2002 ANNUAL REPORT TO MEMBERS
What did we do with your membership dues in 2002? Put simply, we spent it … but always with one objective in mind, one vision:
To return satisfaction to the practice of medicine for member physicians and their patients. Last year we made significant progress in: — Advocating for all physicians (both members and non-members) in San Diego, Sacramento, and Washington, D.C.; — Creating Value for member physicians by returning money to their practices; — Communicationing the SDCMS story to the public and to the decision makers; — Building the Infrastructure necessary to support SDCMS members and their leaders. We invite you to read our 2002 Annual Report and hope that you will continue helping us return satisfaction to the practice of medicine in San Diego County.
San Diego County Medical Society
2002 Annual Report
SDCMS Alliance President Alicia Muñoz and SDCMS President Rodrigo Muñoz, MD, at the 2002 Installation.
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an Diego County’s current health care system is in crisis, and it’s getting worse — not better — with rising health care costs, a faltering economy, health insurance premiums rising at 20% or more, decreasing reimbursements, access to and quality of health care critically impacted, and physicians planning on leaving San Diego County in droves. No one understands the devastating impact of the current health care crisis on physicians and patients better than your San Diego County Medical Society (SDCMS). We are the voice of San Diego physicians, advocating for change on our members’ behalf while recognizing that our patients must benefit. The San Diego County Medical Society has a vision: To return satisfaction to the practice of medicine for member physicians and their patients.
How? By providing Advocacy (what we do for all physicians) and Value (what we do for individual member physicians) supported by robust Communications and Infrastructure. What is our advocacy based on? In 2001, the SDCMS manifesto Medicine at a Crossroads: A Prescription for Change (see www.sdcms.org for the complete document) outlined the following eight points — the first cohesive attempt by any medical society to address the progressively degenerating crisis in health care: 1. Reconnect consumers to the cost of their day-to-day health care by reducing or eliminating most first-dollar insurance coverage. 2. Empower consumers to discover the cost and quality of health care services in advance of consumption. 3. Reduce or eliminate capitation as a form of provider reimbursement. 4. Provide for full tax deductibility of health care expenses for all, including expanding the availability of Medical Savings Accounts. 5. Encourage employer-defined contributions as opposed to employer-defined benefits. 6. Promote private ownership of all health insurance policies. 7. Support mandatory, community-rated catastrophic health insurance. 8. Require adequate funding mechanisms for the provision of government-mandated services.
In 2002, the SDCMS Council formulated a strategic plan to implement this Prescription for Change, a plan centered on four specific axes: 1. Improve Access to Health Care in San Diego 2. Improve the Quality of Health Care in San Diego 3. Improve Health Care Funding 4. Improve the San Diego Physician Workforce
Attorney Nicholas Roth explains the RICO lawsuit to physicians at Sharp-Chula Vista.
CMA CEO Jack Lewin, MD, speaks to the SDCMS Council/Delegation.
SDCMS Councilor Ben Medina, MD, and Rodrigo Muñoz, MD, in Sacramento with José Atilio Hernandez of the Border Health Commission.
SDCMS ADVOCACY: HEALTH CARE ACCESS SDCMS President Rodrigo Muñoz, MD, created a number of initiatives that address critical community needs, including the San Diego Mental Health Commission and the San Diego Committee on Aging (under Dilip Jeste, MD). SDCMS was highly influential in getting AB 3006 (a bill that repealed $1.6 billion in cuts to Medi-Cal providers) and AB 1833 (Maddy Fund Streamlining & Simplification) passed. Both of these bills will result in improved payments to physicians and better access to care for patients. SDCMS and CMA continued to fight in 2002 to defend MICRA, a 1975 California statute that limits non-economic damages in medical malpractice cases to $250,000 — which directly affect access to health care — as MICRA has been the single most significant factor in keeping California malpractice insurance rates under control, ensuring the average California physician pays $44,000 less than if he or she practiced medicine outside California. In September, the SDCMS Council voted to implement a $50 assessment for MICRA defense to ensure that your malpractice premiums don’t swell by thousands or even tens of thousands a year. SDCMS’ Emergency Medicine Oversight Committee, under the leadership of CMA Delegate Roneet Lev, MD, created emergency room (ER) bypass procedures that made a huge improveThe SDCMS Leadership and Support Teams at the 2002 Retreat.
