May 2011 by San Diego Physician

May 2011

of f ici a l p u b l ic at ion of

the san diego county medical society

Reaching

8,500 Physicians

Every Month

Where to Draw

the Line? “ P h y s i c i a n s U n i t e d F o r A H e a l t h y S a n D i e g o ”

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S A N D I E G O P HY S I CI A N .or g may 2011

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may 2011 SAN DIEGO P HY SIC I A N. o rg

thismonth Volume 98, Number 5

features MEDICAL ETHICS

12 Politics, Women’s Health, and Right of Conscience: An Exchange by James S. Grisolía, MD 16 The Conscience Conundrum: Physicians Must Embody Access to Care, Not Hinder It by Katharine Sheehan, MD

18 The New Conscience Rule: Gutting Protections, Laying Landmines by Jonathan Imbody

22 Potential Consequences of Physician Performance Measurement on Patient Care: Maintaining Bioethics Awareness by Kimberly M. Lovett, MD, and Bryan A. Liang, MD, PhD, JD

26 Health Courts: Moving Closer to Reality

by Philip K. Howard, Esq.

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, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Art Director Lisa Williams Copy Editor Adam Elder

SDCMS Board of Directors Officers President Susan Kaweski, MD Past President Lisa S. Miller, MD President-elect Robert E. Wailes, MD Treasurer Sherry L. Franklin, MD Secretary Robert E. Peters, MD, PhD 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 Kearny Mesa John G. Lane, MD, 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 (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD) At-large 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, Mihir Y. Parikh, MD (A: Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Alan A. Schoengold, MD)

departments 4 SDCMS Seminars, Webinars, and Events Mark Your Calendars!

Young Physician Director Van L. Cheng, MD

4 Community Healthcare Calendar

Resident Physician Director Katherine M. Whipple, MD

other board members Communications Chair Theodore M. Mazer, MD Alternate Young Physician Director Kimberly M. Lovett, MD

6 Briefly Noted SDCMS Medical Office Manager Bulletin Board, and More …

Alternate Resident Physician Director Steve H. Koh, MD

9 Get in Touch Your SDCMS and SDCMSF Support Teams Are Here to Help!

CMA PRESIDENT-ELECT James T. Hay, MD

10 San Diego Beacon Community: An Update

by Anupam Goel, MD, Edward Castillo, PhD, MPH, and Robert Seidman, PhD

27 White Coat Gala/SDCMS Installation Dinner and Dance

June 4, 2011

34 Physician Marketplace Classifieds

36 Top Doctors 2011 Voting Is Now Open

Retired Physician Director Rosemarie M. Johnson, MD Alternate Retired Physician Director Mitsuo Tomita, MD Medical Student Director Adi J. Price CMA VICE SPEAKER OF THE HOUSE Theodore M. Mazer, MD

ex-officio, nonvoting board members

CMA Past Presidents Robert E. Hertzka, MD (LEGISLATIVE COMMITTEE CHAIR), Ralph R. Ocampo, MD CMA district I Trustees Albert Ray, MD, Robert E. Wailes, MD,

Sherry L. Franklin, 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.]

S A N D I E G O P HY S I CI A N .or g may 2011

FAST. COMFORTABLE. ACCURATE. THAT’S HOW CANCER TREATMENT SHOULD BE. At San Diego Radiosurgery, we offer treatment using the Novalis Tx platform for image-guided radiosurgery. Novalis Tx incorporates advanced imaging, treatment planning, and treatment delivery technologies from Varian Medical Systems and BrainLAB, enabling fast, highly precise, non-invasive radiosurgery treatments for cancers and other conditions in the brain, head, neck and body. Novalis Tx is optimized to deliver radiosurgery in the shortest possible time, averaging 15 minutes, preventing errors due to minor movements during long treatments. Call or visit our website for more information. Palomar Medical Center Department of Radiation Oncology 555 East Valley Parkway | Escondido, CA 92025 760-739-3835 / SDRadiosurgery.com

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may 2011 SAN DIEGO P HY SIC I A N. o rg

calendar

sdcms Seminars / Webinars / Events Free to member physicians and their staff. For further information, contact Sonia Gonzales at (858) 300-2782 or at Sonia.Gonzales@SDCMS.org, or visit SDCMS.org. IT Update and Overview (seminar/webinar) Thursday, May 19 11:30am–1:00pm

Driving Efficiency and Quality (seminar/webinar) Saturday, June 11 9:00am–12:00pm

The Leader’s Toolbox (workshop) Friday–Saturday, May 20–21, 8:00am–4:00pm

Medicare Incentive Programs (seminar/webinar) Thursday, June 16 11:30am–1:00pm

Coding Specifics: ICD-10 (seminar/webinar) Thursday, May 26 11:30am–1:00pm

SDCMS Installation Dinner and Dance / White Coat Gala

Saturday, June 4 6:00pm–11:00pm Hilton Torrey Pines Resort La Jolla JOhmstede@SDCMS.org

S A N D I E G O P HY S I CI A N .or g may 2011

community Healthcare Calendar Cardiomyocyte Regeneration and Protection June 20–21 • Hilton Torrey Pines, La Jolla • www.abcam.com Family Medicine Update: 2011

June 24–26 • Paradise Point Hotel in Mission Bay • www. sandiegoafp.org

Asthma Camp June 26–July 1 • www. asthmasandiego.org Hugh Greenway’s 28th Annual Superficial Anatomy & Cutaneous Surgery July 11–15 • Del Mar Marriott • cme.ucsd.edu/ superficialanatomy

To submit a physician-focused, San Diego County healthcare event for possible publication, email KLewis@SDCMS.org.

CMA Webinars & Events EHR Overview (webinars) May 25 • 12:15pm–01:15pm • 6:15pm–7:15pm ICD-10 (webinar) June 1 • 12:15pm–1:15pm The Next Step: Successfully Negotiating Health Reform (event) 14th Annual California Health Care Leadership Academy • June 3–5 • Renaissance Esmeralda Resort and Spa, Indian Wells 92210 • (800) 795-2262

Best Practices for Working Your Account Receivable Reports (webinar) June 15 • 12:15pm–1:15pm Key Account Receivable Indicators Physicians Need to Know (webinar) June 15 • 6:15pm–7:15pm

Visit CMAnet.org/ calendar

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brieflynoted

SDCMS Medical Office Manager

SPECIAL FOogCUramS: eRx Incentive Pr

es qualify as “permissible preQ: Do controlled substanc ic prescribing (eRx) scriptions” for meeting the electron : The term “permissible CMS) (from A ? ctive obje use meaningful lished by the De-

s that were estab prescriptions” refers to the restriction olled substances in Schedule contr for eRx on ) (DOJ ce partment of Justi at www.deadiversion.usdoj. found be II–V (Schedule II–V substances can Any prescription not subdf). hed.p s_sc k/e_c eboo orang gov/schedules/ e prescription. Although issibl perm a be ject to these restrictions would allows the electronic that Rule Final im Inter an shed publi DOJ recently incorporate these to le unab were we prescribing of these substances, tive Programs. Incen caid Medi and care Medi the into recent guidelines is a “permissible n riptio presc a her whet Therefore, the determination of tive should be objec ingful use prescription” for purposes of the eRx mean controlled II–V dule Sche ribing presc made based on the guidelines for the notice of when , 2010 13, Jan. e befor or on t effec substances in the Federal Register. For more proposed rulemaking was published in caid EHR Incentive Program, Medi and care Medi the t information abou s. gram visit www.cms.gov/EHRIncentivePro

s (EPs) working with pharmaQ: Will eligible professional bility to accept electronic capa the have not cies that do pt NCPDP SCRIPT) be acce to prescriptions (i.e., unable ntive Program? Ince eRx the in te icipa able to part ally ld transmit prescriptions electronic A: Yes. Participating EPs shouand report this action on claims using

using a qualified eRx system specification. If the primary netthe appropriate G-code per the measure the pharmacy cannot receive use beca fax a into eRx an work converts If the eRx system is only eRx. as ts eRx transmittals, this still coun eRx system to the pharmacy, the from tly direc fax a ing capable of send

By Sonia Gonzales,

Your Off ice Manager Advocate 6

S A N D I E G O P HY S I CI A N .or g may 2011

the system is not a qualified eRx system. EPs located in rural areas and who use local pharmacies should make sure the eRx system they choose is capable of two-way transmission of prescription data.

Are PAs eligible professionals? According to the CMS regulations, PAs and NPs are eligible professionals if they have prescribing privileges. If they do not have prescribing privileges, they would use G8644 as the measure code on the claim.

