July 2011

July 2011

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

the san diego county medical society

Reaching

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Every Month

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

Physician Office Managers Association of America’s

2011 Annual National Conference for Medical Office Managers and Personnel

september 21–23, 2011

Sheraton San Diego Suites at Symphony Hall, San Diego, CA

with Pre-Conference Reception on September 20th

get educated. get information. get connected.

RegisTeR nOw

Topics: • “ICD-10” • “The Top 10 Ways to Make Your Practice Money” • “Lean Six Sigma for the Medical Practice” • “What Makes a Practice Great” • “Simple Ways to Boost a Positive Patient Visit” • “Stop Workplace Drama” • And More…

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Plus: Be one of the first 50 people to mention you saw our ad in San Diego Physician when you register and receive a FREE practice manager book and a POMAA duffel bag when you sign in!

Register today at www.POMAA.com or become a member of POMAA at www.POMAA.net to start receiving all of our great benefits!

“BRinging PhysiciAn Office MAnAgeRs TOgeTheR since 2008” July 2011 SAN DIEGO P HY SICI A N. o rg

1

thismonth Volume 98, Number 7

features HEALTH INFORMATION TECHNOLOGY

16 To Tablet or Not to Tablet?

Is That the Right Question?

by Ofer Shimrat 21 Which EMR Vendor Will Be the

Best for My Practice?

by Rob Yeates

22 The State of Health Information Technology in California: A 2011 Snapshot

by the California HealthCare Foundation 24 Medical E-risk Considerations

for Online Communications

by The Doctors Company

departments 4 Community Healthcare Calendar

12 SDCMS Membership

SDCMS Board of Directors Officers President Robert E. Wailes, MD (CMA Trustee) President-elect Sherry L. Franklin, MD (CMA Trustee) Treasurer Robert E. Peters, PhD, MD Secretary J. Steven Poceta, MD Immediate Past President Susan Kaweski, MD geographic and geographic alternate Directors East County William T-C Tseng, MD, Heywood “Woody” Zeidman,

MD, Kimberly M. Lovett, MD (A:Venu Prabaker, MD) Hillcrest Theodore S. Thomas, MD, Steven A. Ornish, MD, Jason P. Lujan, MD (A:Gregory M. Balourdas, MD) Kearny Mesa John G. Lane, MD (A:Marvalyn E. DeCambre, MD, Sergio R. Flores, MD) La Jolla Gregory I. Ostrow, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Douglas Fenton, MD, Niren Angle, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD)

other voting members

8 Briefly Noted

Featured Member, CAHAN San Diego, POLST, and More …

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

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, Peter O. Raudaskoski, MD, Mihir Y. Parikh, MD, Suman Sinha, MD (A: Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD)

4 SDCMS Seminars, Webinars, and Events

Mark Your Calendars!

6 Office Manager Bulletin Board

ICD-10 FAQs, Practice Management Deadlines, and More …

Managing Editor Kyle Lewis

Communications Chair Theodore M. Mazer, MD (CMA Vice Speaker) Young Physician Director Van L. Cheng, MD Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD Medical Student Director Beth P. Griffiths

12

OTHER NONVOTING MEMBERS Young Physician Alternate Director Renjit A. Sundharadas, MD Resident Physician Alternate Director Christina Pagano, MD

Dr. Robert Wailes: SDCMS President for 2011–12

Retired Physician Alternate Director Mitsuo Tomita, MD

14 Practice Management

CMA Past Presidents Robert E. Hertzka, MD (Legislative Committee Chair), Ralph R. Ocampo, MD CMA Trustee Albert Ray, MD CMA Trustee (OTHER) Catherine D. Moore, MD CMA SSGPF Delegates Michael T. Couris, MD, James W. Ochi, MD CMA SSGPF Alternate Delegates Dan I. Giurgiu, MD, Ashish Wadhwa, MD

CMA President-elect James T. Hay, MD

Pros and Cons of C Corps vs. S Corps

34 Physician Marketplace

Classifieds

36 Build Healthy Lives by Connecting to Quality Assistance

by Rosemarie Marshall Johnson, MD

36 2

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

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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calendar

community Healthcare Calendar

CMA Webinars EHR: Selecting the Right System for Your Practice JUL 27 • 12:15–1:15pm • 6:15–7:15pm What You Need to Know About Surviving Medicare and Medi-Cal Audits AUG 3 • 12:15–1:15pm

sdcms Seminars / Webinars

Medicare: Developing and Adopting Medical Policies AUG 10 • 12:15–1:15pm • 6:15–7:15pm

OSHA Updates AUG 11 • 11:30am–1:30pm

HIPAA Update 2011 AUG 17 • 12:15–1:15pm

Focus on Payor Contracts With ACO Guidelines AUG 18 •11:30am–1:00pm

Legislative Update AUG 24 • 12:15–1:15pm EHR Meaningful Use AUG 31 • 12:15–1:15pm • 6:15–7:15pm CMAnet.org/calendar

4

Financial and Legal Life Skills for (Financially and Legally Clueless) Docs AUG 20 • 8:30–11:30am Changes to Medicare Regulations SEP 1 • 11:30am–1:00pm

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

Deposition Seminar for Doctors SEP 8 • 11:30am–1:00pm Microsoft Outlook for Crazy Busy Docs SEP 10 • 8:30–11:30am HIPAA and HiTech Act Updates SEP 15 • 11:30am–1:00pm Succession/Transition Planning for Your Practice SEP 17 • 9:00am–12:00pm

We Can’t Wait II: Caring for Complex Children 0–5 (presented by the San Diego Academy of Child and Adolescent Psychiatry) SEP 24 • Scottish Rite Event Center, San Diego • $60 • sandiegoacap@yahoo.com 3rd Annual Heart and Vascular Conference 2011: Awareness, Prevention, and Intervention NOV 5–6 • La Costa Resort & Spa, Carlsbad • $125 • sharp. com/classes

Certified Medical Compliance Officer Course BEGINS SEP 22 • 8:00am–5:00pm

Event Summer Pool Party AUG 6 • 3:00pm–7:00pm SDCMS.org/event

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Pictorial Membership Directory. This directory lists complete contact information and specialties for every SDCMS member physician. It is mailed to all members.

San Diego County Physician Directory. This pocket-sized directory lists contact information for every physician in the county. It is mailed to all 8,500 San Diego County physicians.

The deadline to participate is NOW! Space is limited.

Contact Dari Pebdani today: 858-231-1231 or DPebdani@SDCMS.org

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Important ICD-10 FAQs

e for ICD-10?

Question: Will there be a code freez e for ICD-10 beginning freez code al Answer: There will be a parti tes to both ICD-9-CM upda al annu ar regul last The .

October 1, 2012 October 1, 2012 On .

2011 1, ber and ICD-10 will be made on Octo updates to both code d limite only be will there , and October 1, 2013 ology and new techn new re ICD-9-CM and ICD-10 code sets to captu diseases.

being accepted?

Question: When will ICD-9 codes stop for services provided pted acce be not will s code -CM ICD-9 Answer: will not be accepted s code 0 ICD-1 : on or after October 1, 2013. (Note .)

2013 1, ber Octo to for services prior g now to prepare for Question: What should coders be doin implementation of ICD-10?

Answer: ion and unique features of ICD• Learn about the structure, organizat s.

10-CM – all provider type ion and unique features of ICD• Learn about the structure, organizat 10-PCS – inpatient hospitals • Learn about system impact and 5010 of strength/weakness in the • Use assessment tools to identify areas biomedical sciences. edical concepts as needed • Review and refresh knowledge of biom ts. resul nt based on the assessme approximately 6-9 months • Plan to provide intensive coder training prior to implementation ing will likely be adequate • Allocating 16 hours of ICD-10-CM train -CM coders may not need ICD-9 ient for most coders, and very profic that much. ed to refresh or expand • Providing additional training may be need omy, physiology, patho(anat ces scien l edica knowledge in the biom inology). term physiology, pharmacology, and medical .cms.gov/ICD10/, or contact For more information on ICD-10, visit www or at (858) 300-2782.

S.org SDCM me, Sonia, at Sonia.Gonzales@

-2782 Contact Sonia at (858) 300 .org MS DC @S les nza or at Sonia.Go

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

PRACTICE MANAGEMENT DEADLINES! • Before Starting the 2011–12 School Year: All California middle and high school students entering or advancing into 7th through 12th grades will need proof of a Tdap booster shot.

• 09/01/11: Changes to Anthem Blue Cross’ Prudent Buyer physician fee schedule take effect — www.cmanet.org/cmaalert/archives/june-13-2011#3.

• 10/01/11: Last day for eligible professionals to begin their 90-day reporting period in time to attest to and receive their 2011 Medicare EHR Incentive Program payments.

• 12/31/11: Reporting year ends for eligible professionals (eRx).

• 01/01/12: On Jan. 1, 2012, the HIPAA 5010 “implementation guide” standard will go into effect. This affects all of the HIPAA Standard Transactions, including the following pertinent transactions for most medical practices: electronic claims; electronic remittance advices; electronic requests for eligibility and benefit verification and the responses; electronic referral authorizations; and electronic claims status.

The last major change was in October 2003 when the HIPAA transactions and code sets rule took effect. The 5010 changes reduce ambiguity in many of the transactions and provides for some very important new codes such as ICD-10. It also eliminates many of the situational codes while implementing requirements such as taxonomy codes on all claims.