ment in ER bypass hours. SDCMS Alliance and Aux As SDCMS president, Dr. Tijuana General Hospital Muñoz has gone a number of times to Family Centers, Scripps, the California Endowment, and the County HHS, requesting help to create a coalition that will support care for the indigent and the uninsured in north central San Diego. The key factor became the support of the California Endowment — to the tune of $260,000. For the first time, a coalition of interested parties will support a clinic for those unlikely to be helped in other places. The clinic is opening early this year. SDCMS Immediate Past President James Hay, MD, through the Blue Ribbon Task Force on Reshaping Health Care, created a consensus within our community on the direction San Diego’s health care system should take. This task force laid the groundwork for future collaboration between physicians and other major stakeholders such as the business community. SDCMS is recognized as a voice, and we have a seat at the San Diego table. Vern White, MD, and SDCMS Councilor Ben Medina, MD, represented the physician community on the Long-Term Care Integration Project, the goal of which is the creation of an overarching approach to funding and delivery of Medicare/Medi-Cal in San Diego County. SDCMS’ legislative advocacy in Sacramento was critical in incorporating reforms long sought after by CMA into the Medical Board of California. Our work with the Hispanic Caucus has been crucial to getting leverage in Sacramento. Both of these actions resulted in better working conditions for physicians and improved access for patients. We have re-organized and expanded the role of the SDCMS Foundation and positioned the Foundation for a significantly greater philanthropic role in future years. SDCMS was the convener of choice in 2002. We convened a summit with business community leaders, including CEOs from Sharp, Scripps, Children’s, UCSD, Kaiser, the VA, Balboa, the Community Clinics, the County HHSA, and senior business community members, who came together in April and formed the San Diego Healthcare Coalition (SDHC). We convened a meeting of all Specialty Societies in September, significantly bridging the gap between SDCMS and San Diego County Specialty Societies. SDCMS has greatly enhanced its voice at CMA with the election of James Hay, MD, as vice speaker of the CMA House of Delegates — the direct result of his talent and long track record as a leader and the superb teamwork at SDCMS.
At the end of the 2002 CMA House of Delegates, SDCMS Past President Bob Hertzka, MD, chair of CALPAC, announced his candidacy for president of CMA and — as of this writing — is unopposed.
xiliary members in front of with donations in August.
SDCMS ADVOCACY: HEALTH CARE QUALITY In the area of Quality, SDCMS has worked with the California Health Alliance (CHA), a non-profit, mutual-benefit corporation of the SDCMS, to develop various initiatives, including organizing the San Diego County Quality Conference in April and playing a significant role in the September UCSD RE-shaping Healthcare Conference, during which CHA Chief Medical Officer Stephen Carson, MD, hosted an entire section on quality. SDCMS Treasurer Carol Young, MD, continues to work on county-wide efforts on immunization, asthma, and diabetes — the three foci of the April San Diego County Quality Conference. Through our bioterrorism initiative, SDCMS is developing training, supply load-lists, protocols, and communication schema for individual physicians in the event of bioterrorism or natural disaster. SDCMS continued to work closely with the County Board of Supervisors, the Health Service Advisory Board, and the Council of Community Clinics to develop disaster preparedness solutions for solo and small group physicians and to advance County plans for a swift response to any bioterrorist attack on San Diego County.
SDCMS ADVOCACY: HEALTH CARE FINANCING In the area of Health Care Financing, SDCMS President-elect James Knight, MD, has been taking the SDCMS economic advocacy SDCMS Medical Student Councilor Erin Wanner takes applications from students at message directly to the top business UCSD Medical School in September. leaders and public decision makers. His top-down focus on highly leveraged education and advocacy is already paying dividends with the San Diego Chamber of Commerce. Consumer-directed health care will enable American businesses to get control of health benefit costs and provide employees incentives to consume health care services more cost effectively — part and parcel of the SDCMS agenda. The work of SDCMS Past President Bob Hertzka, MD, with the San Diego Regional Chamber of
Commerce — shaping the business response to the Health Care crisis — has been and will continue to be critical in educating the business community in San Diego County.
SDCMS CEO Tom Gehring explains the SDCMS value proposition to physicians at a Town Hall meeting.
SDCMS ADVOCACY: THE PHYSICIAN WORKFORCE In the area of the Physician Workforce, under the leadership of Past President David Priver, MD, and with the inspired work of our summer intern, Patricia Serrano, SDCMS resourced, developed, and executed a survey of the entire San Diego County physician workforce. SDCMS needed to document the depth and breadth of the impending physician crisis in San Diego County: • 35% of respondents are planning on leaving the practice of medicine in the next three to five years; • 39% of respondents indicated they would reduce patient hours in the next one to three years; • 67% of respondents are less satisfied in their practice today than they were five years ago; • 71% of respondents reported some or significant difficulty in recruiting new physicians. The workforce crisis in San Diego County is looming, and your medical society is actively working to address this crisis.
SDCMS Communications Chair James Grisolía, MD, speaks at the December press conference announcing the findings of the SDCMS Workforce Survey.