What eRx measure codes are still valid? There are only four codes available for 2011 reporting: • G8553: At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system. • G8642: The eligible professional practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a) (5)(A) of the Social Security Act. • G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act. • G8644: Eligible professional does not have prescribing privileges.

Q: What type of electronic prescribing system must I have in order to participate in the eRx Incentive Program? A: Eligible

professionals must have adopted a “qualified” eRx system. There are two types of systems: a system for eRx only (standalone) or an electronic health record (EHR system) with eRx functionality. Regardless of the type of system used, to be considered “qualified” it must be based on ALL of the following capabilities: • Generating a complete active medication list incorporating electronic data received from applicable pharmacies and benefit managers (PBMs) if available. • Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts. • Providing information related to lower-cost, therapeutically appropriate alternatives (if any). (The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2010.) • Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan, if available.

Save the Dates

The Best Even Seminars/W ts and ebinars ✓ MAY 19: IT Update

✓ MAY 26: Coding Sp and Overview ✓ JUNE 11: Driving Effiecifics: ICD-10 ✓ JUNE 16: Medicare ciency and Quality ✓ JUly 6/7: Risky Bu Incentive Programs

Question: Are labs and pap collections included in the new Medicare annual wellness visit codes?

Common Medica siness: Avoiding l in a Busy Office Malpractice Concerns

ORNER ns BENEFITShavCe you had important questio

past month • How many times in the , compliance, EMR, or ces, billing and coding our res related to human earching the answer for time have you spent res Medicare? How much s of SDCMS memberefit ben the w that one of yourself? Did you kno S physician advocate, CM SD ian(s) can call their ship is that your physic Sonia Gonzales, your that you can call me, and Marisol Gonzalez, and the research for you, do l wil advocate? We of us as nk Thi le. ilab SDCMS office manager ava n most current informatio we have access to the ce! offi r you of ion an extens es rge, thousands of pag can access, free of cha you h t oug tha w thr n kno atio you rm id • D ent info tor y, and reimbursem .Gonzales@ nia So of medical-legal, regula at , les nza Go Email me, Sonia CMA’s online library? le benefit. rmation on this valuab info re mo for rg S.o SDCM

IMPORTANT! eRx Bonus Requirment for 2011 • Report G8443 on 25 unique events by year end (or # required for GPRO). • Allowed charge for denominator codes must be 10 percent of total allowed charges. • Receive 1 percent of Part B allowed charges for professional services. • To avoid 1 percent payment penalty: Must submit eRx code 10 times via claims submission by June 30 (does not apply if: Less than 10 percent of allowed charges are for denominator codes; or don’t have at least 100 cases containing the denominator). • Can get bonus and still be subject to penalty. For more information, see SDCMS’ archived March 17 seminar, “Medicare Updates,” at sdcms.org/article/sdcms-recorded-seminarmedicare-updates. You will be required to enter your username and password for access to the webinar. If you need login information, please email me, Sonia Gonzales, at Sonia.Gonzales@SDCMS.org. Contact Sonia at (85 8) 300-2782 or at Sonia.Gonzales @SDCMS.org

Answer: The short answer is no. Diagnostic lab work, radiology, Pap collection, and breast/pelvic exam are not included in the AWV codes (G0438, G0439). The AWV also does not include a physical exam, so it is not to be confused with the Preventive Medical E&M CPTS (99381-99397). The following are included in the AWV: • Establishment of patient’s history. • Establishment of providers/suppliers involved in patient’s regular care. • BP and other routine measurements based on patient’s history. • Detection of cognitive impairment. • Review of patient’s potential for depression. • Review of the individual’s functional ability and level of safety. • Establishment of written screening schedule for the patient based on recommendations of the USPSTF. • Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended. • Furnishing of personalized health advice to the patient and a referral, as appropriate, to health education or preventive counseling. • Any other elements determined appropriate by the secretary of Health and Human Services. The following is included in the Preventive Medical E&M (age and gender appropriate): • history • examination • counseling/anticipatory guidance/risk factor reduction interventions • ordering of laboratory/diagnostic procedures References: • AWV Guidelines: www.palmettogba.com/ Palmetto/Providers.Nsf/files/MM7079c_ AnnualWellnessVisitPersonalizedPreventionPlan. pdf/$File/MM7079c_ AnnualWellnessVisitPersonalizedPreventionPlan.pdf • Preventive Service Quick Reference: www.cms.gov/ MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

may 2011 SAN DIEGO P HY SIC I A N. o rg

brieflynoted

The PASD Corner By Rosemarie Marshall Johnson, MD, Medical Community Liaison, Project Access San Diego, SDCMS Foundation Some say that being president of the San Diego County Medical Society is enough to add to a busy medical practice. Nonetheless, our current president, Dr. Susan Kaweski, finds time to generously come to the aid of Project Access San Diego (PASD) patients on a regular basis. One recent patient, Mr. J, suffered significant breathing problems after surgery for a deviated nasal septum. The original healthcare professional denied responsibility; a new ENT surgeon and a plastic surgeon both felt the original provider should take care of the patient. The patient was dumbfounded, caught between two points of view. PASD asked Dr. Kaweski, who is a boardcertified plastic surgeon, for help, and she saved the day! After a repaired nasal septum and quick recovery, Mr. J breathes and sleeps comfortably and has returned healthy to his job. He is immensely grateful to Dr. Kaweski and Project Access San Diego. If you are a specialist physician in San Diego County and are interested in volunteering for PASD, please page Dr. Rosemarie Johnson at (619) 290-5351 or contact Lauren Radano, program manager, at (858) 565-7930 or at Lauren. Radano@SDCMS.org.

Let Your Legislators Know You’re Paying Attention, and That You Vote! One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday! NOTE: Due to mail handling procedures for government office buildings, postal mail to Washington, DC, offices may be delayed by several weeks or even months. Please fax or email if possible.

BIRTHDAY: JUNE 20 State Assemblywoman Diane Harkey (District 73) E: (via website) arc.asm.ca.gov/member/73 E: assemblymember.harkey@assembly.ca.gov Sacramento Office: California State Assembly, PO Box 942849, Sacramento, CA 94249-0073 T: (916) 319-2073 • F: (916) 319-2173 Oceanside Office: 300 North Coast Highway, Oceanside, CA 92054 T: (760) 757-8084 • F: (760) 757-8087 BIRTHDAY: JUNE 22 U.S. Senator Dianne Feinstein E: (via website) feinstein.senate.gov Washington, DC, Office: T: (202) 224-3841 • F: (202) 228-3954 TTY/TDD: (202) 224-2501 San Diego Office: 750 B St., Ste. 1030, San Diego, CA 92101 T: (619) 231-9712 • F: (619) 231-1108 BIRTHDAY: JUNE 28 State Assemblyman Marty Block (District 78) E: (via website) asmdc.org/members/a78 E: assemblymember.block@assembly.ca.gov Sacramento Office: California State Assembly, PO Box 942849, Sacramento, CA 94249-0078 T: (916) 319-2078 • F: (916) 319-2178 Lemon Grove Office: Lemon Grove Plaza, 7144 Broadway, 2nd Floor, Lemon Grove, CA 91945 T: (619) 462-7878 • F: (619) 462-0078

Comparison of UCSD Match Results #

% of Total

SPECIALTY PHYSICIANS

47%

General Surgery

Anesthesiology

Orthopedic Surgery

Pathology

Radiology

General Surgery / Radiology

Neurology

Emergency Medicine

Otolaryngology / Head and Neck Surgery

Neurosurgery

Ophthalmology

General Surgery / Anesthesiology

Radiation Oncology

Vascular Surgery

General Surgery / Urology

Physical Medicine and Rehabilitation

PRIMARY CARE PHYSICIANS

53%

Internal Medicine

23%

Pediatrics

18%

Obstetrics and Gynecology

Psychiatry

Family Medicine

GRAND TOTAL

122

100%

% of Total

SPECIALTY PHYSICIANS

48%

Radiology

General Surgery

Anesthesiology

Emergency Medicine

Orthopedic Surgery

2011

2010

Dermatology

Ophthalmology

Neurology

Physical Medicine and Rehabilitation

Urology

Otolaryngology / Head and Neck Surgery

Pathology

Radiation Oncology

Anesthesiology / Critical Care

Pediatric Neurology

PRIMARY CARE PHYSICIANS

52%

Internal Medicine

23%

Pediatrics

15%

Psychiatry

Family Medicine

Obstetrics and Gynecology GRAND TOTAL

S A N D I E G O P HY S I CI A N .or g may 2011

126

100%

Get in

touch

Your SDCMS and SDCMSF Support Teams Are Here to Help!

you take care of the san diego communit y ’s health. we take care of san diego’s

healthcare communit y.

