because employers must “authorize and permit” non-exempt employees to take a 30 minute meal period for shifts in excess of five hours, if the employer is requiring the employee to work through that time by attending a meeting, the employee has not received 30 minutes free from work. In this case, the employer is required to provide an alternative 30 minutes free from work prior to the conclusion of the fifth hour of work. If the employer does not provide the alternate meal period within the time frame, then the employer is liable for an additional hour of pay to the employee (this hour does not count as time worked).

From a practical standpoint, if you want to schedule a “working lunch,” an employer is advised to do one of the following:

•

•

Make the first half-hour of the lunch meeting truly voluntary and the next half-hour the working portion.

This satisfies the requirement of allowing employees to choose to take the first 30 minutes in the manner they choose. You could provide the food during the first half-hour and certainly if employees choose to enjoy the meal together, it is a good team building experience. Just make sure that the first half-hour is truly voluntary and no employees are penalized for eating in their car or not socializing with the group.

Pay for the working lunch and pay an extra hour of pay. While this may seem costly, some employers make the business decision that it is best for work flow and scheduling.

eMPLoyer oPtionS WHen creating/MoDiFying a vacation/Pto PLan

Q: While I want to give employees time off with pay to take vacation or do other personal endeavors, I don’t know if there are any laws I should know about? Specifically, if they don’t use the allotted time in the year, can the policy say it is forfeited?

A: Employers are not required to provide paid vacation/PTO to employees. However, in California, when an employer chooses to do so, there are regulations around specific components of such policies.

Employer Chooses Specifics of the Policy When creating or revising a policy, the employer has many choices: • which job classifications (full-time, part-time, seasonal, temporary) are eligible, • how much time is earned (and if at a pro-rated rate for less than full-time), • when employees begin to earn vacation/PTO time (upon hire, after introductory period, after one year, etc.), • a reasonable “cap” on accrual (typically 1.5 to 2 times the current accrual rate, future accrual is suspended until the employee takes time off to bring the level below the cap), • when the employee can take time off, • how to request time off, and many other provisions.

California Labor Commissioner Sets Regulations • Vacation/PTO rights vest on a daily basis, which means that once an employee has earned vacation, it must

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 16 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 seven 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.com 26 | THE BULLETIN | JANUARY / FEBRUARY 2011

•

•

•

be treated like money in the bank for that employee and can never be taken away.

A “use-it-or-lose-it” policy, in which employees lose earned vacation/PTO which is not taken by a specific time, is specifically prohibited.

Since vacation accrued is considered wages earned, all accrued but unused vacation must be paid out at the separation of the employment relationship (even for an employee who has accrued vacation which he/ she was not yet eligible to take).

Accrued but unused vacation/PTO must be paid out at the employee’s current rate of pay, regardless of the rate at which it was earned.

Pto = vacation Paid Time Off (PTO) is a common name for a bank of time employers provide which bundles together vacation and sick time. A pro to PTO is that employees can use the time as they see fit; a con is that the California Labor Commissioner views the entire bank of PTO as “vacation” and therefore the entire PTO bank is vested.

For purposes of this article, the words PTO and vacation are the same and interchangeable.

A case for unbundling PTO Into Vacation and Sick Unlike vacation/PTO, paid sick time is NOT a vested benefit and does not have to be paid upon separation of employment. Additionally, unlike vacation/PTO, paid sick time does NOT have a prohibition against a “useit-or-lose-it” policy. Due to these two points, many employers are rethinking their PTO policies and are unbundling into traditional vacation and sick policies.

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 or MCMS member and contact TPO at: 831/ 647-7292 www.tpohr.com. ©2010 TPO – This information is designed to be accurate in content. TPO provides HR 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.

JANUARY / FEBRUARY 2011 | THE BULLETIN | 27

MEMBER BENEFIT

Electronic Medical Records gloStream gives doctors control, flexibility, and choice For doctors, an electronic medical record (EMR) can be a tremendous asset. This technology can help you improve operational efficiency and productivity, decrease costs, and generate more revenue. But with hundreds of EMRs now available to doctors, finding the right one can be difficult.

At gloStream, we believe that doctors deserve control and flexibility through personalized EMR solutions. Our Microsoft-based products, innovative implementation processes, and local support – delivered through partners – are how we bring that vision to life.

These are also the reasons that doctors trust gloStream for their EMR technology.

ProDuct (MicroSoFt oFFice-baSeD)

gloEMR from gloStream is the only EMR on the market that comes with Microsoft technology, such as Word, built right in. Since the vast majority of individuals and businesses already use this software, our solutions are familiar to most doctors and office staff. This means that training and implementation times are significantly reduced and doctors get up to their full patient load quickly. We understand that, for doctors, time is money, and so we’re focused on ensuring that your EMR implementation does not overwhelm your business.

Amanda Wood, a practice manager using gloEMR, had this to say: “We went live with gloEMR on a Monday and four days later we were already up to our full patient load. It’s so intuitive and easy to use – it’s simply phenomenal.”

The fact that we are using well-known Microsoft technology also means we can innovate quickly and that’s helped us prepare for and successfully achieve certification. gloEMR 6.0 from gloStream was one of the very first EMRs to be ONC-ATCB 2011/2012 certified through the Certification Commission for Health Information Technology (CCHIT). Our EMR is Stimulus-ready and doctors using it can be confident they’ll be using a product that will help them achieve meaningful use status. For those who are skeptical, gloEMR comes backed by a Stimulus Guarantee. Doctors using glo-

EMR, who are unable to show meaningful use, will have the purchase price of their software fully refunded. gloStream clients also are protected by the gloStream Data Portability Promise should they ever need to move their data. We can offer this type of protection because we’re using familiar Microsoft standards as the backbone of our EMR. Thousands of technology partners across the globe understand and support this technology and have the capability to access the data. In contrast, it is both difficult and very expensive to pull data from proprietary systems used by many competitors, since support options are limited.

