April 2010

✖ SDCMS Celebrates Its 140th Anniversary in 2010 ✖ Reaching 8,500 Physicians Every Month

april 2010

official publication of the san diego county medical society

SDCMS-CMA Legislative Advocacy: Bridging the Gap Between California’s Physicians and Our Legislators

“Physicians United For A Healthy San Diego”

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head.

We make CME easy, free, and online. We do extra homework.

We protect good medicine.

We are your guardian angels.

We are The Doctors Company.

Donald J. Palmisano, MD, JD, FACS Board of Governors, The Doctors Company Past President, American Medical Association

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety.

In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer.

And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our program for SDCMS members, call (800) 328-8831, extension 4390, or visit us at www.thedoctors.com/sdcms.

Exclusively endorsed by

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Apr il 2010 SAN DIEGO P HY SIC I A N. o rg

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thismonth Volume 97, Number 4

feature SDCMS-CMA Legislative Advocacy

14

20 The Bar to the Corporate Practice of Medicine: Protecting Physician Autonomy and Patient Safety! by the California Medical Association 22 Follow the Legislation! CMA’s Legislative Hot List by the California Medical Association

pract icema

By Jon nie Ma nagem ssey, C P C, C P C-P, CP C-I, CP ent M A, A H FI R

30 Healthcare Reform 2009–10: What CMA Produced and What It Prevented! by the California Medical Association 32 CMA Steps up Where AMA Can’t: An Interview With CMA’s Vice President for Federal Government Relations

by San Diego Physician

espon Recov ding Contr ery Au to a d Nine Ti c t o ps rs18 it departments

36 Healthcare Reform's Unfinished Business for 2010 38 CMA's regulation's quick list

Heari they’reng the word recove feelings y “audit� ca nation ry audit co ou must facn induce fe aggreswide progr ntractors (R e. It’s 2010 ar and pan s almo sive, an audam. And as AC) are a p, and Medicic, but ollowinst a certaint it of your p payers becoermanent, are mpact g are nine y. How wo ractice, on me more ce u of an a t udit onips to help yld you and y a possibilit y, o ou you an u Well I d your minimize t r practice fanow nform re practic he pote ed Me Well P ans repar ntial ? e. ed I

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contributors California Medical Association The California Medical Association (CMA) represents more than 35,000 physicians in all modes of practice and specialties across California. CMA is dedicated to the health of all patients in California.

Franklin Crystal, MD Dr. Crystal, an ophthalmologist practicing in El Cajon, has been a member of SDCMS and CMA since 1974.

Sherry Franklin, MD

2005, is running for South Bay geographic director #2 for SDCMS for 2010–11.

Steve Ornish, MD Dr. Ornish, SDCMS-CMA member since 2008, is running for Hillcrest geographic director #2 for SDCMS for 2010–11.

Bing Pao, MD Dr. Pao, SDCMS-CMA member since 2003, is running for at-large director #2 for SDCMS for 2010–11.

Dr. Franklin, SDCMS-CMA member since 2002, is running for treasurer of SDCMS for 2010–11.

Robert Peters, MD

Sonia Gonzales

Albert Ray, MD

Ms. Gonzales is your new SDCMS director of medical office manager support and your SDCMS office manager advocate. She can be reached at (858) 300-2782 or at SGonzales@ SDCMS.org.

Susan Kaweski, MD Dr. Kaweski, SDCMS-CMA member since 1997, will become president of SDCMS on June 5, 2010.

Dr. Peters, SDCMS-CMA member since 2001, is running for secretary of SDCMS for 2010–11.

Dr. Ray, SDCMS-CMA member since 1993, is running for alternate delegate of AMA.

Mark Sornson, MD Dr. Sornson, SDCMS-CMA member since 2006, is running for at-large director #5 for SDCMS for 2010–11.

William Tseng, MD

Jonnie Massey

Dr. Tseng, SDCMS-CMA member since 2000, is running for East County geographic director #1 of SDCMS for 2010–11.

Ms. Massey is director of payers and audits for the American Academy of Professional Coders.

Robert Wailes, MD

Vimal Nanavati, MD Dr. Nanavati, SDCMS-CMA member since

Dr. Wailes, SDCMS-CMA member since 1993, is running for president-elect of SDCMS for 2010–11.

››Send your letters to the

editor to Editor@SDCMS.org TH

S ITS 140 CELEBRATE � SDCMS

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DIEGO” LTHY SAN FOR A HEA

off % 25 SDCMS member physicians receive

advertising in this publication.

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

S A N D I E G O P HY S I CI A N .or g A pril 2010

Managing Editor Kyle Lewis Editorial Board Van L. Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, MD, PhD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Project Designer Lisa Williams Copy Editor Adam Elder SDCMS Board of Directors Officers President Lisa S. Miller, MD Immediate Past President Stuart A. Cohen, MD, MPH President-elect Susan Kaweski, MD Treasurer Robert E. Wailes, MD Secretary Sherry L. Franklin, MD geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody” Zeidman, MD (Alternate: Venu Prabaker, MD) Hillcrest Steven A. Ornish, MD, Niren Angle, MD (Alternate: Eric C. Yu, MD) Kearny Mesa John G. Lane, MD (Alternate: Jason P. Lujan, MD) La Jolla J. Steven Poceta, MD, Wayne Sun, MD (Alternate: Matt H. Hom, MD) North County Arthur “Tony” Blain, MD, Douglas Fenton, MD, James H. Schultz, MD (Alternate: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Michael H. Verfolin, MD (Alternate: Andres Smith, MD) At-large Directors John W. Allen, MD, David E.M. Bazzo, MD, V. Paul Kater, MD, Jeffrey O. Leach, MD, Mihir Parikh, MD, Robert E. Peters, MD, PhD, David M. Priver, MD At-large alternate Directors James E. Bush, MD, Richard O. Butcher, MD, Ben Medina, MD, Jerome A. Robinson, MD, Alan A. Schoengold, MD, Edward L. Singer, MD, Carol L. Young, MD Communications Chair Theodore M. Mazer, MD Young Physician Director Kimberly Lovett, MD Young Physician alternate Director Van Le Cheng, MD Resident Physician Director Katherine M. Whipple, MD Resident Physician Alternate Director Steve H. Koh, MD Retired Physician Director (open) Retired Physician alternate Director John A. Bishop, MD Medical Student Director Jane Bugea Medical Student alternate Director Iain J. Macewan CMA Speaker of the House James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD, Ralph R. Ocampo, MD CMA Trustees Catherine D. Moore, MD, Theodore M. Mazer, MD, Albert Ray, MD, Diana Shiba, MD, Robert E. Wailes, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD AMA Alternate Delegates Lisa S. Miller, MD, Albert Ray, MD

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 DPebdani@SDCMS.org. 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.]

POLITICAL REALITY:

YOU’RE EITHER

AT THE

TABLE OR

YOU’RE ON THE

MENU SDCMS Is at the Table!

By choosing to join the San Diego County Medical Society (SDCMS), over 3,000 practicing physicians, resident physicians, and medical students in San Diego County have given voice to our patients and to our communities in the healthcare reform discussions and in every single healthcare issue being debated locally, in Sacramento, and in Washington, DC.

Ask your colleagues: “Are You a Member of SDCMS?” San Diego County Medical Society (SDCMS) | 5575 Ruffin Road, Suite 250 San Diego | 858.565.8888 | SDCMS.org Apr il 2010 SAN DIEGO P HY SIC I A N. o rg

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sdcmsseminars/webinars/events

Free to Member Physicians and Their Office Staff!

Don’t See What You Need? Let Us Know!

For further information, visit SDCMS.org or contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SDCMS 2010 Seminars / Webinars / Events Date

Day

Time

Topic

Presenter

APR 28

WED

11:30am – 1:00pm

Advanced Medi-Cal Billing Workshop

Therese Calcagno, EDS Corp.

x

MAY 6

THU

11:30am – 1:00pm

IT Overview

Ofer Shimrat, SOUNDOFF Computing Corporation

x

x

MAY 20

THU

11:30am – 1:00pm

ABCs of Workers’ Compensation Billing

CHMB Solutions

x

x

SDCMS and SDCMSF

x x

JUN 5

SAT

6:00pm – 11:00pm

SDCMS / SDCMSF White Coat Gala (formerly known as the SDCMS Installation Dinner and Dance, formerly known as the SDCMS Inaugural)

jun 10

THU

9:00am – 7:00pm

EMR / EHR Trunk Show

Maxwell IT, Multiple Exhibitors

JUN 24

THU

11:30am – 1:30pm

Sexual Harassment

Alliant Insurance Services The Doctors Company

x x

x

x

JUL 20

TUE

11:30am – 12:30pm

Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”)

JUL 21

WED

6:30pm – 7:30pm

Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”)

The Doctors Company

AUG 18

WED

11:30am – 1:00pm

OSHA Updates

Tom Gehring, SDCMS

x

x

AUG 25

WED

11:30am – 1:00pm

HIPAA Updates

David Ginsberg, PrivaPlan

x

x

SEP 11

SAT

4:00pm – 7:00pm

Young Physician Summer Social

SDCMS

SEP 15

WED

11:30am – 12:30pm

e-Town Hall (T)

Tom Gehring, SDCMS

SEP 16

THU

11:30am – 1:00pm

Palmetto / Medicare

Michele Kelly, California Medical Association

x

SEP 18

SAT

9:00am – 12:00pm

Media Training

Tom Gehring, SDCMS

x

8:00am – 4:00pm

Certified Medical Coder Course

Practice Management Institute

x

OCT 1–29 5 FRIDAYS

x x x

OCT 7

THU

11:30am – 1:00 pm

Economic Survival

AKT CPAs

x

x

OCT 27

WED

11:30am – 1:00pm

Legal Issues (“Scope/Allied Health Professionals”)

California Medical Association

x

x

NOV 4

THU

11:30am – 1:00pm

Legal Issues (“Expert Witness, Medical Board Interactions”)

Alexander & Alexander, Attorneys At Law

x

x

* "S" = Seminar • "W" = Webinar • "E" = Event

6

S* W* E*

S A N D I E G O P HY S I CI A N .or g A pril 2010

Apr il 2010 SAN DIEGO P HY SIC I A N. o rg

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communityhealthcarecalendar

To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. All events should be physician-focused and should take place in San Diego County.

Sharon’s Ride.Run.Walk for Epilepsy

San Diego “Inaugural” Kidney Walk

April 25 • DeAnza Park inside Mission Bay Park • All money raised goes directly to the Epilepsy Foundation of San Diego County • epilepsysandiego.org

May 15 • NTC Promenade at Liberty Station • (619) 415-9163 or rosa.valenzuela@kidney.org

In Our Own Words: Successful Aging Across the Lifespan April 28 • 6pm – 8pm • A UCSD Symposium • Liebow Auditorium, Basic Science Building, UCSD School of Medicine Campus • successfulagingacrossthelifespan.org

11 Annual UC San Diego Stroke Conference th

May 15 • UC San Diego Skaggs School of Pharmacy Health Sciences Education Center • cme.ucsd.edu/stroke

8

S A N D I E G O P HY S I CI A N .or g A pril 2010

U.S. Public Health Service Scientific and Training Symposium May 24–27, 2010 • Sheraton Hotel and Marina • phscofevents.org

Alzheimer’s Disease: Update on Research, Treatment, and Care May 27–28 • Omni San Diego Hotel • cme.ucsd. edu/alzheimers

California Society of Industrial Medicine and Surgery’s 25th Annual Mid-summer Seminar June 18–20 • Paradise Point Resort and Spa • csims.net or (800) 692-4199

UC San Diego Conference on Limb Salvage and Functional Reconstruction: Orthopedic, Vascular, and Wound Care Team Approval June 25–27 • Westin San Diego • cme.ucsd.edu

San Diego Academy of Family Physicians Annual Symposium June 25–27 • Paradise Point Resort and Spa • regonline.com/sdafp10con

Hugh Greenway’s 27th Annual Superficial Anatomy and Cutaneous Surgery July 12–16 • San Diego Marriott Del Mar • cme.ucsd.edu

American Society for Bioethics and Humanities 12th Annual Meeting Oct. 21–24 • Hilton San Diego Bayfront Hotel • asbh.org

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brieflynoted SDCMS Announces Our Newest Team Member Sonia Gonzales, Your New Medical Office Manager Advocate!

Hello SDCMS Medical Office Managers!

My name is Sonia Gonzales, and I am your new medical office manager advocate! Many of you worked closely with Lauren Wendler, your previous SDCMS medical office manager advocate, over the past couple of years, and I hope to continue the great work she did in supporting you. Like Lauren, my primary responsibility will be to help you with all of your questions as you work hard to support our member physicians. I can’t tell you how excited I am to serve our medical community as your advocate!

I believe you’ll find that I am intimately

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S AN D I E G O P HY S I CI A N . or g April 2010

familiar with all of the challenges you face.

Eight years ago, I started out in the medical field as a medical assistant and front-office coordinator for a local family practice. After a few years, I became the referral coordinator, and, finally, for the past five years, I worked as a medical office manager. Recently, I decided to reach out beyond my particular medical practice to help the broader medical office manager community — and here I am!

As recently as last year, I utilized the services of SDCMS’ office manager advocate to clarify certain medical records release forms.

My interactions with SDCMS reminded me how vital it is as a support organization for all

Sonia Gonzales (at right), your new SDCMS medical office manager advocate, and Marisol Gonzalez (at left), your physician advocate, discuss how best to resolve a reimbursement issue currently facing one of our member physician office managers.

of our county physicians and their staff. I got the job done much more easily and quickly when I leveraged the resources of SDCMS! As your new medical office manager advocate, I look forward to meeting each and every one of you either at your office or here at SDCMS — at one of our seminars, for example.

I look forward to learning from you how best to grow my role at SDCMS as your advocate so that you can better serve your physicians and staff. We will have many exciting opportunities ahead of us to work together and to help each other. You are not alone, and I strongly suggest that you not hesitate to pick up the phone or send me an email if ever you have a question or concern you need help with. You can reach me on my direct line at (858) 300-2782 or by email at SGonzales@ SDCMS.org. Talk to you soon!

Get in

touch

Your SDCMS and SDCMSF Support Teams Are Here to Help!