SDCMS Contact Information

3 income Tax Planning

5575 Ruffin Road, Suite 250, San Diego, CA 92123

3 Wealth Management

T (858) 565-8888 F (858) 569-1334

3 employee Benefit Plans

E SDCMS@SDCMS.org • Editor@SDCMS.org • President@SDCMS.org • Membership@SDCMS.org • Accounting@SDCMS.org • SuggestionBox@SDCMS.org • Webmaster@SDCMS.org

3 Profitability Reviews 3 outsourced Professional services (CFo, Controller)

W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org

3 organizational and Compensation structure

COO/CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org

3 succession Planning

Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org

3 Practice Valuations 3 internal Control Review and Risk Assessment

director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or Sonia.Gonzales@SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org BUSINESS MANAGER Nathalia Aryani at (858) 300-2789 or Nathalia.Aryani@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123

akt A KT LLP, CPAs and Business Consu LTAnTs CARL SBAD

ESCONDIDO

760-431-8440

S A N DIEGO

W W W.AKTCPA.COM ron mitchell, cpa director of health services

RMITCHELL@AKTCPA.COM

T (858) 565-8888 F (858) 560-0179 W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or Brenda.Salcedo@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or Lauren.Radano@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or at Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazes at (858) 565-8156 or at Elizabeth.Terrazes@SDCMS.org

Top Docs Voting Is Now Open to Every Board-certified Physician Working in San Diego County — See Page 36 for Details

IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org may 2011 SAN DIEGO P HY SIC I A N. o rg

healthinformationtechnology

San Diego Beacon Community Update By Anupam Goel, MD, UCSD, Beacon Project Co-PI (SDCMS-CMA Member Since 2011), Edward Castillo, PhD, MPH, UCSD, Beacon Project Evaluation Director, and Robert Seidman, PhD, SDSU, Graduate School of Public Health

As introduced in the March 2011 issue of San Diego Physician, the San Diego Beacon Community is a federally funded initiative to improve healthcare delivery across the San Diego region. A primary objective of the project is to develop a robust health information exchange (HIE) so that providers (and patients) can access critical information at the time of care, regardless of the source. With more information about a patient’s medical history, an HIE can lead to better decisions about a patient’s care, resulting in fewer medical errors and improved health outcomes. How will our community measure progress and the impact of an HIE (and other initiatives) on the health of San Diegans? The project includes four clinical targets that can be impacted by a community HIE: hospital readmissions, immunization rates, prehospital acute myocardial infarction care, and radiology-computed tomography (CT) scan use. This month’s San Diego Beacon update will review these targets and the role of an HIE for each goal.

Hospital Readmissions The San Diego Beacon Community is working with the Hospital Association of San Diego and Imperial Counties to lower the

S AN D I E G O P HY S I CI A N. or g may 2011

countywide hospital readmission rate. In the near future, provider organizations will face payment incentives to reduce unnecessary hospital readmissions. A communitywide HIE can potentially reduce readmissions by fostering better communication between providers across care settings. For example, having the hospital discharge team send a copy of the discharge summary to the patient’s primary care provider could improve rates of follow-up and reduce the risk of hospital readmission. A communitywide HIE can track readmissions across medical centers, a metric not currently available to most hospitals.

The HIE has the greatest potential to reduce readmissions for patients who obtain their primary care from one provider organization and are admitted to a separate medical center. The San Diego Beacon Community aims to track patients across medical centers, identify discharge processes, and reduce the risk of a readmission at any facility. Childhood Immunizations San Diego already has a robust immunization registry: the San Diego Immunization Registry (SDIR). As the San Diego Beacon HIE connects medical centers and healthcare providers, the HIE will also facilitate

automated reporting to SDIR, satisfying one of the currently optional meaningful-use criteria for providers. The project’s clinical targets will be to 1) increase the number of children included in the registry and 2) increase the number of children who have received all their recommended immunizations by age 2. While information exchange alone will not increase rates, the visibility of the Beacon and SDIR initiative may spur changes in care delivery to help move the countywide immunization rate above historical averages. Prehospital Heart Attack Care For ST-elevation myocardial infarction (STEMI), time from onset to first cardiac intervention is critical to outcome. Historically, our community has been successful in reducing door-to-intervention times across the region. As prehospital paramedics move to electronic documentation platforms, we can further reduce the time to intervention for STEMI patients in the field. A unique aspect of the San Diego Beacon HIE will be the

inclusion of prehospital care organizations with hospitals and clinics on the exchange. Transmitting the electrocardiogram (ECG) electronically could activate the cardiac catheterization team before the patient arrives in the emergency department, reducing time to intervention. Moreover, direct transmission of the ECG to the emergency physician and cardiologist may reduce falsepositive activations from the field. A few hospitals in our community already send ECGs as point-to-point transmissions, but the San Diego Beacon will create point-togateway transmissions that will allow exchange with multiple hospitals as warranted (for example, if the patient is diverted to another hospital). In the future, the sharing of prehospital data could be expanded to include realtime photographs and videos from the scene to better prepare hospitals for incoming patients. Repeat CT Scans Patients often undergo repeat head, chest, and abdominal CT scans if prior studies are

not available to providers. Unfortunately, this practice exposes patients to unnecessary radiation with potential long-term consequences. A community HIE that can transmit radiology reports and images to providers regardless of source and institution could reduce unnecessary testing and radiation exposure. When combined with center-specific interventions, rates of repeat CTs should decrease. Obviously, the impact of a communitywide HIE will be much broader than these specific targets. After running the HIE for a few months, the evaluation team will look to measure other areas that may have lower costs due to HIE participation. For those who would like more information, please email Karen Miller, San Diego Beacon Community staff, at ktm001@ucsd.edu. Coming Beacon updates in San Diego Physician will review the technical architecture of the HIE, information and data security, and how organizations, providers, and patients can get involved and participate in the San Diego Beacon Community.

may 2011 SAN DIEGO P HY SICIA N. o rg

Politics, Women’s Health, and Right of Conscience An Exchange

by James S. Grisolía, MD

S AN D I E G O P HY S I CI A N. or g may 2011

Medical ethics hit the headlines in the waning days of the Bush administration, with a special federal regulation to extend health professionals’ right to refrain from medical practices that they find ethically intolerable. The Obama administration has now rescinded some but not all of the protections, citing the need to protect patients’ access to abortion, contraception, and other services. This issue pits two essential “goods” against each other: patient autonomy and the physician’s right of conscience. SDCMS holds members with widely divergent views on the onset of human life and the morality of abortion, so we chose distinguished “pro” and “con” writers who could present strong views. Katharine Sheehan is the medical director of Planned Parenthood of the Pacific Southwest, while Jonathan Imbody is the vice president for government relations of CMDA, the Christian Medical and Dental Association. We are honored to have each of them enliven our pages. As a neurologist, my focus tends toward the other end of life, the graying out of gray matter, whether by the sudden quenching of the ICU or the slow ebb of the nursing home. Yet the central miracle of neurology — our marvelous brain, seat of reason, emotion, memory, and perhaps the soul — remains just as miraculous when crippled by stroke, by congenital impairment, or by

other snares of our mortality. What makes our brains uniquely self-aware? How soon do we become special and (arguably) apart from other animals? Do we become fully human only when we achieve some basic level of function, whether at birth or some other quickening, or is the die irrevocably cast for the human, with all its rights and responsibilities, when sperm first unites with egg? On such questions hang the decision to abort a tiny fetus, clearly pre-sentient in its current capacities, but soon with the potential to become another Mozart, another Schiller, or another Schicklgruber. The Biblical authority for life at conception is surprisingly thin: “For You formed my inward parts; You wove me in my mother’s womb. I will give thanks to You, because I am wonderfully and fearfully made” (Psalm 139:13–14). This and a few other hints permit many of my evangelical and Roman Catholic brothers and sisters a profound belief, based on faith, that life already carries a special ethical status at conception, so that abortion and certain kinds of contraception are morally wrong. Our current state of law attempts to say that up to a certain stage of gestation, the fetus has not achieved human or near-human status, hence increasing limitations on late-term or mid-term vs. early abortion. However, drawing an arbitrary line across a continuous developmental process will

may 2011 SAN DIEGO P HY SICIA N. o rg

From our awe should come respect for the human — not only our patients, but also our colleagues. This means respect for many contrasting views on the values that apply to medicine, those values arising from politics and culture as much as from science itself.