A final reason our use of Microsoft technology is so important relates to cost. Your total costs are far more than just the purchase price of your software. Total cost includes the price for hardware, training fees, support, the time it takes to complete a patient note, and the time to create new templates, to name a few.

With gloStream, all of these costs are lower than competitive offerings.

ProceSS (gloDna)

At gloStream, we have a very unique implementation method that we call gloDNA. It stands for gloStream Detailed Needs Analysis, and it’s a step-by-step process that allows us to gather subjective and objective information about a practice so that we can create and deliver the personalized EMR solution that matches how you practice medicine. gloDNA is a proven roadmap that has given gloStream a 100% implementation success rate. Every single practice that has gone through the gloDNA process continues using our software successfully today. This is quite an accomplishment, when you consider that 30%-40% of all EMR implementations fail.

The gloDNA process starts with a Practice Scan. During this phase, we ask the practice a series of questions so that we can learn about their expectations, hopes, and fears when it comes to implementing an EMR solution. Next is the Practice Scan, and during this phase we gather quantitative data and details about practice work flow so that we can build a customized proposal for the practice. De-

28 | THE BULLETIN | JANUARY / FEBRUARY 2011

velopment of a proposal, which is phase three, includes a customized plan of action that provides a clear picture of the technical, team, and financial requirements necessary for a successful implementation.

We call stage four, also known as the implementation stage, Protocol, and this is the moment where we use all of the data gathered during the Scan and Consult phases to successfully transition a practice from paper records, or another EMR, to gloEMR. The final stage of gloDNA, Wellness, is an ongoing process. It consists of the actions, activities, and support the practice receives to address any issues that may have arisen during the implementation phase.

Partner (LocaL SuPPort)

From gloStream’s very inception, we made the decision to be a partner-centric organization and today we are the only 100% partnerdriven EMR company in the industry. What this means is that our products are always sold and supported through gloStream’s nationwide community of local partners. gloStream partners are trained and certified so they understand how to successfully implement gloEMR software and then provide ongoing training and support, as needed.

Since an EMR is a vital part of your business, support is critical. We believe you should always have access to onsite help from a trusted expert who lives in your community and understands your particular hardware and software setup, and overall needs. With gloStream, you can rest assured that if you need assistance, help will be there quickly.

In contrast, many competitors deliver support via individuals who are in other states, or even offshore. There are even some EMR providers that only provide Web-based help. Practices should think carefully about whether they want to call a generic support line instead of a trusted neighbor who lives in the community.

concLuSion

Deciding to change the way a practice does business and shed all of its paper records is a difficult decision, and one that can have significant implications. For that reason, practices should consider the type of product they are getting, the process for implementation, and the support model.

At gloStream we believe that our Microsoft Office-based products, which are powerful, flexible, and easy to use; our innovative gloDNA process, which has given us a 100% implementation success rate; and our nation-

wide community of local partners represent the best option for doctors.

To learn more about gloStream products and solutions, including important tax benefits associated with an EMR purchase, contact us today – 866/456-7995| info@proficientEMR. com | www.proficientEMR.com.

All SCCMA/MCMS members will qualify for an exclusive 25% software discount as well as a free, no-obligation practice consult. gloEMR 6.0 from gloStream is ONC-ATCB 2011/2012 compliant and has been certified

by the Certification Commission for Health Information Technology (CCHITÂŽ), an ONCATCB, in accordance with the applicable certification criteria for eligible providers adopted by the Secretary of Health and Human Services. gloEMR was certified on Sept 30, 2010 for the following clinical quality measures: NQF 0421, NQF 0013, NQF 0028, NQF 0041, NQF 0024, NQF 0038, NQF 004, NQF, 0012, NQF 0032.

This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments.

JANUARY / FEBRUARY 2011 | THE BULLETIN | 29

MEMBER BENEFIT

Regulatory Compliance Partner Cal/OSHA issues its first citation for non-compliance with ATD California Occupational Safety and Health Administration (Cal/ OSHA) recently cited a local health care provider, Police, and Fire department for not complying with the Aerosol Transmissible Diseases (ATD) Standard.

The handling of a patient with bacterial meningitis landed an Alta Bates Summit Medical Center employee and an Oakland police officer in intensive care and prompted California’s Division of Occupational Safety and Health (DOSH) to issue citations to three employers, including willful allegations against Alta Bates.

The citations, issued April 19, were the first issued under Cal/OSHA’s Aerosol Transmissible Diseases (ATD) standard, which took effect last summer. DOSH issued citations to Alta Bates and the Oakland Police and Fire departments, and is investigating possible meningitis exposure to ambulance drivers employed by American Medical Response.

The ATD standard is designed to protect workers in health care and related industries from diseases that are spread by coughing and sneezing. In announcing the citations, DOSH Chief Len Welsh called the situation a “textbook case” of why the ATD standard was developed and said it is a “wake-up call” for other medical facilities and first responders.

The case occurred on December 3, 2009, when emergency responders were summoned to a patient’s Oakland home. “Employees of all three responders at the scene were exposed to bacterial meningitis,” the Department of Industrial Relations says. The patient was transported to Alta Bates, where a respiratory therapist who directly treated the patient developed the disease and required 11 days of hospitalization, including time in the Intensive Care Unit. An Oakland police officer also developed meningitis and spent five days in the ICU. Alta Bates was cited for alleged willful violations for not reporting the original meningitis case to local health authorities in a timely manner and for failure to conduct an exposure analysis of employees exposed to the potentially deadly disease for a week after the exposure.

Alta Bates also was cited for not implementing an ATD program, not

30 | THE BULLETIN | JANUARY / FEBRUARY 2011

providing post-exposure information to employees, not properly fit-testing employees for respirators, and not providing medical treatment for the exposed employee. Proposed penalties are $101,485.