SDCMS Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or at JLockett@SDCMS.org Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or SGonzales@ SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org Specialty Society Advocate and chief recruitment officer Karen Dotson at (858) 300-2787 or at KDotson@SDCMS.org BUSINESS MANAGER Nathalia Aryani at (858) 300-2789 or NAryani@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or at BMatthews@SDCMS.org Letters to the Editor Editor@SDCMS.org General Suggestions SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 560-0179 W SDCMSF.org Executive Director Kitty Bailey at (858) 300-2780 or KBailey@SDCMS.org PASD Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at BRodriguez@SDCMS.org PASD PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or at BSalcedo@SDCMS.org SURGERY DAY PROGRAM MANAGER Alisha Mann at (858) 565-8156 or at AMann@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or at LRadano@SDCMS.org

Personal: • Income Tax Planning • Wealth Management • Financial Planning

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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

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Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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brieflynoted

Please Welcome Our New and Rejoining SDCMS-CMA Members

Patrick D. Fong, MD Nephrology San Marcos • (800) 290-5000

Wender Hwang, MD Emergency Medicine San Diego • (619) 528-5000

Sandra L. Freiwald, MD Surgical Critical Care San Diego • (619) 528-5000

Annie M. Jacob, MD Internal Medicine San Diego • (619) 528-5000

Matthew A. Genovese, MD Family Medicine San Diego • (800) 290-5000

Linda J. Jaffe, MD Neurology San Diego • (619) 528-3825

Ori Ben-Yehuda, MD Cardiovascular Disease San Diego

John W. Cronin, MD Critical Care Medicine Del Mar • (858) 554-8845

Eugene M. Golts, MD Surgery San Diego

Catriona Jamieson, MD Hematology La Jolla

Alethea A. Bernstein, MD Obstetrics and Gynecology San Marcos • (800) 290-5000

Peter T. Curtin, MD Hematology La Jolla

Dennis A. Gonzalez, MD Family Medicine San Diego • (800) 290-5000

Dipul M. Kansagara, MD Internal Medicine San Diego • (619) 528-5000

Anne M. Birkbeck-Garcia, MD Pediatrics San Diego • (619) 528-5000

Robin S. Daus, MD Family Medicine Escondido • (800) 290-5000

Barry H. Greenberg, MD Cardiovascular Disease San Diego • (619) 543-7751

Deana A. Kantartzis, MD Emergency Medicine San Diego • (619) 528-5000

Jennifer N. Blanchard, MD Internal Medicine San Diego

Emily L. Daykin-Clark, MD Diagnostic Radiology San Diego • (619) 528-5534

Ahmad Al-Sabbagh, MD Anatomic Pathology and Clinical Pathology Carlsbad • (949) 582-5286

Jill E. Gustafson, MD Pediatrics La Mesa • (800) 290-5000

Paul P. Koonings, MD Gynecological Oncology San Diego • (619) 528-5408

William G. Bradley, MD Neuroradiology San Diego

Gustavo A. Delgado, MD Neurology San Diego • (619) 528-5000

Cecilia A. Gutierrez, MD Family Medicine San Diego

Alexander Kuo, MD Gastroenterology San Diego

Kenneth A. Altschuler, MD Family Medicine Escondido • (760) 745-2000

Katherine E. Brown, DO Surgery San Diego

Charles J. Dinerman, MD Surgery San Diego • (619) 528-5000

Jon D. Harrison, MD Internal Medicine San Diego • (619) 528-5000

Michael J. Lalich, MD Family Medicine San Diego • (619) 528-5000

Kenneth A. Antons, MD Internal Medicine San Diego • (619) 528-5000

Lori A. Brown, MD Internal Medicine La Jolla

Eric M. Emont, MD Geriatric Medicine San Diego • (619) 528-5000

Lisa E. Heikoff, MD Geriatric Medicine San Diego • (619) 528-5000

Andy Y.C. Lee, MD Internal Medicine San Diego • (619) 528-5000

Celestine J. Arambulo, DO Hospice and Palliative Medicine San Diego • (619) 528-5000

Naomi R. Buckwalter, MD Anatomic Pathology and Clinical Pathology San Diego • (619) 528-5000

Mary A. Endo, MD Diagnostic Radiology San Diego • (619) 528-5000

Thomas M. Hemmen, MD Vascular Neurology San Diego

Patrick Lee, MD Diagnostic Radiology San Diego

Sean J. Evans, MD Neurology San Diego • (619) 287-0147

Alan W. Hemming, MD Surgery San Diego

Joshua Lee, MD Internal Medicine San Diego • (619) 543-6737

Amilcar A. Exume, MD Surgery San Diego • (619) 528-5000

Eric R. Hentzen, MD Orthopedic Surgery San Diego

Victor J. Legner, MD Geriatric Medicine La Jolla

Paul T. Fanta, MD Hematology La Jolla

Karen A. Herbst, MD Internal Medicine San Diego

Wayne I. Levin, MD Internal Medicine San Diego • (800) 290-5000

Jeffrey M. Farrier, MD Surgery San Diego • (619) 528-5000

Santiago Horgan, MD Surgery San Diego

Saul Levine, MD Child and Adolescent Psychiatry San Diego • (858) 495-4936

Rita J. Feghali, MD Pediatrics San Diego • (619) 528-5000

John A. Houkom, MD Orthopedic Surgery San Diego • (619) 528-3087

Dale K.K. Lieu, MD Infectious Disease San Diego • (619) 528-5983

Michael A. Flippin, MD Orthopedic Surgery San Diego • (619) 528-5000

Mark D. Hubbard, MD Family Medicine Escondido

Caroline Y.H. Lin, MD Internal Medicine San Diego • (800) 290-5000

Welcome Our New Members!

Suraj A. Achar, MD Family Medicine San Diego • (858) 657-8600 Unna McPherson Albers, MD Internal Medicine La Jolla Lisa-Jan M. Alcaraz, MD Emergency Medicine San Diego • (619) 528-5000

Vidush P. Athyal, MD Family Medicine San Diego • (619) 528-5000 Edward D. Ball, MD Hematology La Jolla Martin M. Bartolac, MD Family Medicine La Mesa • (619) 528-5000 Alexander S. Battaglia, MD Otology/Neurotology San Diego • (619) 528-5000 Lyudmila A. Bazhenova, MD Hematology La Jolla Charles C. Beeson, MD Ophthalmology San Diego • (619) 528-5000

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Jose J. Canales, MD Endocrinology, Diabetes, and Metabolism San Diego • (800) 290-5000 Jonathan P.K. Chan, DO Family Medicine San Diego • (800) 290-5000 Lo-Ping G. Chen, MD Nephrology San Marcos • (800) 290-5000 Eric E.L. Chiang, MD Diagnostic Radiology San Diego • (619) 528-5000 James Chou, MD Internal Medicine La Mesa • (800) 290-5000 Joseph Ciacci, MD Neurological Surgery San Diego

S AN D I E G O P HY S I CI A N . or g April 2010

Brant C.Z. Liu, MD Clinical Cardiac Electrophysiology San Diego • (619) 528-5000

Dean Peng, MD Medical Oncology San Diego • (619) 528-5000

Steve S. Song, MD Internal Medicine San Diego • (619) 528-5000

Kaimana S. MacDonald, MD Psychiatry San Diego

Veena A. Prabhakar, DO Family Medicine Escondido

Roger L. Sur, MD Urology San Diego • (619) 543-3572

Derek D. Mafong, MD Endocrinology, Diabetes, and Metabolism San Diego • (619) 528-5000 Samir S. Makani, MD Pulmonary Disease San Diego • (619) 543-6737

Ajit B. Raisinghani, MD Cardiovascular Disease La Jolla

Randy A. Taplitz, MD Infectious Disease La Jolla • (858) 822-6260

Edward R. Mariano, MD Anesthesiology San Diego

William L. Read, MD Medical Oncology La Jolla • (858) 822-6189

Todd S. Martin, MD Family Medicine El Cajon • (800) 290-5000

Smitha C. Reddy, MD Rheumatology San Diego • (858) 376-0203

Aida Martinez, MD Pediatrics San Diego • (800) 290-5000

Ames D. Ressa, MD Surgery San Diego • (619) 528-6792

Michael T. McHale, MD Gynecological Oncology La Jolla

Veronica Reyes, MD Family Medicine Escondido

Charles H. Miller, MD Dermatology La Mesa • (619) 528-5000

David R. Riker, MD Critical Care Medicine San Diego

Ha B. Mistry, MD Psychiatry El Cajon • (800) 290-5000

Robin C. Robertson, MD Family Medicine Carlsbad

William C. Mobley, MD Neurology With Special Qualifications in Child Neurology La Jolla

Pany T. Robinson, MD Family Medicine Escondido

George W. Moore, MD Internal Medicine San Diego • (619) 528-5000 Danielle B. Nanigian, MD Diagnostic Radiology San Diego • (619) 528-5000 Hai T. Nguyen, MD Cardiovascular Disease San Diego • (619) 528-5000 Kenneth S. Nitahara, MD Urology San Diego • (619) 528-5000 Christopher M. O’Brien, MD Infectious Disease San Diego • (619) 528-5000 Antonio O. Ong, MD Child and Adolescent Psychiatry Vista • (800) 290-5000 Nehal M. Patel, MD Diagnostic Radiology San Diego • (619) 528-5000

Sonia L. Ramamoorthy, MD Colon and Rectal Surgery La Jolla • (858) 822-6277

Edward J. Rott, MD Pediatrics San Marcos • (800) 290-5000 Stanley A. Salinda, MD Internal Medicine San Diego • (619) 528-5000 Armelia Sani, MD Internal Medicine San Diego Viji Sankar, MD Critical Care Medicine San Diego • (619) 528-5000 Terry A. Schwartz, MD Psychiatry San Diego Christian M. Sloane, MD Emergency Medicine San Diego Kenton O. Smitherman, MD Critical Care Medicine San Diego

Kenneth S. Taylor, MD Sports Medicine San Diego Dan H. Tong, MD Internal Medicine San Diego • (619) 528-5000 Thuy N. Truong, DO Family Medicine San Diego • (800) 290-5000 Jerry T.H. Tseng, MD Internal Medicine San Diego • (800) 290-5000 Zuhre N. Tutuncu, MD Rheumatology Vista John J. Tyner, MD Surgical Critical Care La Jolla • (858) 554-8122 Karl F. Walter, MD Psychiatry San Diego • (800) 290-5000 John J. Weber, MD Internal Medicine San Diego • (619) 528-5000 Perry N. Willette, MD Family Medicine Escondido Jonathan G. Yee, MD Internal Medicine San Diego • (619) 528-5000 Pearl S. Yu, MD Internal Medicine La Jolla Gordon L.K. Yung, MD Critical Care Medicine San Diego Shane A. Zim, MD Otolaryngology San Marcos • (800) 290-5000 Karen M. Ziolo, DO Critical Care Medicine San Diego • (619) 528-5000

Welcome Our Rejoining Members!

Bina Adigopula, MD Pediatrics La Mesa • (619) 698-2184 Christopher T. Behr, MD Orthopedic Surgery San Diego • (619) 299-8500 Stephen M. Capon, MD Internal Medicine San Diego • (619) 528-5000 Richard F. Clark, MD Medical Toxicology San Diego • (619) 543-6463 Jody P. Corey-Bloom, MD Neurology La Jolla • (858) 642-3470 Bruce I. Covner, MD Internal Medicine San Diego • (619) 260-0670 Robert R. Felder, MD Internal Medicine San Diego • (800) 290-5000 Zahra Ghorishi, MD Neonatal-Perinatal Medicine San Diego Steven H. Goldberg, MD Dermatology San Diego • (800) 290-5000 Arthur L. Gruen, MD Emergency Medicine Solana Beach • (858) 759-4765

Mini N. Pathria, MD Diagnostic Radiology La Jolla • (619) 543-6607 Joe W. Ramsdell, MD Pulmonary Disease La Jolla • (858) 657-8000 Spencer T. Rickwa, DO Family Medicine San Diego • (619) 528-5000 Holly M. Salzman, MD Family Medicine San Diego Martin T. Stein, MD Developmental-Behavioral Pediatrics San Diego • (858) 496-4800 Robert W. Steiner, MD Nephrology San Diego • (619) 543-5916 David M. Ward, MD Nephrology San Diego • (619) 543-5800 Stephen I. Wasserman, MD Allergy and Immunology La Jolla Peter B. Wile, MD Orthopedic Surgery San Diego • (619) 299-8500 Kimberly K. Yeager, MD Public Health and General Preventive Medicine San Diego

Lawrence A. Hansen, MD Neuropathology La Jolla Roxanne A. Hon, MD Physical Medicine and Rehabilitation La Mesa • (619) 697-7900 William G. Hughson, MD Occupational Medicine San Diego • (619) 543-7060 Frank L. Mannino, MD Neonatal-Perinatal Medicine San Diego • (619) 543-3759 William C. Mathews, MD Internal Medicine San Diego • (619) 543-6737 Edward F. McClay, MD Medical Oncology Encinitas • (760) 452-3340

Marisol, your SDCMS Physician Advocate, and Sonia, your SDCMS Office Manager Advocate, are here to help you and your staff at (858) 300-2783 and at (858) 300-2782 respectively.

Joanna J. Palica, MD Psychiatry El Cajon • (800) 290-5000

Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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sdcmsmembership

Candidate

Statements For SDCMS Board of Directors and AMA Delegates President: Susan Kaweski, MD

I am honored to serve as your SDCMS president. This year will be particularly tenuous as we try to navigate the stormy waters of the new healthcare reform law. There are some measures in the law that we perceive as victories. Primary care physicians will now receive a 10 percent Medicare bonus for the next five years. The insurance industry will be prohibited from denying coverage to individuals with preexisting illnesses. Healthcare plans will be required to have adequate provider networks as well as direct 85 percent of their revenues to direct patient care. And we don’t have a public option plan that mandates physician participation or requires us to pay to belong.

However, there is so much to accom-

plish. Everyone is sick and tired of fighting Medicare cuts. The SGR has to be repealed, and a system has to be developed for fair reimbursement rates. The California geographic payment localities have to be updated — especially in San Diego County, where we are greatly affected by these payment disparities. And we all need E&M increases. In addition, we don’t want an independent physician advisory board to control our payments and make even more cuts.

