June 2010

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

june 2010

official publication of the san diego county medical society

Which

direction health reform?

“Physicians United For A Healthy San Diego”

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June 2010 SAN DIEGO P HY SICI A N. o rg

1

thismonth Volume 97, Number 6

SD1C M 8 0 S 2 1 1 009 202

features

FORM THRE HEAL

for e n i l e Tim m r o f e ealth R

Which Direction Health Reform?

Health Reform Timeline: 32 2011

nted e pleme 10 issu to be im the May 20 d le u d it e is h v c s e s 0, plea ges are n chan eline for 201 ian physic es islatio g im t le s and rm hom rm . ioner edical ws practit lth refo a health refo go Physician a lead m f-practice la Nurse e h ay t m g ts e-o E FOR Die owin cess assistan if state scop PPLICABL of San A he foll 2018. To ac ly T n O but o NTS TE: N d eated it. (NO SEME 011 an allow tion cr ) MBUR ANS: s for RNIA lan op

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RMS: at th REFO viders NCE SURAinsurance proercent (largedi-

44

“Physic United ians Health for a yS Diego” an

37 2015-18 How Health Reform Will Affect: 37 Physicians 37 Patients with respect to Private Health Insurance Changes 38 Patients with respect to Medicare and Medicaid Changes 39 The Healthcare Sector 39 Individuals

sdcmscma

Be Part the Sol of ution!

departments

“Medica Join SDC l” m riju 4 Contributors u MS-CMA rms to Ph ana eimbspitals requesats R o o n f s T o H e o n terminal from This Issue’s Contributing Writers to A samplin surance R ort dRaefyoramt SDCM p a T n ti S.org! (whol H got San DI g of what’s inomes ents 6 SDCMS Seminars, webinars, and Events rugs dic iego C wao sist that Meit Phar tion D

ou physician s annoye nty’s d…

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macie crip hasve refill requarsethPatre ic est system toan automaticof Mtheedpa ask fo tient’sem patient rmanc eds even th r a refill ough the su ay have refills npo Iap an e r w a in ritten tm C is en due and ha t before the med or has -Term g n renewal o s neve L from the r requested a refil pharmac l y.

n codes osis orderinfor Those10th tests. g. kn ree-page E 20 JUN ow “did yo ” re .O R G

plans’ ph ports from he u manager armacy benefitalth 32 the pote s that warn of medicationtial dangers of All prior authorizat Insultin n X in patien ions for prescr waste ofg, and a major t Y. iption time and medicatio ns paper. those that , but especially take SAN

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more than minutes five of physic ian time complete. to

Insurance compan if I’m a gies listing doctor b ood or bad their crazased on collectio y data n, which often inac is doesn’t re curate and the level flect care pat of medical deserve.ients

Havi my fronnt-g patients yell $5 co-pa office staff aboat that their y for the insura ut a employers nce pay for.

44

Having in companiesurance my recom s decide if are “med mendations necessaryically .”

SA N DI EG O

rks tha arinobl,eattner 8 Community Healthcare Calendar usuallny m h docume ave a welld- 10 Briefly Noted of drugnated history use prior SDCMS Medical Office Manager Bulletin Board, and More … to thisbre quest).

16 SDCMS 2009-2010 Annual Report

32 sc

Politicia decision ns who make practice s regarding med ical unders without any therebytafonding of the sy st rc em, in g me to the way ter cover myI practice in oral der to ***.

Declinin reimbursg ements.

inue their med s.

Phys ia ns who icfe r to psychre o lo inste d gists of psychaia recom trists for endatio for psym n medicachotropic s ti o psycho ns and therapy .

Online physicia nrating sy that lure stems o the dis nly makinggruntled, new pa a Providin potentiatient service agn a afraid to lly g o to a getting pa d then doctor. to six m id three later. onths

Havin systemg an inept c omplainfor physician PH YS IC ts/conce IA N. OR The DM G JU NE rns.

20 10 H a re S A N D I E G O P HY S I CI A N .or g Jun e 2010 uselesCsand the DOI for us.

2

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hedule th Putting appointmeir office waiting a sign in my en room telli people w days a� t two n if they d here to compgla meds will er their o ru n in ’t like don’t do so an urge n out, wha me or if I nt ca Ridicutlothey want. necetossthe pharmacy isll us. ary to cont

22 SDCMS foundation 2009 Annual Report 24 PRACTICE MANAGEMENT ICD-10: Ask Questions Now to Put You Light Years Ahead 26 PRACTICE MANAGEMENT Health Reform and Tax Changes: What Will the Financial Impact on You Be? 28 patient safety Drug Resources From the National Library of Medicine 30 Evidence-based Medicine Intensive Systolic Blood Pressure Control Does Not Reduce Mortality in Patients With Diabetes 42 PHYSICIAN MARKETPLACE Classifieds 44 SDCMS-CMA Be Part of the Solution!

45 Are you taking advantage of Your SDCMS-CMA Member Benefits?

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3

contributors Rhonda Buckholtz Ms. Buckholtz is vice president of business and member development for the American Academy of Professional Coders.

Colleen M. Connor, MD Dr. Connor, SDCMS-CMA member since 2005, is board-certified in psychiatry and geriatric psychiatry, and practices in Escondido.

DynaMed Editorial Team The DynaMed editorial team, which includes physicians, other clinicians, and scientists, systematically monitors the literature using a seven-step, evidence-based methodology.

DynaMed — ebscohost.com/dynamed — is updated daily, is advertisement free, and is published by EBSCO Publishing.

Sonia Gonzales Ms. Gonzales is your 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.

Ronald A. Mitchell, CPA Mr. Mitchell, certified public accountant and principal of SDCMS-endorsed AKT LLP, can be reached at (760) 431-8440. Visit AKTCPA. com for further information.

6/22/10

5:37 PM

Page 1

SECTION : LISTED BY SPECIALTY AND ZIP CODE (P.) (P.)

• SECTION : LISTED ALPHABETICALLY (P.)

San Diego County

Physician Directory

Enclosed with this issue of  – San Diego Physician you will find your copy of SDCMS’ first-annual San Diego County Physician Directory. Thank you to our SDCMS member physicians for making the publication of this directory possible!

San Diego County Me dical Society “Physicians United for a Healthy San Diego”

››Send your letters to the

editor to Editor@SDCMS.org 4

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

Past President (AMA Alternate Delegate) Lisa S. Miller, MD President-elect (CMA District 1 Trustee) Robert E. Wailes, MD Secretary (SDCMS At-large Director) Robert E. Peters, MD, PhD

Ms. Stimson is the outreach services librarian at the Biomedical Library, UC San Diego, 9500 Gilman Drive, La Jolla, CA 920930699.

20100621redbook

SDCMS Board of Directors Officers President Susan Kaweski, MD

Treasurer Sherry L. Franklin, MD

Nancy Stimson

TOM GEHRING Mr. Gehring is executive director and CEO of the San Diego County Medical Society.

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

geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody” Zeidman,

MD (A: Venu Prabaker, MD) Hillcrest Niren Angle, MD, Steven A. Ornish, MD (A: Eric C. Yu, MD) Kearny Mesa John G. Lane, MD (A: Jason P. Lujan, MD) La Jolla J. Steven Poceta, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Doug Fenton, MD, Arthur “Tony” Blain, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD) At-large Directors and At-large alternate Directors Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, John W. Allen, MD, Mihir Y. Parikh, MD (A: Carol L. Young, MD (sdcms foundation president), Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Edward L. Singer, MD, Alan A. Schoengold, MD, Jerome A. Robinson, MD) other board members Communications Chair Theodore M. Mazer, MD Young Physician Director Van L. Cheng, MD Alternate Young Physician Director Kimberly M. Lovett, MD Resident Physician Director Katherine M. Whipple, MD Alternate Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD Alternate Retired Physician Director Mitsuo Tomita, MD Medical Student Director Adi J. Price CMA Speaker of the House James T. Hay, MD

ex-officio, nonvoting board members CMA Past Presidents Robert E. Hertzka, MD, Ralph R. Ocampo, MD CMA district I Trustees Theodore M. Mazer, MD, Albert Ray, MD,

Robert E. Wailes, MD CMA Trustee (other) Catherine D. Moore, MD, CMA Solo and Small-group Practice Forum Delegates

Michael T. Couris, MD, James W. Ochi, MD Alternate CMA Solo and Small-group Practice Forum Delegate Dan I. Giurgiu, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD Alternate AMA 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.]

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June 2010 SAN DIEGO P HY SICI 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/event or contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SDCMS Seminars / Webinars / Events Date

Day

JUL 15

THU

JUL 20

WED

Time

Topic

Presenter

11:30am – 1:00pm

Networks, Hardware, and Software for Dummies (IT)

Ofer Shimrat, SOUNDOFF Computing

6:30pm – 7:30pm

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

The Doctors Company

x

The Doctors Company

x

x

x

JUL 21

THU

11:30am – 12:30pm

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

JUL 22

THU

6:30pm – 9:00pm

Membership Social

SDCMS (Rock Bottom Brewery-La Jolla)

AUG 7

SAT

8:30am – 12:00pm

MS Outlook for Busy Docs (Practice Management)

Tom Gehring, SDCMS

x

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 x

OCT 7

THU

11:30am – 1:00 pm

Economic Survival

AKT CPAs

x

x

OCT 27

WED

11:30am – 1:00pm

“Scope / Allied Health Professionals” (Legal Issues)

California Medical Association

x

x

NOV 4

THU

11:30am – 1:00pm

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

Alexander & Alexander, Attorneys At Law

x

x

NOV 12

FRI

6:00pm – 9:00pm

Membership Social (T)

SDCMS (Location TBD)

NOV 17

WED

6:30pm – 7:30pm

“Emerging Patient Safety Issues Impacting Office Practices” (Risk Management)

The Doctors Company

x

11:30am – 12:30pm

“Emerging Patient Safety Issues Impacting Office Practices” (Risk Management)

The Doctors Company

x

NOV 18

THU

* "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 Jun e 2010

x

June 2010 SAN DIEGO P HY SICI 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.

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

Southwest Regional Integrated Behavioral Health Conference Sep 8–9 • The Crowne Plaza Hotel, San Diego • $299 • mhsinc.org/calendar

Diabetes Day for Primary Care Physicians

Infertility and Pregnancy Loss: Getting Your Patients the Emotional Help They Need

Jul 17 • Presented by the American Association of Clinical Endocrinologists • Hyatt Regency La Jolla • Contact (904) 353-7878

Sep 25 • Skaggs School of Pharmacy Auditorium, UC San Diego • 8:00am– 5:00pm • khirst@ucsd.edu

Critical Care Summer Session 2010

5th Annual Frontiers of Clinical Investigation Symposium: Pain 2010 Bench to Bedside

Jul 22–24 • Catamaran Hotel, San Diego • cme.ucsd.edu/criticalcare

Learn How to Become a POLST Trainer • Physicians Orders for Life-Sustaining Treatment Aug 19 • 8:30am–5:00pm • SDCMS Meeting Room • CME/CEU Provided • $25 • Contact Karen Mitrovich-Dotson at (858) 300-2787, at KDotson@SDCMS.org, or visit CAPOLST.org

The Permanente Federation Twelfth National Hospital Medicine Conference Sep 2–3 • Hotel del Coronado • meetingsbydesign.com

8

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

Oct 14–16 • Estancia La Jolla • cme.ucsd.edu/ b2b2010

Challenges in the Perioperative Management of OSA Patients Oct 15 • San Diego Location TBD • cme.ucsd.edu

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

Cutting Edge Strategies in Diabetes Care: Making the Connection Oct 30 • San Diego Convention Center • cme.ucsd.edu

4th Annual UCSD Hands-on NOTES and Single Site Surgery Symposium Nov 11–13 • Omni San Diego Hotel • cme.ucsd.edu/notes

West Coast Geriatric Psychiatry Conference Feb 16–19, 2011 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu

Topics and Advances in Internal Medicine Mar 7–13, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

Topics and Advances in Pulmonary and Critical Care Medicine Mar 13–14, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

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brieflynoted

SDCMS Medical Office Manager

By Sonia Gonzales, Your Office Manager Advocate rogram 2010 eRx Incentive P m, individu0 eRx Incentive Progra To participate in the 201 and use of a on pti report on their ado al EPs may choose to on one eRx n atio orm submitting inf qualified eRx system by ims, or to cla B t par are dic on their Me measure to either CMS ctronic health CMS via a qualified ele a qualified registry, or to record (EHR) product. iber for the cessful electronic prescr To be considered a suc y to earn alif qu gram and potentially 2010 eRx Incentive Pro entive Inc eRx 0 payment for the 201 a 2 percent incentive re for asu me eRx the EP must report Program, an individual the ich wh in nts eve g onic prescribin at least 25 unique electr the EP during 2010. measure is reportable by m, a group 0 eRx Incentive Progra Beginning with the 201 eRx incentive tially qualify to earn an practice may also poten e’s total esticent of the group practic payment equal to 2 per ed chargllow le-a physician fee schedu mated Medicare Part B the 2010 g rin du hed nal services furnis es for covered professio g the etin me e’s ctic pra on the group eRx reporting year based CMS. by ed cifi spe r ibe scr ctronic pre criteria for successful ele ing Option” ”Group Practice Report the ut abo re To learn mo ctice can sign ns on how a group pra and to obtain instructio it cms.hhs.gov/ s reporting option, vis up to participate in thi ERxIncentive.

