December 2008

official publication of the san diego county medical society • december 2008

SDCMS brings you and your staff

Physician-Centric goods and services

Discover Our endorsed Partners p.30 Attend Our 2009 Seminars and Events p.34 Be Sure to Take Advantage of Our Other Member Benefits p.36

Quality and Cross-cultural Healthcare p.26

Emerging Microbial Resistance in San Diego County p.34

“ P H YSI C IANS UNITED F OR A H EALT H Y SAN DIEGO ”

B

S A N D I E G O P H Y S I C I A N . o r g | O C T O B E R

2 0 0 8

O C T O B E R

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

1

Contents VOL. 95 | NO. 12 SDCMS brings you and your staff

Physician-Centric goods and services

[ F e a t u r e s ]

SDCMS Member Benefits:

26

Bringing You and Your Staff Physician-centric Goods and Services All Year Round

• Your SDCMS Support Team: Here to Help • Political Advocacy: Physicians Fighting Hard • SDCMS Member Benefits: Policies and Procedures • SDCMS’ Endorsed Partners: Members Save Time and Money • SDCMS’ 2009 Seminars/Webinars and Events • Take Advantage of SDCMS’ Other Members-only Benefits

[ D e p a r t m e n t s ]

4 6 8 10 12

Contributors

This Issue’s Contributing Writers

Editor’s Column

Palmetto and Other Problems

Community Healthcare Calendar Ask Your Physician Advocate Briefly Noted

New and Rejoining Members, and More …

2

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

18 20 24 40 44 2 0 0 8

Technology Matters XP5, Vista6, or Windows 7

Public Health

Flu Vaccine and Hand Washing

on leadership

Learn, Anticipate, and Adapt!

Physician Marketplace Classifieds

Medical Student Perspective From the Wards

dece m ber

2 0 0 8 |

S A N   D I E G O   P H Y S I C I A N . o r g

3

Contributors Harrison Bolter Mr. Bolter is the health information specialist for the County of San Diego Health and Human Services Agency’s Immunization Branch.

Matthew Brockwell Mr. Brockwell is a third-year medical student at the UC San Diego School of Medicine.

Tom gehring Mr. Gehring is CEO and executive director of the San Diego County Medical Society (SDCMS).

Marisol Gonzalez

Ms. Gonzalez is your SDCMS physician advocate. She can be reached at (858) 300-2783 or at

MGonzalez@SDCMS.org with any questions you may have about your practice or your membership.

Joseph E. Scherger, MD, MPH Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical director of AmeriChoice, which administers San Diego County Medical Services. Dr. Scherger, along with editing San Diego

Physician, is chair of the SDCMS Communications Committee.

Ofer Shimrat

Mr. Shimrat is founder and CEO of Soundoff Computing Corporation, a consultancy specializing in IT

products and services.

Send your letters to the editor to Editor@SDCMS.org

East County Director Hillcrest Director Kearny Mesa Director EDITOR MANAGING EDITOR

Joseph Scherger, MD, MPH Kyle Lewis

editorial board

Adam Dorin, MD Robert Peters, PhD, MD David Priver, MD Roderick Rapier, MD Joseph Scherger, MD, MPH

La Jolla Director North County Director South Bay Director At-large Director

Young Physician Director Resident physician director Retired Physician director MEDICAL Student Director

Published by

PRESIDENT PUBLISHER DIRector, BUSINESS DEVELOPment & MARKETING MARKETING & PRODUCTION manager

William Tseng, MD Woody Zeidman, MD Roneet Lev, MD Thomas McAfee, MD Adam Dorin, MD Sherry Franklin, MD Steven Poceta, MD Wayne Sun, MD James Schultz, MD Douglas Fenton, MD Arthur Blain, MD Vimal Nanavati, MD Anna Seydel, MD Jeffrey Leach, MD Robert Peters, PhD, MD David Priver, MD Wayne Iverson, MD Paul Kater, MD John Allen, MD Kevin Malone, MD Mihir Parikh, MD Kimberly Lovett, MD Glenn Kellogg, MD Geraldine Kang

Jim Fitzpatrick Maureen Sullivan Heather Back Jennifer Rohr

SDCMS EXECUTIVE COMMITTEE PRESIDENT president-elect past president secretary treasurer COMM. CHAIR DELEGATION CHAIR Board REP. Board REP. LEGIslative chair executive director

Stuart Cohen, MD, MPH Lisa Miller, MD Albert Ray, MD Robert Wailes, MD Susan Kaweski, MD Joseph Scherger, MD, MPH Jeffrey Leach, MD Sherry Franklin, MD Robert Peters, PhD, MD Robert Hertzka, MD Tom Gehring

SDCMS cma trustees

Theodore Mazer, MD Albert Ray, MD Robert Wailes, MD

OTHER cma trustees

Catherine Moore, MD Diana Shiba, MD

ama delegates alternate delegate

ACCOUNT EXECUTIVE PROJECT DESIGNER ADVERTISING ART DIRECTOR COPY EDITOR

James Hay, MD Robert Hertzka, MD Albert Ray, MD Lisa Miller, MD

Dari Pebdani Lisa Williams Geneen Montgomery Adam Elder

1450 Front Street • San Diego, CA 92101 • 619-230-9292 • Fax: 619-230-0493 • 800-600-CITY (2489) • www.sandiegomagazine.com Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to cpinfo@sandiegomag.com. San Diego Physician is published monthly on the first of the month.

Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

4

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

dece m ber

2 0 0 8 |

S A N   D I E G O   P H Y S I C I A N . o r g

5

Editor’s Column

By Joseph E. Scherger, MD, MPH

Palmetto and Other Problems Why You Need SDCMS and CMA

6

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

T

he Palmetto is the state tree of South Carolina, known for its large and nutritious leaf bud.

The palmetto bug is actually a cockroach, but don’t tell that to the people of Florida who allow them to coexist on their property. Saw palmetto is good for the prostate gland. But to the physicians of San Diego County and the rest of California, Palmetto is now a big problem.

Palmetto GBA is the new Medicare fiscal intermediary taking over this year from NHIC, and many physicians are not getting paid for their services. In large numbers, physicians are turning to SDCMS and CMA for help, and organized medicine is willing and able to help its members. Some physicians have recently joined SDCMS just in order to get help dealing with Palmetto. Membership has its benefits, yet sometimes it takes a crisis to remind physicians they are better off not being alone out there.

Executives of Palmetto GBA recently came to the CMA House of Delegates and apologized for all the problems. They agreed to work hard to fix the problems, and CMA and SDCMS will hold them accountable and be the source of current information. SDCMS continues to send out its e-newsletter, “News You Can Use” (to SDCMS members only), with the latest information. Members got answers to these 14 key problems: 1. I can’t get through to Palmetto GBA’s call center. When I do get through, I’m on hold for a long time.

2. Palmetto now has a message that allows us to go to voicemail and leave a request for a return call. It says we will get a call back within 24 to 48 hours. It has been two days, and I have not yet received a call.

3. I am trying to get a status of my enrollment application. Who do I call?

4. How do I get the status of my claims?

5. How do I know if checks have been issued, and how much is approved to pay once the payment floors have been reached?

6. I submitted my application to NHIC, and it still has not been completed. I am not getting paid.

7. How long will it take my enrollment application to be completed once I

submit it to Palmetto?

8. I still have not received my submitter password. I was previously submitting claims electronically to NHIC, so I am not new.

9. I am a new submitter to EDI. How long will it take for me to get my submitter number and password?

10. All of a sudden my claims are rejecting under message Y1C. Why? 11. How can I find out what issues Palmetto has had with the transition?

12. I haven’t been paid since Palmetto took over.

13. I am getting denial or rejects for services (procedure codes/modifier invalid) that NHIC used to pay.

Why? 14. My claims were going through with my NPI and PTAN before transition, and now they are not. Why? But dealing with Palmetto GBA is only one small reason to be a member of SDCMS and CMA. Any practice management concern is addressed to Marisol Gonzalez, your full-time SDCMS physician advocate. Marisol’s job is to help physicians succeed in practice. No expensive consulting fees. You and your staff may call as often as you like, and the service is concierge.

Your San Diego County delegation to the recent CMA House of Delegates (HOD) again demonstrated that we are the best county in California for organized

Every year, about 3,000 bills are introduced into the California Legislature. CMA looks at all of them and addresses every one that is health related in great detail. medicine. Led by Encinitas physician Jim Hay, the HOD spent three days addressing every conceivable issue facing medical practice. San Diego County physicians demonstrated reason and calm in the face of higher emotions elsewhere. We are the problem solvers and peacemakers, while still being innovative with issues such as soccer head protection and membership.

We shined by having the highest voluntary participation in CAL-PAC, CMA’s political action committee.

Every year, about 3,000 bills are introduced into the California Legislature.

CMA looks at all of them and addresses every one that is health related in great detail. Every year there is a bunch of bills from psychologists, nurses, podiatrists, optometrists, chiropractors, and every

CMA is the wall of defense of MICRA, and every year the trial lawyers test its strength. other nonphysician provider seeking to expand their scope of practice into practicing medicine. Every year CMA’s lobbying team beats these off. Frequently, these bills have strong personal interest among legislators, who learn the power of CMA. The centerpiece of California law for physicians is the MICRA protections of liability abuse. We continue to have affordable liability insurance in this expensive and litigious state due to MICRA. CMA is the wall of defense of MICRA, and every year the trial lawyers test its strength. We know the position on MICRA of every state legislator, and if it is not on our side, we help take them out of office whenever possible.

These are just some of the things your dues dollars are doing for you. SDCMS and CMA are a small investment compared with all the savings organized medicine provides to physicians in all practices, small, medium, and large. The discounts on various services alone more than pay for the dues. The work in Sacramento and with Palmetto is extra money in your pocket.

This is December, and if you have not done so already, go to www.SDCMS.org and pay your 2009 dues. We are “Physicians United for a Healthy San Diego.”

Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical director of AmeriChoice, which administers San Diego County Medical Services. Dr. Scherger, along with editing San Diego Physician, is chair of the SDCMS Communications Committee.

About the Author:

dece m ber

2 0 0 8 |

SDCMS Palmetto Success Stories Success Story #1: Right after the transition from NHIC to Palmetto, one of our member hematology oncology groups began to have “delay of payment” reimbursement issues with Palmetto. This delay of payment had a severe impact on their practice, and they were worried that they were going to be forced to admit patients to a hospital for treatment as it became increasingly costprohibitive to provide the care they needed in their office.

SDCMS and CMA were able to review the check amounts with Palmetto, including those claims that were to be released after the 14-day payment floor (CMS mandatory hold). We were able to get this practice’s claims released for payment, as well as provide them with the status of their “pending amounts” (claims that need to be manually processed and are within the required payment period).

Success Story #2: A solo member physician was having difficulty getting his enrollment application through Palmetto’s system. He had submitted his application long before the intermediary transition. His billing company wasn’t able to begin billing for him due to this problem. After several unsuccessful attempts to get a status on his application with Palmetto’s provider enrollment, he called SDCMS for assistance.

SDCMS and CMA were able to get his enrollment application expedited through Palmetto’s system. The billing company is now successfully billing claims for this physician.

S A N D I E G O P H Y S I C I A N . o r g

7

Community Healthcare Calendar

DIAGNOSIS AND TREATMENT OF VITAMIN D DEFICIENCY SEMINAR Dec. 2 at the Liebow Auditorium, UCSD. Visit http://grassrootshealth.org/events/seminars.php.

other health professionals in delivering quality care for the older person. Feb. 25–28 at the Catamaran Resort Hotel. Visit http://cme.ucsd. edu/geriatricpsych.

2008 UPDATE IN RHEUMATOLOGY

THE FUTURE OF GENOMIC MEDICINE II

Dec. 6 at the Rebecca and John Moores UCSD Cancer Center, Goldberg Auditorium. Visit http:// cme.ucsd.edu/rheumatology/index.html.

Examines the salient progress and challenges in the field of genomics. Feb. 27–28 at the Neurosciences Institute Auditorium, Scripps Research Institute, La Jolla. Contact (858) 652-5486 or med.edu@scrippshealth.org.

tion, ergonomics, and environmental pollution.

Apr. 26–29 at the Manchester Hyatt Hotel in San Diego. Visit www.acoem.org.

ESSENTIAL TOPICS IN PEDIATRICS 2009

ANESTHESIA UPDATE 2009 State-of-the-art elements in all the anesthesia subspecialties and important new problems and their solutions. Jan. 14–17 at the Kona Kai Resort, San Diego. Visit http://anes-som.ucsd.edu/update1.htm.

Natural Supplements: An Evidence-based Update Practical information for healthcare professionals who make nutritional recommendations or manage dietary supplement use. Jan. 22-25 at the Paradise Point Resort and Spa, San Diego.

Contact (858) 652-5486 or med.edu@scrippshealth.org.

MELANOMA 2009: 19TH ANNUAL CUTANEOUS MALIGNANCY UPDATE Designed for healthcare professionals with an interest in, and basic understanding of, skin cancer.

Jan. 24 at the Omni San Diego. Contact (858) 652-5486 or med.edu@scrippshealth.org.

UPDATE IN UROLOGY 2008 Physicians in the field of oncology, surgery, and urology encouraged to attend this informational conference. Feb. 20–21 at The Lodge at Torrey Pines, La Jolla. Visit http://cme.ucsd.edu/events. cfm for details.

8

TOPICS AND ADVANCES IN INTERNAL MEDICINE Topics include neoplastic diseases, rheumatology, geriatrics, infectious diseases, and hospital medicine, among others. Mar. 5–11 at the Hilton San Diego Resort. Visit http://cme.ucsd.edu/ internalmed/index2.html.

PERCUTANEOUS CATHETER ABLATION OF ATRIAL FIBRILLATION Directed at those interested in incorporating percutaneous catheter ablation into their clinical management of patients with atrial fibrillation.

Mar. 7 at the Hilton La Jolla Torrey Pines. Contact (858) 652-5400 or med.edu@scrippshealth.org.

May 14-15 at the Catamaran Resort Hotel. Visit http://cme.ucsd.edu/events.cfm.

2009 American Thoracic Society International Conference Educational program for clinicians and researchers in adult and pediatric pulmonary, critical care, and sleep medicine. Sample a broad spectrum of topics or concentrate on critical care, sleep, allergy/immunology or other specialties related to respiratory medicine. May 15–20. Visit www. thoracic.org.

ALZHEIMER’S DISEASE: UPDATE ON RESEARCH, TREATMENT, AND CARE May 21–22 at the Omni San Diego Hotel. Visit http://cme.ucsd.edu/events.cfm.