It is more important than ever that we put our differences aside and work as one organization, one voice for doctors. Otherwise, these crucial issues will continue to be decided by legislators or those lobbyists with the loudest voices and deepest pockets. It is time to contribute to our PAC, contact your legislators, and start working with your physician organization!

Tort reform may never happen at the federal level. In California we should be proud of MICRA, the gold standard for

the rest of the nation. But raising the MICRA cap will be an agenda item for the 2011 legislature, so we must maintain our vigilance.

Finally, we have to translate our concerns to our patients. Some of them may see us as an entitlement, but most look to us as their doctor: someone who will be there to help them when they are sick, to care for their preventative needs, and to comfort them when they are dying. A lot of them don’t understand copayments, balance billing, and that doctors are small businesses. If we don’t get paid, we can’t maintain our practices, and, ultimately, they are denied access to care.

We have many challenges to face in this coming year as we strive to protect patient and doctor rights. I will call on every one of you to do your part. I look forward to representing you as your president in these exigent times.

Notes: * = Incumbent • (#) = Term Length in Years

Candidate for President-elect: Robert Wailes, MD (1) These are very tough times for just about everybody involved in delivering healthcare. Patients lack good access to care, doctors’ practices are suffering from too many restrictions and overhead costs, and the economy stinks! Add to that the uncertainty of our future under any new national legislation and we have a real mess. I think we can all agree that governmental overregulation and insurance company bullying are affecting our professional quality of life. We all have a lot to complain about, and I think organized medicine is the best way to look for solutions. One unified voice has the best chance of successful lobbying for our patients’ health and our professional careers.

I have really enjoyed working with SDCMS at the local and state levels as an advocate representing San Diego. I would like to bring

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S AN D I E G O P HY S I CI A N . or g April 2010

my experience, enthusiasm, and optimism for progress forward to be president-elect for the San Diego County Medical Society. I would like to do this in addition to my work as a trustee for San Diego at the CMA board of trustees and a member of the board of directors for CALPAC. I appreciate your support as well as any input you may have to offer.

I am a firm believer that the more involvement, diversity, and brainpower we can recruit, the more our organization and community will benefit.

Candidate for Treasurer: Sherry Franklin, MD (1) The current cancellation of consultation codes and the impending yearly Medicare cuts remind me why I’m involved in organized medicine. Imagine what would be happening if we weren’t sitting at the

table and watching every bill that goes through our state and federal governments. One unified voice has the best chance of successful lobbying for our patients’ health and our professional careers. I would like to bring my experience, enthusiasm, and optimism for the future of medicine to being this year’s treasurer for the San Diego County Medical Society.

how we are reimbursed.

Thank you for supporting my candidacy for SDCMS directorship as we navigate through these difficult economic and political tides.

Candidate for Secretary: Robert Peters, MD (1)

Candidate for South Bay Geographic Director #1: Vimal Nanavati, MD* (3)

I have had the privilege to represent physicians of San Diego County for the past four years. During this time I have been a delegate to the CMA House of Delegates, chaired Reference Committee E on Quality, Ethics, and Legal Affairs, serve as the chairman of CMA’s Council on Ethical and Legal Affairs, and currently I am your board of directors representative to the SDCMS Executive Committee. I want to continue my active involvement in organized medicine and seek your support for reelection. The San Diego County Medical Society has a rich history as a leader in both local and state issues.

More than ever these issues will have a profound impact on the quality of your Robert Wailes, MD practice and that of your patients’ lives.

These issues include the protection of MICRA, scope of practice, reimbursement, access to and quality of care, information technologies, and satisfaction of practicing medicine. If reelected, I will proudly serve as your advocate, solicit your input, and seek solutions to the issues that are germane to your mode of practice.

Candidate for East County Geographic Director #1: William Tseng, MD* (3)

Robert Peters, MD

I’m William Tseng and I am honored to be your candidate for SDCMS’s East County geographic director. As your candidate, I am committed to addressing physicians’ concerns affected by challenges facing our local and national healthcare policy.

With constant political uncertainties threatening the welfare of physicians’ autonomy over medical practices, it is critical for all area physicians to have a strong voice.

As your candidate, I intend to focus our priorities on protection of patient care access. Through community and professional involvement, I hope to assist SDCMS in becoming an even more influential organization in determining the future of our practices — how we care for patients, how we code (prescribe treatment), and

Doug Fenton, MD

Candidate for North County Geographic Director #2: Doug Fenton, MD* (3)

It has been three years since being asked to serve the South Bay as their representative to the San Diego County Medical Society. My goal was to update my South Bay colleagues about the recent legislation that can affect physicians’ livelihood and lifestyle. In the process of doing this, I have learned what matters to my South Bay physician colleagues.

We are all concerned about the constant threat of pay cuts looming almost every legislative session. I learned that the San Diego County Medical Society, along with CMA, can have an impact on how legislation is passed. This consistent Sherry Franklin, MD effort has borne fruit: We have managed to avert the Medicare pay cuts for the past three years. Our role as physicians was under attack by nurse practitioners and other ancillary services. We managed to define the role of physician clearly and passed legislation to protect patients.

SDCMS, as well as CMA, has been able to prevent egregious cuts to Medi-Cal. Doctors are under constant attack from all sides.

William Tseng, MD I learned that as physicians the adage “United We Stand, Divided We Fall” is especially applicable. The San Diego County Medical Society is an excellent vehicle to promote our common goals. With the recent healthcare reform looming over physicians, it becomes even more critical to stand together in our common goal as advocates for our patients. It is my hope we can engage more physicians in the South Bay to join us in this struggle. I Vimal Nanavati, MD have tried to serve you with dignity and the respect you deserve as physicians and leaders of our society.

Candidate for South Bay Geographic Director #2: Mike Verdolin, MD (2) Candidate for Hillcrest Geographic Director #1: Niren Angle, MD (1) Mike Verdolin, MD

Niren Angle, MD

Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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sdcmsmembership Candidate for Hillcrest Geographic Director #2: Steve Ornish, MD (3) It is a privilege to be a candidate for the geographic director (Hillcrest #2) of the San Diego County Medical Society (SDCMS). As vice president of the San Diego Psychiatric Society (SDPS) and chairman of the CME Committee of the SDPS, I have been able to use the leadership positions granted to me by my professional societies in creative ways for the benefit of the public and all medical specialties in the community. For example, I initiated a partnership with SDCMS and the UCSD School of Medicine whereby I instituted a series of multidisciplinary educational panels that have grown exponentially in popularity.

I am double-board-certified in general and forensic psychiatry and hold the title of associate clinical professor (voluntary), UCSD School of Medicine, Department of Psychiatry. I have an active private solo adult, geriatric, and forensic psychiatric practice in Mission Valley. My writing and speaking skills are a few of my strengths, and a position on the SDCMS board would permit me to use these for the benefit of all of medicine — especially during these times of change and unique challenges.

Steve Ornish, MD

Jason Lujan, MD

Andres Smith, MD

Bing Pao, MD

Kosala Samarasinghe, MD

Mark Sornson, MD

Candidate for At-large Director #3: Kosala Samarasinghe, MD (3)

Candidate for Kearny Mesa Geographic Alternate Director: Jason Lujan, MD* (3)

Candidate for At-large Director #5: Mark Sornson, MD (3)

Candidate for South Bay Geographic Alternate Director: Andres Smith, MD (3) Candidate for At-large Director #2: Bing Pao, MD (2)

Carol Young, MD

Tom McAfee, MD

James Bush, MD

Van Cheng, MD

After graduating from Duke University Medical School and completing my residency at the University of California in San Diego, I have been practicing emergency medicine at Palomar Hospital and currently serve as the assistant director for the Emergency Department. As the director of provider relations for a nationwide group of emergency physicians, I have

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S AN D I E G O P HY S I CI A N . or g April 2010

spent a great deal of time negotiating with health plans and understand the frustration when physicians are being denied payment or underpaid for their services. I have developed experience working with regulatory agencies, legislators, and health plans to improve reimbursement. I hope to bring this experience to the San Diego County Medical Society to enhance physician reimbursement.

My involvement in organized medicine includes serving as the secretary/ treasurer and president for the California Emergency Residency Association and as a councilor for the American College of Emergency Physicians. I have served on the CAL/ACEP Injury and Prevention Subcommittee, Membership Committee, Reimbursement Committee, Government Affairs Committee, and board of directors. My involvement with CMA includes participation in the Hospitalbased Physician Forum, Council on Legislation, Ethnic Medicine Organization Section, and reference committees.

Please allow me to represent you on the San Diego County Medical Society board of directors.

It has been my privilege to serve twice as a CMA alternate delegate representing San Diego. In 2009 I chaired the CMA Young Physicians Section and authored a successful resolution improving debate efficiency at the CMA House of Delegates.

With healthcare reform on the national and state agenda, decisions made today on our key issues will greatly affect our futures. As a board member I would be a voice for reasoned discussion, representing all physicians. I’ve greatly enjoyed my service on behalf of SDCMS and CMA and would be delighted to continue my service as a member of the board.

delegation. This vote of confidence was based, I believe, on my performance and service to the California delegation in my roles Candidate for At-large as chair of the Legislative Alternate Director #2: Tom Committee and chair of McAfee, MD (3) Kimberly Lovett, MD Albert Ray, MD Lisa Miller, MD the Alternates Committee.

As well, I believe that the Candidate for At-large Hay, Hertzka, Miller, and Ray team remains a major voice within the Alternate Director #4: James Bush, MD* (3) California delegation. My record demonstrates that I am a leader who is willing to work with others to achieve results. Our goal is to face Candidate for Young Physician Director: Van Cheng, MD (1) the challenges of healthcare reform with understanding and lively debate, and to communicate that process to you, our constituents. I Candidate for Young Physician Alternate Director: remain grateful to you all based on your past confidence in me, and Kimberly Lovett, MD (1) ask for your vote so that I may continue in this role. Thank you.

Candidate for At-large Alternate Director #1: Carol Young, MD* (3)

Candidate for AMA Alternate Delegate: Albert Ray, MD* I humbly request your support to continue to represent you at AMA. Recently, I was honored to be elected as vice chair of the California

Candidate for AMA Alternate Delegate: Lisa Miller, MD*

URGENT CARE ISN’T JUST FOR PATIENTS i5PSSFZ 1JOFT #BOL IBT DPOTJTUFOUMZ QSPWFO JUT BCJMJUZ UP NFFU NZ MPBO OFFET XJUI WFSZ DPNQFUJUJWF QSJDJOH TPNFUIJOH UIBU IBT CFFO WFSZ JNQPSUBOU JO IFMQJOH NF UP HSPX NZ CVTJOFTT w TORREY PINES BANK *4 A HEALTHY CHOICE FOR YOUR PRACTICE ■4VCTUBOUJBM $BQBDJUZ UP 'VOE #VTJOFTT -PBOT &RVJQNFOU 'JOBODJOH– ■9 UIF '%*$ *OTVSBODF $PWFSBHF 0WFS B 4UBOE "MPOF #BOL¤ ■#SPBE "SSBZ PG $BTI .BOBHFNFOU $BQBCJMJUJFT ■$PNQFUJUJWF .POFZ .BSLFU BOE $% 1SJDJOH To schedule a complimentary Urgent Care banking check-up for your practice, contact our veteran bankers: 858.523.4600 | TORREYPINESBANK.COM *Jeffrey Bernicker, MD Orthopedic surgeon and banking customer of Torrey Pines Bank since 2005.

Endorsed Partner,

%08/508/ t $"3.&- 7"--&: t (0-%&/ 53*"/(-& t ,&"3/: .&4" t 4:.1)0/: 508&34 t -" .&4" t $"3-4#"% t TORREYPINESBANK.COM š Equipment Financing Provided by Western Alliance Equipment Leasing, an AfďŹ liate of Western Alliance Bancorporation – Loan Products are Subject to Credit Approval ² The Waltree Program is provided through each of the afďŹ liates of Western Alliance Bancorporation: Torrey Pines Bank, Bank of Nevada, Alliance Bank of Arizona, and First Independent Bank are members of the FDIC. Alta Alliance Bank is a member of the Federal Reserve. On October 3, 2008 FDIC deposit insurance increased from $100,000 to $250,000 per depositor through December 31, 2013.

TORREY PINES BANK IS AN AFFILIATE OF WESTERN ALLIANCE BANCORPORATION.

Apr il 2010 SAN  DIEGO  P HY SICIA N. o rg

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practicemanagement

By Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI

Responding to Recovery Audit Contractors Nine Tips

Hearing the word “audit” can induce fear and panic, but they’re feelings you must face. It’s 2010, and Medicare recovery audit contractors (RAC) are a permanent, nationwide program. And as payers become more aggressive, an audit of your practice, once a possibility, now is almost a certainty. How would you and your practice fare?

Following are nine tips to help you minimize the potential impact of an audit on you and your practice.

1

Well Informed Means Well Prepared

If you file claims for Medicare feefor-service programs, the RAC may come knocking on your door. Educate your entire staff, including anyone who provides or participates in patient care, about RAC. This includes all practice providers, office/practice managers, compliance, billing, coding, and reception-area personnel.

Prepare yourself and your practice by reviewing the Centers for Medicare and Medicaid Services’ (CMS) website regarding the RAC program at cms.hhs.gov/RAC.

2

Use CMS’ Website to Get Started

At CMS’ website listed above, you will learn who the RAC contractor is for your area; this is based on geographic region. This is important to know and should be a first step in your process. Also explained are how many records the RAC can pull for your practice size, how far back they may review records, how often they may make a record or audit request, and what specific issues the RAC in your region will be auditing.

3

Regulations Require the RAC Choose a Specific Billing Issue to Audit

The RAC then requests approval from CMS to audit these issues. You may find

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S AN D I E G O P HY S I CI A N . or g April 2010

this information posted on the contractors’ website. The contractors may select areas and issues to audit based on selection by software, review of Medicare rules and regulations, as well as knowledge of auditors. With webbased claims submissions and portals, many audits may be conducted securely through the web. It is the decision of the RAC whether to conduct the audit onsite or electronically.

The decision may be based on volume and/ or scope of the audit. Utilization criteria for the audit, such as LCD, ICD9/10 codes, etc., also will be posted on the contractor website for RAC. Make sure that all supporting documentation is given to the RAC at the time of the audit.

