March 2013

official publication of the san diego county medical society March 2013 San Diego Physician

celebrates

100 years

CMA Targets for

2013 “Physicians United For A Healthy San Diego”

ANNOUNCING

LOWER RATES FOR SOUTHERN CALiFORNiA PHySiCiANS

Save 37% UP TO

*

We’re lowering our rates for Southern California — save up to 37% (effective October 1, 2012, for new and renewal business).

NORCAL Mutual is renowned for great customer service, industry-leading risk management and outstanding claims expertise. And now with more competitive rates, there has never been a better time to join us.

What do our LoWEr ratEs mEan to you?

Call 877-453-4486. Visit norcalmutual.com/start for a premium estimate.

Our passion protects your practice

* We’ve lowered our rates in Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura counties. Premium impact varies by factors such as medical specialty and practice location.

B

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

“ We listen to policyholders. We provide solid advice and offer real-time solutions to real-time problems.”

Loss Prevention Senior Representative Kathy Kenady

Join the Insurance Company that always

puts their policyholders first.

MIEC has never lost sight of its original mission, always putting its policyholders (doctors like you) first. For over 30 years, MIEC has been steadfast in our protection of California physicians. With conscientious Underwriting, Policyholder Dividend Ratio* excellent Claims management and 49.2% 50% hands-on Loss Prevention services, 39.4% we’ve partnered with policyholders 38.1% 40% 31.5% to keep premiums low.

29.3% 30%

For more information or to apply: n n n

www.miec.com Call 800.227.4527 Email questions to underwriting@miec.com

25.6%

20% 10% 0%

11.8% 6.4%

2.2% 2007

2008

5.2% 2009

5.2% 2010

6.9%

7.1%

2011

Med Mal Industry (PIAA Composite)

2012

TBA

2013 MIEC

* (On premiums at $1/3 million limits. Future divide nds cannot be guaranteed.)

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800-227-4527 • www.miec.com SDCMS_ad_03.05.13

MIEC

Owned by the policyholders we protect.

this month Volume 100, Number 3

features CMA Targets for 2013 24 CMA Targets for 2013

BY DUSTIN CORCORAN

26 CMA Announces 2013–14 Sponsored Legislation 28 2013–14 Legislator Guide for San Diego County

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)

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

24

departments

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)

4 Briefly Noted

Calendar • Get in Touch • Commercial Real Estate Tips & Trends • And More …

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

10 Thank You to SDCMS’ Third-of-a-Century Members (Part 2) 12 Drug Rebates: Treating the Symptoms But Not the Disease of Financing Healthcare

other voting members Communications Chair: Theodore M. Mazer, MD (CMA SPEAKER) Young Physician Director: Van L. Cheng, MD

by SHERRY L. FRANKLIN, MD

Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Suraj Kedarisetty

16 DSM 5: Major Changes in Diagnosing Mental Illness

12

by TIMOTHY MURPHY, MD, AND STEVE KOH, MD, MPH, MBA

18 The Opposite Is Also True

by HELANE FRONEK, MD, FACP, FACPH

20 Counting by Cancer

by DANIEL J. BRESSLER, MD

22 Relying Too Much on Intuition Is Risky

by THE DOCTORS COMPANY

34 Physician Marketplace

Classifieds

Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Stuart A. Cohen, MD, MPH CMA Past Presidents: James T. Hay, MD (AMA DELEGATE), 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 Mehta, MD

36 San Diego Physician Celebrates 100 Years

May 1951

16 2 march 2013

OTHER NONVOTING MEMBERS Young Physician Alternate Director: Renjit A. Sundharadas, MD

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

brieflynoted calendar SDCMS Seminars, Webinars & Events SDCMS.org/event

For further information or to register for any of the following SDCMS seminars, webinars, or workshops, visit www.

SDCMS.org/event or contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org.

The Allied Health Professional: What You Need to Know Before Hiring (seminar/webinar) APR 11 • 11:30am–1:00pm CURES Sign-up Event APR 12 • 12:00pm-7:00pm HIPAA Omnibus Rule (webinar) APR 17 • 11:30am-1:00pm Contracting (seminar/webinar) APR 25 • 11:30am–1:00pm Media Training (workshop) APR 27 • 8:00am–12:00pm

Cma Webinars

CMAnet.org/events

Strategic Planning From Vision to Action: A Self-guided Process APR 3 • 12:15pm–1:15pm

CMS Incentives and Payment Adjustments: What You Need to Know APR 9 • 12:15pm–1:15pm

17th Annual Heart Failure 2013 APR 6 • Millennium Biltmore Hotel, Los Angeles • www.laheartfailure.com

Preparing for EHR Implementation and Conversion APR 10 • 12:15pm–1:15pm

14th Annual Sharon’s Ride.Run. Walk for Epilepsy APR 14 • 7:30 Registration, 8:45 Bike Ride, 9:30 5K, De Anza Park, Mission Bay, San Diego • http://sharonsride2013. kintera.org

Valuing, Selling, Buying, or Transitioning a Practice APR 17 • 12:15pm–1:15pm California’s Health Benefit Exchange: How It Will Impact Your Practice and Change Commercial Insurance APR 24 • 12:15pm–1:45pm

Community Healthcare Calendar

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.

Volunteers Needed for RAM California Expedition (free medical, dental, and vision clinic) APR 4–7 • Riverside / Indio Fairgrounds • www.ram-ca.org

Become an SDCMS Featured Member!

Mindfulness in Clinical Practice: Our Patients Ourselves MAY 11 • All-day CME (6.75hrs) Workshop • Presented by the UCSD Center for Mindfulness • cme.ucsd.edu/mindfulness/ mcp_workshop_051113_home. html DSM 5: What You Need to Know JUN 8–9 • 8:00am–5:50pm on Saturday, 8:00am–12:30pm on Sunday • Hyatt Regency La Jolla Hyatt • www.dsm5sandiego.org RCMA’s “Cruisin’ Thru CME” — French Waterways: Highlights of Burgundy & Provence JUL 1–13 • Call RCMA at (800) 472-6204

SDCMS Member Physicians: If you

are interested in learning more about joining the San Diego Physician editorial board, please email Editor@SDCMS.org.

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

“

”

Whatever limits us we call Fate.

4 march 2013

— Ralph Waldo Emerson

get in touch Your SDCMS and SDCMSF Support Teams Are Here to Help!

SDCMS Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO • EXECUTIVE DIRECTOR Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO • CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org DIRECTOR OF 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 RECRUITING AND RETENTION Brian R. Gerwe at (858) 300-2782 or at Brian.Gerwe@SDCMS.org DIRECTOR OF MEMBERSHIP OPERATIONS Brandon Ethridge at (858) 300-2778 or at Brandon.Ethridge@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 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 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 RESOURCE DEVELOPMENT DIRECTOR Nicole Hmielewski at (858) 565-7930 or Nicole.Hmielewski@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

Commercial Real Estate Tips & Trends

Physician-friendly Lease Provisions to Negotiate

By Chris Ross

A

s the landscape of healthcare evolves and a lack of predictability persists, now is as important a time as ever to negotiate certain provisions into your lease the next time you renew or relocate.

First and foremost, having favorable assignment and subletting language will help you avoid headaches down the road if at some point you sell your practice. More importantly, since medical office lease terms are generally five to 10 years or longer, keep in mind that when a lease is assigned, the assigner typically remains liable for the lease obligations for the remainder of the term. Many times you can negotiate a provision whereby the assigner is released from liability within a reasonable period of time after the date of assignment, minimizing your potential exposure should the assignee have problems paying the rent.

Another clause that improves flexibility is a right to terminate the lease. Typically, there is a certain amount of advance notice that the tenant will need to provide to the landlord in order to exercise a termination right, along with a reasonable termination fee; but at a bare minimum, having the right to terminate your lease will cap your out-of-pocket expenses should you need to break your lease for any reason. Similarly, ask your broker to negotiate a death and disability clause (again, with reasonable notice and fee), as it will offer you similar “insurance” should unforeseen circumstances arise.

Depending on the market conditions in your area, these provisions can be difficult to achieve, but they are at the very least worth exploring with your broker. If the landlord is motivated, you might have some luck.

Submarket Snapshot: Kearny Mesa Overview Nearly one-third — or approximately 350,000 square feet — of Kearny Mesa’s/Mission Valley’s medical building inventory is comprised of the five Frost Street buildings located directly across the street from Sharp Memorial Hospital and Rady Children’s Hospital.

About one-third of the remaining inventory is within a half-mile of those campuses, with the rest scattered throughout other areas of this Central San Diego submarket.

Net absorption was -400 square feet in Q4 2012 and +2,356 square feet on the year.

Given the near-zero net demand and the fact that we had no new deliveries in

Construction Spotlight Kaiser Permanente has finished construction of its new 71,000-square-foot medical office building on Craven Road in San Marcos, adjacent to its existing 149,000-square-foot MOB. The $60 million building houses an ambulatory surgery center, nuclear medicine, a GI procedure suite, and specialty care. The building marks Kaiser’s fourth new facility in the past four years — a total of 401,000 square feet of new space, excluding the land the company currently has in escrow for its new 350-bed hospital in Kearny Mesa.

Kearny Mesa in 2012, vacancy essentially remained unchanged in Q4 compared to the prior quarter at 12.4%, a slight decrease from the 2011 year-end rate of 12.6%. This marked the fifth straight year in which vacancy came in between 12 and 14%.

Rents have steadily declined from their peak of $2.87/square foot full-service in Q4 2007 to $2.27 in Q4 2012 — a 21% decrease over that time and a 4% decrease from the $2.36 rate that we saw at Q4 2011. This is somewhat misleading, however, as many physicians in the area have upgraded from Class “B-” and “C” buildings to newer Class “A” developments, meaning most of the vacancy currently lies among older MOBs with depressed rental rates.

Forecast Only three of the 36 medical buildings in the Kearny Mesa/Mission Valley submarket currently contain more than 10,000 square feet of aggregate vacancy.

Only two of the three

(7930 Frost Street and now Mesa Medical Plaza, recently acquired by neurosurgeon Scott Leary, MD) are available to private practices since Rady’s is highly selective as to which specialties it will accommodate in its Frost Street buildings.

With Sharp Memorial Hospital being Sharp’s anchor hospital — the largest of any hospital in the county — and Rady Children’s Hospital also having the strength and reputation that it does, demand should remain steady in this area.

With no new MOB construction on the horizon, vacancy should continue its downward trend in 2013 and may dip into the single digits in the next 18–24 months. Rental rates will likely stabilize in the year ahead and start to trend upward by 2014.

Mr. Ross is vice president of healthcare real estate services at Colliers International. He is a commercial real estate broker specializing exclusively in medical office and healthcare facilities in San Diego County. He can be reached at (858) 677-5329 or at chris.ross@colliers.com.

SAN DI EGO PHYSICIAN.org 5

brieflynoted Letters to the editor

SDI Online

Now Available: State Disability Insurance Online Poster!

By Laurel Waters, MD, FCAP, FASCP The California Employment Development Department (EDD) has implemented a new electronic claim filing system, known as State Disability Insurance (SDI) Online, for claimants, physicians/practitioners, employers, and voluntary plan administrators.

SDI Online is secure and convenient. When a patient files their claim online, the physician/practitioner or their authorized representative is able to electronically certify the claim using SDI Online. This secure online system provides expedited claim processing for patients and will save physicians/practitioners time and money.

To increase awareness of this new online system, the EDD has created a poster to promote and encourage the participation and use of SDI Online. To download a copy of the poster for your office, visit our website at www.edd.ca.gov/Forms/. Search for keyword “SDI Online poster.”