S AN D I E G O P HY S I CI A N. or g may 2011

seem unsatisfactory to nearly everyone; by contrast, the pro-life position at least has the logic of clarity behind it, but forces us to choose against the mother’s autonomy. Please note that each of our protagonists claims scientific fact as a key support for their positions. Modern philosophers tell us the supposed divide between objective “facts” and subjective “values” collapses into a continuum. Even 2 + 2 = 4 depends on a worldview where entities are separate from each other, yet like enough that we can usefully group them and call them “4 things,” even though each of the quartet may vary importantly from its fellows. These values of separateness, countability, and equivalence are built into the simplest, most obvious “truth” statement we can make. Similarly, all medical “fact” is valueladen, and it’s our job as readers to unpack phrases like “the morning-after pill prevents pregnancy, while medication abortion terminates pregnancy,” and examine the component realities. How ought organized medicine respond to this controversy? We should begin by acknowledging that, indeed, our bodies are “wonderfully and fearfully made,” so the study of the body, how it develops from a microscopic mulberry of cells, how simplicity gives rise to great complexity, how it responds to stress and illness — all this should inspire our awe, apart from religious explanation as to how we got here. From our awe should come respect for the human — not only our patients, but also our colleagues. This means respect for many contrasting views on the values that apply to medicine, those values arising from politics and culture as much as from science itself. As medical colleagues, we each need to learn from the other’s point of view, under-

standing and appreciating even the points of view with which we disagree. Respectful listening to colleagues leads to better understanding and better patient care. Yet we each must stand for something, avoiding the nihilism that “every answer is just as valid,” which even the postmodernists deny. Daily, we confront potential ethical dilemmas in medicine. Many of us would stop short of providing active assistance in dying, providing pain relief and palliative care only. Many of us have our own, refined position on “right to life” vs. “right to choose.” Many of us feel that certain conditions should not be medicalized, whether it’s social shyness, short stature, criminal responsibility, etc. Some feel stem cell preparation from abandoned fetuses or genetic modification of human potential to be beyond our pale. While each of us wants a doctor with values like our own, who among us would want to be cared for by a physician who had no moral qualms of any sort? A doctor without scruples would be dangerous, much more than the ethical doctor whose ethics we personally don’t like. So please read on, and draw your own conclusions in this complex issue. But recall that organized medicine must represent all our colleagues, whether solo or large group, specialist or primary care. Not only that, while we hold to common ethical standards fundamental to our profession, we must represent physicians of all religions, with their varied ethical perspectives. About the Author: Dr. Grisolía, SDCMS and CMA member since 1983, is a neurologist in solo practice and has previously served as editor of San Diego Physician and as a CMA trustee.

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The Conscience Conundrum

Physicians Must Embody Access to Care, Not Hinder It

by K at h a rine Sheeh a n, MD

S AN D I E G O P HY S I CI A N. or g may 2011

The Department of Health and Human Services (HHS) recently issued a rule that clarifies the conscience clause for doctors who oppose a woman’s right to choose abortion. If a physician has moral or religious objections to providing abortion or sterilization services, he or she may decline to offer such care. However, this does not extend to the provision of contraception. A small group of physicians argues that doctors should be permitted to opt out of providing contraception to their patients. They suggest that some contraception can be considered abortifacient. The real question is: By whom? Contraception prevents conception; an abortifacient interrupts a pregnancy. The science is conclusive. There is no debate about this in mainstream medicine. As the medical director at Planned Parenthood of the Pacific Southwest, I occasionally come across a person who interchangeably uses the terms “morning-after pill” and “abortion pill.” After a quick explanation, he or she understands that the morningafter pill prevents pregnancy, while medication abortion terminates pregnancy. Those of us who attended medical school have no excuse for confusing the two. Why would any doctor want to withhold information about how to prevent pregnancy? Half of the pregnancies in the United States are unintended. Half of those pregnancies will end in abortion. If one is truly opposed to abortion, there is no better way to reduce the need for it than by providing contraception for patients. Those who support a conscience clause extending to birth control argue that emergency contraception, which is taken up to five days after intercourse, does, in fact, interrupt a pregnancy. Anyone with a basic understanding of conception can see the speciousness of this argument. The movement to opt out of providing contraception can be seen as a microcosm of our larger current political landscape.

Support for Life. Earlier this year, the United States House of Representatives voted to defund Title X, the federal family planning program. Representatives offered a conscience clause of sorts, claiming that they did not want to fund birth control programs for organizations that also provide abortion care. The reality is that when we reduce access to contraception, we see an increase in the rate of unintended pregnancy and abortion. According to the Guttmacher Institute, the elimination of the Title X family planning program would result in a 37 percent increase in teen pregnancy and a 34 percent increase in abortion. Yet a small minority is fighting to limit access to contraception. As physicians we are the embodiment of access to healthcare for patients. It is not our role to judge their actions. If doctors believe that young people should be sexually abstinent, there are many opportunities to serve as volunteer counselors at churches or community groups that hold similar values. But as physicians, it is our job to teach, not preach. The federal conscience statutes were originally intended to allow healthcare providers to decline to participate in medical procedures that violated their moral or religious beliefs. They were never meant to allow physicians to refuse to provide medical care to those engaged in behavior healthcare providers found objectionable. To do so would be as absurd as allowing a doctor to decline treatment to a patient from a different political party. The clarification of the HHS rule is wise public policy and good medicine. Healthcare providers are charged with providing care to our patients. Our decisions should be based in science, not dogma. About the Author: Dr. Sheehan, SDCMS-CMA member since 1987, is the medical director of Planned Parenthood of the Pacific Southwest.

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may 2011 SAN DIEGO P HY SICIA N. o rg

W The New Conscience Rule

Gutting Protections, Laying Landmines

by Jon at h a n Imbody

While trial lawyers — whose lobbying prowess and cozy relations with the current administration have made them a virtual protected class — retain the right to decline cases based on conscientious objection, physicians may lose such professional discretion if current trends continue. Within medicine, a subculture of activists has been relentlessly pursuing an ideology that paints professional discretion and conscientiously declining ethically controversial procedures as patient abandonment. The ultimate upshot of this ideology is that if a patient wants a legal procedure, the physician must provide it regardless of reservations. Patient autonomy trumps physician professional judgment. Within politics, abortion ideologues, including the current administration, while for the time-being stopping short of mandating participating in abortion procedures, are meanwhile laying the groundwork for such compulsion incrementally, beginning with mandating abortion referrals and prescription of potential abortifacients. The administration’s recent decision to gut the 2008 federal regulation, which had finally implemented three federal civil rights laws regarding the exercise of conscience in healthcare, illustrates this incremental strategy. The new Obama rule exchanges objectivity and the rule of law for subjectivity and the power of the bureaucracy. Instead of embracing broad and inalienable conscience rights as a cherished American virtue, the administration casts conscience as a concession to vice. Political partisans in the U.S. Department of Health and Human Services (HHS) elevate contentious abortion ideology over sound empirical evidence. Following are direct quotes from the Obama administration’s new conscience rule, which included explanations and interpretations by HHS officials1.

Gutting the Only Conscienceprotecting Regulation

Sections 88.2 through 88.5 of the 2008 Final Rule have been removed. Section 88.2 contains definitions of terms used in the federal healthcare provider conscience statutes. These few sentences in the new rule cut the heart out of the original conscience reg-

S AN D I E G O P HY S I CI A N. or g may 2011

ulation. The definitions in the original regulation were key to making sure the law was interpreted correctly, providing concrete examples of conscience protections backed by law. Examples included definitions of what constitutes “discrimination”; what it means to “assist in the performance of abortion”; what is a “healthcare entity”; and who within a healthcare institution “workforce” enjoys protection under the law.

“Abortion” Interpreted to Not Include Abortifacients

The provision of contraceptive services has never been defined as abortion in federal statute. There is no indication that the federal healthcare provider conscience statutes intended that the term “abortion” included contraception. Potential abortifacients available today simply were not in existence at the time Congress passed several conscience-protecting laws. However, the clear intent of Congress was to prevent compelling conscientiously objecting healthcare professionals to end human life, which is precisely the view many pro-life physicians take of potential abortifacients. Abortion advocates have been tirelessly pushing legislation to mandate the provision and prescription of contraception, including potential abortifacients, and this language appears to be tailored to that drive to remove ethical choices from healthcare professionals.