Stay Con Your Colnected to leagues If you w

ould like to stay connec your SDCMS ted to office manag er and practice adminis trator colleag ues, join ou Google Group r at groups.g oogle.com/ group/sdcm s-office-man agers.

10

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

[SAVE THE DATEsS!] for The Best Events and Seminar Medical Office Managers

✓ July 15: INFORMATION RVIEW

TECHNOLOGY OVE July 20 or 21: RISK MANAGEMENT

✓ ✓ August 18: OSHA ✓ August 25: HIPAA tified ✓ October 1-29: CerCou rse

rg’s Access SDCMS.oly Members-on Content!

Medical Coder

ed the new login If you have not receiv the members-only information to access rg, send me a request content at SDCMS.o S.org, and be sure to at SGonzales@SDCM physician’s name. include your member

! u o Y m o r F r a e H We Want to

ts, pics, commen like to n o ti s e u q d your would Please sen anything that you r’s Bulletin — s a e Man ge c ffi tures, idea O l a ic d r “Me onzales@ see on you to me, Sonia, at SG -2782. The Board” — all me at (858) 300 d into a , or c ntere SDCMS.org ils received will be e e SDCMS a th first five em ceive a “Lunch With !” re te a to c g o v in d w dra ager A n a M e c ffi O

Top 5 Reasons To Attend

An Sdcms Seminar:

5. Enjoy a Delicious, Catered Meal  4. Network With Your Office Manager Colleagues and Exchange Experiences 3. Get the Answers to Your Questions From Experts in Their Fields earn About the Latest Practice 2. L Management Topics and Issues 1. TAKE ADVANTAGE OF YOUR FREE SDCMS BENEFITS!

ions Get your qurest Answe ed! ribing (eRx) re Electronic Presc What is the Medica ?

Incentive Program g Incentive Proctronic Prescribin The Medicare Ele thorized under . 1, 2009, and is au Jan n ga be ich wh , gram (eRx) d Providers Act of ents for Patients an em ov pr Im re als ica the Med r eligible profession ides incentives fo ov pr ), latest PA e IP th (M all 2008 ribers. For ful electronic presc ess cc su xInare ER o v/ wh .go ) (EPs , visit cms.hhs Incentive Program x eR e th .

10 on ge ws pa ne article on overview, see the centive. For a brief

Question: Answer:

medical do I have to forward How many times practice? r ou of red out nt who has transfer ars since ye o tw records for a patie st ur times in the pa fo em th d r ste ue She has req offer to provide he has declined our d an te sta of t ou moving r entire chart. with a copy of he the right mstances, you did proUnder these circu t a compromise by attempt to work ou an g nt in tie ak pa m e in th g g thin ds and havin with a set of recor nt ss tie ce pa ac e nt th g tie in pa vid ibution. The y for further distr nt take responsibilit s for frequent patie ion pt ains no exce arr he ot an law, however, cont t work ou nt is not willing to uest requests. If a patie sent each time a req be t us m ds or rec l ica ed m t, Th rangemen de §123110). e ealth & Safety Co (H r he or m 4 (c) hi r fo is made is (45 C.F.R. §164.52 do not change th les Ru cu cy do iva L Pr A AL HIPA CMA’s ON-C rmation, consult fo in er le ab rth ail fu r av Fo — (3)). ical Records” ent Access to Med ment #1150, “Pati ANet.org CM at MA members free to SDCMS-C

Question:

If we have a locum tenens arrangem ent with a substitute physician, can we still bill under our physician as the provider of service?

Answer:

The answer depends on the insuranc e plan being billed. Under Medicare, the same requirements for reciprocal billing apply, except that: 1) the regu lar physician pays the locum tenens physician on a per diem or fee-f or-time basis; and 2) the regular physician identifies the serv ice as locum tenens services by using the Q6 modifier after the procedure code (Medicare Claims Processing Manual, Chapter 1, §30.2.11-B, Rev. 1486, Issued: 04-04-08, Effective: 01-01-08 , Implementation: 05-05-08 available at cms.hhs.gov/manuals/do wnloads/clm104c01.pdf).

Some contracts with managed care plans may prohibit the group from billing for a noncontracti ng, covering physician, unless the physician is approved by the plan. Managed contracts should be reviewed before enga ging in locum tenens arrangements. You may wish to send a lette r to a plan that requests permission to bill for a covering phys ician. If a managed care plan or insurer does not follow Medicare policy on this issue, having a medical group bill on behalf of a non-employee physician could be considered a “false claim .” Physicians should contact the third-party payer before engaging in this practice. For further information, consult CMA’s ON-CAL L document #0107, “Covering Physicians (Locum Tenens)” — available free to SDCMS-CMA members at CMANet.org.

Question:

Answer:

sation Workers’ Coa,mpen , 2010, "ABCedsbyof Liz cou ac doz Our May 20ina en M CHMntB.s nt ese pr r, sem g" llin Bi S-endorsed receivable manager from SDCM June 2010 SAN DIEGO P HY SICIA N. o rg

11

brieflynoted UC San Diego Health System Honors

Physician

of the Year

Thomas J. Savides, MD This year, the UC San Diego Health System’s Medical Staff Executive Committee has selected Thomas J. Savides, MD, professor of clinical medicine in the division of gastroenterology, Department of Medicine, and SDCMS-CMA member since 2005, as its 2010 Physician of the Year.

Dr. Savides — interim chief of the gastroenterology division, GI fellowship training director, and GI clinical services chief — has been on the faculty of UC San Diego since 1993 and was named a “Top Doctor” by San Diego Magazine in their “Physicians of Exceptional Excellence” survey in 2005, 2007, 2008, and 2009.

He has an international reputation for his innovative clinical research on novel uses of endoscopy, and, with fellow UCSD faculty in the Department of Surgery, he is working on a new research area involving “natural orifice translumenal endoscopic surgery (NOTES).”

Congratulations, Dr. Savides!

Dr. Robert Singer

Receives the ASAPS Distinguished Service Award Board-certified plastic surgeon Robert Singer, MD, SDCMS-CMA member since 1977, is the recipient of the Distinguished Service Award for plastic surgery leadership, presented by The American Society for Aesthetic Plastic Surgery (ASAPS).

This award is presented to an ASAPS member who shows exemplary leadership, service, creativity, and dedication to the subspecialty of aesthetic surgery, advancing the organization in the pursuit of its stated mission. The award is presented at the discretion of the board of directors to recognize superior contributions to ASAPS and its members.

Congratulations, Dr. Singer!

Grossmont Healthcare

District Healthcare Hero Award

Congratulations to endocrinologist Raymond Fink, MD, SDCMS-CMA member since 1987, for his having been selected as a Grossmont Healthcare District Healthcare Hero for his work as a physician volunteer for Project Access San Diego. This award recognizes volunteer caregivers who help advance the delivery of healthcare and improve the quality of life for East County residents.

A practicing physician, Dr. Fink was the first endocrinologist to provide consultative care for Project Access, and has been active in recruiting other medical specialists to help those who Raymond cannot afford specialty care. His private practice focuses on the diagnosis and management of Fink, MD hormonal conditions and often involves diabetes or metabolism conditions, including thyroid issues.

As a volunteer, the La Mesa resident reviews and analyzes medical charts, makes treatment recommendations by phone or email, and often personally sees patients who have been referred from an East County community clinic.

Recently, he cared for an uninsured patient with a thyroid nodule that was later discovered to be cancerous. His willingness to provide timely medical advice to those who lack access to specialty care is improving the overall health outcomes of our community.

Thank you, Dr. Fink, for your dedication to the medically underserved of San Diego County!

12

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

Take a at San Diego Physician magazine.

Reach all 8,500 doctors in San Diego County.

Contact Dari Pebdani today! 858-231-1231 or DPebdani@SDCMS.org URGENT CARE ISN’T JUST FOR PATIENTS Torrey Pines Bank has been integral to my success in establishing and growing my practice into the largest independent private medical group in the North County.

My needs and concerns have always been met with respect and expertise in a timely and professional manner. As I re-invent my medical practice, the Bank’s staff has helped make my success more of a certainty and taken the stress out of all my banking needs. I couldn’t have done it without them — then and now!*

TORREY PINES BANK IS A HEALTHY CHOICE FOR YOUR PRACTICE ■ Substantial Capacity to Fund Business Loans & Equipment Financing¹ ■ Up to $1.25 Million in FDIC Insurance Coverage² ■ Broad Array of Cash Management Capabilities To schedule a complimentary Urgent Care banking check-up for your practice, contact our veteran bankers: 858.523.4600 | TORREYPINESBANK.COM

*Stuart B. Kipper, MD, Internal Medicine Torrey Pines Bank customer %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 ¹ Equipment Financing Provided by Western Alliance Equipment Leasing, an Affiliate of Western Alliance Bancorporation – Loan Products are Subject to Credit Approval ² The WALTree Program is provided through each of the affiliates 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. June 2010 SAN DIEGO P HY SICIA N. o rg

13

brieflynoted

Program for 12–25 Year Olds With Prodromal Mental Illness

Kickstart

By Colleen M. Connor, MD

*

Kickstart provides community education, confidential assessment, and early assistance for young people between the ages of 12 and 25 who are at risk for mental illness in San Diego County. Our team evaluates and treats youth experiencing early warning signs of psychosis or mood disorders. We complete an extensive initial evaluation for accurate diagnosis, including the Structured Interview for Prodromal Symptoms. Kickstart is a prevention and early intervention program funded through the County of San Diego and the Mental Health Services Act. Family therapy, group therapy, individual therapy, peer support, occupational therapy, and psychiatric medication management are included.

It is a great place to refer young patients with early psychiatric symptoms for comprehensive care in an attempt to prevent or lessen the severity of illness. If a patient is already seeing a psychiatrist, they may continue to do so. We would not interfere with their treatment but rather augment it with psychosocial therapies. If the patient has no treating psychiatrist, I will see them. We accept unfunded and funded (County or private) patients. I believe that this program will be a wonderful resource for families dealing with the prodromal phase of mental illness. If you are interested in further information or if you would like to make a referral, please contact us at (619) 481-3790.

Get Your Tough HR Questions Answered

Free of Charge!

14

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

SDCMS-endorsed Strategic HR Services provides a complete range of HR solutions, from individual services delivered on a consulting basis to a staff of more than 50 professionals who can develop and manage all or some of your HR department.