Riverside County Medical Association: 5th Annual “Cruisin’ Thru CME” (Eastern Mediterranean) Jul. 6–17. Call (800) 745-7545.

ADVANCES IN THE NEUROPSYCHOLOGICAL ASSESMENT AND TREATMENT OF SCHOOL-AGED CHILDREN WITH COGNITIVE DEFICITS Presentation of the latest findings on the assessment and remediation of cognitive and behavioral impairments in school-aged children. Apr. 2–5 at the Hilton San Diego Resort. Visit http://cme.ucsd. edu/neuro.

2ND ANNUAL SUDDEN CARDIAC ARREST Apr. 25–26 at the Hilton San Diego Resort. Visit www.scripps.org/health-education.

WEST COAST GERIATRIC PSYCHIATRY CONFERENCE

AMERICAN OCCUPATIONAL HEALTH CONFERENCE 2009

Up-to-date, clinically relevant information to assist psychiatrists, primary care physicians, and

Topics include occupational medicine/research, infectious disease, toxicology, workers’ compensa-

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

20TH ANNUAL CORONARY INTERVENTIONS Oct. 28–30 at the Hilton La Jolla Torrey Pines.

Visit www.scripps.org/health-education.

To submit a community healthcare event for possible publication, email KLewis@SDCMS.org.

All events should be physicianfocused and should take place in San Diego County.

dece m ber 2 0 0 8 |

S A N   D I E G O   P H Y S I C I A N . o r g

9

Ask Your Physician Advocate

By Marisol Gonzalez

• Professional Courtesy •

• Threatening Patients • • License Renewal • Your Physician Advocate Has the Answers!

Q

uestion: I have a patient who happens to be a physician and who is Medicare insured. Can I extend a professional courtesy to them for services?

Answer: Under federal law, “professional courtesy” is broadly defined as “the provision of free or discounted healthcare items or services to a physician, his or her immediate family members, or office staff.” That said, professional courtesy offered by an entity (such as a solo practice, partnership, or medical

corporation) to a physician, a physician’s immediate family member, or physician’s office staff would not constitute an improper referral under the federal prohibition if the following six requirements were met: 1. The professional courtesy is offered to all physicians on the entity’s bona fide medical staff (i.e., physician recipient’s office staff) or the entity’s local community or service area without regard to the volume of referrals or other business generated

between the parties; 2. The professional courtesy includes only those services regularly offered by the practice; 3. The professional courtesy policy is set out in writing and approved in advance by the entity’s governing body; 4. The professional courtesy is not offered to a physician (or immediate family member) who is a federal healthcare program beneficiary, unless there has been a good-faith showing of financial need (presumably this requirement also includes office staff); and 5. The arrangement does not violate the anti-kickback statute or any federal or state law or regulation governing billing or claims submission.

It is very difficult for physicians to provide any professional courtesy services to a physician-patient who is a Medicare beneficiary without violating the law. For further information on this topic, SDCMS member physicians may obtain CMA ON-CALL document #0624, “Professional Courtesy,” free of charge from the San Diego County Medical Society.

Q

uestion: A patient of mine has stopped taking their medication, and, due to some violent history in their past, they may be a threat to their family. I want to warn the family of this, but the patient has not allowed me to do so. What can I do?

Answer: According to CMA ONCALL document #0815, “Physician’s Duty to Warn,” in Tarasoff V. Regents of the UC (1976), the California Supreme Court held that when a psychotherapist determines, or,

Does Your Office Manager Have a Question Too? Lauren Wendler, your SDCMS office manager advocate, is on staff and ready to help your office manager with any questions he or she may have. Feel free to contact Lauren at (858) 300-2782 or at LWendler@SDCMS.org for help.

10

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Rosenberg, Spall_SD Phy(1)_508:Layout 1

in accordance with the standard of care, should determine that a patient presents a serious danger of violence to another person, the psychotherapist has a duty to use reasonable care to protect the intended victim from the danger. Other healthcare providers are similarly subject to certain duties to warn and protect. This ON-CALL document goes on to talk about these instances as well as other situations. Physician members can contact the San Diego County Medical Society to obtain this ON-CALL document free of charge.

6/10/08

Abo u t t h e A u t ho r : Ms. Gonzalez is your SDCMS physician advocate.

She can be reached at (858) 300-2783 or at MGonzalez@SDCMS.org with any questions you may have about your practice or your membership.

Page 1

If your medical license or privileges are on the line‌

Rosenberg, Shpall & Associates, APLC A P R O F E S S I O N A L L A W C O R P O R AT I O N

Members Of The Firm: David Rosenberg, J.D. Tomas A. Shpall, J.D. Annette Farnaes, J.D. Steven H. Zeigen, J.D. Corey Marco, M.D, J.D. Jason L. Nienberg, J.D. Amy C. Lea, J.D.

Q

uestion: My medical license has expired, and I was never notified by the Medical Board of California. What can I do?

Answer: The license to practice medicine in California must be renewed every two years. It is illegal to practice medicine with an expired license. The license expires at midnight of the expiration date, which is the last day of the physician’s birth month. To renew a license, the physician must apply on or before the expiration date. The renewal must be on the Medical Board’s renewal form and must include the current renewal fee.

Please allow 4–8 weeks for processing.

If a renewal notice is not received, the license must still be renewed before the expiration date on the license.

If you have not submitted your renewal notice within two weeks of the expiration date, you may submit it to the following address: Medical Board of California 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815 (916) 263-2637 You may also renew online at www. mbc.ca.gov — click on the “Licensees� tab then scroll down and click on the “License Renewal� hyperlink.

3:21 PM

Wells Fargo Bank Plaza 401 “B� Street, Suite 2209 San Diego, California 92101 Telephone: (619) 232-1826 Facsimile: (619) 232- 1859 Email: RSALAW@yahoo.com

• More than 50 years of combined experience in Medical License/Hospital Privilege Disputes • Medical Board accusations • Hospital privilege disputes • Wrongful termination • Civil actions/Independent counsel for medical malpractice claims • Provider Membership Disputes/Exclusion • Medical Corporations/Partnership Formation/Disputes Allscripts_SDP_08:Layout 1

10/15/08

11:54 AM

Page 1

Announcing Allscripts as a Preferred Vendor of the San Diego County Medical Society Allscripts is pleased to announce that it will offer preferred pricing to SDCMS members on the award winning Allscripts Professional Practice Management and Electronic Health Records solution.

This integrated PM and EHR solution offers state of the art technology that includes: t $PNQMFUF XPSL GMPX NBOBHFNFOU t 1 1 DMJOJDBM BOE GJOBODJBM SFQPSUJOH t "EWBODFE 4DIFEVMJOH t $PNQSFIFOTJWF $MBJNT NBOBHFNFOU

t & QSFTDSJCJOH XJUI GPSNVMBSJFT t &MFDUSPOJD PSEFST BOE SFTVMUT t "VUPNBUFE )FBMUI .BJOUFOBODF t 0OMJOF 1BUJFOU 1PSUBM

For more information please contact Jamie Smolin at 619.955.6929 or at jamie.smolin@allscripts.com. Visit us online at www.allscripts.com

dece m ber

2 0 0 8 |

S A N   D I E G O   P H Y S I C I A N . o r g

11

Noted

Risk Tip Emergencies: Are You Prepared?

I

By The Doctors Company

t is easy to ignore the need to plan ahead for emergencies, but you are putting your patients and your staff at risk when there has been no preparation to handle these challenging events.

Chances are, upon close inspection of your offices, you will discover there are certain areas — whether it is equipment, supplies, or training — that could use improvements. While it is neither possible to anticipate every contingency nor practical and affordable to put every conceivable precautionary measure in place, it takes relatively little time and effort to predict the most likely problems and institute basic reaction plans.

Ask yourself the following questions: Are you and your staff ready to respond quickly and efficiently if a child collapses in your waiting room? What would you do if a patient undergoing a routine pro-

12

December stat

y l f e i r B

cedure went into cardiac arrest? When was the last time your office carried out a fire drill, or even discussed what to do in case of fire?

Untoward events take many different forms, but a uniform basic approach can be used to plan for all of them. Consider the following steps: • Identify potential crises.

• Decide which to prepare for.

• Develop basic contingency plans.

• Procure needed resources.

• Train staff to carry out the plans and reinforce the training with periodic drills.

Always remember: If an unexpected event involves injuries to patients or staff members, the immediate priority and focus should be on clinically treating and emotionally supporting those individuals.

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

One in seven (14%) Americans report that they “saw” and “used” comparative health quality information for health insurance plans, hospitals, or doctors in the past year … down from roughly one in five in both 2006 (20%) and 2004 (19%).

— Kaiser Family Foundation 2008 Update on Consumers’ Views of Patient Safety and Quality Information

MILLION (UMANA MEMBERS NEEDING A PHYSICIAN

(UMANA EMPLOYEES MAKING IT EASY FOR YOU TO TREAT THEM

*OIN THE (UMANA NETWORK AND l ND OUT HOW EASY WE ARE TO WORK WITH 7E OFFER YOU s %LECTRONIC CLAIMS l LING TO HELP YOU GET PAID MORE QUICKLY s ! NATIONAL NETWORK WITH STRONG LOCAL REGIONAL AND NATIONAL RESOURCES s 2ESOURCES n LIKE 3MART3UMMARY AND 0HYSICIAN &INDER 0LUS n TO HELP MEMBERS MAKE INFORMED HEALTH INSURANCE CHOICES s 3PECIAL CLINICAL SERVICES AND PROGRAMS TO SUPPORT YOUR TREATMENT PLAN 3-

n'ROUP HEALTH n-EDICARE n)NDIVIDUAL HEALTH n$ENTAL ,IFE 6ISION

3MARTER CONSUMERS ARE EASIER TO WORK WITH 3O ARE SMARTER INSURANCE COMPANIES 4O l ND OUT MORE GO TO (UMANA COM 0ROVIDERS '#! ".(( dece m ber

2 0 0 8 |

S A N   D I E G O   P H Y S I C I A N . o r g

13

Noted

Daniel “Stony” Anderson, MD, Receives Volunteer Award For Access Orange County and Project Access San Diego Work

D

aniel S. Anderson, MD, received the Volunteer Award at the inaugural Molina Healthcare of California Community Champions Awards dinner. Dr. Anderson was among 10 of San Diego’s unsung heroes who were honored at the event.

Molina Healthcare Community Champions Awards was created in 2006 to recognize individuals in the community who inspire others through selflessness and extraordinary service. Each year, Community Champions are nominated by community-based organizations and celebrated at a dinner in honor of Molina Healthcare’s physician founder, C. David Molina, MD. “The champions all share a common vision: to help those in our community who are the most vulnerable,” said Lisa Rubino, president of Molina Healthcare of California.

Dr. Anderson, a gastroenterologist, a retired partner of Southern California Permanente Medical Group, and a retired member of the San Diego County Medical Society (SDCMS), remains ac-

14

December Quotes

y l f e i r B

tive as a volunteer in the community and as a champion for safety-net patients and for access to specialty care.

As a leader in the San Diego County Medical Society Foundation (SDCMSF), he has been instrumental in implementing Project Access San Diego and the county’s first Surgery Day, to be held December 6, 2008. SDCMSF is partnering with Kaiser Permanente to provide up to 20 free surgeries for San Diego County patients who do not have health insurance and who fall within 250 percent of the federal poverty level. Dr. Anderson’s passion and collaboration will enable prescreened, indigent patients to receive services that they might not otherwise be able to afford.

As the Volunteer Award winner for the Molina Healthcare Champions, Dr. Anderson received a check for $1,000 to be donated to the charity of his choice.

SDCMSF would like to thank Dr. Anderson for donating his award to the Foundation in support of its Project Access San Diego. Congratulations!

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

“

The holiest of holidays are those kept by ourselves in silence and apart; the secret anniversaries of the heart.

”

— Henry Wadsworth Longfellow, American Poet (1807–1882)

“

In the depth of winter, I finally learned that within me there lay an invincible summer.

”

— Albert Camus, French Author, Philosopher, Journalist, and 1957 Nobel Prize Laureate (1913–1960)

“

Adversity draws men together and produces beauty and harmony in life’s relationships, just as the cold of winter produces ice flowers on the windowpanes, which vanish with the warmth.

”

— Soren Kierkegaard, Danish Philosopher and Theologian (1813–1855)

James Dunford, MD, Honored as Physician Volunteer of the Year

work in building teams that have successfully translated cutting-edge scientific advances in heart attack, stroke, and AKT_SDP_08:Layout 1 8/22/08 3:52 PM Page 1 cardiac arrest into everyday care here in San Diego,” Dr. Dunford said when notified of the honor. “The American Heart Association has helped me realize a regional cardiac receiving system for STEMI, a regional public access to defibrillation program for cardiac ar-

rests, and a soon-to-be regional stroke system,” he explained, adding, “In turn, these regional successes have been amplified to the state level where our best local practices are now being emulated.”

Dr. Dunford is medical director for the City of San Diego, a UCSD emergency physician, and longtime member of the San Diego County Medical Society. Congratulations, Dr. Dunford!

By the American Heart Association

J

ames V. Dunford, MD, board president of the San Diego Division of the American Heart Association, has been honored as the American Heart Association’s 2008 Physician Volunteer of the Year, an award that honors the physician volunteer who demonstrates the most dis-

Personal: • Income Tax Planning • Wealth Management • Financial Planning tinguished commitment to the mission of the American Heart Association and who shows outstanding achievement in advancing the objectives of the Western States Affiliate during the year and over time.

Dr. Dunford is a leading advocate for improving patient quality of care. His work is most evident through his local leadership as a STEMI and Stroke Champion, including his involvement with the ST Elevation Heart Attack (STEMI) Medical Oversight Committee and the San Diego County Stroke Committee that is nearing the rollout of improved stroke destination protocols.

“The thing I am most proud of is our

Local: • Employee Benefit Plans • Profitability Reviews • Outsourced professional services (CFO, Controller)

Ron Mitchell, CPA Director of Health Services rmitchell@aktcpa.com 760-431-8440

Global: • Organizational Structure • Succession Planning • Internal Control Review and Risk Assessment 5946 Priestly Drive, Ste. 200 Carlsbad, CA 92008

dece m ber

2 0 0 8 |

CPA’s and Consultants

S A N D I E G O P H Y S I C I A N . o r g

15

y l f e i r B

Noted

Joel David Myers, DO • Surgery Fallbrook, (760) 728-4597

Welcome New and Rejoining SDCMS-CMA Members!