Oakland P.D. was cited for allegedly failing to develop and implement an ATD program, not properly notifying the Fire Department and American Medical Response of the officer’s exposure, not obtaining a medical evaluation of the exposed employee, failing to report the hospitalization to Cal/ OSHA, and not notifying the officer of his exposure to meningitis. Proposed penalties total $31,520.

The Fire Department was cited for not having an ATD program and lack of exposure notification.

Cal/OSHA reminds employers that all employers involved in the transportation and treatment of patients exposed to bacterial meningitis are required to provide respiratory protection, report the case to the local health authority and employees or other employers exposed, and initiate appropriate medical treatment.

To learn more, visit this link at: http://www.cal-osha.com/CalOSHA-Issues-First-ATD-Citations-in-Meningitis-Exposure-Case. aspx.

EnviroMerica, Inc., an approved vendor of choice for SCCMA and MCMS, provides complete implementation of ATD and other Cal/OSHA standards for all of our members at a special discounted price. Want to cut your medical waste bill in half?

Call EnviroMerica for a quote. Take advantage of their free compliance evaluation (valued at $275) and waste quote.

Schedule your visit today by calling 1-888/323-0583 or 650/6552045.

See Jane Save Meet Dr. Jane. She is a California Medical Association member and a member of her local medical society.

Dr. Jane takes full advantage of the member discounts available to her. In 2010, she saved: $22,476.

• Purchased four annual magazine subscriptions for her practice. Saved: $67 • Changed medical insurers, modified plan design, added an HSA compatible plan through CMA’s insurance partner, Marsh. Saved: $17,500 • Purchased auto insurance through CMA’s partnership with Mercury Insurance. Saved: $174 • Received 30% off a one-year subscription to Epocrates online clinical reference guide. Saved: $60 • Changed credit card processing to Heartland Payment Systems’ Transparent Cost Plus structure. Saved: $600 • Moved payroll processing for her eight employees to Heartland Payment Systems’ 100% paperless system with direct deposit. Saved: $750 • Attended the California Health Care Leadership Academy. Saved: $300 • Contacted CMA’s Economic Services help line for assistance with a problem payor. Recovered: $500 • Bought security prescription pads from RX Security. Saved: $25 • Called CMA’s Member Help Line and spoke with a health law information specialist about some legal questions. The specialist directed her to several member legal resources. Dr. Jane downloaded 10 medical-legal documents, with sample letters from CMA On-Call, CMA’s medical-legal library and the most comprehensive health law and medical practice resource for California physicians (instead of paying an attorney for the same information). Saved $2,500 Note: Cost savings represents an average savings of a solo physician accessing CMA member benefits. Actual savings may vary.

To learn more about additional member savings visit cmanet.org/benefits or call the CMA Member Services Help Line at 800.786.4262 JANUARY / FEBRUARY 2011 | THE BULLETIN | 31

MEMBER BENEFIT

SCCMA/MCMS Directory App Member directory listings/photos are now available on iPhone!

HIPAA-Compliant Multi-Media Messaging Now Available to Members with DocBookMD Ver. 3.0 Santa Clara County Medical Association and Monterey County Medical Society continually strive to introduce members to mobile communication tools to increase efficiency and save time. By partnering with DocBookMD®, we are able to offer a next-generation HIPAAcompliant multi-media communication tool exclusively to our members.

DocBookMD®, a company created by physicians for physicians, empowers you to connect, communicate, and collaborate with your local medical community.

DocbookMD® ver 3.0 key FeatureS •

•

•

•

32 | THE BULLETIN | JANUARY / FEBRUARY 2011

On-Demand Messaging Communicate with your colleagues via HIPAA-compliant messages instantly. You can improve communication efficiency by prioritizing outgoing messages.

Multi-Media Collaboration Exchange critical information such as pictures of X-rays or wounds via HIPAA-compliant messaging to enhance collaboration.

Pharmacy Search Find and map a local pharmacy with updated contact details near you or near your patient.

Fast Look-Up Locate a physician fast – by last or

•

first name, or by specialty, and contact him/her via multiple means including messaging or office phone.

Personalize Customize your personal info, create a list of your favorite physicians, add notes and detailed contact information.

regiStration iS eaSy

1. Contact your Medical Society to get your Medical Society ID. 2. Go to DocBookMD.com to register.

3. Download the free iTunes app and login.

Currently available for iPhone/iPad/ iTouch (Droid to be available soon).

DocBookMD® DocBookMD®

is a smartphone platform designed by Physicians for Physicians.

DocBookMD provides doctors-on-the-go an exclusive HIPAA-compliant professional network to

connect, communicate and collaborate.

2 Multi-Media Collaboration Exchange critical information such as pictures of x-rays or wounds via HIPAAcompliant messaging to enhance collaboration

1 On-Demand Messaging Communicate with your colleagues via HIPAA-compliant messages instantly. Prioritize the responses and improve efficiency

3

Fast Look-Up Find a local physician fast – by name (last or first) or by specialty

4 Pharmacy Search Find a local pharmacy with contact details near you or near your patient

5 Personalize Customize your personal info, and create a list of your favorite physicians with detailed contact information