“Informed Consent” May Be Code for Mandated Discussions and Referrals

Many comments expressed concern that the 2008 Final Rule would prevent a patient from being able to give informed consent because the healthcare provider might not advise the patient of all healthcare options. Politicians and bureaucrats often speak in code, and good words too often cover up bad intentions. Every healthcare professional values informed consent. In this context, however, the concern is that ensuring informed consent could easily be interpreted to mean mandating presenting the option of and referring for abortions and other controversial procedures and prescriptions to which the professional is ethically opposed.

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may 2011 SAN DIEGO P HY SICIA N. o rg

Misdiagnosing the Real Threat to Healthcare Access

The new Obama rule exchanges objectivity and the rule of law for subjectivity and the power of the bureaucracy.

The Department partially rescinds the 2008 Final Rule based on concerns expressed that it had the potential to negatively impact patient access to contraception and certain other medical services without a basis in federal conscience protection statutes. The 2008 regulation had been in effect for more than two years. No evidence was presented indicating that any of these claims were valid. Nine of 10 faith-based physicians say they will leave medicine absent the ability to practice according to their conscientiously held ethical standards2. That evidence reveals that the real threat to patient access to healthcare — particularly for the poor and those in medically underserved areas and populations — is the loss of faith-based healthcare professionals and institutions that depend on strong and broad conscience protections.

Reporting Provision Retained

This final rule retains the provision in the 2008 Final Rule that designates the Office for Civil Rights (OCR) of the Department of Health and Human Services to receive complaints of discrimination and coercion based on the federal healthcare provider conscience protection statutes. It is good that the new regulation retains the very important provision for reporting cases of discrimination to the HHS Office of Civil Rights. Physicians experiencing discrimination should do so. Whether an administration that holds such a narrow and tenuous view of conscience rights will aggressively pursue allegations, however, remains in question, so keep a private attorney handy.

Biased Outreach Education Worse Than None at All

The Department believes it is important to provide outreach to the healthcare community about the federal healthcare provider conscience protection statutes. Having a radically pro-abortion HHS secretary, president, and administration officials interpreting and explaining laws designed to protect pro-life healthcare pro-

S AN D I E G O P HY S I CI A N. or g may 2011

fessionals is hardly an appealing prospect. If one ever wondered what view of conscience rights the administration might propagate in its “education campaign,” a look at the latest HHS website shows how selectively biased the administration chooses to be in its interpretation of existing law. The HHS website’s summary of federal civil rights law, known as the Church Amendments, would leave one to conclude that it only covers performing abortions or sterilizations. In fact, however, the Church Amendments much more broadly protect the exercise of conscience in healthcare: No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded in whole or in part under a program administered by the secretary of Health and Human Services if his performance or assistance in the performance of such part of such program or activity would be contrary to his religious beliefs or moral convictions [emphasis added]. But no one would ever realize that from HHS’ conveniently redacted summary, which omits the broad protections and mentions only abortion and sterilization procedures. The medical community currently has at best only a faint idea of what conscience rights are actually protected under federal law. The Obama administration’s education/propaganda campaign seems likely to make that idea even fainter. Having eviscerated the only objective regulation protecting the professional exercise of conscience in healthcare, now the fox will be educating the chickens about the right to life. About the Author: Mr. Imbody is vice president for government relations for the Christian Medical Association (www. joincmda.org) and manages Freedom2Care (www.Freedom2Care.org), a coalition dedicated to conscience rights in healthcare. Footnotes: 1. The regulation can be viewed in its entirety at www.ofr.gov/OFRUpload/OFRData/2011-03993_PI.pdf. 2. See www.freedom2care.org/learn/page/ surveys.

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Potential Consequences of Physician Performance Measurement on Patient Care Maintaining Bioethics Awareness

by Kimberly M. Lovett, MD, and Bryan A. Liang, MD, PhD, JD 22

S ANâ&#x20AC;&#x2C6; D I E G Oâ&#x20AC;&#x2C6; P HY S I CI A N. or g may 2011

Note: For a copy of this article with references, please visit SDCMS.org.

Physician performance measurement

is here to stay. With programmatic requirements enacted under healthcare reform, private-payer mandates, as well as the high degree of public interest in physician performance transparency, there is a growing and evolving movement to measure the quality of care that physicians provide, and subsequently report that quality performance to the public. Patients, payers, and government are searching for methods of measuring and comparing the quality of care that physicians and physician groups provide to patients, mainly in the interest of transparency in consumer choice and accountability, but also clearly to limit costs. For physicians, performance measurement, whether private or public, allows them to objectively assess the quality of care they provide, which can direct CME efforts and clinical behavior. This is important, as physicians have a limited ability to accurately self-assess in the absence of objective feedback. Thus, accurate measurement of physician performance is necessary and important to promote quality and safety in healthcare.

The Problem: How?

Unfortunately, how to evaluate the quality of care that physicians provide has been a tremendous challenge. At the outset, measures currently being used in programs, while typically evolving from clinical practice guidelines, do not always reflect high-quality care in specific patient circumstances. Areas of concern have been raised regarding attribution of patients to providers, longitudinal care, accuracy of data with respect to sample size, as well as provisions for patient autonomy when declining rec-

ommended management. Nonetheless, despite the need for measures to evolve and improve, quality outcomes measures (whether internal or external, private or public) continue to be used. In this context, several areas of bioethical concern for physicians arise that may impact patient care. Some of these are reviewed below.

“Treating for the Lab Number”

In the interest of meeting quality goals, physicians could potentially be pressured to prescribe multiple medications to demonstrate control of a single clinical issue, despite the risks that polypharmacy may create for patients. For example, Boyd et al. presented the case of a hypothetical patient who, if treated according to current clinical practice guidelines, would encounter several “potential adverse effects on other diseases when treating the target disease, interactions between recommended medications, and interactions between food and medications.” However, the danger of polypharmacy in patients under clinical performance measures can be further exacerbated by a physician’s interest in “treating to the test” to meet measures of quality care. For example, overaggressive treatment of blood pressure, LDL, hemoglobin A1C, or any number of clinical values may be a temptation to achieve quality targets at the expense of truly considering the needs or complicating social situation of an elderly or complex patient first and foremost.

“Treating for the Patient Satisfaction Number”

Physicians have been reported to increase drug prescriptions when they deem a patient desires the therapy. The thought is, by increasing desired prescriptions, patient

experience and satisfaction scores will rise, and financial incentives in this area will increase. Clearly, this is inappropriate clinically as well as ethically. Beyond inappropriate use of drugs, as well as untoward effects such as increasing drug resistance when antibiotics are inappropriately prescribed, this is ethically suspect because of the lack of medical appropriateness for providing treatment. Thus, when patient satisfaction is measured as an indicator of physician performance, physicians must guard against prescribing unwarranted therapies in the context of patient desire for therapy.

“Treating Only Measured Care”

Several studies have suggested that the quality of unmeasured care falls as physicians focus their efforts on the quality of measured care. These studies imply that the very act of choosing which areas of care to measure performance represents an act of agendasetting that can adversely influence a physician’s judgment on which areas of care delivery are a priority for a given patient or set of patients. The work of Higashi and colleagues also demonstrates that “the quality of care, measured according to whether patients were offered recommended services, increases as a patient’s number of chronic conditions increases.” This suggests that physicians may, in fact, inadvertently provide sub-optimal care to patients perceived as “less complex” and less likely to affect performance measures in lieu of directing focus to patients perceived as more likely to affect performance scores. This reduced care may result in missed opportunities for effective screening and prevention. In this setting, physicians must be cognizant that all care is relevant to be asmay 2011 SAN DIEGO P HY SICIA N. o rg

Avoidance of gaming any system, maintaining clinical competency, and consistent provision of quality care in a patient-centered way is and will be the standard for success, as it always has been.

sessed, rather than simply care that will be the basis of performance measurement.

“Treating Only Advantageous Patients”

Some physicians have reported that they are more likely to refuse care to patients who have severe disease or have treatment intolerance because of the potential to adversely affect physician performance measures. However, boldly refusing to treat a needy patient because of performance measures does not place the patient’s interests first, a key tenet of medical ethics. Such refusal may also implicate civil rights laws and liability if this refusal is seen as inappropriate discrimination.

“Treating for Score Outcome”

Take the example of a hypothetical patient, well known by her physician to have controlled blood pressures documented below 130/80 over multiple visits. She shows up for an acute care visit in pain, has not taken her blood pressure medications that morn-

ing, and has a documented blood pressure of 155/95. In an effort to salvage the performance measurement of hypertension control, a physician will theoretically either have to “game” the reading or ask the patient to come back for a follow-up visit just for a blood-pressure check. This repeat visit merely to document a controlled “most recent” blood pressure represents a significant time (and potential financial) burden to the patient. This, too, is highly suspect ethically as it focuses on medical treatment that is not in the best interest of the patient. As well, of course, each additional test, procedure, and medical action has its own risk for patient injury. Treating for score outcome hence places those additional clinical risks on the patient without an accompanying potential medical benefit.