4

RAC Auditors May Use Physicians, Nurses, and Certified Coders to Audit Your Records

Ensure your records are compliant with all rules and regulations for appropriate documentation and coding. This is critical and should be done now. Conduct regular audits of your records. Having your work audited as a preemptive measure will give you peace of mind that you have documented and coded properly the work you have done, and are compliant in all areas of your practice. An experienced and skilled auditor will be able to identify potential issues in coding, compliance, and documentation, including missed

revenue opportunities. You may be underpaid and not even know it! Education should also be part of the audit process in order to ensure accuracy and compliance.

5

Know How to Respond to a Request for Overpayment

Contractors may request money back if an overpayment has been identified. You should review the findings carefully, which typically are sent to you within 60 days of the records being received by the RAC. Go over the results line by line, and contact the RAC with any questions.

The RAC website will guide you through the steps you need to take. If you agree with the RAC findings, you can pay the money back, allow the money to be recouped from future payments, or request or apply for a payment plan. You may also appeal. You will have options; explore them.

6

Consider the Appeals Process

Be sure you understand the audit and/or enlist the help of credible resources to assist you with the appeal of the audit findings overpayment. Always follow the instructions to appeal given by the RAC. You may not appeal an underpayment. Responses to audit findings do not need to be lengthy. Instead, they should be accurate and to the point — this is critical. Do not supply the same information the RAC already has if you are challenging the audit. State your issues clearly and submit pertinent information only. It is important to leave emotion out of your appeal. Heed time limitations for appealing the audit findings; do not exceed your appeal deadline. If an extension is needed, ask and make sure the request is reasonable and well-documented. Always document your appeal, and address letters to a specific contact person, not a general address. A certified, return-receipt request is best.

7

Document Where You Obtained Information That Supports Your Billing, Coding, or Documentation Protocols Always document who you talked to and when — whether it is with a RAC, health

plan, coding, or documentation source.

Keep a file with original source information that supports your practice standards and protocols. Use forums carefully, and request and rely on original source information only.

Information obtained on a forum is typically the opinion of the person posting and may not necessarily be accurate. Industry forums can be very helpful when utilized properly.

If you appeal the audit, it will be important to have credible information that supports your position. Make sure you keep your files current. Submitting old or outdated information is not going to get you very far in any appeal.

8

Always Stay Compliant With HIPAA

If auditors show up, instruct staff to ask for identification. Never release confidential records unless you know the person has the right to review the records.

Watch the date span, and provide only the information required to be compliant with the request for records. Send records securely, either electronically or by other secure methods. Review HIPAA rules and regulations when in doubt.

9

Get Help If You Need It

If you are overwhelmed by an audit, get some help early on.

This may be in the form of a certified professional medical auditor, a certified professional coder, or legal professional. Issues can be simpler than you may be initially aware of if you have someone reviewing your practice who truly understands and has expertise in this arena. It is not necessary to escalate simple situations that can be resolved by engaging when you need to. Remember, experts can give you unbiased audit support and save you time, worry, and frustration in your practice that could be spent providing patient care and continuing revenue flow.

Do not forget to learn from this experience.

Consider the value of continued education in the areas of practice management, coding, and billing. Staying current can save you in the long-run and help ensure a smoother audit process. As rules change, continued training becomes critical to ensuring all rules and regulations are followed.

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Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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SDCMS-CMA LEGISLATIVE ADVOCACY

The Bar to the

Corporate practice of medicine

Protecting Physician Autonomy and Patient Safety!

by the California Medical Association 20

S ANâ&#x20AC;&#x2C6; D I E G Oâ&#x20AC;&#x2C6; P HY S I CI A N . or g April 2010

Editorial Note: At press time, there continue to be new developments to this issue. CMA, with the help of our grassroots efforts, has raised many questions in the minds of members of the Assembly about the wisdom of allowing the direct employment of physicians and surgeons by hospitals and hospital districts. Because of the increasing difficulty in obtaining the votes to approve SB 726 in the Assembly, the sponsors of the bill changed tactics and tried to revive AB 646 in the Senate Business and Professions Committee by amending it and setting it for hearing on Monday, April 19, 2010. Due to a quick response from CMA and the local societies with members sitting on that committee, it appears there are not sufficient votes to move the bill along, so it was removed from the agenda. The sponsors continue to remain active and are searching for the right opportunity to press this issue through the Legislature. While CMA was able to defend the bar on the corporate practice of medicine in 2009 and is on pace to do so in 2010 as well, we feel educating our physicians on this very important and active issue warrants publishing this article

Physician autonomy and patient safety are under attack in Sacramento this year by hospitals districts* and labor unions that are challenging the bar to the corporate practice of medicine, California’s patient protection law that prohibits corporations from hiring physicians and thus from practicing medicine.

The bar against the corporate practice of medicine has been in place in California since 1938 and continues to protect patients from corporate entities exerting control over the delivery of medicine. When hospitals are allowed to hire and charge for physician services, a division of the physician’s loyalty to the patient can be created, commercial exploitation of medical care can occur, and lay control over a physician’s professional medical judgment can be exerted, each of which resulting in higher healthcare costs and — what is worse — diminished quality of care provided to patients in California In 2009, three separate bills undermining or eliminating the corporate bar were introduced. These three bills were derailed through the lobbying of CMA. In 2010, those bills were consolidated into one: SB 726 by Senator Roy Ashburn and sponsored by the American Federation of State, County, and Municipal Employees (AFSCME) — a labor union interested in unionizing doctors — and the California Association of Healthcare Districts, whose members want to hire and control physician services.

The supporters claim this is about creating access to physician services where there is none today. They claim that hospitals, especially in rural areas, are unable to attract and retain physicians and therefore must be allowed to directly employ physicians.

CMA is opposed to any bill that diminishes the bar to the corporate practice of medicine for a number of reasons: 1. These bills do not increase the number of physicians in California. The only way to increase access to physician services is to increase the number of physicians. Increasing slots to allow residents to train in California, developing the medical schools at UC Merced and UC Riverside, and expanding access to California’s loan repayment program will truly ensure physicians go to and stay in rural and underserved areas. CMA-supported bills, for example, are now providing over $2 million in medical school loan repayment for physicians who agree to practice in rural and underserved areas.

Since loan repayment obligations are one of the primary reasons physicians will not go to underserved areas, this will

attract physicians to those areas without compromising the quality of care patients receive.

2. Allowing a hospital to directly employ a physician will NOT increase access to physician services. The hospital will push patients to their preferred physicians and thereby control the competitive market. Non-employed physicians will not be able to compete and will likely be forced out of town, resulting in reduced access.

3. Physicians and hospitals have conflicting goals. Physicians want to keep their patients well and out of the hospital.

Hospitals are focused on patient utilization of their beds and other facilities.

The ban on corporations practicing medicine is an important protection for patients in California’s hospitals and ensures that those who make decisions that affect the provision of medical services: 1) understand the quality-ofcare implications of that medical service; 2) have a professional ethical obligation to place the patient’s interests first; and 3) are subject to the Medical Board of California. Physicians, not hospitals, are the ones who are ethically and legally obligated to do what is best for patients.

4. Placing doctors under the oversight of nonphysicians who are under enormous pressures to cut costs or increase revenues will threaten the independent medical judgment necessary to ensure patients are protected. A study was recently released that shows that a motivation for hospitals to acquire physician practices is financially based, that is, to increase referrals from the physicians that they employ and to share in their revenue — not just for increased access for patients. In addition, hospitals are already interfering with medical staffs’ ability to ensure quality care through independent self-governance. For example, some hospitals have adopted medical management protocols that have resulted in inappropriate hospital tests, procedures, and stays, jeopardizing patients and increasing costs.

5. Hospital districts already have numerous financial incentives they can use to recruit physicians. Proponents of elimi-

nating the corporate bar, including hospitals districts, have failed to show why allowing corporate entities to directly hire physicians would work where these incentives have failed. A list of incentives currently available to hospitals and hospitals districts includes: a. guaranteeing to a physician and surgeon a minimum income for a period of no more than three years from the opening of the physician and surgeon’s practice, b. guaranteeing purchases of necessary equipment by the physician and surgeon, c. providing reduced rental rates of office space in any building owned by the district or any of its affiliated entities, and d. providing other incentives to a physician and surgeon in exchange for consideration and upon terms and conditions the hospital district’s board of directors deems reasonable and appropriate.

None of these incentives grants hospitals or hospital districts the control over the actions of physicians that they seek through the ability to hire physicians — the real goal of eliminating the patient protections of the corporate bar.

Of concern to CMA, there is significant misrepresentation by opponents of the bar to the corporate practice of medicine.

They have created a website that claims that eliminating the corporate bar would solve California’s physician shortage (despite not creating a single new additional physician or residency slot in the state!), that incorrectly states that “support for SB 726 is broad, diverse, and expert” [“From doctors and healthcare experts, to civil-rights groups and faith-based organizations, Californians with conscience are calling for an exemption to the ‘physician hiring ban.”], that falsely states that AMA supports eliminating the corporate bar, and that inappropriately uses CMA data in an effort to make it appear as though CMA supports SB 726 as a way to solve the doctor shortage in California. * California’s Legislature responded to a hospital shortage after World War II by enacting the Local Hospital District Act, which later became the Health Care District Act, a body of law that authorizes communities to form special districts to construct and operate hospitals and other healthcare facilities to meet local needs.

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SDCMS-CMA LEGISLATIVE ADVOCACY

Follow the

legisla

CMA’s Legislative Hot List

by the California Medical Association

*

CMA sponsors approximately five to seven bills during each legislative session.

CMA will closely follow ⇢ approximately 500 bills in 2010.

22

S AN D I E G O P HY S I CI A N . or g April 2010

CMA employs four full-time staff lobbyists and one full-time chief lobbyist.

ow

CMA’s Legislative Hot List provides a summary and current status of CMA-sponsored bills, as well as the progress of other significant legislation followed by CMA’s Center for Government Relations. The Hot List represents only a small sampling of the hundreds of bills CMA is following this year. For the current status or more information on a specific bill, please contact the appropriate lobbyist identified at the end of each bill summary by email or by calling (916) 444-5532.

!

slation CMA-sponsored Legislation HEALTHCARE PRACTITIONERS: DISCLOSURE OF EDUCATION CMA is co-sponsoring this bill with the California Society of Plastic Surgeons. It is becoming increasingly difficult for the public to identify the license, education, and training of healthcare professionals who practice in the state, and many are unable to distinguish between physicians and nonphysicians.

To protect the public’s health and safety, this “truth in advertising” legislation will require a healthcare professional to disclose information in various healthcare settings to help patients understand who will be helping them with their healthcare, such as information about their license, education, and recognized board certifications.

• Bill: AB 583 (Hayashi) • Status as of April 12, 2010: On Senate floor. Two-year bill.

• CMA Staff: Carolyn Ginno

PEER REVIEW This bill improves an already robust peer review system to make it even more effective in ensuring high quality care in California hospitals. Nearly all peer review in California is done in an efficient and timely manner that protects patients from quality of care deficiencies. However, the current peer review system can be strengthened. For example, improper or biased review can be utilized to remove physicians for non-quality of care concerns. In rare circumstances peer review can be delayed to the point that patients are placed in danger by the inability to promptly remove a physician that is providing substandard care. This bill is a reintroduction of AB 120, which CMA sponsored last year but which was vetoed by the governor — the veto was based on the fact that AB 120 was joined to a bill the governor objected to. AB 1235 is not joined with the same provisions that led to the veto of AB 120.

• Bill: AB 1235 (Hayashi) • Status as of April 12, 2010: On Senate floor.

• CMA Staff: Brett Michelin Apr il 2010 SAN DIEGO P HY SICIA N. o rg

23

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SDCMS-CMA LEGISLATIVE ADVOCACY

ADEQUATE VACCINE REIMBURSEMENT Co-sponsored with AAP and CAFP, this bill would require health plans and insurers to fully reimburse physicians for the direct and indirect costs to acquire and administer recommended vaccines that are already required to be covered; prohibit health plans and insurers from charging co-payments, deductibles, or other out-of-pocket expenses that deter parents from immunizing their children; and prohibit health plans and insurers from including the cost of immunizations in a policy’s dollar limit provision.

CMA has extensive policy on this issue that has been highly ranked by the CMA House of Delegates. This bill is a reintroduction of AB 1201 (Perez), which was held on the Assembly Appropriations Committee suspense file in 2009.

• Bill: AB 2093 (M. Perez) • Status as of April 12, 2010: Referred to Assembly Appropriations Committee.

• CMA Staff: Teresa Stark EMS/MADDY FUND ACCOUNTING Co-sponsored with the Chapter of the American College of Emergency Physicians (CAL/ACEP), this bill would clarify the EMS/ Maddy Fund reporting requirements in existing law. A CMA House of Delegates resolution was passed in 2009 on this issue, stating the need for timely and accurate reporting by counties. This legislation will expand the level of detail that counties are required to report to the state in order to make it easier for members of the public, including physicians, to access thorough and helpful information on counties’ Maddy Funds. Nearly every county in the state has a Maddy Fund, and the economic downturn has led to a significant increase in the number of uninsured in California, increasing pressure on these critical resources.

In many cases the Maddy Fund is a physician’s only source of payment for providing emergency care to this population, and so it is essential that these monies be thoroughly accounted for and effectively spent.

• Bill: AB 2248 (Hernandez) • Status as of April 12, 2010: In Assembly Committee on Health.

• CMA Staff: Carolyn Ginno UNLAWFUL RESCISSION This bill is intended to stop the unscrupulous practice of “unlawful rescission,” where HMOs dump patients off their insurance after their policy has been approved. This legislation will ensure that health plans and insurers do no act as “judge and jury” whenever they want to rescind or cancel a policy in the individual market. This bill provides protection to patients by requiring a healthcare service plan or health insurer to obtain final approval from an independent review organization prior to rescinding a plan contract or insurance policy. This review would use a clear legal framework to determine whether the rescission is appropriate while protecting the enrollee’s rights during the review process. The bill would also improve the process at the frontend by requiring plans and insurers to complete medical underwriting prior to issuing a policy and to make applications

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S AN D I E G O P HY S I CI A N . or g April 2010

QUALITY MEASUREMENT AB 2533 requires healthcare service plans and insurers to file with the Department of Managed Care or Department of Insurance a description of policies and procedures related to quality or physician rating of physicians or surgeons used by the plan or insurer. Quality rating or physician rating is any attempt of a healthcare service plan, insurer, or a third party to develop, evaluate, or rate the performance of a physician or surgeon based on quality measurements and insurance claims data. Many insurers are attempting to rate physicians based on quality or cost measures without the consent of physicians.

