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official publication of the san diego county medical society august 2012

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One of the Many Ways SDCMS Strives to Support Our Members’ Office Managers and Practice Administrators! PAGE 18

“Physicians United For A Healthy San Diego”

NUMBERS NO INDEMNITY REGIONAL CLAIMS OFFICES

29 Years “a” raTeD BY a.M. BesT

86

88

TRIALS

THAT PROTECT YOU

At NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed in 2011, 88% were closed without settlements or jury awards, compared to an industry average of 71%.* We won 86% of our trials, compared to 80% industry-wide.** You’re prepared for each stage of litigation and kept fully informed — and we don’t settle without your consent. We help you manage events so they don’t become claims, and, to back up our promise to stand by you, we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.

Our numbers add up to great claims support for your practice. * Physicians Insurers Association of America Risk Management Review: 2011 Edition. **Jena et al. Research Letter, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Archives of Internal Medicine. May 14, 2012.

Call 1-800-652-1051 or visit norCalmutual.Com Proud to support the San Diego County Medical Society Our passion protects your practice

B

S A N D I E G O P HY S I CI A N .or g O c tob e r 2011

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

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this month Volume 99, Number 8

Managing Editor: Kyle Lewis Editorial Board: Van L. Cheng, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager: Jennifer Rohr Sales Director: Dari Pebdani Art Director: Lisa Williams Copy Editor: Adam Elder

SDCMS Board of Directors Officers President: Sherry L. Franklin, MD (CMA TRUSTEE) President-elect: Robert E. Peters, PhD, MD Treasurer: J. Steven Poceta, MD Secretary: William T-C Tseng, MD, MPH Immediate Past President: Robert E. Wailes, MD (CMA TRUSTEE)

features Office manager Support 18 SDCMS Office Managers / Practice Administrators: Think SDCMS First!

20 SDCMS Seminars, Webinars, Workshops, and Courses Through 2012: Mark Your Calendars Today!

21 CMA Webinars Through 2012: Mark Your Calendars Today!

22 Become a Certified Medical Office Manager in Four Days! Course Starts Friday, Sept. 14 24 Preliminary Schedule of SDCMS Seminars & Webinars for 2013: Let Us Know What to Change!

10

departments 4 Briefly Noted

Calendar • In Memoriam • Welcome New Members! • Get in Touch • And More …

25 Join SDCMS’ Invitation-only Private Forum for San Diego County Office Managers and Practice Administrators!

26 Wage and Benefit Competitiveness: Giving Your Employees Something to Think About

8 Q&A With Your Physician Advocate

28 The Results of SDCMS’ 2012 Medical Office Salary Survey Are In!

10 UC San Diego Health System: 2016 and Beyond

36 SDCMS’ 4th Annual “Outstanding Medical Office Manager” Contest Is Now Under Way!

by MARISOL GONZALEZ

by DAVID A. BRENNER, MD

Hillcrest: Theodore S. Thomas, MD (A: Gregory M. Balourdas, MD) Kearny Mesa: John G. Lane, MD, Jason P. Lujan, MD (A: Sergio R. Flores, MD) La Jolla: Geva E. Mannor, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County: Niren Angle, MD, Douglas Fenton, MD, James H. Schultz, MD (A: Anthony H. Sacks, MD) South Bay: Vimal I. Nanavati, MD, Michael H. Verdolin, MD (A: Andres Smith, MD)

At-large Directors Karrar H. Ali, MD, David E.J. Bazzo, MD, Jeffrey O. Leach, MD (DELEGATION CHAIR), Mihir Y. Parikh, MD (EXECUTIVE COMMITTEE BOARD REP), Peter O. Raudaskoski, MD, Kosala Samarasinghe, MD, Suman Sinha, MD, Mark W. Sornson, MD (EXECUTIVE COMMITTEE BOARD REP) At-large ALTERNATE Directors James E. Bush, MD, Theresa L. Currier, MD, Thomas V. McAfee, MD, Carl A. Powell, DO, Elaine J. Watkins, DO, Samuel H. Wood, MD, Holly Beke Yang, MD, Carol L. Young, MD other voting members Communications Chair: Theodore M. Mazer, MD (CMA VICE SPEAKER) Young Physician Director: Van L. Cheng, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Suraj Kedarisetty

OTHER NONVOTING MEMBERS Young Physician Alternate Director: Renjit A. Sundharadas, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Stuart A. Cohen, MD, MPH CMA President: James T. Hay, MD (AMA DELEGATE) CMA Past Presidents: Robert E. Hertzka, MD (LEGISLATIVE COMMITTEE CHAIR, AMA DELEGATE), Ralph R. Ocampo, MD CMA Trustee: Albert Ray, MD (AMA ALTERNATE DELEGATE) CMA Trustee (OTHER): Catherine D. Moore, MD CMA SSGPF Delegates: James W. Ochi, MD, Marc M. Sedwitz, MD CMA SSGPF Alternate Delegates: Dan I. Giurgiu MD, Ritvik Prakash

14 Report From AMA’s Annual Meeting: June 2012

geographic and geographic alternate Directors East County: Alexandra E. Page, MD, Venu Prabaker, MD

Mehta, MD

by LISA S. MILLER, MD

16 Properly Implemented Checklists Prevent Patient Injuries

by DAVID O. HESTER 30 With the Rwanda Christian Medical Society on Yom Kippur

by SUSAN BOIKO, MD 34 Physician Marketplace

Classifieds

2 SAN DIEGO PHYSICIAN .org august 2012

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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.]

Safe. Smart. Accountable.

august 2012 SAN DIEGO PHYSICIAN.org 3

brieflynoted In Memoriam

calendar Community Healthcare Calendar

Richard Alan Brower, MD

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

Hyperglycemia Management Using Insulin Therapy SEP 19 • Bombay Restaurant, Hillcrest, San Diego • 6pm • scripps.org/conferenceservices Hyperglycemia Management Using Insulin Therapy OCT 10 • Ruth’s Chris Steak House, Del Mar • 6pm • scripps.org/ conferenceservices CMA / CMA Foundation Gala — Save the Date!

OCT 14 • California Museum, Sacramento • Contact Enid at egallegos@cmanet.org for sponsorship and advertising or Shelley at stirsbeck@ thecmafoundation.org for individual or group ticket sales.

13th Annual Science and Clinical Application of Integrative Holistic Medicine OCT 28 – NOV 1 • Hilton San Diego Resort • www.scripps.org/events/ science-and-clinical-applicationof-integrative-holistic-medicine 13th Annual Science and Clinical Application of Integrative Holistic Medicine NOV 2 • Hilton San Diego Resort RCMA’s “Cruisin Thru CME” — French Waterways: Highlights of Burgundy & Provence JUL 1–13, 2013 • Call RCMA at (800) 472-6204

Tragically, Dr. Richard Alan Brower, chief of gastroenterology for Kaiser Permanente and SDCMS-CMA member since 2006, died on July 18 of intracranial hemorrhage. Our great sadness stems from his premature death, the devastating blow to his family and friends, and the loss of his remarkable skill and wisdom to his patients and colleagues.

After a distinguished career in the U.S. Navy, where he trained many gastroenterologists, Rich joined Kaiser San Diego in 1986 as the fourth gastroenterologist. We knew that we were very fortunate to have been able to attract and hire one of the best gastroenterologists in San Diego.

SDCMS membership

Welcome New Members!

4 SAN DIEGO PHYSICIAN.org august 2012

David W. Amory, MD Orthopedic Surgery Oceanside (760) 724-9000

From the beginning, he demonstrated outstanding clinical ability. He applied his masterful endoscopic expertise, especially in the developing technique of therapeutic endoscopic retrograde cholangiopancreatography (ERCP), to countless patients, sparing many from invasive surgical procedures. He generously assisted and taught his colleagues and GI fellows, who were often amazed that he was as good as internationally prominent endoscopists. If he knew he was as good as he was, he didn’t flaunt it. He was a true professional. It was always about his patients and Kaiser, not him.

Rich was highly motivated and never compromised the quality of his patient care, no matter how long the workday. He became gastroenterology chief in 2007 and, despite challenges such as the new Health Connect and expanding to Garfield, he solved problems so calmly and efficiently that his colleagues never knew how hard he was working. He offered his opinions at regional meetings unhesitatingly and respectfully. Because he led by example, the GI staff

Christy M. Jackson, MD Neurology La Jolla (858) 554-8896 Michelle L. Jackson, MD Dermatology Encinitas (760) 942-1311

willingly cooperated to achieve goals rather than needing to be pushed. As his department struggles without his leadership, at least it will proceed from a high level of professionalism that he contributed to it.

His wife, Ruhiyyih, and children, Jessica and Jason, are dealing with an immense and unexpected loss. As would be expected, Rich designated himself as an organ donor, so that his final medical contribution will save and improve the lives of some fortunate transplant recipients.

— Daniel “Stony” Anderson, MD, George F. Longstreth, MD

Dr. Brower’s family have most graciously asked that he be remembered through contributions to Project Access San Diego, specifically designated to continue his work to screen, diagnose, and prevent colorectal cancer. The SDCMS Foundation was blessed with Dr. Brower’s dedication to our mission and will continue his work as stewards of the Dr. Richard Brower Memorial Fund.

To make a contribution, please visit www.SDCMSF.org.

Jonathan Y. Lee, MD Emergency Medicine San Diego Lawrence T. Malak, MD Psychiatry La Jolla (619) 471-9398

Payam Moazzaz, MD Orthopedic Surgery Oceanside (760) 724-9000 Sirius K. Yoo, MD Otolaryngology San Diego (619) 229-4900

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

healthcare communit y.

get in touch

3 income Tax Planning 3 Wealth Management

Your SDCMS and SDCMSF Support Teams Are Here to Help!

