2004

San Diego County Medical Society ANNUAL REPORT TO MEMBERS

2004

SDCMS Bylaws Changes

Medi-Cal Cuts Blocked

SDCMS Foundation Initiatives

Disaster Preparedness

Workers’ Compensation Reform Defending Scope of Practice

Message From the President irst and foremost, thank you for entrusting me with the office of president of the San Diego County Medical Society (SDCMS) in 2004. Colin Powell defines leadership as “the art of accomplishing more than the science of management says is possible.” As you will see in this, our 2004 annual report, your SDCMS leadership team was highly successful in accomplishing far more — both in Sacramento and locally — than merely managing the status quo.

In Sacramento SDCMS member physicians held strategic leadership positions in 2004 at the California Medical Association (CMA): Dr. Robert Hertzka as CMA president, Dr. James Hay as CMA vice speaker, and Drs. Theodore Mazer, James Grisolía, Catherine Moore, Carol Solomon, and myself as CMA trustees. These physicians along with our SDCMS Delegation to CMA and our Legislative Committee were able not only to influence but very often direct legislation coming out of Sacramento.

Locally, SDCMS leadership actively pursued an agenda of healthcare system reform in 2004 by regularly speaking with area hospital medical executives and general staffs, local and state politicians, area medical and law students, and many other healthcare stakeholders, including the San Diego Chamber of Commerce, the San Diego Hospice, and the Wye River Group on Healthcare.

In April 2004, SDCMS invited then-American Medical Association President Donald Palmisano, MD, to come to San Diego to deliver a message of unity and determination in reforming our healthcare system to local hospital medical staffs.

SDCMS continues its strong commitment to addressing those issues that affect our member physicians and the patients whom they serve within four broad categories: access to care, quality of care, healthcare financing, and physician workforce. We will continue to fight on your behalf in 2005 and beyond, advocating for you, the individual physician, and for all physicians. On behalf of your 2004 leadership team and staff, I thank you for your continued support!

F

HIPAA

MICRA Defense Medicare Reimbursement Rates Edgar D. Canada, MD, 2004 SDCMS President

SDCMS Foundation: The San Diego County Medical Society Foundation was re-organized in May of 2004 with the goal of broadening the impact and visibility of the good works that physicians provide to our community. The Foundation is addressing access-tocare issues in several ways: Retired Physicians Club: The Foundation has established a venue through the Retired Physicians Club whereby retired physicians can come together, learn more about our community’s needs, and connect with other retired physicians as well as community organizations that can benefit from their talents and skills.

Corps (MRC) with the purpose of strengthening communities by helping medical and public health volunteers offer their expertise throughout the year betes. The goal of this coalition, which as well as during times of community need. includes the County of San Diego, major Since San Diego County already utilizes the community clinics, UCSD, and others, is to Disaster Service Worker volunteer program, see every diabetic in San Diego County forming the MRC provides the perfect achieve regimen compliance for their disumbrella under which the volunteers can ease. expand their efforts. The County has partnered with SDCMS to develop the MRC strucMICRA: ture, recruit volunteers, and coordinate the SDCMS and CMA have led efforts to defend mobilization of these volunteers during a disthe Medical Injury Compensation Reform Act aster. John Hill, SDCMS director of disaster (MICRA) and, with AMA, to get a national preparedness, is the lead coordinator for the MICRA instituted. Many organizaMRC and attended the National MRC tions, spearheaded by the trial Conference on behalf of San Diego. To date lawyers, SDCMS has been working want to to develop a marketing weaken, strategy for the program MICRA IN 2005: if not and orientation trainings for overturn, new volunteers. Flu SDCMS and CMA will aggressively MICRA. Vaccine Shortage: After defend MICRA against a California CMA the announcement in Senate bill that threatens to raise the legal October 2004 that over 40 current $250,000 MICRA cap on nonadvocamillion doses of flu vaccine economic damages to more than cy prewould not be delivered to $900,000! vailed in those in the United States UCSD medical students at the Top Doctors Gala in October 2004, Palmer that had ordered it, SDCMS raising money for the UCSD, student-run free clinics, vs. leadership and the SDCMS along with Stephen Carson, MD (SDCMS Foundation Chief Medical Sharp Rees-Stealy Medical Group, GERM Commission were asked by the public Officer, third from left), and James Hay, MD (SDCMS Foundation President, third from right). an attempt to define medical groups health officer, Dr. Nancy Bowen, along with as not qualifying as “healthcare the Healthcare Association of San Diego and Free Clinics: The Foundation has begun to providers” under the law and as such as not Imperial Counties, the Council of Community raise funds for and distribute resources to being protected by MICRA. Clinics, Community Health Immunization the UCSD, student-run free clinics, which Partners, and other medical leaders, to parserve county residents who have no other Disaster Preparedness: ticipate in strategic meetings on how to option for care. County physicians as well SDCMS continued in 2004 in its ongoing ensure the available flu vaccine in San Diego may choose to donate a few hours of their efforts to educate physicians in disaster prebe re-distributed in order to reach the largest time per year to supervise and support the paredness issues, including: Medical number of high-risk persons. The group students in their clinics. Diabetes Coalition: Reserve Corps: In early 2004 the County of developed a very successful broker exchange The Foundation has become a partner with a San Diego was awarded an Office of Surgeon that was utilized by numerous physicians and major, countywide coalition to address diaGeneral grant to develop a Medical Reserve clinics.