For example, the California Physician Performance Initiative (CPPI) has been ongoing for the past two years, yet problems continue to exist. Given that there are many concerns about the accuracy of the claims data used by insurers, and the irreparable harm such ratings may bring to a physician’s personal and professional reputation or how patients

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Typically, CMA’s lobbyists each spend 25 hours or more each week in the Capitol, depending on the length of the committees or major bills up in hearings.

Toward the end of the legislative session, each of CMA’s lobbyists may spend as many as 50 hours or more in the Capitol during the week.

24

easier to fill out accurately and completely.

This is a reintroduction of AB 2 (2009) and AB 1945 (2008), both vetoed.

• Bill: AB 2470 (De La Torre) • Status as of April 12, 2010: Referred to Assembly Committee on Appropriations.

• CMA Staff: Teresa Stark

CMA’s chief lobbyist is involved in each bill.

could be mislead by the information, CMA believes that health plans, insurers, or any third party contracted to conduct a quality rating program should be required to simply disclose a description of the policies and procedures related to the rating. â&#x20AC;˘ Bill: AB 2533 (Fuentes) â&#x20AC;˘ Status as of April 12, 2010: Referred to Assembly Appropriations Committee. â&#x20AC;˘ CMA Staff: Dean Grafilo NETWORK TRANSPARENCY This bill would require the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) to more effectively enforce network adequacy requirements in current law and ensure that provider directories are accurate. The bill would require DMHC/DOI to regularly review provider networks to ensure that the required physician-to-patient ratios are being maintained, as well as to ensure that the networks and directories do not include doc-

tors who are deceased, retired, have moved out of state, or whose practices are closed to new patients. Providing these departments with better network adequacy enforcement tools will improve access and continuity of care and will equip patients with full and complete information about their healthcare provider network. AB 2586 will help ensure consumers and employers are being offered real value in exchange for their healthcare premiums. â&#x20AC;˘ Bill: AB 2586 (Chesbro) â&#x20AC;˘ Status as of April 12, 2010: In Assembly Committee on Health. â&#x20AC;˘ CMA Staff: Teresa Stark

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MEDICAL MALPRACTICE COVERAGE FOR VOLUNTEER PHYSICIANS In order to encourage more physicians to provide voluntary care to Californians in need, CMA, in conjunction with the Medical Board of California, will use this bill to provide malpractice coverage to volunteer physicians. Currently, CMA staff is managing a workgroup comprised of insurers, hospitals, clinics, and the Medical Board of California that is charged with finding a solution to this ongoing problem, including public coverage, requiring government agencies to cover physician employees who volunteer, and mandates on other insurers to provide funds.

Approximately 2,500 bills have been introduced so far in the current 2009â&#x20AC;&#x201C;10 legislative session in Sacramento â&#x20AC;&#x201D; CMAâ&#x20AC;&#x2122;s government relations team continues to read them all.

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Apr il 2010 SANâ&#x20AC;&#x2C6; DIEGOâ&#x20AC;&#x2C6; P HY SICIA N. o rg

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SDCMS-CMA LEGISLATIVE ADVOCACY

This bill will address a key barrier to improving access to care.

• Bill: SB 1031 (Corbett) • Status as of April 12, 2010: In Senate Business and Professions Committee.

• CMA Staff: Dean Grafilo

CMA-opposed Legislation PHYSICIANS AND SURGEONS: EMPLOYMENT This bill was amended in Assembly Health Committee to establish a pilot program to allow healthcare districts located in an underserved area to directly employ and charge for physician services. Districts would be allowed to hire up to five physicians with an ability to request up to five additional contracts and would limit the pilot to 10 years.

• Bill: AB 646 (Swanson) • Status as of April 12, 2010: In Senate Business and Professions Committee.

• CMA Staff: Brett Michelin RURAL HOSPITALS: PHYSICIAN SERVICES This bill, as amended in Assembly Health, would allow a rural hospital that serves an underserved area or population to directly employ and charge for physician services.

The demonstration project would last up to 10 years and would allow the hospital to employ up to 10 physicians. To be eligible, the hospital must demonstrate that it can document that it has been unsuccessful in recruiting a physician for 12 months, and the CEO must certify to the MBC that there is a critical unmet need in the community.

• Bill: AB 648 (Chesbro) • Status as of April 12, 2010: Failed Senate Business and Professions Committee.

Reconsideration granted.

• CMA Staff: Brett Michelin

HEALTHCARE: BILLING: INTEREST AND FEES This bill would prohibit medical providers, medical groups, IPAs, and health facilities from charging, assessing, or collecting directly or through a collection agency any interest, late fees, or charges on any unpaid balance on a bill for medical services rendered. The bill would also require those providers and facilities to include in a bill for medical services a notice to this effect. Charging interest and late fees is allowed by law and is common practice in many industries to encourage timely payment for services rendered. This bill unfairly singles out healthcare providers. Physician practices in particular can suffer when outstanding medical bills are unpaid, so this option should remain available to them.

• Bill: AB 2334 (Salas) • Status as of April 12, 2010: In Assembly Committee on Health.

• CMA Staff: Teresa Stark HEALTHCARE COVERAGE: RATE APPROVAL This bill would require the Department of Managed Health Care and the Department of Insurance to approve any increase in the amount of the premium, copayment, coinsurance obligation, deductible, and other charges under the healthcare service plan or health insurance policy. CMA opposed similar legislation in recent years because rate setting in healthcare is bad precedent, and this type of rate oversight would merely be passed down to physicians, leading to lower provider reimbursement and less time with patients.

• Bill: AB 2578 (Jones) • Status as of April 12, 2010: Referred to Assembly Committee on Appropriations.

• CMA Staff: Teresa Stark

Sponsoring a bill means formally supporting that bill and being its primary advocate. CMA’s government relations team is responsible for testifying, for lobbying, and for the general health and wellbeing of getting all of CMA’s sponsored bills through the legislative process during each legislative session.

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S AN D I E G O P HY S I CI A N . or g April 2010

k

HOSPITALS: EMPLOYMENT OF PHYSICIANS AND SURGEONS This bill, as amended in Assembly Health Committee, will allow virtually all healthcare districts and rural hospitals to directly employ up to five physicians in a pilot program. The CEO of a facility must show that they have been unsuccessful in recruiting a physician for 12 months, that no currently contracted physician or physician with privileges will be supplanted, and that the physician was not recruited from an FQHC. Employment contracts can be up to 10 years but may be renewed if signed prior to December 31, 2017.

The Medical Board of California would be responsible for an interim report on the success of the pilot program due in 2013, with a final report due in 2016.

• Bill: SB 726 (Ashburn) • Status as of April 12, 2010: Placed on Assembly inactive file. Two-year bill.

• CMA Staff: Brett Michelin SINGLE-PAYER HEALTHCARE This bill is a reintroduction of SB 840 (Kuehl) from last session. The bill would create a single-payer system of healthcare in California. Specifically, SB 810 would create a single-payer purchasing pool and would prohibit most private health insurance from being sold.

• Bill: SB 810 (Leno) • Status as of April 12, 2010: On Assembly floor. Awaiting referral to policy committee for hearing.

• CMA Staff: Carolyn Ginno

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Each CMA lobbyist has major support and major oppose bills that require heavy advocacy in the Legislature.

Each CMA ⇢ lobbyist has

two to four sponsored bills.

NATUROPATHIC MEDICINE (Oppose Unless Amended) Expands the category of people that may perform clinical laboratory tests or examinations that are classified as waived to include licensed naturopathic doctors and defines a naturopathic medical assistant.

• Bill: SB 1246 (Negrete McLeod) • Status as of April 12, 2010: Senate Business, Professions Committee.

• CMA Staff: Dean Grafilo

Bills of Interest NONPAYMENT FOR ADVERSE EVENTS (Watch) In the face of strong CMA opposition, this bill was dramatically narrowed by the author before its first committee hearing.

The bill now applies only to hospitals and merely requires the state to adopt regulations establishing uniform policies and practices governing the nonpayment to hospitals for hospital-acquired conditions by public

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and private payers, consistent with those developed by the federal Centers for Medicare and Medicaid Services (CMS). The original problematic language creating a state Patient Safety Committee that would substantiate a broader list of adverse events and determine nonpayment policies for all providers was removed. CMA will continue to provide suggestions to further improve this bill and will stay engaged in the discussion.

• Bill: AB 542 (Feuer) • Status as of April 12, 2010: In Senate Health Committee. Two-year bill.

• CMA Staff: Teresa Stark PHARMACISTS: IMMUNIZATION ADMINISTRATION (Watch) The author has gutted her bill after it failed in committee in the face of strong CMA opposition. The bill would have allowed pharmacists to independently initiate and administer immunizations to children, and adults and now only contains uncodified language requesting the California Pharma-

Approximately 5,500 bills were introduced during the 2007–08 legislative session in Sacramento — CMA’s government relations team read each one of them.

cists Association to provide information to the chairpersons of Business and Professions and Health committees on the status of immunization protocols between independent pharmacists and physicians. CMA will monitor the bill closely to ensure that any study conducted is unbiased and narrowly focused and to ensure that objectionable language is not inserted at a later date.

• Bill: AB 977 (Skinner) • Status as of April 12, 2010: Referred to Assembly committees on Business and Professions, and Health.

• CMA Staff: Teresa Stark

Special Offer for San Diego Physicians to visit one of the best kept secrets in our county. Come join us at de Anza Country Club for a great desert golf experience.

This private club is located in the heart of the Anza Borrego Desert State Park and is renowned for its beautiful setting and the friendliness of its membership. Come and play a single round for $75.

Junior and Intermediate golfing memberships for various lower age groups are now available at very reasonable prices and payment terms. www.deanzacountryclub.com - (760) 767-5105 Ext. 3 Dress Code: Resort Desert Casual

Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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SDCMS-CMA LEGISLATIVE ADVOCACY

HEALTHCARE COVERAGE: PRESCRIPTIONS (Support) This bill would prohibit a healthcare service plan or a health insurer from requiring enrollees or healthcare providers to utilize a “fail first” or step-therapy process for prescription medication treatments. CMA policy recognizes health insurer abuse of step-therapy and calls for better enforcement to end this practice and protect patients and physicians. Furthermore, numerous CMA policies insist that health plans must not interfere in physician prescribing practices.

The choice of medications should be made by treating physicians. CMA supported an identical measure in 2009.

• Bill: AB 1826 (Huffman) • Status as of April 12, 2010: In Assembly Committee on Health.

• CMA Staff: Teresa Stark

PRESCRIPTION RECORD PRIVACY ACT (Support) This bill will prevent the sale of data collected by pharmacies on physician prescribing habits for the purposes of marketing.

Prescribing data can be used for multiple purposes, but this bill will prevent its use by pharmaceutical companies in direct-toprescriber advertising or marketing visits by detail representatives.

• Bill: AB 2112 (Monning) • Status as of April 12, 2010: In Assembly Committee on Health.

• CMA Staff: Brett Michelin MEDI-CAL: ORGAN TRANSPLANTS: ANTIREJECTION MEDICATION (Support) Provides that a Medi-Cal beneficiary shall remain eligible to receive antirejection medication (paid by Medi-Cal) for up to two years following an organ transplant, unless during that period they become eligible for Medicare or obtain private health insurance that would cover it. CMA sponsored a nearly identical bill last year — AB 998 (Perez, J.) — that would have extended the time requirement to three years.

• Bill: AB 2352 (Perez, J) • Status as of April 12, 2010: In Assembly Committee on Health.

• CMA Staff: Carolyn Ginno

CMA usually opposes from five to 10 major bills during each legislative session — bills ranging from scope-of-practice expansions, to corporate bar bills (three in 2010 alone), to major mandates interfering with the physician-patient relationship, etc.

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CMA’s staff lobbyists are responsible for bills by issue area, with each lobbyist following approximately 50–70 bills and actively lobbying approximately 20 bills.

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S AN D I E G O P HY S I CI A N . or g April 2010

PEER REVIEW (Support) The bill has been gutted, amended, and now contains the contents of SB 840, which CMA supported last year. SB 840 was vetoed by the governor. The bill allows a physician who has an 805 report filed against them to submit explanatory or exculpatory information that would be available through the Medical Board of California (MBC) when information is requested about that physician. The bill also requires the MBC to remove an 805 if a court finds peer review was conducted in bad faith. Furthermore, if a peer review body makes a proposed final determination that a physician acted with gross negligence, resulting in patient harm, or practiced medicine under the influence of drugs or alcohol and a patient was injured, the peer review body shall notify the MBC. This information shall remain confidential but allows the MBC to initiate an investigation. The bill makes other technical changes to the peer review system and includes a definition of peer review.

• Bill: SB 700 (Negrete McLeod) • Status as of April 12, 2010: Referred to Assembly Committee on Appropriations.

• CMA Staff: Brett Michelin

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MATERNITY SERVICES (Support) This bill will close a loophole exploited by health insurance companies in order to sell cheap, “subprime,” non-comprehensive health insurance that lacks maternity coverage. This bill brings two bodies of law into conformity by requiring all individual and group health insurance policies regulated under the Department of Insurance to cover maternity services, while HMOs regulated by the Department of Managed Health Care (DMHC) are already required to meet these standards. This bill will ensure fair, affordable access to maternity coverage in healthcare benefits, regardless of the type of plan offered.

• Bill: AB 1825 (De La Torre) • Status as of April 12, 2010: Referred to Assembly Committee on Health.

• CMA Staff: Teresa Stark

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Each CMA lobbyist has two to four sponsored bills.

HYPODERMIC NEEDLES AND SYRINGES (Support) This bill expands statewide and makes permanent a local pilot project that allowed pharmacists to provide up to 10 syringes without a prescription if they were registered with a local health department in a county that had opted into the program. CMA supported the original legislation establishing the pilot project, and CMA policy supports the deregulation of syringe and needle sales in California, and the sale of syringes and needles without a prescription at licensed pharmacies.