“Treating Against the Patient”

There is a potential strain created in the patient-physician relationship as it relates to patient adherence to recommendations

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and performance measurement. On the one hand, it is important to respect patient autonomy, and doing so will build trust between a patient and a physician. On the other hand, a good physician who is delivering quality care will arguably be more adept at rationalizing with a non-adherent patient and recruiting the patient’s buy-in to the treatment plan. However, when the performance measure is in place that penalizes a physician for patient non-adherence to clinical measures, patient autonomy can be theoretically compromised as physicians may pressure them to accept treatment plans so as to improve performance measures or build resentment when the patient refuses. Physicians must have a high index of awareness in this arena, because financial incentives combined with a desire to provide optimum treatment may justify internally a physician’s decision to push for one kind of care.

Treating the Patient

Given the inevitability of physician perfor-

mance measurement, it is vitally important that physicians make a concerted effort to understand and mitigate the adverse affects that performance measurement can have on patient care. Many of the issues that arise as the result of performance measurement are not new, but they are magnified by the sometimes-confounding incentives created as a result of measurement. Physicians have an obligation to patient-centered, ethical care. And, despite the implied value that performance measurement places on A+ care for all patients based upon identical criteria for every patient, medicine remains an art and requires the sound and ethical judgment of a physician caring for the patient. What this means, of course, is that the mission of the responsible physician under performance measurement systems does not change from the standard medical ethics tenets. Avoidance of gaming any system, maintaining clinical competency, and consistent provision of quality care in a patientcentered way is and will be the standard for success, as it always has been. What is differ-

ent is that we are starting to move to a practice world where we can be provided with important data to help our patients reach their healthcare goals. Although there are challenges, the movement toward performance measurement can eventually reward the best quality, for the most patients, for the benefit of this generation of patients and future generations. About the Authors: Dr. Kimberly Lovett, SDCMS-CMA member since 2006, is a family medicine physician with Southern California Permanente Medical Group in San Diego, as well as clinical instructor at the UC San Diego School of Medicine. Dr. Bryan A. Liang, SDCMS-CMA member since 2004, is executive director and professor of law at the Institute of Health Law Studies, California Western School of Law, as well as associate professor of anesthesiology at the UCSD School of Medicine, co-director for the San Diego Center for Patient Safety, and vice president of Partnership for Safe Medicines.

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COLLIERS INTERNATIONAL 4660 La Jolla Village Drive, Suite 100 San Diego, CA 92122 858.455.1515 www.colliers.com/sandiego

may 2011 SAN DIEGO P HY SICIA N. o rg

Health Courts

Moving Closer to Reality

by Philip K. Howard, Esq. 26

S AN D I E G O P HY S I CI A N. or g may 2011

President Barack Obama’s recent federal budget proposal contains a breakthrough to address medical malpractice reform. It includes $250 million in grants to help states create a reliable system of healthcare justice, with special health courts topping the list. The proposal is especially notable because health courts have long been opposed by the trial lawyers, a powerful Democratic special interest in Washington that benefits handsomely from the lack of consistency in the current medical justice system. This is a major development in controlling healthcare costs because health courts address the staggering waste of defensive medicine better than any other proposed reform. While caps on damages limit one category of damage, they do nothing to protect a blameless doctor from liability. Instead of upholding reasonable standards of care, the current system is an ad hoc process in which one jury could find liability, where another jury on the same facts finds no liability. This unreliable system — referred to by one prominent scholar as “an engine of inconsistency” — is why distrust of justice by doctors is nearly universal. The current system works well for no one — except the lawyers. Overall, according to a 2006 Harvard study, the error rate is about 25 percent, hardly inspiring confidence in doctors. Nor is the system effective for injured patients — it takes an average of five years until settlement, and almost 60 percent of an award goes to lawyers and administrative costs. But the worst cost of unreliable justice is the prodigious waste that results from doctors’ ordering unnecessary tests and care to protect themselves in case there’s a lawsuit. An estimated $50–200 billion annually is attributed to defensive medicine. Controlling healthcare costs is not possible without addressing the distrust that fuels this waste. That’s why America needs special health courts, aimed not at stopping lawsuits but at making lawsuits reliable to distinguish

Presented by

the San Diego County Medical Society (SDCMS) & the SDCMS Foundation

Welcoming

Robert E. Wailes, MD

SDCMS President, 2011–12,

And Thanking

Susan Kaweski, MD

For Her Service as Immediate Past President of SDCMS

Saturday, June 4, 2011 The Hilton Torrey Pines Resort 10950 N. Torrey Pines Road, La Jolla (858) 558-1500 6:00pm–7:30pm

No Host Cocktail Reception & Opening of Breathtaking Silent Auction

7:30pm–8:15pm Dinner & Music

8:15pm

Silent Auction Closes

8:30pm–9:00pm

Special Guest MC Kimberly Hunt of Channel 10 News Program Featuring Project Access San Diego & Installation of Robert E. Wailes, MD SDCMS President, 2011–12

9:00pm–11:00pm

White Hot Dancing to Haute Chile!

Black Tie Optional

Valet for $11 or complimentary self-parking. A limited number of rooms at the Hilton Torrey Pines Resort are available at a discounted rate of $155 per night if reserved by May 20th. For hotel reservations, questions regarding membership, or auction item details, contact Jennipher Ohmstede at (858) 300-2781, via email at JOhmstede@SDCMS.org, or visit www.SDCMS.org.

may 2011 SAN DIEGO P HY SICIA N. o rg

The transformative benefits will be farreaching. Once trust in medical justice is restored, doctors can emerge from their defensive cocoons, be more candid about decisions of care, and start focusing on what they think is right, not self-protection.

between good care and bad on a consistent basis. The concept of health courts originated with Common Good, the nonprofit organization I chair, working in conjunction with experts at the Harvard School of Public Health and with funding from The Robert Wood Johnson Foundation. In health courts, expert judges with special training would resolve healthcare disputes. As with existing administrative courts in other areas of law — for workers’ compensation and vaccine liability, among others — there would be no juries. The judge would be advised by a neutral expert and would issue written rulings providing guidance on proper standards of care. These rulings would set precedents on which both patients and doctors could rely. Each ruling could be appealed to a new medical appeals court. The transformative benefits will be farreaching. Once trust in medical justice is

restored, doctors can emerge from their defensive cocoons, be more candid about decisions of care, and start focusing on what they think is right, not self-protection. Hospitals can acknowledge opportunities for improvement and institute systemic safety enhancements without fear of opening themselves to greater legal risk. President Obama, with his budget proposal, has broken free of the trial lawyers. What’s needed now is for Americans to urge their elected officials to support this initiative and make health courts a reality. About the Author: Mr. Howard is chair of Common Good (www.commongood. org), the nonpartisan reform coalition dedicated to restoring common sense to America. He is the bestselling author of The Death of Common Sense, and, most recently, Life Without Lawyers: Restoring Responsibility in America.

No down payment for home mortgages up to $1 million Our special home financing is designed to meet your needs as a physician for the purchase of your primary residence. • Financing available with no down payment – up to $1,000,000. Expansion of loan-to-value ratios for loan amounts up to $1,750,000. • Private mortgage insurance is not required – save thousands over the life of the loan

• Single family homes, townhomes, lofts, and condominiums are eligible • Student loans that are deferred for 12 months are not counted in qualifying ratios. Refinances with high loan-to-values are also available.

For information on this special home financing program from BBVA Compass, give us a call today. Bryan Yaninek, Mortgage Banking Officer 719-329-3256 • bryan.yaninek@bbvacompass.com apply online at: www.bbvacompass.com/mortgages/byaninek

All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC.

S AN D I E G O P HY S I CI A N. or g may 2011

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A Higher Level of Service. Sound Business Practices. Relationships Built on Values. may 2011 SAN DIEGO P HY SICIA N. o rg

S AN D I E G O P HY S I CI A N. or g may 2011

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may 2011 SAN DIEGO P HY SICIA N. o rg

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. 32

S AN D I E G O P HY S I CI A N. or g may 2011

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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.