Medical practices should be preparing now for this change by ensuring your vendors (billing software, billing services, and clearinghouses) are ready and that your software is capable of generating a 5010 transaction. If your practice management systems are not compliant with HIPAA Version 5010 standards by Jan. 1, 2012, you will risk not getting electronic payments from Medicare or private insurers.

• 02/29/12: Last day for eligible professionals to register and attest to receive an incentive payment for calendar year 2011 — www.cms.gov/EHRIncentivePrograms.

Mark Your Calendars!

The Best Semina rs/Webinars Ar FREE TO MEM BERS and ST ound — AFF! 08

✓ /11 OSHA Update ✓ 08/18 Focus on Payo s (11:30 a.m.–1:30 p.m.)

r Contracts With Guidelines (11:30 ACO a.m.–1 p.m.) ✓ 09/01 Changes to M (11:30 a.m.–1 p.m edicare Regulations .) ✓ 09/15 HIPAA and Hi Tech Act Update s (11:30 a.m.–1:30 p.m.)

n eeuo v a s icals! t c a m ar

ph

aceuticals to ith STAT Pharm w d re ive ne rt pa bers now rece SDCMS has benefit! Mem w ne t g en in rc az pe bring you an am rchases and 10 pu t en rr cu r s ei st of th their current co free analysis compared to s s ng vi de sa lu e xc in (e cals bottom-l d pharmaceuti an s s, lie ug pp dr su gy colo on medical a products, on m as pl l d al an on d tice vaccines, bloo ith a 30-day no W . s) ug dr S yo ID ounts u HGH and HIV/A these are disc s, se ea cr in e ly pric (858) 300-2782 medical supp contact me at e, or m n ar le S.org. can trust! To zales@SDCM or at Sonia.Gon

NEED TRAINING ?

Couldn’t attend our recent seminars? No problem!

Simply go to SDCM S.org/webinars to vie w our archived librar y of rec orded seminars. A few of the recent presentation s include “The Road to ICD-10,” “Best Practices in Re venue Cycle Manage ment,” and “Legalities of Hir ing.” If you need to set up your username and pass word, please email me at Sonia.

Gonzales@SDCMS.o rg.

Question: Why am I getting 64493-50 (Facet Injection) x 2 units, 64494-50 x 2 units, 64495-50 x 2 units, and 64495-50 x 2 units denied by Medicare?

Answer: Looks like there are two issues here, the first being the use of 2 for units with a 50 modifier for 64493 and 64494, while the other is how 64495 is being coded. To the first issue, each level can be billed bilaterally, but for these CPTs use the 50 modifier with 1 unit.

The Medicare Provider Fee Schedule Database or MPFSDB — www.cms. gov/PhysicianFeeSched/PFSRVF/list. asp?listpage=1 — is the first place that I turn to when receiving a denial of this nature. This document gives a wealth of information related to global periods, bilateral surgery status, assistant surgeon status, etc. The CPTs mentioned above have a status indicator of 1, which means that a 50 modifier would be appropriate and if billing modifier LT and RT then 2 for units would appropriate as well. As for the second issue, CPT 64495 is to be reported just once for any for third and any additional levels. The above scenario should be submitted to Medicare as 64493-50 x 1 unit, 64494-50 x 1 unit, and 64495-50 x 1 unit. No additional payment will be made for the additional levels per the code change in 2010.

July 2011 SAN DIEGO P HY SICI A N. o rg

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brieflynoted you c oul here d appear next!

Become an SDCMS Featured Member!

SDCMS would like to begin featuring some of our member physicians for their noteworthy accomplishments in these pages and on SDCMS.org! If you would like to be considered for our next “Featured Member” spotlight, please email Editor@SDCMS. org. Thank you, and thank you for your membership in SDCMS and CMA!

Upcoming Legislator Birthdays One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday!

BIRTHDAY: AUGust 1 State Assemblywoman Toni Atkins (District 76) E: (via website) asmdc.org/members/a76 E: assemblymember.atkins@assembly.ca.gov Sacramento Office: California State Assembly, PO Box 942849 Sacramento, CA 94249-0076 T: (916) 319-2076 • F: (916) 319-2176 San Diego Office: 1557 Columbia St., San Diego, CA 92101 T: (619) 645-3090 • F: (619) 645-3094 BIRTHDAY: september 4 U.S. Representative Bob Filner (District 51) E: (via website) house.gov/filner Washington, DC, Office: T: (202) 225-8045 • F: (202) 225-9073 Chula Vista Office: 333 F St., Ste. A, Chula Vista, CA 91910 T: (619) 422-5963 • F: (619) 422-7290 Imperial Office: 1101 Airport Rd., Ste. D, Imperial, CA 92251 T: (760) 355-8800 • F: (760) 355-8802

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

CAHAN San Diego Keeps Local Healthcare Providers Informed on Key Public Health Issues

By Bruce Even, Coordinator, CAHAN San Diego Health Alert Network

Physicians take pride in being knowledgeable of the latest health information, yet how do you know for sure if it’s accurate and up-to-date? To ensure that it is, please consider enrolling in the California Health Alert Network (CAHAN) San Diego to receive the latest health alerts issued by County Public Health Services and the State.

CAHAN is the official public health emergency alerting system for San Diego County and California.

Alert topics include communicable diseases, requests for heightened surveillance, recommendations on disease identification, prevention, infection control, specimen submission, and laboratory testing.

Past alerts have also included public health emergency information on the earthquake/radiation issues/tsunami in Japan, H1N1 activities, and local firestorms. CAHAN includes a secure, web-based portal that provides information on such topics as disease reporting, communicable diseases, physicians’ bulletins, archived alerts, bioterrorism resources, and emergency preparedness.

CAHAN is the Another important example of the usefulness of CAHAN would official public be in the event of an earthquake or other public health emergency. health emergency Information from a CAHAN San Diego alert can mean you and your alerting system for staff are better prepared to screen, triage, and treat the potentially San Diego County numerous patients (including “worried well”) that begin presenting and California. at your healthcare facility. CAHAN updates you on a regular basis as recommendations change and the situation unfolds.

San Diego County physicians are encouraged to complete the CAHAN San Diego online registration form. There is no cost to enroll. Please go to www.cahansandiego.com and select the “Subscribe to CAHAN San Diego” link. For questions, please contact Bruce Even at bruce.even@sdcounty.ca.gov or (619) 285-6588.

Letter to the Editor

It takes suffering, as Buddha discovered, to motivate people to search for remedies. The last 250 years of revolutions against authoritarian regimes around the world led to paradigm shifts that raised popular expectations and promoted an era of secular rationality. Science promised a better world: Indeed, unprecedented technological results are being achieved beyond belief. The December 2010 issue of the Journal of Medicine and Philosophy was dedicated to “transhumanism” and our “posthuman” future. The authors posit that biotechnological advances have redesigned the boundaries of human existence. Braincomputer interfaces, radical life extension, enhancement through pre-implantation diagnosis, organ transplantation, bionic limbs, and regenerative medicine will remove all constraints on our bodies and brains.

Under these conditions, there will be a struggle between human values and cost factors, between libertarian autonomy and financial allocation of resources. We think of the “rights” of an insolvent octomom to receive multiple artificial embryo implantations, then to be supported by the state.

In the 21st century, the role of bioethicists must expand to include educating the public regarding their choices, avoiding over- and underutilization.

Sincerely, Olgard Dabbert, MD

*

NOTE: Dr. Dabbert is a retired SDCMS member. Views expressed by letter writers do not represent those of SDCMS or CMA. If you would like to respond to Dr. Dabbert or submit your own letter to the editor, please email Editor@SDCMS.org.

Get in

touch

Your SDCMS and SDCMSF Support Teams Are Here to Help!

SDCMS Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or 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 accounting and administrative 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 LETTERS TO THE EDITOR Editor@SDCMS.org GENERAL SUGGESTIONS SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 560-0179 W SDCMSF.org

Welcome Our New SDCMS-CMA Members John Junghwan Lee, MD Anesthesiology • San Diego (858) 565-9666

Melanie Dawn Palm, MD Dermatology • Encinitas (760) 944-7000

Angela Beatrice Nahl, MD Ophthalmology • San Diego (858) 551-4100

Dora Tsotsoo Saforo, MD Family Medicine • Oceanside (760) 754-0974

Cheryl Emily Thompson, MD Family Medicine • Vista

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 IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

July 2011 SAN DIEGO P HY SICI A N. o rg

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brieflynoted

The Physician Orders for Life-Sustaining Treatment (POLST) form was passed into California law via AB 3000 back in 2008, and these forms have been legally recognized since January 2009 — with an updated version of the form as of April 2011.

Despite this, many clinicians are still only passingly familiar with the bright pink POLST form. As a reminder of some of POLST’s attributes, recall that it is a portable order set that is meant to accompany the patient wherever he or she goes. It is similar to a pre-hospital Do Not Resuscitate (DNR) form, but is more comprehensive and must be honored in whatever setting the patient Please contact is in, including the Caroline Etland at hospital. It is pri(619) 740-5515 or at marily designed caroline.etland@sharp. for patients within com if you are interested the last year or two in educational offerings. of life, but can be completed by any patient. It does not replace an advance directive, such as a durable power of attorney for healthcare, but complements it — it is not necessary to have a separate advance directive, though.