As a benefit of SDCMS membership, you can get your difficult human resources questions answered by contacting your SDCMS physician advocate, Marisol Gonzalez, at (858) 300-2783 or at MGonzalez@SDCMS.org. For services such as training, handbooks, or outsourcing your HR, contact Connie Arthur at (949) 260-5021 or at carthur@strategichr.com or visit StrategicHR.com.

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 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 Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at BRodriguez@SDCMS.org project access 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

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

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

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

CPA’s and Consultants

off % 25 SDCMS member physicians receive

advertising in this publication.

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

June 2010 SAN DIEGO P HY SICIA N. o rg

15

SDCMS

2009–2010 Annual Report “Physicians United for a Healthy San Diego”

16

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

*

Health REFORM

SDCMS and CMA were engaged at all levels of health reform throughout 2009 and into 2010, ensuring bills were amended to account for California’s socioeconomic differences, health status differences, and geographic differences in practice costs. Had the rural states prevailed — i.e., had CMA not fought this fight — California’s physicians would have received up to 22% in payment cuts! SDCMS and CMA did an incredible job throughout the health reform process as well of educating San Diego County’s and California’s congressional delegations, particularly those House Democratic leaders that included $450 billion in physician payment fixes in the House bill to provide coverage and access to doctors. Though CMA should have been stronger in its opposition to the Senate bill, we did get commitments from the White House and House and Senate leaders to address physician payment issues, to stop the 21% SGR cut and repeal the SGR payment formula, and to weaken the impact of the Medicare Independent Payment Advisory Board (IPAB) on physicians.

CMA is working on these issues and continues to fight to pass a California fix.

What Did CMA Enable?

» 85% of health plan revenues directed to patient care. » Adequate health plan provider networks. » Affordable, universal access to care for low-income, uninsured Californians. » Two-thirds of low-income, uninsured Californians going into private coverage instead of Medicaid. » Medicaid rates for primary care physicians increased to Medicare levels. » 100% federally funded Medicaid expansion and rate increase. » State-based health insurance exchanges instead of one national exchange. » Increased Medicare rates for all physicians to bolster primary care in California. » Additional Medicare payment increase for primary care physicians. » Patient right to seek care from the physician of their choice outside of health plan networks. » Quality reporting program physician information protected and accurate, physician data statistically valid, attribution methodology correct, information risk-adjusted, physician right to review data before it is finalized or made public. » Appropriate CMS systems to produce accurate physician information for quality reporting programs. » Physician accountable care organizations not to need to include a hospital. » Current, unused residency slots redistributed for primary care and general surgery. » Uniform Medicare prescription drug appeals form and process.

Health Reform’s Unfinished Business for 2010: ✓ Stop the 21% Medicare cut and repeal the Medicare SGR. ✓ Eliminate the Medicare Independent Payment Advisory Board. ✓ Update California’s 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.

What Did CMA Prevent?

» Insurance companies from rescinding insurance when a patient becomes ill. » A public option that would have mandated physician participation and paid Medicare rates. » The implementation of a “value index” payment system that would have reduced payments to California physicians by up to 15%. » The reduction of Medicare payments in California for geographic practice costs by up to 8%. » A provision that would have allowed nurse practitioners to lead medical homes. » A provision that would have banned existing physician-owned hospitals. » A 5% Medicare penalty on physician utilization outliers. » A $350 Medicare participation fee for doctors. » CMA worked with AMA to push back the penalties for nonparticipation in Medicare’s Physician Quality Reporting Initiative (PQRI) until 2014. » A cosmetic surgery tax. » CMA joined the chorus in opposition to the Cadillac health plan tax on high-end benefits because it disproportionately harms California’s employers and individual 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-for-service payments. Medicare Advantage plan rates will be cut by $130 billion; however, plans that meet certain quality standards may qualify for bonuses.

June 2010 SAN DIEGO P HY SICIA N. o rg

17

*

Political/

Legal/ Reimbursement

Reimbursement

Advocacy

CMA SPONSORED LEGISLATION THAT:

»» Gives osteopathic physicians access to the Steve Thompson Loan Repayment Program — signed by the governor. [SB 606] »» Would have protected patients from having their insurance policies rescinded — passed by the Assembly and Senate but vetoed by the governor. [AB 2] »» Would have strengthened the current peer review system — passed by the Assembly and Senate but vetoed by the governor. [AB 120]

CMA KILLED LEGISLATION THAT:

» Would have allowed virtually all healthcare districts and rural hospitals to directly employ up to five physicians. [SB 726] » Would have allowed healthcare districts located in underserved areas to directly employ and charge for physician services. [AB 646] » Would have allowed rural hospitals that serve underserved areas or populations to directly employ and charge for physician services. [AB 648] » Would have allowed physical therapists to evaluate and treat patients without a previous diagnosis or referral from a licensed physician. [AB 721] » Would have circumvented MBC’s fair hearing process by not allowing a physician to test the validity of charges prior to an 805 report’s being filed. [SB 700]

CMA STRONGLY OPPOSED LEGISLATION — AB 542: “Nonpayment for Adverse Events” — AND CONVINCED ITS AUTHOR TO DRAMATICALLY NARROW ITS SCOPE TO APPLY ONLY TO HOSPITALS

» Draws down federal funds to help fund the Healthy Families Program — signed by the governor. [AB 1422] » Would require the DHCS to improve and streamline the Medi-Cal treatment authorization request process. [AB 613] » Would require the performance of an occupational analysis on any bill seeking to substantively expand the scope of a healing arts practice. [AB 877]

SDCMS worked to enroll physicians in the California Health Alert Network (CAHAN) as it transitioned from the San Diego County Emergency Medical Alert Network (EMAN)

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

»» Would have required all physicianowned surgical clinics to be licensed by the state. [AB 832] »» Would have allowed pharmacists to independently initiate and administer immunizations to children and adults. [AB 977] »» Would have allowed nurse practitioners to admit patients and to be designated primary care providers.

[SB 294]

CMA PREVENTED LAWMAKERS FROM TAKING MORE THAN $100 MILLION FROM CALIFORNIA’S MEDI-CAL PHYSICIAN PROVIDERS IN 2008 AND 2009

CMA BACKED LEGISLATION THAT:

18

CMA GUTTED LEGISLATION THAT:

SDCMS AND CMA CONTINUED TO FIGHT HEALTH PLAN AND GOVERNMENT MALFEASANCE:

»» By suing WellPoint for colluding with Ingenix on a price-fixing scheme. »» By getting the California DOI to sue PacifiCare for widespread and unfair payment processes in the wake of United Healthcare’s takeover of PacifiCare in 2005. »» By publishing a Blue Cross tool kit to help physicians understand the impact all of Anthem Blue Cross’ 2009 changes would have on their practices. »» By co-signing a letter with UCSD to our congressional delegation strongly opposing the elimination of the CPT codes for consults. »» By hosting live webinars and developing a written toolkit to help members understand and comply with the “Red Flags Rule.”

SDCMS AND CMA FOUGHT FAULTY QUALITY REPORTING INITIATIVES: CMA APPEALED TO THE U.S. COURT OF APPEALS TO REINSTATE THE INCORRECTLY REJECTED STANDING OF ITS GPCI LAWSUIT IN 2009

MADDY FUNDS CONTINUE TO FLOW TO ER PHYSICIANS In 2009, Maddy Fund disbursements, which go to hospitals and physicians providing uncompensated trauma care, came to more than $4,250,000. Recall that an additional funding source for the Maddy Fund was procured in 2007 with SDCMS’ support.

» By urging physicians to request their data from the California Physician Performance Initiative (CPPI) to verify its accuracy. » By requesting that the California Cooperative Healthcare Reporting Initiative (CCHRI) not publish the faulty and misleading 2009 CPPI results. » By withdrawing from the Blue Shield-led initiative when the CCHRI didn’t correct the deficiencies CMA raised before moving forward in 2010.

MEDICAL

»» CMA reached out to all the major payers in California for clarification on their H1N1 billing policies and compiled the information into an easy-toread members-only chart. »» SDCMS was heavily involved in the redistribution of vaccines from San Diego County’s hospitals to physician practices. »» SDCMS worked with the County of San Diego and others to record a series of “quick and easy” H1N1 videos for physicians and office staff: • “Pandemic H1N1 Influenza Vaccine” • “H1N1 Epidemiology” • “Laboratory Diagnosis of Influenza During the H1N1 Pandemic” • “Use of the Pandemic H1N1 Vaccine for Fall 2009” • “Pandemic 2009 H1N1 Influenza: Treatment in Adults” • “H1N1 Pandemica Influenza: Treatment of Infants and Children” »» SDCMS collected resources from as many authoritative HIN1 sources as possible and made them available to members at SDCMS.org.

CMA FENDED OFF A TRIAL LAWYER ATTACK ON MICRA IN 2009

when the 5th District Court of Appeal unanimously upheld its constitutionality, thereby keeping your professional liability insurance premiums reasonable. SDCMS continued in 2009 and continues today to interview all candidates for San Diego County legislative offices in order to ensure they understand the paramount importance MICRA holds for California’s physicians.

PALMETTO

» SDCMS and CMA continued in 2009 to help member physicians — many who hadn’t been paid in months — get their issues resolved by putting their problems directly into the hands of our contacts at Palmetto. » SDCMS invited a Palmetto representative to give two three-hour post-transition seminars for members and their staff. » Thanks to CMA advocacy, Palmetto GBA agreed to repeal its overly restrictive “monitored anesthesia care” policy.

Cma, Sdcms, And Others Lobbied Both Houses Of Congress To Submit Bills To Fix The Gpci In 2009, Which Decreases San Diego County Physician Payments From $30 To $100 Million Annually

CMA FORCED HEALTH PLANS, REGULATORS, AND OTHERS:

»» To clarify new prepayment review requirements documentation. [Health Net] »» To agree to automatically reprocess all affected claims after it delayed loading new 2009 CPT codes into its claims payment system. [Blue Shield] »» To remove a number of problematic provisions in a proposed contract. [Blue Cross] »» To allow physicians to opt out of its paperless EOB program.

[Blue Cross] »» To allow physicians with Prudent Buyer contracts to continue to treat Blue Cross Healthy Families patients through the end of October 2009. [Blue Cross] »» To clarify how physicians would be paid for vaccines under its new contract. [Blue Cross] »» Not to allow chiropractors to perform manipulation under anesthesia. »» Not to expand the scope of practice of psychologists and potentially all other healthcare facility healthcare practitioners. »» To expedite the MBC review process of resident physician and other medical license applicants with time-specific needs. »» To stop the transfer of $6 million from the MBC’s Contingent Fund to the state’s General Fund. »» To stop the imposing of three furlough days per month on the MBC. »» To postpone (after vociferous objections from CMA and others) the “Red Flags Rule” deadline from May 1 to Aug. 1 to Nov. 1, 2009, and then to June 1, 2010.

June 2010 SAN DIEGO P HY SICIA N. o rg

19

*

Political/

Legal/ Reimbursement

Reimbursement

Advocacy

PHYSICIAN WORKFORCE MONITORED

»» In 2009, we conducted our fourth San Diego County Physician Workforce and Compensation Survey — alone in San Diego County and across California in monitoring our physician workforce in order to ensure physician shortages, whether actual or projected, can be identified before they result in access-to-care crises.

SDCMS’ physician workforce surveys are critical tools in our discussions with lawmakers and decision makers.

Engaging Physicians

» SDCMS held young-physicians socials in May and August, with more than 50 young physicians and residents attending each. » SDCMS’ 2009 Installation Dinner and Dance brought together more than 230 physicians, guests, healthcare leaders, other VIPs, and eight of our 13 state legislators — our largest event in seven years. » More than 450 physicians and guests attended the 2009 “Top Doctors” gala. » SDCMS convened quarterly chiefs of staff meetings. » SDCMS took five senior physician leaders to Washington, DC, in March to meet with each of our congressional representatives. » SDCMS took eight medical student members to Sacramento to meet with all of our San Diego County state legislators. » SDCMS went to Sacramento in April to meet with each of our San Diego County state legislators. » SDCMS held two past-presidents dinners. » SDCMS participated in UC San Diego’s Student Fair in June and signed up 120 new medical student members. » SDCMS attended 22 general staff and medical executive committee meetings at hospitals throughout the county.