ACCESS TO HEALTHCARE

The SDCMS GERM Commission: The SDCMS GERM Commission (Group to Eradicate Resistant Microorganisms) produced a number of educational materials in 2004 addressing infectious disease (flu and MRSA bulletins and a flu PSA that ran on San Diego-area radio stations) intended to educate and inform patients, physicians, and hospital ER and ID staffs. The SDCMS GERM Commission is a collaboration of County, Navy, UCSD, and private-sector representatives from each local hospital to help maintain community health and promote the distribution of information to

SDCMS Foundation: Through the participation and generosity of San Diego’s physicians, the SDCMS Foundation is making a conprevent or control serious disease outbreaks. siderable contribution to improving the lives of the citi“Top Doctors”: zens of San TOP DOCTORS IN 2005: SDCMS decided in 2004 to work Diego with San Diego Magazine to reCounty. The SDCMS will continue to solicit design the process for the selecFoundation is physician feedback in order to tion of San Diego County’s “Top addressing develop a process and outcome Doctors” (formerly “Best quality-ofthat is both fair and addresses Doctors”). The process as it existcare issues quality of care issues for San ed needed to be rehabilitated and in several Diego’s patients. controlled locally. ways:

QUALITY OF HEALTHCARE

Technology: The Foundation has partnered with the California Institute of Information Technology and Telecommunications to deliver comprehensive, “real-time” medical information to the point of patient care for all San Diego and Imperial County healthcare stakeholders. The project — SD Mine (San Diego Medical Information Network Exchange) — is being designed to yield measurable improvements in quality and patient safety for rural and urban community clinics, physician SDCMS Foundation workshop in the fall of 2004 to demonstrate the San Diego Medical Information Network Exchange (SD Mine) to physicians.

groups, and hospitals. This initiative will also focus on establishing electronic mechanisms to improve access to care and delivery of clinical information to the point of care for the underserved population of the county.

Consumer Health Education: Beginning with a focus on diabetes, the Foundation is producing health education information for San Diego’s inner-city residents. This information is being produced in the threshold languages of these communities and at a reading level that will allow patients to understand how to help themselves in their own disease management.

Scope of Practice: SDCMS’ and CMA’s hard work in 2004 either killed or significantly limited efforts by podiatrists (AB 932), dentists (SB 1336), and clinical social workers (SB 1853) to expand their scopes of practice. Orthopedists: AB 932 marks an instance in which a bill, with CMA starting out in full opposition, was successfully negotiated to the point where CMA was able to support the final version, which included amendments that increased the education and testing requirements in order for podiatrists to perform limited amputa-

tions, assist in surgical procedures, and perform foot, ankle, and tendon surgical procedures. Plastic Surgeons: CMA successfully lobbied for the vetoing of SB 1336 (with particular recognition going to SDCMS member physicians, Drs. Robert Hertzka and Susan Kaweski), a scope-of-practice bill that would have authorized oral and maxillofacial surgeons (dentists) to perform elective, facial cosmetic surgery. Psychiatrists: SB 1853 would have allowed clinical social workers to engage in the “diagnosis and treatment of mental, emotional, and behavioral disorders, conditions, and addictions.” This bill, though carried by Senate President Pro-Tempore Don Perata, was nonetheless defeated by CMA on the Assembly floor in the waning days of the legislative session.