SDCMS’ Bioethics Commission is the home agency for San Diego County’s POLST coalition, which has received grant support from the Compassionate Care Coalition of California to promote POLST and educate clinicians as to the importance of these documents. The Coalition’s website (capolst.org) has the latest version of POLST in several languages and features numerous other resources, including some documents that can be shared with patients and families with respect to CPR and tube feeding (found within the CARE recommendations for nursing home patients). A great deal of work has gone into the development of POLST and related documents, with many diverse stakeholder organizations involved. The latest version of the form, which is administered by the Emergency Medical Services Authority, has some improvements on the original form, but pre-

San Diego POLST Coalition Active in 2011

By Karl Steinberg, MD

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

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

healthcare communit y.

viously executed POLSTs on the old form are still valid.

Building on the strong work by SDCMS Bioethics Commission co-chair Lynette Cederquist, MD, as lead San Diego POLST grantee over the last two years, Caroline Etland, RN, PhD, has stepped into the leadership role for our local coalition. We are primarily focusing on POLST implementation in skilled nursing facilities and evaluating the hospital/SNF interface, but we are also available to do POLST educational presentations and “how-to” trainings for other healthcare professionals, including physicians. Please contact Caroline Etland at (619) 740-5515 or at caroline.etland@sharp. com if you are interested in educational offerings. We are collaborating with several local and regional stakeholder organizations, including representatives from the hospice and palliative care community, assisted living, and others.

While the specific language (and reimbursement) with respect to advance care planning under Medicare was ultimately removed from the PPACA (amid rhetoric about “death panels,” etc.), it remains our responsibility to talk to our frail and chronically ill patients about end-of-life issues.

And when we take the time to do so, it is almost always appreciated. Having POLST forms in our examination rooms is a good way to remember to bring this topic up with our patients and to embrace, on their behalf, this vital and sacred undertaking.

Although we can’t bill specifically for endof-life planning, we can certainly use the counseling code when appropriate and bill for the time spent discussing these critically important issues. And even without getting reimbursed at all, these conversations are a way to truly honor and respect our patients and to help them get their wishes honored as they near the end of their lives.

About the Author: Dr. Steinberg, SDCMS-CMA member since 2008, is associate medical director at Scripps Coastal Medical Group in Oceanside and serves as medical director for two skilled nursing facilities.

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SDCMS Member Physicians

You, your spouse/significant other, and your children are cordially invited to attend our August 6 SDCMS pool party and BBQ (3–7pm)!

Contact Jen at JOhmstede@SDCMS.org or at (858) 300-2781 with questions or to RSVP.

Hope to see you there!

July 2011 SAN DIEGO P HY SICIA N. o rg

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sdcmsmembership

Dr. Robert E. Wailes Installed as SDCMS President for 2011–12 Longtime SDCMS member Dr. Robert E. Wailes was installed as its 126th president on Saturday, June 4, at the second-annual White Coat Gala, an event hosted by SDCMS and the SDCMS Foundation to raise funds for the Foundation’s Project Access San Diego, the county’s only comprehensive network of coordinated, donated healthcare services for medically underserved patients.

Dr. Wailes, who grew up in Northern California, graduated from UC Berkeley with his B.S. in public finance and pre-medical sciences, and from Wake Forest School of Medicine. Upon receiving his doctor of medicine degree, Dr. Wailes returned to California where he trained at the UC San Diego Medical Center in anesthesiology and pain management. In 1984, Dr. Wailes founded Pacific Pain Medicine, the oldest comprehensive, full-time pain medicine clinic providing care for patients in North San Diego County: “Our practice is a leader in San Diego County for providing quality pain medicine services,” he says. “We are fortunate to participate in many different research projects as part of our medical practice, and we continue to remain dedicated to evaluating, preventing, and effectively treating all types of pain using the most advanced techniques available in an environment that emphasizes compassionate patient care.”

Among the attendees at Dr. Wailes’ installation were California State Senators Juan Vargas and Mark Wyland, California Assemblymembers Marty Block and Martin Garrick, U.S. Representative Bob Filner and representatives from U.S. Representative Brian Bilbray’s office, Mr. and Mrs.

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

John Thornton, Reneé Schatz, along with many other distinguished guests.

Along with his duties as president of SDCMS, Dr. Wailes will continue in his second term as trustee from San Diego on the California Medical Association’s (CMA’s) board of trustees, as a member of the board of directors of CALPAC, CMA’s political action committee, and as a member of the board of directors of CMA’s Foundation. Dr. Wailes is also very active with the American Academy of Pain Medicine and is currently their alternate delegate to the American Medical Association.

Dr. Wailes has stated some goals for his presidential year. The first is to tirelessly advocate for all San Diego County physicians and their patients in this era of health reform with all of the surrounding legislation and policymaking. Secondly, he would like

to initiate a public health outreach to address the prevention and treatment of obesity, which is becoming an epidemic here and across the nation.

Dr. Wailes has three wonderful children and enjoys many hobbies, including a love of many sports (tennis, golf, skiing, snowboarding, and occasional surfing) and traveling whenever possible: “I feel very lucky to have a wonderful family and career along with a variety of gratifying roles in organized medicine,” he says.

Opposite page, top: Current and Past SDCMS Presidents (l–r): Dr. Robert Wailes, Dr. Rosemarie Johnson, Dr. Albert Ray, Dr. Lisa Miller, Dr. Richard Butcher, Dr. Susan Kaweski, Dr. Ralph Ocampo, Dr. James Hay, Dr. Robert Hertzka, and Dr. Theodore Mazer; Bottom: (l–r) Congressman Bob Filner, Dr. Robert Hertzka, Dr. Robert Wailes, Dr. Sherry Franklin; This page, clockwise from below: Immediate Past President, Dr. Susan Kaweski, and Current President, Dr. Robert Wailes; Dr. Robert Wailes, Current SDCMS President; Calif. Sen. Juan Vargas and Mrs. Vargas.

Meet Your SDCMS Board of Directors for

2011–12

OFFICERS: • President: Robert E. Wailes, MD • President-elect: Sherry L. Franklin, MD • Treasurer: Robert E. Peters, PhD, MD • Secretary: J. Steven Poceta, MD • Immediate Past President: Susan Kaweski, MD GEOGRAPHIC DIRECTORS: • East County: William T. Tseng, MD, Heywood “Woody” Zeidman, MD, and Kimberly M. Lovett, MD • Hillcrest: Theodore S. Thomas, MD, and Steven A. Ornish, MD • Kearny Mesa: Jason P. Lujan, MD, and John G. Lane, MD • La Jolla: Gregory I. Ostrow, MD, and Wynnshang “Wayne” Sun, MD • North County: James H. Schultz, MD, Douglas Fenton, MD, and Niren Angle, MD • South Bay: Vimal I. Nanavati, MD, and Michael H. Verdolin, MD AT-LARGE DIRECTORS: • Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, Peter O. Raudaskoski, MD, Mihir Y. Parikh, MD, and Suman Sinha, MD GEOGRAPHIC ALTERNATE DIRECTORS: • East County: Venu Prabaker, MD • Hillcrest: Gregory M. Balourdas, MD • Kearny Mesa: Marvalyn E. DeCambre, MD, and Sergio R. Flores, MD • La Jolla: Matt H. Hom, MD • North County: Steven A. Green, MD • South Bay: Andres Smith, MD AT-LARGE ALTERNATE DIRECTORS: • Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD OTHER VOTING MEMBERS: • Communications Chair, CMA Vice Speaker: Theodore M. Mazer, MD • Young Physician Director: Van L. Cheng, MD • Resident Physician Director: Steve H. Koh, MD • Retired Physician Director: Rosemarie M. Johnson, MD • Medical Student Director: Beth P. Griffiths OTHER NONVOTING MEMBERS: • Young Physician Alternate Director: Renjit A. Sundharadas, MD • Resident Physician Alternate Director: Christina Pagano, MD • Retired Physician Alternate Director: Mitsuo Tomita, MD • CMA President-elect: James T. Hay, MD • CMA Past Presidents: Robert E. Hertzka, MD, and Ralph R. Ocampo, MD • CMA District 1 Trustee: Albert Ray, MD • CMA Trustee (other): Catherine D. Moore, MD • CMA SSGPF Delegates: Michael T. Couris, MD, and James W. Ochi, MD • CMA SSGPF Alternate Delegates: Dan I. Giurgiu, MD, and Ashish Wadhwa, MD

July 2011 SAN DIEGO P HY SICIA N. o rg

13

practicemanagement

Pros and Cons

of C Corps vs. S Corps C CORP

S CORP

Double taxation on profits. Income is taxed at the corporate level; profits distributed as dividends are taxed at the individual level. Can reduce double tax by bonusing the income rather than taking a dividend.

Taxation

Profits are passed through directly to shareholders, escaping corporate-level tax. Can take distributions from corporation tax free (subject to change — currently there is a bill in Congress proposing distributions to be subject to payroll taxes).

Dividends paid by a C corporation are generally taxed to the individual at the same rate as longterm capital gains, 15 percent.

Dividends

S corporation earnings passed through to a shareholder are taxed as ordinary income.

C corporation losses are not passed through to shareholders. Losses can be deducted only at the corporate level as NOL carrybacks and carryforwards.

Ordinary Losses

Losses are passed through directly to shareholders.

Current-year losses are deductible up to the shareholder’s basis in S corporation stock and loans to the S corporation.

Taxed at same rate as ordinary income (most likely 35 percent for doctors).