3 employee Benefit Plans

SDCMS Contact Information

3 Profitability Reviews

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 ENGAGEMENT Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org DIRECTOR OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org OFFICE MANAGER • DIRECTOR OF FIRST IMPRESSIONS Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org MEMBERSHIP ADMINISTRATIVE ASSISTANT Rhonda Weckback at (858) 300-2779 or Rhonda.Weckback@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) 300-2777 F (858) 560-0179 (general) W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Francesca Mueller, MPH, at (858) 565-8161 or Francesca.Mueller@SDCMS.org resource development director Erich Foeckler, CFRE, at (858) 565-7930 or Erich.Foeckler@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazas at (858) 565-8156 or Elizabeth.Terrazas@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org IT PROJECT MANAGER Victor Bloomberg at (619) 252-6716 or Victor.Bloomberg@SDCMS.org

3 outsourced Professional services (CFo, Controller) 3 organizational and Compensation structure 3 succession Planning 3 Practice Valuations 3 internal Control Review and Risk Assessment

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

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“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

august 2012 SAN DIEGO PHYSICIAN.org 5

brieflynoted State Disability Insurance Program

By Laurel Waters, MD, Medical Director, California Employment Development Department The California Employment Development Department (EDD) administers the State Disability Insurance Program (SDI), a partial wage-replacement insurance plan for California workers, funded through mandatory payroll deductions with two components: 1. Disability Insurance (DI) provides benefits to workers unable to work due to non-work-related illness, injury, or pregnancy that prevents them from performing their regular or customary work.

2. Paid Family Leave (PFL) provides benefits to workers who take time off work to care for a seriously ill child, spouse, parent, or registered domestic partner, or to bond with a new child.

SDI relies heavily on the medical community since all DI claims and a portion of PFL claims require Medi-

cal Certification with the following information: • physician’s certification and license number • estimated return date to patient’s regular or customary work • ICD-9 codes and diagnoses (primary and secondary) • nature, severity, and extent of the incapacitating disease or injury • type of treatment surgery or procedure performed • pregnancy due date Workers may be unaware that they qualify for SDI benefits. We would like to partner with the medical community to better serve patients by making them aware of DI and PFL when the need arises. You may download the DI Benefits Claim Form, order the PFL Claim Form, and make additional form requests at www.edd.ca.gov/disability. I hope this information will help you and your patients properly complete claim forms so they can be processed more quickly.

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: SEPT. 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 BIRTHDAY: OCT. 3 State Senator Christine Kehoe (District 39) E: senator.kehoe@sen.ca.gov W: dist39.casen.govoffice.com Sacramento Office: State Capitol, Rm. 5050 Sacramento, CA 95814 T: (916) 651-4039 • F: (916) 327-2188 San Diego Office: 2445 Fifth Ave., Ste. 200 San Diego, CA 92101 T: (619) 645-3133 • F: (619) 645-3144 BIRTHDAY: OCT. 27 State Senator Mark Wyland (District 38) E: (via website) cssrc.us/web/38 E: senator.wyland@sen.ca.gov Sacramento Office: State Capitol, Rm. 4048 Sacramento, CA 95814 T: (916) 651-4038 • F: (916) 446-7382 Carlsbad Office: 1910 Palomar Point Way, #105 Carlsbad, CA 92008 T: (760) 931-2455 • F: (760) 931-2477

6 SAN DIEGO PHYSICIAN.org august 2012

Hepatitis Free San Diego: Call to Action!

By Robert Gish, MD, SDCMS-CMA Member Since 2011, and Binh Tran, PharmD, MBA The Hepatitis Free San Diego Project is aimed at building a successful strategy to screen at-risk individuals for both hepatitis B virus (HBV) and hepatitis C virus (HCV) with an overall goal to assess the treatment needed and link the ones screened to an optimal care solution. A crucial component of our project will be a community-wide comprehensive awareness campaign to educate healthcare providers, people at risk for HCV as well as HBV, and the general public about viral hepatitis and liver disease. An important focus of our project will be to use pointof-care (POC) testing for HBV and HCV in our community-based screening programs.

Led by the University of California, San Diego (UCSD) Center for Hepatobiliary Disease and Abdominal Transplantation team, members will collaborate with the Asian Pacific Health Foundation, UCSD’s Hepatitis Care Connection Program, the UCSD Student Health Service, Neighborhood

Healthcare, and other partner organizations to screen the students on campus and the people in San Diego County who are at greatest risk for HBV and HCV. Our goal will be to screen 2,000 individuals in San Diego County for both HBV and HCV in the first year of our program; with additional funding, we hope that our project can directly screen 4,000 individuals during the first two years, and that testing can ultimately be expanded to a total of at least 10,000 individuals through advocacy testing via primary care providers.

The emphasis will be on screening individuals who are at high risk for HCV, including the HCV birth cohort of Americans born from 1945 to 1967 and Asians and Pacific Islanders (APIs) and members of other groups at high risk for HCV as well as HBV. HBV vaccination is provided to those not immune, exposed, or infected with HBV, along with appropriate linkage to care and follow up for HCV serologically positive individuals.

A very important component of this

project will be to integrate HCV testing into programs that previously focused only on hepatitis B as well as into other broad-based health screening programs for glaucoma, osteoporosis, diabetes, and hyperlipidemia in order to increase the total number of people screened. We will also evaluate barriers to care in San Diego County and use program resources to help enhance screening and linkage to care, especially in the underserved populations in San Diego County. As part of this project’s overall goal of overcoming barriers to care, patients will have access to a hepatologist on site in community clinics and via telemedicine.

We are requesting a “Call to Action” for all healthcare systems and organizations in San Diego County to support, partner, and increase awareness of viral hepatitis and how it has affected our communities. If you have any questions or would like to be a part of Hepatitis Free San Diego, please contact Robert Gish, MD, at rgish@ucsd.edu or Binh Tran, PharmD, MBA, at btran.aphc@ sbcglobal.net. august 2012 SAN DIEGO PHYSICIAN.org 7

Practice Management

Q:

Q&A With Your Physician Advocate Keeping Billing Records • Reporting Domestic Abuse • Security Cameras • And More!

by Marisol Gonzalez, Your SDCMS Physician Advocate

Q:

How long do we need to keep billing records such as EOBs and superbills?

Submitted by the billing staff of a three-year member specializing in cardiovascular disease.

Answer: Physicians generally do not have to keep billing records as long as medical records. Rather, billing records would be treated like accounts receivable, payable, and invoice records, which experts generally recommend be retained for seven years.

However, records of medical necessity or other disputes with health plans should generally be kept with the patient chart for the same period as the underlying medical record, as these records may be relevant to subsequent professional liability or health plan disputes. Source: CMA ON-CALL #1160, “Retention of Medical Records”

Q:

We have a patient who has scheduled an appointment with us to repair damage done to her face by one of her family members.

Do we have a duty to report this? Submitted by the office manager of a seven-year member specializing in facial plastic and reconstructive surgery.

Answer: Yes. The reporting requirement may be triggered if the physician learns of the relevant injury when treating a patient, regardless of whether the patient is actually being treated for the types of injuries cov-

ered by Penal Code §11160 (any wound or other physical injury inflicted by his or her own act or inflicted by another where the injury is by means of a firearm or inflicted upon the person where the injury is the result of assaultive or abusive conduct).

However, to be reportable, the injury must be current: The patient must be suffering from it. The report must be made regardless of the seriousness of the injury if the injury was caused by a physical force from an act prohibited under the Penal Code. The only exception is spousal rape, which must be reported even if it does not involve physical injury otherwise reportable. Source: CMA ON-CALL #1511, “Reporting Domestic Violence”

Q:

Is it a violation of HIPAA if we install security cameras in the hallway of our office and in our waiting room? Submitted by the practice administrator of a 31-year member specializing in family medicine.

Answer: This is not a violation, and it is a good component of physical and facility security. It actually helps the practice comply further with the HIPAA Security Rule.

Physicians should consider how the surveillance is reviewed or stored and should stay away from sensitive areas such as restrooms and exam rooms. Source: David Ginsberg, President, PrivaPlan Associates, Inc.

As a result of an audit, Medicare claims that they’ve overpaid us for a claim back in 2009. How far can they go back when requesting reimbursements as a result of overpayments? Submitted by the office manager of a seven-year member specializing in allergy and immunology.

Answer: They can go back six years. The Medicare Act itself contains an express statute of limitations that provides that no action may be brought against a physician with respect to any claim, request for payment, or other occurrence prohibited by law later than six years after the date for claim or request for payment was made or occurrence took place. Source: CMA ONCALL #0625, “Medicare Audits”

Q:

We had a patient come into the office that we haven’t seen for six years. The patient wanted to pay cash for services, but our practice no longer accepts cash. Can we assume that because it’s been so long, a physician-patient relationship no longer exists?

Submitted by the office manager of a 35-year member specializing in internal medicine.

Answer: The passage of time alone does not necessarily establish that a patient has terminated the physician-patient relationship. It should not be assumed that, because a patient has not made an appointment with a physician for a year or more, the patient does not expect to receive further services from the physician. A patient may still anticipate that the physician, particularly a primary care physician, will be available to treat the patient for future problems. Source: CMA ON-CALL #0805, “Termination of the Physician-Patient Relationship”

Q:

One of our physicians had a prescription pad stolen from her car. Can you tell me to whom I should report this? Submitted by the office manager of a nephrology group with 100% membership.