New Members Rashad Abdel-Kader Ansari, MD • Rheumatology • Internal Medicine Vista, (760) 724-6100 Kevin Neil Antonio, MD • Internal Medicine San Diego, (858) 499-2703 Akash Bajaj, MD • Pain Medicine • Anesthesiology San Diego, (858) 581-8255 Lauren Denise Bales, MD • Obstetrics and Gynecology San Diego, (858) 277-9378 Julie Lynn Barone, DO • Surgery San Diego Robert Angelo Bei, MD • Emergency Medicine San Diego, (619) 287-3270 Mark Robert Bell, MD • Emergency Medicine San Diego, (619) 287-3270 Ratana Grace Bhardwaj, MD • Diagnostic Radiology San Diego, (858) 454-4235 Jason Patrick Bronner, MD • Internal Medicine La Jolla, (858) 657-6848 Brian Vuong Tran Chu, MD • Pediatrics San Diego, (619) 662-5122 Christina Youngmo Chung, MD • Surgery San Diego Jessica Michelle Coullahan, MD • Pediatrics San Diego, (858) 566-4444

16

Gabriela Moreno DiLauro, MD • Obstetrics and Gynecology Escondido, (760) 745-7060

Roya Kohani, MD • Internal Medicine La Jolla, (858) 459-2040

Luis Aristides Fiallo, MD • Internal Medicine • Pulmonary Disease • Critical Care Medicine Chula Vista, (619) 421-4000

Jan Kulhanek, MD • Internal Medicine • Cardiovascular Disease La Jolla, (858) 457-1234

Amy Colleen French, MD • Obstetrics and Gynecology San Diego, (858) 277-9378 Jonathan S. Gallen, MD • Anesthesiology Poway, (858) 444-5781

Hiten K. Lakhani, MD • Ophthalmology San Diego, (858) 442-1634 Thomas Edward Lawrie, MD • Internal Medicine • Pulmonary Disease • Critical Care Medicine San Diego, (858) 939-3366

Paulo Guillinta, MD • Internal Medicine • Cardiovascular Disease San Diego, (858) 939-6561

Lillian Catherine Lee, MD • Ophthalmology Poway, (858) 451-8600

Stephen Bradford Hulse, MD • Diagnostic Radiology San Diego, (858) 454-4235

Agnes Deborah Letai, MD • Emergency Medicine San Diego, (619) 287-3270

Michael Brian Jacobson, MD • Pediatrics El Cajon, (619) 442-2560

Martin Wayne Lunceford, DO • General Practice Camp Pendleton, (760) 763-1831

David Alexander Kaminskas, MD • Internal Medicine • Cardiovascular Disease • Neurology Del Mar, (858) 353-6049

Ronald James MacCormick, MD • Emergency Medicine Encinitas, (760) 230-2252

Radmila Kazanegra, MD • Obstetrics and Gynecology Escondido, (760) 745-7060 Katrina Lynn Kelly, MD • Obstetrics and Gynecology Encinitas, (760) 753-5594 Shafi M. Khalid, MD • Internal Medicine • Geriatric Medicine • Pain Medicine Poway, (858) 485-7246

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

Joel Eduardo Mata, MD • Anesthesiology San Diego, (858) 874-0033 John Paul McHugh, MD • Obstetrics and Gynecology San Diego, (619) 675-4071 Chetan Amritlal Mistry, MD • Pediatrics Chula Vista, (619) 426-7910 Anthony Paul Morocco, MD • Emergency Medicine • Medical Toxicology San Diego, (619) 287-3270

2 0 0 8

David Keith Naugle, MD • Diagnostic Radiology San Diego, (858) 454-4235 Rahul Ramesh Patel, MD • Diagnostic Radiology San Diego, (858) 454-4235 Sayjal Jitendra Patel, MD • Ophthalmology Carlsbad, (619) 532-6702 Tony Huy Pham, MD • Ophthalmology San Diego, (619) 298-2733 Harold Giovanni Pimenta, MD • Diagnostic Radiology San Diego, (858) 454-4235 Valencia Booth Porter, MD • Public Health • General Preventive Medicine Carlsbad, (760) 494-1600 Ghazala Amjad Rehan, MD • Psychiatry Encinitas, (760) 753-7341 Sunny Renee Richley, MD • Internal Medicine San Diego, (858) 288-7705 Parag R. Sanghvi MD • Radiation Oncology San Diego, (619) 230-0400 Andrew Ira Schwartz, DO • Family Medicine • Osteo Manipulative Medicine • Sports Medicine San Diego Geoffrey Feher Sternlieb, MD • Psychiatry San Diego, (619) 785-5943 Christopher William Sterrett, MD • Emergency Medicine San Diego, (619) 287-3270 Jo Ann Lee Stewart, MD • Internal Medicine • Geriatric Medicine La Jolla, (858) 554-6158 Reza Hakimzadeh Tirgari, MD • Internal Medicine San Diego, (619) 287-3270

Kelly Leighanne Van Den Heuvel, MD • Obstetrics and Gynecology San Diego, (619) 688-0770

Kevin Michael Kelly, MD • Emergency Medicine San Diego, (619) 287-3270 Herbert Clifford Kimmons, MD • Pediatrics San Diego, (858) 966-8567

Timothy Scott Watt, MD • Emergency Medicine San Diego, (858) 939-3411

Tom Christopher Lian, MD • Psychiatry San Diego, (619) 220-8114

Daniel Ethan Zelac, MD • Dermatology La Jolla, (858) 764-3000

Rejoining Members Faith H. Barnett, MD • Neurological Surgery La Jolla, (858) 554-8920 Enrique Espinosa-Melendez, MD • Internal Medicine • Nephrology National City, (619) 477-7779 James Robert Hemp, MD • Cardiac Surgery • Thoracic and Vascular Surgery San Diego, (619) 297-5600

Nathan Arthur Miller, MD • Anesthesiology • Pain Medicine Carlsbad, (760) 753-7127 Jonathan Nissanoff, MD • Orthopedic Surgery Poway, (858) 451-2280 William J. Padilla, MD • Family Medicine Chula Vista, (619) 422-1324

PR 4 ES 5% O LD

!

Paul Jeffrey Rickards, MD • Diagnostic Radiology • Vascular and Interventional Radiology Bressi_Urban West_SDP_08:Layout 11/17/08 1:49 PM San1Diego, (858) 454-4235

Page 1

Build Equity with Ownership!

PR 4 ES 5% O LD

!

• Attractively designed two story 20,000 SF Class “A” medical office building • Flexible floor plans and suite sizes from 1,500 SF • Adjacent to Tri-City Hospital’s new Wellness Center • Abundant parking - 5/1,000 SF • Fronting El Camino Real • Access to the fastest growing North County markets - Carlsbad & San Marcos (SANDAG 2020 Population Growth Forecast of nearly 75,000 more residents) • Expected completion: Q2 2009 • Please call for pricing & availability

1000 Aviara Parkway, Suite 100, Carlsbad, CA 92011 p | 760.431.4200 f | 760.454.3869 | www.brecommercial.com Aric Starck | 760.431.4211 | astarck@bre.com

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

17

Technology Matters

XP 6 Vista

By Ofer Shimrat

5

Windows7 Perception vs. Reality

or

C

omputers and effective computing are an integral part of any successful medical practice. Like any good tool, proper use of computers can greatly enhance business processes, while improper computing practices can adversely affect the overall well-being of any practice regardless of its size. This issue of San Diego Physician launches a new monthly column that

18

will analyze information technology, examine computing trends, and recommend best practices. We welcome your questions or comments at Editor@SDCMS.org.

Windows 7, wryly named as such more for the historical sequence of Windows versions than for any brilliant marketing campaign, is out but only in “pre-beta

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

build” — an industry term that denotes “in testing” and not quite ready for commercial use. It was delivered to software developers and industry pundits at the 2008 Microsoft Professional Developers Conference held at the Los Angeles Convention Center on October 27-30.

It is already having an impact on the information technology (IT) landscape.

Businesses of all sizes are eagerly awaiting more details about Windows 7 features, how it works with their existing software applications, and what the hardware requirements will be.

With the less-than-favorable coverage on Windows Vista — known as Windows 6 — perception is larger than reality, leading observers to conclude that Microsoft wishes to release Windows 7 sooner rather than later. Rumored release dates vary wildly, but knowledgeable sources hint at somewhere between the third quarter of 2009 and the first quarter of 2010. Interest is so high in Windows 7 that industry watchdogs like the Corporate IT Forum (TIF) report that more businesses are currently investigating or analyzing updating to Windows 7 (30 percent) rather than updating to Windows Vista (14 percent).

But wait, some of you just went out and outfitted your offices with Windows Vista. You were told that your older hardware did not have sufficient horsepower to handle Vista and that you needed all new equipment, which you faithfully went out and purchased.

And now Windows 7 will be out ... a new operating system so soon? How can that be?

Let’s go back in time, shall we? Microsoft Windows XP — known as Windows 5 — was released in October 2001. You read right: seven years ago.

Windows XP has gone through numerous patches and three service pack updates. It is a very stable operating system still in use by approximately 75 percent of businesses in the United States.

Windows Vista was released in January 2007, which represents a five-year gap between operating system releases. It has also gone through numerous patches

and one service pack update. With new hardware, it is a stable operating system currently in use by approximately 10 percent of businesses in the United States.

In other words, Microsoft’s sevenyear old operating system is in use by 75 percent of businesses, and its two-yearold operating system is in use by only 10 percent of businesses — not what you would call an enthusiastic adoption rate.

The slow Vista adoption rate has caused Microsoft to vow that there will never again be so lengthy a gap between its operating system versions.

My take is that Windows XP has been around long enough and is stable enough that the slow Vista adoption rate CS_SDP_08:Layout 1 8/15/08 10:16 AM Page has more to do with the lack of business requirement to move to Vista than any pre-defined artificial gap between operating systems. You and I know that, but Microsoft wants to “fix” that with its

7 as soon as it is released in a store near early release of Windows 7. you. As I am a beta tester, I will probably But as “fixes” go, this is a good fix. be analyzing Windows 8. So I may not Based on all the fanfare at the Octobe in line with you. ber Microsoft Professional Developers Conference, Windows 7 promises to be faster, simpler, and easier to implement.

Good news for all of us.

The bottom line: • Those of you still utilizing Windows Abo u t the A u t ho r : Mr. XP should consider skipping WinShimrat is founder and CEO of Soundoff dows Vista entirely and continue Computing Corporation, a consultancy to amortize your existing hardware. specializing in IT products and services.

Then switch to all new equipment Originally an applications developer, he and systems once Windows 7 arbrings database methodology approaches rives. to network implementations. Mr. Shimrat • Those of you who recently made the combines practical experience as a thrice new hardware investments for Winbusiness owner with best practices in prodows Vista should stay put since an viding organizations with needs analyupcoming service pack 2 will fursis, business logistics, IT infrastructure, 1 Project3:Layout 1 10/9/08 11:45 AM Page 1 ther improve on core functions and and proactive maintenance. Visit www. speed. soundoffcomputing.com or reach Ofer at Then there are those of you on the cut(858) 569-0300. ting edge that will want to stand in line until midnight and purchase Windows

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

19

From the County Public Health Officer

Flu Vaccine

HandComplementary Washing Tactics

By Harrison Bolter

I

n much of the United States, influenza season is again underway.

The Centers for Disease Control and Prevention (CDC) estimates that every year 5–20 percent of the U.S. population gets this very contagious and potentially life-threatening illness. Influenza can worsen chronic heart disease, lung disease, and diabetes, and can lead to bacterial or viral pneumonia. CDC estimates that as many as 200,000 persons will be hospitalized because of flurelated complications, and up to 36,000 people will die from flu.

Influenza Vaccine as Primary Tactic to Reduce Influenza Incidence

Yearly influenza vaccination is the best way to help protect against this disease.

Influenza vaccine is recommended to all persons who want to reduce the risk of becoming ill with influenza or of trans-

20

and

in the Fight Against Influenza

mitting influenza to others. Up to 146 million doses of vaccine will be available from currently licensed manufacturers in the United States, so plenty of vaccine will be available this influenza season.

The groups for which vaccination with inactivated influenza vaccine (TIV) is recommended are listed below: • all persons aged ≥50 years; • all children aged ≥6 months to 18 years of age (new recommendation this year); (Children aged 6 months–8 years who have not been vaccinated with influenza vaccine or only received one dose previously have special recommendations.

Please see MMWR Recommendations and Reports, Aug. 8, 2008: Prevention and Control of Influenza, Vol. 57, RR-7, pp. 26–27 for the current recommendations.); • women who will be pregnant dur-

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

ing the influenza season (NOTE: California law prohibits flu vaccine with >1mcg mercury per 0.5mL for pregnant women or children under 3 years old); • children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk for Reye syndrome after influenza infection; • adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus); • adults and children who have immunosuppression (including immunosuppression caused by medications or HIV); • adults and children who have any condition (e.g., cognitive dysfunc-

tion, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions, or that can increase the risk for aspiration; and, • r esidents of nursing homes and other chronic-care facilities.

It is estimated that that some bacteria and viruses can live from up to 20 minutes to two hours or more on surfaces like doorknobs, desks, and cafeteria tables.

To prevent transmission to persons identified above, vaccination with TIV or LAIV (live, attenuated influenza vaccine) also is recommended for the following persons: •h ealthy household contacts (including children) and caregivers of children aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and •h ealthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

All healthcare professionals (HCPs), as well as those in training for healthcare professions, should be vaccinated annually against influenza. This includes: •p hysicians, nurses, and other workers in both hospital and outpatientcare settings; •m edical emergency response workers (e.g., paramedics and emergency medical technicians); and • e mployees of nursing home and chronic care facilities who have contact with patients or residents.

HCPs are asked to remind their patients that the flu season often lasts until spring, and therefore getting immunized against the flu in December, January, or later is not too late. And, as indicated above, vaccine supply is not an issue this year.

Both inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV) are contraindicated in persons with life-threatening allergies to eggs, severe allergy to any vaccine

component, or who have had a severe reaction to a previous dose, including Guillain-Barre Syndrome of influenza vaccine. Additionally, the LAIV (nasal spray) should only be given to healthy persons 2–49 years of age who are not pregnant.

There are a number of myths about the flu vaccine that providers are encouraged to dispel. Three of the most common are: 1. The vaccine causes illness; 2. The patient feels he or she is not at risk for influenza; and 3. The vaccine doesn’t work.

Each of these myths can be debunked with facts.