Capital Gains

Pass through to shareholders and are eligible for favorable capital gain tax rates for individuals.

Allowed only to the extent of capital gains. Net capital losses are carried back three years and forward five years.

Capital Losses

Pass through to shareholders. Capital losses are deductible subject to limitation on the shareholder’s return. (Cannot show more than $3,000 in losses per year.)

Few restrictions.

Fringe Benefits

Restrictions for shareholders who own more than 2 percent of the corporation’s stock.

14

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

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Hope to see you there!

July 2011 SAN DIEGO P HY SICIA N. o rg

15

Health

Information Technology

To Tablet or Not to Tablet Is That the Right Question?

By Ofer Shimrat

16

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

There are so many tablet computer options on the market today that there is a good chance nobody in a meeting would notice if you were to bring a clay tablet, an Etch-A-Sketch, or an aspirin tablet. Odds are people would look at it, shrug their shoulders while muttering “cool,” and inquire if you knew the password so they too could get on the wireless with their tablet.

While physical tablet computers have been around since the 1980s, it wasn’t until 2001 that tablets came to be widely adopted in the workplace — mainly as tablet PC devices running a touch- and pen-sensitive version of Microsoft Windows. Several more tablet designs were introduced by hardware manufacturers like Apple, Nokia, Samsung, and HP throughout the decade but with limited commercial success. The common thread was tablets were state-of-the-art and were mainly used for commercial applications at work.

Then in 2010 Apple introduced the iPad, a consumer device. In just a few months, its adoption transformed the tablet, portable, and wireless technology landscapes.

Arguably, in fact, it transformed the relationship between corporate IT and consumer IT. Whereas it used to be that workplace technology trickled down to consumer technology, the trend abruptly reversed. Company executives and early adopter staff were now more state-ofthe-art than their IT departments. iPad, iPhone, and Droid devices were now placing enormous pressures on IT staff, IT budgets, and company security policies to embrace the new consumer technology.

This new trend has a name: the “consumerization of IT.” Paired with the also-recent adoption en masse of social/ visual media and, for better or for worse, staff’s wanting to constantly be connected, corporate IT is now forced to incorporate consumer devices and technologies that just a few years ago weren’t allowed in the workplace.

So now, insofar as tablets are concerned, multiple hardware manufacturers lever-

aging multiple designs using multiple operating systems have furiously released more than 100 tablet models in the past 18 months in the hopes that the market will adopt something — like throwing spaghetti on the wall to see what sticks.

This makes for an unbelievably frustrating business standardization process.

Developers of EMR software are just barely getting a grip on which tablet types will be winners in 2011 and going into 2012. They are not willing to allocate large development budgets for tablet platforms, interfaces, or form factors that will disappear overnight in an extremely volatile market.

Mindboggling are the tablet selection choices for your medical practice with the “winning” set of features: ergonomics, battery life, remote capabilities, EMR application compatibilities, and, above all, staying power.

Should you get the Apple iPad, Motorola Xoom, Samsung Galaxy, or ASUS Eee Pad Transformer? What tablets will run your EMR application? Will the virtual keyboard hide half the screen and thereby render data entry annoyingly sluggish?

What about HIPAA and wireless security?

Let’s quickly delve deeper and examine these topics.

Tablet Design and Form Factors Some industry pundits predict that the tablet will become the technology of choice for doctors. It is the electronic counterpart to paper charts, it’s easy to use, it’s portable, and it has a long battery life.

As a presentation device or for browsing, it has no equal. However, others report that heavy word processing or data entry is not very efficient on the tablet itself due to the touchscreen keyboard, which is too kludgy for anything beyond rudimentary notes.

When selecting a tablet, be sure to investigate its design and its form factor. Look for the types of accessories, add-ons, and docking capabilities it supports. External imaging, scanning, or input ports — will it support Dragon Naturally Speaking Medical Edition, print wirelessly, or remote into your EMR software on your Terminal Server? Will the aggregate of accessories associated with the tablet you have to lug around eclipse a single device like a normal compact tablet PC with built-in keyboard, microphone, and flip screen?

Should you get the Apple iPad, Motorola Xoom, Samsung Galaxy, or ASUS Eee Pad Transformer? What tablets will run your EMR application? Will the virtual keyboard hide half the screen and thereby render data entry annoyingly obtuse? What about HIPAA and wireless security?

Tablet Interfaces There are four main interfaces, or operating systems, used in tablets today: 1. Apple iOS: current version 4.3 with version 5.x being released fall 2011.

2. Google Android: current version 2.x with version 3.x being released now.

3. HP webOS: current version 2.x with version 3.x being released summer 2011.

4. Microsoft Windows: current version 7 with version 8 being released fall 2012.

Describing each interface is beyond the scope of this article. What’s important to know is that each has its pros and cons and must be weighed against how your medical practice will use them and what your current or future EMR natively supports. Your EMR requirements and the tablet interface must be aligned properly.

July 2011 SAN DIEGO P HY SICIA N. o rg

17

Health

Information Technology

Cloud, Client/Server, or Hybrid?

Of extreme importance in your selection of a tablet is what you’re going to connect to. For example, if your EMR is in the cloud and it supports the Safari browser, then the iPad should be your obvious choice. If your EMR only works on Windows desktops or Terminal Server, and your client/server network is physically at your practice, then a Windows-based tablet would be recommended.

You have to gather and determine what all of the software requirements are before you undertake the step of purchasing a new tablet. Does the hospital you work with support the iPad in terms of connectivity to their servers? Will the imaging, pharmacy, or fax applications you need to install work on Android? Are the wireless attributes of your tablet secure and HIPAAcompliant?

Think long and hard before you undertake purchasing a tablet because it’s “cool” and “trendy” lest you end up with a gadget at your workplace that excels at email and browsing but little else.

Staying Power Gartner Research estimates tablet sales will be about 100 million units in 2012. In the same year, Gartner expects PC sales to be about 400 million units. So while this new form factor represents significant market

Some industry pundits predict that the tablet will become the technology of choice for doctors.

18

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

penetration, the jury is still out on whether tablets will overtake the desktop computer completely. Select a tablet that runs on one of the four major interfaces described above. Investigate the form factor that will fit your office workflow. Choose the tablet that will work best with your EMR. Avoid “consumerizing” your business with trendy gadgets, and your tablet purchase will have staying power.

support it is like trying to insert a round peg into a square hole. Go back to basics and use best practices in your business endeavor. Select the EMR software first, and then build the hardware around it, including tablets. Your practice will then be able to fully leverage that tablet purchase in the meeting you are attending while others are monkeying around with their Etch-ASketches.

The Bottom Line The right question is not whether to get a tablet; instead, the question should be how do you intend to use your tablet and will it bolster or detract you and your staff from being productive? Trying to align your tablet with an EMR that does not natively

About the Author: Ofer Shimrat is founder and CEO of Soundoff Computing Corporation, a consultancy specializing in IT products, EMR implementation, hardware, networks, software, and managed services. Visit www.soundoffcomputing. com or call (858) 569-0300.

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VISIT THE HEALTHCARE PROFESSIONAL SECTION OF www.BetterToKnowC.com TO LEARN MORE. References: 1. CDC. DVH – Hepatitis C Information for the Health Professional. http://www.cdc.gov/hepatitis/hcv/. Accessed September 16, 2010. 2. Institute of Medicine. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press; 2010. 3. Pyenson B, Fitch K, Iwasaki K. Consequences of Hepatitis C Virus (HCV): Costs of a Baby Boomer Epidemic of Liver Disease. New York, NY: Milliman Inc; 2009, commissioned by Vertex Pharmaceuticals. 4. Swain MG, Lai M-Y, Shiffman ML, et al. A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. Gastroenterology.

2010;139:1593-1601. 5. Ferrante JM, Winston DG, Chen P-H, de la Torre AN. Family physicians’ knowledge and screening of chronic hepatitis and liver cancer. Fam Med. 2008;40:345-351. 6. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335-1374. ©2011 Vertex Pharmaceuticals Incorporated. All rights reserved. VX11-0957.01 06/11

20

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

Health

Information Technology

Which EMR Vendor Will Be the Best for My Practice?

By rob yeates With more than 400 EMR vendors in the marketplace today, it’s easy to feel overwhelmed by the choices. Below are some guidelines to help you select the best product for your needs.

Start by clearly defining your needs: You want to make decisions about EMR products based on your functional needs and how closely a particular product matches your needs. Write down 10 or 20 functions you want an EMR to do for you.

Make a scorecard of functional requirements: Turn your wishlist into a scorecard with room to write notes by each category for each vendor that you want to see. Develop a simple scoring system (1–5 will do) and assign a value to each category based on how well that product performs. Evaluate all vendors based on the same list.

Make a short list of the vendors: Now that you have your list of functional requirements, it’s time to make a list of the vendors you would like to investigate. Some companies can be eliminated quickly if they haven’t been around long enough or don’t deal with a certain size of practice or a particular specialty.

Arrange product demonstrations: After you’ve decided which vendors’ products you would like to see, invite them to showcase their system during a product demonstration.

Do your homework on cost: The cost associated with an EMR falls under five general categories: 1. Hardware: Most physicians’ practices will need to upgrade existing hardware (computers and servers) to run the EMR. Typically, the vendor will give

you a “shopping list” for the hardware so that you purchase equipment that is compatible with the EMR. Don’t forget to factor into your business plan the cost of regular hardware upgrades, including printers, scanners, and personal computers.