Answer: This can be done electronically by going to http://oag.ca.gov/cures-pdmp.

If you scroll to the bottom of the page, you will see the heading, “Lost or Stolen Prescriptions.” Click on the hyperlink, and it will take you to the web application. Going through these steps will notify the Department of Justice electronically. Source: State of California Department of Justice’s Office of the Attorney General Website

SDCMS member physicians are encouraged to contact Marisol with any practice or membership questions at (858) 300-2783 or at MGonzalez@SDCMS.org.

8 SAN DIEGO PHYSICIAN.org august 2012

Special Mortgage Financing for Physicians Our special home financing program is designed to meet your needs as a physician for the purchase, refinance or construction of your primary residence.

• Financing for single family homes available with low down payment up to $1,750,000. Refinances with high loan-to-values are also available • Private mortgage insurance is not required • One-Time Close Construction Loan - one application, one approval and one closing for both construction and permanent loans.

For information on this special home financing program from BBVA Compass, give us a call today.

Bryan Yaninek, NMLS #392774 Mortgage Banking Officer 719-499-9000 • bryan.yaninek@bbvacompass.com apply online at: bbvacompass.com/mortgages/byaninek

1-800-COMPASS • bbvacompass.com

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

8.4375x11_SMF Physicians AD.indd 1

11/17/11 11:59 AM

UC San Diego Health System — ONE IN AN OCCASIONAL SERIES OF ARTICLES FROM SAN DIEGO COUNTY’S HEALTH SYSTEM LEADERS —

UC San Diego Health System 2016 and Beyond

by David A. Brenner, MD

UC San Diego Health System will be celebrating its 50th anniversary in 2016. This will be an important milestone for our now farreaching academic health system, which started with the purchase of San Diego’s county hospital in Hillcrest in 1966.

The year 2016 will also mark important milestones in UC San Diego Health System’s physical growth and our ability to provide access to patients in our region and beyond.

Two new buildings are slated to open that year: UC San Diego Jacobs Medical Center 10 SAN DIEGO PHYSICIAN.org august 2012

and the Altman Clinical and Translational Research Institute building. Together, these two facilities will allow us to increase the volume of our clinical care and accelerate the delivery of research discoveries to our patients.

UC San Diego Health System has grown exponentially since 1966. Our second hospital, UC San Diego Thornton Hospital in La Jolla, was built in 1993. We opened a number of specialized facilities, such as UC San Diego Moores Cancer Center, which

was founded in 1978 and moved to its present location in 2005. Our Health System developed a network of affiliated physicians through UC San Diego Medical Group, comprising clinics and centers both within and outside of San Diego County.

Our most accelerated growth has taken place during the last five years. In 2011 alone, we opened UC San Diego Sulpizio Cardiovascular Center and acquired both the San Diego Cancer Center and the Nevada Cancer Institute in Las Vegas.

We recently opened new clinics in North County, adding to existing locations in the Inland Empire and South Bay.

FACILITIES GROWTH

With 245 additional beds, Jacobs Medical Center will allow UC San Diego Health System to meet the needs of the region’s growing and aging population. For instance, we now have the largest inpatient cancer program in San Diego County. Moores Cancer Center currently offers comprehensive services for outpatient cancer patients but does not have inpatient beds for cancer patients. Our new Hospital for Cancer Care will provide 24 medical and surgical beds and 12 intensive care unit beds, as well as an entire floor dedicated to blood and bone marrow transplant patients.

UC San Diego Health System performs some of the most advanced surgical procedures in the world. The new Hospital

Altman Clinical and Translational Research Institute Building Adjacent to Jacobs Medical Center and also scheduled to open in 2016 will be our new Altman Clinical and Translational Research Institute (CTRI) building. This 311,000-square-foot building — financed in part by a generous donation from San

UC San Diego Health System Welcomes New CEO

120606-0022.jpg

Jacobs Medical Center UC San Diego Jacobs Medical Center will be the cornerstone of our growth in the next five years. Named for Joan and Irwin Jacobs, this 10-story, 509,500-square-foot building will encompass three new hospitals — the Hospital for Advanced Surgery, Hospital for Cancer Care, and Hospital for Women and Infants — and will adjoin the existing Thornton Hospital and Sulpizio Cardiovascular Center in La Jolla.

for Advanced Surgery, which will have 10 operating rooms and four additional ORs within a fully inclusive intra-operative suite, will utilize the latest technology. This hospital will allow our surgeons to put into practice new techniques developed at the Center for the Future of Surgery, the largest surgical training site in the United States.

[See “Training Physicians for the 21st Century” in the March 2012 issue of San Diego Physician.]

We offer more birth options than anywhere else in San Diego. However, our regional Neonatal Intensive Care Unit (NICU) at UC San Diego Medical Center in Hillcrest, while a Level III, has only a limited number of private rooms. Today, best practice is to provide all private NICU rooms to prevent the spread of infection and to give family members privacy.

Our new Hospital for Women and Infants will have 52 private NICU rooms, in addition to eight labor and delivery rooms and three holistic birthing center rooms.

One of the most important features of the new Jacobs Medical Center is its garden-based design. The facility will include numerous outdoor areas.

The interior spaces are designed to maximize natural light and integrate nature. Most importantly, the building centers on the patient experience.

Throughout the planning process, physicians, staff, and patients have been able to give feedback based on life-size model rooms, built by FOAMCo, a local San Diego company.

On June 1, 2012, Paul S. Viviano assumed the concurrent positions of CEO for UC San Diego Health System and associate vice chancellor for Health Sciences.

Mr. Viviano, 59, brings to UC San Diego Health System a record of exceptional leadership and strategic vision. He has a hands-on philosophy of working with clinicians and researchers to ensure outstanding patient care — exactly the kind of skills needed to elevate levels of innovation and quality as UC San Diego Health System grows.

Mr. Viviano was most recently chairman of the board and CEO of Alliance HealthCare Services, the nation’s largest provider of advanced outpatient diagnostic imaging services and a national leader of radiation oncology services, serving more than 1,300 hospitals.

His prior positions include president and CEO of USC’s University Hospital and USC/ Norris Cancer Hospital, a private research and teaching hospital staffed by faculty from the Keck School of Medicine at the University of Southern California. USC/ Norris is a National Institute of Health-designated comprehensive cancer center.

A Los Angeles native and University of California alumnus, Mr. Viviano earned his bachelor’s degree from UC Santa Barbara and master’s degree in public administration-public health at UCLA. Mr. Viviano is a member of the board of trustees at Loyola Marymount University, where he also serves as chair of the governance committee, a member of the finance committee, and chair of the Bioethics Institute. He is also a member and former chairman of the National Association for Quality Imaging, and will continue to serve as a member of the board of directors for Alliance HealthCare Services.

august 2012 SAN DIEGO PHYSICIAN.org 11

UC San Diego Health System Building on advances in genomic and stem cell research, nanotechnology, wireless communications, bioinformatics, robotics and minimally invasive surgical techniques — many of which were spearheaded at UC San Diego — our Health System will play a key role in delivering leading-edge medical care not only in the San Diego region but throughout the United States and beyond.

Diego philanthropists Steve and Lisa Altman — will house research laboratories and clinical research space to support UC San Diego medical and bioengineering investigators, as well as collaborators in San Diego’s biotech community.

This new building, situated in close proximity to our clinical facilities, will further leverage UC San Diego’s strengths as the only academic health system in San Diego and one of just eight in California.

Building on advances in genomic and stem cell research, nanotechnology, wireless communications, bioinformatics, robotics, and minimally invasive surgical techniques — many of which were spearheaded at UC San Diego — our Health System will play a key role in delivering leading-edge medical care not only in the San Diego region but throughout the United States and beyond.

INCREASING ACCESS TO CARE Telemedicine One medium to deliver care beyond our region is telemedicine. UC San Diego Health System has been using telemedicine to provide remote clinical care to underserved communities throughout California. It began with a project called UCSD STRokE DOC, led by Brett C. Meyer, MD, SDCMS-CMA member since 2005, aimed at reducing the amount of time it takes to get treatment for a stroke victim. UCSD STRokE DOC has now been expanded, enabling UC San Diego Health System specialists to access remote, rural EDs via live video, audio, and data-stream.

12 SAN DIEGO PHYSICIAN.org august 2012

Our telemedicine team has developed protocols and networks and has already negotiated partnership agreements with more than 50 community healthcare sites and providers. To date, our partnerships involve the following specialties: neonatology, endocrinology, neurology, HIV medicine, internal medicine, oncology, radiology, pain medicine, hepatology, and psychiatry. Given our centralized clinical infrastructure, we have the potential to provide telemedicine services for almost all UC San Diego specialties.

The innovative technology housed within our new three-story, $70 million Medical Education and Telemedicine Building allows students and physicians to videoconference around the world with any clinic or doctor with similar technical capability at the other end. [See “Telemedicine: Closing in on Distance Medicine” in the July 2010 issue of San Diego Physician.]

OUR FUTURE In many ways, the future of medicine is already being practiced at UC San Diego Health System — advances such as awake brain surgery, scarless surgeries through Natural Orifice Translumenal Endoscopic Surgery (NOTES), pulmonary thromboendarterectomy (PTE), and cancer treatments using hyperthermic intraperitoneal chemotherapy (HIPEC or “chemobath”). Much of what is common practice in medicine today was unimaginable when our Health System was established in 1966.