You may also order hard copies of EDD forms, including the Claim for Disability Insurance Benefits, DE 2501, from this website. Orders may take two to four weeks for delivery.

To register for an SDI Online account, or to add an authorized representative to certify for your practice, visit our website at www.edd.ca.gov/Disability. For more information, call the phone line dedicated to physicians/practitioners at (855) 342-3645.

6 march 2013

Dear Editor: Typically, I read most of the content of the Physician with respect and thankfulness. This time the juxtaposition of David Bressler’s “Undressed” and “Mindfulness in Clinical Practice” troubled me [see February 2013 issue]. My father, a fine, small-town physician, and the good physicians before and after him fully accepted the permanently intertwined mind and body. A significant, and, I perceive, growing problem in medicine, is the profoundly counterproductive process, subliminal and sometimes not, of diagnosis and treatment of the body while ignoring its mind. At best Dr. Bressler’s poem and narrative confused me.

I am confident that the mindfulness workshop will profoundly support the inseparable mind-body in the patient and the physician.

As usual, James Grisolia’s essay pleased me.

I am disappointed, often, that my specialty — psychiatry and sub-specialty child and adolescent psychiatry — is usually absent in your issues. Clearly with the mindfulness article, adult psychiatrists are represented and I thank you for that.

Larry Schmitt, MD, Retired SDCMS-CMA Member Dear Editor, Although I might disagree with the Feb. 20, 1931, Bulletin’s allusion to the danger of private capital [see February 2013 issue], the editor’s willingness to speak out contrasts with the gutless medical leadership with which we are now afflicted. Today, we are ignoring — to our profession’s and country’s detriment — a failed president’s intention to establish single-payer (meaning federal) medical insurance. Nor is Obama interested in the welfare of the “common man,” but, instead, the shepherding of tax dollars to retain power and further install his destructive socialistic national vision.

Jon Lischke, MD, SDCMS-CMA Member Since 2005

Your Healing.

Hip replacement that gets you back in balance faster.

If your bones and joints are slowing you down, you don’t have to live with the pain. At Tri-City Medical Center’s Orthopaedic and Spine Institute, our advanced surgical techniques include the use of a hana® operating table. This state-of-the-art tool gives surgeons like Dr. Joel M. Heiser (pictured) an innovative option for hip replacement. We are also home to San Diego’s only Mazor Robotics guidance system for spinal surgery and the exclusive e+™ Vitamin E total knee replacement procedure. At Tri-City Medical Center, we believe as we progress, so does your health.

For more information, call (855) 222-8262 or visit TRICITYMED.ORG/ORTHO SAN DI EGO PHYSICIAN.org 7

brieflynoted membership

Welcome Our New and Rejoining SDCMS-CMA Members!

New Members Justin M. Brown, MD Neurological Surgery La Jolla • (619) 471-9398 Ithaar H. Derweesh, MD Urology • La Jolla Harold M. Hoffman, MD Allergy and Immunology San Diego • (858) 966-5961 Melissa E. Hurd, MD Family Medicine Vista • (760) 758-1988 Lawrence S. Prince, MD Pediatrics San Diego • (858) 966-8567 David D. Rotenberg, MD Orthopedic Sports Medicine San Diego • (858) 571-0606 Robert T. Schooley, MD Internal Medicine San Diego • (858) 822-0216 Andrew J. Skalsky, MD San Diego • (858) 966-8567 Maria L.A. TiamsonKassab, MD Psychosomatic Medicine San Diego • (858) 552-8585 Christopher J. Wahl, MD Orthopedic Surgery La Jolla • (619) 471-9398 Kimberly H. Wright, MD Diagnostic Radiology Escondido • (760) 739-5400 Rejoining Members Natalia Y. Cherepnina, MD Critical Care Medicine La Mesa • (619) 460-1441 Lorne D. Kapner, MD Ophthalmology Escondido • (760) 738-9985

8 march 2013

website spotlight

CDC WONDER: Information and Communication http://wonder.cdc.gov/

CDC WONDER is an easy-to-use, menu-driven system that makes the information resources of the Centers for Disease Control and Prevention (CDC) available to public health professionals and the public at large. It provides access to a wide array of public health information.

CDC WONDER furthers CDC’s mission of health promotion and disease prevention by speeding and simplifying access to public health information for state and local health departments, the Public Health Service, and the academic public health community. CDC WONDER is valuable in public health research, decisionmaking, priority setting, program evaluation, and resource allocation.

CDC WONDER is an integrated information and communication system for public health. Its purposes are: 1. to promote information-driven decision-making by placing timely, useful facts in the hands of public health practitioners and researchers, and

2. to provide the general public with access to specific and detailed information from CDC. With CDC WONDER you can: • access statistical research data published by CDC, as well as reference materials, reports, and guidelines on health-related topics; • query numeric data sets on CDC’s computers, via “fill-in-the blank” webpages. Public-use data sets about mortality (deaths), cancer incidence, HIV and AIDS, tuberculosis, vaccinations, natality (births), census data, and many other topics are available for query, and the requested data are readily summarized and analyzed, with dynamically calculated statistics, charts, and maps.

The data is ready for use in desktop applications such as word processors, spreadsheet programs, or statistical and geographic analysis packages. File formats available include plain text, webpages, and spreadsheet files. All of these facilities are menu-driven and require no special computer expertise.

Special mortgage financing for physicians Our special home financing program is designed specifically to meet your needs as a busy physician for the purchase of your primary residence.

• Financing available with low down payment up to $1,750,000; refinances with high loan-to-values also available • Private mortgage insurance is not required • Single family homes are eligible

For details contact or visit: Daniel Schroeder Mortgage Banking Officer NMLS# 633034 Daniel Schroeder (858) 356-2601 Daniel.Schroeder@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.

thank you to the following third-of-a-century members Doctors: In the laudable process of recognizing SDCMS physicians who have been members for more than a third of a century, we managed to slight these physicians in the January issue of San Diego Physician. Apologies. I, as the CEO, take full responsibility for not thinking through our process carefully enough — a process we will change going forward. Thank you third-of-acentury members for your long-term support of SDCMS and CMA, and, again, please accept my apologies.

SDCMS Member Physician’s Name, Years of Membership

Joseph De Luca, MD, 66

Lino P. Trombetta, MD, 54

Milan L. Brandon, MD, 53

John C. Carson, MD, 52

Marjorie A. Crews, MD, 52

Margaret E. Branscom, MD, 45

Robert A. Bullock, MD, 45

George N. Riffle, MD, 45

Myron Schonbrun, MD, 45

John A. Berger, MD, 44

Duane Blickenstaff, MD, 44

Allan H. Goodman, MD, 44

Leonard David Rutberg, MD, 44

Harold J. Simon, MD, PhD, 44

John J. Lilley, MD, 36

Peter H.B. McCreight, MD, 36

Richard O. Butcher, MD, 43

James C. Esch, MD, 43

George W. Kaplan, MD, 43

Miguel A. Losada, MD, 43

William L. Nyhan, MD, 43

Leonard S. Bernstein, MD, 42

Raymond M. Peterson, MD, 42

Robert Matthew Thomas, MD, 42

William G. Moseley, MD, 41

C. Plowden Bridges, MD, 40

Anthony J. Cuomo, MD, 40

Edward M. Goldstein, MD, 40

Carlos J. Sanchez, MD, 40

Dennis F. Coughlin, MD, 39

Jerome S. Litvinoff, MD, 39

Dee Edward Silver, MD, 39

Thomas R. Vecchione, MD, 39

Elaine H. Cohen, MD, 38

Ronald E. Feldman, MD, 38

Richard G. Just, MD, 38

Michael I. Keller, MD, 38

Yaroslav Kushnir, MD, 38

John B. Marino, MD, 38

Martin Joseph McGreevy, MD, 38

Gerald W. Ondash, MD, 38

Fernando A. Zamudio, MD, 38

Lawrence P. Bogle, MD, FACR, 37

John Michael Casey, MD, 37

Paul B. Dean, MD, 37

Steven D. Emmet, MD, 37

Nicholas R. Frost, MD, 37

Richard Greenfield, MD, 37

10 march 2013

Danny L. Keiller, MD, 37

Daniel J. Marnell, MD, 37

Lawrence S. Rice, MD, 37

Heini Robin Rinderknecht, MD, 37

Robert M. Stein, MD, 37

Patricia C. Venn-Watson, MD, 37

Donald C. Balfour, MD, 36

Richard L. Buccigross, MD, 36

K. Cameron Campbell, MD, 36

Lawrence Nathan Cooper, MD, 36

Frank E. Corona, MD, 36

John H. Detwiler, MD, 36

Jeffrey I. Gorwit, MD, 36

William S. Halsey, MD, 36

P. Lance Hendricks, MD, 36

Rodney G. Hood, MD, 36

Wayne L. Iverson, MD, 36

Sandra L. Jassmann, MD, 36

L. Dale Lapp, MD, 36

S. Y. Thomas Song, MD, 36

Paul F. Speckart, MD, 36

Richard L. Stennes, MD, 36

Heywood W. Zeidman, MD, 36

Victor M. Dalforno, MD, 35

Terence M. Davidson, MD, 35

Richard A. Katz, MD, 35

Paul K. Raffer, MD, 35

Edward L. Singer, MD, 35

Steven M. Steinberg, MD, 35

William D. Tench, MD, 35

Douglas A. Wemmer, MD, 35

Paul J. Zlotnik, MD, 35

Edward S. Colby, MD, 34

J. Terence Daly, MD, 34

Edward B. Friedman, MD, 34

Robert N. Hamburger, MD, 34

James A. Helgager, MD, 34

Donald C. Lipkis, MD, 34

Harrison R. McDonald, MD, 34

Robert S. Segnit, MD, 34

Paul L. Treger, MD, 34

Leon Fajerman, MD, 33

Robert A. Ginsberg, MD, 33

Michael Gordon, MD, 33

Louis J. Levy Jr., MD, 33

Ben Medina, MD, 33

Eugene W. Rumsey, MD, 33

Pritam Singh, MD, 33

William I. Stanton, MD, 33

Laurence K. Tanaka, MD, 33

Carol L. Young, MD, 33

Robert W. Ziering, MD, 33

George G. Zorn, MD, 33

SAN DI EGO PHYSICIAN.org 11

Healthcare Financing

EDITOR’S NOTE: On various issues, healthcare stakeholders — doctors, hospitals, nurses, health plans, etc. — may find themselves on the same or opposing sides. Often we overlook opportunities where the sometimes opposing stakeholders may have agreement on an issue and could better collaborate, rather than ignore the opportunity to work together. Finding common ground may also at times lead to finding opportunities to resolve our differences on issues. The following article by President Sherry Franklin, MD, evolved after some discussions between a leader in the physician community and an advocate from Pharma, and demonstrates where such discussions may lead to opinions by which stakeholders may find common ground on an issue and work toward a mutual goal.

Drug Rebates

Treating the Symptoms But Not the Disease of Financing Healthcare

by Sherry L. Franklin, MD President, SDCMS

12 march 2013

President Obama has proposed requiring that prescription drug manufacturers pay rebates to the federal government for drugs dispensed to Medicaid/Medicare dual-eligible beneficiaries and other low-income seniors through the Medicare Part D program. The required rebates would be in addition to the manufacturer-paid rebates already in the Part D program.