Engaging

Our Physician

Members

Communicating

to, for, and From Our

*

Members

»» CMA’s Ethnic Physician Organization Section implemented a mentoring program where second- and thirdyear medical students are paired for one year with compatible physicians who practice in their city. »» Created under a CMA-sponsored law in 2020, the Steven M. Thompson Physician Corps Loan Repayment Program continued in 2009 to offer physicians medical school loan repayment grants of up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state.

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

SDCMS Website

We launched our new website at the end of 2008 and continued to expand our membersonly online resources to include the ability to: » build your own website » post and manage your own classified ads » view previously recorded seminars and webinars » consult our growing FAQ database with answers to hundreds of your practice management questions » renew your membership online » manage your profile » and much more …

*

Physician Communications »» San Diego Physician magazine continued to give voice to San Diego County’s physician community in 2009, reaching 8,500-plus subscribers monthly. »» Our biweekly “News You Can Use” e-newsletter continued to keep its 4,000-plus recipients abreast of information critical to maintaining successful physician practices. »» San Diego County’s print and broadcast news media continued to turn to SDCMS first when seeking the opinion of San Diego County’s physicians.

SDCMS Membership Grew to 2,578 in 2009

SDCMS is now the second-largest CMA component medical society, after the Los Angeles County Medical Association.

members

3000

2,562 2,578 2,390 2,419 2,029 2,056 2,163 2,195

2000

2002 2003 2004 2005 2006 2007 2008 2009

Member Benefits » Your SDCMS physician advocate and office manager advocate resolved more than 400 member and member office staff issues, including economic advocacy issues, legal issues, and member benefits requests. » Your SDCMS-endorsed partner, The Doctors Company, saved you from hundreds to thousands of dollars with its 5% discount on insurance premiums and 7.5% dividend credit. » SDCMS members (only) were listed in San Diego Magazine’s May 2009 “Health Annex” supplement. » For the fifth straight year — while continuing to improve the selection process — SDCMS partnered with San Diego Magazine in 2009 to select San Diego County’s “Top Doctors: Physicians of Exceptional Excellence.” » SDCMS continued to invite you and your staff to attend our seminars virtually via our 3000 webinar technology. » SDCMS created an “E-prescribing for Dummies” presentation. » SDCMS partnered with Strategic HR to give our members and their office staff a complete range of HR solutions, including free answers to your difficult HR questions. » As we do every year, SDCMS 2500 2,578 2,562partnered with RCL Portrait Design to take your photos for our directory and website free of charge.

2,419 » SDCMS made available to you and your staff 2,390 a treasure trove of answers to your practice management questions via our online FAQ search tool.

2,195

2,163

2000

2,056

SDCMS Revenues and Expenses 1500

SDCMS Fiscal Year 2008-2009

Labor and Cash Expenses Physician Engagement Governance 6% 13% Physician Database 4% Communication 1000 25%

Benefits

13% 500

SDCMS Income 2008-2009 Rent 10%

Advertising & Sales 16%

Accounting 1% Consumables 1% Copier 1%

Infrastructure 31%

Credit Card/ Bank Charges 1% Insurance 2% Misc. Expense 3% Postage 1% Telephone 1%

Dues 62%

Investments 14%

Staff time G&A 8%

Advocacy Specialty Foundation 6% 2% Societies 1%

Misc 3%

AMA/CMA Commission Sponsorships 4% 1%

*

membership and

operations

KEEPING YOU AND YOUR STAFF TRAINED AND INFORMED In 2009, SDCMS conducted 26 seminars and 25 webinars with 185 members and 575 of their office staff attending, with topics including “Palmetto Post-transition,” “Top 10 Collections Procedures,” “E-prescribing for Dummies,” “How to Attract and Keep the Best Patients,” “Health Plan Contracting Savvy,” “Coding to Optimize Compliance and Reimbursement,” “Human Resources Essentials,” “The Patient-centered Medical Home,” “Preparing to Practice,” “What the Health Is Happening in Washington and Sacramento?” “EMR Trunk Shows,” “Leader’s Toolbox,” “The Perils and Pitfalls of Business Relationships With Nonphysicians,” “Employment Law 101,” “A Step-by-step Guide to Maximizing Your Cash Flow,” “OSHA Updates,” “Health Reform Townhalls,” “How to Successfully Select and Implement an EMR,” “HIPAA and HITECH Updates,” “10 Strategies for Economic Survival,” “Become a Certified Medical Coder,” “POLST Training for Physicians,” “Electronic Medical Records: Are You Ready?” and more.

Technology » SDCMS held two “EMR Trunk Shows” in 2,029 2009 to allow members and their staff to see the major EMR/EHRs in operation, to meet the sales staff, and to learn how to choose an EMR. » SDCMS created a members-only “E-prescribing for Dummies” presentation to detail the pros and cons of e-prescribing, to explain how to receive Medicare’s 2% e-prescribing incentive, and to give a vendor-neutral overview of some e-prescribing products. » CMA created an HIT resource center online.

June 2010 SAN DIEGO P HY SICIA N. o rg

21

Connecting Patients With Donated Healthcare Services

SDCMS foundation

2009 Annual Report Our Mission:

“addressing unmet San Diego health care needs for all patients and physicians through innovation, education and service”

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

SDCMSF’s Project Access San Diego (PASD) coordinates private physician volunteer care by providing patient navigation and referral management services. In 2009 PASD recruited 300 physicians in 18 specialties to see medically underserved patients for free.

Eighty-six percent of PASD patients fell below 150% of the federal poverty level, earning less than $35,000 per year for a family of four. Our PASD partners in 2009 included: Alliance Healthcare Foundation • Anesthesiology Services Medical Group • California Endowment • County of San Diego • Grossmont Healthcare District • Imaging Healthcare Specialists • Kaiser Permanente • San Diego Pathology Group • Supervisor Greg Cox • Supervisor Ron Roberts • Valley Radiology • The WebMD Foundation • UCSD Medical Center • And Many Others …

Your SDCMS Foundation in the Spotlight SDCMSF was invited to present our innovative models of caring for the medically underserved in our community on the national stage in 2009. The County of San Diego, led by Supervisor Ron Roberts, recognized SDCMSF with a proclamation that June 16, 2009, was “San Diego County Medical Society Foundation Day,” in honor of our service to the community. Assemblywoman Lori Saldaña also recognized SDCMSF’s efforts to support the needs of the safety net. In 2009, nonprofit leader Guidestar awarded SDCMSF with a preferred partner seal and a premium presence on its donor-driven website (22,000 visitors every day).

Optimizing Specialty Care Resources in the Community SDCMSF’s new Specialty Care Access Initiative partnership with the Council of Community Clinics is increasing access to specialists at the clinic level by recruiting physicians to volunteer at health centers and by hosting specialty roundtables at SDCMS to promote referral efficiency and new referral guidelines for practicing primary care providers. E-consults are in the works for 2010.

SDCMSF Financial Snapshot FY09 Assets: »» Cash: $166,254 »» Investments: $504,808 »» Accounts Receivable: $53,928 »» Note Receivable: $48,411 »» Equipment Net: $630 »» TOTAL: $774,031 Income Summary: »» Grants: $601,712 »» Contributions: $63,769 »» In-kind Contributions (SDCMS): $39,135 »» Miscellaneous (bad debt recovery): $20,934 »» Investment Income (includes losses): $5,629 »» TOTAL: $731,179 Activities Summary: »» Programs: $584,672 »» Fundraising: $8,258 »» Administrative: $50,216 »» TOTAL: $643,146

Your SDCMS Foundation in the Headlines

SDCMSF hit the headlines in 2009. We were featured in the San Diego Business Journal, on Fox News, on Channel 10 News, on Channel 7 & 39 News, online at Yahoo!

News and at CNBC, with coverage on service to safety net patients through PASD and Surgery Days.

SDCMSF Financial Review Governance and Oversight »» The Foundation maintained focus on strong governance and oversight and implemented several new financial policies in FY09, including an investment policy and a conflict of interest policy. »» The Foundation received an unqualified opinion from the public accounting firm Leaf & Cole, LLP, concluding another successful audit.

SDCMSF Staff (l–r): Lauren Radano, Barbara Rodriguez, Kitty Bailey, Tana Lorah, Alisha Mann, and Brenda Salcedo

Protecting Volunteer Physicians From Medical Liability Medical liability protection for volunteer physicians is on the radar screen of California’s legislators. SDCMSF worked to support a partnership between CMA and the Medical Board of California to introduce new legislation that will cover physicians who volunteer in California. Watch for developments in 2010.

Supporting Future Physicians In 2009, SDCMSF supported future physicians through scholarships for UC San Diego School of Medicine students Ruben Carmona, Tuan Van Mia, and Colin Zimmerman. We look forward to seeing the future accomplishments of all of our scholarship winners who all demonstrated an outstanding commitment to our community.

And Helping Patients Achieve Wellness

Through Project Access San Diego, more than $800,000 in donated care was provided in 2009, making a significant impact in achieving better health for patients by lowering symptomatic days, by reducing the number of missed days of work, and by reducing the number of clinic and emergency department visits. » 4 Surgery Days » $800,000 in Donated Services » 600 Volunteers » 160 Lives Changed » 3 Lives Saved

Operating Budget »» Operating income increased in 2009 by 58% over the prior year, as the Foundation increased revenues and expenses to accommodate five new staff persons to support three programs. »» SDCMSF closed the budget year with a balanced budget.

Investment Review »» Through extreme turmoil in the financial markets, the Foundation adopted an investment policy to protect the corpus of investments and maintained a disciplined approach to asset allocation and management of the investments. »» Risk was reduced by employing a conservative reinvestment policy and shifting investments to U.S. Treasury Securities. Investments are reviewed monthly and approved by the board of directors.

June 2010 SAN DIEGO P HY SICIA N. o rg

23

practicemanagement

By Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Vice President of Business and Member Development, American Academy of Professional Coders (AAPC)

ICD-10 Ask Questions Now to Put You Light Years Ahead

Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Vice President of Business and Member Development, American Academy of Professional Coders (AAPC)

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

There are many unknowns right now with the implementation of ICD10-CM; however, tackling a few obstacles early on, along with a keen sense of ICD-10 awareness, will put you ahead of the game and able to continue on after Oct. 1, 2013. Waiting until the last minute in hopes of delays will surely jeopardize the financial stability of your practice.

First and foremost, don’t plan on delays based on past experiences.

Keep in mind that CMS feels that they have already given an extension of two years based on the Notice of Proposed Rule Making. The original proposed date was Oct. 1, 2011, and the date was extended, based on comments, to Oct. 1, 2013. In addition, the transition to ICD-10 will take numerous resources — failure to budget properly and spread out the task will leave you in a financial pinch. It will be impossible to prepare your practice for ICD-10-CM in just a few short months, so asking a few key questions now will put you light years ahead for implementation.

What Do the Health Plans Have in Store for Implementation?

Take a good, hard look at your contracts and how payments are tied to them. Also look at how any quality payments are processed.

Anything based on clinical and diagnostic findings will need to be reassessed, and new guidelines put in place to match up with the more-specific ICD-10-CM codes. Schedule meetings with provider reps early on to see what their plans and timeframes are for addressing these issues so that you will be assured of communications and notifications regarding any changes in payments that may be coming. This will help you prepare and budget.

How Are Your Vendors Gearing Up? Will You Need Software or Hardware Upgrades?