The construction of UC San Diego Jacobs Medical Center, which officially began in January, is progressing on schedule. This and our other new facilities will help us push the envelope even further to grow and increase access to care. UC San Diego Health System has imagined the future of healthcare — and is well on its way to realizing this vision.

Dr. Brenner, SDCMS-CMA member since 2007, is vice chancellor of UC San Diego Health Sciences and dean of the UC San Diego School of Medicine.

Where Are Your Patients Coming From?

“...most experts say referral marketing will only become more entrenched as healthcare cuts continue”

Each month, every practicing physician in San Diego County receives a copy of this magazine.

What better way to ensure they know about your practice? We have advertising packages available at very attractive price points, and member physicians receive 50% off!

If your doors are open for business, keep patients coming in with a referral advertisement in San Diego Physician magazine.

Contact Dari Pebdani at 858-231-1231 or at DPebdani@sdcms.org august 2012 SAN DIEGO PHYSICIAN.org 13

American Medical Association

Report From AMA’s Annual Meeting June 2012

by Lisa S. Miller, MD

The American Medical Association (AMA) convened its 161st House of Delegates on June 15, 2012, in Chicago. Given the existing climate in healthcare delivery, financing, and reform, many issues arose that were pertinent to current state and national concerns. For example, the House adopted a resolution regarding financing of Medicare. With the goal of transitioning from the current defined-benefit program to a financing mechanism based on defined contributions, the House asked the AMA’s Council on Medical Service to further refine AMA policy. The House wished to ensure that with such funding, beneficiaries could maintain their existing traditional Medicare plan or purchase an affordable, private insurance plan in a competitive marketplace.

Recent news stories have highlighted conflicting recommendations regarding the use of various screening tests, such as mammograms and PSA levels. At the AMA meeting it was alleged that the United States Preventive Services Task Force used flawed methodology in arriving at their recommendation against the routine monitoring of PSA levels. A resolution addressing this issue was adopted. It built in safeguards by promoting expert or specialty input when task forces establish recommendations for screening guidelines. Such guidelines have far-reaching implications. The repercussions extend from who should have certain screening tests done to who should pay for them 14 SAN DIEGO PHYSICIAN.org august 2012

based on their efficacy.

Other meeting highlights included resolutions on: • Medicare-Medicaid dual-eligible patients • national drug shortages • Medicaid financing reform • graduate medical education financing • physician workforce shortages • marketing directed at children • screening mammography • third-party payer quantity limitations on prescribed medications • physician stewardship of healthcare

resources and support for physicianled, team-based care Additionally, our San Diego delegate, Robert Hetzka, MD, SDCMS-CMA member since 1988 and past president of both SDCMS and CMA, was reelected to the AMA Council on Medical Service. Please see AMA’s website at www.ama-assn.org for further information on these issues and other current AMA business.

Dr. Miller, SDCMS-CMA member since 1992, is past president of SDCMS and current alternate delegate to AMA.

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Risk Management

Properly Implemented Checklists Prevent Patient Injuries

by David O. Hester, BS, FASHRM, Patient Safety/Risk Management Account Executive, The Doctors Company

The use of checklists to help prevent fatal and nonfatal injuries originated with the aviation industry. In the mid-1930s, a Boeing 299 crashed after takeoff, and the investigation revealed that the pilot neglected to release the elevator lock prior to takeoff. Reducing the probability of pilot error became an immediate priority and, in 1937, separate checklists were developed for takeoff, flight, before landing, and after landing to decrease incidence of human error (1).

16 SAN DIEGO PHYSICIAN.org august 2012

Checklists are not new to medicine either; however, a renewed emphasis on checklists, specifically for use in surgery, continues to evolve. The World Health Organization (WHO) piloted its Surgical Safety Checklist in 2007 and 2008 in eight sites throughout the world. The results, published in The New England Journal of Medicine in 2009, showed that the use of the checklist reduced complications and mortality in surgery by greater than 30%.

The tool — Safe Surgery Saves Lives — was

developed by WHO and created by a group of international experts, including anesthesiologists, nurses, surgeons, and patients to foster communication between members of the surgical suite and keep patients safe during all phases of the procedure (2).

In addition to the WHO surgical safety checklist, other organizations, including the Association of periOperative Registered Nurses, Veterans Affairs Hospitals, and The John Hopkins Hospital, have developed and implemented successful checklists that start with addressing issues related to organizational culture, hierarchy, and leadership.

Surgical checklists should comprise detailed tasks for each member of the surgical team and be broken into the following sections: • Pre-procedure verification process checklist.

• Procedure area time-out checklist inclusive of the immediate members of the surgical team, standardized by the facility, and initiated by a designated member of the surgical team.

• Verbal confirmation checklist at the conclusion of the surgery, initiated by a designated member of the team as defined by the facility.

• Team confirmation checklist to address key concerns for the recovery and management of the patient.

It is important to note that when two or more procedures are being performed on the same patient by different surgeons, another time-out should be initiated prior to skin incision for the next procedure.

The purpose of a checklist is to remind healthcare providers of the importance of certain details, not to shame or blame a member of the healthcare team when things don’t go according to plan. Unlike other checklists, forgetting or disregarding certain details when treating patients can and does result in injury or death. Thorough checklists used in hospitals, ambulatory surgery centers, and physician offices that have fostered and created a culture of patient safety are a valuable tool.

Notes: 1. Schamel, John; How the Pilot’s Checklist Came About. www.atchistory.org/History. checklst.htm. Sept. 26, 2011.

2. Haynes AB MD MPH, Weiser TG MD MPH, William BR MD MPH, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N. Engl J Med. 2009;360 491-499. Jan. 29, 2009

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august 2012 SAN DIEGO PHYSICIAN.org 17

Office Manager support

SDCMS Office Managers / Practice Administrators: Think SDCMS First!

We at the San Diego County Medical Society (SDCMS) endeavor to be a practice management resource for the office managers and practice administrators of our member physicians. Not only do we strive tirelessly to support our member physicians — advocating on your behalf locally, in Sacramento, and in Washington, DC, and bringing you member benefits that make a real difference to your bottom line — but we recognize that our physicians’ office staff often require support with the day-to-day administration of the practice as well. By helping your office staff find the answers and resources they need day in and day out, we can make a genuine difference in the success of your practice and in the health and wellbeing of your patients. With that in mind, please share this issue of San Diego Physician magazine with your office manager or practice administrator and encourage him or her to “Think SDCMS First!” whenever they have a question about how to proceed, or a problem or issue they need resolved. Thank you for your membership!

18 SAN DIEGO PHYSICIAN.org august 2012

Office Manager Benefits Access to SDCMS’ Full-time Physician Advocate / Chief Problem Solver: Let your office manager and staff know that they have a full-time advocate on staff at SDCMS ready to help them with any questions they may have, free of charge.

Contact Marisol at (858) 300-2783 or at MGonzalez@SDCMS.org.

Ensure Your Office Manager Has Her Own SDCMS.org Username and Password: Your office manager as well has access to valuable members-only content, including SDCMS’ online FAQ database, members-only toolkits, SDCMS recorded seminars, and more. For assistance, contact Kyle at (858) 300-2784 or at KLewis@SDCMS.org.

Free Attendance at All SDCMS Seminars and Webinars: SDCMS member physician office staff attend free of charge all SDCMS seminars and webinars, covering legal issues, HIPAA, risk management issues, contract negotiations, getting paid, billing, and much more. For details, contact Rhonda at (858) 300-2779.

Free Coding Hotline: Are you unsure about a code and need it verified? Access a free coding hotline (provided by SDCMS-endorsed CHMB Solutions) by emailing your coding question(s) to Coding@SDCMS.org.

Become Certified at a Significant Discount: Members and office staff attend all SDCMS certification courses at a discount, including “Certified Medical Office Manager” (begins Sept. 14 — see page 22), “Certified Medical Coder,” “Certified Medical Insurance Specialist,” and “Certified Medical Compliance Office.” For details, contact Rhonda at (858) 300-2779.

Free and On-demand Access to All SDCMS Recorded Seminars at SDCMS.org: All SDCMS member physicians and their staff can access all recorded seminars free of charge at SDCMS.org/webinars. Some of the more popular seminars from 2012 include “The Road to ICD-10,” “Changes to Medicare Regulations,” “Collections Procedures,” “OSHA Updates,” “HIPAA Updates,” “Palmetto GBA / Medicare,” “Treating Patients Right,” and “HIPAA 510 Changes.” For assistance, contact Kyle at (858) 300-2784 or at KLewis@SDCMS.org.

CMA Webinar Series: CMA’s webinar series gives your office staff the opportunity to watch online presentations on important topics of interest to help meet regulatory and accreditation standards, learn effective practice management techniques, provide quality care, and more — as well as interact with legal and financial experts. For assistance, contact Kyle at (858) 300-2784 or at KLewis@SDCMS.org.

Free San Diego County Physician Mailing List: Are you making sure that referring physicians can find you? Receive one free physician mailing list annually and a 50% discount on all additional mailing lists requested in the same year. Contact Betty at (858) 565-8888 or at Betty.Matthews@ SDCMS.org.

Access SDCMS Endorsed-partner Expertise and Discounts to Save Your Physicians Time and Money: To schedule a five-minute SDCMS Benefits Check-up in order to ensure you’re taking advantage of all of our member benefits, email Kyle at KLewis@ SDCMS.org.

If you have any SDCMS benefit suggestions, please email them to Membership@ SDCMS.org.

Thank you!