2. Software: Most EMR vendors sell licenses for the initial cost of the software based on the number of physician-users in the practice. Typically, there is a discount given for mid-level providers, and office staff are generally given free access through the provider’s license.

3. Implementation and Training: Typically, the physician’s office will pay for the cost of bringing a vendor trainer to the office to teach, test, and train on the system. This is a one-time fee for the implementation of the EMR, which usually takes place over weeks or months.

4. Professional Support: Depending on the existing expertise in your office, you may find yourself in need of a shortterm project manager, a lawyer to review your EMR contract, and/or a technology professional to establish your server and internet connections.

5. Maintenance: Typically, EMR vendors will charge a percentage of the initial software fee on an annual basis to cover the cost for standard upgrades, regular patient education updates, drug database updates, etc.

Other considerations may add to the total cost of ownership due to any expenses you incur to: • perform project management task • spend time selecting a vendor • make changes to human resources (more/less staff) • travel to conduct vendor research or make site visits • time away from your practice to do any of the above • reduced productivity when you first go live For assistance with this process, contact Rob Yeates at the San Diego County Medical Society Foundation at (619) 542-4357 or at Rob.Yeates@SDCMS.org. Assistance is funded by CalHIPSO. About the Author: Mr. Yeates is the IT project manager for the SDCMS Foundation.

Turn your wishlist into a scorecard with room to write notes by each category for each vendor that you want to see.

July 2011 SAN DIEGO P HY SICIA N. o rg

21

Health

Information Technology

The State of Health Information Technology in California A 2011 Snapshot

By Jodi Simon, DrPH

for the California HealthCare Foundation (CHCF)

HIT tools have the potential to reduce errors and adverse clinical events, and to improve the quality and efficiency of patient care.

22

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

Reprinted with permission from the California HealthCare Foundation. To read the complete report, visit www.chcf.org/publications/2011/05/ health-information-technology-california.

The use of health information technology (HIT), defined as the software used to store, retrieve, share, and use clinical information effectively, has been growing within the state of California. HIT tools have the potential to reduce errors and adverse clinical events, and to improve the quality and efficiency of patient care.

However, significant progress remains before these benefits can be fully realized.

This snapshot is the second comprehensive overview of HIT adoption and use in California; the first snapshot was published in 2008. The results reported here describe the use of HIT by physicians, hospitals, and community clinics and reveal overall growth in adoption, with certain key gaps.

Highlights include: • A larger percentage of physicians reported access to electronic health records (EHRs) and ordering systems than reported in the 2008 snapshot. In general, the larger the practice the more likely it uses HIT tools.

• Use of decision support tools, particularly for medication orders, also became more widespread among physicians. In practices where technology is available, the majority of the physicians reported using decision support tools routinely.

• HIT use by hospitals varied widely by type of HIT tool. While nearly 90 percent of California hospitals reported having or being in the process of installing clinical decision support systems, only 40 percent reported having order entry systems installed.

• Community clinics saw tremendous growth in HIT use over the last six years.

In 2005, 3 percent of clinics reported having an EHR; in the most recent survey, 47 percent reported having implemented one.

The growth of HIT use among physicians and community clinics in particular is a positive trend that ideally will accelerate with the current influx of federal funding. This financial support is a critical factor in transitioning the California healthcare system from the early stages of HIT adoption to a phase in which technology is effectively and routinely leveraged to create a safer and more efficient care delivery system.

About the Author: CHCF, which is a nonprofit grantmaking philanthropy based in Oakland, California, works as a catalyst to fulfill the promise of better healthcare for all Californians. CHCF supports ideas and innovations that improve quality, increase efficiency, and lower the costs of care. Visit chcf. org for further information.

EHR Implementation at Physician Practices ■ Implemented

■ Not Implemented

The results reported here describe the use of HIT by physicians, hospitals, and community clinics and reveal overall growth in adoption, with certain key gaps.

■ Unknown

All Practices (n=65,388)

48%

46% 7%

Solo

20%

63%

16%

2 to 5 MDs

39%

56% 5%

6 to 50 MDs

64%

33% 3%

51+ MDs

80%

18% 1%

Physician Implementation of Electronic Prescribing Technology ■ Implemented

Physician Implementation of Automated Reminder Systems for Preventive Services ■ Implemented

■ Not Implemented

All Practices (n=521)

42%

■ Not Implemented

All Practices (n=526)

58%

Solo

42%

59%

Solo

23%

78%

2 to 5 MDs

18%

82%

2 to 5 MDs

39%

61%

6 to 50 MDs

39%

61%

6 to 50 MDs

33%

67%

51+ MDs

44%

56%

51+ MDs

84%

16%

Hospitals/Med Schools

85%

15%

38%

62%

Hospitals/Med Schools

34%

66%

Physician Implementation of Electronic Clinical Data Exchange Systems With Hospitals and Laboratories Physician Implementation of Electronic Clinical Data Exchange Systems With Other Physicians

■ Implemented

■ Not Implemented

All Practices (n=527)

■ Implemented

51%

■ Not Implemented

All Practices (n=526)

49%

Solo

51%

49%

Solo

34%

66%

2 to 5 MDs

24%

76%

2 to 5 MDs

43%

57%

6 to 50 MDs

39%

61%

6 to 50 MDs

58%

42%

51+ MDs

57%

43%

Hospitals/Med Schools

88%

12%

Hospitals/Med Schools

63%

37%

48%

52%

July 2011 SAN DIEGO P HY SICIA N. o rg

23

Health

Information Technology

Medical E-risk Considerations for Online Communications 2010 Update

By The Doctors Company To read this article in its entirety, please visit SDCMS.org.

The Medical E-risk Considerations were initially developed by the eRisk Working Group for Healthcare, a consortium of professional liability carriers, medical societies, and state licensure board representatives.

They are meant to provide information to healthcare providers related to the use of electronic clinical systems, including electronic health records (EHRs) and online communications and services with patients.

These considerations are meant to serve as general suggestions and do not serve as professional advice of any kind. Clinicians are advised and encouraged to conduct their own independent research and seek further guidance on any specific questions or issues related to the subject matter herein from independent professionals. Full or partial adherence with any of these considerations imposes no obligation on any of the members of the eRrisk Working Group, the iHealth Alliance, or any other person or entity to offer any benefits of any kind to clinicians such as lowering premiums, providing coverage of any claims, or offering any other benefits.

General Principles: The legal rules, ethical guidelines, and professional etiquette that govern and guide traditional treatment and communications between the healthcare

24

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

provider and patient are equally applicable to EHRs, email, websites, list serves, personal health records (PHRs), social media, and other electronic services and communications.

However, this technology introduces special concerns and risks as follows: 1. Confidentiality. The healthcare clinician is responsible for protecting patient privacy and guarding against unauthorized access to and/or use of patient healthcare information. This responsibility extends to the use of network services that have an appropriate level of privacy and security as required under HIPAA. Following are key considerations: a. Privacy and Security. Online communications between healthcare clinicians and patients should be conducted over a secure network, with provisions for privacy and security, including encryption, in accordance with HIPAA. Standard email services do not meet the requirements under HIPAA. Note: With respect to email specifically, clinicians are encouraged to add a disclosure to the bottom of their standard, non-secure email service stating that “this email is not secure and is not for use by patients or for healthcare purposes in general.” b. Authentication. Healthcare clinicians

have responsibility for taking reasonable steps to authenticate the identity of correspondent(s) in electronic communication and to ensure that recipients of information are authorized to receive it. Authentication of the patient or an authorized patient proxy (i.e., parent of a minor, authorized family member, etc.) for patient-provider online communication, including the delivery of patient data, is important in order to ensure patient privacy and confidentiality. Clinicians are encouraged to follow these suggestions for patient authentication: i. Have a written patient authentication protocol for all practice personnel and require them to understand and adhere to it. ii. Establish minimum standards for patient authentication when a patient is new to a practice or not wellknown. iii. Keep an electronic or paper record of each patient authenticated for online communication or data exchange. The record should include the name of the patient, the date of authentication, the name of practice staff authenticating the patient, and the means used to authenticate the patient. iv. Providers should not offer, promote, or encourage patients to participate in online healthcare services where patient authentication is not addressed.

2. Unauthorized Access to Computers. Unauthorized physical access to computers can compromise patient information.

Practices should establish procedures to guard against unauthorized access to computers with technologies such as automatic log-out and password protection.

3. Informed Consent. Prior to the initiation of online communication between healthcare clinician and patient, informed consent should be obtained regarding the appropriate use and limitations of this form of communication.

Clinicians should develop written protocols for online communications, such as avoiding emergency use, heightened consideration of use for sensitive medical topics, and setting expectations for response times. Clinicians should also exercise discretion when selecting patients for the use of online services in

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Prior to the initiation of online communication between healthcare clinician and patient, informed consent should be obtained regarding the appropriate use and limitations of this form of communication. order to ensure that they are capable of electronic communication and will be compliant. These guidelines should be documented in the clinician’s practice policy manuals.

4. Preexisting Clinician-Patient Relationship. Healthcare clinicians may increase

their liability exposure by initiating a clinician-patient relationship online.

Online communications of any kind are best suited for patients previously seen and evaluated in an office setting.

5. Licensing Jurisdiction. Online interactions between a healthcare clinician and a patient are subject to requirements of state licensure. Communications online with a patient, outside of the state in which the clinician holds a license, may subject the clinician to increased risk.