The Medicaid program is the thirdlargest source of health insurance in the United States, after employer-based coverage and Medicare. As the largest program in the federal “safety net” of public assistance programs, Medicaid provides essential medical and medically related services to the most vulnerable populations in society. In general, Medicaid provides three types of critical health protection: (1) health insurance for low-income families with children and people with disabilities; (2) long-term care for older Americans

and individuals with disabilities; and (3) supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare (e.g., outpatient prescription drugs) and Medicare premiums, deductibles, and cost-sharing.

The Medicaid program is jointly financed by the states and the federal government. Medicaid is an entitlement program, and the federal spending levels are determined by the number of people participating in the program and services provided. Federal funding for Medicaid comes from general revenues. There is no trust fund for Medicaid as there is for Medicare Part A or Social Security. The federal government contributes between 50% and 83% of the payments for services provided under each state Medicaid program. This federal matching assistance percentage (FMAP) varies from state to state and year to year because it is based on the average per capita income in each state. The lack of appropriated funding for Medicaid leaves the program unable to provide the appropriate care for its enrollees unless other mandates, such as the drug rebate program, are instituted.

The Medicaid Drug Rebate Program, instated on Jan. 1, 1991, is a partnership between the Centers for Medicaid and Medicare Services (CMS), state Medicaid agencies, and participating drug manufacturers that helps to offset the federal and state costs of most outpatient prescription drugs dispensed to Medicaid patients. The program requires a drug manufacturer to enter into a national rebate agreement with the secretary of the Department of Health and Human Services (HHS) in exchange for Medicaid coverage of most of the manufacturer’s drugs. Manufacturers are then responsible for paying a rebate on those drugs each time they are dispensed.

Initially for brand-name drugs the rebates were set to the greater of 12.5% of the average manufacturer price (AMP) or the difference between AMP and the “best price” offered to any payer. For generic drugs, the initial rebate was 10% of AMP. These minimum rebate percentages were, as would be expected, increased over time.

The Patient Protection and Affordable Care Act (PPACA) increased the minimum rebate amounts even further, effective Jan. 1, 2010, to 23.1% of AMP for most brandname drugs, 17.1% of AMP for clotting factors and pediatric-only drugs, and 13% of AMP for generic drugs.

Separately, in 2006 Medicare began to cover prescription drugs under Part D, created by the Medicare Modernization Act (MMA). Part D is available to all Medicare beneficiaries. However, those eligible for both Medicare and Medicaid (Medi/Medi or dual-eligibles), as well as several million other low-income Medicare beneficiaries not eligible for Medicaid, receive additional “low-income subsidies” (LIS) to pay the Part D premium and all or part of the co-payments.

Part D plans (and Medicare Advantage plans that include prescription drug coverage) are run by private companies and therefore do not receive statutory Medicaid drug rebates for their enrollees who are eligible for Medicaid. However, Part D plans negotiate with drug manufacturers for, and receive, rebates that apply to prescriptions filled by all their enrollees, not just those who are eligible for Medicaid or LIS. Any given Part D plan may not receive rebates for all drugs from all manufacturers. In fact, part of the reason Part D works is that drug makers compete for preferential access to Part D enrollees.

For example, a Part D plan might negotiate with a drug maker to offer placement on a preferred formulary tier (translating further into a lower co-pay for members) in exchange for a larger rebate (that is, a lower price to the Part D plan). This competition can be very effective, and it is part of the reason that, unique among government health programs, Part D spending is running substantially less than initially projected. Allowing the private sector to find competitive ways to save money for its publically covered and privately covered members is a win-win for all involved, including the taxpayer.

Recently, however, the administration has proposed requiring brand and generic drug makers to pay to the federal government the same percentage rebates they pay in the Medicaid program (in addition to those already paid to Part D plans), for Medicare Part D enrollees who are eligible for Medicaid and for those LIS beneficiaries not eligible for Medicaid. At a minimum, these additional rebates would constitute a direct, dollar-for-dollar reduction in revenue to the pharmaceutical industry.

Although this may not seem like a problem for physicians and their patients, it will impact both directly. In a less-than-best case, the rebates would make at least some SAN DI EGO PHYSICIAN.org 13

Healthcare Financing

TrusT A Common sense ApproACh To InformATIon TeChnology Trust us to be your Technology Business Advisor hArdwAre  sofTwAre neTworks emr ImplemenTATIon seCurITy  supporT mAInTenAnCe

(858) 569-0300

www.soundoffcomputing.com

Endorsed by

14 march 2013

drugs outright money-losers; these drugs would then be withdrawn from the market. The reduction in revenue would likely result in reduced investment in research and development, slowing the process of bringing newly needed medications to the market. Furthermore, revenue reduction to the pharmaceutical industry would inevitably be absorbed through what is commonly known as “cost-shifting” to private payers.

In other words, where will the lost money be made up for the pharmaceutical company? It will inevitably be made up on the backs of employer-based plans, the employer, and the patient. This is what we have been doing with Medicare for decades.

The fundamental problem: To borrow a healthcare slogan, we are treating the symptoms, not the disease, of financing healthcare.

Put simply, when a Medicare beneficiary goes to the doctor or a hospital, the payment isn’t covering the true cost of the visit. The employer-based plans are making up the difference. With a yearly increase in cost-shifting, employers have begun to do their own cost-shifting by increasing the out-of-pocket expense covered by the employee. If that weren’t enough, the latest employer survival mode cost-shifts based on salary. More and more employers are asking their higher-paid employees to fork over a higher percentage of their wages for health benefits than lower salaried employees. The rationale? Employers have already realized they can’t afford to absorb the escalating costs themselves, but they are also cognizant their lower-income-earning employees will be quickly upside down beneath a lateral shifting of costs. And they are probably right — the latest studies showing employee premium increases already outweighing salary increases over the past five years, nearly three to one. Employers who aren’t cost-shifting primarily to the higher paid are finding other ways to redistribute

or “bury” the cost increases through increasingly complicated benefit design changes. Elevating dependent care costs, increased hospital/emergency room visit costs, and confusing circumstantial cost changes to plan designs leave employees wondering whether they are completing benefit enrollment or combing through the minutiae of the latest Ponzi scheme.

The new pharmaceutical mandate for drug rebates for dual-eligibles will compound our already horribly cost-shifted system. The fundamental problem: To borrow a healthcare slogan, we are treating the symptoms, not the disease, of financing healthcare.

References: • Martin Gaynor, Jian Li, and William B. Vogt, “Substitution, Spending Offsets, and Prescription Drug Benefit Design,” Forum for Health Economics and Policy, vol. 10, no.

2 (2007), pp. 1–31.

• Baoping Shang and Dana P. Goldman.

Prescription Drug Coverage and Elderly Medicare Spending, Working Paper No. w13358 (Cambridge, Mass.: National Bureau of Economic Research, September 2007).

• John Hsu et al. “Unintended Consequences of Caps on Medicare Drug Benefits,” New England Journal of Medicine, vol. 354, no. 22 (2006), pp. 2349–2359.

• Amitabh Chandra, Jonathan Gruber, and Robin McKnight. “Patient Cost Sharing and Hospitalization Offsets in the Elderly,” American Economic Review, vol. 100, no. 1 (2010), pp. 193–213. Christopher C. Afendulis and others, “The Impact of Medicare Part D on Hospitalization Rates,” Health Services Research, vol. 46, no. 4 (2011). pp.

1022–1038.

• J. Michael McWilliams, Alan M. Zaslavsky, and Haiden A. Huskamp. “Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults with Limited Prior Drug Coverage,” Journal of the American Medical Association, vol. 306, no. 4 (2011), pp. 402–409.

• Yuting Zhang et al. “The Effect of Medicare Part D on Drug and Medical Spending,” New England Journal of Medicine, vol.

361, no. 1 (2009). pp. 52–61.

• Kaiser Family Foundation. “Expanding Medicaid under Health Reform: A Look at Adults at or below 133% of Poverty,” April 2010.

• California Welfare and Institutions Code § 14103.6 • Antos & King. “Tampering with Part D Will Not Solve Our Debt Crisis,” American Enterprise Institute Health Studies Working Paper, June 2011.

HSY-905-PAC-Ad-SDCMS

San Diego Physician Magazine Full-page, non-bleed 7.25�w x 9.875�h

WR__________DE__________SL__________ED__________

One Place One number offers 80 + medical specialties

gives you access

Physician Access is a dedicated line that allows you to speak directly with one of our physicians at UC San Diego Health System. This number gives you real and immediate access to a fellow physician, and a trusted partner. So whether you want to talk about a particular case, facilitate a transfer or refer your patient for highly specialized care, our physicians are standing by to take your call.

855-543-0555 | health.ucsd.edu/access

CMYK sp

Mental Illness

DSM 5 Major Changes

in Diagnosing Mental Illness

by Timothy Murphy, MD, and Steve Koh, MD, MPH, MBA

16 march 2013

Recognition and treatment of mental health disorders are significant concerns for all physicians, particularly those in primary care, as they provide the majority of the country’s mental healthcare. Studies indicate that between 11% to as many as 40% of primary care patients have a psychiatric disorder (a National Ambulatory Medical Survey 2008 Survey Tables; Center for Disease Control, Mental Health Work Group, 4770 Buford Hwy, NE MS K-51, Atlanta, Ga. 30341-3717.). Just as important, it is well known that those with mental illness have shorter life expectancy and those with chronic diseases with mental illness have poor outcomes. With these facts in mind, the publication of DSM 5 — the Diagnostic and Statistical Manual of Mental Health Dis-

orders — is a major event for all physicians.

The DSM provides standard criteria for the diagnosis and classification of psychiatric disorders, and is used in this country and in much of the world. The DSM was first published in 1952 and has undergone several versions with the continuing advances in mental health research.

The launch of DSM 5 in May marks its first overhaul since 1994, culminating a monumental undertaking that involved the efforts of top psychiatric researchers for most of the past decade. A cast of thousands representing expertise in all areas of mental health spent countless hours to develop DSM 5.

The goal of DSM 5 is to incorporate the most important findings from genetic,

In partnership with the American Psychiatric Association, the San Diego Psychiatric Society has organized a 1½-day CME conference devoted to DSM 5 to be held at the La Jolla Hyatt at Aventine on June 8–9 (www. dsm5sandiego.org). neurobiological, and treatment research.

It incorporates a developmental approach to psychiatric disorders and recognizes the influence of culture and gender. There is a movement toward use of dimensional measures to rate symptom severity, and the presence of symptoms that may not be specific to a diagnosis but that are nonetheless important (e.g., insomnia in a patient with schizophrenia). Another important goal was to harmonize DSM with that of ICD text, paralleling changes anticipated for ICD-11.

The work on DSM 5 has been unprecedented. From 1999 to 2002, the American Psychiatric Association worked with the National Institute of Mental Health, the World Health Organization, and the World Psychiatric Association to develop the overarching research criteria. From 2004 to 2008, hundreds of articles were written synthesizing the current state of knowledge, and recommendations were developed. Workgroup members were selected, representing 90 academic institutions; 30% were international. Task group members included psychiatrists, psychologists, statisticians, epidemiologists, social workers, speech and hearing specialists, and family representatives. All task group and work group members were vetted against any undue outside influences (such as pharmaceutical and industry conflicts). More than 300 outside advisers contributed to DSM 5, including many non-psychiatric physicians, and the draft manual was overseen by separate, independent scientific and public health committees. In an unprecedented effort to solicit input from the public, draft versions of DSM 5 were posted

on the internet. Nearly 11,000 comments were received and reviewed, significantly impacting the final draft. After exhaustive work, draft DSM 5 criteria were subjected to field trials at 11 academic medical centers in North America and in community and individual practitioners’ offices. Overall, about 3,500 patients were evaluated in the field trials.