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Your Contact Info Here may 2011 SAN DIEGO P HY SICIA N. o rg

classifieds CLINICAL TRIALS DO YOUR PATIENTS NEED TO LOSE WEIGHT AND REDUCE THEIR RISK FACTORS?:If so, please refer them to UCSD’s Healthy Road to a Healthy Heart study. Patients are eligible if they are/have: BMIbetween 30 and 45; 25–70 years old; at least one cardiovascular risk factor (HTN, stabilized type 2 diabetes, metabolic syndrome, smoker); English or Spanish speaking; willing to attend health coach and measurement sessions at a participating doctor’s office; a stable phone; not pregnant or plan to be during the two-year study period. For more information, call (858) 534-9333 or 1 (866) 6677223. [919] OFFICE SPACE / REAL ESTATE ENCINITAS: Beautiful, completely renovated office available for sublease two days per week. Four exam rooms, generous waiting area, andbathroom. Perfect for specialist, lots of primary care physicians on campus. Located at the largest outpatient health center in coastal North County. Surgery center, pharmacy, lab, and radiology onsite with ample free parking. Go to ochiphotos.com/office for photos and floor plan. Contact jwochi@yahoo.com or (858) 792-4800 for more information. [926] OFFICE SPACE POWAY/RANCHO BERNARDO: Medical office space for lease, all or part. Up to 1,100 sq. ft. Great location in medical/dental complex in Poway, next to Pomerado Hospital (borders Rancho Bernardo). Open treatment areas and private treatment rooms, two bathrooms, waiting room/lobby, front office. Second floor. Elevator/stair access. Beautiful view of the hills. Ideal for medical, complementary/alternative medicine, physical therapy, chiropractic, acupuncture, massage/bodywork, etc. Patients/clients from Poway, Rancho Bernardo, Carmel Mountain, 4S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Contact Debbie Summers at (858) 382-8127 or at debjsummers1@yahoo.com. [923] SCRIPPS/XIMED BUILDING, LA JOLLA, OFFICE SPACE TO SUBLEASE: Occupied by vascular and general surgeons. One room office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, Ximed Building is the office space location of choice for anyone doing surgeries at the hospital or for anyone seeking a presence in the La Jolla area. Reception and staff available if needed. Full ultrasound lab on site in office for anyone interested in this service. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [921] NORTH COAST HEALTH CENTER, ENCINITAS, OFFICE SPACE TO SUBLEASE: Newly remodeled and beautiful office space available at the 477 Building. Occupied by seasoned vascular and general surgeons. One office and two exam room available. Great window views and location with all new equipment and furniture. Full ultrasound lab and tech on site for extra convenience. New hardwood floors and exam tables. Staff available for an add-in if needed. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858)-452-0306. [922] 1,100 SQUARE FOOT SUITE FOR RENT IN CHULA VISTA MEDICAL CENTER COURT CHULA VISTA, CA 91911: +/- 1,100 sq. ft. medical office. Full-service pharmacy conveniently located in adjacent suite. Directly across the street from Sharp Chula Vista Medical Center. Ancillary services such as laboratory and radiology, physical therapy available within walking distance. Close to public transportation. Easy access to I-805 via L Street. Great floor plan with three exam rooms, waiting room, two restrooms, kitchen, file area, reception, and doctor’s office. Contact Tracy Clarke at (858) 458-3339 or at (619) 726-7335. [920]

LUXURIOUS / BEAUTIFULLY DECORATED DOCTOR’S OFFICE NEXT TO SHARP HOSPITAL FOR SUB-LEASE OR FULL LEASE: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price is very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 279-8111 or at (619) 823-8111. Thank you. [836] SUBLET ~ 2 EXAM ROOMS AND PHYSICIAN OFFICE: Beautiful new spacious medical office suite located at 501 Washington St., San Diego 92130, contiguous to Vibra Hospital and across from Scripps Mercy Medical Campus in a Class A office building. Shared waiting room, break room, receptionist area included. Currently office suite is occupied by seasoned primary and specialty physicians. Ample parking, freeway access to interstates 5/163/8, ancillary services are in close proximity for patient convenience. Please contact Ms. Betterton or Dr. Carla Fox at (619) 299-2570. [914] OFFICE SPACE TO SHARE FOR RENT OR LEASE: Adjacent to Tri-City Medical Center and North Coast Surgery Center. Provide large consultation room, two exam rooms, fax, copier, wireless. FREE parking. Conditions are negotiable. Full or part time. Easy access to 78 or I-5. If interested, please email jean@tricitycts.com or call (760) 726-2500. [911] 3998 VISTA WAY IN OCEANSIDE: Two medical office spaces approximately 2,000ft2 available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground floor access. Lease price: $2.20 +NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@coveycommercial.com. [834] OFFICE SPACE IN HILLCREST: Office space available in Hillcrest at the Mercy Medical Building. Located directly across from Scripps Mercy Hospital. Excellent staff, state-of-the-art office and equipment. Please send letter of interest to KLewis@sdcms.org. [810] OFFICE SPACE FOR RENT IN POWAY: Medical office space for lease, 1,215ft2. Office has furnished waiting area, front and back stations for four staff members, two exam rooms, a break room, and a doctor’s office. This office is fully furnished. Equipment and furniture are negotiable and can be removed if not necessary. Located in a great medical/dental complex in Poway, close to Pomerado Hospital, on the border with Rancho Bernardo. Second floor. Elevator/stair access. Large free patient parking area. Ideal for medical, complementary/ alternative medicine, physical therapy, chiropractic, acupuncture, massage/body work, etc. Patients/clients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Affordable rent. Please contact Olga at (858) 485-8022. [903] OFFICE SPACE TO SHARE IN LA MESa: Currently occupied by orthopaedic surgeon. Great location close to Grossmont and Alvarado Hospital. Looking to share with part-time or full-time physician. Fully furnished, fully equipped with X-ray machine, three exam rooms, and staff. Please contact Carmen at (619) 668-0900 or email at carmen@drcham.com or at rcham1000@aol. com. [902] SHARE OFFICE SPACE IN LA MESA — AVAILABLE IMMEDIATELY: 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. 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]

MEDICAL OFFICE SPACE FOR RENT IN ENCINITAS: Convenient location five minutes from Scripps Encinitas Hospital. Close to 5 freeway. The 800ft2 space includes two spacious exam rooms, private consultation/doctor’s office, private bathroom, lunchroom, 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 (760) 519-0102 or email ktagdiri@gmail.com for more information. [855] OPPORTUNITY TO PURCHASE YOUR OWN SURGERY COMPLEX IN CORONADO: 2,100 square feet, street presence, three (3) exam, mini and larger surgery, scrub and recovery rooms (with private exit), business office, large reception area, nurse’s stations, two (2) private offices, and in-house restroom. Further information, please call: Apua Garbutt, Real Living Napolitano Real Estate, at (619) 818-8126. [899] BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa/East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact venk@cox.net or (619) 504-5830. [835] HILLCREST OFFICE SPACE AVAILABLE: Office space available at the corner of 8th Avenue and Washington St in Hillcrest. Approximately 3,000ft2. Surgical center building. Ample parking and freeway access. Proximity to Scripps Mercy Hospital. Contact Laura Hurshman at (619) 299-5000 or at laura@sdhandcenter.com. [874] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@sdcms.org for more information. [867] OFFICE SPACE IN UTC: Full-time office in 8th floor suite with established psychologists, marriage and family therapist, and psychiatrist in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room, and abundant parking. Contact Christine Saroian, MD, at (619) 682-6912. [862] OFFICE SPACE TO SHARE: Currently occupied by orthopedic 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] PHYSICIAN POSITIONS AVAILABLE FAMILY PRACTICE PHYSICIANS NEEDED: Full-time and part-time. Days, nights, weekends available. Fax CV to La Costa Urgent Care and Family Practice at (760) 603-7719. [925] SEEKING A MEDICAL DIRECTOR/PHYSICIAN FOR AMBULATORY CLINIC: Southern Indian Health Council is made up of board-certified physicians who are experts in primary care and health management. Working closely with a well-trained support staff, our medical providers have established a solid reputation of delivering quality outpatient care and a broad scope of services to individuals of all ages. We are seeking a full-time, boardcertified medical director/physician Monday–Friday,

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.

