September 2013 by San Diego Physician

San Diego Physician

100 celebrates

years

official publication of the san diego county medical society Sept 2013

This is Not a test!

micra Under Attack â&#x20AC;&#x153;Physicians United For A Healthy San Diegoâ&#x20AC;?

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Contents

Volume 100, Number 9

MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Theodore M. Mazer, MD, James Santiago Grisolía, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Van C. Johnson, MD, Roderick C. Rapier, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder

features

SDCMS BOARD OF DIRECTORS OFFICERS PRESIDENT: Robert E. Peters, PhD, MD PRESIDENT-ELECT: J. Steven Poceta, MD TREASURER: William T-C Tseng, MD, MPH (CMA Trustee) SECRETARY: Mihir Y. Parikh, MD IMMEDIATE PAST PRESIDENT: Sherry L. Franklin, MD (CMA Trustee)

THIS IS NOT A TEST! MICRA UNDER ATTACK

MICRA Under Attack: This Is Not a Test!

CALIFORNIA MEDICAL ASSOCIATION

21 Please Donate to the MICRA Fight Today! 22

Know Your MICRA History

departments 4 Calendar • Get in Touch • In Memoriam • And More …

GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORS EAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD (A: Susan Kaweski, MD (CALPAC Treasurer)) HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD (A: Sunny R. Richley, MD) KEARNY MESA: Jason P. Lujan, MD, John G. Lane, MD (A: Anthony E. Magit, MD, Sergio R. Flores, MD) LA JOLLA: Geva E. Mannor, MD, Wayne Sun, MD (A: Lawrence D. Goldberg, MD) NORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD (A: Anthony H. Sacks, MD) SOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD (A: Elizabeth Lozada-Pastorio, MD)

The Trial Lawyers’ Ballot Initiative

What Have We Done for You Lately?

AT-LARGE DIRECTORS Jeffrey O. Leach, MD (Delegation Chair), Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD (Board Representative), Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Suman Sinha, MD

OBERT E. PETERS, MD, PHD, R AND TOM GEHRING

AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, Phil Kumar, MD, Holly B. Yang, MD, Perry N. Willette, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD

MICRA’s Key Provisions

Timeline of California’s Initiative Process

The Trial Lawyer-sponsored Changes to MICRA

MICRA Works!

Answers to the Tough Questions

Your SDCMS Membership Team & Benefits

Discover Your New www.SDCMS.org

No-show New Patients

the doctors company

Choosing Wisely: Five Things Physicians and Patients Should Question

OTHER VOTING MEMBERS COMMUNICATIONS CHAIR: Theodore M. Mazer, MD (CMA Vice Speaker) YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MD RESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MD RETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MD MEDICAL STUDENT DIRECTOR: Jason W. Signorelli OTHER NONVOTING MEMBERS YOUNG PHYSICIAN ALTERNATE DIRECTOR: Renjit A. Sundharadas, MD RESIDENT PHYSICIAN ALTERNATE DIRECTOR: Erin Whitaker, MD 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 AMA ALTERNATE DELEGATE: Lisa S. Miller, MD

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Physician Marketplace: Classifieds

12 2 septem b er 2013

San Diego Physician Celebrates 100 Years: August 21, 1942

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

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/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// calendar SDCMS Seminars, Webinars & Events SDCMS.org

For further information or to register for any of the following SDCMS seminars, webinars, workshops, and courses, email Seminars@SDCMS.org.

Economic Survival: Preserving and Growing Your Financial Resources (seminar/webinar) OCT 17: 11:30am–1:00pm

Cma Webinars CMAnet.org/events Successful Medi-Cal Provider Enrollment for Physician Providers OCT 2: 12:15pm–1:45pm Benefits of Financing Your Electronic Medical Records Project OCT 9: 12:15pm–1:15pm CMS Quality Reporting Programs: What Physicians Need to Know and Do Now to Improve Care and Avoid Penalties OCT 30: 12:15pm–1:45pm External Auditors and You: Medi-Cal Recovery Audit Contract Process NOV 6: 12:15pm–1:15pm Managing Difficult Employees and Reducing Conflict NOV 13: 12:15pm–1:45pm Medicare: 2014 New Rules DEC 4: 12:15pm–1:15pm ICD-10 Documentation for Physicians: Part 1 DEC 5: 12:15pm–1:15pm ICD-10 Documentation for Physicians: Part 2 DEC 12: 12:15pm–1:15pm