Will your system be able to handle dual reporting during transitions? When will they begin testing, and how do you get on their training and testing schedules? You will want to work with your vendor now to make sure that they have already begun preparation for the changes. If your vendor cannot assure you readiness, you will need to start looking for new vendors now. This is a time-consuming process that could take a year or two to research and put into place. Being caught with a vendor who is not ready will bring the practice to a complete halt.

Will Your Clinical Documentation Stand Up to the Level of Specificity Required in ICD-10-CM?

One way to assess and prepare for this is to run a practice management report with your most frequently used ICD-9-CM codes now.

Use those codes along with the GEMS files to crosswalk your current ICD-9-CM codes to possible ICD-10-CM code selections. Are you tech-savvy enough to manipulate the files yourself? If not, utilize the AAPC’s free ICD10 Code Translator at www.aapc.com/ICD10/codes. You simply type in the ICD-9 code and the work of translating to ICD-10 codes is done for you. Keep in mind that ICD-9 codes do not map 1:1 with ICD-10 codes, and you will not find exact matches. What you will find, though, is the possible code choices and descriptors that will allow you to take a look at your clinical documentation and make sure it will match up with what is needed to assign the more specific ICD-10-CM code. ICD-10CM addresses laterality, stages of healing for fractures and injuries, trimesters for pregnancies and pregnancy-related issues, and so on.

Have someone take your ICD-9 report and walk the codes over using the Code Translator tool found on the AAPC website. Then run a separate report for matching up patients to those diagnosis codes found on your report.

Pull the charts and look at the documentation found within and where more information will be required. This way you can begin to work on any documentation issues now so that your encounters can continue to be coded after Oct. 1, 2013.

How Much Training Will Be Needed, and Who Will Need to Be Trained in Your Practice?

Training and education is often expensive, and budgets have been cut in medical practices. Almost everyone in your practice will require some type of training on ICD-10 implementation and code sets; the amount of training will depend on their position and current knowledge of anatomy and terminology, and their current ability to use ICD9-CM. Consider whether or not you have someone in-house to provide your training or if you will need to obtain training outside of your practice. Either method will require time away from duties, and finances to be budgeted, which should happen early on in implementation planning.

Are You Considering Transitioning to an EMR?

If so, you will not want to try and implement both your EMR and ICD-10 transition at the same time. Careful planning and staging will be required. Meaningful use requirements will need to be met to gain access to stimulus money, and to put that additional burden on top of the major change of ICD-10 implementation could bring a practice to its knees.

Begin transitioning to your EMR now to capture all of that available revenue and begin ICD-10 awareness in your practice. Then carefully roll out each stage. Detailed attention is required to workflow and processes, and mapping of all areas affected in the practice. You may consider developing teams in your practice for both EMR and ICD-10 implementation. If you do implement teams, make sure that they meet occasionally to ensure that implementation requirements are met.

Wherever you are in the process, you must leap ahead in planning in order to be successful in the transitions coming your way over the next several years. Careful planning and budgeting are essential to financial health.

Meeting the changing demands head on is key to success. Let the journey begin …

June 2010 SAN DIEGO P HY SICIA N. o rg

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practicemanagement

By Ronald A. Mitchell, CPA

Health Reform and Tax Changes What Will the Financial Impact on You Be?

The two health reform bills Major Individual Tax Changes signed by the president Medical Insurance Tax: Starting in 2013, Medical Expense Deduction: The threshan additional 0.9 percent Medicare Hospiold will be raised for the itemized medical exwill have an impact on tal Insurance tax (HI tax) will be charged on pense deduction from 7.5 percent of adjusted every medical practice, self-employed individuals and employees gross income (AGI) to 10 percent of AGI bewith respect to earnings and wages received ginning after 2012. However, individuals employer, and U.S. citizen. during the year above certain thresholds — 65 years and older — and their spouses Though most of the changes $200,000 single and $250,000 married filing age — would be temporarily exempt from the jointly. increase until 2017. mandated will not be implemented for a number Unearned Income Medicare Contribu- Limit on Health Flexible Spending Artion: There is a provision for an unearned rangements: Beginning in 2011, employee of years, others will take income Medicare contribution assessed on salary reductions for coverage under a cafeteeffect sooner. income from interest, dividends, capital ria plan FSA will be limited to $2,500 per taxgains, annuities, royalties, and rents. The tax would be at 3.8 percent based on the lesser of the taxpayer’s net investment income or modified adjusted gross income in excess of the threshold amounts of $200,000 for singles and $250,000 for joint filers.

able year. If a cafeteria plan does not contain this limitation, then benefits from the FSA will not be qualified benefits.

Individual Mandate: All individuals are required to obtain health insurance or pay a penalty on their federal tax returns beginning in 2014. A new refundable healthcare premium tax credit will be provided to assist individuals and families who purchase healthcare on the individual market.

Since these initiatives have varying implementation dates, physicians should carefully evaluate which aspects of the legislation affect them — see whitehouse. gov/health-care-meeting/proposal — and create a budget to determine the financial impact on their organizations.

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

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 June 2010 SAN DIEGO P HY SICIA N. o rg

27

patientsafety

By Nancy Stimson

Although PubMed is the most popular and heavily used database from the National Library of Medicine (NLM), it is by no means the only NLM resource. NLM produces a huge number of databases on a variety of topics (nlm.nih.gov/databases), including drug information sources, some of which are listed below.

Drug Resources From the National Library of Medicine 28

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

• Drug Information Portal (druginfo. nlm.nih.gov): Start here. This is the largest, most complete gateway to current, accurate drug information from NLM and other government agencies. Search everything at once by drug name or category, or limit by audience or class.

• Pillbox (pillbox.nlm.nih.gov): This beta site allows you to rapidly identify unknown tablets and capsules based on physical characteristics (e.g., shape, color, imprint), and provides high-resolution images and links to drug information and FDA-approved drug labels.

• LactMed — Drugs and Lactation Database (toxnet.nlm.nih.gov/cgibin/sis/htmlgen?LACT): The LactMed database includes drugs that breastfeed-

ing mothers may be exposed to. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

• Household Products Database (hpd. nlm.nih.gov): The Household Products Database addresses the potential health effects of more than 9,000 common household products (i.e., auto, pesticide, personal care, home and yard maintenance, arts and crafts, pet care, and home-office products). Information from the Material Safety Data Sheet (MSDS) and manufacturer contact information is provided.

This is just a sampling of the NLM drug databases, all freely available.

• Toxicology Data Network (TOXNET) (toxnet.nlm.nih.gov): TOXNET is a collection of databases on toxicology, hazardous chemicals, and environmental health, including information about specific chemicals, mixtures, and products, unknown chemicals, and special toxic effects of chemicals in humans and/or animals. Use the “multi-database” option to search all the TOXNET databases at once.

• Poison Control Information (sis. nlm.nih.gov/enviro/poisoninginformation.html): For nonemergency situations, this page links to several poisoning resources including TOXNET, Pillbox, LactMed, and the Household Products Database. For poisoning emergencies, call your local Poison Center at (800) 2221222, or call 911 if the victim has collapsed or is unconscious.

• Drug Information for the Public (druginfo.nlm.nih.gov/drugportal/jsp/drugportal/consumerDrugs.jsp): Patients and other laypeople may be referred to this site as a portal to several reputable drug resources. Authoritative information about herbs and supplements is also included.

This is just a sampling of the NLM drug databases, all freely available. If you need help finding drug information and are not finding what you need, contact the UC San Diego Biomedical Library at biomed.ucsd.edu/ ask or at (858) 534-1201.

TH

S ITS 140 CELEBRATE � SDCMS

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June 2010 SAN DIEGO P HY SICIA N. o rg

29

evidence-basedmedicine By the DynaMed Editorial Team

Intensive Systolic Blood Pressure Control Does Not Reduce Mortality in Patients With Diabetes DynaMed EBM Series 331 Current guidelines from the American Diabetes Association (ADA) and other organizations recommend a blood pressure target < 130/80 mm Hg for patients with diabetes (Diabetes Care 2010 Jan;33 Suppl 1:S11). To date, there has been little experimental data to guide blood pressure target recommendations, but a new trial directly compared two different blood pressure goals. The Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD BP) compared intensive systolic blood pressure control (target < 120 mm Hg) vs. standard control (target < 140 mm Hg) in 4,733 patients. While the trial did

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

not stipulate specific antihypertensive regimens, patients in both groups were required to receive a drug class associated with reduction in cardiovascular events in patients with diabetes (ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or diuretics). They could also receive other medications as necessary.

Mean systolic blood pressure from the end of first year to end of follow-up was 119.3 mm Hg for the intensive group and 133.5 mm Hg for the standard group. Systolic blood pressure target < 120 mm Hg does not reduce mortality or myocardial infarction but does reduce non-

fatal stroke compared to target < 140 mm Hg (level 1 [mid-level] evidence). During a mean follow-up of 4.7 years, cardiovascular mortality was 2.5% in each group. There were no significant differences in all-cause mortality (6.3% vs. 6.1%), nonfatal myocardial infarction (5.3% vs. 6.2%), or heart failure (3.5% vs.

3.8%). Stroke occurred in 1.7% of the intensive group compared to 2.6% of the standard group (p = 0.01, NNT 84). However, the risk of serious adverse events from treatment was increased for the intensive group (3.3% vs. 1.3%, p < 0.001, NNH 50). Adverse events reported (not all individually significant) included hypotension, syncope, bradycardia or other arrhythmia, hyperkalemia, angioedema, and renal failure(N Engl J Med 2010 Mar 14 early online). For more information, see the hypertension treatment in patients with diabetes topic in DynaMed. In DynaMed’s hypertension treatment in patients with diabetes topic, under Target Blood Pressure Goals — Evidence, the content is: • systolic blood pressure target < 120 mm Hg does not reduce mortality or myocardial infarction but does reduce nonfatal stroke

compared to target < 140 mm Hg (level 1 [likely reliable] evidence) »»based on randomized trial »»4,733 patients (mean age 62 years) with type 2 diabetes, HbA1c ≥ 7.5% and high risk for cardiovascular events were randomized to intensive therapy with systolic pressure target < 120 mm Hg vs. standard therapy with systolic pressure target < 140 mm Hg »»antihypertensive regimens for both groups were required to include a drug class associated with reduction in cardiovascular events in patients with diabetes ¤¤ ACE inhibitors ¤¤ angiotensin receptor blockers ¤¤ beta blockers ¤¤ calcium channel blockers ¤¤ diuretics »»mean follow-up 4.7 years »»mean systolic blood pressure from end of first year to end of follow-up ¤¤ 119.3 mm Hg with intensive therapy ¤¤ 133.5 mm Hg with standard therapy »»comparing intensive therapy vs. standard therapy ¤¤ death from cardiovascular cause in 2.5% vs. 2.5% (not significant) ¤¤ death from any cause in 6.3% vs.

6.1% (not significant) ¤¤ annual mortality 1.28% vs. 1.19% (not significant) ¤¤ nonfatal myocardial infarction in 5.3% vs. 6.2% (not significant) ¤¤ major coronary disease event (fatal coronary event, nonfatal myocardial infarction or unstable angina) in 10.7% vs. 11.48% (not significant) ¤¤ any stroke in 1.7% vs. 2.6% (p = 0.01, NNT 84) ¤¤ nonfatal stroke in 1.4% vs. 2.3% (p = 0.03, NNT 167) ¤¤ annual rate of stroke 0.32% vs.

0.53% (p = 0.01, NNT 556 patientyears) ¤¤ fatal or nonfatal heart failure in 3.5% vs. 3.8% (not significant) ¤¤ serious adverse events attributed to antihypertensive treatment in 3.3% vs. 1.3% (p < 0.001, NNH 50) • Reference: ACCORD BP trial (N Engl J Med 2010 Mar 14 early online), editorial can be found in N Engl J Med 2010 Mar 14 early online

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June 2010 SAN DIEGO P HY SICIA N. o rg

31

healthreform

Health Reform Timeline for

2011-2018

2011

The following health reform legislation changes are scheduled to be implemented between 2011 and 2018. To access a health reform timeline for 2010, please visit the May 2010 issue of San Diego Physician.