Join SDCMS’ Invitation-only Private Forum for San Diego County Office Managers and Practice Administrators: SDCMS has created an online forum to enable our valued office managers to build a community of mutual support in order to, for example, get answers to your practice management questions, share best practices, stay abreast of upcoming deadlines, and much more! To sign up, email Kyle at KLewis@SDCMS.org.

Post Free Classified Ads in San Diego Physician and Online at SDCMS.org: Email Kyle at KLewis@SDCMS.org.

Receive Free of Charge SDCMS’ List of San Diego County Pharmacies — Updated Annually: Email Kyle at KLewis@SDCMS.org.

august 2012 SAN DIEGO PHYSICIAN.org 19

Office Manager support

SDCMS Seminars, Webinars, Workshops, and Courses Through 2012 Mark Your Calendars Today!

Practice Valuation (seminar/webinar) SEP 6 11:30am–1:00pm

Identity Theft (seminar/webinar) NOV 1 11:30am–1:00pm

How To’s of Appeals (seminar/webinar) SEP 20 11:30am–1:00pm

The (Physician) Leader’s Toolbox (workshop) NOV 10–11 8:00am–4:00pm on Nov. 10, and 8:00am– 12:00pm on Nov. 11

Certified Medical Office Manager (course) SEP 14, 21, 28, OCT 5 9:00am–4:00pm Media Training (workshop) SEP 29 8:00am–12:00pm EHR Meaningful Use (seminar/webinar) OCT 18 11:30am–1:00pm

Top 10 Patient Safety Issues for Office Practice (webinar) NOV 14 6:30pm–7:30pm Top 10 Patient Safety Issues for Office Practice (webinar) NOV 15 11:30am–12:30pm

20 SAN DIEGO PHYSICIAN.org august 2012

“I've enjoyed and learned from all of the seminars and webinars.

Thank you for putting these together. They are invaluable! I hope a lot of medical professionals take advantage of these webinars and seminars!”— Cherisse, Office Manager for Edward Aaron Brantz, MD, SDCMS-CMA member since 1979 Thank you, Cherisse, for your kind words and for attending more SDCMS seminars in 2012 than any other office manager!

L–R: Christina, Dan, Samantha, and Sara

“After speaking with staff and reviewing seminar topics, the conclusion is that you are doing a fantastic job with informative, knowledgeable presentations. Thank you for such a valuable contribution to medical practices in San Diego!”— Sara, Office Management for William J. Previte, DO, SDCMS-CMA Member Since 1989

For further information or to register for any SDCMS seminars, webinars, workshops, and courses, visit www.SDCMS.org/event or contact Rhonda Weckback at (858) 300-2779 or at Rhonda.Weckback@SDCMS.org.

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www.tscarsolutions.com For further information or to register for any of the following CMA webinars, visit www.CMAnet.org/events or contact your SDCMS physician (and office manager) advocate, Marisol Gonzalez, at (858) 300-2783 or at MGonzalez@ SDCMS.org.

Program Integrity in Medicare and Medi-Cal: The Physician’s Role AUG 15 • 12:15pm–1:45pm

California Workers' Compensation E-bill Part 4: Effective E-billing SEP 6 • 12:15pm–1:45pm

California Workers’ Compensation E-bill Part 1: Are You Ready?

AUG 16 • 12:15pm–1:45pm

Creating and Implementing Financial and Office Policies SEP 19 • 12:15pm–1:15pm

California Workers’ Compensation E-bill Part 2: Implementation AUG 23 • 12:15pm–1:45pm California Workers’ Compensation E-bill Part 3: Understanding Remittance Advice Rules AUG 30 • 12:15pm–1:45pm A Guide to Reviewing Payor Contracts SEP 5 • 12:15pm–1:15pm

To find out more about our services and how we can help you start collecting more money, contact our sales department at 760-681-5022 or sales@tscarsolutions.com Endorsed by SDCMS Member of the California Associations of Collectors and ACA International

EMR is great for record-keeping but it’s not the answer to getting you paid or managing your claims.

Protect Your Practice From Payor Abuse OCT 3 • 12:15pm–1:15pm Establishing Expectations for High Performance from Medical Staff OCT 17 • 12:15pm–1:15pm Understanding ARC and CARC Revenue Codes NOV 7 • 12:15pm–1:15pm

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Mention this ad, and we will waive your set-up fee! A $250 vALue!

www.medbillconnection.com / (800) 980.4808 x115

august 2012 SAN DIEGO PHYSICIAN.org 21

Office Manager support

Become a Certified Medical Office Manager in Four Days!

Course Starts Friday, Sept. 14 LIMIT: 35 ATTENDEES • SIGN UP EARLY! This program is recommended for experienced medical office managers who want to take their skills to the next level. Learn to initiate policies and protocols that will improve, protect, and stabilize the financial security of the practice. More physicians need “Certified Office Managers” who understand the newest business and regulatory issues. “Certified Medical Office Managers” help guard the practice against risks and motivate employees to improve productivity and increase revenue. Find out how to analyze managed care contracts, stay in compliance with OSHA, OIG, and HIPAA, and deliver exceptional patient service.

COURSE CURRICULUM Financial Management: • Developing and Maintaining a Budget • Forecasting and Revenue Projecting • Revenue and Cost Accounting • Financial Control Managed Care and the Medical Practice: • Types of Managed Care Plans and How to Select the Right Ones • Evaluating Contracts • Organizing the Fee-for-service Practice • MCO Coordinator • Physician Utilization Committee • Utilization Control Techniques • OIG Compliance Program Guidance • HIPAA Compliance Issues Practice Administration: • Improving Employee Relations • Operations Management • Facility Management • Risk Management • Terminating the Patient / Physician 22 SAN DIEGO PHYSICIAN.org august 2012

Relationship • Medical Record Keeping • Time Management and Delegation Personnel Management: • Job Descriptions and Training • Maintaining Valued Employees • Effective Communication • Terminating Employees • Dealing With Difficult Employees • Unique Employee Relations Issues COURSE DETAILS • “Certified Medical Office Manager” Course (CMOM) [Program # 181260914] • Presented by Practice Management Institute (PMI) (www.pmimd.com) • Hosted by SDCMS • Four Fridays: Sept. 14, 21, 28, and Oct. 5 • 9 a.m.–4 p.m. (sign-in at 8:45 a.m.)

• Held at the SDCMS Meeting Room, 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123 • Cost for SDCMS Members / Staff: $640 (includes breakfast, lunch, and instructional materials) • Cost for Nonmembers / Staff: $1,040 • Contact Rhonda Weckback at SDCMS at (858) 300-2779 or at Rhonda.Weckback@SDCMS.org.

CANCELLATION POLICY A full refund less $20 processing fee, if cancellation is received 7+ days prior to program start date. A 50% refund if cancellation is 6 days to 48 hours prior to start date. No refund if cancellation is less than 48 hours in advance. Upon registration, custom materials are printed, refreshments are ordered, and seating is reserved. Due to this, PMI strictly adheres to this policy.

To Register, Fax This Form to SDCMS At (858) 569-1334 SDCMS Member Physician Full Name

Attendee Name (ONE FORM PER ATTENDEE)

Attendee Job Title

Attendee Telephone

A ttendee Fax

A ttendee Email

Payment Information

o Visa

o MasterCard

o AmEx

o Check *

*Make check payable to “Practice Management Institute” and mail to: SDCMS, Attn., Rhonda Weckback, 5575 Ruffin Road, Suite 250, San Diego, CA 92123

Credit Card #

Exp Date

Cardholder Name

Cardholder Signature

“think SDCMS FIRST!”

Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

Total Amount

Dx: Serious risk of lost income Rx: SDCMS disability protection!

• Save 10% to 43% • Premiums may be tax-deductible • Own-occupation, sub-specialty contract language Lock in low rates before pending state rate hikes.

For your individual quote, call Wealth Legacy Group at 619.370.7472 or visit www.sdcmsdisability.com.

august 2012 SAN DIEGO PHYSICIAN.org 23

Office Manager support

Preliminary Schedule of SDCMS Seminars & Webinars for 2013

Let Us Know What to Change!

Below is SDCMS’ preliminary schedule for seminars, webinars, and workshops in 2013. If you think we’re not covering a topic we should, or if you’d like to give further direction to a topic we have scheduled, please let us know at Membership@SDCMS.org!

JANUARY »» Treating Patients Right Seminar / Webinar »» Political Advocacy Training Workshop »» Medi-Cal Updates (Dual Eligible) Seminar / Webinar FEBRUARY »» Tax Time Seminar / Webinar »» HIPAA Seminar / Webinar MARCH »» Certified Medical Coder Course »» OSHA Seminar / Webinar »» The (Physician) Leader’s Toolbox Workshop »» Medicare Updates Seminar / Webinar

24 SAN DIEGO PHYSICIAN.org august 2012

APRIL »» Contracting & ACOs Seminar / Webinar »» How to Oversee Your Outside Billing Company Seminar / Webinar »» Preparing to Practice Workshop MAY »» Collection Strategies Seminar / Webinar »» Interpreters and the Medical Practices Seminar / Webinar JUNE »» Human Resources — Disciplinary Actions Seminar / Webinar »» The Road to ICD-10 Seminar / Webinar

JULY »» Risk Management Webinar AUGUST »» Sexual Harassment Seminar / Webinar »» Allied Healthcare Staff-Scope of Practice Seminar / Webinar SEPTEMBER »» Legal Seminar Seminar / Webinar »» Social Media Seminar / Webinar »» Certified Medical Insurance Specialist Course OCTOBER »» Economic Survival Seminar / Webinar NOVEMBER »» Identity Theft Seminar / Webinar

Office Manager support

SDCMS Office Manager Forum

Join Our Invitation-only Private Forum for San Diego County Office

SDCMS has created an online forum for our member physicians’ office managers and practice administrators. This online forum will enable our valued office managers to build a community of mutual support in order to, for example, get answers to your practice management questions, share best practices, stay abreast of upcoming deadlines, and much more!