DocBookMD® JANUARY / FEBRUARY 2011 | THE BULLETIN | 33

MEMBERSHIP

Welcome 157 New Members Santa Clara County Medical Association Arman Abdalkhani Palo Alto Iype Abraham San Jose Danielle Acosta San Jose Arshanoush Ahmadi Santa Clara Patti Allen-Colevas Sunnyvale David Alyono Santa Clara Anna Anderson Mtn View Swati Andhavarapu San Jose Sangeetha Balasubramanian Cupertino William Barnard Santa Clara Marcelina Behnam Santa Clara Louai Bilal Santa Clara Lilia Blanco Gilroy Michelle Blanco Gilroy Jerome Booker San Jose Clarence Braddock Stanford Elisabeth Calvelli San Jose Allison Chan Mtn View Grace Chan Fremont Allen Chen Santa Clara Dora Chin Santa Clara Jordan Cloyd Stanford Allison Collins Santa Clara Michael Conklin Santa Clara Dan Dang San Jose Alex Dimitriu Santa Clara Graham Dresen Mtn View Leigh Durlacher Palo Alto Kier Ecklund Mtn View Zachary Edmonds Mtn View Bogdan Eftimie Santa Clara John Elliott Santa Clara Maureen Fa Santa Clara Helen Feng San Jose Abdullah Feroze Stanford Parastoo G Daryani Santa Clara Thoranage K Gamage Santa Clara Amy Gilliam Palo Alto Erin Gillis Santa Clara Deborah Goddard San Jose Jennifer Haggerty San Jose Iris Hanna Mtn View Sanaz Hariri Los Gatos David Hiroshima Santa Clara

OTO IM US EM IM CDS OBG US RHU P EM P US US US IM IM US EDM PMR US US US IM CS US FP EM ORS IM IM US R IM US IM IM D EM US *FP PD ORS FP

Oscar Ho Lawrence Hou George Hsieh Heather Iezza Danagra Ikossi Neeta Jain Stephanie Jeske Thaichan Jobalia Tessa Johung Vadim Kagramanov Michael Kan Harrup Kaur Gary Kawesch Janet Kim Yuri Knauer Andreas Kogelnik Ganesha Krishna Marie-Eve Laden Ian Lam Ava Lee Chai Lee Jay Lee Jennifer Lee Keane Lee Melissa Lee Peter Lee Kathleen Leonard Tom Liu Margaret Lo Hong Du Ly Cameron McClure Kevin Merrill Michael W. Moore John Murao Jenny Murase Karrie Murphy Deepu Nair Holly Nath John Nguyen Blanca Ochoa Daniel Ouyang Rachana Palitkar Mary Parman Brandon Patton

Santa Clara San Jose San Jose Santa Rosa San Jose Palo Alto Santa Clara Mtn View Stanford Sunnyvale Los Gatos Los Gatos San Jose San Jose Santa Clara Mtn View Mtn View Stanford Mtn View San Jose Santa Clara Palo Alto Palo Alto Santa Clara Santa Clara San Jose Palo Alto Los Altos Los Altos Santa Clara Santa Clara Campbell Santa Clara Palo Alto Mtn View San Jose Palo Alto Mtn View Mtn View San Jose Santa Clara Los Gatos Palo Alto Santa Clara

US OPH *D PD GS IM HEM, ON, IM IM US CCM GP OPH *OPH US NPM IM CCM US IM IM D IM IM US IM US PD PS FP US US ONS US *DR, *IM D US US OBG OTO IM IM IM OBG RO

Claudia Pena Caroline Perry Surat Phonsombat Poonam Puri Amritha Raghunathan Daljeet Rai Lisa Rapoport Pavani Reddy Katherine Reyes Sayema Saifullah Prabhjot Sandhu Eric Sandoval Priscilla Sarinas Raymond Shaheen Karen Shih Aaron Sin Navneet Singh Kerry-Ann Stewart Diane Suchet Karen Suskiewicz Darrell Sutijono Amanuel Teklu Judy Thai Sarah Torres Choung Tran Anthony Tsao Elizabeth D. Turner Alec Uy Katherine Vega Jennifer Yi-Wen Wang Edan Wernik Janet Whang Karen White Deidre Williams Lara Wong Kristen Woo Assefa Worku Ying Wu Wilson Yan Wendy Yang Kenneth Yu Eric Yun

San Jose San Jose Mtn View Santa Clara Santa Clara San Jose Santa Clara Santa Clara San Jose San Jose Santa Clara Santa Clara Sunnyvale Mtn View Sunnyvale Stanford San Jose Menlo Park Palo Alto Mtn View Santa Clara San Jose Santa Clara Palo Alto San Jose San Jose Santa Clara San Jose Palo Alto San Jose San Jose Santa Clara Sunnyvale Santa Clara Mtn View Palo Alto San Jose Santa Clara Santa Clara Santa Clara Santa Clara San Jose

US US UC CD US FP US US US US PD IM IM *VS OPH US PD US PD IM US US AN US EM IM US US FP US FP IM OBG US EDM GYN GS US IM FP *EM US

Salinas Salinas Salinas Salinas Salinas Salinas Salinas Salinas

IM US US IM PD IM US IM

Monterey County Medical Society David Altman Monterey Sheetal Ankoleka Salinas Ian Atkinson Salinas Carlo Bernardino Monterey Candice Blagmon-Weaver Salinas Debra Bright Salinas Elaine Chiu Salinas Jose Espinosa Salinas Timothy Friederichs Salinas

ADMD, *GE, *IM IM IM *OPH US PD EM US FP

Aurelio Gonzalez Gary Gray Tyler Hensel Reza Iranmanesh Roya Javid Catherine Johnson Scott Landis Stefano Lee Lynette Mendoza

* - Board Certified

34 | THE BULLETIN | JANUARY / FEBRUARY 2011

Salinas Salinas Salinas Salinas Carmel Salinas Salinas Salinas Salinas

|

IM *FP US OPH *D IM IM US IM

US - Unspecified

Neftali Nevarez Alison Palacios Angel Parker Angelica Salazar Chuyen Trieu Nicholas Urrutia Jeannine Wahl Jason Wasche

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JANUARY / FEBRUARY 2011 | THE BULLETIN | 35

AllIANCE NEwS

SCCMA Alliance News The philanthropic and volunteer arm of SCCMA

Alliance members at the Holiday luncheon at lisa’s Tea Treasures include (left to right) Gabrielle Greif, Suzanne Jackson, linda Bruton, Judy Cseuz, Alina liniecki, and event organizer Heather Goodman.