• Bill: SB 1029 (Yee) • Status as of April 12, 2010: In Senate Committee on Business and Professions.

• CMA Staff: Teresa Stark TAXATION: SWEETENED BEVERAGE TAX (Support) This bill would levy a one-cent tax at the manufacturer level for every teaspoon of sugar placed into a sweetened beverage or concentrate. The revenues collected from this tax, estimated to be approximately $1.5 billion annually, would be deposited in the Childhood Obesity Fund to pay for childhood obesity prevention programs throughout the state. Over-consumption of sugar-sweetened beverages, especially among very young children, is a primary culprit in the childhood obesity epidemic and is linked to diabetes. CMA policy supports increased taxes on sodas and other sugar-sweetened beverages with the revenues to be utilized for public health education efforts on obesity prevention and treatment.

• Bill: SB 1210 (Florez) • Status as of April 12, 2010: Referred to Senate Committee on Revenue and Taxation.

• CMA Staff: Teresa Stark

Support for Life.

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healthcare

reform

2009-10 What CMA Produced and What It Prevented! by the California Medical Association

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S AN D I E G O P HY S I CI A N . or g April 2010

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What Did CMA Produce?

1. CMA amendment requires health plans to direct 85 percent of revenues to direct patient care.

2. CMA amendment requires health plans to have adequate provider networks.

3. CMA strongly advocated for affordable, universal access to care for California’s low-income uninsured.

4. CMA advocated for expansion of private insurance coverage vs. Medicaid.

Two-thirds of those eligible under the bill will go into private coverage.

5. CMA vigorously promoted a Medicaid payment increase to accompany any Medicaid coverage expansion to ensure Medicaid patients have access to all physician specialties. The final bill provides a rate increase for primary care physicians up to Medicare levels.

6. CMA successfully advocated for 100 percent federal financing for the Medicaid expansion and the Medicaid rate increase to reduce the burden on the state of California.

7. CMA successfully argued for state-based health insurance exchanges rather than one national exchange of private health plan choices.

8. CMA fought for an additional Medicare payment increase for primary care physicians on top of a rate increase for all physicians to bolster primary care in California. Primary care received a 10 percent increase annually for five years (2011–16).

9. Initially, the bills included a ban on balance billing and out-of-network care.

CMA successfully fought to maintain the right for patients to seek care from the physician of their choice outside of health plan networks. There is no federal preemption of California’s balance billing prohibition in the final bill.

10. CMA won a series of amendments to protect and ensure the accuracy of physician information in quality reporting programs. Based on California’s experience, CMA worked with AMA to achieve amendments that require that physician data be statistically valid (most individual physicians do not have enough patients to make the data statistically significant); that require that attribution methodology

be correct; that require that information be risk-adjusted; that require that physicians have the right to review their data before it is finalized or made public; that require that CMS have appropriate systems to produce accurate physician information — among many other amendments. Additional cleanup legislation is needed.

11. CMA amendment ensures that physicians forming accountable care organizations do not need to include a hospital within the organization. CMA advocacy also promoted that physicians keep a substantial portion of any savings achieved in their region.

12. CMA strongly urged that Medicare increase the number of physician residency training slots overall to increase physician supply and improve access to care. The final bill redistributes current, unused residency slots for primary care and general surgery.

13. CMA won amendments that require a uniform Medicare prescription drug appeals form and process.

14. CMA amendment included in the House bill would have allowed medical groups to contract directly with Medicare on a capitated basis to avoid some of the Medicare Advantage cuts.

Unfortunately, this was not included in the final bill.

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What Did CMA Prevent?

• CMA amendment prohibits insurance companies from rescinding insurance when a patient becomes ill.

• CMA opposed a public option that mandated physician participation and paid Medicare rates. The public option was dropped from the bill.

• CMA successfully fought efforts by rural Midwest states to implement a “value index” payment system that would have reduced payments to California physicians by up to 15 percent. The Midwest states claim they are more efficient users of Medicare resources than California and therefore should receive bonuses and California payments should be reduced. CMA amendments were accepted in the House and Senate bills that ensure that any Medicare adjustments in payment must account for California’s higher practice costs (rent

•

•

•

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•

•

• •

•

and wages) and socioeconomic factors (race/ethnicity, income, health status, rate of uninsured) that drive up practice costs. AMA represents physicians in all states, so CMA had to fight this battle.

CMA successfully fought amendments by rural states to reduce Medicare payments in California for geographic practice costs by up to 8 percent. CMA amendments were accepted in the Senate and require California doctors be held harmless from cuts until a study of geographic practice costs can be performed. AMA represents physicians in all states, so CMA had to fight this battle.

CMA opposed the provision to allow nurse practitioners to lead medical homes. Although we were unable to remove that provision entirely, we were able to maintain the language that leaves it to state scope of practice laws.

California law prohibits a nurse practitioner from running a medical home.

CMA helped to eliminate a provision that would have banned existing physician-owned hospitals. The final bill did, however, contain a ban on future physician-owned hospitals, which will go into effect on December 21, 2010.

CMA worked with AMA to eliminate a 5 percent Medicare penalty on physician utilization outliers.

CMA worked with AMA to eliminate the $350 Medicare participation fee for doctors.

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

CMA and AMA opposed the cosmetic surgery tax, and it was eliminated.

CMA joined the chorus in opposition to the Cadillac health plan tax on highend benefits because it disproportionately harms California’s employers and individuals purchasing insurance. The tax was delayed until 2018.

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

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CMA Steps up where AMA can't An Interview With CMA's Vice President for Federal Government Relations by san diego physician

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S AN D I E G O P HY S I CI A N . or g April 2010

up

Note From SDCMS: Carefully note the references to CMA vs. AMA in Elizabeth McNeil’s comments and the ways CMA is better able to address California-specific issues than is AMA, especially due to the different constituent members. Elizabeth and CMA have been at the forefront of educating federal legislators and White House aides in the truth behind the Dartmouth Atlas studies and the inappropriate use of the studies by rural states to reallocate funds away from California. Without CMA’s efforts on this front, we stood to lose much more in coming years!

San Diego Physician: Tell us how you got started at CMA. Elizabeth McNeil: I actually started my career on Capitol Hill working as a legislative assistant to several members of Congress. After I left Washington, DC — almost 20 years ago now — I came to California and have been working for CMA ever since. For years CMA had been doing some federal lobbying, but not to the extent that it needed to. We realized that, because of our unique circumstances here in California and the enormous impact federal issues have on our doctors and how they practice medicine, we differed from a lot of the other states and from AMA on different issues.

SDP: Can you give us an example?

McNeil: There are some issues where AMA can’t help California’s doctors — when we have, for example, geographic fights between the states, which was the central theme this year. The president and his budget staff focused in on the Dartmouth studies that show wide disparities in Medicare spending across the country. For instance, in Los Angeles and Miami-Dade, Florida, we spend four times as much as other regions to provide the same care to senior patients.

Many analysts believe it is inefficient delivery of care, and they have used the Dartmouth studies as a way to curb runaway healthcare costs.

The Midwest and Northwest rural states that spend less than California operationalized it into legislation.

The rural state proposal would have rewarded the states that spend less than the national average, and doctors in California, for example, who spend above the national average, would have had their reimbursements cut significantly.

So that was the proposal put before Congress in an environment of cost containment and no new Medicare revenue.

We spent our entire year fighting this fight, and AMA couldn’t enter the fray because

they have states who are winners and states who are losers, and they couldn’t get in the middle of it. CMA had to be engaged in Washington, DC, ensuring that the bills were amended to account for California’s socioeconomic differences (income, racial and ethnic diversity, insurance status), health status differences, and our geographic differences in practice costs. As we know from numerous studies, including MedPAC, if researchers account for these other factors, the geographic variation in spending between states goes way down. Had the other states prevailed, we would have had up to 22 percent in payment cuts in California.

SDP: What would you say to physicians who are angry with AMA right now with respect to health reform?

McNeil: It’s easy to stand on the outside and criticize AMA on healthcare reform, saying they should have gotten more for the docs.

A lot of physicians are upset that AMA didn’t stand up and fight for the right to privately contract, for example. Private contracting is an uphill battle with Congress. It’s an issue that will take several years and a lot of work to take hold.

There are some issues where AMA can’t help California’s doctors.

I think AMA did the right thing in supporting expansion of coverage to the uninsured and all of the reforms on the for-profit insurance industry, which has been a part of CMA’s agenda for decades. Could AMA have done more to leverage Congress and their support for getting more on the physi-

Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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SDCMS-CMA LEGISLATIVE ADVOCACY

cian payment side? Yes, they could have, and that’s what’s frustrating and lacking in this bill — that’s the unfinished business of health reform [see page 36]. However, physicians also need to understand that the health reform bill was more about reigning in escalating healthcare costs than it was about covering the uninsured.

It was a tough environment. There was enormous pressure to contain costs in the Medicare program. Compared to the other providers — health plans, hospitals, pharma, nursing homes, and home health — physicians did not receive deep payment cuts. However, other than primary care, we were not given appropriate updates, and physicians are rightfully angry and frustrated. The Medicare SGR needs to be eliminated. That’s a huge start to getting us on the path of stable updates. But the incentives in our payment systems need to be completely realigned.

CMA physicians did an incredible job of educating our congressional delegation, particularly those House Democratic leaders that included $450 billion in physician payment fixes in the House bill to provide coverage and access to doctors. I think AMA was right in their support of the House bill, but, unfortunately, we ended up with the Senate bill, which wasn’t nearly as good for doctors.

I think we all should have been stronger in our opposition to the Senate bill. CMA tried to be very outspoken about the Senate bill.

But AMA has a lot of commitments from the White House, the House leadership, and, to some extent, the Senate leadership, to address the physician payment issues, to stop the 21 percent SGR cut and repeal the SGR payment formula, and to weaken the impact of the independent Medicare board on physicians. CMA is working on these issues as well as including the California GPCI fix in the SGR bill this year. We expect a bill

by June.

I think our CMA leadership did a better job of nuancing our position on what we supported and what we didn’t. We were very strong in our opposition to the Senate bill. I think we did a better job of pointing out to our physician members where we had problems and what we wanted fixed. AMA did some important things for physicians, but they didn’t do a good job of involving the grassroots. CMA and San Diego have fantastic physician advocates who have been most

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S AN D I E G O P HY S I CI A N . or g April 2010

effective. However, I think we have no idea the wrath that would have fallen upon physicians from the public and from Congress if physicians once again were standing in the way of low-income people who need health insurance. I think it’s something that we had to play very carefully.

Medicine wanted to be relevant to the conversation and a partner at the table in the negotiations. If we had said hell no like the insurance industry finally did, we would have been left out of the room like they were, and you saw how the Obama administration went after them with full force. I think if medicine had come out with a single oppose position, it would have been very harmful to our future success in achieving our legislative goals and on implementation of reform. And there are good things in this bill for physicians. So you have to be firm about what you oppose, but you also have to let Congress know that you want to be part of the solution. Whether it’s legislative or clinical, physicians are always looking for the solutions, rather than being part of the problem.

SDP: Any last words?

McNeil: This bill is a mixed bag for doctors. It’s great that we’ve covered a lot of uninsured patients and that we’re going to reform the insurance industry. The primary

care investments are significant. The fact that we’ve covered 80 percent of Californians is no small feat to be overlooked — we have to keep our perspective on that. It isn’t the way I would have done it. It isn’t the way most physicians would have done it. But I think we all need to move forward at this point and focus on improving it.

There are a lot of important battles to be fought on SGR and reform implementation, and physicians have got to stay united.

They’ve got to stay engaged in this battle; it’s probably more important than ever to speak out about access to doctors. And the implementation … boy, the devil’s in the details on this. It’s going to be an enormous amount of work, and that’s really where this bill will be won or lost for the doctors and the patients.

I urge physicians not to get discouraged.

Half of our doctors support this bill and the other half are very discouraged. For those who are discouraged, I encourage you to remain engaged, to stay in the fight because there’s still a lot to be gained here. The unfinished business agenda is important. We have to explore new payment and delivery models, realign incentives, and let physicians practice medicine. And as physicians, whether we agree or disagree, we will only prevail if we fight together — AMA, states, counties, and specialties.

CMA had to be engaged in Washington, DC, ensuring that the bills were amended to account for California’s social and economic differences, health status differences, and our geographic differences in practice costs. Had the other states prevailed, we would have had up to 22% in payment cuts in California.

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Apr il 2010 SANâ&#x20AC;&#x2C6; DIEGOâ&#x20AC;&#x2C6; P HY SICIA N. o rg

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*

SDCMS-CMA LEGISLATIVE ADVOCACY

Healthcare reform's unfinished business For 2010

by the California Medical Association

CMA will continue to vigilantly press Congress to address the following issues immediately: • Stop the 21% Medicare Cut and Repeal the Medicare SGR! • Eliminate the Independent Medicare Payment Advisory Board • Update the California Geographic Payment Localities (GPCI) • Increase Medicaid Rates for All Physician Specialties • Improve the Quality Reporting Programs • Prevent Additional Physician Liability Exposure • Allow Patients to Privately Contract With Physicians

36

S AN D I E G O P HY S I CI A N . or g April 2010

Project Access

San Diego

Volunteerism Made Easy The heart of the program is to link low-income, uninsured adults in San Diego County with specialist volunteers who agree to see a limited number of patients per year in their office for free.

• Physician Volunteer Flexibility: Physicians set their own volunteer commitment (ideal is one patient per month). Project Access patients are seen in the private office setting so you do not have to travel far to provide care for the medically underserved.

• Enrolling Patients Based on Need: Patients are referred to us exclusively from the community clinics in the area and do not qualify for any type of public health insurance program. Specialty care is a significant challenge for the clinics, and many patients endure wait times of up to six months to see a volunteer specialist at their clinic.

• Making Appropriate Referrals: Project Access publishes referral guidelines for community clinic

use. Our Chief Medical Officer also reviews each case individually so that specialists see only the most appropriate referrals.

• Providing Enabling Services: We provide services such as transportation and translation so that you don’t have to wonder if a patient is going to miss an appointment or if there will be a language barrier.

• Providing Case Management Services: We work with each patient one-on-one to coordinate followthrough on all medical needs.

• Providing All Needed Services: Through our partnerships, we ensure that a full scope of services is available to all of our patients, from hospital and ancillary services to a defined pharmacy benefit.