1. Influenza vaccine, made either with killed (TIV) or weakened live (LAIV) influenza virus, is unable to cause significant illness. Any illness that follows influenza immunization is either not influenza (many other respiratory diseases are circulating among the population at any given time) or a different strain of influenza not contained in the vaccine.

2. Influenza is highly contagious, and the CDC estimates that every year, between 5 and 20 percent of the U.S. population becomes ill with it. Many of those who get influenza are otherwise healthy people, not frail or chronically ill. Tens of millions of people get sick each year from influenza.

3. The vaccine has been intensively studied and is effective in preventing influenza in most people, or at least greatly reducing its severity.

Even some protection against influenza is better than no protection at all.

Proper Hand Hygiene Is a Complementary Tactic

The practice of hand washing (hand hygiene) is another simple but powerful tactic to help control the spread of flu and other contagious diseases, not just during flu season, but all year long.

December 7–13, 2008, is National Hand Washing Awareness Week (an observance to encourage hand washing in promoting health and preventing disease) and a good time to emphasize the im-

D E C E M B E R

2 0 0 8 |

portance of hand washing as a tool in flu prevention campaigns. Thorough hand washing, done regularly with plenty of soap and warm water, can help reduce the spread of contagious diseases such as influenza, as well as colds, hepatitis A, meningitis, and norovirus. Hand washing can also play an important role in maintaining overall good health, especially when combined with other behaviors such as getting enough sleep; exercising regularly; and eating a healthy, balanced diet with plenty of fresh fruits and vegetables.

Unfortunately, observation indicates that hand washing may not be as widely practiced as it should be. In a 2005 survey (sponsored by the American Society for Microbiology and the Soap and Detergent Association), 91 percent of adults said they always wash their hands after using public restrooms; however, just 83 percent were observed doing so. The survey reported that Americans who said they “always wash their hands” after using the bathroom in their home (83 percent) and before handling or eating foods (77 percent) was reported. However, smaller percentages of Americans always wash after petting a dog or cat (42 percent), after coughing or sneezing (32 percent), or after handling money (21 percent).

It is estimated that some bacteria and viruses can live from up to 20 minutes to two hours or more on surfaces like doorknobs, desks, and cafeteria tables. The logical conclusion is that poor hand washing (or a lack of hand washing) plays a factor in the spread of contagious diseases like influenza and others.

Influenza A (H3N2) viruses, which have been associated with higher mortality, predominated in 90 percent of influenza seasons during 1990– 1999, compared with 57 percent of seasons during 1976–1990.

Hand washing is most effective at reducing the chances of getting and spreading disease if it is done properly and often — especially after using the restroom, before preparing food and eating, and anytime the hands get dirty. The following are tips physicians and other health professionals

S A N D I E G O P H Y S I C I A N . o r g

21

can use to inform their patients about proper and thorough hand washing and related prevention steps: 1. Wet hands with warm running water.

2. Apply liquid or clean bar soap.

3. Away from the running water, rub hands together vigorously and make a soapy lather. Scrub all surfaces — the front, the back, between the fingers, under your fingernails, and around the wrists. Take about 15–20 seconds; a fast splashing does not remove germs.

4. The soap and scrubbing action dislodges the germs.

5. Rinse well under warm running water to remove the germs and dry hands with a clean towel. Turn off the water with a paper towel.

6. The paper towel should be thrown in a wastebasket when finished.

7. Keep your hands away from your eyes, nose, and mouth.

8. Avoid touching surfaces that are constantly being touched by others.

If soap and running water are not available, hand-wash gels containing at least 60 percent alcohol significantly reduce the numbers of germs on skin and are fastacting. Some hand-wash gels also contain ingredients to moisturize the skin.

Adults and children should be advised not to sneeze or cough into their bare hands, but to use a tissue (and dispose of it immediately) or their sleeve, whenever

Yearly influenza vaccination is best way to help protect against this disease. possible, and to avoid putting their fingers into their eyes, nose, or mouth.

Healthcare professionals as well as the general public benefit from proper and frequent hand washing. Studies have shown that proper hand washing (hand hygiene) is the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of healthcare-associated infections. However, research also has shown that hand hygiene practices in healthcare personnel may be less than optimal. A 2004 Annals of Internal Medicine

22

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

San Diego County Statistics • Rates of serious illness and death from influenza and its complications are highest among persons aged ≥65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for complications of influenza (1).

• Influenza A (H3N2) viruses, which have been associated with higher mortality, predominated in 90 percent of influenza seasons during 1990–1999, compared with 57 percent of seasons during 1976–1990 (2).

article indicated that physicians’ adherence to hand hygiene was low in most hospitals.

Developing a positive attitude about hand hygiene by healthcare staff is important to promote these behaviors in patients.

Increased acceptance and use of influenza immunization, in combination with proper hand washing technique, gives communities the potential to prevent Kindred_Physician_Dec08:Layout transmission of influenza and reduce mor-3

bidity and mortality for those at highest risk of complications from the disease.

Mr. Bolter is the health information specialist for the County of San Diego Health and Human Services Agency’s Immunization Branch.

Abo u t t h e A u t ho r :

11/19/07

3:16 PM

Page 1

To request additional health statistics describing health behaviors, diseases, and injuries for specific populations, health trends and comparisons to national targets, please call the County’s Community Health Statistics Unit at (619) 285-6479. To access the latest data and data links, including the Community Regional Profiles, go to www.sdhealthstatistics.com.

References: 1. CDC, MMWR Recommendations and Reports, Vol. 56, RR-6, Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007, pp. 1–2.

2. Ibid., p. 5.

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

23

On Leadership soundly in a battle they should not have lost? Why did the Japanese lose all four of their large flattops, while the Americans lost only one of their three aircraft carriers?

As physicians — and almost all of our readers are — you’re probably asking yourself why in the heck this is relevant to you. I want you to think about three principles when you are faced with difficult decisions in your practices: the principles of learn, anticipate, and adapt.

Learn, (about the past) Anticipate, (the future) and Adapt (in the present) Principles to Lead By

By Tom Gehring

M

y love of history, and in particular military history, started as a serving naval officer. Why, I asked, is success routine for some organizations and failure routine for others?

I recently read a very detailed analysis of the Battle of Midway, one of the most important naval battles in both U.S. and Japanese histories. The Battle of Midway, which was fought in the early days of June 1942, occurred at a time when Japan, with its superior naval capacities, could choose when and where to attack.

They decided to attack the Midway atoll, the next step on their way to Hawaii. The Japanese invasion fleet was escorted by

24

the cream of their carrier aviation. The Americans, forewarned by cryptologists’ breakthroughs, surprised and ambushed the Japanese fleet, and thereby stopped the domination of the Japanese Navy.

After Midway, the two opposing fleets were essentially equals, and the United States soon took the offensive.

The authors examined the battle strictly from the perspective of the Japanese.

Though they did provide fascinating details, the authors focused their analysis on a fundamental question: Why was an organization, i.e., the Imperial Japanese Navy, which, after Pearl Harbor, ran unchecked the length and breadth of the Pacific and Indian oceans, defeated so

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Learn From the Past Those who do not understand and learn from history are doomed to repeat it — a principle as applicable in medicine as it is in business, warfare, and politics. But the principle demands more than rote memorization of the events of the past.

The seeds of defeat (and victory) are often planted many, many years in the past, when an organization or an individual learns the wrong (or right) lessons based on an honest and thoughtful assessment of what went wrong and what went right. Physicians are taught this kind of thinking, sometimes brutally, at morbidity and mortality conferences. I would suggest that you take this concept outside of the hospital, the operating room, and the exam room, and apply it in your daily decisions and strategic thinking. What did I learn from this mistake? What went wrong with this contract? Why? Why? Why? Anticipate the Future

Regretfully, life does not come with a crystal ball. However, an honest and forthright assessment of future possibilities is mandatory for an organization as well as for an individual. This is really about creating a spectrum of options for the future, assessing relative probabilities and risks to these possibilities, and then planning for the likeliest and/or riskiest of these possibilities. One cannot plan for everything, but only a fool assumes that his competitors (or enemies) will do what he thinks they should. In the late ’80s, many physicians hopped on board the managed-care bandwagon, hoping (wrongly as it turned out) that signing

contracts that reduced rates in exchange for volume would not turn into a financial death spiral. The Japanese Navy, in the early summer of 1942, planned to take Midway, having assumed that the three remaining American carriers in the Pacific would be nowhere to be found.

Interestingly, during the Japanese prebattle war game, the officers assigned to emulate the Americans performed exactly as the Americans did one month later. The Japanese admiral supervising the war game deliberately and blatantly disregarded this harbinger of disaster.

Likewise, many of the people who work for you, if allowed to speak up, will point out that perhaps your rosy vision of the future is disconnected from reality.

tury Prussian military thinker, who said there were no American carriers nearby. (paraphrasing) that no plan ever survives If you’re paying attention to even the subtlest signals that tell you your plan first contact with the enemy. Even if you isn’t, in fact, as effective as you thought, learned your lesson from the past, even then you can and should change it — if you properly anticipated the future, adapt to current realities. you still need to recognize that you have Think about, analyze, and learn from to change your plans based on the reality the past. Anticipate what the future of the moment, not the wishful thinking could look like, develop your plans acthat went into these plans. Physicians are cordingly, and be ready to change those trained to do this, and this is one of the plans when things don’t turn out exactly great strengths of a doctor in a clinical environment. However, in business or the way you thought they might. political environments, physicians must become as fluid in adapting to different realities as they are in adapting in the operating room.

Abo u t t h e A u t ho r : Mr. GehOn June 4, 1942, no one in the Japaring is CEO and executive director of the nese leadership noted that the torpedo San Diego County Medical Society (SDHMB_SDP_08:Layout 1 9/11/08 11:15 AM Page bombers 1 swarming their fleet could only CMS). be carried on American flattops, thereby Adapt to Changes in the Present disproving the underlying assumption of no American carriers. The Japanese My father was fond of quoting Carl von Project4:Layout 1 9/22/08 11:22 AM Page 1 plans continued to operate as though Clausewitz, the early nineteenth cen-

Time Well Spent?

Tracy Zweig Associates A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants Choose Allscripts Enterprise EHR Powered by CHMB Solutions CHMB Solutions Delivers Business, Clinical & Technology Solutions to Physician Practices • Serving over 600 physicians • IT Services & Maintenance • Tier 3-level secured hosted servers • Billing & Revenue Cycle Management

www.chmbsolutions.com

The industry leader in electronic medical records technology • Award-winning software to fit your practice • Ability to customize to any level or specialty • Cost-effective ASP platform

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

t z we i g @ t r a c y z we i g . c o m www. t r a c y z we i g . c o m

800.727.5662

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

25

SDCMS Members-only Benefits

Your SDCMS S We're Here to Help!

Tom Gehring

Chief Executive Officer Executive Director T: (858) 565-8597 (desk) T: (619) 206-8282 (cell) F: (858) 569-1334 W: Gehring@SDCMS.org Contact Tom should you have questions about what SDCMS is doing locally, in Sacramento, and in Washington, DC, on the political advocacy front, or if you have general questions, complaints, or concerns about what SDCMS is doing or can do for you as a San Diego County physician.

James Beaubeaux Chief Operations Officer Chief Financial Officer

T: (858) 300-2788 (desk) T: (619) 851-1235 (cell) F: (858) 569-1334 E: Beaubeaux@SDCMS.org Contact James should you have questions about SDCMS finances and operations.

Kyle Lewis

Director of Communications and Marketing Managing Editor T: (858) 300-2784 (desk) T: (619) 991-9242 (cell) F: (858) 569-1334 E: KLewis@SDCMS.org Contact Kyle should you have questions about San Diego Physician magazine, SDCMS’ email newsletter (“News You Can Use”), SDCMS’ website, or our annual pictorial membership directory. Contact Kyle as well should you like to be contacted by San Diego County media for your expertise in certain medical issues, should you like to place a classified ad (free of charge for member physicians) or display ad (discounted for member physicians) in San Diego Physician magazine.

26

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Janet Lockett Director of Membership Development

T: (858) 300-2778 F: (858) 569-1334 E: JLockett@SDCMS.org Contact Janet should you have questions about your SDCMS membership benefits, as well as if you have ideas or suggestions as to how SDCMS can increase the value of your membership and thus serve you better.

Support Team Lauren Wendler Office Manager Advocate

T: (858) 300-2782 F: (858) 569-1334 E: LWendler@SDCMS.org Your office manager can contact Lauren should they have questions about SDCMS’ regularly scheduled office manager forums, if they would like to sign up to receive the office manager e-newsletter, or should they need assistance with coding, billing, legal, compliance, or any other issue they are facing.

Jennipher Ohmstede Director of Engagement

T: (858) 300-2781 F: (858) 569-1334 E: JOhmstede@SDCMS.org Contact Jen should you have questions about SDCMS committees and leadership, CMA councils and committees, SDCMS events, or how you can become more involved with your San Diego County Medical Society.

Marisol Gonzalez

Director of Membership Operations and Physician Advocate T: (858) 300-2783 F: (858) 569-1334 E: MGonzalez@SDCMS.org Contact Marisol should you have questions about your SDCMS membership status or dues, if you need to change or update your contact information, or if you need assistance with any political, legal, or economic advocacy issue you’re facing.

Dareen Nasser Office Manager

T: (858) 300-2786 F: (858) 569-1334 E: DNasser@SDCMS.org Contact Dareen to request a mailing list and labels, to receive SDCMS’ e-newsletter (“News You Can Use”), to order additional copies of the SDCMS pictorial membership directory, or should you have any questions pertaining to SDCMS.

Karen Dotson

Specialty Society Advocate T: (858) 300-2787 F: (858) 569-1334 E: KDotson@SDCMS.org Contact Karen to learn how SDCMS can work with your specialty society to lower operational costs through economies of scale.

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

27

SDCMS Members-only Benefits

Political Advocacy Physicians Fighting Hard!

H

undreds of California physicians convened in Sacramento this past October for the 2008 House of Delegates, the California Medical Association’s annual meeting. Each year, physicians from all 53 California counties, representing all modes of practice, meet to discuss issues related to healthcare policy, medicine, and patient care.

The following is but a partial list of action priorities adopted by this year’s House, with “Balance Billing” receiving the highest priority. This partial list only hints at the breadth and depth of the nearly 100 issues that the member physicians of the California Medical Association will be actively addressing in 2009 in order to protect and defend all physicians and their patients in California.