Office Managers Forums: As a benefit to our members and their office staffs, SDCMS presented quarterly seminars on practice management topics of interest to physician office staffs, including OFFICE Medicare MANAGERS updates, forums on FORUMS employment IN 2005: law and on the latest SDCMS will continue its workers’ steadfast support of the compensaoffice staffs of its members tion reforms by providing free, quarterly as well as workshops and forums forums on around requested topics, how including preparing for the to HIPAA Security Rule. deal SCOPE OF PRACTICE IN 2005: with difficult patients and how to get paid.

SDCMS and CMA plan to fight Attendance by physicians and their further scope of practice assaults, office managers continues to grow as including psychologists’ efforts to see enacted they take advantage of the opportunia bill that would allow non-physician practitioners ty to network with those individuals to prescribe medication. who have similar interests and problems.

Disaster Preparedness: SDCMS continued in 2004 in its ongoing efforts to educate physicians in disaster preparedness issues, including Disaster Coordination and Communication: SDCMS has worked closely with the Health and Human Services Agency (HHSA) and Emergency Medical Services (EMS) to improve coordination of and communication to physicians and other clinical volunteers during disasters. Included in this was the HIPAA: development of an SDCMS Procedures SDCMS conducted a series of free — for Manual for the Department Operations members and their staffs — Health Center, where the SDCMS director of disaster Insurance Portability and Accountability Act preparedness will report during large-scale (HIPAA) workshops at hospitals throughout disasters and other community health emerthe county gencies. Health Resources and to assist Services Administration: physicians SDCMS is a core member of the and their San Diego County Health HIPAA IN 2005: office staffs Resources and Service in underAdministration (HRSA) Executive SDCMS will continue organizing and standing the Steering Committee and the conducting HIPAA-preparedness workimplications HRSA Workgroup. Both groups shops in 2005 to ready its members of the new worked diligently in 2004 to and their office staffs for the April 20, HIPAA develop plans and recommen2005, Security Rule compliance date.

Security dations on the best ways to Rule while regionally approach emergenoffering cies and to improve the pre“tools” for paredness of hospitals, clinics, physicians’ offices. and the community.

Physician Practice Investigations and Prescribing Guidelines (SB 1782): This bill marked a major step forward in protecting physicians from inappropriate law enforcement intrusion into the practice of medicine. This bill provides greater peace of mind to physicians practicing in pain management that they will not be unfairly targeted by law enforcement.

CMA’s Healthcare Financing Reform: In September 2004, the CMA Board of Trustees unanimously approved a new and innovative healthcare financing proposal that would provide meaningful healthcare coverage to more than half of the currently uninsured without any impact on state or federal

Tamper-resistant Prescription Forms: SDCMS negotiated a huge member benefit in 2004 to assist physicians in the purchase of tamper-resistant prescription forms.

With December 31, 2004, as the last date to

HEALTHCARE FINANCING

Dr. Robert Hertzka, longtime SDCMS member and 2003–2004 CMA president, speaking at the San Diego Rotary in 2004.

budgets.

RICO Lawsuit: In 2003 we secured Aetna’s and in 2004 CIGNA’s settlements in the RICO (Racketeering in Criminal Organizations) lawsuit. In 2004 as well, in an enormous victory for physicians, class status for more than 700,000 physician plaintiffs in the lawsuit

RICO LAWSUIT IN 2005: The case is set to go to trial, and SDCMS/CMA, with all appeals rejected in early 2005, will continue to pursue other managed care entities such as United Healthcare, Coventry, WellPoint, Humana Health Plans, Pacifica Health Systems, and Anthem Blue Cross. was upheld. Many physicians have collected several times their annual association dues payments from the CIGNA settlement alone.

All physicians are eligible for participation in the settlement.

HEALTHCARE FINANCING REFORM IN 2005: The challenge will be to work with private sector employers and others to build bi-partisan support for a proposal that will be a solid first step in addressing the current, alarming trends in healthcare financing. SDCMS will as well be convening a symposium in 2005 to discuss the next generation of healthcare, including health savings accounts and consumer-directed healthcare, with the goal of preparing stakeholders for this sea change. keeping physicians’ doors and clinics open to Medi-Cal beneficiaries, a huge win for CMA, all Medi-Cal providers, and their patients!