In November, a group of Alliance members attended the exhibit of post-impressionist artists at the De Young Museum in San Francisco. On December 13, SCCMA Alliance members held their annual holiday luncheon at Lisa’s Tea Treasures on Santana Row. This year’s speaker was Joshua Krammes, Fund Development Director for the nonprofit agency Next Door: Solutions to Domestic Violence.

Alliance members donated gifts for victims of domestic abuse.

An ongoing local Alliance project continues to be working as volunteers one morning per month with the Food Basket Program in Santa Clara County. The “Not Even for a Min-

ute” campaign will return in late spring.

In January, Debbi Ricks, Immediate Past President of the California Medical Association Alliance, attended an Anti-Bullying Conference sponsored by the Los Angeles County Medical Alliance. Anti-bullying strategies learned will be posted on the SCCMAA website. Debbi also sends a weekly “Monday Memo” to all state members of the Alliance.

The memo provides helpful information regarding events and programs of county alliances throughout the state. For more information regarding those events, contact Debbi at debbiricks@aol.com.

36 | THE BULLETIN | JANUARY / FEBRUARY 2011

uPcoMing event:

May 6-7, 2011: CMAA Annual Session, Toll House Hotel, Los Gatos

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. To join, please visit the website at http://www.sccmaa.org. You will also find the most current updates and contact information on that site.

Law Offices of

Michael J. Khouri Michael J. Khouri

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OFFICE: (949) 336-2433 CELL: (949) 680-6332 4040 BARRANCA PARKWAY SUITE 200 IRVINE, CALIFORNIA 92604 www.khourilaw.com w w w.law yer- medicare.com JANUARY / FEBRUARY 2011 | THE BULLETIN | 37

TA CLARA SAN

•

IAT SSOC ION • LA

Y MEDIC UNT A CO

C AL

IF O R N IA

Dear Members: “Electronic Medical Record” is the hot topic today, and I know that many of you are starting to weigh your options. Recently, our billing company, Bureau of Medical Economics (BME), needed to obtain new EMR/practice management software; and after a thorough review, we chose gloEMR from gloStream. Based on our satisfaction with the product and the service, we chose to introduce gloStream as a new member-services benefit. This member benefit includes a 25% software discount as well as a free, no-obligation practice consult. Below is some information about their product and their company. gloEMR is the only EMR on the market that is built on the Microsoft Office platform, which means it is familiar; and easy to learn, use, and customize. As one of the only products to be certified by the Certification Commission for Health Information Technology (CCHIT), each year CCHIT has offered a major certification level, gloEMR has consistently met the highest standards for security, functionality, and interoperability. gloEMR 6.0 was one of the first EMRs to be ONC-ATCB 2011/2012 certified. I have seen gloEMR first hand and was especially impressed by the integrated voice recognition technology and the fact that every piece of patient information can be accessed with a single click. gloEMR comes backed with a Stimulus Guarantee and Data Portability Promise. Not only is it guaranteed to help you qualify for EMR incentives, you will always have the ability to move your data from gloEMR to another system, if you so choose.

Just as gloEMR is a very different product than most other solutions, gloStream is a very different kind of company. They are the only 100% partner-driven EMR company, which means support is offered through local technologists in your community who provide local on-site support. In addition, gloStream has developed a unique implementation process called gloDNA, which has earned them a 100% implementation success rate. In an industry where implementations fail 30%-40% of the time, this is impressive.

I encourage you to learn more about gloEMR and gloStream. Tell them you are a physician member, to take advantage of the 25% software discount as well as a free, no-obligation practice consult. For more information, contact: gloWest Alliance, 866/456-7995 or www.proficientEMR.com.

William C. Parrish, Jr. Best regards,

William C. Parrish, Jr. SCCMA/MCMS CEO

38 | THE BULLETIN | JANUARY / FEBRUARY 2011

FREE EMR SEMINAR March 9, 2011 SCCMA Headquarters (12:00 to 1:30 PM)

Discover How the Latest Microsoft Office-­based EMR Software Can Help You Comply With Federal Mandates

During your session, you will…

• Learn why federal mandates are real and how you can qualify.

• Discover a Microsoft Office-­‐based EMR that’s familiar and easy to use.

• Hear why it’s important to choose EMR software that comes with local support, training, and a Stimulus Guarantee.

• Learn about an innovative and unique implementation process, enabling a 100% success rate for doctors.

• Find out how we can offer a 15-­‐day success guarantee. If your practice isn’t back to full patient load within 15-­‐days of implementation completion, we’ll refund your entire software and services purchase!

Register to win a FREE copy of Microsoft Office 2010 Home & Business ($280 value)* *Must be present to win

-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐ FAX-­‐BACK RSVP ASAP to (408) 289-­‐1064 Attn: Jean Cassetta. For MCMS seminar dates/locations, please look at the calendar of events on sccma-­‐mcms.org.