S AN D I E G O P HY S I CI A N. or g may 2011

8:00am–4:30pm. Must have current CA and DEA licenses; computer skills. Malpractice coverage provided. Forward resume to jobs@sihc.org or fax to (619) 445-7976 or visit our website at www.sihc.org. Contact jobs@sihc. org or HR phone at (619) 445-1188, ext. 291 or HR fax at (619) 445-7976. [918] CONTRACT PHYSICIAN: Provides medical leadership, oversight, and management of human clinical trials while ensuring the integrity of the studies and the safety and wellbeing of human subjects. Performs duties in accordance with company’s values, policies, and procedures. For further details, visit www.profilinstitute.com and click on “Current Job Opportunities.” [917] SATURDAY /PER DIEM PHYSICIANS: Independent diagnostic imaging facility seeks physicians to monitor patient examinations requiring contrast. Various Saturday shifts available on an ongoing basis, scheduled 8am– 5pm. Please contact Heidi at (858) 658-6577 for more information. [915] PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic. org or fax to (760) 414-3702. Visit our website at www. vistacommunityclinic.org. EOE/MF/D/V [912] PHYSICIAN: Multiple positions available at our family practice clinics in Escondido and Temecula. Seeking pediatricians, family practice, and internal medicine physicians. All positions provide comprehensive medical services for members of family, regardless of age or sex, on continuing basis. Candidates must have current California medical license, DEA and CPR certification. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: Physician.” [907] PEDIATRICIAN OR PEDIATRIC NURSE PRACTITIONER: Part-time position (four days per week) provides comprehensive medical services for pediatric patients. Candidates must have a current California medical or NP license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: Pediatrician — Peds.” [909]

SEEKING BOARD-CERTIFIED / BOARD-ELIGIBLE FAMILY PHYSICIAN: To work in solo family practice office in Chula Vista. Excellent work environment and staff support in a well-established, patient-centered practice. Open to flexible hours. Must have excellent communication skills, bilingual in Spanish preferred. Must have a compassionate and caring attitude. Please email CV and interest to ann@padillamd.com or fax to (619) 422-1324. [896] P/T FAMILY PRACTICE PHYSICIAN NEEDED FOR A BUSY, FEDERALLY QUALIFIED HEALTH CENTER IN ESCONDIDO: MHCS is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for 35 years and offer a competitive salary. Board certified and bilingual English/Spanish preferred. Send CV to hr@mtnhealth.org or (619) 478-9164. You may contact HR directly at (619) 478-5254, ext. 30. www.mtnhealth.org. [894] CHIEF MEDICAL OFFICER TO SERVE FOUR FEDERALLY QUALIFIED HEALTH CENTERS: MHCS is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for 35 years and offer a competitive salary, medical benefits, vacation, paid holidays, sick time, CME reimbursement, and license reimbursement. Board certified family practice and bilingual English/Spanish preferred. This position will require 60 percent clinical and 40 percent administrative. Contact Tabitha at (619) 4785254 or at hr@mtnhealth.org. [893] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night. Benefits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at venk@gpeds.sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778]

INTERNAL MEDICINE PHYSICIAN: SHARP ReesStealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking a part-time (job-share) BC/BE internal medicine physician to join our staff in La Mesa. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Ave., San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [901]

PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$200+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to hpmg11@yahoo.com. [801]

LOOKING FOR A PART-TIME PHYSICIAN — bilingual Spanish a plus — to permanently join our group practice of three physicians and six providers in the San Diego/ Chula Vista area. Family medicine or internal medicine preferred. The opportunity can become full time as well as eligible for partnership in this well-established (30 year) group. The office is exceptionally well run, efficient, and friendly, and is completely on EHR. Respond by email with CV to sharpgate@yahoo.com or contact our office manager Connie Espinoza for additional information at conniee4@gmail.com. [900]

INTERNAL MEDICINE PRACTICE FOR SALE: Beautiful beach weather. Established 27 years with excellent reputation. Two exam rooms. Free-standing building. Main street corner location. Great visibility. Office shared with another physician. Patient parking. 2010 gross $483K. Asking $290K. 100% financing available. Please Contact ProMed at (888) 277-6633 or at info@promed-financial. com, or visit www.promed-financial.com. [906]

LOOKING FOR EXPERIENCED FAMILY PRACTICE OR INTERNAL MEDICINE PHYSICIAN: Interested in working in a community clinic setting. Our corporation recently converted to electronic medical records and would need to have some computer experience. Salary and benefits are dependent on qualifications and years of experience. The site is in the Linda Vista area close to Fashion Valley Mall and USD. We have great hours with no hospital call. Physician should be available to work 32–36 hours a week. If interested, email CV to awalton@ Lvhcc.com. [897]

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 FULL-TIME TEMP ADULT NURSE PRACTITIONER NEEDED: Full-time temporary NP position available for coverage of current office NP maternity leave in May for 10 weeks. Busy internal medicine practice located adjacent to Scripps Mercy Hospital. Clinical experience, furnishing number and EMR experience required. Spanish speaking a plus but not required. Based on performance,

scheduling needs and ability to build a patient base, there is the potential for continued work upon the return of the current office NP. [916] NURSE PRACTITIONER: With physician supervision, provides medical oversight and management of human clinical trials while ensuring the integrity of the studies and the safety and wellbeing of human subjects. Performs duties in accordance with company’s values, policies, and procedures. For further details, visit www.profilinstitute. com and click on “Current Job Opportunities.” [913] FAMILY NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Two positions available. Full-time position (40 hours per week) and part-time position (24 hours per week) open at our clinic in Temecula. The FNP or PA provides healthcare services to patients under direction and responsibility of physician. Candidates must have a current California PA or FNP license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: FNP/ PA — Date.” Please indicate which position (FT or PT) is desired. [908] SEEKING NURSE PRACTITIONER / PHYSICIAN ASSISTANT: To work in solo family practice in Chula Vista. Excellent work environment and support in a well-established, patient-centered practice with flexible hours. Must have excellent communication skills, bilingual in Spanish preferred. Must be experienced with a compassionate, caring attitude and able to practice independently with appropriate backup. Please email CV and interest to ann@ padillamd.com or fax to (619) 422-1055. [895] FULL-TIME OFFICE MANAGER / MEDICAL BILLER: Busy Hillcrest OB/GYN practice. Pay and 401k eligibility based on experience. Medical manager transitioning to EHR. Must be outgoing, proactive, flexible, and willing to work with small staff. Fax resume to (619) 298-4250. [891] EXPERIENCED MEDICAL INSURANCE BILLER/COLLECTOR needed for busy orthopedic and occupational therapy office: Must have excellent AR collections skills and proven abilities. Workers’ compensation experience a must and excellent understanding of their reimbursement as well as other thirdparty payers. Must have the ability to work accounts and denials, including re-determinations, appeals, and collections procedures. Candidates should be able to work independently, organized, pays attention to details, and motivated. Minimum of two years experience, high school diploma or general education degree. Thirty-two a week. Excellent benefits. Salary based on experience. Please fax resume to (619) 718-4122. [890] PRACTICE ANNOUNCEMENTS ZAVARO CARDIOVASCULAR INSTITUTE IS MOVING MAY 1, 2011! Our new address is: 300 S. Pierce St., Ste. 102, El Cajon, CA 92020-4124. Phone: (619) 6684700. Fax: (619) 668-0049. [924]

Place your advertisement here Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

may 2011 SAN DIEGO P HY SICIA N. o rg

Top Docs Voting Is Now Open to Every Board-certified Physician Working in San Diego County If you are a valued member of the San Diego County Medical Society (SDCMS), you should have received your Top Doctors balloting information via the U.S. mail. Please email James Beaubeaux at James. Beaubeaux@SDCMS.org if you need personalized help. If you are NOT an SDCMS member, we sincerely hope that you will consider joining at SDCMS.org. Nonmembers may obtain their Top Doctors 2011 voting password by clicking on the â&#x20AC;&#x153;Top Doctorsâ&#x20AC;? link on the SDCMS.org homepage and following the instructions.

We Celebrate Excellence – Calvin Lee, MD CAP Member, Internationally Renowned Violinist, and Dedicated Philanthropist

800-252-7706 www.cap-mpt.com/physicians San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For over 30 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like general surgeon Calvin Lee, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the more than 11,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection. may 2011 SAN DIEGO P HY SICIA N. o rg

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

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

Why choose between national resources and local clout? In California, The Doctors Company protects its members with both. With nearly 55,000 member physicians nationwide, we constantly monitor emerging trends and quickly respond with innovative solutions, like incorporating coverage for privacy breach and Medicare reviews into our core medical liability coverage. Our over 20,000 California members also benefit from significant local clout provided by long-standing relationships with the state’s leading attorneys and expert witnesses, plus litigation training tailored to California’s legal environment. This uncompromising approach, combined with our Tribute® Plan that has already earmarked over $106 million to California physicians, has made us the leading national insurer of physician and surgeon medical liability. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our benefits for SDCMS members, call us at (800) 852-8872 or visit us at www.thedoctors.com. Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

Endorsed by

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We relentlessly defend, protect, and reward the practice of good medicine.