INSURANCE reforms: • Health insurance providers that do not dedicate 85 percent (largegroup market) or 80 percent (individual and small-group markets) of revenue to direct patient care must provide a rebate to enrollees.

LONG-TERM CARE INSURANCE: • National, voluntary, long-term care insurance program established.

Tort Reforms: • Five-year demonstration grants awarded to states to develop, implement, and evaluate alternatives to current tort litigations. (NOTE: NOT APPLICABLE FOR CALIFORNIA)

REIMBURSEMENTS TO physicians: • Ten percent primary care bonus for internists, geriatricians, family physicians, and pediatricians for five years for whom primary care services account for at least 60 percent of Medicare-allowed charges over a designated period of time.

• Ten percent general surgeon bonus for general surgeons practicing in health professional shortage areas for five years. (NOTE: NOT APPLICABLE FOR CALIFORNIA)

reimbursements to hospitals:

MEDICARE PRESCRIPTION DRUGS:

• Medicare payments to qualifying hospitals in counties with the lowest quartile Medicare spending for 2011 and 2012 provided. (NOTE: NOT APPLICABLE FOR CALIFORNIA)

• Pharmaceutical manufacturers required to provide a 50 percent discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011.

• Federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap begun to be phased in.

• Demonstration program for primary care medical homes for patients with multiple chronic conditions established.

• Physicians eligible for shared savings bonus payments for medical homes.

2011

Medical Homes:

Insurance Reforms Tort Reforms

• Nurse practitioners and physician assistants may lead medical homes but only if state scope-of-practice laws allow it. (NOTE: NOT APPLICABLE FOR CALIFORNIA) • New Medicaid state plan option created to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a medical home.

• States taking up the option provided with 90 percent FMAP for two years for health home related services, including care management, care coordination, and health promotion.

medicaid: • Coverage for preventive services, and preventive services cost-sharing eliminated.

• Federal payments to states for Medicaid services related to healthcare-acquired conditions eliminated.

• State Balancing Incentive Program in Medicaid created to provide enhanced federal matching payments to increase non-institutionally based long-term care services.

Reimbursements to Physicians Reimbursements to Hospitals

Medicaid

Medicare Prescription Drugs Long-Term Care Insurance 32

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

Medical Homes

Community First Choice Option in Medicaid created to provide communitybased attendant support services to certain people with disabilities.

Federally Qualified Health Centers: • Access to care improved by increasing funding by $11 billion for community health centers and the National Health Service Corps over five years; new programs to support school-based health centers and nurse-managed health clinics established.

PHYSICIAN-OWNED HOSPITALS: • Physician-owned hospitals banned after Dec. 31, 2010, with exception for those in place by this date.

WELLNESS: • Preventive services covered and cost sharing for Medicare preventive services eliminated. Medicare payments for certain preventive services increased.

FMAP increased by 1 percent for these services for states that provide Medicaid coverage for preventive services and remove cost sharing for preventive services.

• Medicare beneficiaries provided access to comprehensive health risk assessments and personalized prevention plans. Incentives provided to Medicare and Medicaid beneficiaries to complete behavior modification programs.

• Grants for up to five years provided to small employers that establish wellness programs.

• National strategy established to improve the nation’s health.

• Chain restaurants and food sold from vending machines required to disclose the nutritional content of each item.

PHYSICIAN WORKFORCE: • Graduate medical education changes phased in, including redistributing unused residency slots for primary care and general surgery, allowing training in outpatient settings, and allowing teaching health centers to expand primary care residency programs.

• National Health Care Workforce Commission to examine barriers to primary care careers, to authorize state grants, to increase funding for NHSC scholarship and loan repayment program; access to loans for primary care providers eased, health professions and diversity programs funded.

QUALITY: • Medicare quality reporting program continued. Physician bonuses of 0.5 percent to 1 percent provided in 2011–13. Participation mandatory in 2014 with penalties for nonparticipation.

• ICD-9 to ICD-10 crosswalk. Secretary required to hold stakeholder meetings.

• National quality improvement strategy developed.

• Community-based Collaborative Care Network Program established to support consortiums of healthcare providers to coordinate and integrate healthcare services for low-income uninsured and underinsured populations.

• New trauma center program established to strengthen emergency department and trauma center capacity.

Quality

Physician Workforce Physician-owned Hospitals

• Phase-in of fiscal neutrality for Medicare Fee-for-Service and Medicare Advantage (MA) started. Quality bonus for care coordination, care management, and quality established.

• Medicare payment cuts to health insurance providers, pharmaceutical companies, medical device manufacturers, hospitals, home health, and nursing homes begun.

• Income threshold for income-related Medicare Part B premiums for 2011–19 frozen at 2010 levels; Medicare Part D premium subsidy for those with incomes above $85,000 per individual and $170,000 per couple reduced.

• Phase-in of multiple initiatives to curb fraud and abuse started.

• Five percent penalty for physician utilization outliers eliminated. Current program to provide confidential feedback to physicians comparing their utilization and resources use to their peers continued.

INCREASE REVENUES: • Some revenue provisions, including the fees on health insurance providers, pharmaceutical and device manufacturers, and the Medicare tax start to phase in.

• Tax on nonmedical distributions from HSA or MSA increased.

• New annual fees on the pharmaceutical manufacturing sector imposed.

REDUCED TAX BREAKS: • Costs for OTC drugs excluded from being reimbursed by HRA, health FSA, HSA, or MSA.

Federally Qualified Health Centers Wellness

REDUCE MEDICARE EXPENSES:

Increase Revenues

Reduce Medicare Expenses

Reduced Tax Breaks

June 2010 SAN DIEGO P HY SICIA N. o rg

33

2012

TORT REFORM:

MEDICARE:

• GAO reports whether the new practice guidelines and payments policies would create causes of action against physicians.

• Bonus payments to high–quality Medicare Advantage plans provided.

• Rebates for Medicare Advantage plans reduced.

QUALITY:

ACCOUNTABLE CARE ORGANIZATIONS (ACOs):

• Enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations required.

2012: CMS required to establish ACOs to allow groups of physicians who report on quality and coordinate care to share in the savings achieved in their region.

REIMBURSEMENTS TO HOSPITALS: • Medicare payments to hospitals reduced to account for (preventable) excess hospital readmissions.

• Hospital value-based purchasing program in Medicare established.

• Plans to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers developed.

• Medicaid demonstration projects for bundled payments for episodes of care that include hospitalizations: to make global capitated payments to safety net hospital systems (effective fiscal years 2010–12); to allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective Jan. 1, 2012, through Dec. 31, 2016); and to provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition (effective Oct. 1, 2011, through Dec. 31, 2015).

• CMS required to establish ACOs to allow groups of physicians who report on quality and coordinate care to share in the savings — particularly from preventing unnecessary ER visits or hospitalizations — achieved in their region. ACOs can be small groups of loosely affiliated physicians or large organized groups. ACOs do not have to involve a hospital. Because ACOs will be groups of physicians who are clinically and financially integrated, a path to physician antitrust relief to be established.

Tort Reform

2012

Quality

Accountable Care Organizations

Medicare Reimbursements to Hospitals 34

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

2013

healthreform INSURANCE REFORMS:

MEDICARE:

INCREASED REVENUE:

• Program to foster nonprofit, memberrun health insurance companies created.

• Health insurance provider administration simplified by adopting a single set of operating rules for eligibility verification and claims status (rules adopted July 1, 2011; effective Jan. 1, 2013), electronic funds transfers and healthcare payment and remittance (rules adopted July 1, 2012; effective Jan. 1, 2014), and health claims or equivalent encounter information, enrollment, and disenrollment in a health plan, health plan premium payments, and referral certification and authorization (rules adopted July 1, 2014; effective Jan. 1, 2016). Health insurance providers required to document compliance with these standards or face a penalty of no more than $1 per covered life, effective April 1, 2014.

• Public reporting of Medicare physician and private payer performance information related to quality (PQRI) and other factors such as care coordination, resource use, and patient satisfaction required. Data would meet certain safeguards (valid, risk-adjusted), and physicians would have prior opportunity to review the data. Appropriate attribution methodology, timely feedback, and accurate systems that can provide reliable data required. AMA and CMA worked to include multiple amendments to protect physician information and ensure that it is accurate based on the CCHRI experience in California. Further protections need to be addressed in clean-up legislation.

• Administrative simplification requires health insurance plans to certify that their information systems comply with standards. New operating rules for eligibility and health plan claim status transactions to take effect.

• Threshold increased for itemized deduction for unreimbursed medical expenses from 7.5 percent to 10 percent of AGI, but waived for individuals age 65 and older for tax years 2013–16.

• Medicare Part A (hospital insurance) tax rate on wages increased by 0.9 percent (from 1.45 percent to 2.35 percent) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly; 3.8 percent assessment on unearned income imposed for higher-income taxpayers.

• Contributions to flexible spending accounts for medical expenses limited to $2,500 per year.

• Excise tax of 2.3 percent on the sale of any taxable medical device imposed.

• Tax deduction for employers who receive Medicare Part D retiree drug subsidy payments eliminated.

MEDICAID REIMBURSEMENTS: • Medicaid payments to primary care doctors increased for 2013 and 2014 with 100 percent federal funding.

QUALITY: • Disclosure of financial relationships between health entities required — includes physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.

2013

Medicaid Reimbursements

Ouality Insurance Reforms

MEDICARE: • Federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (to 25 percent in 2020, in addition to the 50 percent manufacturer brand-name discount) begun to be phased in.

• Medicare pilot program to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care established.

Medicare

Medicare

Increased Revenue

June 2010 SAN DIEGO P HY SICIA N. o rg

35

2014

healthreform INSURANCE COVERAGE: • Individual mandate for uninsured individuals to purchase health insurance begun. Penalties of up to 10 percent of income for those who do not purchase insurance.

Tax credits and cost sharing subsidies for low-income individuals.

• Substantial fees on large employers who do not provide coverage, but no employer mandate.

• State-based health insurance exchanges where individuals and small businesses with up to 100 employees can purchase qualified coverage with a choice of private health insurance providers, benefits packages, and doctors.

• At least two multistate plans in each exchange required. At least one plan must be offered by a nonprofit entity, and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

• Refundable and advanceable premium credits and cost-sharing subsidies to eligible individuals and families with incomes 133–400 percent FPL to purchase insurance through the exchanges.

• Health insurance providers prohibited from denying coverage to adults with preexisting conditions.

• Rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio) allowed.

• Health insurance providers required to limit waiting periods for coverage to 90 days.

• Out-of-pocket limits for those with incomes up to 400 percent FPL reduced.

• Deductibles for small-group market health plans limited to $2,000 for individuals and $4,000 for families.

• Essential health insurance package that provides a comprehensive set of services, covers at least 60 percent of the actuarial value of the covered benefits, limits annual cost sharing to the current law HSA limits ($5,950 per individual and $11,900 per family in 2010), and is not more extensive than the typical employer plan created.

MEDICAID: • Medicaid expanded to all non-Medicare-eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133 percent FPL. Enhanced federal matching for new eligibles provided. 1.7 million Californians covered in Medi-Cal.

PREVENTION AND WELLNESS: • Employers may offer rewards of up to 30 percent — increasing to 50 percent if appropriate — of the cost of health insurance coverage for participating in a wellness program and meeting certain health-related standards.

Establish pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

Insurance Coverage

2014

Prevention and Wellness

Medicaid 36

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

MEDICAID REIMBURSEMENT: • Increase in Medicaid reimbursement rates for primary care physicians (internists, family physicians, and pediatricians) up to Medicare levels for E&M services and immunizations provided in 2013 and 2014.