(Lunch provided) SCCMA Headquarters -­‐ 700 Empey Way, San Jose, CA 95128 Attendee(s) Name: _______________________________________________________

Physician Name: _________________________________________________________

Phone: _____________________________ Fax: ________________________________

JANUARY / FEBRUARY 2011 | THE BULLETIN | 39

In Memoriam John H. Bennitt, mD *Obstetrics & Gynecology Infertility 11/16/41 – 11/28/10 SCCMA member since 1976

marvin linder, mD

Alexander H. Christensen, mD

Patrick H. marrone, mD

Internal Medicine 11/7/27 – 8/13/10 SCCMA member since 1957

*Pathology-Anatomic & Clinical *Dermatopathology 4/16/22 – 10/19/10 SCCMA member since 1962

*Ophthalmology 3/1/26 – 10/23/10 SCCMA member since 1960

Everett R. Eaton, mD

Gynecology 1/7/24 – 9/12/10 SCCMA member since 1956

*Obstetrics & Gynecology Infertility 4/20/29 – 8/2/10 SCCMA member since 1963

Bernice Giansiracusa, mD *Public Health 2/10/23 – 10/24/10 SCCMA member since 1984

Donald E. Silvius, mD

William A. Reeves, mD

*General Surgery 1/1/31 – 12/24/10 SCCMA member since 1965

Hubert Upton, mD

John Rieger III, mD

*Family Practice 5/14/25 – 11/16/10 SCCMA member since 1955

Gynecology *Obstetrics & Gynecology 1/1/22 – 11/10/10 SCCMA member since 1957

Robert D. Wuerflein, mD Cardiac Surgery, *Thoracic Surgery 5/27/36 – 9/16/10 SCCMA member since 1972

larry l. Gossack, mD *Obstetrics & Gynecology 11/4/20 – 11/17/10 SCCMA member since 1958

James R. Green, mD *Internal Medicine 11/20/20 – 11/8/10 SCCMA member since 1955

Edward D. Harris, Jr., mD *Rheumatology, *Internal Medicine Administrative Medicine 7/7/37 – 11/19/10 SCCMA member since 1988

Tracy Zweig Associates A

REGISTRY

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FIRM

Physicians

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J. mayfield Harris, mD *Orthopaedic Surgery Sports Medicine 11/3/24 – 12/27/10 SCCMA member since 1958

larry E. Hayes, mD *Pediatric Surgery *General Surgery 9/4/37 – 6/18/10 SCCMA member since 1973

James P. laster, mD *Neurology 10/22/28 – 9/6/10 SCCMA member since 1981 40 | THE BULLETIN | JANUARY / FEBRUARY 2011

Locum Tenens ~ Permanent Placement V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

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JANUARY / FEBRUARY 2011 | THE BULLETIN | 41

MEDICO NEwS

Physicians file lawsuit to block weakened standards for treating glaucoma The California Medical Association (CMA) joined with the California Academy of Eye Physicians and Surgeons (CAEPS) on January 11 in filing a lawsuit in San Francisco Superior Court to block the implementation of new standards to certify optometrists to treat glaucoma.

The physician groups took this step in an effort to ensure Californians afflicted with glaucoma get appropriate medical treatment.

The regulations, which went into effect on January 8, provide a pathway by which optometrists can complete the entire certification process without having to treat a single patient with glaucoma. The prior process required the treatment of 50 glaucoma patients, over two years, under the supervision of a board-certified ophthalmologist.

“Let’s be clear: These new regulations are not up to snuff and in fact jeopardize the quality of eye care Californians deserve,” said James Hinsdale, MD, CMA president. “Failing to require certification that includes treating actual glaucoma patients is the equivalent of handing out driver’s licenses to people who have read a driving manual and attended a class, but have never driven a car.”

Frank A. Scotti, MD, CAEPS president, noted while the new process mandates that optometrists attend certain classes, it does not require them to have any experience treating patients using anti-glaucoma medications.

“Although we had hoped to be able to support the new standards, they simply do not adequately protect patients, but instead focus on streamlining the prior certification process. Not requiring any hands-on treatment of actual glaucoma patients is ridiculous on its face,” Scotti said. “Glaucoma is a blinding disease and any certification process to treat it should respect that fact.”

Widely reported incidents at the Palo Alto Veterans Affairs hospital highlight the potential consequences. Substandard care in that facility’s optometry department apparently resulted in eight veterans with glaucoma going blind and many others suffering “progressive visual loss.”

Two of these patients reached out-of-court legal settlements for $250,000 and $400,000.

CMA and CAEPS do not oppose optometrists treating glaucoma, but rather aim to ensure training is adequate so the quality of care is not compromised. Both organizations remain willing to consider certification standards that will sufficiently protect glaucoma patients.

The complete petition and complaint filed in the San Francisco Superior Court can be found at http://www.cmaalert.org.

(CMA Alert, January 24, 2011 issue)

CMA tells IOM to protect senior citizens’ access to care To ensure senior citizens get the health care they need, no matter what their background or where they live, policy makers must balance concerns about Medicare spending with other factors to accurately ensure access to care, the California Medical Association (CMA) said at a January 17 hearing before the Institute of Medicine (IOM).

An independent, nonprofit organization tasked with studying geographic differences in Medicare spending and value of care, IOM took comments on the issue in Washington, D.C. CMA joined the American College of Physicians as the only two major physician organizations asked to testify.

After studying the issue, IOM will present Congress with a recommendation on how to change the Medicare payment system. Congress commissioned the study as part of health care reform, and as a compromise offered by California congressional leaders, after legislators from rural Midwestern states pushed for changes in Medicare funding that could have cut payments to California by 22%.

“While Dartmouth Atlas studies show big variations in Medicare spending region to region, they do not adequately weigh for other crucial factors that account for these differences, such as costs to practice medicine in different regions and differences in patients’ income levels, ethnicities, and health histories,” said Larry deGhetaldi, MD, who testi42 | THE BULLETIN | JANUARY / FEBRUARY 2011

fied on behalf of CMA. “Once you accurately assess risk and cost factors unique to each region, Medicare spending does not differ as much region to region. A failure to do so would compromise access to care for the most vulnerable Medicare patients, low-income beneficiaries.”

For example, deGhetaldi said, Los Angeles County has a high poverty rate and high rents and wages, which all push up the cost of providing health care there.

The IOM is also charged with developing payment methods and delivery models that provide more “value.” On that topic, deGhetaldi gave examples from his medical group, the Palo Alto Medical Foundation, in which it reduced unnecessary clinical variation and improved care by offering physicians incentives.