DSM 5 workgroups evaluated mountains of research on mental disorders, concluding that certain diagnoses should be changed, others added, and some eliminated altogether. Among the changes: The 5 Axis system, which has separated certain psychiatric conditions from personality disorders and medical conditions, has been eliminated. Asperger’s disorder, pervasive development disorder, and autism have been combined into a single condition: autistic spectrum disorder. Chronically sullen children who experience frequent, severe, angry emotional outbursts may meet criteria for a newly described mood disorder: disruptive mood dysregulation disorder. The diagnosis of hypochondriasis has been replaced with somatic symptom disorder, the core symptom being anxiety that is grossly out of proportion to an identified medical problem. Dementia and mild cognitive impairment will be renamed as neurocognitive disorders, categorized by severity. The bereavement exclusion has been eliminated in the diagnosis of major depressive disorder. Hoarding disorder and excoriation (skin picking) disorder have been added to a new category: obsessivecompulsive and related disorders. Nearly every category of disorder will see changes — some large, some fairly small.

San Diego psychiatrists have played a major role in the creation of DSM 5. Dr. Dilip Jeste, Estelle and Edgar Levi Chair in Aging at UCSD and SDCMS-CMA member since 2011, is the current president of the American Psychiatric Association and served as chair of the Workgroup on Neurocognitive Disorders. Joel Dimsdale, MD, professor emeritus at UCSD, chaired the Workgroup on Somatic Symptom Disorders, Murray Stein, MD, professor of psychiatry and family and preventative medicine at UCSD, served on the Anxiety

Disorders Workgroup, and Marc Schuckit, MD, distinguished professor of psychiatry at UCSD, served on the Substance-related Disorders Workgroup.

DSM 5 will be formally published in May of 2013. As physicians, we must be prepared to learn about its differences from DSM-IV-TR and how it should be properly utilized in the clinical setting. In partnership with the American Psychiatric Association, the San Diego Psychiatric Society has organized a one-and-a-half-day CME conference devoted to DSM 5 to be held at the La Jolla Hyatt at Aventine on June 8–9 (www.dsm5sandiego.org). Presenters include many of the individuals who helped write it. Dr. Darrel Regier of the American Psychiatric Association and vice chair of the DSM 5 project will open the event. Presenters also include two past APA presidents, researchers from UCSD, UCLA, Harvard, New Mexico, Johns Hopkins, and the Menninger Clinic at Baylor. They will present the changes to the DSM, describing the evidence that led to those changes. At breakout sessions, the new criteria will be illustrated through application to clinical vignettes.

Presenters at the June event will be making the case that the changes being made to the diagnosis of psychiatric conditions are based on advances in neuroscience, clinical experience, objective evidence, and data, and that they will improve the quality of care for the mentally ill. The potential impact of DSM 5 to physicians working with mental illness cannot be overemphasized. As physicians specializing in mental health, we hope to provide collaboration and guidance to our physician colleagues in the coming changes.

For SDPS DSM 5 Conference and other inquiries, contact Janelle Kistler, executive director of the San Diego Psychiatric Society, at Janelle.Kistler@sdcms.org or at (858) 300-2787.

Dr. Murphy, SDCMS-CMA member since 1999, is president-elect of the California Psychiatric Association. Dr. Koh, SDCMS-CMA member since 2009, is president-elect of the San Diego Psychiatric Society.

SAN DI EGO PHYSICIAN.org 17

Physician-Patient Communications

The Opposite Is Also True

by Helane Fronek, MD, FACP, FACPh

I recently saw a frustrated patient whose physician had quickly scheduled a procedure without much explanation. Increasingly squeezed for time, even those of us who tend toward explanation may leave this part out of the patient encounter. Still, I was irritated as I thought, “That physician should have explained this!” Fortunately, this thought was followed by some wiser words that a friend recently saw on a bumper sticker: THE OPPOSITE IS ALSO TRUE The work of Byron Katie (www.thework. com) can help whenever we are caught in the rigid thinking that rejects the reality of what is happening. We can all remember a time (or a thousand) when our insistence that something should be different caused us anxiety, grief, ruined relationships, or missed opportunities.

18 march 2013

Katie suggests that whenever we have a thought that something should not be the way it actually is, we ask four questions and then turn the thought around. For example, I would take my statement, “The physician should have explained this to the patient,” and ask: 1. Is this true? Well, I certainly believe it’s true!

2. Can you absolutely know that it’s true? I guess not. Nothing terrible happened to the patient, and this is how the physician’s successful practice operates. I guess it’s just my opinion!

3. How do you react when you think that thought? I get angry and resentful, and that certainly doesn’t feel good. These feelings distract me from focusing on what I’m doing.

4. Who would you be without the thought? I would be happier and more peaceful. I would treat the patient as I thought appropriate and not waste time or energy on ill feelings toward the other physician. (At this point, I’m really starting to want to drop this thought.)

Then, turn the statement around, and see if any of them are at least as true, if not more so: 1. The physician should NOT explain this to the patient. I can imagine that there might have been a good reason why explaining on that day was not the best choice. Perhaps he had an emergency, or maybe he prefers to explain after the patient has read the brochure he gives out.

2. The PATIENT should explain this to

Eastern traditions teach us that it isn’t what happens that makes us unhappy — it’s our thoughts about what happens that create our distress.

By questioning these thoughts — either through “the work” or by asking, “How might the opposite be true?” — we can make some space to accept the realities in our lives. the PHYSICIAN. The patient should definitely explain that he was unhappy to the physician; this might help the physician see that his patients appreciate more explanation. It might serve the patient in other areas of his life if he became more assertive about what he needs.

3. I should explain this to the patient. Well, that is the truest of all the statements! As a doctor, I love having the opportunity to help people understand their medical condition and how to stay healthy.

At this point, I’ve stopped feeling angry with the physician and am simply enjoying the experience of caring for my patient in the best way I know how.

Eastern traditions teach us that it isn’t what happens that makes us unhappy — it’s our thoughts about what happens that create our distress. By questioning these thoughts — either through “the work” or by asking, “How might the opposite be true?”

— we can make some space to accept the realities in our lives. Then we can consciously decide what we want to do with that reality.

By using this simple technique, you might be surprised at what you learn and how much less stressful life becomes.

Dr. Fronek, SDCMS-CMA member since 2010, is a certified physician development coach, certified professional co-active coach, and assistant clinical professor of medicine at the UC-San Diego School of Medicine. You can read her blog at helanefronekmd.wordpress.com.

Physician Local San Diego

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

SAN DI EGO PHYSICIAN.org 19

Poetry and Medicine

Counting

by Cancer

by Daniel J. Bressler, MD

Introduction In February of this year, a family member of mine died after a long and difficult battle with cancer. Most of my conversations with her over the last year of her life had little to do with my knowledge of medicine (she had her own excellent team of doctors for that) but with personal matters having to do with our families, her thoughts about the future, and sometimes about the changes going on in her own body. It was, among other things, a series of nontechnical lessons in clinical oncology delivered to me from the inside out.

As we’ve known for a number of decades, cancer is not one disease but a diverse assemblage of dysfunctions.

Some cancers are easily cured, others controllable, and others (most still, it seems) march on with a gruesomely determined inevitability that defies our cleverest therapeutic maneuvers.

Because of both its diversity and generally progressive nature, we describe cancer using a set of numbers, the most basic of which are stage and grade. There are also precise numerical assignments related to bone marrow 20 march 2013

response to chemotherapy, ejection fraction diminution from the cardiotoxic drugs, and the Karnofsky score, which enumerates the residual functional capacity of a human life struggling with the disease.

Driving home from my visits with her, I often reflected on her mixture of gritty determination and fearful self-observations. There were longterm plans about the future but also complaints about her weight loss.

There was her faith in God and in her doctors, and her grim sense that the disease was progressing. One morning, a few months before her death, pieces of our conversations started to assemble themselves into a poem about her disease told in the form of a nursery rhyme or a jump-rope singalong, using the numerical theme so prevalent in discussions of cancer.

This poem is dedicated to her.

Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and longtime contributing writer to San Diego Physician.

Counting by Cancer (in memory of DSF) One two three four You ask are my large muscles sore Four three two one Chemo’s not my kind of fun Two three four five Tired but very much alive Five four three two This is me, it could be you Three four five six Oh boy, new medication tricks Six five four three And all the side-effects for free Four five six seven Feels like hell, on fire even Seven six five four Distant knocking from heaven’s door Five six seven eight Sport a grin and stand up straight Eight seven six five Still ambitious to survive Six seven eight nine It was malignant, not benign Nine eight seven six Why do my legs resemble sticks?

Seven eight nine ten I can still remember when Ten nine eight seven The future was a loom to weave on.

Reach

All

8,500

Physicians

in San Diego County

Receive

25% off

your advertising package.

Call today!

Contact

Dari Pebdani

at 858-231-1231 or DPebdani@sdcms.org

Risk Management For more patient safety articles and practice tips, visit www.thedoctors. com/patientsafety.

Relying Too Much on Intuition Is Risky Be Wary of Being a “Dr. House” SDCMS-endorsed The Doctors Company

22 march 2013

In the TV show House, Dr. Gregory House bases his diagnoses on heuristics — the use of intuition and rule-of-thumb techniques or mental short cuts. While heuristics can improve efficiency and decision-making effectiveness, this unconscious process may lead a physician to make a judgment based on the facts that most readily come to mind, rather than making a conscious decision after formally analyzing all facts.

It’s important to be wary of relying too heavily on heuristics, as this could lead to negative patient outcomes and increased liability risk.

The following is from a case study: A patient presented progressive neurological symptoms and severe pain, but hospitalists based their diagnoses on heuristics and

failed to consider a spinal epidural abscess (SEA). While infrequently encountered in clinical practice, SEA requires prompt diagnosis and treatment to prevent serious neurological complications. A delayed diagnosis can lead to irreversible neurological deficits. In this particular case, various hospitalists who saw the patient failed to initially order an MRI of the spine or a neurology consultation, which would have led to an appropriate diagnosis.

When an MRI was finally done, it showed an epidural abscess compressing the spinal cord. After surgery, the patient remained paraplegic. Had the hospitalists been aware of the unconscious tendency toward using heuristics and had instead followed the standard of care to read nurses’ notes, review physical therapy assessments, and conduct thorough neurological examinations, it is more likely the patient would have had a timely SEA diagnosis and an increased chance to regain neurological function.

Because decision-making and problemsolving behavior in medical practice is guided by years of experience, heuristics inevitably plays a part, and that can be beneficial or harmful. Here are a few ways to avoid the risk: • Don’t stop at the first diagnosis. Ask, “What else could happen?” or “What else could this be?”

• Be prepared to alter your course of treatment.

• Consider family history when making a diagnosis.

• Engage your extended team, including specialists, pharmacists, and physical therapists, to consult and treat the patient.

• Always review what other care providers have noted on the patient’s chart.

• Communicate with all providers involved in a patient’s care.

• Use a structured communication process to communicate critical or worrisome findings.

• Keep an open mind when there is conflicting information.

• Always have a backup plan.

San Diego Physician Magazine Advertisers:

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

healthcare communit y.

We Appreciate Your Support!