• Balance Billing • Pre-authorization for Diagnostic Testing • Economic Profiling and Pay-for-Performance • Payment for Services of Non-contracted Physicians • Disclosure of Health Insurance Payment Recipients • Support for Non-contracted Physicians • State Vaccine Registry Interfaces • Elimination of Medicare TAR Program • Medicare Part B Contractor Changes • Definition of Abortion and Access to Contraception • Internet Submission of Medicare Claims • Payor Fee Schedules and Medicare Rates • Performance of History and Physical by a Podiatrist • Scope of Practice in Licensed Health Facilities • MRSA Active Surveillance Testing • Influenza Vaccine Distribution • Disposal of Unused Pharmaceuticals • Full Payment for Medicare Recipients’ Care • Medi-Cal Managed Care Drug Coverage • Public Service Message on Impact of Medicare Cuts

28

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

ww

Happy Holidays

From Your SDCMS and SDCMS Foundation Support Teams!

Back Row, Left to Right: Tana Lorah, Kyle Lewis, Janet Lockett, Lauren Wendler, Lee Forrester, Kitty Bailey, James Beaubeaux Middle Row, Left to Right: Dareen Nasser, Karen Dotson, Marisol Gonzalez, Brenda Salcedo, Barbara Rodriguez, Jennipher Ohmstede Front: Tom Gehring

Join

SDCMS

online today!

ww.SDCMS.org www.SDCMS.org www.SDCMS.org www.SDCMS.org www.SDCMS.org dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

29

SDCMS Members-only Benefits

Bringing You and Your Staff

Physician-centric Goods and Services

Member Benefits Policies and Procedures

W

e at the San Diego Medical Society (SDCMS) have standardized our processes and procedures for selecting those companies with which we choose to partner to bring to you and your staff those physician-centric goods and services that you have indicated you want.

SDCMS intends to keep you, our member physicians, first and foremost in all decisionmaking when it comes to selecting benefits partners. To that end, we have implemented the following policies and procedures:

• Negotiations: SDCMS will negotiate

with all potential benefits partners to acquire the best possible deals for our members.

• Benefits Accrue to Members: All contracts will be entered into with the expressed understanding that all financial gain will accrue to SDCMS’ member physicians and not to SDCMS. • Member Discrimination: SDCMS members will receive a better value or a lower cost of goods and services than nonmembers.

• Ease for Member: Little or no work will be required by SDCMS members to take advantage of any and all benefits partners’ goods and services.

• Standardized Vetting: Benefits partners must have current SDCMS members as customers. SDCMS member feedback will be solicited to ascertain acceptable benefits partners. SDCMS member feedback will be reviewed annually. Benefits partners will be asked for proof of solvency. Ben-

efits partners’ local Better Business Bureau membership status will be queried.

• Market Segment Discrimination:

Market segments will be identified using mode-of-practice data, and goods and services will be identified for each segment, with the intent of offering comprehensive benefits for each of our member market segments.

• Feedback and Tracking: A feedback tracking system will be implemented for both benefits partners and SDCMS members in order to provide benefit dollar values to SDCMS members. SDCMS members and benefits partners will be routinely surveyed to gauge SDCMS member satisfaction with benefits partners.

partner ben • Choice: SDCMS members will, when-

ever possible, be given a choice of benefits partners, i.e., SDCMS will not normally enter into exclusive relationships.

• Member Input: Goods and services SDCMS members want and need will be identified and prioritized using secondary research, focus groups, one-on-one interviews, and surveys.

30

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

If you would like to suggest any other policies or procedures, or a specific SDCMS member benefit, please contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@ SDCMS.org.

Take Advantage of Your SDCMS Endorsed Partner Benefits!

Insurance Products and Services SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive discounts on a comprehensive portfolio of insurance products and services, including savings of 5–10 percent or more off the cost of insurance, or cash rebates related to practice size, a savings of 7–12 percent on long-term disability income protection, and no-cost human resources consulting.

Contract Analysis and Revenue Optimization

ABOUT OUR ENDORSED PARTNER Alliant Insurance Services, Inc., is California’s largest, premier specialty insurance broker, ranking among the 13th largest in the United States.

ENDORSED PARTNER CONTACT INFORMATION Contact Mark Allan, first vice president, at (800) 654-4609 or at mallan@alliantinsurance.com. Contact Alliant Insurance Services at (888) 849-1337 or online at www. alliantinsurance.com.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $1,000–$2,500

Professional Liability Insurance SDCMS MEMBERS-ONLY BENEFIT Besides giving SDCMS members a 5 percent discount on their professional liability insurance, The Doctors Company has just lowered its premium rates, effective January 1, 2009, an average of 14.5 percent. As well, claims free credits of 12.5 percent for primary care and 17.5 percent for surgical specialties are in addition to the premium reductions.

ABOUT OUR ENDORSED PARTNER The Doctors Company is fiercely committed to advancing, protecting, and rewarding the practice of good medicine. With $3 billion in assets, 43,000+ members, an A- rating (excellent)

by A.M. Best Company, and an A (Strong) by Fitch Ratings, we are the nation’s leading physician-owned medical liability insurer. To learn more about our aggressive claims defense, superior financial and organizational strength, and unrivaled financial rewards, visit www.thedoctors.com.

nefits

SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive a free contracting analysis, a discount on hourly rates, and a package price on services for contract negotiations, including health plan contracts.

ABOUT OUR ENDORSED PARTNER Coastal Healthcare Consulting Group, Inc., is a specialty consulting firm that assists clients with managed care contracting, health plan contract negotiations, physician credentialing, revenue optimization, and strategic planning. Coastal Healthcare helps physicians increase net revenue and streamline business administration by reevaluating their health plan contracts. After a complete contract review, Coastal Healthcare provides a strategic plan to renegotiate or terminate health plan contracts. By implementing the plan, most practices realize a four-fold return on investment within one year of service.

ENDORSED PARTNER CONTACT INFORMATION Contact Kim Fenton, president, at (949) 481-9066 or at KimF@ Healthcareconsultant.org, or visit www.healthcareconsultant.org for more information.

SDCMS CONTACT INFORMATION For consultation scheduling, contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@SDCMS.org.

POTENTIAL VALUE: 10% OR MORE IMPROVEMENT IN NET REVENUE

ENDORSED PARTNER CONTACT INFORMATION To learn more, contact Bob DeSimone at (858) 452-2986 or at bdesimone@tdia.com, or contact Mark Allan at Alliant Insurance Services at (800) 654-4609 or at mallan@alliantinsurance. com.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $500–$2,500

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

31

SDCMS Members-only Benefits

Billing Solutions SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive a 50 percent discount on startup fees and a $33 per-physician-per-month services credit, 10 percent off of outsourced IT support, 10 percent off of already discounted Dell hardware solutions, and a free coding hotline.

ABOUT OUR ENDORSED PARTNER CHMB Solutions provides outsourced medical billing, revenue cycle management services, information technology support and hardware solutions to physician practices, clinics, and multispecialty organizations.

ENDORSED PARTNER CONTACT INFORMATION Contact Ron Anderson at (760) 520-1340 or at randerson@chmbsolutions.com. Email your coding question(s) to SDCMS at Coding@SDCMS.org.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $1,000

Banking Products and Services SDCMS MEMBERS-ONLY BENEFIT Approved SDCMS members receive no-fee lines of credit, $1,000 fee discounts on commercial real estate loans, waived monthly maintenance fees on personal accounts for practice partners and employees up to $10/month, free first order of standard checks for personal accounts, increased deposit interest rates, waived monthly maintenance fee for business online banking and bill pay services, ATM fees waived up to $15/month, and free courier service or remote deposit service.

ABOUT OUR ENDORSED PARTNER Torrey Pines Bank is familiar with the business challenges facing medical professionals. Its goal is to be a “low-maintenance” bank, meeting business owners’ high expectations, with the absolute minimum time and effort required of them. The bank offers a full array of banking services.

ENDORSED PARTNER CONTACT INFORMATION Contact Benjamin Pimentel at (858) 259-5317 or at bpimentel@torreypinesbank.com.

Collections Services SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive a 10 percent discount on monthly charges.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $2,500

ABOUT OUR ENDORSED PARTNER TSC Accounts Receivable Solutions has provided personalized, innovative collection and total accounts management services since 1992. This local, San Diego family-owned business management team has combined experience of more than 50 years in the healthcare billing and collection field. TSC now provides its clients with 24/7 online access to their accounts portfolio.

ENDORSED PARTNER CONTACT INFORMATION Contact Catherine Sherman at (888) 687-4240, ext. 14, or at csherman@tscarsolutions.com. Visit TSC online at www. tscarsolutions.com.

partner ben SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $350–$500

32

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Accounting Services SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive a 15 percent discount on standard rates for professional services, with an unconditional satisfaction guarantee: “SDCMS members who are not completely satisfied with the work AKT performs for them pay only what they thought the work was worth.”

Information Technology SDCMS MEMBERS-ONLY BENEFIT Free site inspection and subsequent infrastructure recommendations. Free inventory and assessment of network and hardware computing assets. Free analysis of Internet/telco/data activity and subsequent ROI recommendations.

ABOUT OUR ENDORSED PARTNER AKT CPAs and business consulting LLP has provided audit, tax preparation and planning, accounting assistance, and business consulting to San Diego County clients for more than 50 years. AKT understands physician practices, and their personal, local, and global services can help you achieve success.

ABOUT OUR ENDORSED PARTNER Soundoff Computing Corporation provides best-of-breed hardware/software/network technologies for your practice, and utilizes best practices for all aspects of IT implementations, including needs analysis, network design, installation, electronic medical systems, backups, security, proactive maintenance, training, and support. Soundoff Computing Corporation recommends and refines computing infrastructure solutions that will handle present and future requirements as your practice grows and matures.

ENDORSED PARTNER CONTACT INFORMATION Contact Ron Mitchell at (760) 268-0212 or at rmitchell@aktcpa.com.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

ENDORSED PARTNER CONTACT INFORMATION Visit www.soundoffcomputing.com or contact Ofer Shimrat at (858) 569-0300 or at ofer@soundoffcomputing.com.

POTENTIAL VALUE: $500–$2,000

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

Tamper-resistant Prescription Pads SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive discounts on tamper-resistant prescription forms.

ABOUT OUR ENDORSED PARTNER American Security Rx is a California Department of Justice and California Board of Pharmacy-approved Security Printer (SP-9), providing tamper-resistant California security prescription forms for controlled medications.

POTENTIAL VALUE: $1,000

Practice Management Consulting

ENDORSED PARTNER CONTACT INFORMATION Contact American Security Rx at (877) 290-4262 or at info@ americansecurityrx.com. Visit American Security Rx online at www.americansecurityrx.com.

nefits SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $300

dece m ber

SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive practice-management consulting discounts on productivity and patient flow, personnel, governance and management, market strategy and tactics, practice acquisitions, and sales and mergers, (equal to 10 percent or $500, whichever is larger), free half-day seminars at SDCMS (watch your faxes and emails), and a free one-year subscription to their newsletter, UnCommon Sense®.

ABOUT OUR ENDORSED PARTNER Practice Performance Group (PPG) provides high-performance medical practice management services for physicians, including consulting, expert witness, workshops, speaking, and a monthly newsletter.

ENDORSED PARTNER CONTACT INFORMATION Contact Jeffrey Denning or Judy Bee at (858) 459-7878 or at Jeff@PPGConsulting.com, or visit www.PPGConsulting.com.

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

POTENTIAL VALUE: $500

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

33

SDCMS Members-only Benefits

Frequently Asked Questions About SDCMS Seminars and Events Question: When are most SDCMS seminars and events held?

Answer: Most are held during lunch-

2009 SDCMS

Seminars/WEBINARS and Events

Free to Member Physicians

and Their Office Staff!

time or dinnertime, with lunch and dinner provided free of charge. Lunchtime seminars usually target office staff, and dinnertime seminars usually target physicians, though all member physicians and their office staff can attend all of our seminars.

Question: Where are the seminars held?

Answer: Most SDCMS seminars are held at the San Diego County Medical Society meeting room at 5575 Ruffin Road, Suite 250, San Diego 92123. Call SDCMS for directions at (858) 565-8888. For those who can’t get away from the office to attend our seminars in person, SDCMS now offers to our member physicians and their staff the ability to “attend” our seminars as webinars, i.e., you can attend from wherever you are — all you need is access to the Internet!

Question: Do I need to register?

Answer: Yes. Our seminars and events require attendees to pre-register.

SDCMS Seminars/Webinars and Events SDCMS MEMBERS-ONLY BENEFIT SDCMS strives to build a robust schedule of free seminars and events for our member physicians and their office staff. All SDCMS member physicians and their office staff attend SDCMS seminars free of charge (including Office Managers Forums).

Our seminars cover a broad range of practice management topics, including legal issues, HIPAA, risk management issues, contract negotiations, and more.

Question: How much does it cost to attend SDCMS’ seminars?

Answer: There are two courses for office managers during the year (the “Certified Medical Coder (CMC)” course and the “Certified Medical Office Manager (CMOM)” course that require a fee); otherwise, all SDCMS seminars are free to member physicians and their office staff.

partner ben SDCMS CONTACT INFORMATION For further information about any of these seminars and events, watch your emails and faxes, visit SDCMS’ website at www.

SDCMS.org, or contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org.

POTENTIAL VALUE: $100 PER ATTENDEE PER SEMINAR

34

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Question: Who should I contact if I have further questions?

Answer: For further information about SDCMS seminars or events, watch your emails and faxes, visit www.SDCMS.org, call SDCMS at (858) 565-8888, or email SDCMS at SDCMS@SDCMS.org. Details may change as seminars and events approach — please contact SDCMS to confirm.