MEDICARE REIMBURSEMENT: • Independent Payment Advisory Board established to submit legislative proposals containing recommendations to reduce the percapita rate of growth in Medicare spending if spending exceeds a target growth rate.

• Out-of-pocket amount that qualifies an enrollee for catastrophic coverage in Medicare Part D reduced.

INSURANCE: • Medicare Advantage plans required to have medical loss ratios no lower than 85 percent.

• Administrative simplification operating rules for electronic funds transfers (EFT) and healthcare payment and remittance advice to take effect. Physicians also required to comply with the EFT standards for Medicare payments.

HOSPITALS: • Medicare Disproportionate Share Hospital (DSH) payments reduced initially by 75 percent and payments subsequently increased based on the percent of the population uninsured and the amount of uncompensated care provided. States’ Medicaid Disproportionate Share Hospital (DSH) allotments reduced.

Medicare Reimbursement Insurance

Medicaid Reimbursement

2015

Hospitals

Medicare

2015 2016 2018

MEDICARE: • Value Index Modifier to modify physician payments based on level of spending and quality reporting. Physicians who spend less than national average will be paid a higher rate.

Physicians who spend more than the national average will be paid a lower rate. Rate adjusted for geographic practice expense and socioeconomic status of the patients.

COST: • Multistate compacts to allow insurers to sell policies across state lines implemented. Implementation regulations due by 2013.

• Additional Administrative Simplification rules to take effect. Operating rules for claims, (dis)enrollment, and health claims attachment standards.

• Medicare payments to certain hospitals for hospital-acquired conditions reduced by 1 percent.

COST: • Cadillac tax on health insurance plans offering high-end benefits implemented. Excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage imposed.

How Health Reform Will Affect …

Physicians

»» 2010: Medicare will increase payment for psychotherapy services by 5%. »» 2010: Medical liability protections under the Federal Tort Claims Act will be extended to officers, governing board members, employees, and contractors of free clinics. »» The federal government may award five-year demonstration grants to states to develop, implement, and evaluate alternative medical liability reform initiatives, such as health courts and early offer programs, beginning in 2011. (NOTE: NOT APPLICABLE FOR CALIFORNIA) »» Physicians will receive incentive payments of 1% in 2011 and 0.5% from 2012 to 2014 for voluntary participation in Medicare’s Physician Quality Reporting Initiative (PQRI). An additional 0.5% incentive payment will be made to physicians who participate in a qualified Maintenance of Certification Program (quality practice-based learning programs through specialty boards). In 2015, physician payments will be reduced by 1.5% if they do not participate in the PQRI program. In 2016 and beyond, the PQRI nonparticipation penalty will be 2.0%. »» 2011–2016: Physicians in family medicine, internal medicine, geriatrics, and pediatrics whose Medicare charges for office, nursing facility, and home visits comprise at least 60% of their total Medicare charges will be eligible for a 10% bonus payment for these services. »» 2011–2016: General surgeons who perform major procedures (with a 10or 90-day global service period) in a health professional shortage area will be eligible for a 10% bonus payment for these services. (NOTE: NOT APPLICABLE FOR SAN DIEGO COUNTY) »» National rules will be developed and implemented between 2013 and 2016 to standardize and streamline health insurance claims-processing requirements.

Patients With Respect to Private Health Insurance Changes

2016 2018 Cost Cost

»» 2010: Insurer can no longer drop patients if they get sick. »» 2010: Insurers can no longer impose lifetime financial limits on benefits. »» 2010: Children ages 18 and younger can no longer be denied private insurance coverage if they have a preexisting medical condition. (While some ambiguities have been raised about the application of this provision, implementing regulations will clarify that the prohibition on preexisting condition exclusions for children will begin as planned in September. America’s Health Insurance Plans has stated it will fully comply with the regulations.) »» 2010: Young adults up to age 26 can remain as a dependent on their parents’ private health insurance plan.

June 2010 SAN DIEGO P HY SICIA N. o rg

37

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

»» 2010: For adults with preexisting medical conditions who cannot obtain private insurance coverage, a temporary national “high-risk pool” will be established to provide coverage, with financial subsidies to make premiums more affordable, until all insurers are required to cover people with preexisting conditions in 2014. »» 2010: Preventive services for women, such as mammograms, and immunizations for children must be covered by insurers, with no co-payments or deductibles required. »» 2011: States can require insurance companies to submit justification for premium increases and can impose penalties for excessive increases. »» 2014: U.S. citizens and legal residents cannot be denied private health insurance coverage for any reason. »» 2014: All U.S. citizens and legal residents must obtain health insurance coverage or pay a tax penalty (with some exemptions). »» 2014: State-based health insurance exchanges (where those without access to employer-based insurance can shop and compare the benefits/costs of private health insurance plans) will begin. All insurance companies in the exchange must provide at least a minimum benefit package, as well as additional coverage options beyond a basic plan. »» 2014: Federal subsidies through tax credits or vouchers will be provided for those who cannot afford the full cost of coverage provided by state-based health insurance exchanges.

Patients With Respect to Medicare and Medicaid Changes

»» 2010: Medicaid will be required to cover tobacco cessation services for pregnant women. »» 2010: Medicare patients whose prescription expenses reach the so-called Medicare Part D coverage “donut hole” ($2,700 to $6,150) in 2010 will receive a $250 rebate. During the following 10 years, the beneficiary co-insurance rate for this coverage gap will be narrowed in phases from the current 100% to 25% in 2020. »» 2011: Cost-sharing for proven preventive services will be eliminated in Medicare and Medicaid. Medicare payments for certain preventive services will be increased to 100% of payment schedule rates (that is, co-payments will be eliminated), and incentives will be available to encourage Medicare and Medicaid beneficiaries to complete behavior modification programs.

healthreform »» 2014: Medi-Cal coverage expanded to all eligible children, pregnant women, parents, and childless adults under age 65 who have incomes at or below 133% of the federal poverty level.

The Healthcare Sector

»» 2010: Excise tax of 10% imposed on the amount paid for indoor tanning services. »» 2011: Annual fee on certain manufacturers and importers of branded prescription drugs (including biological products, but excluding orphan drugs) based on annual sales and set to reach a certain revenue target each year. »» 2013: Annual excise tax of 2.3% imposed on the sale of Class I (vast majority of orthotics and prosthetics, as well as durable medical equipment medical devices by manufacturers) with exemptions for eyeglasses, contact lenses, hearing aids, and any device that is generally purchased at retail for individual use. »» 2014: Annual fee on health insurance providers applied on net premiums of all health insurers based on their market share. For nonprofit insurers, only 50% of net premiums will be taken into account in calculating the fee. Exemptions are granted for: nonprofit plans that receive more than 80% of their income from government programs targeting low-income or elderly populations, or people with disabilities; voluntary employees’ beneficiary associations (VEBAs) not established by an employer; certain nonprofit insurers with medical loss ratios within specific limits; and self-insured plans and federal, state or other government entities. (The fee does apply to companies that underwrite government-funded insurance, such as Medicaid managed care plans and the Federal Employee Health Benefits Program.) »» 2018: Excise tax imposed on the coverage provider (i.e., insurer, plan administrator, or employer depending on the type of coverage) of high-cost, employer-sponsored health plans with aggregate values exceeding $10,200 for individual coverage and $27,500 for family coverage. The tax is equal to 40% of the value of the plan that exceeds these threshold amounts. For insured plans, the coverage provider will be the health insurance issuer; for self-insured plans, the coverage provider will generally be the plan administrator. Employers that make contributions to a health savings account (HSA) or medical savings account (MSA) must pay the excise tax if those contributions exceed the thresholds. The tax is not imposed on the individual enrollee. The dollar thresholds are indexed to inflation.

Individuals

»» 2010: Payments made under any state loan repayment or loan forgiveness program that is intended to provide for the increased availability of healthcare services in underserved or health professional shortage areas will be excluded from gross income. »» 2011: Tax on distributions from a Health Savings Account (HAS) raised to 20%. »» 2011: Cost of over-the-counter/nonprescibed medicines not reimbursed by FSA or HSA. »» 2013: For high-income individuals earning more than $200,000 and joint filers earning more than $250,000, Medicare payroll tax will increase by 0.9%, and a 3.8% Medicare tax will be imposed on net investment income from interest, dividends, annuities, royalties, rents, and taxable net gain. »» 2013: The threshold for claiming the itemized tax deduction for unreimbursed medical expenses will increase from 7.5% to 10% for taxpayers under 65. The increased threshold applies to individuals 65 years and older in 2017. »» 2013: Contributions to Flexible Savings Accounts (FSAs) capped at $2,500. »» 2014: Tax penalties for failure to obtain health insurance coverage.

Individuals must obtain minimum essential coverage for themselves and their dependents, with certain exemptions (i.e., hardship, religious reasons). Those without coverage will pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family, or 2.5% of household income. The penalty will be phased in according to the following schedule: $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee; or 1.0% of taxable income in 2014, 2.0% in 2015, and 2.5% in 2016.

2014: Individual mandate for uninsured individuals to purchase health insurance begun. Penalties of up to 10 percent of income for those who do not purchase insurance.

June 2010 SAN DIEGO P HY SICIA N. o rg

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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.

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

Professional Services Absolute Solutions

Sexuality Clinic of San Diego Cognitive/behavioral/psychodynamic therapy allows for understanding and treatment of sexual dysfunction, sexual addiction, and mental health problems.

Relationships with others kindle thoughts in our minds about one’s self. The dramas are powerful and maintain their status at various levels of one’s psyche resulting in sexual and psychological turmoil. The therapeutic relationship with Dr. Silbert rn,cns,phd,faacs, promotes healing by trusting expression and freedom of the authentic self.

Absolute Solutions is a full-service consulting and outsourcing company dedicated to the healthcare industry. Our billing service uses state-of-the-art technology to ensure code validation, electronic submission/remittance, patient statements, structured follow-up/ appeals, electronic document storage and meaningful reporting. Consulting services include business development, credentialing, contracting, executive assistant, financialoperational practice management, relocation coordination and much more. Contact us today for your free consult!

619.326.0700 | www.abs-sol.com

858.483.1430 | www.sextherapyofsandiego.com

Shred San Diego

Absolute Solutions International

• Onsite shredding • Cost at least 50% less than in-house shredding • Bonded and fully insured • Highly professional employees • Certificate of destruction after each shred • Free estimates on all jobs • Confidential containers – free of charge • We can guarantee you are HIPAA and HITECH compliant • Ask us about our box storage facilities

Scalable Outsourcing for Every Practice.

Do you wish you had 10 more hours in your day? ASI can give you all the time your business needs! Services starting as low as $8.00 per hour total cost!

• Accounts Receivable • Demographic Entry • Database Clean-up • Fee Schedule Updates • Online & Telephone • Payment Posting • Special Projects

Joey Rohr joey@shredsandiego.com

619.985.1799 | www.shredsandiego.com

Looking for a costeffective way to reach 8,500 physicians each month?

Place your message here in the Professional Services page of San Diego Physician magazine.

Rates starting at $250 for a six time contract.

Contact: Dari Pebdani 858.231.1231 or DPebdani@sdcms.org

Call 619.326.0700

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Professional Services page ads: • Are cost effective • Target physicians and their staff • Get you monthly exposure • Build your business • Start at $250/month for six issues

Your Contact Info Here June 2010 SAN DIEGO P HY SICIA N. o rg

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classifieds office space New Commercial Building in La Mesa • Spaces for Rent/Pre-Lease: Very close to Grossmont Hospital and highways 8 and 125. New building being constructed at 5980 Severin Dr., La Mesa. Near corner of Severin Dr. and Amaya, just north of the Brigantine restaurant. Beautiful and functional design. Spaces available from 1,000 to 5,500ft2. Pre-leasing/renting spaces. Call Nathan at (619) 787-3422 or email hythams@att.net. [823] SHARE OFFICE SPACE IN LA MESA — AVAILABLE IMMEDIATELY: La Mesa (Grossmont Hospital Campus) 1,400ft2 available to an additional doctor. Separate receptionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice compatible with OB/ GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648]

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 OFFICE SPACE IN LA JOLLA: Beautiful bright office, with natural light, perfect for a plastic surgeon or other specialties. Ground level medical office complex (UTC area) across from the Hyatt Regency La Jolla at Aventine. Mult-specialty building. Several plastic surgeons in building.