3 income Tax Planning 3 Wealth Management 3 employee Benefit Plans 3 Profitability Reviews 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 AKT, LLP BBVA-Daniel Schroeder Cooperative of American Physicians Cassidy Turley San Diego Colliers International The Doctors Company Imaging Healthcare Specialists Law Offices of Matthew D. Rifat, LLP Medical Billing Connection MIEC Norcal Soundoff Computing Tri-City Medical Center UC San Diego Health System Vibra Bank

A KT LLP, CPAs and Business Consu LTAnTs CARL SBAD

ESCONDIDO

760-431-8440

S A N DIEGO

W W W.AKTCPA.COM

RMITCHELL@AKTCPA.COM

ron mitchell, cpa director of health services

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

SAN DI EGO PHYSICIAN.org 23

SDCMS-CMA

F CMA Targets for

2013

By Dustin Corcoran, CEO California Medical Association

or more than 150 years, the California Medical Association (CMA) has fought on the frontlines of nearly every major policy, political, budgetary, societal, and legal campaign affecting the state’s physicians. The shared challenges facing physicians are more formidable today than ever.

As California, and the rest of the nation, faces a time of unique budgetary challenges and monumental changes in healthcare, it is more critical than ever before that physicians come together with a unified voice to advocate for the profession and for the health and wellbeing of the patients we serve.

In January 2013, CMA’s Board of Trustees adopted five distinct goals for the association this year. Below are details of each of those goals.

Grow Membership by 5% CMA member physicians are our most valuable asset. Without your dues dollars, CMA wouldn’t be able to do its vital work protecting the practice of medicine and ensuring access to quality medical care for all Californians.

Over the past two decades, organized medicine nationwide has seen a gradual decline in membership, and CMA was no different. In 2011 and 2012, we reversed that trend, reaching a 20-year

24 march 2013

onstrating its commitment to public health, including providing educational briefings to legislators on public health matters and participating in health-fair-type events. membership high of more than 37,000 members last year.

CMA made a significant investment in membership development in 2012, increasing data analysis and ramping up recruitment and retention efforts. These efforts, along with focused recruitment achievements in select counties, resulted in a net growth of over 2% for the year. It may not sound like a lot, but after years of slow decline, 2% growth is a significant and laudable achievement.

Our goal for 2013 is to continue the forward momentum and grow membership by 5% by year’s end. Increased recruitment activities in 2013 will focus on “pilot projects” with select partner counties.

Commitment to Public Health CMA has a rich history and legacy of demonstrating its commitment to public health.

CMA has incorporated key public health legislation in its legislative agenda every session and has maintained a high profile on public health issues. Advancing reforms in order to benefit our patients and the public has always been a priority for the association, and continues to be at the top of our list.

In 2013, CMA will be working proactively with public health leaders to track emerging trends and to strategize solutions for continuing challenges.

We will continue to include legislation focusing on public health in the legislative agenda this year. CMA is also exploring new ways of dem-

Prosperity for All Physicians At no time, perhaps since the creation of Medicare, has the healthcare delivery system seen such dramatic and rapid changes. The transformation of healthcare in California is largely being driven by three major developments: 1. The rise of large medical groups, integrated delivery systems and advanced analytics, health information technology, and population health management.

2. Healthcare reform-related policy changes at the federal and state levels that emphasize care coordination, accountability, and paying for “value” — efficient, high-quality care.

3. Purchasers — private insurers in California and the nascent Covered California Health Benefit Exchange — are making it very clear that physicians and hospitals need to control costs or risk being isolated or frozen out of increasingly narrower network products.

These trends will likely accelerate as cost pressures grow, and health reform and other private sector initiatives continue to ramp up in 2013 and beyond.

These powerful forces pose particular challenges, and opportunities, for independent physicians and medical groups interested in maintaining a degree of autonomy while market and policy forces are driving the industry toward hospital-led systems.

At the end of the day, the system benefits from a diverse set of providers competing to deliver high-quality, high-

Over the next year, CMA will be working feverishly to help physicians in all modes of practice to not only thrive in the rapidly changing healthcare marketplace, but to lead the charge toward new patientcentric, physician-led models of care.

value care.

Over the next year, CMA will be working feverishly to help physicians in all modes of practice to not only thrive in the rapidly changing healthcare marketplace, but to lead the charge toward new patient-centric, physician-led models of care.

One of the biggest challenges for physicians now and in the future is access to capital to invest in their own practices so that they can expand into different markets, adopt new technologies and care models, and maximize reimbursement. Without capital for necessary infrastructure, physicians are unable to implement systems to help them remain competitive and independent. In contrast, hospital systems and health plans are at a strategic advantage.

CMA staff are developing three distinct proposals that represent “game-changing” strategies in support of prosperity for all physicians: 1. Study and design physician-led healthcare delivery models and create a CMAsponsored backbone for independent physicians and medical groups.

2. Develop and implement a quality initiative for independent practices with

the goal of reducing clinical variation.

3. Increase physician access to financial capital.

Stay tuned for additional details as these proposed initiatives evolve over the coming months.

Defend MICRA As we all know, the trial attorneys have sought to modify or eliminate California’s Medical Injury Compensation Reform Act (MICRA) protections since the state’s landmark medical malpractice insurance reforms were established in 1975.

Under MICRA, injured patients are fairly compensated, medical liability rates are kept in check, and physicians and clinics can remain in practice treating patients.

MICRA has no limits on the economic damages that can be recovered by injured patients (medical costs and lost wages). Injured patients also can sue for unlimited punitive damages and recover up to $250,000 in non-economic damages (pain and suffering).

In addition, MICRA includes a sliding pay scale, which ensures that more money goes to patients, not lawyers. The $250,000 cap on non-economic damages has proven to SAN DI EGO PHYSICIAN.org 25

For more than 40 years, CMA has defended MICRA in the legislature, in the courts, and in the court of public opinion. We have been successful primarily due to vigilance and allocation of sufficient resources on all fronts. This year will be no different.

be an effective way of limiting meritless lawsuits, but has been targeted by the trial lawyers because it restricts the amount of money they can collect in damage awards.

For more than 40 years, CMA has defended this important law in the legislature, in the courts, and in the court of public opinion. We have been successful primarily due to vigilance and allocation of sufficient resources on all fronts. This year will be no different.

Several factors make 2013 a decisive year for defending MICRA. Both houses of the Legislature contain Democratic supermajorities, traditional allies of the trial attorneys. Also, nearly half of the members of the Assembly are newly elected without a voting history. Attorneys are utilizing new and creative arguments to challenge longstanding constitutional approval of MICRA and to move public opinion. They are attempting to use heartwrenching horror stories placed with compliant media outlets in order to defeat MICRA. CMA in 2013 will focus on educating new members of the Legislature on the importance of MICRA for their constituents and the 26 march 2013

role MICRA plays in patient protection and access to care.

CMA’s government relations team will also be ready to jump into action at a moment’s notice should the trial attorneys try and utilize a late “gut and amend” to push an anti-MICRA bill through the Legislature, as they did at the end of last session.

As always, CMA’s political action committee (CALPAC) will remain involved in the fight, amassing the financial resources that will be needed should a costly MICRA challenge emerge this session.

CMA’s legal team also continues to aggressively monitor court activity and seek out opportunities to provide guidance to courts when they are asked by plaintiff attorneys to weaken or eliminate MICRA. Lead Change in Healthcare Reform In 2010, Congress passed historic sweeping healthcare legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry and, beginning in 2014, will provide health insurance to most of the nation’s uninsured. The ACA also formed the CMS Innovation Center to fund myriad pilot programs to test new

CMA Announces 2013–14 Sponsored Legislation U.C. Riverside Medical School (SB 21 and AB 27) These bills would provide $15 million a year in funding for the recently accredited University of California Riverside School of Medicine. According to a 2010 report by the California Health Care Foundation, the Inland Empire has the lowest ratio of primary care physicians and specialists of any region in the state, with barely half of the recommended number. The UC Riverside School of Medicine is the first UC medical school accredited since the 1960s.

GME Funding (SB 488) This bill would augment the amount of graduate medical education (GME) funding that California receives in order to increase the number of resident physicians in California.

Medi-Cal Cuts (SB 640) This bill is the vehicle for a proposed rollback of the 10% Medi-Cal provider rate reduction contained in the 2011–12 state budget. CMA is building a coalition of different providers who have been impacted by the cuts or who, like CMA, are still in court over their implementation. This bill would both eliminate the retroactive cuts, as well as stop them going forward, helping to provide needed stability to the Medi-Cal system as the state prepares for full federal health reform implementation in 2014.

Therapeutic Substance (AB 670) This bill would close a loophole in the law that lets pharmacists receive financial incentives each time they recommend a therapeutic switch (a chemically different drug) from the drug prescribed by the physician.

Physician Workforce: Medically Underserved Communities (AB 1288) This bill will serve to create additional residency slots across California and develop a stronger pipeline for physicians to serve in California’s medically underserved communities.

Employment of Physical Therapists (AB 1003) Since 1990, the Physical Therapy Board of California has explicitly allowed physical therapy services to be provided by medical corporations. In 2010, the Board rescinded this policy, threatening to disrupt the lives of hundreds of physical therapists who work for medical corporations, hospitals, home healthcare services, and nursing care facilities. This bill will clarify existing law to explicitly authorize medical corporations to hire persons licensed under the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act.

healthcare delivery and payment models.

Under the ACA, two-thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool. The remaining uninsured will be covered through a massive expansion of the Medicaid program.

CMA in 2013 will continue to monitor implementation of the ACA in California, ensuring that healthcare reform works for physicians and their patients. Specifically, CMA will remain engaged as Covered California, the state’s health benefit exchange, prepares to open for business.

The exchange’s goal is to start pre-enrollment in October 2013. Critical federal regulations and guidance, however, still must be finalized and

released.

Among the critical issues still needing to be hammered out before the exchange opens for business: the state’s plan for monitoring and enforcing network adequacy requirements; the reconciliation of major discrepancies between state and federal grace period guidelines for premium nonpayment; and how exchange plans will handle the subject of out-ofnetwork benefits.

While the pre-enrollment date is only months away, exchange leadership has yet to select which plans will offer products on the new marketplace, meaning that benefit design, contracting, and enrollment policies will need to be developed at a breakneck pace.

CMA will also be working

to make sure that physicians understand the implication of contracting with exchange plans and to ensure that doing so places minimal administrative burdens on physicians.

Together We Are Stronger The shared challenges facing those who practice medicine may never have been more formidable than today. In this uniquely turbulent political and fiscal environment, we have redoubled our efforts to provide the support and services physicians need to be able to focus on their jobs and bring good health and happiness to the lives of millions of Californians.

Changes are coming, and CMA is poised and ready to meet the demands of the future.

CMA has incorporated key public health legislation in its legislative agenda every session and has maintained a high profile on public health issues.