January 15 21 22 28 29

Thursday Wednesday Thursday Wednesday Thursday

11:30AM–1:00PM 6:30PM–7:30PM 11:30AM–12:30PM 6:30PM–8:30PM 11:30AM–1:00PM

Collections Seminar/Webinar (Office Managers Forum) Risk Management Webinar: “Dealing With Demanding and Challenging Patients” Risk Management Webinar: “Dealing With Demanding and Challenging Patients” Marketing Seminar/Webinar Marketing Seminar/Webinar (Office Managers Forum)

6:30PM–8:30PM 11:30AM–1:00PM 6:30PM–8:30PM 11:30AM–1:00PM

Contract Negotiations Seminar/Webinar Contract Negotiations Seminar/Webinar (Office Managers Forum) Coding Seminar/Webinar Coding Seminar/Webinar (Office Managers Forum)

Wednesday Thursday

6:30PM–8:30PM 11:30AM–1:00PM

Insurance Services Seminar/Webinar Insurance Services Seminar/Webinar (Office Managers Forum)

Wednesday Thursday Saturday

Wednesday Thursday

5:00PM–9:00PM 9:00AM–1:00PM 8:30AM–3:30PM

6:30PM–8:00PM 11:30AM–1:00PM

Practice Management Seminar/Webinar Practice Management Seminar/Webinar (Office Managers Forum) Resident and New Physician Seminar: “Preparing to Practice: What You Need to Know BEFORE You Begin Your Practice” Risk Management Seminar/Webinar: “How to Handle Legal Notices (Summons, NOI, Subpoenas)” Risk Management Seminar/Webinar: “How to Handle Legal Notices (Summons, NOI, Subpoenas)”

Wednesday Thursday Wednesday

4:00PM–8:00PM 9:00AM–12:30PM 11:30AM–1:00PM

EMR Road Show EMR Road Show (Office Managers Forum) Billing Seminar/Webinar (Office Managers Forum)

Wednesday Thursday Wednesday

Thursday

6:30PM–8:30PM 11:30AM–1:00PM 2:00PM–6:00PM

9:00AM–2:00PM

Legal Seminar/Webinar Legal Seminar/Webinar (Office Managers Forum) CMA Contracting Seminar/Webinar: “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations — A Focus on Payor Contracting” CMA Reimbursement Seminar/Webinar (Office Managers Forum): “Back to Basics: A Step-by-Step Guide to Maximizing Your Cash Flow”

Wednesday Thursday

6:30PM–7:30PM 11:30AM–12:30PM

Risk Management Webinar: “Who Can Be Told What? (Communicating in a HIPAA World)” Risk Management Webinar: “Who Can Be Told What? (Communicating in a HIPAA World)”

February 11 12 18 19

Wednesday Thursday Wednesday Thursday

March 18 19 April 15 16 18

22 23 May 6 7 20 June 17 18 24

25

July 22 23

nefits August 12

Wednesday

11:30AM–1:00PM

HIPAA Update Seminar/Webinar (Office Managers Forum)

6:30PM–8:30PM 11:30AM–1:00PM 8:00AM–4:00PM

Financial Issues Seminar/Webinar (Including Estate Planning) Financial Issues Seminar/Webinar (Office Managers Forum) Certified Medical Coder (CMC) Course

6:30PM–7:30PM 11:30AM–12:30PM 8:30AM–3:30PM

Risk Management Webinar: “Electronic Health Records — Are You Ready?”

Risk Management Webinar: “Electronic Health Records — Are You Ready?”

Resident and New Physician Seminar: “Preparing to Practice: What You Need to Know BEFORE You Begin Your Practice”

October

14 Wednesday 15 Thursday 23, 30, Five Fridays Nov. 6, 13, 20 November 18 19 21

Wednesday Thursday Saturday

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

35

SDCMS Members-only Benefits

Bringing You and Your Staff

Physician-centric Goods and Services

Take Advantage of These Members-only Benefits! sdcms Physician Advocate on Staff SDCMS MEMBERS-ONLY BENEFIT Have a question? Don’t know where to begin? Contact your full-time, SDCMS physician advocate, Marisol Gonzalez, free of charge, to get the answers to all your questions.

SDCMS Office Manager Advocate on Staff SDCMS MEMBERS-ONLY BENEFIT Let your office manager and staff know that they have a full-time office manager advocate on staff at SDCMS ready to help them with any questions they may have, free of charge.

partner ben SDCMS CONTACT INFORMATION Contact Marisol Gonzalez at (858) 3002783 or at MGonzalez@SDCMS.org.

SDCMS CONTACT INFORMATION Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org.

36

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Members-only Website Access SDCMS MEMBERS-ONLY BENEFIT Access, free of charge, the “Member Physicians” section of SDCMS’ website and the members-only section of CMA’s website to find valuable resources, such as a list of San Diego County physician NPIs, updated weekly. SDCMS member physicians can now build their own physician website with SDCMS, free of charge.

SDCMS CONTACT INFORMATION Contact Kyle Lewis, your SDCMS director of communications and marketing, at (858) 300-2784 or at KLewis@SDCMS.org.

SDCMS Annual Pictorial Membership Directory SDCMS MEMBERS-ONLY BENEFIT Appear in SDCMS’ annual pictorial membership directory, which is used by thousands of physicians and patients across the county throughout the year. Receive a free directory each year, a 50 percent discount on any additional directories purchased, and discounts on display advertising in the directory.

SDCMS CONTACT INFORMATION Contact Kyle Lewis, your SDCMS director of communications and marketing, at (858) 300-2784 or at KLewis@SDCMS.org.

San Diego Physician Magazine SDCMS MEMBERS-ONLY BENEFIT Receive a free subscription to the voice of San Diego County’s physicians. Place free classified ads and discounted display ads.

2008 MAGGIE AWARD WINNER

SDCMS E-newsletter: “News You Can Use” SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive our email newsletter — “News You Can Use” — free of charge. “News You Can Use” keeps physicians up to date with the latest in medical, local, state, and federal news critical to your practice ... free of advertising.

SDCMS CONTACT INFORMATION Contact Dareen Nasser, your SDCMS office manager, at (858) 300-2786 or at DNasser@SDCMS.org.

Auto Insurance

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

Epocrates’ Clinical Reference Guides SDCMS MEMBERS-ONLY BENEFIT Receive a 30 percent discount off of a oneyear subscription and a 35 percent discount off of a two-year subscription to Epocrates’ clinical reference guides. Students and residents receive a 50 percent discount.

SDCMS CONTACT INFORMATION Contact Epocrates at (800) 230-2150 or visit www.cmanet.org.

dece m ber

for

2 0 0 8 |

Pay

performance How do you measure Quality?

interview witH stuart a. CoHen, md, mPH, sdCms President P.18

Legal Hotline

PHysiCian emPloyment emerging miCrobial Quality and SDCMS MEMBERS-ONLY agreements strongly resistanCe in san BENEFIT Cross-Cultural reCommended HealtHCare .26 County .34 SDCMS membersdiego access free of charge CMA’s Legal Hotline. pP.22

SDCMS MEMBERS-ONLY BENEFIT Along with your spouse, receive discounts of 4.5 percent to 14 percent on all lines of coverage from the Automobile Club of Southern California.

nefits SDCMS CONTACT INFORMATION Contact Kyle Lewis, your SDCMS director of communications and marketing, at (858) 300-2784 or at KLewis@SDCMS.org.

OFFICIAL PUBLICATION OF THE SAN DIEGO COUNTY MEDICAL SOCIETY NOVEMBER 2008

p

“ P H y s i C i a n s u n i t e d F o r a H e a lt H y s a n d i e g o ”

SDCMS CONTACT INFORMATION Call (415) 882-5144.

Hertz Discounts SDCMS MEMBERS-ONLY BENEFIT SDCMS members can save up to 15 percent on daily Hertz car rental rates. Special international discounts are also available.

Visit www.Hertz.com or call Hertz at (800) 654-2200. Frequent traveler miles and bonus points may be earned for qualifying rentals. An SDCMS-CMA members-only code is needed to take advantage of this discount.

SDCMS CONTACT INFORMATION Email MGonzalez@SDCMS.org to receive your code.

S A N D I E G O P H Y S I C I A N . o r g

37

SDCMS Members-only Benefits

Faxed and Emailed Emergency Alerts

San Diego Magazine SDCMS MEMBERS-ONLY BENEFIT Receive a gift subscription (active physician members) or a discounted subscription (resident physician members).

Legal Services SDCMS MEMBERS-ONLY BENEFIT Receive a free consultation and discounts on corporate legal services.

SDCMS CONTACT INFORMATION Call Ladd Young Attorneys at Law at (619) 564-6696. Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@ SDCMS.org.

San Diego County Physician Mailing Lists SDCMS MEMBERS-ONLY BENEFIT Receive one free physician mailing list annually and a discount on all additional mailing lists requested in the same year.

SDCMS CONTACT INFORMATION Contact Dareen Nasser at SDCMS at (858) 565-8888 or at DNasser@SDCMS.org.

SDCMS CONTACT INFORMATION To sign up, contact Janet Locket, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS. org. To update your subscription address, contact San Diego Magazine at (888) 3500963 or at sdgm@kable.com.

Investments SDCMS MEMBERS-ONLY BENEFIT Invest with Dunham & Associates and discount your SDCMS dues by $150.

SDCMS CONTACT INFORMATION Call Jeff Dunham at (619) 308-9700, or contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

SDCMS MEMBERS-ONLY BENEFIT Stay informed of the news that affects your bottom line and your patients’ health with faxed and emailed alerts sent by SDCMS to you, free of charge … and free of advertising!

SDCMS CONTACT INFORMATION Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

CMA’s Weekly E-newsletter: “Alert” SDCMS MEMBERS-ONLY BENEFIT Receive CMA’s e-newsletter, “Alert,” delivered directly to you, free of charge, via email or fax.

SDCMS CONTACT INFORMATION Contact Katherine Gallia at CMA at (916) 551-2074 or at kgallia@cmanet.org.

OUR NEXT GENERATION OF CIVIC POWER BROKERS

Free Coding Hotline SDCMS MEMBERS-ONLY BENEFIT Access a coding hotline free of charge (provided by CHMB Solutions).

partner ben

Season

SDCMS CONTACT INFORMATION Email your coding question(s) to SDCMS at Coding@SDCMS.org. Contact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at JLockett@SDCMS.org.

‘TIS TH

HOW LOC CELEBRIT EMBRA THE SPI OF GIVI

“

DANICA MCKELLAR:

My real goal is to empower girls to know they can be smart… and to do whatever they want to follow their dreams.

38

S A N D I E G O P H Y S I C I A N . o r g | D ece m ber

2 0 0 8

”

DECEMBER 20

sandiegomagazine

Reimbursement Hotline SDCMS MEMBERS-ONLY BENEFIT SDCMS members access free of charge CMA’s Reimbursement Hotline.

Legislative Hotline SDCMS MEMBERS-ONLY BENEFIT SDCMS members access free of charge CMA’s Legislative Hotline.

SDCMS CONTACT INFORMATION Call (888) 401-5911.

HIPAA Compliance

CMA ON-CALL Documents

SDCMS MEMBERS-ONLY BENEFIT Receive a discount on a complete, doit-yourself HIPAA privacy and security compliance toolkit (CD ROM).

SDCMS MEMBERS-ONLY BENEFIT SDCMS members can access, free of charge, thousands of pages of medical-legal, regulatory, and reimbursement information, through CMA’s online library.

SDCMS CONTACT INFORMATION Call David Ginsberg at PrivaPlan at (877) 218-7707.

SDCMS CONTACT INFORMATION Contact CMA at (415) 882-5144, at legalinfo@cmanet.org, or visit www.cmanet.org.

California Emergency Driving Emblem SDCMS MEMBERS-ONLY BENEFIT SDCMS members receive their first California physician emergency driving emblem free of charge, and any additional emblems at the discounted price of $10 each.

SDCMS CONTACT INFORMATION Call (866) 462-2819.

Physician Confidential Line SDCMS MEMBERS-ONLY BENEFIT SDCMS members access free of charge CMA’s Physician Confidential Line, a 24-hour phone service for physicians who may have an alcohol or other chemical dependence or mental/behavioral problem.

Completely confidential. Using it will not result in any form of disciplinary action or referral to any disciplinary body.

SDCMS CONTACT INFORMATION Call (213) 383-2691.

SDCMS CONTACT INFORMATION Contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@SDCMS.org.

nefits

D ece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

39

Classifieds OFFICE SPACE

fax letter of interest to (619) 463-4181. [648]

EL CENTRO/IMPERIAL MEDICAL OR COMMERCIAL BUILDING FOR LEASE/RENT: New upscale

MISSION HILLS OFFICE FOR SALE: Why rent when you can own? North Mission Hills physician’s office for sale. Beautifully restored house located in the West Lewis Planned District. Classic hardwood floors, stained glass, craftsmanship woodwork throughout, recessed lighting, complete exam rooms, two patient waiting areas, and four offices. Neighborhood atmosphere; perfect for primary or specialty practice. Ample street parking. Mills Act designation with significant tax savings. Call Annamarie Clark at (619) 962-2095 for photos and appointment. [610]

MEDICAL OFFICE SPACE FOR LEASE IN ENCINITAS: Available August 2009. Share space with established

11,761ft2 building located in the northeast quadrant of Hwy. 86 and Aten Road, with Hwy. 86 visibility. Three phase power with 800 amps ideal for medical imaging or businesses requiring additional power. The building is divisible up to five suites, and bathrooms are stubbed in at each location. Please call Patseay at (760) 562-1436 or email patseay@roadrunner.com for further information. [643]

physician-owner. Office located in new LEED-certified professional office development on Encinitas Blvd., close to 5 freeway, Scripps Hospital, and public transportation. Free parking, private bathroom, front desk area, and additional storage space included. One to two offices 11x14 are available full or part time. Affordable lease rate in desirable area. Contact Wendy Khentigan, MD, at (760) 845-0434 or at wendykmd@aol.com. [646]

ENCINITAS MEDICAL OFFICE SPACE: Spacious, ocean view office to share or sublease with three other physicians. Minutes from the 5 freeway and Scripps Encinitas Hospital. Office includes private bathroom and entrance, common waiting area, wireless Internet, and free parking. LabCorp and MRI center are located in the same building. Contact DeeAnn Wong, MD, at (760) 753-7341, ext. 2#. [650]

VISTA MEDICAL SPACE FOR LEASE: 3,500ft2 former medical space. The space is built out nicely for a medical practice or urgent care in an excellent location with Lankford_SDP_08:Layout 1 10/27/08 1:22 PM great visibility. The address is 1680 S. Melrose Dr., Ste. 105–107, in the Shadowridge area just across from Rancho Buena Vista High School. Please call Steve at (760) 7270533 for more information. [649] LA MESA OFFICE SPACE TO SHARE: Over 6,000ft2 OB/GYN office of four doctors with one leaving, available January 2009. Space is ideal for a medical practice or clinical studies, and is located on Grossmont Hospital campus. Contact La Mesa OB/GYN at (619) 463-7775 or

Leasing, Renewals AND Sales: Call the Healthcare Real Estate Specialists at Colliers International for a complete inventory of all available medical office space for lease or for sale in San Diego County. Use our knowledge and expertise to help Pageyou 1 negotiate a new lease, renewal, or purchase agreement to assure you obtain the best possible terms. There is no charge for our consulting services. Contact Chris Ross at (858) 677-5329; e-mail chris.ross@colliers.com.