Join over 75 specialists as a Project Access volunteer!

Project Access is actively recruiting physicians, hospitals, and ancillary service providers to participate in our program.

Together we can ensure that our vulnerable populations have access to needed healthcare services.

Your commitment to Project Access is needed for our success! Please visit our website at SDCMSF.org to learn more and to sign up.

Sign up NOW at SDCMSF.org We need your volunteer commitment to help even one patient.

Our Medical Community Liaison, Rosemarie Marshall Johnson, MD, can answer your questions. Dr. Johnson can be paged at 619.290.5351. You may also contact Lauren Radano, Healthcare Access Manager, at 858.565.7930.

Apr il 2010 SAN DIEGO P HY SICIA N. o rg

37

*

SDCMS-CMA LEGISLATIVE ADVOCACY

On the Regulatory Side:

• The California Department of Public Health • The Board of Chiropractic Examiners • The Medical Boarad of California • The Department of Insurance • The Physician Assistant Committee • The Department of Managed Health Care • The Board of Optometry • The Managed Risk Medical Insurance Board • The Board of Pharmacy • The Department of Managed Health Care • The Division of Workers’ Compensation • The Federal Centers for Medicare and Medicaid Services • And on and on and on …

And On Your Side: CMA by the California Medical Association

38

S AN D I E G O P HY S I CI A N . or g April 2010

CMA’s Regulations Quick List provides a summary and current status of significant regulations followed by CMA’s Center for Medical and Regulatory Policy. The Quick List is circulated regularly on a monthly basis or more frequently, as needed. For more information on a specific regulatory package, please contact the appropriate CMA staff member identified at the end of each regulation summary by email or by calling (916) 444-5532.

*

CMA Regulations of Interest

SCOPE OF PRACTICE IN LICENSED HEALTH FACILITIES Proposed by the California Department of Public Health (CDPH) This regulatory package proposes to dramatically increase the scope of practice for a variety of licensed healthcare providers in hospital settings. These regulations would allow nonphysician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers.

In an earlier iteration, these regulations also contained provisions that would have defeated the right of medical staff self-governance, but which were removed after strong opposition from CMA. On October 14, 2009, OAL disapproved the regulations, thus beginning the 120-day period for CDPH to submit a revised package. CMA remains strongly opposed to these regulations.

• Status as of 04/13/10: Noticed: 07/11/08.

Disapproved by OAL: 10/09/09. Second 15-day Comment Period: 11/20/09–12 /07/09. CMA Comments Submitted: 12/07/09. Revisions Sent to OAL: 02/11/10.

Approved by OAL: 03/03/10. Effective: 04/02/10.

• CMA Staff: Veronica Ramirez

MANIPULATION UNDER ANESTHESIA Proposed by the Board of Chiropractic Examiners These regulations propose to allow chiropractors to perform manipulation on a patient who is under anesthesia administered by a physician, surgeon, or other authorized healthcare provider. CMA repeatedly urged the board to withdraw this regulatory proposal and remains concerned that manipulation under anesthesia is outside the lawful scope

of chiropractic practice.

• Status as of 04/13/10: Noticed: 01/12/09.

Fourth 15-day Comment Period: 10/28/09–11/12/09. CMA Comments Submitted: 11/12/09. Approved by OAL: 02/16/10. Effective: 03/18/10.

• CMA Staff: Veronica Ramirez

PHYSICIAN OFFICE SIGNAGE Proposed by the Medical Board of California (MBC) These regulations would require physicians to post a “Notice to Consumers” that the MBC regulates physicians and to provide the phone number and website for the MBC. CMA is concerned that this requirement will be an unnecessary administrative burden on physicians who are already required to post their medical license or wear a nametag indicating their licensing status. CMA’s amendment requests were rejected by the MBC. • Status as of 04/13/10: Noticed: 06/05/09.

CMA Comments Submitted: 07/15/09.

Final Statement of Reasons Issued: 07/24/09. Sent to OAL: 02/17/10. Approved by OAL: 04/01/10. Effective: 06/27/10.

• CMA Staff: Yvonne Choong

RESCISSION AND UNDERWRITING Proposed by the Department of Insurance (DOI) These regulations would provide regulatory protections for consumers in the event a health insurer attempts to rescind their individual health coverage. It would specifically require health insurers to prove that the consumer “knowingly” misrepresented facts.

CMA is working with DOI to address the issue of having an independent third party review all proposed rescission before it gets finalized.

• Status as of 04/13/10: Noticed: 06/05/09.

CMA Comments Submitted: 07/14/09.

Expected Decision: 06/05/10.

• CMA Staff: Armand Feliciano

CHANGES TO CME REQUIREMENTS Proposed by the Physician Assistant Committee CMA took no issue with the intent of this regulatory package; however, in the original language, physician assistants were referred to as possessing a “license to practice medicine,” which CMA opposed through written comments. The Physician Assistant Committee has since removed language referring to such a license.

• Status as of 04/13/10: Noticed: 06/26/09.

CMA Comments Submitted: 08/13/09.

Awaiting Committee Revision. Expected Decision: 06/26/10.

• CMA Staff: Veronica Ramirez

DISCIPLINARY GUIDELINES Proposed by the Medical Board of California (MBC) These regulations were issued to amend the Manual of Model Disciplinary Orders and Disciplinary Guidelines to reflect changes in law, clarify existing language, and make technical changes to reflect the current probationary environment. CMA submitted comments offering amendments to sections related to the use of alcohol and controlled substances because the original language would have allowed for the MBC to order a cessation of medical practice should a licensee have a positive biological fluid test for certain substances or fail to cooperate in a random biological fluid testing program. CMA’s amendment requests have been rejected by the MBC, but a final decision by the OAL is Apr il 2010 SAN DIEGO P HY SICIA N. o rg

39

still pending.

• Status as of 04/13/10: Noticed: 09/11/09.

CMA Comments Submitted: 10/23/09.

Board Has Completed Final Revisions of the Regulation. Expected Decision: 09/11/10.

• CMA Staff: Yvonne Choong

*

Rulemaking

Process

The executive rulemaking process is governed by the Administrative Procedures Act (Government Code § 11340). Once the appropriate state agency has published the regulatory text and notified the public of its availability, regulations are said to have been officially “noticed.” This commences a 45-day minimum comment period during which written public comments may be submitted. In many cases, a public hearing will be held at the close of the comment period through which the agency may receive oral testimony.

The agency will then consider the comments and make appropriate changes to the regulatory text.

Major changes require that the regulations be noticed and published for a second 45-day minimum comment period and public hearing.

Substantial and sufficiently related changes only require a 15-day comment period. If no substantial changes are made, the agency will issue a Final Statement of Reasons responding to all comments.

The agency then officially adopts the regulations and files them with the Office of Administrative Law (OAL) within one year of the official notice date. If the OAL approves the regulations, they are filed with the Secretary of State and effective within 30 days. If the OAL rejects the regulations, the OAL can either return them to the agency for revisions or publish a final notice of disapproval.

40

S AN D I E G O P HY S I CI A N . or g April 2010

TIMELY ACCESS REGULATION Proposed by the Department of Managed Health Care These regulations would require health plans and physicians to abide by specific time standards when setting up appointment for patients (e.g., urgent care appointments within 48 hours of the requested appointment). CMA submitted comments to give physicians more flexibility in abiding by the specific time standards, and to prohibit health plans from passing on administrative costs to physicians associated with the implementation of the regulation.

• Status as of 04/13/10: Noticed: 09/25/09.

CMA Comments Submitted: 10/07/09.

Approved by OAL: 12/21/09. Effective: 01/17/10. HMOs Must Demonstrate Compliance Plans to DMHC: 10/17/10.

Full Implementation by HMOs Required: 01/17/11.

• CMA Staff: Armand Feliciano

GLAUCOMA CERTIFICATION REQUIREMENTS Proposed by the Board of Optometry These regulations were issued as a result of SB 1406 (Correa), which was chaptered in 2008.

These regulations would establish requirements that optometrists must meet in order to be issued a certificate to treat glaucoma.

In its current form, the regulations would allow optometrists to treat glaucoma without requiring any hands-on training, to which CMA has testified in opposition.

• Status as of 04/13/10: Noticed: 11/12/09.

CMA Comments Submitted: 12/21/09.

First 15-day Comment Period: 03/24/10– 04/08/10. CMA Comments Submitted: 04/07/10. Expected Decision: 11/12/10.

• CMA Staff: Veronica Ramirez

HEALTHY FAMILIES PROGRAM: LEGAL IMMIGRANTS Proposed by the Managed Risk Medical Insurance Board These emergency regulations would allow the state to access federal funding to cover legal immigrants who have been in the country less than five years. The state of California has previously covered this population using state funds but, due to changes passed to the CHIP program earlier this year, the federal government will now cover this population.

CMA supports these regulations, as they would provide healthcare to all children regardless of immigration status.

• Status as of 04/13/10: Noticed: 11/12/09.

CMA Comments Submitted: 01/04/10.

Effective: 01/21/10.

• CMA Staff: David Ford

PATIENT-CENTERED PRESCRIPTION LABELS Proposed by the Board of Pharmacy This regulatory package would specify how prescription drug information is to be displayed on a prescription drug container label. It would require pharmacists, when applicable, to use standardized words and phrases on these labels to describe directions for use of the drug. These regulations would also clarify what language interpretive services are required to be provided by pharmacies and would require the Board of Pharmacy to publish language translations of certain directions of use on its website by October 2011. CMA generally supports these regulations, with the exception of a physician liability concern that has since been corrected by the board.

• Status as of 04/13/10: Noticed: 11/12/09.

CMA Comments Submitted: 01/04/10.

First 15-day Comment Period: 02/22/10– 03/10/10. CMA Comments Submitted: 03/10/10. Expected Decision: 11/12/10.

• CMA Staff: Veronica Ramirez

DISCOUNT HEALTH PLANS Proposed by the Department of Managed Health Care The DMHC is currently considering regulations that would allow them to regulate “discount health plans.” The discount health plan business model generally market discount health services to employers and individual consumers. Services can include dental, chiropractic, pharmacy, acupuncture, physician, hospital, or basic medical care.

The programs typically charge a monthly or annual fee in exchange for a list of participating providers whose services will be provided at a “discount.” Marketing of these programs has increased through the use of the Internet and fax machines. CMA submitted written and oral comments in opposition to the regulations.

• Status as of 04/13/10: Noticed: 01/08/10.

CMA Comments Submitted: 02/22/10.

Awaiting Department Revision. Expected Decision: 01/08/11.

• CMA Staff: Armand Feliciano

ELECTRONIC AND STANDARDIZED MEDICAL TREATMENT BILLING Proposed by the Division of Workers’ Compensation These regulations would encourage both workers’ compensation insurers and provid-

ers to transition to electronic billing. They would implement standard claims forms to be used in workers’ compensation cases, clarify that workers’ compensation insurers are subject to HIPAA rules, and increase penalties on insurers that fail to pay physicians in a timely manner. In addition, these regulations would clarify rules and procedures to be used in electronic billing. CMA policy generally supports an expansion of electronic billing, as it is a more efficient means of submitting claims to payers.

• Status as of 04/13/10: Noticed: 03/05/10.

Public Hearings: 04/23/10 and 04/26/10.

Forty-five-day Comment Period: 03/05/10–04/26/10.

• CMA Staff: David Ford

MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS Proposed by the Center for Medicare and Medicaid Services Under the American Recovery and Reinvestment Act (also known as the “Stimulus Bill”), Medicare provider physicians are eligible to receive up to $44,000 for demonstrating

“meaningful use” of an electronic health record system. This federal rulemaking will institute the first stage of the definition of meaningful use. As the incentive program continues, there will be two more stages.

CMA believes that the current definition of meaningful use is unreasonable and will be extremely difficult to attain.

• Status as of 04/13/10: Language Released: 12/30/09. Sixty-day Comment Period: 01/13/10–03/15/10. CMA Comments Submitted: 03/12/10.

mitted comments urging this process to be as inclusive and straightforward as possible, grandfathering in legacy systems.

• Status as of 04/13/10: Noticed in Federal Register: 03/10/10. Thirty-day Comment Period on Temporary Program: 03/10/10– 04/09/10. CMA Comments Submitted: 04/05/10.

• CMA Staff: David Ford

CERTIFICATION OF ELECTRONIC HEALTH RECORDS Proposed by the Center for Medicare and Medicaid Services

This interim final rule would, for the first time, allow physicians to transmit prescriptions for controlled substances electronically.

The regulations will also allow pharmacies to receive, dispense, and archive these prescriptions. Recent CMA policy supports the establishment of requirements enabling the use of eprescribing for controlled substances.

• Status as of 04/13/10: Noticed in Federal Register: 03/31/10. Comment Period: 03/31/10–06/01/10.

• CMA Staff: David Ford

In order to qualify for federal electronic health record (EHR) provider incentives, physicians must use a certified EHR system. These regulations would lay out two processes through which systems would be certified. The first process would begin in early summer but would only be temporary.

The second process would take longer to begin, but would be permanent. CMA sub-

ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES Proposed by the Department of Justice

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classifieds housing needed CANADIAN SURGEON SEEKING HOUSING: Canadian surgeon moving to San Diego for a one-, possibly two-year fellowship with wife and single child. Seeking housing, preferably furnished. Any and all assistance is greatly appreciated. Please contact at nearest convenience: denniskim@rogers.com. [791] OFFICE SPACE Medical Office Space for Rent in Encinitas: Convenient location five minutes from Scripps Encinitas Hospital. Close to 5 freeway. Features include two spacious exam rooms, private consultation/doctor’s office, lunchroom, private bathroom, and a spacious waiting room shared with one other doctor. Very affordable rent. Office located at the corner of Encinitas Blvd. and Manchester Ave. Call (858) 756-3021 or email ktagdiri@gmail.com for more information. [800] SINGLE DOCTOR PRACTICE SPACE AVAILABLE: Office located across from Sharp Chula Vista Hospital. Space includes a physician office and 2–3 exam rooms fully equipped. Share reception and a large remodel waiting room. Preferably a primary care physician or internal medicine.

Reduce your overhead by sharing space. Flexible to any arrangement proposed. Call (619) 9944366, email jeannette0038@yahoo.com, or fax letter of interest to (619) 421-3315. [796]

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.