SAN DI EGO PHYSICIAN.org 27

2013–14 Legislator Guide San Diego County

U.S. Presidency Barack Obama E: www.whitehouse.gov/ contact/submit-questionsand-comments W: www.whitehouse.gov The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 T: (202) 456-1111

U.S. Senate www.senate.gov Barbara Boxer E: (via website) www.boxer. senate.gov Washington, DC Office: United States Senate 112 Hart Senate Office Building Washington, DC 20510 T: (202) 224-3553 • F: (202) 228-2382 San Diego Office: 600 B Street, Suite 2240 San Diego, CA 92101 T: (619) 239-3884 • F: (202) 228-3863 Birthday: Nov. 11

28 march 2013

Dianne Feinstein E: (via website) www.feinstein.senate.gov Washington, DC Office: United States Senate 331 Hart Senate Office Building Washington, DC 20510 T: (202) 224-3841 • F: (202) 228-3954 San Diego Office: 750 B Street, Suite 1030 San Diego, CA 92101 T: (619) 231-9712 • F: (619) 231-1108 Birthday: June 22

U.S. House of Representatives www.house.gov Susan Davis E: (via website) house.gov/ susandavis Washington, DC Office: United States Congress 1526 Longworth House Office Building Washington, DC 20515 T: (202) 225-2040 • F: (202) 225-2948 San Diego Office: 2700 Adams Avenue, Suite 102 San Diego, CA 92116 T: (619) 280-5353 • F: (619) 280-5311 Birthday: April 13 Duncan D. Hunter E: (via website) hunter. house.gov Washington, DC Office: United States Congress 223 Cannon House Office Building Washington, DC 20515 T: (202) 225-5672 • F: (202) 225-0235 El Cajon Office: 1611 North Magnolia Avenue, Suite 310 El Cajon, CA 92020 T: (619) 448-5201 • F: (619) 449-2251 Birthday: Dec. 7

Darrell Issa E: (via website) issa.house. gov Washington, DC Office: United States Congress 2347 Rayburn House Office Building Washington, DC 20515 T: (202) 225-3906 • F: (202) 225-3303 Vista Office: 1800 Thibodo Road, Suite 310 Vista, CA 92081 T: (760) 599-5000 • F: (760) 599-1178 Birthday: Nov. 1 Scott Peters E: (via website) scottpeters. house.gov Washington, DC Office: United States Congress 2410 Rayburn House Office Building Washington, DC 20515 T: (202) 225-0508 • F: (202) 225-2558 San Diego Office: 4350 Executive Drive, Suite 105 San Diego, CA 92121 T: (858) 455-5550 • F: Birthday: June 17 Juan Vargas E: (via website) vargas.house. gov Washington, DC Office: United States Congress 1605 Longworth House Office Building Washington, DC 20515 T: (202) 225-8045 • F: (202) 225-9073 Chula Vista Office: 333 F Street, Suite A Chula Vista, CA 91910 T: (619) 422-5963 • F: (619) 422-7290 Birthday: March 7

Official California Legislative Information www.leginfo.ca.gov

California Governorship http://gov.ca.gov Jerry Brown E: http://gov.ca.gov/m_contact.php W: http://gov.ca.gov/home. php State Capitol, Suite 1173 Sacramento, CA 95814 T: (916) 445-2841 • F: (916) 558-3160 Birthday: April 7

California State Senate http://senate.ca.gov Joel Anderson (District 36) E: senator.anderson@sen. ca.gov E: (via website) http://district36.cssrc.us Sacramento Office: State Capitol, Room 2054 Sacramento, CA 95814 T: (916) 651-4036 • F: (916) 447-9008 El Cajon Office: 500 Fesler Street, #201 El Cajon, CA 92020 T: (619) 596-3136 • F: (619) 596-3140 Committees: Budget and Fiscal Review; Budget Subcommittee 5; Elections and Constitutional Amendments (vice chair); Health (vice chair); Public Safety (vice chair) Birthday: Feb. 11 Marty Block (District 39) E: senator.block@sen.ca.gov E: (via website) http://sd39. senate.ca.gov Sacramento Office: State Capitol, Room 4090 Sacramento, CA 95814 T: (916) 651-4039 • F: (916) 327-2188 San Diego Office: 701 B Street, Suite 1840 San Diego, CA 92101 T: (619) 645-3133 Committees: Budget and Fiscal Review; Budget Subcommittee 1 (chair); Education; Public Employment and Retirement; Public Safety; Veteran’s Affairs Birthday: June 28 Ben Hueso (District 40) E: senator.hueso@sen.ca.gov E: (via website)

______________________________ Sacramento Office: State Capitol, Room __________ Sacramento, CA 95814 T: (916) ___-____• F: (916) ___-____ District Office: ______________________________ ______________________________ T: (___) ___-____ • F: (___) ___-____ Committees: Birthday: Sept. 2

Mark Wyland (District 38) E: senator.wyland@sen. ca.gov E: (via website) cssrc.us/ web/38 Sacramento Office: State Capitol, Room 4048 Sacramento, CA 95814-4900 T: (916) 651-4038 • F: (916) 446-7382 Carlsbad Office: 1910 Palomar Point Way, Suite 105 Carlsbad, CA 92008 T: (760) 931-2455 • F: (760) 931-2477 Committees: Business Professions and Economic Development; Education (vice chair); Labor and Industrial Relations (vice chair); Transportation and Housing Birthday: Oct. 27

California State Assembly http://assembly.ca.gov Toni Atkins (District 78) E: assemblymember.atkins@ assembly.ca.gov E: (via website) http://asmdc. org/members/a78 Sacramento Office: State Capitol PO Box 942849 Sacramento, CA 94249-0078 T: (916) 319-2078 • F: (916) 319-2178 San Diego Office: 2445 5th Avenue, Suite 401 San Diego, CA 92101 T: (619) 645-3090 • F: (619) 645-3094 Committees: Agriculture; Health; Housing and Community Development; Veteran’s Affairs Birthday: Aug. 1

Medical Professional Liability Protection, and more!

800-356-5672 www.caPphysicians.com

Rocky Chavez (District 76) E: assemblymember.chavez@ assembly.ca.gov E: (via website) http://arc. asm.ca.gov/member/AD76 Sacramento Office: State Capitol, Room 2170 Sacramento, CA 94249 T: (916) 319-2076 • F: (916) 319-2176 Carlsbad Office: 1910 Palomar Point Way, Suite 106 Carlsbad, CA 92008 T: (760) 929-7998 • F: (760) 929-7999 Committees: Budget; Budget Subcommittee No. 1 on Health and Human Services; Budget Subcommittee No. 6 on Budget Process, Oversight, and Program Evaluation; Education; Higher Education (vice chair); Veteran’s Affairs (vice chair); Water, Parks, and Wildlife Birthday: May 12

San Diego orange LoS angeLeS PaLo aLTo SacramenTo

SAN DI EGO PHYSICIAN.org 29 CAP_1402.indd 1

2/5/13 11:13 AM

2013–14 Legislator Guide Brian Jones (District 71) E: assemblymember.jones@ assembly.ca.gov E: (via website) http://arc. asm.ca.gov/member/AD71 Sacramento Office: State Capitol, Room 3149 Sacramento, CA 94249-0071 T: (916) 319-2071 • F: (916) 319-2171 Santee Office: 10152 Mission Gorge Road Santee, CA 92071 T: (619) 441-2322 • F: (619) 441-2327 Committees: Business, Professions, and Consumer Protection; Governmental Organization; Utilities and Commerce; Assembly Legislative Ethics Birthday: Aug. 9 Brian Maienschein (District 77) E: assemblymember.maienschein@assembly.ca.gov E: (via website) http://arc. asm.ca.gov/member/AD77 Sacramento Office: State Capitol PO Box 942849 Sacramento, CA 94249-0077 T: (916) 319-2077 • F: (916) 319-2177 San Diego Office: 9909 Mira Mesa Blvd, Suite 130 San Diego, CA 92131 T: (858) 689-6290 • F: (858) 689-6296 Committees: Business, Professions, and Consumer Protection; Health; Housing and Community Development; Human Services; Judiciary Birthday: Marie Waldron (District 75) E: assemblymember.waldron@assembly.ca.gov E: (via website) http://arc. asm.ca.gov/member/AD75 Sacramento Office: California State Assembly Sacramento Office PO Box 942849 Sacramento, CA 94249-0075 T: (916) 319-2075 • F: (916) 319-2175 District Office: Escondido Office 350 West 5th Avenue, Suite 110 Escondido, CA 92025 T: (760) 480-7570 • F: (760) 480-7516 Committees: Arts, Entertainment, Sports, Tourism, and Internet Media (vice chair); Governmental Organization; Local Government; Public Safety; Rules Birthday: March 28

30 march 2013

Shirley Weber (District 79) E: assemblymember.weber@ assembly.ca.gov E: (via website) http://asmdc. org/members/a79 Sacramento Office: State Capitol PO Box 942849 Sacramento, CA 94249-0079 T: (916) 319-2079 • F: (916) 319-2179 District Office: Committees: Appropriations; Banking and Finance; Education; Higher Education; Rules Birthday: Sept. 20 (District 80 Is Vacant)

San Diego County Board of Supervisors www.sdcounty.ca.gov/general/bos.html Greg Cox (District 1) E: greg.cox@sdcounty.ca.gov W: www.gregcox.com 1600 Pacific Highway, Room 335 San Diego, CA 92101 T: (619) 531-5511 • F: (619) 235-0644 Birthday: July 2 Dianne Jacob (District 2) E: dianne.jacob@sdcounty. ca.gov W: www.diannejacob.com 1600 Pacific Highway, Room 335 San Diego, CA 92101 T: (619) 531-5522 • F: (619) 696-7253 Birthday: Dave Roberts (District 3) E: dave.roberts@sdcounty. ca.gov W: www.supervisordaveroberts.com 1600 Pacific Highway, Room 335 San Diego, CA 92101 T: (619) 531-5533 • F: (619) 234-1559 Birthday: Dec. 8 Ron Roberts (District 4) E: ron.roberts@sdcounty. ca.gov W: www.ronroberts.com 1600 Pacific Highway, Room 335 San Diego, CA 92101 T: (619) 531-5544 • F: (619) 531-6262 Birthday: Aug. 20

Bill Horn (District 5) E: bill.horn@sdcounty. ca.gov W: www.billhorn.com 1600 Pacific Highway, Room 335 San Diego, CA 92101 T: (619) 531-5555 • F: (619) 685-2662 Birthday:

San Diego Mayor www.sandiego.gov/mayor Bob Filner E: bobfilner@sandiego.gov City Administration Building 202 C Street, 11th Floor San Diego, CA 92101 T: (619) 236-6330 • F: (619) 236-7228 Birthday: Sept. 4

San Diego City Council www.sandiego.gov/citycouncil President Pro Tem Sherri Lightner (District 1) E: sherrilightner@sandiego.gov City Administration Building 202 C Street, MS #10A San Diego, CA 92101 T: (619) 236-6611 • F: (619) 236-6999 Birthday: Dec. 1 Kevin Faulconer (District 2) E: kevinfaulconer@sandiego.gov City Administration Building 202 C Street, MS #10A San Diego, CA 92101 T: (619) 236-6622 • F: (619) 236-6996 Birthday: Jan. 24 President Todd Gloria (District 3) E: toddgloria@sandiego.gov Contact Us City Administration Building 202 “C” Street, MS #10A San Diego, CA 92101 T: (619) 236-6633 • F: (619) 595-1481 Birthday: May 10

(District 4 Is Vacant) Mark Kersey (District 5) E: markkersey@sandiego.gov City Administration Building 202 C Street, MS #10A San Diego, CA 92101 T: (619) 236-6655 • F: (619) 238-0915 Birthday: April 6 Lorie Zapf (District 6) E: loriezapf@sandiego.gov City Administration Building 202 “C” Street, 10th Floor San Diego, CA 92101 T: (619) 236-6616 • F: (619) 236-7329 Birthday: May 27

Scott Sherman (District 7) E: scottsherman@sandiego. gov City Administration Building 202 C Street, MS #10A San Diego, CA 92101 T: (619) 236-6677 • F: (619) 238-1360 Birthday:

Marti Emerald (District 9) E: martiemerald@sandiego. gov City Administration Building 202 “C” Street, MS #10A San Diego, CA 92101 T: (619) 236-6699 • F: (619) 533-3275 Birthday:

David Alvarez (District 8) E: davidalvarez@sandiego. gov City Administration Building 202 “C” Street, 10th Floor San Diego, CA 92101 T: (619) 236-6688 • F: (619) 231-7918 Birthday: July 27

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

Medical Billing Connection gives you: � Professionally Skilled Staff � Claims Management Expertise � Follow-up and Follow-through � Proven Results � MBC Never Outsources to Overseas � Established in 1999 The difference is our service... Let MBC make the difference for you!