In addition, deGhetaldi called upon IOM to fix the outdated Medicare physician payment regions that undercut physician payments in several California counties. Seniors struggle to find doctors to treat them in counties such as Santa Cruz, San Diego, and Sacramento, which are classified as rural under Medicare and therefore offer physicians low reimbursement rates.

CMA advocates for realigning those counties with hospital payment localities, which more accurately reflect urban and suburban costs.

(CMA Alert, January 24, 2011 issue)

CMA Foundation provides resources for diabetes care The California Medical Association (CMA) Foundation’s Diabetes Quality Improvement Project has released two new practice-based resources to assist physicians with diabetes care.

The “Diabetes and Cardiovascular Disease Provider Reference Guide” is a comprehensive set of clinical guidelines developed with the support and expertise of 33 physicians. Also contributing to the guide were health care leaders from a variety of physician associations, medical groups, health plans, and other organizations dedicated to the prevention and management of diabetes and its complications.

This valuable reference guide is now available in a user-friendly, web-based format at the CMA Foundation website, http://www.thecmafoundation.org.

The CMA Foundation is currently recruiting physicians to help update the content for the guide’s next edition. If you are interested in participating, contact the CMA Foundation (contact information below).

The CMA Foundation has also, in collaboration with the University of California, San Francisco Neuropathy Center, completed an educational handout for patients who have diabetic peripheral neuropathy (DPN) called “Diabetes and Your Nerves.” DPN is the most common polyneuropathy in the United States, and worldwide, and contributes to incidences of lower limb amputation due to patients’ loss of sensation and associated infections.

The handout educates patients on the symptoms of DPN and other forms of neuropathy, so they can seek professional help and take action to prevent further nerve damage, when necessary. The handout is available in both English and Spanish and can be accessed from the Multicultural Diabetes Education Materials Database, also at the CMA Foundation website, http://www.thecmafoundation.org.

(CMA Alert, January 24, 2011 issue)

CMA calls on DMHC to levy bigger fines, exercise greater oversight of health plans California’s seven largest health plans were fined nearly $5 million for failing to properly pay medical claims submitted by thousands of doctors and hospitals over the last three years, the state Department of Managed Health Care (DMHC) announced on November 29.

The California Medical Association (CMA) responded by calling on regulators to exercise greater vigilance.

“California’s physicians support the Department of Managed Health Care’s attempt to hold insurers accountable to the law,” CMA President James Hinsdale, MD, said in a statement. “These fines, however, are chump change that amount to little more than a slap on the

wrist for highly profitable health plans that systematically deny legitimate claims and routinely block, delay, or limit physician reimbursements as one tactic to boost their bottom lines.

“Our members are especially concerned about solo physician practitioners and specialists, who are significantly impacted by these illegal practices.

“Every battle over a claim hurts access to care by taking a physician’s time away from treating patients. Unpaid claims also cause patients immense stress that can undermine their recovery. It’s crucial that DMHC and other regulators remain vigilant and force insurers

to follow the law so that doctors can focus on patient care.”

Insurance regulators said the companies also would pay tens of millions of dollars in restitution to medical providers whose claims were underpaid or incorrectly rejected.

The fines capped an 18-month investigation by DMHC into the payment practices of Aetna Inc., Anthem Blue Cross of California, Blue Shield of California, Cigna Corp., Health Net Inc., Kaiser Foundation Health Plan, and UnitedHealthcare/PacifiCare.

(CMA Alert, December 13, 2010 issue)

CalHIPSO tops nation in sign-ups of doctors getting electronic health records CalHIPSO, a federally funded, nonprofit regional agency founded in part by the California Medical Association (CMA), has signed up more than 2,100 providers seeking assistance in selecting and implementing electronic health records in their practices.

The success of CalHIPSO makes it the No. 1 such agency in the nation, having enrolled more than any other regional extension center.

Physicians who are considering the transition to electronic health records (EHRs) should visit CalHIPSO’s website, http://www.calhipso. org, for information. CalHIPSO helps physicians choose the most appropriate EHR system, implement it, and access federal grant funding.

CMA joined with the California Primary Care Association and the

California Association of Public Hospitals to create CalHIPSO, a federally designated regional extension center (REC) for all of California, except for Los Angeles and Orange counties.

The RECs are federally funded nonprofits that help physicians transition to EHR systems.

While CMA is proud of CalHIPSO’s early success, the enrollment represents only one-third of the agency’s ultimate goal: 6,200 signups.

CalHIPSO continues to reach out to physicians and will launch an aggressive campaign aimed at solo and small group practice physicians.

(CMA Alert, November 29, 2010 issue) JANUARY / FEBRUARY 2011 | THE BULLETIN | 43

Classifieds offIcE spacE for rENT/LEasE PRImARY CARE/loS GAToS SPACE FoR lEASE Part- or full-time physician sought to join existing practice to share rent and staff. 3,400 sq. ft. recently remodeled space with onsite lab.

Currently, we have one full-time MD and one part-time MD. Concierge practice setting. Very light call schedule, approximately one weekend in 17. Hospital work by choice only, close to Good Samaritan Hospital.

If interested, or for further details, please call 408/829-3033.

MEDICAL SUITES • LOS GATOS – SARATOGA Two suites, ranging from 1,000 to 1,645 sq. ft., at gross lease cost. Excellent parking. Located next door to 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. oFFICE SUITE AVAIlABlE Location is highway 85 at De Anza. One suite available. Currently configured with six 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. $2.00 per sq. ft. plus 3N. Located at 1196 South De Anza at Rainbow.

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 408/2280454.

OFFICE/LAB SPACE FOR LEASE • MTN VIEW One room space. Office/lab – upstairs. Located at 2500 Hospital Dr, Bldg I, Mtn View. Call 831/375-6105.