“

ICD-10 Documentation for Physicians: Part 3 DEC 19: 12:15pm–1:15pm

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. 1st Annual Scripps Cancer Care Symposium: A Nursing & Advanced Practice Provider Collaboration SEP 27–29 (www.scripps.org/ conferenceservices) 24th Annual Cardiovascular Interventions OCT 1–4 at the Hilton La Jolla Torrey Pines from 6:30am to 6pm, $899 for physicians, 27.5 AMA PRA Category 1 Credits™ (www.scripps.org/ conferenceservices) The Fundamentals of Diabetes Management OCT 9 (www.scripps.org/ conferenceservices) Initiation and Management of Insulin and Incretin Therapy OCT 10 (www.scripps.org/ conferenceservices) Diabetes Management in the Hospital and Long-term Care Facility OCT 11 (www.scripps.org/ conferenceservices) 9th Annual UC San Diego Perinatal Symposium OCT 11 (https://cme.ucsd. edu/perinatal) ILADS 2013 Lyme Disease Basics Course OCT 17 (http://ilads.org/ lyme_programs/sandiego/ ilads_sandiego-lyme-course. php)

Carpe diem, quam minimum credula postero.

”

(Seize the day, put no trust in tomorrow.)

— Horace, Roman poet (65BCE–27CE)

4 septem b er 2013

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 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

/////////////////////////////////////////////////////////////////////////////////////////////////// In Memoriam

Simon C. Brumbaugh, Jr., MD

Dr. Simon C. Brumbaugh, Jr., who first joined SDCMS-CMA in 1953, died on August 21, 2013. Dr. Brumbaugh — “Si” to his legions of friends and colleagues — embodied healthcare in Lemon Grove and San Diego County in an epic career that spanned more than six decades. “Brumbaugh Babies” — those delivered or attended to — number in the thousands. As a general practitioner, he tended the medical needs of countless patients of all ages, a veritable alumni group with long, fond memories of the man who symbolized the term “family doctor.” The family will hold a joint Celebration of Life for Si and Mary Lou — his wife, who died in her sleep at home on February 21, 2013 — on November 30, 2013, at 2:00pm at the Joan B. Kroc Center Theater, 6611 University Ave., San Diego. In lieu of flowers, donations may be sent to Lemon Grove Community Church, 3122 Main St., Lemon Grove, CA 91945.

Thomas ‘Tom’ McAfee, MD

SDCMS-CMA member since 2004 and UC San Diego former dean of clinical affairs, Dr. Thomas ‘Tom’ V. McAfee recently died in an accident while on vacation in Tanzania, Africa. Dr. McAfee was set to begin a new job at the University of Southern California on Tuesday, September 3, as the CEO of the Keck Medicine of USC Medical Foundation. In his roles at UC San Diego, Dr. McAfee was the dean of Clinical Affairs for the UC San Diego Health Sciences, as well as chief executive officer for UC San Diego Faculty Practice. He provided leadership for UC San Diego Medical Group, an inpatient and outpatient physician practice. He also served as president of UC San Diego Ambulatory Surgery Center. On Thursday, October 10, a “Celebration of Life” to honor Dr. McAfee will be held at the main auditorium in the Medical Education and Telemedicine building on the UC San Diego campus from 4:30pm to 6:00pm, followed by light refreshments in the courtyard. Parking for the event will be available in lot P602 with overflow in the Gilman parking structure. Those unable to attend are invited to make donations in honor of Dr. McAfee to Big Life Foundation USA (https://biglife.org), the only organization in East Africa with coordinated cross-border antipoaching operations.