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

www.medbillconnection.com / (800) 980.4808 x102

SAN DI EGO PHYSICIAN.org 31

YOU HERO YOU ARE ARE OUR HERO thank youfor forgiving givingaccess accessto tohealthcare healthcare for those thank you those without! without!

San Diego County Medical Society Foundation’s Mission Is To Improve Health, Access San Diego County Medical Society Foundation’s Mission Is To Improve Health, Access To Care, And Wellness For Patients And Physicians Through Engaged Volunteerism.

To Care, And Wellness For Patients And Physicians Through Engaged Volunteerism.

You are the Heart & Soul of Project Access San Diego YouThrough are the Heart & Soul of Project Access San Diego your support of our flagship program, Project Access San Diego, we have

Through your to support our1,850 flagship program, Project San to Diego, we have been able assist of over uninsured adults in ourAccess community improve their been able to assist over 1,850 uninsured adults in our community to improve health through access to specialty healthcare services. You have provided their over health through access to specialty healthcare services.

You have provided $5.8 million in contributed healthcare services to community members sinceover our $5.8 million beginnings in contributed healthcare services to community members since our program’s in December 2008! program’s beginnings in December 2008!

Thanks to more than 625 volunteer physicians providing specialty healthcare services Thanks to more volunteer physicians providing specialty healthcare to those whothan most625 need our help, we are getting people back to work, andservices able to care for their families. to those who most need our help, we are getting people back to work, and able to care for their families.

Without the generous support and dedication of all of our physician volunteers, hospitals outpatient surgery imaging, labs, therapy,volunteers, and other Without the and generous support andcenters, dedication of all of physical our physician ancillary health providers, hundreds of hard-working but uninsured adults would go hospitals and outpatient surgery centers, imaging, labs, physical therapy, and other without care every year.

Thank you for being a hero to our community! ancillary health providers, hundreds of hard-working but uninsured adults would go

without care every year. Thank you for being a hero to our community!

Get Involved

Diego County Medical Society Foundation needs you! Join us to volunteer for GetSan Involved

Project Access, or provide specialty consultations to primary care physician colleagues San Diego County Medical Society Foundation needs you! Join us to volunteer for through eConsultSD, our HIPAA-compliant, web-based system from the comfort of Project Access, or provide specialty consultations to primary care physician colleagues your home or office. Attend an event, assist us to recruit fellow physicians, or provide through eConsultSD, our HIPAA-compliant, web-based system from the comfort of educational opportunities for primary care physicians or medical students. Our first your home or office. Attend an event, assist us to recruit fellow physicians, or provide annual Golf Tournament is scheduled for Thursday, February 28, 2013 at Del Mar educational opportunities for primary care physicians or medical students. Our first Country Club; we hope you can join us! To register or for more information, go to annual Golf Tournament is scheduled for Thursday, February 28, 2013 at Del Mar sdcmsf.org/golf.

Please consider making a contribution to SDCMS Foundation to Country Club; we hope you can join us!

To register or for more information, go to support our efforts at www.sdcmsf.org, or call us at 858.300.2777. sdcmsf.org/golf. Please consider making a contribution to SDCMS Foundation to support our efforts at www.sdcmsf.org, or call us at 858.300.2777.

5575 Ruffin Road, Suite 250, San Diego, California 92123 p: 858.300.2777 f: 858.569.1334 n

n

5575 Ruffin Road, Suite 250, San Diego, California 92123 p: 858.300.2777 f: 858.569.1334 n

32 march 2013

n

Adam Fierer, MD Mark MD AdamRansom, Fierer, MD Mark Ransom, MD Expanding our model of care Expanding model of care Drs. Fierer andour Ransom practice and partner at the Carlsbad Surgery Center, Drs. Fierer and Ransom practice and one of the SurgeryOne facilities. partner at the Carlsbad Surgery Center, Seeing what an impact an ambulatory one of the SurgeryOne facilities. surgery can be for a person without Seeing what an impact anWorld ambulatory healthcare access in a Third surgery can be for a person country, Dr. Fierer approached without the healthcare access in a to Third World Carlsbad Surgery Center make country, Fierer the same Dr. impact at approached home. Now athe Carlsbad Surgery Center toa make semi-annual event involving growing the same impact anesthesiologists at home. Now a group of surgeons, semi-annual event involving a growing and other healthcare staff, we have groupable of surgeons, been to increaseanesthesiologists our capacity otherthe healthcare staff, we have toand improve health and change been to increase our most capacity the livesable of our community’s vulnerable. to improve the health and change themajority lives of of ourPASD community’s The patients most vulnerable. require just office consultations and 30% ofpatients patients Theprocedures. majority of PASD require or GIconsultations procedures, requiresurgery just office which occur during a30% Carlsbad or and procedures. of patients Kaiser Permanente Day, or require surgery or Surgery GI procedures, are accommodated partnering which occur duringataour Carlsbad or hospitals and outpatient surgery Kaiser Permanente Surgery Day, or centers throughout the year. are accommodated at our partnering Thank you to all of our physician hospitals and outpatient surgery volunteers-- you are all our heroes!! centers throughout the year.

Thank you to all of our physician volunteers-- you are all our heroes!!

www.sdcmsf.org

www.sdcmsf.org

16th Annual California Health Care Leadership Academy

May 31 - June 2, 2013 • Planet Hollywood, Las Vegas

Welcome to the era of health reform. Increasing demand for services. Intensifying pressure for cost and quality accountability. Small practices joining larger groups seeking safe harbor. Undercapitalized medical groups sinking.

Hospitals and health plans acquiring practices in a “vertical integration” (consolidation?) of the health care market.

Can physicians control their own destiny – and the future of medical practice?

Hear from experts and leaders of change and attend a comprehensive slate of practice management seminars and workshops to position your practice for success.

Keynote: “The Future of Medical Practice” • Jeff Goldsmith, Ph.D., President, Health Futures Inc. Early-Bird and Multiple Registration Discounts Save up to $200 per person when you register before May 3!

Register at 800.795.2262 or caleadershipacademy.com

classifieds PHYSICIAN POSITIONS AVAILABLE Physician needed immediately! Southern Indian Health Council is seeking a board-certified physician for family practice Mon–Fri, 8:00am–4:30pm. Must have CA medical license, DEA license, ACLS, BLS. We offer: competitive salary, health benefits, vacation pay, holiday pay, sick pay, CME and license reimburse, and paid malpractice coverage. No weekends. Contact: tdentice@sihc.org or HR phone (619) 445-1188, ext.

308 or ext. 307, or HR fax (619) 659-3145. Visit www. sihc.org. [120] BOARD-CERTIFIED PHYSICIAN:(pediatrics and/ or internal medicine or family medicine preferred) to provide medical consultation for agency serving individuals with developmental disabilities across lifespan.

Subspecialty certification or training in neurodevelopmental disabilities, developmental-behavioral pediatrics, or child neurology and experience assessing individuals with developmental disabilities desirable.

Full-time salaried position with benefits, including paid vacation and holidays, medical, dental, vision, disability, and life insurance, retirement plan, and paid malpractice coverage. Requires active California license. Based in Kearny Mesa with occasional travel to regional offices. Contact Human Resources Department at San Diego Regional Center: hr@sdrc.org or (858) 576-2996. [115] LOOKING FOR A BOARD-CERTIFIED FAMILY PHYSICIAN OR NURSE PRACTITIONER: Family medicine, private practice, part- or full-time coverage, North County San Diego. Looking for a board-certified family physician or licensed nurse practitioner who would like to join our small practice and provide personable, high quality, patient-centered care. Great position for someone who wants to practice medicine and make a difference. Flexible hours. Online access to EMR. We have a great team and would like to work with someone who can contribute to that experience. Please email CV to familypracticeNC@gmail.com. [111a] SEEKING DERMATOLOGIST: Established dermatology and cosmetic surgery practice in Encinitas is seeking a part-time to possible full-time dermatologist. We are currently looking for a dermatologist who is interested in doing general dermatology, dermatologic surgery, and possibly cosmetic procedures. Need physician with excellent patient rapport and interpersonal skills.

Confidence and excellent surgical skills are key for this position. Compensation competitive! Please respond to this ad with cover letter and CV to dana@doctorlashgari.com. [109] PEDIATRIC PHYSICIAN — NORTH COUNTY HEALTH SERVICES, OCEANSIDE: Full-time lead pediatrician position in FQHC community health center. Please email your CV to Araceli Mercado at araceli.mercado@nchshealth.org or fax to (760) 736-8740. [108] PHYSICIAN OR NURSE PRACTITIONER: Physician or nurse practitioner to perform housecalls in North San Diego County Monday thru Friday. 10-12 patients per day. Please forward CV. Full time. Excellent time management skills required. Pager one week per month, no hospital rounds. Established patient base. Independent contractor position with great income potential. NP’shome health experience a plus. Please respond by email only to mobiledoctor@sbcglobal.net. Thank you. [106a] PEDIATRIC PHYSICIAN — NORTH COUNTY HEALTH SERVICES, OCEANSIDE: Full-time lead pediatrician position in FQHC community health center. Please forward your CV to Araceli Mercado at araceli.mercado@ nchs-health.org or fax to (760) 736-8740. [105] FULL-TIME FAMILY MEDICINE PHYSICIAN: The San Diego American Indian Health Center is seeking a BC/ BE full-time family medicine physician for an ambulatory care clinic. Clinic hours are Monday through Friday, 8:00am to 5:00pm. Light telephone call. No hospital duties. No weekends. Malpractice covered. Benefits. Disclaimer: Preference is given to qualified American Indian

applicants in accordance with the Indian Preference Act of 1934 (Title 25, USC Section 472). Please email CV to Natalie Cadena at natalie.cadena@sdaihc.com. [904] CHIEF, MATERNAL AND CHILD HEALTH: The County of San Diego Health and Human Services Agency is seeking a qualified medical doctor to fill the position of chief, Maternal, Child, and Family Health Services (MCFHS) branch. The chief is responsible for the management and administration of public health programs that improve the health of mothers, children, and their families. For more information on the position, including minimum requirements and how to apply, please visit www.sdcounty.ca.gov. [092] ADULT PSYCHIATRIST — PART TIME: The County of San Diego’s Health and Human Services Agency is seeking a psychiatrist for 10-hour weekdays, part-time shifts for adult outpatient clinic work. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide outpatient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psychiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candidates may contact Lita Santos at (619) 563-2782 or email a CV to lita.santos@sdcounty.ca.gov. [091] ADULT PSYCHIATRISTS: County of San Diego’s Health & Human Services Agency seeks FT/PT psychiatrists for key components in the Behavioral Health Division’s continuum of care. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide outpatient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psychiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candidates can contact Gloria Brown at (858) 505-6525 or email CV and cover letter to gloria.brown@sdcounty.ca.gov, and Marshall Lewis, MD, Behavioral Health clinical director, at marshall.lewis@sdcounty.ca.gov. Please specify clinical area of interest. [090] SENIOR PHYSICIAN: The County of San Diego, Health and Human Services Agency’s HIV/STD/Hepatitis clinic has an immediate opening for a licensed physician with at least three (3) years of recent post-internship training or experience in internal medicine or as a general practitioner to manage a team responsible for planning and directing clinic services. Must be available to work flexible schedules at multiple sites, including some evenings is expected. Please read more about the senior physician job description, benefits, and application process at www. sdcounty.ca.gov/hr. Please include a copy of your CV along with your online application. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at gloria.brown@sdcounty.ca.gov. [088] MEDICAL DIRECTOR / PHYSICIAN / AND OTHER HEALTHCARE POSITIONS: Southern Indian Health Council is seeking a FT, board-certified physician, M–F, 8:00am–4:30pm. Must have current CA medical license, DEA license, ACLS, BLS. We offer: a competitive salary, health benefits, vacation, holidays, sick, CME and license reimbursement, and malpractice coverage.