MEDICAL OFFICE SPACE: Beautiful turnkey medical office space to share in the village of La Jolla with ocean view. Available three days a week, including secretary on two days. Space is suitable for physician, psychologist, or therapist. All inclusive rent: $2,000 per month. Parking in building. Contact Jane Reldan, MD, at (858) 454-5527.

[642]

LA JOLLA: Newly remodeled medical office space for lease in La Jolla. Shared space with orthopaedic surgeons.

Preferably part-time needs. Convenient location near the Orthopaedic Surgery Center in La Jolla. Contact Jo Turner for more information at (619) 733-4068 or email jo@ lajollaspine.com. [641] ACROSS FROM SHARP CHILDREN’S HOSPITAL: Beautifully furnished, fully equipped 2,000tf2 office with five exam rooms. Share with a part-time physician. Please call (619) 823-8111 or (858) 279-8111. [385]

SAN DIEGO: A unique physician opportunity with a highly successful and profitable multispecialty office located in beautiful Bankers Hill. Enjoy the freedom of your private practice in our luxurious medical office. Your personal office has incredible views of the harbor. We are a

Pinnacle Introducing

Medical Plaza

The Building…

• New 80,000-square-foot Class “A” Medical Office Building • First floor is the new home to Sharp-Rees Stealy Medical Group • Second floor available to independent medical practitioners • New suites available from 1,200 to 11,000 square feet • Offices can be built to meet your exact long-term needs

Location, Location, Location

• Located at 10672 Wexford Street, off the I-15 at Scripps Poway Parkway (92131) • Strategic Scripps Ranch/Poway location perfectly situated off the I-15 to serve the North County Communities of Scripps Ranch, Rancho Bernardo, Poway, Mira Mesa and Carmel Valley • Minutes from SR-52 and SR56 for easy access to the coastal communities

For more information, please call Ed Muna at 619-702-5655 or e-mail ed@lankfordsd.com. • www.PinnacleMedicalPlaza.com

40

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Classifieds fully equipped and fully staffed, ready to increase your reimbursement from day one. Let us help build or relocate your practice! Open to all specialties. Call Eric Noll at (619) 233-4044. [637]

AFFORDABLE OVERHEAD FOR YOUR PRACTICE: Large practice looking to share office space or total overhead. Will consider sublease of space or combining total overhead, including supplies and staff, to reduce cost for all. Space is over 4,000ft2 and includes eight exam rooms. Located in metro region. Close to all major freeways and Sharp Memorial Hospital. Room set-up/building facilities could benefit any primary care and meet most specialist needs. Call (858) 268-1111, ext. 311, for further information. [632]

NEW MEDICAL BUILDING ALONG I-15: Pinnacle Medical Plaza is a new 80,000 SF building recently completed off Scripps Poway Parkway. The location is perfect for serving patients along the I-15 from Mira Mesa to Rancho Bernardo and reaches west with easy access to Highway 56. Suites are available from 1,000 -11,000 SF and will be improved to meet exact requirements. A generous improvement allowance is provided. For information, contact Ed Muna at 619-702-5655, ed@ lankfordsd.com; www.pinnaclemedicalplaza.com

MEDICAL OFFICE SPACE AVAILABLE: Office located in downtown San Diego. Two exam rooms and one office. Please call (619) 985-0017. [631] LA MESA: Medical office space available for sublease in conveniently located La Mesa building. Please call Debbie at (619) 668-4700 for more information. [630] Office Space to Share: Modern, spacious medical office. Close proximity to Alvarado and Sharp Hospitals. Call (619) 668-0900 for more information. [616]

Medical Office Space (Scripps Encinitas Campus): OB/GYN-type consultation room and one to two exam rooms with staff, receptionist, etc. Equipment is available at extra cost. Surgical center next door. Free parking. Perfect for low-volume hospital campus consultations one to five half-days per week. Email sbrooksreceptionist@yahoo.com or call (760) 753-8413. [557]

3998 Vista Way, Ste. 100 in Oceanside: Three medical office spaces (approximately 2,000ft2 each) available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot, and ground floor access. Lease price: $2.40/ft2+NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@ coveycommercial.com. [556]

Office Space Available: Office space at the corner of 8th Ave. and Washington St. in Hillcrest. Surgical center in building. Ample parking and simple freeway access. Close proximity to Scripps Mercy Hospital. Call (619) 297-6100 or email rbraun@handsrus.com. [555]

Office to Share: Office available in desirable building on Scripps Encinitas lot. Share elegant office that has just undergone complete interior design renovation.

Includes doctor’s desk, your own exam room, front desk, common waiting area, staff bathroom (including shower), and kitchen. Call us at the San Diego Vein Institute at (760) 944-9263. [546]

Space for Lease (Coronado): Brand new building in Coronado. Last space available: 1,105ft2, $2.75+NNN. Call (619) 742-5555 or email cpatricia@glenncookmd.com.

[435] Beautiful, Newly Renovated Office Space to Share: Located in Hillcrest/Uptown San Diego. Physician with large suite seeking physician/healthcare professional or other business professional to share offices and/or exam rooms and receptionist. Parking spaces available for rent (off street, covered). Call (858) 354-9833 for further information. [346]

NEW DOWNTOWN OFFICE SPACE AVAILABLE: Cosmetic Office Available to Share: East County location with accredited operating room. Ideal for facial or general plastic surgeon to use as satellite office.

Central location with ample parking. For more information, please call (619) 701-4786. [542]

Office Space for Sublease: Office available part time for Scripps doctor in desirable Scripps/Ximed building in La Jolla. Share elegant office; available full day Mondays and Friday afternoons. Includes consultation office, two exam rooms, front desk, common waiting area, staff bathroom, and kitchen. Use of operating suite or use on other days negotiable. Call Cindi at (858) 452-6226.

[535]

Share Medical Office Space in Point Loma Area (off Midway): Share fully furnished, six-exam-room/two-office suite with internist. Ample free parking, great location. Contact Elaine Watkins at (858) 945-3813 or at ejwatkins@gmail.com. [527]

Office Space to Share (South County): Chula Vista-area family practice office to sublease at 340 4th Ave., Ste. 10, just north of Scripps Mercy Chula Vista Hospital. Office includes three exam rooms and one treatment room, and is 1,700ft2. Support staff available. Call Dr. Jenkin or Dr. Tetteh at (619) 804-7252. [521]

Class “A” Medical building for sale or lease: 3-Story, 55,450/SF located at 838 Nordahl Road in San Marcos, CA. Suites from 1,000/SF. Premier location. Easy freeway access & close proximity to restaurants & Sprinter. Shower & locker facilities. Resort quality restrooms. Tropical landscaping. Koi ponds. Panoramic views. Latest in “green” building design standards with utility cost savings.

Scheduled for completion in April 2009. For more information contact Mark Avilla (760) 431-4223 / mavilla@breg.com. www.nordahlmedicalcentre.com / www.brecomercial.com Office Space for Lease (Escondido): Premier furnished medical office space for lease in Escondido. Excellent location near Palomar Medical Center. Please call (760) 743-1033. [501]

New cozy family medicine office space available to share.

Furnished office includes three exam rooms and one bathroom. Office ideal for solo practitioner interested in starting a new practice or in expanding to a new area.

Call (619) 200-9664. [658]

LOOKING FOR BEAUTIFUL, BRAND-NEW, STATE-OF-THE-ART, AFFORDABLE OFFICE SPACE? For internist, podiatrist, surgeon, pain management, chiropractor, or other healthcare specialist. Brandnew office (River View MD Spa, a Medical-Dental Spa) in new development in Santee. Offering office space, ability to share reception area, and a minimum of one beautiful exam room (sometimes up to two rooms) to see patients. $1,650/month rent plus shared expenses if applicable.

Call (619) 456-4555. [655]

PHYSICIAN POSITIONS AVAILABLE FAMILY PRACTICE POSITIONS AVAILBLE: Busy family practice in Escondido is seeking one full-time and one part-time, practice share physician. Please send CV to jshaw@pennelm.com or fax to (760) 745-0451. [644] SEEKING BOARD-CERTIFIED/BOARD-ELIGIBLE FAMILY PHYSICAN: To join a patient-centered practice in Chula Vista specializing in primary care and cosmetic medicine. Successful candidate will be enthusiastic, caring, with positive attitude, good work ethic, and able to build practice with exceptional people skills. Bilingual in Spanish preferred. Competitive compensation and benefits package. Flexible, part-time schedule. Email CV to doctorwp@pacbell.net or fax to (619) 422-1055. Call Ann at (619) 422-1324 for more information. [640]

TEMPORARY EXPERT PROFESSIONAL (TEP) MD (GENERAL PRACTITIONER) — COUNTY OF SAN DIEGO PUBLIC HEALTH: Examine patients and make recommendations for further study, or treat patients with medical illnesses or complications and consult with providers in the community on related cases. Assignments may be in the HIV/STD/hepatitis, TB, or well child exam clinics. TEPs may provide clinical supervision of certified nurse practitioner, public health nurses, staff nurse, vocational nurses, and support staff California medical license desired. Fax CV to (619) 236-1196. [634]

.

TEMPORARY EXPERT PROFESSIONAL (TEP) MD (INTERNEST) — COUNTY OF SAN DIEGO: Examine patients and make recommendations for further study, or treat patients with medical illnesses or complications and consult with providers in the community on related cases. When assigned to the San Diego County Psychiatric Hospital (SDCPH), candidate will serve as a medical consultant to psychiatrists, nursing staff, and medical director. California medical license desired. Fax CV to (619) 236-1196. [633]

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $250 (75-word limit) per ad per month of insertion.

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

41

Classifieds OB/GYN PHYSICIAN POSITION: Private practice opportunity to join two board-certified OB/GYNs. Outstanding earning potential. Perinatologists and NICU available 24/7. 1:4 on-call. Fax CV to (858) 451-8473. [625]

Internal Medicine/Family Practice Position: Seeking board-certified/eligible internist or family practice physician with interest in holistic health for employment with an integrative medical practice located in San Diego’s Bay Park community. Part- to full-time hours, flexible schedule, generous benefits, light call. Please email résumé to mgolden@CHWBonline.com. [617]

Physician Needed: Part-time or full-time position for board-certified/eligible physician to help two physicians in Chula Vista. Cheerful work atmosphere, variety of options (office, hospital, or nursing homes). Very light calls mainly over the phone. We are very flexible in job details.

Please call Suzi King at (619) 426-9731. [613]

Interventional Cardiologist Opportunity: Income potential well above national average. Immediate opening to take over 20-year private practice in North County. Excellent referral basis, limited HMO care, new cath lab opening in July. One-in-three interventional call, mature hospitalist program for other call. Office diagnostic services include: nuclear, holtor, accredited ECHO lab. Fax CV to office manager at (760) 940-8153. [607]

KAISER PERMANENTE IS HIRING PER-DIEM AND FULL-TIME PHYSICIANS: We have current openings for full-time and per-diem physicians in the East County of San Diego. These positions are available at our La Mesa, Rancho San Diego, and Bostonia medical offices. For more information regarding these opportunities, please contact Kathy Dundovich, area operations administrator at (619) 589-3206 or at kathy.l.dundovich@ kp.org. [653]

well as a traditional outpatient setting. Open to hospitalist work if available. If you are looking to fill a temporary position with someone who is ambitious, accountable, and has a positive mental attitude, please email inquires to drdorner@yahoo.com. [628]

TEMPORARY POSITION WANTED: Board-certified

NONPHYSICIAN POSITIONS AVAILABLE

family physician looking for a part-time position from September to December to work in an outpatient setting. I have my own insurance ad have experience working with EMRs. Email brentgmd@aol.com. [626]

MEDICAL ASSISTANT (MA) JOB OPPORTUNITY:

Medical Ophthalmologist (Per Diem):

MA wanted to work part time (25 hours) in Poway starting November 12. Call (858) 521-0806 or email familyallergy@ cox.net for more information. [647]

Board-certified medical ophthalmologist available two days per week for per-diem or locums work in the San Diego or nearby areas. Highest ethical standards. Experienced and skilled in therapeutic and cosmetic Botox and dermal fillers. Also experienced in clinical trials. Email bshaw1@san.rr.com. [569]

Registered Nurse (RN): Family medicine office in Torrey Hills seeking a full-time, experienced RN. Previous clinical experience required. Salary and benefits are negotiable. Please call (858) 350-8100 or email résumé to admin@torreyhillsfamilymedicine.com. [577]

Part-time Medical Assistant/Back Office: Two years experience required including phlebotomy. Busy specialist office near Alvarado Hospital. Submit résumés via email to dlpotter22@hotmail.com. [576]

CARDIOLOGIST AVAILABLE: Non-invasive cardiologist (ex-professor) wants to work in office-based practice.