MEDICAL/DENTAL OFFICE SPACE FOR LEASE • MTN VIEW Medical/dental office space located at 2500 Hospital Dr, Bldg I, Mountain View. Call 831/375-6105.

MEDICAL BUILDING FOR LEASE • FREMONT New Class A medical building for lease in Fremont with surgery center, imaging center, and abundant parking. Trask Leonard, Bayside Realty Partners, 650/282-4620, or tleonard@baysiderp.com.

MEDICAL OFFICE TO SHARE • SUNNYVALE One exam room plus one large office, shared waiting room and front office. Newly built, 1,280 sq. ft. Call 408/438-1593.

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

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.

44 | THE BULLETIN | JANUARY / FEBRUARY 2011

DoWNToWN moNTEREY oFFICE FoR SUBlEASE Spacious, recently remodeled, excellent parking, flexible terms. Call Molly at 831/644-9800. mEDICAl/DENTAl CoNDomINIUmS FoR SAlE oR lEASE Two-story, medical/dental condominiums for sale or lease located in Willow Glen. Beautiful building completely renovated and remodeled. Suites range from 1,376 sq. ft. to 6,000 sq. ft. or full building for 13,170 sq. ft. Elevator served. Plenty of on-site parking and great visibility. Call brokers to tour: Alice Teng 408/282-3808 or Steve Hunt at 408/282-3846. mEDICAl oFFICE To SHARE IN mEDICAl BUIlDING oF o’CoNNoR HoSPITAl One large exam room and one office, shared waiting room, and receptionist area. Email at minasehhat@yahoo.com. mEDICAl/PRoFESSIoNAl oFFICE FoR lEASE Medical/Professional office 2,600 sq. ft, ground floor near Santana Row. $2.00 sq. ft. Available now. Email at sksiddiqui@yahoo.com.

OFFICE SPACE FOR LEASE OR PURCHASE • SAN JOSE For lease or purchase. 900 sq. ft. space in a medical/dental office building opposite Regional Medical Center. Please call 408/926-2182.

AGRESSIVElY PRICED mEDICAl/DENTAl oFFICES FoR lEASE • CAMPBELL, CA 3,000 Sq. ft. and 1,600 sq. ft. office spaces conveniently located on Bascom Avenue between O’Connor and Good Sam Hospital. Larger suite has two separate entrances and break area. Space is ideally suited for separate office/procedure area configuration. Covered parking, monument signage, and elevator included. Vascular surgeon currently occupies second floor. 50 K TI package offered for 5+ year lease. Owner will build to suit. $2.25/sq. ft. NNN. Call 408/858-3586.

MEDICAL/DENTAL SUITE • MORGAN HILL This Class A suite is 2,300 sq. ft. and is located right off of 101 Cochrane Exit. Minutes from the DePaul Health Center. $3,500 no triple net, $7.00 sq. ft. TI by owner. Call Farr at 408/386-8728.

PRIME MEDICAL OFFICE FOR LEASE • SAN JOSE Excellent location. Westgate area. 1,584 sq. ft. West Valley Professional Center, 5150 Graves Ave. Suite 2/stand-alone unit. Private office, reception area, exam rooms with sinks. Available 2/1/11. Call owner at 408/867-1815 or 408/221-7821.

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

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 qual-

ity occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Dan R. Azar MD, MPH at 408/790-2907 or e-mail dazar@allianceoccmed.com for additional information.

NURSE PRACTITIoNER/PHYSICIAN ASSISTANT Part-time Nurse Practitioner/Physician Assistant to provide care under MD supervision.

Includes H&P and occasional detoxification from drugs/alcohol. Knowledge in CD is desirable, but not necessary. Physician training is provided. Call Robert Daigle, MD at 408/568-7004.

mETRo mEDICAl BIllING, INC. • Full Service Billing • 25 years in business • Bookkeeping • ClinixMIS web-based software • Training and Consulting • Client References Contact Lynn (408) 448-9210 lynn@metromedicalbilling.com Visit our Website www. metromedicalbilling.com

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

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

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

JANUARY / FEBRUARY 2011 | THE BULLETIN | 45

Our Policyholders Own the Company

James O. Gemmer, MD Chairman of the Board

What does this mean?

It means they receive the profits, $24,000,000 in dividends in 2011!

“

We return all operating profits after expenses back to our policyholders as dividends in the form of premium credits.

”

In California this is an average savings on premiums of 40.4%* for 2011.

MIEC has returned dividends to our California policyholders 18 of the last 21 years.

Total California dividends now exceed $144,000,000.

KEEPING TRUE TO OUR MISSION For more information or to apply contact: n

www.miec.com

n

Call 800.227.4527

n

Email questions to underwriting@miec.com

* (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800-227-4527 • www.miec.com SCCMA_ad_01.21.11

MIEC Owned by the policyholders we protect.

46 | THE BULLETIN | JANUARY / FEBRUARY 2011 SCCMA_Ad_01.21.11.indd 1

1/21/11 3:26 PM

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JANUARY / FEBRUARY 2011 | THE BULLETIN | 47

BULLETIN THE

Address service requested

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

700 Empey Way, San Jose, CA 95128-4705

PRSRT STD U.S. Postage PAID San Jose, CA Permit No. 573-001

You invested everything in building your practice and reputation.

Some insurers cap their defense costs or take them from your coverage limits. NORCAL Mutual does not. We are committed to protecting you Our passion protects your practice NORCAL Mutual is proud to be endorsed by the Santa Clara County Medical Association as the preferred medical professional liability insurer for its members.

regardless of the cost. There is no cap on the value of the reputation you’ve earned.

Call NORCAL Mutual today at 800.652.1051.

Or, visit www.norcalmutual.com.