Forward resume to tdentice@sihc.org or fax to (619) 659-3145 or website at www.sihc.org. Contact: tdentice@sihc.org or HR phone (619) 445-1188, ext. 308 or ext. 307 or HR fax (619) 659-3145. [048] OPPORTUNITY KNOCKS FOR BC/BE DERMATOLOGISTS: 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 dermatologists. 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. [084] FAMILY HEALTH CENTERS OF SAN DIEGO: JOIN OUR FAMILY! As we continue to grow, we currently have

great career opportunities for: Family Practice Physicians; Internal Medicine Physicians; Internal Medicine / Pediatric Physicians. With 33 locations that include 13 clinics and growing, we offer a wide variety of flexible career choices for you to select from as well as a positive work environment, grateful patients, and a competitive salary and excellent comprehensive benefits packages.

To talk to someone directly about provider careers at Family Health Centers of San Diego, please contact our Recruitment Supervisor, Anna Marie Jameson, at (619) 906-4591 or at ajameson@fhcsd.org. [046] PRIMARY CARE 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] 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] 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 SCRIPPS-XIMED MEDICAL OFFICE SPACE FOR SUBLEASE PART-TIME: Newly renovated office for sublet 0.5–1.5 days per week. Perfect for Scripps physician desiring on-campus presence. Full use of 1100sqft, including reception, business office, three exam rooms, consultation room, nurses station, and breakroom. Suitable for internist, internist specialty, surgeon, or psychiatrist. Receptionist help available if needed. Call (858) 354-1088. [118] Recently renovated medical office in vista, calif. available for sublease: Available Wednesday, Thursday, and Friday for $500 per room.

Staff can also be provided based on need. Near Tri-City Hospital. Call or email for more details: (858) 735-9879, drsameergupta@gmail.com. [119] SPACE FOR SUBLEASE IN ALVARADO HOSPITAL AREA IN SAN DIEGO: Two rooms and the front desk area available for sublease in comprehensive neurology and epilepsy center. This is a newly remodeled nice and bright office. Includes some storage area, chart area, and doctor’s parking. Walking distance to Alvarado Hos-

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 march 2013

pital. Five-minute drive to Grossmont Hospital. Call (619) 582-2595 to schedule viewing and for questions. [117] PROFESSIONAL SPACE FOR LEASE: La Jolla Office Space: Two private offices with shared reception, waiting area, and exam / consultation rooms in new office. Five exam rooms. On-site X-rays with tech available. Office is close to Scripps Memorial Hospital. In Golden Triangle between 805 and 5 freeways. Terms negotiable. Please contact Kathy Koppinger at (858) 678-0455. [113] 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] SCRIPPS XIMED MEDICAL CENTER BUILDING, LA JOLLA: Office Space to sublease occupied by vascular and general surgeons. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, XiMed Building is the office space location of choice for anyone doing surgeries at the hospital or seeking a presence in the La Jolla area. Reception and staff available if needed.

Full ultrasound lab onsite in office for anyone interested in this service. For more information, call Irene at (619) 8402400 or at (858) 452-0306. [101] NORTH COAST OFFICE SPACE TO SUBLEASE: North Coast Health Center, 477 El Camino Real, Encinitas, office space to sublease. Newly remodeled and beautiful office space available at the 477/D Building. Occupied by seasoned vascular and general surgeons. Great window views and location with all new equipment and furniture.

New hardwood floors and exam tables. Full ultrasound lab and tech on site for extra convenience. Will sublease partial suite for two exam rooms and office work area or will consider subleasing the entire suite, totally furnished, if there is a larger group. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 4520306. [041] FULL- AND PART-TIME OFFICE SPACE IN UTC: in 8th floor suite with established neuropsychologists and psychiatrists in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room and parking. Contact Christine Saroian, MD, at (619) 682-6912. [862] 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] 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 sqft 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]

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]

agement skills required. Pager one week per month, no hospital rounds. Established patient base. Independent contractor position with great income potential. NP’shome health experience a plus. Please respond by email only to mobiledoctor@sbcglobal.net. Thank you. [106b]

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]

NURSE PRACTITIONER OR PHYSICIAN’S ASSISTANT: Established, busy pain management practice in Mission Valley is looking for a nurse practitioner or physician’s assistant, 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 paindoctorstaff@hotmail.com. [094]

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 LOOKING FOR A BOARD-CERTIFIED FAMILY PHYSICIAN OR NURSE PRACTITIONER: Family medicine, private practice, part- or full-time coverage, North County San Diego. Looking for a board-certified family physician or licensed nurse practitioner who would like to join our small practice and provide personable, high quality, patient-centered care. Great position for someone who wants to practice medicine and make a difference. Flexible hours. Online access to EMR. We have a great team and would like to work with someone who can contribute to that experience. Please email CV to familypracticeNC@gmail.com. [111b] PHYSICIAN OR NURSE PRACTITIONER: Physician or nurse practitioner to perform housecalls in North San Diego County Monday thru Friday. 10-12 patients per day. Please forward CV. Full time. Excellent time man-

PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician in Coachella Valley (Palm Springs / Palm Desert). Part time, flexible days/hours. Competitive compensation. Call (619) 9925330. [038] MEDICAL EQUIPMENT ELECTRONIC TOUCH SCREEN MEDICAL CHECK IN SYSTEM FOR SALE: Eliminate staff interruptions and increase your office efficiency with this easy-touch patient sign-in kiosk in your waiting room. The average sign-in time for patients with a Medical Check In touchscreen kiosk takes fewer than 10 seconds. With this reduction in interruptions and the clear, organized communication of patient information to your receptionist’s computer, Medical Check In will reduce the time for the patient sign in process, reduce congestion for your reception area and save you money. Compatible with all electronic health records. Still under warranty. Cost for new Medical Check In is $2,500. Great price for this at $995. For more information please see medicalcheckin. com. Email KLewis@SDCMS.org. [982]

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

SHARE OFFICE SPACE IN LA MESA: Available immediately. 1,400 square feet available to an additional

SAN DI EGO PHYSICIAN.org 35

San Diego Physician Celebrates 100 Years!

The Bulletin of the San Diego County Medical Society May 1951

the bulletin S. D. C. M. S. History

In celebration of 100 years of publication of San Diego Physician (formerly known as The Bulletin), we will be reprinting throughout the year excerpts from past issues, and we will devote our December 2013 issue to recognizing the achievements of the official “Bulletin” of the San Diego County Medical Society. If you would like to contribute in any way to our December issue, please email Editor@SDCMS.org. Thank you!

the bulletin : An Editoria lly Speak ing

Explanation

of the Society reSome yea rs ago a member Secreta ry he caras ed marked that when he serv Everybody knew . hat his in ried the ent ire roster es and we did n’t have each other by their first nam nt bugaboos “Public to worry about those rece ine .” But things have Rel ations” and “State Medic se we aren’t say ing. cha nged, for better or wor t have intervened the However, in the yea rs tha in numbers and we are Society has grown steadily person al relation ships losi ng the more inti mate that existed in the past. least know who is a So, in order that we may at where he practices, the member of the Society and lish a Directory. Thi s Cou nci l has decided to pub ing of all our members, issue is devoted to the list and add resses. It wil l wit h their phone numbers, Even the Secreta ry is be of inestim able value to all. es, etc. He’s supposed put to it at times to give nam job has become too to know everybody, but the ing wil l be rev ised. list the big. From time to time Bul leti n unt il a later So hang on to this issue of the edition is presented. ry.

W. H. Gei stweit, Jr., Secreta

36 march 2013

Antoinette Le Marqui, M. D., Associate Edito

r

The San Diego County Medical Society was first formed July 23, 1870. It will be recalled that this was the year that saw the permanent organ ization of the California Medical Association and also the first convention of the American Medical Assoc iation to be held in California.

The San Diego physicians who formed this local society were: Dr. David Hoffman Dr. George McK instry Dr. Edward Burr Dr. Robert J. Gregg Dr. Thomas C. Stockton Dr. Jacob Allen Dr. Charles Fenn Dr. Hoffman was chosen president and was sent as delegate to the C. M. A. convention. This was the first time a delegate represented Southern Calif ornia at a medical meeting.

There were no minutes kept of the meetings or, if there were, these have been destroyed and we have no record. Historian Smythes wrote, in 1907, that the speech made by Dr. Hoffman on the day of his election is extant but I have failed to find it.

It is possible that the local society was abandoned after a while or it may have been inact ive until 1887. That year the society was reorganize d, March 16, and a constitution was drawn. The found ers of the permanent San Diego County Medical Society marked present, on March 16, were: Drs. W. W. Smart, C. C. Valle, D. W. Northrop, R. Armstrong, Thomas C. Stockton, P. C. Remondino, J. R. Doig, W. J. B. Lewis, H. P. Wood ward and D. McSegan.

This first meeting took place in rooms seven and eight, Johnston Block, San Diego, and the first men elected to office were: President, Dr. McSw egan; Vice-President, Dr. Valle ; President-Elect, Dr. Smart and Treasurer, Dr. Armstrong.

Your TrusteHealth d Sou rce for care Real Estate Services Group Healthy Real Estate Solutions.

4660 La Jolla Village Drive Suite 100 San Diego, CA 92122 MAIN +1 858.455.1515 DIR +1 858 677.5329 FAX +1 858 546.9146 EMAIL chris.ross@colliers.com

www.colliers.com

A Smart

Healthy Decision

Colliers International | Healthcare Real Estate Services Group We Are -

San Diego’s trusted leader in medical oďŹƒce & health care real estate services

We Simplify - Leases, renewals, sales and complex real estate transactions We Perform - Through our unparalleled specialization, experience, market knowledge & leverage We Thrive -

On saving our clients time & money and providing you with optimal solutions

Contact us today and we will help you achieve your goals: PAUL BRAUN 858.677.5324 paul.braun@colliers.com

CHRIS ROSS 858.677.5329 chris.ross@colliers.com

Lic. No. 00891709

Lic. No. 01469025

Colliers International

|

Accelerating success.

|

www.colliers.com/sandiego

$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 ]

radiology practice, a leaking fire suppression system destroyed a $1,000,000 1.5 tesla MRI. Make sure you’re covered.

In a Los Angeles

For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.

Call (800) 852-8872 today for a quote or a complimentary insurance assessment. n

Medical Malpractice

n

Employment Practices Liability

n

Workers’ Compensation Health and Disability

n

Directors and Officers/Management Liability Errors and Omissions Liability

Property and General Liability

n

n n

License#: 0677182 38 march 2013

n

Billing Errors and Omissions Liability

www.thedoctors.com/TDCIS