Workers’ Compensation Reform: As a result of SDCMS/CMA lobbying efforts, more than 90% of proposed reimbursement cuts to physicians were eliminated. In midApril 2004, CMA successfully headed off strong efforts by labor, business, and insurance interests to cut physician reimbursement and mandate a Medicare-based fee schedule. CMA also defeated unmanageable

WORKERS’ COMPENSATION IN 2005: As new workers’ compensation regulations are written, CMA will participate fully to ensure that the changes are evenhanded and that they do not hurt physicians or their patients.

billing requirements and an “economic credentialing” program that would have excluded physicians based on the cost of care that they authorize. CMA also won legislative Medi-Cal Cuts Blocked: support for the independent medical review In 2003 we stopped a 5% cut and in 2004 a process, which places treatment decisions 10% cut to Medi-Cal provider rates. In fact, in the hands of qualified physicians with all proposed appropriate clinical Medi-Cal knowledge, and the abiliMEDI-CAL IN 2005: provider rate ty to integrate treatment With state-wide budget cuts expected, cuts were of injured workers with CMA and SDCMS will continue to fight to eliminated, other healthcare services. guard against Medi-Cal provider rate cuts. thereby

MEMBER BENEFITS IN 2005: SDCMS will continue to expand its portfolio of benefits available exclusively to its members.

use triplicate prescription forms to prescribe Schedule II medications, SDCMS contracted with American Security Rx in the fall of 2004 to offer tamper-resistant prescription forms to SDCMS members at the best prices in California. Several physicians have joined the Medical Society to take advantage of this significant discount.

Medicare’s Geographic Practice Cost Indices: Until the system is made equitable, SDCMS and CMA will fight for fair Medicare reimbursements that now underpay San Diego County physicians 7% per annum. CMA’s Geographic Practice Cost Indices (GPCI) Committee voted overwhelmingly to send the Centers for Medicare and Medicaid Services (CMS) a statewide, all-county solution to the inequitable formula used to determine Medicare reimbursement rates within California. We are cautiously optimistic that this will result in correcting the long-standing reimbursement discrimination against San Diego County, and several other California counties, because of an inequitable countyby-county cost-of-living adjustment to Medicare rates, which of course impacts many other non-governmental reimbursements.

Dr. Susan Kaweski, SDCMS Legislative Committee chairperson, and Dr. ? at the CMA House of Delegates.

SDCMS Foundation: The Foundation is addressing physician workforce issues by supporting medical students in the area. The original Foundation was established in 1968 to offer and offers students the opportunity to travel loans to medical and paramedical students. with our physicians to Sacramento to meet The organization has, once again, begun to legislators and discuss healthcare issues. offer student loans as well as grants to UCSD medical students who exhibit themselves to Medical Staff Self-governance: be promising California State young physicians Senate Bill 1325 was of the future but a tremendous victory PHYSICIAN WORKFORCE have critical for CMA and for medIN 2005: financial need. ical staffs in The Foundation is California. This bill SDCMS will follow up on its also educating recognizes the rights 2002 physician workforce survey students on the and responsibilities of — “Is There a Doctor in the House? San importance of medical staffs and Diego’s Looming Physician Shortage” — governmental legclarifies their ability to by conducting another survey to evaluate islation and reguseek an injunction San Diego County trends with respect to its lation of the pracagainst hospitals if physician workforce. tice of medicine, the medical staff’s

independence is threatened.

In the face of opposition from hospitals, Governor Schwarzenegger ultimately signed the measure, delivering a huge victory for medical staffs throughout California.

PHYSICIAN WORKFORCE

n 2004 SDCMS continued its public relations push to be known by local media as the primary resource on healthcare matters in San Diego County. SDCMS was consistently contacted first by local print and broadcast outlets to deliver both original editorial content and experts on a myriad of healthcare topics.

I

Dr. Edgar Canada (second from right), 2004 SDCMS president, helping recruit UCSD medical students as SDCMS members.

SDCMS IN THE NEWS

The following op-ed articles were penned by SDCMS physicians and published in local print media: • In The San Diego Union-Tribune on April 20, 2004: “Is drug reimportation the answer?” by SDCMS Communications Committee Chairperson James S. Grisolía, MD, and Kathleen D. West; • In The San Diego Union-Tribune on May 26, 2004: “Health care costs: Don’t blame labor or business” by SDCMS President-elect Carol Young, MD; • In The San Diego Union-Tribune on October 26, 2004: “Emergency rooms are on life support” by SDCMS member and emergency room physician Roneet Lev, MD; • In The San Diego Union-Tribune on November 10, 2004: “Strong medicine needed for health care” by SDCMS member and CMA President Robert E. Hertzka, MD, and SDCMS Presidentelect Carol Young, MD.