This is a private, invitation-only forum for the office managers and practice administrators of current SDCMS member physicians.

There you have access to a shared calendar, discussion forums, member profiles, a photo gallery, file storage, and more. We encourage you to upload your photo, complete your profile, and participate!

This continues to be a work in progress. If you have any thoughts, ideas, suggestions that might make this a more valuable resource, please let us know at Membership@SDCMS.org.

To join the forum today, visit sdcmsofficemanagerforum.groupsite.com! august 2012 SAN DIEGO PHYSICIAN.org 25

Office Manager support

Handing out small raises this year? None?

No matter how carefully you prepare for fair and reasonable pay raises for your staff, some of them may be disappointed. Most mature workers understand the ways of the business world. Others have an imperfect understanding of what their job is really worth. That’s why the job of educating employees to the economic realities of the workplace is so important. Here’s one way to do it.

Your employee handbook probably explains how you approach wage and salary reviews. But what about the employee who was expecting more and seems disappointed, even though the hourly or monthly rate is fair? Every couple of years we recommend you try this easy way of reviewing with your team the benefits of working for you.

Claim the High Ground

Wage and Benefit Competitiveness Giving Your Employees Something to Think About

By Jeffrey J. Denning

26 SAN DIEGO PHYSICIAN.org august 2012

It’s best to take the initiative in your compensation reviews, even if there are going to be no raises. You need to let every employee know you carefully consider this every year, and just saying so in your personnel policy isn’t enough. Hold private compensation reviews — interviews — with each employee. That’s far better than responding to employee requests for raises when you’re unprepared. (If they come to you at some other time, remind them of the language in your personnel policy that tells them when pay reviews are done: “As you know, I do wage and salary reviews in December unless someone’s job changes. I’ll be happy to discuss this with you then.” (Note: Since so few employees of medical practices are exempt from the overtime rules of the wage and hour laws, get used to using the term “wages” instead of “salaries.”)

In the interview, restate the main points of your prior performance reviews and how your worker’s progress (or lack of it) influenced your thinking about the base pay rate for the next year. Then provide her or him with a summary of the total economic value of the job, especially if you provide costly benefits like generous time off with pay, retirement plans, and health insurance.

Our recap sheet (see Figure 1) breaks down the gross wage, showing pay for time

not worked separately. That includes all classes of time off like holidays, vacations, personal and sick leave, and so forth. It’s pretty easy to figure this as a percentage of the total by just counting the days off and dividing by 260 (52 five-day weeks).

(For half-time workers, prorate the year by multiplying 260 by 0.5.) Most employees don’t really appreciate the value of getting paid for not working. This can give them a sense of what this benefit costs you and is worth to them.

List all the other benefits, like your share of the matching contributions to Social Security and Medicare, payroll taxes you pay for their benefit, and insurance premiums.

If you provide parking at an extra cost, list it along with mileage reimbursements, uniform allowances, child care — anything that makes your job more appealing than other places your employee could work.

And don’t be bashful about listing the cost of workshops, seminars, books, tapes, and other training and self-improvement benefits. Sure, they benefit the practice, but the employee benefits from these new skills, too, becoming more versatile and valuable in the process.

Take Some Credit You have to get the payroll and retirement plan information together every year anyway. Why not share it with the employees in a way that is more complete and meaningful than IRS Form W-2? Our example to the right is for a receptionist earning $13 who may not consider herself in the $41,000 per year category. She’s worth it, though, and this summary will give her something to think about if tempted by 25 cents an hour more at another job.

Figure 1: Annual Employee Compensation Form Here’s What We Paid You:

Time Worked

Time Not Worked

24, 547 $_____________

2,453 $_____________

In Addition, We Provided These for You:

1,676 $_____________

Employer’s Contribution to Social Security

Employer’s Contribution to Medicare

State Unemployment Insurance Premium

66 $_____________

196 Worker’s Compensation Insurance Premium $_____________

Health Insurance Premium

2,900 $_____________

Free Healthcare

660 $_____________

Life Insurance Premium

$_____________

Disability Insurance Premium

$_____________

Pension Plan Contribution

Profit Sharing Plan Contribution

Other:

uniforms ______________________________

training ______________________________ parking ______________________________ ______________________________

27,000 $_____________

372 $_____________

2,704 $_____________

4,056 $_____________

370 $_____________ 420 $_____________ 650 $_____________ $_____________

14,070 $_____________

Our Total Investment in You:

41,070 $_____________

Mr. Denning is a principal management consultant with SDCMS-endorsed Practice Performance Group. SDCMS members receive discounted management consulting on productivity and patient flow, personnel, governance and management, market strategy and tactics, practice acquisitions, sales and mergers, and a free one-year subscription to its newsletter, UnCommon Sense. To learn more, contact Jeffrey Denning or Judy Bee at (858) 459-7878 or at jeff@ppgconsulting.com. august 2012 SAN DIEGO PHYSICIAN.org 27

Office Manager support

SDCMS’ 2012 Medical Office Salary Survey The Results Are In!

SDCMS conducted its first-annual medical office salary survey in April and May of 2012, with data collected and analyzed for the following office positions: • front desk position (see sample results at right) • front / back office position for a one-person office • certification / insurance / pre-auth verifier • surgery / procedure scheduler • data entry / clerical position • insurance biller / insurance claim tracker • patient collection representative • computer / IT technician • department / site lead (for at least three staff) • office manager (1–3 doctors, 3–14 staff) • administrator (>5 doctors, >25 staff) • medical assistant • certified medical assistant • clinical technician • LVN • RN • physician assistant • nurse practitioner

Front Desk Position: Average Hourly Salary District

Average Hourly Salary

Average Tenure in Years

East County

$13.42

6

Hillcrest

$14.24

6

Kearny Mesa

$15.77

5

La Jolla

$15.55

5

North County

$14.33

5

North County Coastal

$15.00

4

South County

$14.22

6

Overall

$14.67

5

Front Desk Position: Hourly Salary vs. Years Experience $23 $21 $19 $17 Hourly Salary

Receive your salary survey results today!

SDCMS member physicians are invited to email Membership@SDCMS.org to receive their copy of our survey results. Thank you for your membership!

Sample Results for a Front Desk Position

$15 $13 $11 $9 $7 $5

28 SAN DIEGO PHYSICIAN.org august 2012 28 SAN DIEGO PHYSICIAN.org august 2012

0

5

10 Years Experience

15

20

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 Erich Foeckler, resource development director, at (858) 565-7930 or at Erich.Foeckler@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) 300-2777 or Fax: (858) 569-1334

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

29

S A N D I E GO P HY S I CI A N. or g A u gust 2011

august apri j u ly l 2012 2012SAN DIEGO PHYSICIAN.org SAN DIEGO PHYSICIAN.org 29 29

Physician volunteerism

With the Rwanda Christian Medical Society on Yom Kippur Saturday, Oct. 8, 2011

By Susan Boiko, MD

30 SAN DIEGO PHYSICIAN.org august 2012

I left home on foot at 7:20 a.m. to meet a bus at the Kobil gas station in Kicukiro, 45 minutes away. A chartered bus seating 30 arrived. Packaged cookies I brought were devoured gratefully

by Rwandan medical colleagues, including a professor of pediatrics who arose before sunrise in Butare, the site of the National University of Rwanda Medical School, a gynecologist, an ENT resident (word of the name change to head and neck surgery hasn’t reached here yet), a pharmacist, and an emergency medicine specialist.

I chatted with a medical student finishing his second year. Medical school here is for the top scorers on a standardized test given to all secondary students. Medical education is six years — the first two years are preclinical sciences, and there is no real patient exposure until the final two years.

We stopped at Nyamata Hospital to pick up additional doctors and load medicines donated by Barry Wood Ministries, a Christian medical charity. The health station we were going to had sparse supplies. The 9-mile journey from the hospital to the station took over an hour. Once we hit the dirt roads, there were no signposts and few landmarks. Twice our bus had to turn around.

More than 1,000 people had gathered, from newborns to elderly using tree branches for walking sticks, and someone on an improvised stretcher. Many had never seen a doctor. We walked a few hundred yards down the road to a small building where we introduced ourselves, discussed our strategy, and had a brief prayer.

Returning to an eager crowd, the bullhorn was not working, so the ENT resident gave a rousing sermon saying that doctors were here to help, but Jesus heals. A medical student interpreted for me.

I was shown to an exam room with no sink, no exam table, no light except from the doorway, and a small window with no glass.

I was grateful to my Kaiser colleague, dermatology nurse practitioner Ted Scott, who had donated two powerful handheld lights, of which one always stayed in my pocket. The clinic was part of the 90% of Rwanda without electricity.

I insisted that I would only see skin problems. That was a wise move, since I had not done any general medicine since 1985, when I had to cover a military hospital ER as a pediatrician.

I had the assistance of a terrific medical student interpreter named Brian. He had just completed his second year and had zero knowledge of patient care or dermatology.