For example, pathologists, radiologists, and other clinicians interpreting specimens, slides, or images sent through interstate commerce for a primary diagnosis that becomes part of the patient’s medical record should have a license to practice medicine in the state in which the patient presents for diagnosis or where the specimen is taken or the image is made. Intra-specialty consultation generally does not require in-state licensure, provided the consultation is requested by a physician licensed within the state and is referenced in a report he or she issues. Physicians are advised to

check with their state’s medical board to determine their licensure requirements.

6. Sensitive Subject Matter. Clinicians should advise patients of the risks that information the patient may consider sensitive might be inadvertently accessed by someone not authorized to see it, such as information on mental health, substance abuse, reproductive history, sexually transmitted diseases, drug and alcohol problems, genetic disorders, and HIV status. Some states have laws about special classes of health information, such as HIV or mental health. Clinicians should follow state law in obtaining approval from the patient to exchange those classes of information. Some states may prohibit electronic transfer of specific classes of information regardless of patient consent.

7. Patient Education and Care Management. Healthcare clinicians are responsible for the information that they make available to their patients online. Information that is provided to patients through PHRs, automated patient education programs, care management, and

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other online services should come either directly from the healthcare clinician or from a recognized, credible and authoritative source.

8. Emergency Subject Matter. Clinicians should discourage use of online communication to address medical emergencies, such as chest pain, shortness of breath, high fever, physical trauma, or bleeding during pregnancy. Instruct patients to call the office or go to an emergency department for emergency issues.

Physicians should consider including a disclaimer on webpages and emails reminding patients that emergency subject matter is not appropriate for electronic communication.

9. Medical Records. A permanent record of online communications relevant to the ongoing medical care of the patient should be maintained as part of the patient’s medical record, whether that record is paper or electronic. Accurate and thorough documentation is effective risk management. Providers and patients should be aware that email and online information, including PHRs

and consultations, are not erased from a computer’s hard drive when deleted and are discoverable in litigation. Therefore all communicated information should be accurate and professional.

10. Practice Website Considerations. a. Authoritative Information. Healthcare clinicians are responsible for the information they make available to their patients online. Information that is provided on a medical practice website or provided to a patient via secure email or other online services should come either directly from the healthcare clinician or from a recognized and credible source. b.

Commercial Information. Websites and online communications of an advertising, promotional, or marketing nature may unrealistically raise patient expectations and subject clinicians to increased liability. Liability risks include implicit guarantees or implied warranty and potential violation of consumer protection laws designed to guard against deceptive business practices. This is particularly true when

cosmetic procedures, off-label drug use, and non-FDA approved procedures are promoted. c. Links to Third-party Websites and Other Sources of Information. Clinicians are encouraged to post a disclaimer page between their website and a link to any third-party website/information that advises patients and other visitors that they are leaving the clinician practice website and that the clinician and the practice do not assume any responsibility for the content or the privacy of other websites linked to the practice website.

Electronic Health Record Liability Risks: The EHR has the potential to advance the practice of good medicine. However, when new technologies are adopted, there are always unanticipated consequences. Real and potential liability risks are beginning to be recognized, and it is important for physicians to become familiar with them.

1. Doctors are responsible for information to which they have reasonable access

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SDCMS Will Soon Publish the 2011–12 Directory of San Diego County Physicians 20100621redbook

6/22/10

5:37 PM

SECTION 1: LISTED BY SPECIA LTY AND

An Easily Portable 5.375” x 8.375” Book That Lists ALL Practicing San Diego County Physicians

Page 1

ZIP CODE (P.4) (P.2) • SECTION 2: LISTED ALPHA BETICALLY (P.39)

San Diego County

Physician Directory 2010 –2011

For physicians who are not SDCMS-CMA members, we will use the address published by the Medical Board of California (MBC). Please San Diego County Medical Soc iety check the MBC website “Physicians United for a Healt hy San Diego” at www.mbc.ca.gov to make sure that the address listed is acceptable to you.

If you prefer NOT to be listed in SDCMS’ 2011–12 San Diego County Physician Directory, or if you wish us to use a different address, please email your complete name, address (if you desire a different address), and specialty to Janet.Lockett@SDCMS.org.

5575 Ruffin Road, Suite 250, San Diego, CA 92123 Telephone: (858) 565-8888 Fax: (858) 569-1334 Email: SDCMS@SDCMS.org Website: SDCMS.org

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— and there may be increased access to e-health data from outside the practice that enters the practice EHR or website or is accessed from the practice EHR or website, i.e. hospital charts, consultants’ reports, lab results and radiology reports, community medication histories, etc. If patient injury results from a failure to access or utilize available patient information, the physician may be held liable.

2. E-prescribing is being rapidly adopted, driven by federal financial incentives, and is currently used by approximately 25 percent of office practices. It works as follows: a. Most electronic prescriptions are transmitted via a Surescripts network (they have data on 200 million insureds) to all chain pharmacies, 60 percent of independent pharmacies, and most insurance formularies. b. Most EHRs have an e-prescribing module, and e-prescribing is a required capability under the federal financial incentives for meaningful use of EHRs. c. Standalone e-prescribing software is also available at no cost from Allscripts and the National ePrescribing Patient Safety Initiative (NEPSI). d. Most programs also check for drug interactions, dosage errors, medication allergies, and patient-specific medication factors. e. Office prescription renewal requests can be synchronized with this system and with some personal health records. f. E-prescribing encourages patients to fill prescriptions (currently 20 percent do not), because the prescription is sent to the pharmacy electronically and is ready to be picked up when they arrive. g. Costs are lowered by flagging generic and “on-formulary” drugs.

However, practices are exposed to community medication histories through e-prescribing; i.e., Dr. A renews a medication, and his e-prescribing program sends an alert advising him that it could interact with another drug. He has not prescribed that drug, so his office staff will have to contact the patient to identify who has, and then Dr. A will have to contact Dr. X to “negotiate” which drug will be discontinued or changed. If failure to do so results in patient injury from a drug interaction, the physician may be liable.

3. Many EHRs provide e-prescribing drug information and clinical decision sup-

4.

5.

6.

7.

8.

port, and the government’s meaningful use requirements mandate minimum functionalities in both of these areas.

Clinicians should know the source of the drug and clinical decision support information in their EHRs because the standards to which they may be held accountable are the clinical standards for their specialty and the information in FDA-approved drug labels or drug alerts.

Doctors may ignore, override, or disable alerts, warnings, reminders, and embedded practice guidelines — due to “alert fatigue.” If it can be shown that following an alert or guideline would have prevented an adverse patient event, the physician may be found liable for failing to follow it.

Meaningful use requires online patient connectivity, and many EHRs have patient questionnaires that utilize an algorithm to interview the patient. These questionnaires often address, and memorialize in the record, issues that many physicians are simply not prepared to pursue (depression, substance abuse, etc.). Lack of or incomplete follow-up can create potential liability — and there is a clear record for the plaintiff’s attorney to follow.

Vendor contracts may attempt to shift medical liability risks resulting from faulty software design or decision support data onto the physician. They may also provide that the vendor has rights to utilize patient or provider data. Read these contracts carefully.

Electronic Discovery: Lawyers may request not only printed copies of the EHR but also the “raw” e-data for metadata analysis, i.e., log-on time, what was reviewed and for how long, what changes or additions were made and when, logoff time, etc. Smart phone and email records are also discoverable. Physicians need to know that all of their interactions with the EHR are time-tracked and discoverable.

Doctors may “copy” information from a prior note or visit and “paste” it into a new note or visit (known as “cloning”), making changes where appropriate or documenting by exception. This may result in irrelevant over-documentation and the patient may appear to have more or less complex problems since the prior encounter. By substituting a word processor for the physician’s thoughtful review and analysis, the narrative

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documentation of daily events and the patient’s progress may be lost, thereby compromising the record of the patient’s course. The quality of notes and documentation may be further compromised by the use of templates.

9. EHRs may auto-populate fields in the history and physical (from data derived from data fields in a prior H&P) and in procedure notes (from personalized or packaged templates). While overdocumentation may facilitate billing, if erroneous or outdated information is entered, it may increase liability. For example: An internist was deposed and his EHR was the medical record. Some of the auto-populated fields contained obviously wrong information, and at deposition the plaintiff’s attorney asked these questions: a. “So is the information in this record accurate or not?” b. “Do you bother looking at your records?” c. “If these ‘auto-populated’ fields are incorrect, can we trust anything in this record?” d. “Do you deliver the same level of care as you do in record keeping?”

Templates with dropdown menus facilitate data entry. However, they are usually integrated with other automated features, and an entry error may be perpetuated elsewhere in the EHR, and overlooked, resulting in a new potential for error. Erroneous information, once entered into the EHR, is easily perpetuated and disseminated.

10. The computer may become a barrier between the doctor and patient — as the doctor fills in a computer template that diverts attention from the patient and restricts creative thinking. This may weaken the doctor-patient relationship.

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Looking for a way to give back to the community?

The San Diego County Medical Society Foundation’s (SDCMSF) mission is to address the unmet San Diego healthcare needs of all patients and physicians through innovation, education, and service. SDCMSF is proud to partner with volunteer specialty physicians and nearly 100 community clinics in the county who provide primary care services for the medically uninsured and underserved. These clinics have little to no access to specialty care for their patients and need your help!