FREE RENT INCENTIVES and a generous improvement allowance is provided.

For information, contact Ed Muna at 619-702-5655, ed@lankfordsd.com www.pinnaclemedicalplaza.com DOWNTOWN OFFICE SPACE AVAILABLE: Family practice physician in downtown San Diego has office space available. Preferably a primary care physician, but open to any healthcare provider. If interested, please call (858) 270-7633. [735] SCRIPPS ENCINITAS CONSULTATION ROOM/ EXAM ROOMS: Available consultation room with two examination rooms on the campus of

Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed.

Contact Stephanie at (760) 753-8413. [703] CARMEL VALLEY OFFICE SPACE FOR SHARED LEASE OR SUBLEASING: 2,900 square feet located in the Scripps Medical Offices on El Camino Real and High Bluff. Busy women’s health office ideal for physician seeking exposure to new patients. Convenient practice ready space ideal for a solo physician. Possibility for shared staff and/or overhead. Contact Mrs. Kim at cvwh858@ gmail.com or at (858) 259-9821. [790] BEAUTIFUL OFFICE IN SCRIPPS LA JOLLA XIMED BUILDING TO SHARE/SUBLET: Scripps La Jolla Ximed office to sublet/share. Upscale décor; currently equipped for ophth. Could work well for derm, cosmetic, bariatric, neuro, IM, etc., or even consultant. Days/fees negotiable/ reasonable, ~1700ft2, could share staff/phones, etc. (858) 449-9867 or fwlmd@cox.net. [787] SORRENTO VALLEY/MIRA MESA OFFICE SPACE TO SHARE: Space includes physician’s office, three exam rooms, and space for receptionist. This office is available Monday, Wednesday, and Friday afternoons. Reduce your overhead by sharing space. Call us at (858) 458-0940 or fax your letter of interest to (858) 458-3688. [785] OFFICE SPACE TO SHARE: Currently occupied by orthopaedic surgeon situated in La Mesa, five minutes away from Alvarado Hospital and 10 minutes from Grossmont Hospital. Looking to share with part-time or full-time physician. Fully furnished, fully equipped, with X-ray equipment and three exam rooms. Please call (619) 6680900 or email either rcham1000@aol.com or carmen@drcham.com. [784] 1,200FT2–1,600FT2 OF OFFICE SPACE IN EAST SAN DIEGO/LA MESA AVAILABLE FOR LEASE: Ideal as a satellite clinic or administrative office, on University Ave. near 70th St. Very visible tower signage provides outstanding visibility and exposure to cars and pedestrians on University Ave. Adjacent to a pediatrics office, and with easy access from Highways 8, 94, 125, and 15, Alvarado and Grossmont College, La Mesa, El Cajon, Spring Valley, Lemon Grove, points south and north. Plenty of parking and directly across from the Joan Kroc Recreation Center (over 3,000 families visit each week). Fixed rent for three years $1.95/ft2 per month, includes lighted tower signage, and NO additional charges for common areas or services. Please contact Venk at (619) 504-5830 or by email at venk@gpeds. sdcoxmail.com. [777]

MEDICAL OFFICE SPACE: Multi-specialty medical office with large office available with view of San Diego harbor/downtown. Share three fully equipped exam rooms, reception, lobby, and common areas. Lab on site, underground parking available. Phone (619) 233-4044 or email hivdocs@yahoo.com. [775] LA JOLLA MEDICAL OFFICE AVAILABLE FOR PART-TIME SUBLEASE: Beautiful ScrippsXimed office offers two consultation offices and one exam room. Receptionist help provided if needed. Contact Cindi at (858) 452-6226. [774] SPACE AVAILABLE FOR PHYSICIAN TO SHARE: Space available for physician to share with a very busy internal medicine group near Alvarado Hospital. Established practice with five internists serving the community for more than 30 years. The “turn-key” practice is waiting for the right doctor. Great opportunity! Please call the office manager, Lydia, at (619) 229-5055. [765] LA JOLLA OFFICE SPACE AVAILABLE AT XIMED MEDICAL BUILDING: Brand new, renovated office space available, preferably to a primary care MD to share. This is a rare opportunity to have a presence at the prestigious XiMed Medical Building right next to Scripps Memorial Hospital and to reduce your overhead by sharing space. Currently, the office is being used by a single physician part of the time. Flexible to any arrangement proposed. Call (858) 837-1540 or email melkurtulus@hotmail.com. [664] PHYSICIAN POSITIONS AVAILABLE Primary Care Job Opportunity: Home Physicians (www.thehousecalldocs.com) is a fastgrowing group of house-call doctors. Great pay ($140–$200+K), flexible hours, choose your own days (full or part time). No weekends or inpatient duties. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to hpmg11@yahoo.com. [801] CALIFORNIA-LICENSED MD FOR CONSULTATIVE WORK: Alternative care/medical marijuana clinic looking for California-licensed MD for consultative work. Part time with excellent compensation. Contact James Gould (760) 703-3767. [799] INTERNAL MEDICINE PHYSICIAN NEEDED: Full-time internal medicine physician needed for busy primary care practice. Central San Diego location. Affiliated with Scripps Hospital. Mostly outpatient, but some inpatient medicine as well.

Board-certified or board-eligible applicants only.

Please email a CV and cover letter to KLewis@ SDCMS.org. [797]

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 $150 (100-word limit) per ad per month of insertion.

42

S AN D I E G O P HY S I CI A N . or g April 2010

FULL-TIME PHYSICIAN OR NURSE PRACTITIONER NEEDED IN NORTH SAN DIEGO COUNTY: Physician or nurse practitioner to perform housecalls in North San Diego County Monday thru Friday. Ten to 12 patients per day.

Please forward CV. Full time. Excellent time management skills required. Pager one week per month. No hospital rounds. Established patient base. Independent contractor position. Email to mobiledoctor@sbcglobal.net or fax to (760) 5919976 or mail to 1582 W. San Marcos Blvd., Suite 100, San Marcos, CA 92078-4081, Attn: Julie Humphrey, Administrator. [795] SAN MARCOS IM, FP, ENCINITAS IM/FP: We are a Joint Commission-accredited, federally qualified community health center, celebrating nearly 40 years of service, and serving more than 60,000 patients in multiple locations in North San Diego County. We have opportunities for BC/ BE physicians. Compensation includes attractive base, incentive, and great benefit programs, malpractice, reimbursement for CME/licensure. This is an opportunity to make a difference in the lives of patients who are under- or uninsured without having the expense of overhead or management concerns, and provides work-life balanced hours.

NHSC loan repay may also be available. Email cynthia.bekdache@nchs-health.org or fax to (760) 736-8740. [794] PHYSICIANS NEEDED: Full-time, part-time, and per-diem 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) 4143702. Visit our website at VistaCommunityClinic. org. EOE/M/F/D/V [792] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT 3.5 DAYS PER WEEK POSITION (TO START): Private practice in La Mesa seeks pediatrician 3.5 days per week (to start) on a PARTNERSHIP track. Practice pediatrics in a modern office setting with a reputation for outstanding patient satisfaction for 14 years. Dedicated triage-pharmacy-referrals and education nurse takes routine calls off your hands, leaving you to focus on direct, quality patient care. Nine office staff provide experienced, attentive support. Clinic care is three patients per hour, 1-in-3 call is minimal, rounding at Sharp Grossmont on newborns, no high-risk delivery attendance (ALS nurse team present), all make for a very tolerable practice profile. Benefits include paid tail coverage included professional liability insurance, paid holidays/vacation/sick time off, paid practice expenses, professional dues, health and dental insurance, uniforms, CME, disability and life insurance. Please contact Venk at (619) 504-5830 or by email at venk@gpeds.sdcoxmail.com for a July–September placement. [778]

PHYSICIAN: Profil Institute for Clinical Research Inc. (PICR) is an independent research institute conducting clinical phase I–II trials, primarily in diabetes and carbohydrate metabolism, under contract to the biopharmaceutical industry [http://www.profil-research.com]. We are seeking a physician who will ensure integrity of study data and provide medical leadership and supervision for human clinical trials within PICR. Will screen, review of I/E criteria, and determine suitability of study volunteers for enrolment. Provide supervision of clinical procedures for all ongoing clinical studies at Profil and provide medical expertise to all clinical staff. Works with the associate medical director and medical director in training of physicians and other clinical staff as needed. Requirements: medical doctor, current, unrestricted license to practice medicine in California and current advanced cardiac life support (ACLS) certification. Understanding of the drug development process and of basic physiology of glucose homeostasis, diabetes, and obesity. Ability to manage medical care of diabetics, obese subjects, and other common medical problems, including medical emergencies. Thorough understanding of good clinical practices and FD, a regulations governing conduct of clinical trials.

Previous clinical research experience desirable.

If interested, please send CV/resume to hrpicr@ profil-research.com. [779] THE COUNTY OF SAN DIEGO HAS AN EXCITING OPPORTUNITY FOR DEPUTY PUBLIC HEALTH OFFICR: The full posting can be found at sdcounty.ca.gov/hr. For questions, contact Carmen A. Padilla-Baluis, human resources analyst, at (619) 531-5144 or carmen.padillabaluis@sdcounty.ca.gov. [773] PRACTICE FOR SALE

in fast growing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 755-0510. [185] NONPHYSICIAN POSITIONS AVAILABLE NURSE PRACTIONERS NEEDED: Full-time, part-time, and per-diem 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 VistaCommunityClinic.org. EOE/M/F/D/V [793] PHYSICIAN ASSISTANT: Multi-site rheumatology practice is seeking a physician assistant to provide support and treatment of patients with rheumatoid arthritis as well as other diseases affecting the body’s connective tissues. Background in internal medicine is a must and rheumatology experience is helpful but not required. This position will require travel between our San Diego offices and our office in Imperial Valley. Qualified candidates may email CV to hr.providerjobs@ gmail.com. [788] FULL-TIME FRONT DESK / BILLING POSITION (EAST COUNTY): Full time front desk/billing position available for a small, two-physician specialty office. Billing experience required. Please send resume to Debbie0774@gmail.com. Call (619) 2291005 for further information. [780] medical equipment FOR SALE: Exam tables and other exam furniture. Call (619) 585-0476. [798]

DEL MAR-AREA GENERAL PRACTICE: Prime location, huge potential for practice expansion

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858-231-1231 or DPebdani@SDCMS.org Apr il 2010 SAN DIEGO P HY SICIA N. o rg

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firstpersonperspective

By Franklin Crystal, MD

Surviving 8.8 Santiago, Chile

W

February 26 and 27, 2010

While en route to South America for a muchanticipated vacation cruise from Chile to Brazil, my wife informed me that Chile was known to have earthquakes — how right she was. At the time, though, it didn’t really dawn on me that we might actually experience an earthquake; after all, what were the odds that one would occur during our brief, four-day visit?

We departed San Diego at 11 a.m. on Thursday, February 25, and arrived in Santiago, Chile at around 8 a.m. the next day. Upon our arrival, we eagerly walked through the long airport corridors, waited for our luggage, waited in lines to pay the Chilean entry fees, waited in lines to clear immigration customs, and waited in still more lines for agriculture inspection. Then we headed past the airport shops and restaurants to the ground transportation exit. Little did we know that within hours the airport building’s ceiling would collapse.

We arrived at our hotel at about 10 a.m., and our room became available at 11:30 a.m.

By 11:31 a.m., I was in bed, sleeping. We awoke at around 5:30 p.m. and were still too tired to get dressed and go out to dinner, so we ordered room service. After eating, we went back to sleep. At around 3:34 a.m., the room suddenly began to shake like a

typical California earthquake, and then it began to lurch.

Things began to shift and fall within our room. The electricity went out, and the city went dark. The shaking continued to get more violent, and the building swayed more with each jolt of the earthquake. Bits of ceiling plaster started to shower down onto the bed.

The building groaned, popped, and cracked, and within a few seconds it got worse, as if we were on a ship in a very stormy sea.

The swaying got more and more exaggerated for another 30 seconds. At the extreme of each sway, I worried that the building would start to fracture and collapse. These were truly the longest 90 seconds of my life. The odor of plaster dust was heavy in the air, but, fortunately, there was no smell of smoke. I have lived in California for 37 years and never felt tremors like these.

We exited the building and were instructed to walk away from the structure. About 300 guests congregated in the dark a block from the hotel. Everyone had stunned looks on their faces. Many guests were barefoot, and some men were not wearing shirts. It was now 4 a.m. The sky was clear and the moon

fairly full. It was around 60 degrees but getting colder. In less than an hour, hotel employees came out to us with bottled water and towels for warmth. At around 4:30 a.m., the sky lit up twice in the distance with what we later found out were fireballs from explosions at a chemical factory.

At around 6 a.m., we where escorted to a hotel ballroom, a three-story building adjacent to the main 19-story tower of the hotel, where we were served breakfast and given access to restrooms. After one especially strong aftershock, we and many other hotel guests decided to exit the ballroom and wait outside, carrying our chairs with us and camping in the driveway where it felt safer. Blankets were handed out since the sun had not yet come up and the temperature was still in the 50s.

Fortunately, no one at the hotel seemed to have any serious injuries. Our aging leg muscles, however, were sore from descending the 16 stories. Once the hotel had been inspected and cleaned up, we asked to be moved to a lower floor in case we had to exit again, but the hotel was completely full. Some of the guests, especially the elderly, chose to sleep on the couches in the lobby that night.

Like the rest of the world, we learned the extent of the quake damage on CNN, which informed us of the rising death toll throughout Chile and showed the areas of devastation, chemical fires, and collapsed roads. Everyone was shocked and saddened by the damage, injuries, and deaths. Many of the hospitals were in the older areas of Santiago and had tremendous damage. They had to close and evacuate the patients. Many of the major roads were damaged or blocked. The airport was closed, but helicopters flew over the city assessing the damages.

This misadventure was not the peaceful stay in Santiago that we had anticipated, and surely one we will never forget.

Our sympathy goes out to the many families involved in this tragedy.

Travel Advice: • Stay in shape to be able to descend many flights of stairs.

• Stay on the lower floors in the hotels just in case of disaster evacuation.

• Carry a pocket flashlight.

• Learn the money conversion rate before entering a foreign country.

• Listen to your wife’s concerns and intuition.

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