Harold J. Simon, MD, PhD

Dr. Harold J. Simon, SDCMS-CMA member since 1969, died peacefully surrounded by his family on August 6, 2013. He was a founding member of the UCSD School of Medicine faculty and a leader in the field of international health and health policy; professor emeritus on international medicine; and founding chief of the Division of Global Health. As one of the first faculty members recruited to UCSD School of Medicine in 1966, in advance of the 1968 charter class of students, Dr. Simon was integral in designing the school’s innovative curriculum and established many of its lasting programs. Donations may be made to the American Technion Society of San Diego, the Covell Geriatric Innovation and Education Fund (UCSD), or the Program on Gender Inequities and Global Health (UCSD).

legislator birthdays

One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday! Senator Mark Wyland (District 38) E: (via website) cssrc.us/web/38 E: senator.wyland@sen.ca.gov Capitol Office: California State Senate PO Box 942848 Sacramento, CA 94248-0038 Telephone: (916) 651-4038 Fax: (916) 446-7382 District Office: 1910 Palomar Point Way, #105, Carlsbad, CA 92008 T: (760) 931-2455 • F: (760) 931-2477 Birthday: Oct. 27

Become an SDCMS Featured Member! 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!

Other member physicians whose recent passing we mourn: • Harold A. Davis, MD (member since 1966) • William J. Ceretto, MD (member since 1981) • George Cierny, III, MD (member since 2006) SAN DI EGO PHYSICIAN.org 5

/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// icd-10

Are You Prepared for the ICD-10 Transition? On Oct. 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 codes sets. Physicians, here are the top 10 questions you should be asking yourselves about the ICD-10 transition:

Do I have an ICD-10 implementation plan?

Do I have an ICD10 implementation champion / personin-charge in my office?

Did my ICD-10 champion sign up for one of the two SDCMS orientation sessions held on Sept. 18 and 19 of this year?

What are our training needs for ICD-10 implementation, and how will we achieve them?

What systems and work processes in my office use diagnosis codes?

6 septem b er 2013

What workflow and business processes will change as a result of ICD-10?

Do our vendors, specifically including our billers, have a plan for implementing ICD-10?

How will we verify that our vendors have successfully completed their implementation plan?

What is our budget for implementing ICD-10?

What are the differences between ICD-10CM and ICD-10PCS?

Don’t know where to start? Did you miss the orientation sessions? A recording of one of these sessions is available to SDCMS members. Watching the recorded orientation session will give you access to the follow-up webinars that will assist you with this transition. Contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@ SDCMS.org to obtain the link to the recording.

Hipaa

HIPAA Omnibus Rule Compliance FAQs On Jan. 25, 2013, the U.S. Department of Health and Human Services published new regulations that made significant changes to the privacy and security requirements under the Health Insurance Portability and Accountability Act (HIPAA). These new regulations, known as the HIPAA Omnibus Final Rule, implement many of the key provisions of the Health Information Technology for Economic and Clinical Health Act (HITECH) Act of 2009. Covered entities and their business associates have until Sept. 23, 2013, to comply with the new rule. CMA’s “HIPAA Omnibus Rule Compliance FAQs” answers most commonly asked questions related to the HIPAA Omnibus Final Rule compliance requirements. This information does not constitute, and is no substitute for, legal or other professional advice. Physician offices should consult their personal attorneys or professional advisors for specific guidance on their HIPAA compliance plan. SDCMS member physicians and staff are invited to contact Marisol Gonzalez to have these FAQs emailed to them. Marisol can be reached at (858) 300-2783 or at MGonzalez@ SDCMS.org.

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www.SanDiegoSafePrescribing.org The San Diego and Imperial County Prescription Drug Abuse Medical Task Force is a coalition of medical leaders who have joined efforts to reduce deaths and addiction due to prescription drugs. The No. 1 cause of unintentional deaths in San Diego County is from drugs. Almost one person a day in our county dies from this preventable cause. The task force includes pain specialists, internal medicine physicians, emergency physicians, psychiatrists, dentists, pharmacists, hospital administrators, health department administrators, and our local DEA. The task force also includes broad health partners, including Kaiser Permanente, Scripps Health, Sharp HealthCare, UC San Diego Health System, Palomar Health, and the Community Clinics. The task force encourages all medical practitioners to use the materials provided to improve patient care. Visit www.SanDiegoSafePrescribing.org!

SDCMS MEMBEREXCLUSIVE BENEFIT:

SDCMS provides free notary services to member physicians at SDCMS’s office in Kearny Mesa for the processing of CURES applications. Contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org to make an appointment.