Opportunities for Physicians 1

Volunteer for Project Access San Diego:

If you are a specialist in private practice in San Diego, please consider joining more than 180 specialists in the county by seeing a limited number of uninsured adult community clinic patients in your office for free. Project Access coordinates all aspects of care so your volunteerism is hassle-free for you and your office staff.

2

Volunteer for eConsultSD:

eConsultSD allows primary care physicians from the community clinics in San Diego to articulate a clinical question to a specialist and receive a timely response in a HIPAA-compliant, web-based portal. eConsultSD is an easy way for busy specialist physicians to give back to the community who are not able to provide direct patient care.

3

Obtain a Volunteer or Paid Position at a Local Community Clinic: SDCMSF is happy to connect specialist physicians with a community clinic that needs your services on site. This opportunity involves traveling to a clinic within San Diego County as your schedule permits.

4

Make a Contribution:

SDCMSF needs your support to care for the medically underserved in our community. Please consider making a contribution of any size to support the Foundation’s efforts.

Contributions can be made online at SDCMSF.org or sent to the San Diego County Medical Society Foundation at 5575 Ruffin Road, Suite 250, San Diego, CA 92123.

Thank you for your support!

Thank you for your dedication to the medically underserved. If you are interested in any of the opportunities above, please contact Lauren Radano, program manager, at (858) 565-7930 or at Lauren.Radano@SDCMS.org.

The San Diego County Medical Society Foundation is a 501(c)3 organization (Tax ID # 95-2568714).

Please visit SDCMSF.org for more information. Telephone: (858) 565-8888 or Fax: (858) 569-1334

SDCMSF was formed as a separate 501(c)3 in 2004 by the San Diego County Medical Society.

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

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classifieds 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) 668-4700.

Fax: (619) 668-0049. [924] PHYSICIAN POSITION WANTED SEEKS PERMANENT, PART-TIME POSITION: Physician experienced in primary care (no obstetrics) relocating to San Diego. BC in preventive medicine (occupational medicine subspecialty). 25 years experience in Cleveland VAMC, ambulatory care. Good patient rapport. Formerly chief, Occupational and Environmental Medicine, Louis Stokes-Cleveland VAMC (3,000 employees), 1987–2002. Experience includes minor surgery, office orthopedics, internal medicine, administration of wellness program. Subsequently followed by nine years clinical experience in correctional medicine, Cuyahoga County Sheriff’s Dept. (current). Seeks permanent, part-time position. Benefits not necessary. Available July 18 or later. For CV/references, contact me at (216) 3214273 or at dtinman@sbcglobal.net. [941] PHYSICIAN POSITIONS AVAILABLE SENIOR PHYSICIAN: Are you looking for a rewarding career giving care and hope to those who need encouragement? An exciting and challenging career as a senior physician awaits you at the County of San Diego. As the head of the HIV/STD/Hepatitis clinic, you would manage a team responsible for planning and directing clinic services. We are looking for a candidate who has the drive to excel and can work collaboratively on a team to improve the lives of San Diego County residents. We require a license to practice medicine in the State of California and at least three years of recent post-internship training or experience in internal medicine or as a general practitioner. For further information, visit http://sdcms.org/classifieds/physicianpositions-available. [953] Internal Medicine: SHARP Rees-Stealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine physician to join our staff. We offer a first-year competitive compensation guarantee and excellent benefits package.

Please send CV to SRSMG, Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp.com. [951] Dermatology: SHARP Rees-Stealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking a full-time BC/BE dermatologist to join our staff. We offer a first-year competitive compensation guarantee and excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Avenue, San Diego, CA 92101.

Fax (619) 233-4730. Email lori.miller@sharp.com. [950] MD OR NURSE PRACTITIONER: Dr. Parmela Sawhney is looking to fill an MD or nurse practitioner position at her Imperial Beach office, located at 705 Palm Ave., Imperial Beach CA 91932. Please fax resume to (619) 435-4489 or email to ayurvedicintegrated@yahoo.com. [944] PHYSICIAN WANTED: ENT practice looking for boardcertified/eligible otolaryngologist to join office and quickly achieve ownership. Located in central San Diego County.

Full office with typical ENT equipment, including endoscopy. Position to be filled by Sept 2011. Terms available. Email KLewis@SDCMS.org. [936] PHYSICIAN RESEARCH (206507): Seeking a research physician to work with the DoD’s Infectious Disease Clinical Research Program (IDCRP) at the Naval Medical Center in San Diego, CA. IDCRP is a collaborative program among the Uniformed Services University (USU), NIH-NIAID, the U.S. Military, and the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF). Applicant will be responsible development, direction, and execution of clinical research protocols related to infectious diseases including HIV/sexually transmitted infections, respiratory infections, travel/deployment-related infections, trauma infections, skin and soft tissue infections, and other infectious disease threats to the military population. Must have thorough knowledge of clinical medicine and knowledge of research tasks; knowledge of medical science and develop-

ment of clinical research programs; experience in design of clinical research trials; excellent communication, interpersonal, and presentation skills. Must have an MD or DO degree and ID Fellowship training, plus two years each of clinical research and ID specialty patient care. Must have licensure to practice medicine within the continental United States; Board certified or board eligible for certification in the specialty associated with the clinical research program. Please apply online at www.hjf.org/careers/search. html Job No: 206507. HJF offers a competitive salary and generous benefits package. AA/EEO [935] PSYCHIATRIST, WEEKEND, AND PER DIEM: Palomar Pomerado Health is seeking board-eligible / board-certified psychiatrists to take weekend call or per diem weekday work at Palomar Medical Center and Pomerado Hospital.

Weekend duties include pager call from home, rounding at both inpatient units, and performing consultation to the medical surgical floors. $3,000 / weekend. Contact Jason Keri MD, at (619) 299-4374. [934] SAN DIEGO, NORTH COUNTY: Our busy urgent care is in need of locum tenens family practice physicians for evenings and weekends. Hours are 5–9 pm, Monday through Friday, 9am–5pm on Saturdays, and 10am–4pm on Sundays. Malpractice coverage is provided. Please send your CV to judy@cassidymg.com or call (760) 630-5487 for additional information. You may also fax your CV to (760) 630-2558, attention Judy. [929] FAMILY MEDICINE: SHARP Rees-Stealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking full-time BC/BE family medicine physicians to join our staff. We offer a first-year competitive compensation guarantee and excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@ sharp.com. [928] 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]

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] PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE FOR SALE IN NATIONAL CITY: $318,000 yearly average gross earnings for the past three years. Office-based busy practice of 31 years on the busiest street of the city. Option to add hospital practice to the office practice, with the nearest hospital 1.6 miles close. Two other nearby hospitals are less than 7 miles. Easily accessible location right between two freeways, I-5 and I-805. $89,000–$99,000. Terms negotiable.

Financing if needed. Call (619) 948-4946 anytime or (619) 449-4318 7pm–2am. [945] 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 $245K. 100% financing available. Please contact ProMed at (888) 277-6633 or at info@promed-financial.com, or visit www.promed-financial.com. [906] 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: BMI between 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) 667-7223. [919] OFFICE SPACE / REAL ESTATE

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, board-certified medical director/physician Monday–Friday, 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]

FOR LEASE: Medical office space (1,116 square feet) located at 300 South Pierce Street, Suite 103, El Cajon, CA 92020. Newly built suite includes: 4 exam rooms; 2 MD offices; reception and lobby area; ample parking (no charge); storage. If interested, please feel free to call Debbie at (619) 668-4700 or email Debbie@zavaromd.com. [952] HILLCREST GENERAL OFFICE SUITES AND MEDICAL OFFICE WITH SURGICAL CENTER: Prime location in the medical community near Scripps Mercy/UC Medical Center. Offices for general business use such as accountant, lawyer, internet company, etc. Office for medical use is near move-in ready with exam rooms, reception/waiting room, offices, and storage. Patient parking available. T1 line for large voice and data communication needs. Property manager onsite. Contact Dottie Surdi at (858) 3492007. [948] 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/body work, etc. Patients/clients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Contact Debbie Summers at (858) 382-8127 or at debjsummers1@yahoo.com. [946]

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]

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]

PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of

DOWNTOWN OFFICE SPACE AVAILABLE: Family practice physician in downtown San Diego has office space

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

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available. Preferably a primary care physician, but open to any healthcare provider. If interested, please call (858) 270-7633. [938] SCRIPPS ENCINITAS CONSULTATION ROOM/EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed.

Contact Stephanie at (760) 753-8413. [703] OFFICE SPACE TO SHARE IN EASTLAKE AREA: Currently occupied by owner, family physician. Great location close to Sharp Chula Vista Hospital. Beautiful new building with ample parking. Procedure and exam room available.