I had no paper. No one had a spare piece of paper, so I used a 4-inch-long store receipt and, in tiny handwriting, enumerated every case. In four hours I saw 36 patients. The pediatrician in the next room saw 30, and his cases, including a toddler with previously undiagnosed Tetralogy of Fallot, were more complicated than most of mine. I saw everything from multiple cases of tinea versicolor (pronounced ee-say in Kinyarwanda) to abdominal stretch marks after pregnancy, tinea capitis, atopic dermatitis, mostly infected, a thyroglossal duct cyst in a 4-year-old (that went to the ENT resident), AIDS-associated eosinophilic folliculitis with the IRIS phenomenon, and chronically infected leg wounds that had only been treated with short courses of oral antibiotics without resolution.

The medical record consisted of a “blue book”-type 8-inch square paper book, which had been cut in half. If I was lucky, in somewhat clear handwriting there might have been a date, a diagnosis, and a treatment on one of the pages. More often, the book only had the patient’s name in it.

Brian and I devised a system. He called the patient in, asked what the skin complaint was, and, with the help of Ted’s light, I saw the patient and made a diagnosis, with a quick explanation of its nature and treatment, which Brian ably interpreted to the patient. Then, because I am not licensed in Rwanda, Brian wrote the date, the diagnosis, and the treatment in the little half-book. I had no difficulty with the diagnoses. The treatment was another matter. Like many American patients, people feel cheated if they don’t emerge from their encounter with a prescription. On the other hand, there is

august 2012 SAN DIEGO PHYSICIAN.org 31

Physician volunteerism

It might mean only a five-day supply of antibiotic pills or a 15-gram tube of medicine, but it was something. Of course, followup would be back at this local clinic with a nurse. no water, let alone soap or spare cash for effective over-the-counter remedies, even if there were a nearby store where such things could be bought. Luckily, the Barry Wood Ministries had supplied us with antibiotics and topical steroids, so when Brian wrote out treatment in the half-book, it could be given to the pharmacist. It might mean only a five-day supply of antibiotic pills or a 15-gram tube of medicine, but it was something. Of course, follow-up would be back at this local clinic with a nurse. In case of a severe problem, the nurse could write a consultation in English or French to our local Nyamata Hospital, but then would come the challenge of transporting the patient to and from the visit. It would be at least a day’s walk just one way.

Exhausted and hungry, but exhilarated that we had offered something to these desperate people, we volunteers made our way through knots of people who had to be turned away because we just couldn’t see everyone. An elderly woman leaning on a tall stick for balance shoved me on the shoulder as I walked with the doctors.

Her harsh, scolding cry expressed her frustration, but I could not express in return my sorrow that I could not help her.

We gathered at the smaller building. Donations from doctors and medical students paid for the bus, the meal, and 50 Mutuelle cards for the most impoverished. The medical supplies not used would be left for the clinic.

I was asked to say a few words.

I explained that this day, Yom Kippur, was the holiest in the Jewish calendar. Normally, Jews spend the day fasting and praying for forgiveness of sins. This was the first day I can remember in my adult life that I did not spend in reflection, whether at home or in a synagogue. I finished by giving a Hebrew blessing to the Christian Medical Society.

We ate the catered meal, which had been sitting unrefrigerated for eight hours: individual packets of French fries, spaghetti, boiled 32 SAN DIEGO PHYSICIAN.org august 2012

potatoes, a chunk of chewy beef on a bed of rice, and a tablespoon of African spinach washed down with a glass bottle of Fanta soda.

Most of the participants at 4:20 p.m. enjoyed their first meal of the day and cleaned their foil containers.

By 4:45 we were back on the bus.

I may never have the experience of seeing patients every seven minutes again, but I will never forget Yom Kippur with my Rwandan colleagues.

Dr. Boiko, SDCMS-CMA member since 2000, is celebrating her 15th year as San Diego Permanente Medical Group’s pediatric dermatologist.

She enjoys teaching medical students and residents from Rwanda to Los Angeles. She and husband Martin A Schwartz, MD, enjoy visiting their daughters in Philadelphia and Davis, Calif.

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Where Are Your Patients Coming From?

Each month, every practicing physician in San Diego County receives a copy of this magazine.

What better way to ensure they know about your practice? We have advertising packages available at very attractive price points, and member physicians receive 50% off!

If your doors are open for business, keep patients coming in with a referral advertisement in San Diego Physician magazine.

Contact Dari Pebdani Today!

858-231-1231 • DPebdani@SDCMS.org

R e f e r r a l p a g e s

classifieds PRACTICE FOR SALE SAN DIEGO (ENCINITAS) DERMATOLOGY, MOHS, AND COSMETIC SURGERY PRACTICE FOR SALE: Practice address is 477 N. El Camino Real, Encinitas at North Coast Health Center, a large multi-specialty health center. The practice has been at the location for the past 13 years. The seller is a solo, board-certified dermatologist who will be moving on to an academic position. Gross revenue has been in the $930,000 to $1.3 million range over the last four years. The office is about 1,600 square feet and has four exam rooms and two offices, a small lab, and two bathrooms. The practice is located in a populated area comprised of a large skin cancer population, and an affluent population seeking cosmetic procedures. Asking price is $325,000 (including at least $75K in inventory/equipment). If interested, please email dermmd10@gmail.com. [054] PHYSICIAN POSITION WANTED SENIOR FAMILY PRACITIONER: Seasoned, popular Savannah physician moving to San Diego, searching for position where I can be helpful. All-round clinician, whose strengths include developing friendships with my patients and love of medicine. Double boarded with MRCP degree (UK). Not afraid of hard work. Coming west to reconcile with my ex-wife, which she says is OK. Hospital privileges in our three hospitals, excellent managed care grades, recognized as a Distinguished Physician by Memorial University Hospital. When I cross the Talmadge Bridge, there will be tears in the river. Have stethoscope, will travel. Contact: jimmypinckney@ix.netcom.com or (912) 596-6100. [062]

8:00am–4:30pm, as well as a PT psychiatrist. Must have current CA medical license, DEA license, ACLS, BLS. We offer a competitive salary, health benefits, vacation, holidays, sick, CME and license reimburse, and malpractice coverage. Forward resume to jobs@sihc.org or fax to (619) 659-3145 or website at www.sihc.org. Contact jobs@sihc.org or HR phone (619) 445-1188, ext. 308 or ext. 307 or HR fax (619) 659-3145. [048] PHYSICIAN NEEDED — FULL- OR PART-TIME SCHEDULES AVAILABLE: Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego's healthcare safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our patients and community.

We offer an excellent comprehensive benefits package that includes: malpractice coverage; NHSC loan repay eligibility; and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. To apply, visit our website and apply online at www.fhcsd.jobs. [046]

PHYSICIAN — SAN DIEGO COUNTY: Are you looking for a rewarding career in public health, providing care at the community level in a team environment? An exciting and challenging career as a physician awaits you at the County of San Diego. The County has a physician opening in the Public Health Services’ TB clinic located in San Diego (92110). Incumbents will deliver professional medical services related to tuberculosis treatment and prevention. Valid NPI, current California licensure, MD or DO degree, and one year of post-graduate experience required. For more information and to apply, visit www.sdcounty.ca.gov/hr, recruitment #12419307. Open until filled. Contact darah.frondarina@sdcounty.ca.gov for questions on the application process. [063] MID-CAREER PEDIATRICIAN: Great opportunity for a mid-career pediatrician with kind manner and strong entrepreneurial spirit to work FT/PT in small solo progressive practice. This position is a partnership track. Night call is minimal but must be willing to work some Saturdays and evenings to help grow the practice. Nice mix of parents in great school area. Salary DOE. Nice, stable office staff with EMR. Send CV to cvp315@sbcglobal.net. [057] LOOKING FOR PER DIEM PHYSICIAN FOR BUSY URGENT CARE: San Diego North County group looking for per diem physician for busy urgent care. Family medicine physician preferred. Need coverage for two days per week.

Malpractice is covered. Please email CV to judy@cassidymg.com or fax to (760) 630-2558, attention Judy. [055] PHYSICIAN AND PSYCHIATRIST NEEDED FOR AMBULATORY CLINIC: Southern Indian Health Council is seeking a FT board-certified physician Mon–Fri,

PRACTICE WANTED WE BUY URGENT CARE OR READY MED-CLINIC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County.

Please contact Lyda at (619) 417-9766. [008] OFFICE SPACE / REAL ESTATE

PART- OR FULL-TIME DERMATOLOGIST: Busy dermatology and cosmetic surgery practice in Encinitas looking for a part- or full-time dermatologist. Will train in cosmetic procedures. Ideal candidate should have excellent leadership and organizational skills and have excellent patient rapport. There is great growth potential with this practice. If interested, please send your letter of interest and CV to dermmd10@gmail.com. [044]

PHYSICIAN POSITIONS AVAILABLE OPPORTUNITY KNOCKS FOR BC/BE PEDIATRICIANS: Live in one of the country’s most desirable locations and practice with a premier San Diego multispecialty medical group! Sharp Rees-Stealy Medical Group is looking for BC/BE Pediatricians. Competitive first-year compensation guarantee, excellent benefits, and shareholder eligibility after two years. Unique opportunity for professional and personal fulfillment while living in a vacation destination. Please send CV to Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 2334730. Email: Lori.Miller@sharp.com. [064]

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]

PRIMARY CARE/PSYCHIATRY JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com ) is a fast-growing group of house-call doctors. Great pay ($140–$220+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. [037] PHYSICIANS WANTED: Vista Community Clinic, a private, nonprofit clinic serving the communities of North San Diego County, has openings for part-time and perdiem positions. Five locations in Vista and Oceanside.

Family medicine, OB/GYN medicine, pediatric medicine.