Board eligible. Experienced in echo, stress test, stress echo, nuclear and CT. Willing to work in academic position. Call (760) 633-3044, or (858) 922-8354, or email cvshah@aol.com. [663]

PRACTICES FOR SALE Physical Therapist: Part-time or full-time PT

Primary Care Job Opportunity: Home Physicians is a fast growing group of doctors who make house calls. Great pay ($60–$100+/hour), flexible hours, choose your own days (full or part time). No weekends, no call, transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212. [458]

needed for group orthopedic practice. Great opportunity, benefits. Please fax CV to (619) 229-3933. [565]

Successful Medical Skin Care Clinic for Sale: Small investment for 51 percent ownership. Look-

Medical Receptionist/Front Office: We are

ing for a new medical director. Call Leonard Schulkind at (619) 807-5485. [539]

looking for a front office receptionist for a busy OB/GYN practice. Bilingual in Spanish and OB/GYN experience is a must! Résumés can be faxed to (858) 565-0033. [563]

FAMILY PRACTICE (CHULA VISTA): Seeking a family practice physician to cover solo physician practice one week every two months. Contact Ann at (619) 422-1324 or at doctorwp@pacbell.net. [451]

Family Practice Doctors Needed: Full time and part time; days, nights, and weekends available. Fax CV to La Costa Urgent Care at (760) 603-7719. [449] FULL-TIME FAMILY MEDICINE AND URGENTCARE OPPORTUNITIES: At Kaiser Permanente Southern California, we believe our achievements are best measured by the health and wellness of the community we serve. That’s why we provide a fully integrated system of care guided by values such as integrity, quality, service, and, of course, results. If you would like to work with an organization that gives you the tools, resources, and freedom you need to get the best outcomes possible for your patients, come to Kaiser Permanente. For consideration, please forward your CV to: Bettina.X.Virtusio@kp.org or call Bettina at (800) 541-7946. We are an AAP/EEO employer. http://physiciancareers.kp.org/scal. [662]

PHYSICIANS NEEDED: Full-time, part-time, and perdiem opportunities available for family medicine, pediatric, and OB/GYN physicians. Vista Community Clinic is a private, nonprofit outpatient clinic serving the communities of North San Diego County. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EOE/M/F/D/V [659]

OB/GYN PHYSICIAN: Seeking board-certified/boardeligible OB/GYN physician to join our group practice in North San Diego County. Please email CV to madrod1@ cox.net. [656]

42

Nurse Practitioner: Four-physician internal medicine practice in Chula Vista seeks part-time/full-time nurse practitioner. Work with a quality group; reasonable hours. Previous experience is preferable; salary negotiable depending on experience. Call (619) 421-4470 or (619) 421-4000. [488] NURSE PRACTITIONER/PHYSICIAN ASSISTANT: Flexible, part-time schedule. Patient-centered practice specializing in primary care, neurology, cardiology. Successful candidate will be caring, enthusiastic, and with positive attitude and work ethic. Bilingual in Spanish preferred but not a condition. We’ll provide necessary training, so newly graduates are welcome to apply. Good fringe benefits. Email CV to harmonymedicalgroup@yahoo.com or fax: (619) 393-0830. [661]

NURSE PRACTITIONERS NEEDED: Part-time and per-diem opportunities available for family medicine, pediatric, and OB/GYN nurse practitioners. Vista Community Clinic is a private, nonprofit outpatient clinic serving the communities of North San Diego County. Must have current CA license. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EOE/M/F/D/V [660]

PHYSICIAN POSITIONS WANTED MD SEEKING PART-TIME EMPLOYMENT: Elderly MD in North San Diego with prior legal, weight, etc., experience seeking part-time employment. Call (949) 4920198. [651]

FP SEEKING EMPLOYMENT: Family physician looking for temporary employment in the Northern San Diego area from October through December and possibly the first part of 2009. Has experience in urgent care as

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

Del Mar-area General Practice: Prime location, huge potential for practice expansion in fast growing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 755-0510. [185]

PRIMARY CARE PRACTICE FOR SALE — SAN DIEGO: Turnkey operation. Large, nicely decorated, fully furnished space with six exam rooms, two offices, spacious waiting room, and large front office. Room to expand with ancillary services, ample free parking, good location.

Reasonably priced. Interested parties email ejwatkins@ gmail.com. [654]

MEDICAL EQUIPMENT MEDICAL OFFICE EQUIPMENT FOR SALE: Vein practice, closing end of November, is selling off all assets including: Terason portable ultrasound with 15 inch laptop and Levitator stand; Midmark electric table; two Holga 6 shelve chart filing units; stools; office furniture; Minolta copier; fax machine; HP color laser jet printer; AT&T Model 945 Small Bus. Speaker phone; desk with matching floor hutch and two two-drawer files; lobby furniture; and more!

Contact Brentgmd@aol.com for more information, photos, and pricing. [652]

COSMETIC LASER EQUIPMENT FOR SALE: Preowned lasers in great condition for great prices! Lumenis Quantum SR/HR Intense Pulse Light (IPL) system available for $13,000. Treats: photo facials, telangiectasias, vascular and pigmented lesions. Reliant Fraxel SR 1500 Laser (Fraxel II) available for $65,000. Treats: pigmented lesions, facial rhytides, scars, melasma. Includes Zimmer Cryo5 Chiller. Reliant Fraxel SR 750 Laser (Fraxel I) available for $35,000. For more information, contact Dan Rich at (858) 204-9802 or email drich@laserperfectioninc. com. [627]

Retired Surgical Practice Operating Room/Surgical Equipment: Perfect for plastic surgery/oral surgery. Endoscopy, cameras, loupes, tools.

Waiting room furniture inventory list is available upon request. Email kwahl@san.rr.com. [506]

Medical Student Perspective continued from page 44

MEDICAL EQUIPMENT FOR SALE: Ritter 100 teal exam table, physician stool, plastic-encased pillow, and exam room chair(s). $500.00 each set. Call (858) 485-6644. [662]

REAL ESTATE Mission Hills Office for Sale: Why rent when you can own? North Mission Hills physician’s office for sale. Beautifully restored house located in the West Lewis Planned District. Classic hardwood floors, stained glass, craftsmanship woodwork throughout, recessed lighting, complete exam rooms, two patient waiting areas, and four offices.

Neighborhood atmosphere; perfect for primary or specialty practice. Ample street parking. Mills Act designation with significant tax savings. Call Annamarie Clark at (619) 962-2095 for photos and appointment. [610]

MEXICO VILLA: Sell or rent. Fifty-year trust.

Ocean front. Twenty-five miles to border. Two bedrooms. Two baths. Two alcoves. Sleeps eight. Security. Pool. Spa. Furnished. Rent $1,500/month. Sell $595,000. (619) 659-9555. [657]

SERVICES OFFERED Medical Billing Connection (MBC): After your patients’ care, the most important aspect of your business is your billing. MBC provides full-practice management to ensure your billing and collections are optimal. With MBC, expect great services and great results! The difference is our service … let MBC make the difference for you. Call (800) 9804808, ext. 102. [575]

Practice Financing for Physicians: Up to 100 percent financing available for physicians!

Includes purchase of a practice, equipment, partner buyout, working capital, and real estate. Contact Monica Coburn at CBN Financial at (702) 310-7111 or at mcoburn@communitybanknv.com. [522]

Billing, Consulting, Outsourcing: We are committed to maximizing your bottom line! Our billing service uses state-of-the-art technology to ensure charge capture, code validation, electronic submission and remittance, payment postings, patient statements, structured follow-up and appeals, electronic document storage and meaningful reporting. Supplemental services include online appointment scheduling, automated call reminders, scan systems, and other technological advances. Consulting services include accounts payable, auditing, business development, electronic medical record selection and implementation, credentialing, contracting (payor, physician, and staff), executive assistant, financial management, information systems, operational management, practice assessment, practice management, relocation management, and other technological advances. Contact us today for your free consult! Contact Kena Galvan at (619) 326-0700 or at kena.galvan@abs-sol.com. [452] RMC Vinyl Repair Plus: Medical equipment upholsterer. Expert in repair and replacement of medical fixture upholstery, including exam room equipment and waiting room furniture. Free estimates and mobile service! Call (619) 443-4060.

[400]

joined the army because that was what the other new arrivals were doing — one sure foothold in a foreign land for a newcomer who barely spoke English. He made it through Vietnam, survived, returned, and now, forty years later, was being wheeled on a hospital gurney through the VA for a minor surgery.

After surgery, patients are returned to the post-anesthesia recovery room, and the nurses have six slots to put them in. They put a travel poster over each slot, to make it easier to roll the beds to the right place. “Hip replacement done — put him in Hawai’i!” they call out, and the gurney is rolled over underneath the big poster of Hawai’i.

When Ludvik came out from his surgery, guess where they sent him? That’s right, into the slot marked by a kitschy poster of dancing Russians, the kind you’d see in a high school Russian classroom. Which just goes to show: Symbols, posters, and empires may all eventually fade, but people will survive. By hook, by crook, and sometimes by the concern of complete strangers, still they survive, and move on to a new chapter.

And then I met one of the greatest survival stories of all. I’ll call him Bill. Bill was in his mid-90s. Bill had served in World War II, and he was, to the best of his knowledge, the oldest still-living Marine Corps survivor of the battle for Iwo Jima. He’d gone out in March of 1945 — not part of the initial assault, but to take part in the fierce battles that followed. He’d returned to Southern California after the war, and opened a barbershop.

When the attending surgeon walked into the pre-op area to introduce himself, Bill looked him up and down and said, “Young man, when this surgery is over, I’d like to give you a haircut.” This is really only funny if you happen to know that the surgeon in question, while not completely bald, doesn’t have a whole lot of hair. He took the ribbing well, and told Bill he’d be happy to take him up on the offer.

We went over the details of the surgery with Bill. We all stood in a circle around his bed — the pre-op “huddle” of nurses, surgeons, anesthesiologists, and medical students. For a moment I wanted to take a picture of the scene and send it, a single time-defying postcard, in violation of all of the laws of physics, back to the younger Bill, as he sailed across the Pacific in 1945.

He must have been terrified. Who wouldn’t have been?

Lying in the belly of a troop ship, the throb of diesel engines around him, surrounded by salt, sweat, and fear — he knew exactly where he was going. In some units, as many as three out of every four marines were killed. Those

were the men he was going to relieve.

The U.S. Air Force had bombed the islands until they looked like the surface of the moon.

In response, the Japanese had retreated to a network of tunnels that gave them complete cover as they picked off the Americans who were scrambling on the rocky surface above. This was their destination, and they all knew it.

I wanted to send a message back through time, telling him: Look, this is how it ends — not cut down by a bullet on the surface of the moon, but instead, more than 60 years later, in San Diego. Here, a team of compassionate and dedicated people will care for you, you will go home, and one day, you will experience a dignified, peacetime death.

But then I realized that there was no need. If Bill had faced Iwo Jima the same way he did his surgery, he already knew. It didn’t make a difference — he had no control over how things turned out, but in his imagination, he was already giving a haircut to the attending surgeon.

Maybe that is what let him survive Iwo Jima — in his imagination, he could already see himself on the other side.

Because in the end, we don’t know what fate has in store for us — but if we live as if fate will be kind to us, at least we can make the most of every moment that we are granted.

And perhaps, in the end, that is what makes all of us fundamentally human: In the space between what we know and what we do not know, there is a gap. How we navigate that gap and stay afloat within this mysterious balance determines how we live and how we survive.

For Al, exploring the space between knowledge and mystery in mathematics blessed him with his greatest feelings of freedom. And for Ludvik, his life was probably saved by an anonymous man whom he’d never be able to thank — the mystery of that would remain with him forever. And for Bill, the very definition of his courage was in the divide between what he knew and what he did not, and how he faced that division while confronting danger.

And for me? From my experience with VA patients, I have learned that old words such as freedom, compassion, survival, and courage could mean more things than I ever expected.

And when I hear people say, “The VA patients are all the same,” I know that I will never agree.

the A u t ho r : Mr. Brockwell is a third-year medical student at the UC San Diego School of Medicine.

Abo u t

Reprinted from The Human Condition, a student-run annual publication of artwork, poetry, and prose contributed by members of the UCSD medical community.

dece m ber

2 0 0 8 |

S A N D I E G O P H Y S I C I A N . o r g

43

Medical Student Perspective

From the Wards Lessons in Mathematics, Survival, and Courage (Life Lessons From Patients of the VA)

I

By Matthew Brockwell, MS III

t is an oft-repeated cliché among students at my medical school that the patients at the Veterans Affairs hospitals all tend to look the same after a while. Men, usually in their 40s or older, with chronic health problems brought on by lifetimes of smoking and alcohol use — casebook presentations of hypertension, diabetes, high cholesterol — these patients are the bread and butter of our rounds each morning.

Clichés have a way of hiding more than they reveal, though, and this proved to be true for me over the nine weeks that I spent on the VA’s surgery rotations. Perhaps it started with my conversations with Al, a homeless Vietnam vet who spends a lot of his time in the vicinity of the hospital.

In what was perhaps my second conversation with him, Al let slip that he was interested in mathematics. This caught my attention right away because my dad is a mathematician, and I grew up studying math. Al explained that he was

44

interested in the repetend problem.

If you take the reciprocal of any prime number expressed as a decimal, it will repeat itself.

For instance, if you write “1/7” as a decimal, it will be “0.142857142857 …” with the last six digits repeating endlessly, ad infinitum. But, for any given prime, is it possible to predict how long the string of repeating digits (the “repetend”) will be?

Al had been hanging out on campus, attending the occasional campus event, eating the cheap food offered by the Hare Krishnas, and thinking about this problem. He explained to me that when he solved a math problem he felt completely unfettered and free — that his mind could relish a triumph that depended on nobody else’s approval, that he felt ecstatic and blessed.

By the time he shared his problem with me, it became apparent that he had grown sophisticated in his mathematical thinking.

For the next few months we played tag team, meeting occasionally at the VA cafeteria, to dis-

S A N D I E G O P H Y S I C I A N . o r g | dece m ber

2 0 0 8

cuss the problem. Neither of us figured out the answer, but we did discover something interesting.

In mathematical terms, for a given prime p, the decimal expansion of 1/p will always include a repeating string of length (p-1). In other words, expand 1/7, and you will find a repetend of length 6. Expand 1/19, and there will be an 18-digit repetend. And so on. Apparently this follows from a theorem that Pierre de Fermat came up with in 1640, known to mathematicians as “Fermat’s Little Theorem.”

It gets more complicated, though. There’s no way to tell if that repetend is itself composed of smaller, repeating strings of digits. Take the number 13 — it’s supposed to have a repetend length of twelve, as Al and I predicted — and it does. But those twelve digits consist of a doubled-up string of six digits. Neither of us has yet discovered how to tell in advance which primes do that.

But we’re working on it. And I have a feeling that it will be Al who will figure it out first, sitting outside somewhere on campus, homeless, living among the elements, but nonetheless a king in his own domain, for a moment, privy to the thoughts of God in a way that few people ever can be.

As I left Al to navigate the mysteries of the mathematical phenomenon, I came across another veteran who wrestled with his own personal mystery. In the same nine-week period, I met a Czech man in his 50s, I’ll call him Ludvik, who was in the hospital for surgery. My attending surgeon explained, “If you meet a Czech who came here in ’68, they came here because of the Prague Spring.” Ludvik was a teenager in 1968 when President Dubcek launched the reforms that were answered months later when Brezhnev ordered Soviet tanks to roll into the streets of Prague. Three hundred thousand people fled, among them Ludvik, who never saw his parents again.

He’d tried to join the resistance. Who could blame him? He was probably like any other teenage boy at the time: He had heard stories of Molotov cocktails being thrown in the narrow streets of the Czech capital, saw his uncles and older brothers and friends taking up arms, and wanted to contribute to the defining struggle of his time.

But when he lined up to receive a weapon, he reached the front of the line, and the man handing out weapons looked him up and down and said, “Kid, I appreciate your spirit, but you’re too young for this,” and turned him away, probably saving his life.

He fled, made it to the United States, and Continued on page 43

dece m ber

2 0 0 8 |

S A N â&#x20AC;&#x2C6; D I E G O â&#x20AC;&#x2C6; P H Y S I C I A N . o r g

45

$5.95 | www.SANDIEGOPHYSICIAN.org San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA 92123 [ RETURN SERVICE REQUESTED ]

PRSRT STD U.S. POSTAGE PAID DENVER, CO PERMIT NO. 5377