If interested please call Norma (office manager) at (619) 946-4073. [931] MEDICAL OFFICE SPACE AVAILABLE PART TIME TO SHARE IN SOLANA BEACH: Excellent location off I-5 by coast. Space includes three fully equipped exam rooms, waiting room, lunchroom, two bathrooms. Available all day Thursdays and other half days — flexible schedule. Great opportunity for a start-up practice that can’t fill a full-time schedule. Affordable rent and flexible arrangements. Call (858) 259-9708 or email solanabeachmed@sbcglobal.net for more information. [878] ENCINITAS: Beautiful, completely renovated office available for sublease two days per week. Four exam rooms, generous waiting area, and bathroom. 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] 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) 8238111. 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) 2992570. [914] 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] 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] 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- and part-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] NONPHYSICIAN POSITIONS AVAILABLE EXPERIENCED NURSE PRACTITIONER: We are a highvolume family practice office. We are urgently seeking an experienced NP to share in patient care duties. Minimum two years experience. Credentials must be up to date. The position is available part time. Flexible hours and competitive pay. If interested, please send your resume to primaryhealthpartners1@gmail.com. We will be in touch. [954] PHYSICIAN ASSISTANT • PART TIME • ORTHOPAEDIC SURGERY: Well-established, high-volume orthopaedic practice in Chula Vista has an opportunity for a part-time (16–24 hours) physician assistant who has a strong interest in orthopaedic medicine. We strive to provide the best orthopaedic care possible for all patients, and to treat each patient the way we would treat a family member. JOB SUMMARY: Provide a full range of physician assistant services and orthopaedic procedures within the scope of practice, which include, but not limited to, obtaining medical histories, performing physical examinations, requesting and evaluating diagnostic tests, rendering a diagnosis, formulating appropriate treatment plans and follow-up instructions autonomously or in collaboration with the supervising physician, prescribing medications as indicated, providing patient education, performing diagnostic ultrasound, aspirations, and injections under ultrasound guidance, application and removal of all types of traction, casts, splints, and other immobilization devices and equipment, providing wound care, functioning as first assist in the operating room, running and overseeing the injection clinics. REQUIREMENTS: current BLS — ACLS certification recommended; previous full-time experience working as a physician assistant in orthopedic surgery, with first assist experience preferred; new graduate applicants are welcomed; board certification under the National Commission on Certification of Physician Assistants; graduate from PA training program accredited by the Commission of Physician Assistants; must have current DEA licensure or otherwise be eligible to obtain a license; must be able to provide two letters of recommendation written within the last two years. Please email CV and two letters of recommendation to hkay@williamevesmd.com. [949]

MEDICAL PRACTICE ADMINISTRATOR FOR A BUSY SAN DIEGO OPHTHALMOLOGY PRACTICE: Candidate must possess a minimum of five years of medical administration experience. This is a full-time position requiring travel to two practice locations. Strong skill set required in delegation and structure of staff and policies. Experience needs to include financial reporting, good working knowledge of Quickbooks, payroll functions, and total human resource management. Duties will include: 1) Hiring, terminating, and training as well as responsibility for full management of the employees at two practice locations; 2) Credentialing, contract negotiations, financial reporting, and analysis of the practice on a monthly basis; 3) Oversight of the annual operating budget and development of business goals; 4) Assisting physicians in marketing and expansion related issues; 5) Submitting accurate and timely payroll information and processing all accounts payable information in a timely manner; 6) Performance of administrative duties to ensure the efficiency of the practice; 7) Oversight of quality assurance and compliance within the office practice in keeping with state, federal, and hospital policies and procedures. Fulltime position. Excellent benefits and compensation. EXPERIENCED CANDIDATES ONLY PLEASE. Respond with resume to hr.sdra@gmail.com. [947] MD OR NURSE PRACTITIONER: Dr. Parmela Sawhney is looking to fill an MD or nurse practitioner position at her Imperial Beach office, located at 705 Palm Ave., Imperial Beach CA 91932. Please fax resume to (619) 435-4489 or email to ayurvedicintegrated@yahoo.com.

[944] FAMILY NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Part-time to full-time position (4–5 days per week) available in the North region: Escondido and 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 — North. [942] FULL OR PART-TIME NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Busy family practice with strong geriatric population located in downtown is seeking full- or part-time nurse practitioner or physician assistant. Experience in EMR preferred. Must be fluent in Spanish and English. Please fax resume to (858) 2707633. [939] FULL-TIME OFFICE MANAGER/BILLER: Dr. Marc Kramer has a full-time office manager/biller position open. The ideal candidate would need to be a strong leader with great communication skills and a strong background in billing. Practice location is in La Jolla.

Please fax resumes to (858) 457-0049. [933] SAN DIEGO, NORTH COUNTY: Our busy urgent care is in need of per diem physician assistants for evenings and weekends. Hours are 5–9 pm, Monday through Friday, 9am–5pm on Saturdays, and 10am–4pm on Sundays. Malpractice coverage is provided. DEA certificate is necessary. Please send your CV to judy@cassidymg. com or call (760) 630-5487 for additional information.

You may also fax your CV to (760) 630-2558, attention Judy. [930] 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. Contact Kyle Lewis at KLewis@ SDCMS.org. [916] MEDICAL EQUIPMENT CHART RACKS FOR SALE: Three free-standing metal chart racks for sale in very good condition. Each rack has nine shelves with four metal dividers per shelf. Dimensions are 36” wide by 92” tall by 13” deep. Each chart rack can hold approximately 575–625 charts, depending on size. These chart racks cost over $600 each brand new. Asking $375 or best offer. Email KLewis@SDCMS. org. [879]

July 2011 SAN DIEGO P HY SICIA N. o rg

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accesstohealthcare

Build Healthy Lives by Connecting to Quality Assistance

N11 Codes

Project Access San Diego and 2-1-1

By Rosemarie Marshall Johnson, MD, Medical Community Liaison, Project Access San Diego, SDCMS Foundation

As the medical community liaison for the SDCMS Foundation’s Project Access San Diego (PASD), San Diego County’s only comprehensive network of coordinated, donated healthcare services for medically underserved patients, I’ve learned many things from my visits with our PASD volunteer specialists, one of which is the need to disseminate information to our physician community about 2-1-1 San Diego.

2-1-1 is a resource and information hub that connects people across San Diego County with community, health, and disaster services through a free, 24/7, stigma-free, confidential phone service and searchable online database (see www.211sandiego. com for more than 6,000 health and human service programs provided by more than 2,000 community agencies). By dialing 2-1-1, clients are linked to a live, highly trained client services representative who navigates them through their situation by assessing their needs and then matching them to the best and closest resources in their community. These representatives speak multiple languages, including English, Spanish, and Somali, and utilize a translation service of more than 190 languages.

The majority of calls begin by addressing food and housing needs, but the wise and trained client services representatives also check eligibility for additional public assistance programs, including Medi-Cal. There are two dedicated health navigation specialists available — also by appointment — to assist with finding in-depth medical help. Currently, healthcare and mental health/substance abuse account for about 15 percent of referrals per year, but this is becoming more critical with the current economic woes and fears.

The sophisticated telecommunications equipment at 2-1-1 also plays an important role in re-

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gional disaster assistance. During a disaster, 2-1-1 works with the County of San Diego’s Office of Emergency Services to provide public information to the community and rumor control, and to act as the central communications point for other community agencies and nongovernmental organizations. During the wildfires, for instance, more than 120,000 callers were assisted with related problems. Additionally, 2-1-1 collects and interprets data reflecting gaps in service and trends, such as a decrease in emergency and nonemergency visits to hospitals and other clinical centers. PASD has shown similar reductions in acute and chronic care generated by the consultations donated by our specialist volunteers.

2-1-1 San Diego is a nationally prominent information service for everyone in areas of social services, and is an expanding navigational resource in physical and mental health. With a closer association between our physician community and 2-1-1, San Diegans can be directed to primary medical care that is complementary to the specialty consultations provided by PASD. John Ohanian, 2-11’s visionary and dedicated chief executive officer, states their role so well: “Our mission at 2-1-1 San Diego is to listen to the needs of every single client with compassion, and to get them connected to help. It’s critical that we take these thousands of voices and build systems together that make it easier for the community to connect to quality assistance in order to build healthy lives.”

Remember 2-1-1, an invaluable collaborator, as we strive to bring improved health and wellbeing to all.

N11 codes, more formally known as service codes, are used to provide three-digit dialing access to special services. In the United States, the FCC administers N11 codes.

The FCC recognizes 211, 311, 511, 711, 811, and 911 as nationally assigned, but has not disturbed other traditional uses. The table below summarizes N11 assignments, reservations, and traditional usage. In some states, N11 codes that are not assigned nationally may be assigned locally, provided that these local assignments can be withdrawn promptly if a national assignment is made. There are no industry guidelines for the assignment of N11 codes.

For information about obtaining a national N11 assignment, contact the appropriate regulatory authority (www.naruc.org/ commissions.cfm).

211: Community Information and Referral Services 311: Non-emergency Police and Other Governmental Services 411: Local Directory Assistance 511: Traffic and Transportation Information 611: Repair Service 711: Telecommunications Relay Service 811: Access to One-call Services to Protect Pipeline and Utilities From Excavation Damage 911: Emergency

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

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$5.95 | www.SANDIEGOPHYSICIAN.org PRSRT STD U.S. POSTAGE PAID DENVER, CO PERMIT NO. 5377

San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA 92123 [ RETURN SERVICE REQUESTED ]

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What does uncompromising protection look like? 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.

In addition, our 20,000 California members benefit from the significant local clout provided by our long-standing relationships with the state’s leading attorneys and expert witnesses, plus litigation training tailored to California’s legal environment.

When it comes to your defense, don’t take half measures. Get protection on every front with The Doctors Company. This uncompromising approach, combined with our Tribute® Plan that has already earmarked over $105 million to California physicians, has made us the nation’s largest 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 (800) 852-8872 or visit us at www.thedoctors.com.

Robert D. Francis Chief Operating Officer, The Doctors Company

Exclusively Endorsed by

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