The following articles were published in local print media with SDCMS physicians used as primary resources: • In San Diego Magazine’s January 2004 issue: “The Doctor Dilemma: More and more physicians are quitting practice in San Diego; fewer are coming in. Is this a prescription for disaster?”

• In the Navy Dispatch on January 8, 2004: “County medical society flu preparedness tips”; • In the Ramona Sentinel on January 8, 2004: “How to avoid catching the flu”; • In the Del Mar Times on January 16, 2004: “County Medical Society flu preparedness tips and FAQs”; • In The San Diego Union-Tribune on March 12, 2004: “Doctors push opposition to insurance law”; • In The San Diego Union-Tribune on March 15, 2004: “Doctors urge insurance for catastrophes: CMA struggles with ways to pay for health care”; • In The Carlsbad Sun on April 22, 2004: “San Diego Blood Bank Bloodmobile Makes Local Rounds”; • In The San Diego Union-Tribune on April 27, 2004: “Paperless prescriptions on horizon: Doctors to

transmit orders via computer”; • In The San Diego UnionTribune on September 10, 2004: “Health care costs bruise employers, workers alike”; • In San Diego Magazine’s October 2004 issue: “Top Doctors: To whom would your own doctor trust his or her family when it comes to medical care? Follow us.”

• In the North County Times on November 18, 2004: “Panelists say health insurance costs everyone’s responsibility.”

As for radio and television, SDCMS served as a primary resource for news stories at KPBS in 2004, including topics covering health insurance under the new administration and the future of healthcare, and for news stories by many local television stations, including KGTV, KUSI, XETV, KFMB, and KNSD on topics covering Medicare, Medi-Cal cuts, the ER crisis, the allergy season, the sex supplement controversy, hormone replacement options, website information on doctors, being “too clean,” herbal supplement dangers, the uninsured, and the flu vaccine shortage.

SDCMS Membership: In 2004 SDCMS not only maintained its membership numbers, it grew membership 4%, gaining one delegate seat

Ninety-nine new UCSD physicians joined SDCMS in 2004.

INFRASTRUCTURE membership and the communications team in increasing advertising revenue allowed SDCMS to exceed the budgeted net income and remain revenue positive. The support and dedication of our staff and physicians combined with our strong financial position put SDCMS in a strong, flexible position. Even amidst the tough economic times, our Medical Society is prepared to meet the needs of our member physicians.

(the elected body that is charged with the operation and strategic direction of the Medical Society). In 2005: Our goal will be to implement these bylaws changes in order to develop a streamlined and much more agile SDCMS leadership.

Sale of Building: Wanting to get out of the landlord business as it detracts from SDCMS’ staff’s job of delivering value to our member physicians, SDCMS went into escrow on the sale of its 3702 Ruffin Road property in 2004.

at CMA! At the close of 2004, SDCMS represents 2163 practicing physicians in San Diego County, increasing membership 101 physicians from 2003.

SDCMS MEMBERSHIP UCSD signed an addiIN 2005: SDCMS began the process of selling its 3702 Ruffin tional 99 physicians Road location in 2004, with plans to relocate sometime SDCMS’ goal for 2005 is to count 51% late in the year, bringin 2005. of the practicing physicians ing the total UCSD in San Diego County as members physician membership of the San Diego County Medical Society, up to 122. SDCMS [Balance sheets, Website: enabling it to continues to seek income stateBecause we are designing a 21st-century “speak for the majority of physicians ways to make memments, and state- website that will incorporate a myriad of in the county.” bership more benefiments of change membership, advocacy, and patient health cial to our county in financial positools and information, the launch of the new physicians. This comtion are available SDCMS website has had to be postponed bined with focused recruitment efforts and at any member’s written request.] until the first quarter of 2005. At that time, your individual support will result in a steady SDCMS members will not only have the abiliincrease in membership numbers, strengthBylaws Changes: ty to manage their memberships online in ening SDCMS’ position in San Diego County.

SDCMS members voted in 2004 to change real time, but they will as well have access to SDCMS bylaws principally in order to commany resources 24 hours a day, seven days Finances: bine the SDCMS Delegation (the elected body a week.

Fiscal year 2003–04 was strong for SDCMS. that annually represents SDCMS at the CMA Outstanding work by the staff in increasing House of Delegates) and the SDCMS Council

San Diego County Medical Society 3702 Ruffin Road, Suite 206 ❚ San Diego, CA 92123 Telephone: (858) 565-8888 ❚ Fax: (858) 569-1334 ❚ Email: sdcms@sdcms.org ❚ Website: www.sdcms.org