Requirements: California license, DEA license, CPR, board certified, one (1) year post-graduate clinic experience. Bilingual English / Spanish preferred. Benefits: malpractice coverage. Email resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit website at www.vistacommunityclinic.org. EOE/M/F/D/V [035] MEDICAL DIRECTOR — SUNNY SAN DIEGO: County Psychiatric Hospital needs a full-time medical director.

This is a key leadership role in our very physician-friendly, dynamic behavioral health system. Facility includes an inpatient unit and a very busy psychiatric emergency unit. County has partnered with UCSD to develop a community psychiatry fellowship, and teaching opportunities will be available, though the facility does not do research. Medical director does limited direct clinical care.

Required: Proven administrative, leadership, and supervisory skills, and a “big-picture” orientation to help us evolve our entire system. Salary competitive and excellent County employee benefit package. San Diego combines the lifestyle of a resort community and the amenities of a big city. Hospital centrally located, minutes from many recreational opportunities and great residential communities. Wonderful year-round weather, of course!

CV and letter of interest can be submitted online at www. sdcounty.ca.gov/hr. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at gloria.brown@sdcounty.ca.gov, or Darah Frondarina, human resources specialist, at (858) 505-6534 or at darah.frondarina@sdcounty.ca.gov. Questions and interest can also be directed to Marshall Lewis, MD, Behavioral Health Clinical Director, Health & Human Services Agency, at marshall.lewis@sdcounty.ca.gov. [021]

Medical Office Space for Lease: Medical office space of 1,846 square feet located at 15721 Pomerado Road, Poway, CA 92064 in the Gateway Medical Center available for immediate lease. This recently remodeled facility has a shared waiting room, medical records storage area, front desk reception area, three exam rooms, nursing station, private office, shared bathroom. The larger space is shared with an internal medicine group and is blocks away from Pomerado Hospital. Imaging is located in an adjacent building. The lease rate is $1.69/ SF NNN with a 3% annual increase. The NNNs are currently running $0.73/SF. Tenant will be responsible for pro rata share of utilities and janitorial in addition to NNNs. Great opportunity in this affluent community.

Call Angie at (858) 605-9966. [065] OFFICE FOR LEASE SCRIPPS MEMORIAL HOSPITAL MEDICAL OFFICE BUILDING: La Jolla multispecialty group, excellent referral base, great location, corner office large windows, full- or part-time space available (one doctor retiring). Please call Dr. Shurman cell (858) 344-9024 or office (858) 320-0525. [058] 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] 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 if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 279-8111 or at (619) 823-8111. Thank you. [836] NEW — EXTREMELY LOW RENTAL RATE INCENTIVE — EASTLAKE / RANCHO DEL REY: Two office/medical spaces for lease. From 1,004 to 1,381 SF available.

(Adjacent to shared X-ray room.) This building’s rental rate is marketed at $1.70/SF + NNN; however, landlord now offering first-year incentive of $0.50/SF + NNN for qualified tenants and five-year term. $2.00/SF tenant improvement allowance available. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thoroughfares and walkable retail amenities. Please contact listing agents Joshua Smith, ECP Commercial, at (619) 442-9200, ext. 102. [006] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467

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.

34 SAN DIEGO PHYSICIAN.org august 2012

sq-ft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease/satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at mzarei@cox.net. [873] 3998 VISTA WAY, IN OCEANSIDE: Four medical office spaces approximately 1,300–2,800 square feet available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@coveycommercial.com. [965] 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] 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] NONPHYSICIAN POSITIONS AVAILABLE PART-TIME NURSE PRACTITIONER: Needed to work 20–25 hours a week for family practice/urgent care facility in Fallbrook. Candidate qualifications: MS in nursing for nurse practitioner, must have RN experience, and bilingual (Spanish/English) preferred but not required.

Interested applicant send resume to karenberrios@ fallbrookmedicalcenter.com or contact Karen Berrios at (951) 751-5593. Visit our website at www.fallbrookmedicalcenter.com. [060] PHYSICIAN ASSISTANT NEEDED: Physician assistant needed on per diem basis for busy urgent care in the San Diego North County area. Hours are evening and/ or weekends. Please send CV to judy@cassidymg.com or fax to (760) 630-2558. [056] LOOKING FOR A NURSE PRACTITIONER: Established, busy pain management practice in Mission Valley is looking for a nurse practitioner preferably experienced in pain management or family practice. Knowledge of controlled substance prescriptions and regulations is required. Interpretation of diagnostic tests and the ability to apply skills involved in interdisciplinary pain management is necessary.

We offer a competitive salary and benefit package that provides malpractice coverage, CME allowance, as well as an excellent professional growth potential. Please email your curriculum vitae/resume to sdpainclinc@yahoo.com. [052] MEDICAL BILLER NEEDED FOR BUSY PAIN MANAGEMENT CLINIC IN MISSION VALLEY: Must be knowledgeable and experienced with Allscripts Misys.

Please email references, contract, and terms to sdpainclinic@yahoo.com. [053] OB/GYN NURSE PRACTITIONER WANTED FOR BUSY WOMEN'S HEALTH OFFICE IN DEL MAR AREA: This position conducts annual pap smear exams, deals with all gynecological issues, IUD insertions, as well as obstetric patient weekly appointments. Triage and detailed discussions of lab results. Midwife experience a plus but not required. Ultrasound experience preferred but not required. Position is for Tuesdays and Thursdays, 8:30am

to 5:30pm. OB/GYN experience REQUIRED. Ability to keep up with a fast-paced schedule, 18–25 patients a day. Please contact us at cvwh858@gmail.com with resume and salary requirements. [050] PA NEEDED FOR DERMATOLOGY AND COSMETIC SURGERY PRACTICE IN ENCINITAS: Experience in general dermatology a must! Applicant must be knowledgeable in diagnosing and treating common dermatologic conditions, possess excellent interpersonal skills, be a caring and empathetic provider, and possess the highest of ethical standards. Being a team player and having a positive attitude is essential. Please forward resume and cover letter in Word format to dana@doctorlashgari.com. [049] PHYSICIAN ASSISTANT: Physician assistant needed for house-call physician in Coachella Valley (Palm Springs / Palm Desert). Part time, flexible days/hours. Competitive

compensation. Call (619) 992-5330. [038] MEDICAL EQUIPMENT MICROMAXX ULTRASOUND SYSTEM: MicroMaxx® Ultrasound System offers impressive image quality, wireless data transfer, and extreme durability. Portable unit that slides into a stand. The software is hard-wired and purpose-built for faster boot-up times (<15sec), faster digital image processing, and the ability to run for a long time.

Can take videos or print images. Comes with a 6cm Micromaxx M-Turbo 6-13mHz transducer (HFL38x). Our Price: $13,000. Compare: $45,999 (new). MicroMaxx Applications Include: Anesthesia; Critical Care; Cardiology; Cardiovascular Disease Management; Emergency Medicine; Musculoskeletal; OB/GYN; Radiology; Vascular; Surgery; Shared Service. Contact our office at sdvi.office@gmail. com or call (760) 944-9263. [043]

Where Are Your Patients Coming From?

Each month, every practicing physician in San Diego County receives a copy of this magazine.

What better way to ensure they know about your practice? We have advertising packages available at very attractive price points, and member physicians receive 50% off!

If your doors are open for business, keep patients coming in with a referral advertisement in San Diego Physician magazine.

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

august 2012 SAN DIEGO PHYSICIAN.org 35

Office Manager support

SDCMS’ 4th Annual

“Outstanding Medical Office Manager”

Contest Is Now Under Way Physicians: Nominate Your Office Manager Today!

SDCMS wants to recognize San Diego County’s most outstanding medical office manager: someone who goes above and beyond their job description, who anticipates problems before they arise, who works efficiently with the practice’s time and resources, who strikes the right balance between control and morale while supervising staff, and who gives the physician(s) the support needed to do what they do best: see patients!

Does your physician (or physicians) think you’re the best office manager in San Diego County? If so, we want to hear all about it!

SDCMS member physicians can nominate their office managers by explaining in writing (up to approximately 600 words) why their office manager is the best in San Diego County. We’re sorry, but staff cannot nominate their office managers — only letters written by SDCMS member physicians will be accepted.

Send nominations to SDCMS, Attn: Kyle Lewis, 5575 Ruffin Road, Suite 250, San Diego, CA 92123, or email them to KLewis@SDCMS.org.

The winner will receive a $250 gift card and recognition as SDCMS’ “Outstanding Medical Office Manager” for 2012. Nominations will be accepted until Sept. 30, 2012, and contest results will be published in the December 2012 issue of San Diego Physician magazine. Contact Kyle with any questions at (858) 300-2784 or at KLewis@ SDCMS.org.

Clockwise from left: 2009 Winner: Anne Billeter, Nominated by John A. LaFata, MD, SDCMS-CMA Member Since 1981; 2010 Winner: Sue Rose, Nominated by David Bodkin, MD, SDCMS-CMA Member Since 1990; 2011 Winner: Robert O’Meara, Nominated by Irwin Goldstein, MD, SDCMS Member Since 2007

36 SAN DIEGO PHYSICIAN.org august 2012

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, 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 11,500 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

37

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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 ]

We do what no other medical liability insurer does. We reward loyalty at a level that is entirely unmatched. We honor years spent practicing good medicine with the Tribute® Plan. We salute a great career with an unrivaled monetary award. We give a standing ovation. We are your biggest fans.

We are The Doctors Company.

Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our program for SDCMS members, including the Tribute Plan, call us at (800) 852-8872 or visit www.thedoctors.com/tribute.

Endorsed by

www.thedoctors.com Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

38 SAN DIEGO PHYSICIAN.org august 2012