Two surgical centers on site. Ample free parking.

From 1,100ft2 — 5,400ft2 / divisible. For further information, call Sidney H. Levine, MD, at (858) 457-4040 or visit 8929 University Center, Suite 100/104, San Diego, CA 92122 (slevine@northcountyomg.com) — ask for Helen. [819] MEDICAL OFFICE BUILDING WITH AN ONSITE SURGICAL CENTER: Prime spaces on the third and fourth floors in the heart of San Diego. Signage available on heavily traveled Kearny Villa Road. Great location, close to freeways, I-805, and I-163. Nearby Sharp Hospital. Immediate occupancy available. Free rent! Visit www.PromusCommercial.com for pictures and details, or email Scott Cook at (858) 751-6300 or at Scott@ PromusCommercial.com. [813] MEDICAL OFFICE SPACE AVAILABLE PART TIME TO SHARE IN SOLANA BEACH: Excellent location off I-5 by coast. Space includes three fully equipped exam rooms, waiting room, lunchroom, two bathrooms. Available all day Thurs-

days and other days half-day flexible schedule.

Great opportunity for a start-up practice that can’t fill a full-time schedule. Affordable rent and flexible arrangements. Call (858) 259-9708 or email solanabeachmed@sbcglobal.net for more information. [811] OFFICE SPACE IN HILLCREST: Office space available for a physician with an established primary care practice in Hillcrest, located near Scripps Mercy and UCSD. Turnkey opportunity with excellent staff, state-of-the-art office and equipment. Please send letter of interest to KLewis@sdcms.org. [810] OFFICE SPACE TO SHARE: Currently occupied by orthopaedic surgeon. Great location close to Scripps/Mercy and UCSD Hospital. Looking to share with part-time or full time physician. Fully furnished, fully equipped with fluoro machine and 4 exam rooms and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] MULTI-SPECIALTY MEDICAL OFFICE SPACE AVAILABLE IN BANKER’S HILL AREA: Large office with view of San Diego harbor, eight fully equipped exam rooms, lab on site, and underground parking. Please contact Chris Bobritchi at (619) 233-4044 or at hivdocs@yahoo.com. [767] 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] 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] 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] PHYSICIAN POSITIONS AVAILABLE PHYSICIANS WANTED: Founded in 1972 in North San Diego County, California, Vista Community Clinic is a private, nonprofit medical, dental, and social services center, including advocacy and education programs. We serve people who experience social, cultural, or economic barriers to healthcare in a comprehensive, high-quality setting. We provide the highest quality services in five different locations throughout Vista and Oceanside. We currently have openings for parttime and per-diem physicians in the following specialties: family medicine, OB/GYN medicine, and pediatric medicine. All candidates must hold a current Calif. license and DEA license. Malpractice coverage is provided by the clinic. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414 3702. Visit our website at www.vistacommunityclinic.org. EOE/M/F/D/V [821]

DO YOUR PART FOR HOMELAND SECURITY!: STG INTERNATIONAL INC. IS A LEADING PROVIDER OF CONTRACT SERVICES IN THE GOVERNMENT HEALTHCARE SECTOR. WE HAVE AN IMMEDIATE NEED TO FILL AN OPENING FOR A PSYCHIATRIST, IN SAN DIEGO CA. IT IS WITH THE DIVISION OF IMMIGRATION HEALTH SERVICES (DIHS) UNDER THE DEPARTMENT OF HOMELAND SECURITY. Please contact Tony Cooper at (866) 790-4321 x 216 or acooper@stginternational.com, www.stginternational.com MEDICAL DIRECTOR: Licensed physician for busy outpatient substance abuse program. Treatment for opiate addiction — Methadone and Suboxone — MAT format. Thirty-two hours a week.

San Diego and El Cajon locations. Contact DWhitmyer@CRCHealth.com or (619) 718-9895. [820] UROLOGIST NEEDED IN CHULA VISTA NOW: Huge potential for association with very busy urologist in practice in Chula Vista since 1977.

Next to Scripps Mercy Chula Vista. Full time or locum tenens or part time. Could be just busy office practice and/or very active urological surgical practice. We have more urology work than we can handle. No Medi-Cal or Medi-Cal HMOs. Little managed care. 30% cash practice with potential to expand cash business. Contact Bayside Urology at (619) 420-0201, fax (619) 425-7795, or email dbhcv@pacbell.net. Talk with Dr. Dan. Shareholder status or just employee. [815]

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.

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PART-TIME AND FULL-TIME OPENINGS FOR PRIMARY CARE PHYSICIANS: Board-certified family practice or internal medicine physicians wanted to join our prominent East County private medical group. One year or more experience preferred. Located on the Grossmont Hospital campus, our primary care group practices full-spectrum family medicine, including hospital care. Sharp Community Medical Group providers.

Ownership opportunities available. Interested applicants please send CV to brad.kesling@gfmg. net. For further information, visit us at www. gfmg.net. [808] GREAT FP OPPORTUNITY IN RAMONA: Immediate opening for CA-licensed physician in thriving family practice with small-town, rural atmosphere. We are flexible and friendly with excellent working conditions, loyal staff, and wonderful patients. No hospital work, easy call, attractive compensation package. Email fredarsham@hotmail.com. [807] UNIQUE, PART-TIME INTERNAL MEDICINE OPPORTUNITY IN NORTH SAN DIEGO COUNTY: Tired of working too much? Want more flexibility? Then this may just what you’re looking for. Well-established internal medicine practice in North County seeking part-time, board-certified internist on a long-term basis. This is a rare chance to enjoy the rewards of private practice in a well-respected, single-specialty group setting and still have plenty of free time for other work or family commitments. If interested, call (619) 248-2324. [806] URGENT CARE PHYSICIAN NEEDED ON A LOCUM TENENS BASIS FOR 4–5 SHIFTS PER MONTH: The location of the urgent care is in the north county coastal area of San Diego County.

Please visit our website at www.cassidymg.com for information on the group and hours of the urgent care. If interested, please send CV to judy@ cassidymg.com or fax to (760) 630-2558, attention: Judy Krueger, Executive Director. [803]

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] 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]

Family Practice for Sale in Grossmont: Solo Family Practice located on Grossmont Hospital Campus.

Established in 2002, huge potential for expansion. Well-established patient base; EMR implemented in 2006; extremely efficient staff; lots of parking; 1250sq ft office space fully equipped and patient ready.

Inquiries call Stacey @ 619-994-3233 or via email stacey.ks@sbcglobal.net.

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. Dedi-

cated 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] PRACTICE FOR SALE DEL MAR-AREA GENERAL PRACTICE: Prime location, huge potential for practice expansion in fast growing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 755-0510.

[185] NONPHYSICIAN POSITIONS AVAILABLE SEEKING MEDICAL TECHNOLOGIST: We are seeking a highly motivated and skilled medical technologist to join our team. We are a busy, five-physician internal medicine practice with an in-house lab, and we are looking for a candidate with five years of experience performing basic chemistries and hematologies, as well as other job functions pertinent to this position. We offer competitive pay and benefits. If interested, please email your resume with salary history to Lydia Gormish (office manager) at idiagormish@ cox.net and Kathy Fisher (administrative assistant) at kfisher_sd@hotmail.com. [812] NURSE PRACTITIONER: We are looking for a nurse practitioner with at least two years experience in OB/GYN mandatory. Please call Valerie at (858) 618-1156, ext. 105 or email vrizzotto.kohatsu@yahoo.com. [805] MEDICAL EQUIPMENT

Reach 8,500 doctors by advertising in San Diego Physician magazine.

Contact Dari Pebdani today!

858-231-1231 or DPebdani@SDCMS.org

OLYMPUS ELF P3 FIBEROPTIC NASOPHARYNGOSCOPE GREAT CONDITION: Lightly used.

Halogen light source, clear Lucite wall stand, carrying case, and all accessories included. Online comparable cost is $3450. Asking $2,750, OBO. Call (858) 277-8600, ext. 4. [817] BIOMERIDIAN MSAS VANTAGE ELECTRODERMAL INSTRUMENT PACKAGE: Includes the instrument, the Epic Probe, hand mass, stylus, and the slim external hard drive. Installed programs in the computer are Microsoft Windows XP, Symptom Survey Maestro, and MSAS 2007. Included literature: MSAS Vantage Operator’s Manual, BioMeridian Basic Training Manual, Epic Addendum, Protocol Addendum and the Virtual Library Addendum for Metagenics and HEEL products. This system is in excellent condition and is being sold because it is just underutilized in the practice. The asking price is $4,000. A mobile stand and printer for the instrument is included. Monitor is not but is typically at 99-120. Call (858) 277-8600, ext. 4. [818] FOR SALE: Exam tables and other exam furniture. Call (619) 585-0476. [798]

June 2010 SAN DIEGO P HY SICIA N. o rg

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sdcms-cma

Be Part of the Solution!

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A sampling of what’s got San Diego County’s physicians annoyed …

Medicare diagnosis codes for ordering tests.

Those three-page “did you know” reports from health plans’ pharmacy benefit managers that warn of the potential dangers of medication X in patient Y. Insulting, and a major waste of time and paper.

All prior authorizations for prescription medications, but especially those that take more than five minutes of physician time to complete.

Insurance companies listing if I’m a good or bad doctor based on their crazy data collection, which is often inaccurate and doesn’t reflect the level of medical care patients deserve.

Having patients yell at my front-office staff about a $5 co-pay for the insurance that their employers pay for.

Having insurance companies decide if my recommendations are “medically necessary.”

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Pharmacies that have an automaticrefill request system to ask for a refill of the patient’s meds even though the patient may have refills written or has an appointment before the med renewal is due and has never requested a refill from the pharmacy.

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

“Medical” marijuana requests from nonterminal patients (who insist that it works better than marinol, and usually have a welldocumented history of drug abuse prior to this request).

Putting a sign in my waiting room telling people where to complain if they don’t like me or if I don’t do what they want.

Ridiculous.

Patients who schedule their office appointment two days after their meds will run out, so an urgent call to the pharmacy is necessary to continue their meds.

Politicians who make decisions regarding medical practice without any understanding of the system, thereby forcing me to alter the way I practice in order to cover my ***.

Declining reimbursements.

Online physicianrating systems that lure only the disgruntled, making a new patient potentially afraid to go to a doctor.

Physicians who refer to psychologists instead of psychiatrists for recommendations for psychotropic medications and psychotherapy.

Providing a service and then getting paid three to six months later.

Having an inept system for physician complaints/concerns.

The DMHC and the DOI are useless for us.

Are You Taking Advantage of Your SDCMS-CMA Member Benefits? ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛ ˛

Are you getting your reimbursement issues resolved?

Does your office manager have an ally she can turn to?

Do you have a tough HR question you need answered?

Are you protecting your assets?

Is your bank working as hard as you?

Are you saving on your professional liability insurance?

Are you writing off bad debt unnecessarily?

Is your prescription pad reorder rut costing you money?

Are you squeezing all you can out of your health plan contracts?

Is outsourcing your billing the solution?

Have you done enough to prevent an IT meltdown?

Is the right person doing your accounting?

Are you unsure about a code and need it verified?

Are your waiting-room magazines increasing your malpractice risk?

Are you letting deadlines critical to your bottom line pass?

Are you meeting your staff’s training needs?

Are you getting stopped unnecessarily on your way to an emergency?

Are you saving on car rentals?

Are you or your spouse paying too much for car insurance?

Contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org today!

June 2010 SAN DIEGO P HY SICIA N. o rg

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