Internet. The California Health Alliance (CHA) continues to offer its value proposition of increasing membership and improving physicians’ lives and Stephen Carson, MD, James Hay, MD, Mrs. Tricia Hay, Mrs. Marcy Mazer, and Theodore Mazer, MD. patient care through business and technology solutions. CHA prescreens affiliate vendors that CREATING VALUE FOR OUR INDIVIDUAL have been selected for their commitment to offering San Diego County Medical PHYSICIAN MEMBERS Society members products and servMahatma Gandhi is quoted as saying, “We must become the ices that have the change we want to see.” SDCMS wholly abides by this philosophy potential to help by offering value to its membership and to their practices in the physicians improve areas of business, technology, and CME. patient care, In July, SDCMS put together and sent out a survey to our enhance the qualimembership, asking them what they wanted and needed from ty of office life, and increase earnings. SDCMS. More than 31% responded that they would like to use a coding hotline, which, through Physician Services, Inc., is already In 2002, CHA partnered with a benefit to membership in SDCMS. More than 26% responded Sterling Medical that they would like to use online eligibility verification of beneProducts for medfits, a service we provide our members through MedUnite. SDCMS President-elect, James Knight, MD, and SDCMS Treasurer ical supplies and SDCMS exists in part to bring to our membership solutions to Carol Young, MD, at an SDCMS Council Meeting. PAYCHEX for paypractice issues, and we are always open to your suggestions. roll and select HIPAA is a revolution in how almost all physicians will do human resources services. business. In November, SDCMS partnered with PrivaPlan to SDCMS is dramatically expanding our seminar and CME offer to our membership a comprehensive HIPAA compliance offerings. SDCMS offered several seminars in 2002, many with workshop at an affordable price — this as a direct result of the CME. With UCSD Extension, SDCMS is bringing more classes to nearly 40% of our membership survey respondents who indicated to us that they would like more training in HIPAA. its membership. With CMA, SDCMS brought reimbursement consultants to We have reached out to the military community by creating San Diego in October. — with the help of CMA — a special dues category for active We are continuing to expand the SDCMS Physician duty military physicians. Advocate Program and are completely reassessing our mix of vendors and services based on the results of the membership COMMUNICATING THE SDCMS STORY TO THE survey. In 2002, SDCMS created the SDCMS Tech Center, which PUBLIC, STAKEHOLDERS, AND PHYSICIANS offers a wide range of courses specifically designed for physicians and their office staffs. The courses range from how to use In 2002, the SDCMS communiPersonal cations team, led by James SDCMS Secretary Edgar Canada, MD, Rodrigo Muñoz, MD, chatting with Tony Linares, MD, and SDCMS Digital Grisolía, MD, has been instruat the 2002 Retreat. Past President Ralph Ocampo, MD, at the 2002 Retreat. Assistants mental in communicating your to training concerns to the public through on online television, radio, and print verification media. In 2002, we have on more than 60 occasions either of insurparticipated in or directly ance eligiauthored programs or articles bility and covering topics ranging from the medical current physician shortage in uses of the
AMA President-elect Don Palmisano, MD, and SDCMS Communications Chair James Grisolía at the 2002 Retreat.
San Diego County to California’s budget cuts and
their adverse effects on physicians and patients. In 2002, articles, op-ed pieces, and letters to the editor have appeared in The San Diego Union-Tribune, The Business Daily, San Diego Daily Transcript, North County Times, San Diego Business Journal, The Wall Street Journal, and others. In January, James Knight, MD, authored “Paying for What You Get”; James Hay, MD, authored “Palomar Crisis Is a Symptom”; Rodrigo Muñoz, MD, authored “Proposed California Budget Cuts Deep in the Heart of Health Care.” In March, Carol Young, MD, authored “The Real Message of John Q” and James Grisolía, MD, authored “Sticker Shock at the Pharmacy.” In May, James Knight, MD, authored “Higher Premiums Won’t Save Our Ailing Health Care System” and Rodrigo Muñoz, MD, authored “Parity or Parody: How Health Care Insurers Avoid Treating Mental Illness.” In August, James Grisolía, MD, and Ben Medina, MD, authored “Playing Politics With the Medicare Drug Benefit.” And in November, James Grisolía, MD, authored “Killing Medical Access for Seniors.” Topics ranging from the impending doctor shortage, medical malpractice, treating addiction, mental health and the marketplace for drugs, to toxic chocolate, body scans, the RICO lawsuit, and minorities and health care — along with many others — were covered over the year on television and radio. We instituted our bi-weekly fax UPDATE of important items for member physicians. We upgraded our website to make it more user-friendly and content rich. Rodrigo Muñoz, MD, chats with AMA Past President Stormy Johnson, MD, and APA Past President Harold Eist, MD, at the 2002 Retreat.
We revamped our banking Bob Moffit, MD, and SDCMS CEO Tom Gehring at the 2002 Retreat. and investment processes. We created over $85,000 in savings despite having to recapitalize in a number of areas. Our SDCMS database is significantly improved in content and process, permitting much improved analysis and decision making.
••• The San Diego County Medical Society is a vibrant organization with a vision: To return satisfaction to the practice of medicine for member physicians and their patients. We hope you can see the tangible and intangible benefits we have brought to our members. Please maintain your commitment to SDCMS and share this annual report with your non-member colleagues.
IMPROVING THE INFRASTRUCTURE TO SUPPORT MEMBERS AND LEADERSHIP SDCMS made dramatic improvements in our Information Technology Infrastructure in 2002. We developed detailed roles, responsibilities, metrics, and goals for the Support Team while reorganizing the Team to significantly improve customer orientation. We implemented fiscal controls and procedures.
SDCMS Past President James Hay, MD, accepts a gift for his tenure as president from SDCMS CEO Tom Gehring.
San Diego County Medical Society 3702 Ruffin Rd., Suite 206 San Diego, CA 92123 Telephone: (858) 565-8888 Fax: (858) 569-1334 E-mail: sdcms@sdcms.org Website: www.sdcms.org