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SDCMS-CMA Membership

What Have We Done for You Lately? September 2013 Dear Physicians: Periodically, we want to let you know what your SDCMS-CMA membership has allowed us to do for you lately. Following is a summary of how we’ve created value for you since our last letter. MICRA ASSAULT — OUR EXISTENTIAL CRISIS • Your malpractice rates are the envy of the other 49 states because over decades we’ve successfully spent your dues and CALPAC dollars ensuring MICRA’s safety in California’s Legislature and defending MICRA in state and federal courts. • Since we stymied the trial lawyers in the legislative and judicial branches, they’ve shifted to the ballot box, submitting initiative language to the Attorney General — the first step in a long and expensive process to qualify a ballot measure for November 2014. °° The initiative’s most pernicious provision would increase the cap on speculative, non-economic damages from the current $250,000 to more than $1.25 million, with automatic annual increases. °° There are multiple other onerous provisions, including invasive physician drug testing, but — make no mistake — the main purpose is to change MICRA to make it easier for lawyers to file lawsuits against doctors, hospitals, community clinics, and other healthcare providers, thereby generating big paydays for trial lawyers. • It matters not whether you’re an academic physician, whether you practice in a large group, whether you’re a community clinic doctor, or whether you’re in solo practice, if this initiative passes, the immediate impact on you, your practice, and your patients will be dramatic and severe. • We will ask every member to contribute above and beyond their dues in order to ensure a win at the ballot box in 2014. • For your nonmember colleagues, you need to ensure they join SDCMS-CMA and contribute — just like you. There are no free passes for nonmembers — this is an existential crisis for every doctor in California. ADVOCACY • CMA federal advocacy was directly responsible for the House Energy & Commerce Committee’s unanimously approving HR 2810 to repeal/ replace the Medicare SGR, including a “California GPCI Fix” that corrects the longstanding Medicare underpayment travesty for San Diego while holding rural physicians harmless. This is a huge step in the right direction! • CMA negotiated substantial positive changes to fund and upgrade the Controlled Substance Utilization Review and Evaluation System (CURES). • We killed dramatic scope-of-practice expansions by pharmacists, optometrists, and nurse practitioners — a trifecta of big wins for patient safety. • CMA created SB 191 — now on the governor’s desk — to provide $50 million annually to the Maddy fund, which is used to offset the costs incurred for care provided to uninsured patients in hospital ERs. • CMA and SDCMS are deeply involved in molding the California Health Insurance Exchange (Covered California) so that it does not become (in 2014) the monopoly that depresses all reimbursements to Medi-Cal rates. PUBLIC HEALTH • SDCMS is integral in establishing a self-sustaining San Diego-wide Health Information Exchange. • SDCMS’ Emergency Medicine Oversight Commission led a campaign against overprescribing of pain medicines. • SDCMS’ GERM Commission has been proactively following the meningococcal outbreak this past year in San Diego and is discussing steps to prepare for the possibility of the arrival in San Diego of the H7N9 flu virus. • Our SDCMS Foundation will be coordinating a countywide effort to increase adult flu immunization in community settings. BENEFITS • Your SDCMS Physician Advocate provided “concierge care” to members, resolving approximately 200 problem tickets. Here are just two examples of how we’ve helped our members: °° A member psychiatrist had a problem with an authorization denial from Blue Cross after the patient was seen, which resulted in the patient’s being stuck paying the bill. The denial was overturned, saving the patient more than $30,000. °° We were able to stop a member cardiologist from losing her Medi-Cal incentive monies due to missing paperwork during her application process. • SDCMS and CMA have created resources to help with the Sept. 16 Medicare Part B transition from Palmetto to Noridian. • Members get free classified ads on our website and in San Diego Physician magazine. • More than 600 SDCMS physicians saved nearly $370,000 with The Doctors Company (TDC), SDCMS’ endorsed professional liability carrier. TDC offers SDCMS members a 5% discount on professional liability insurance. 8 septem b er 2013

• Are you using SDCMS’ e-forum for office managers and practice administrators? Email KLewis@SDCMS.org to join. • More than 120 physicians attended a CURES sign-up event at SDCMS, with a CURES representative onsite, a significant savings in time and money for physicians. • Since our last letter, we have offered 28 seminars and webinars with 300+ physicians and office staff attending. Our most in-demand seminar topics for 2013 have been “Medicare 2013 and Beyond,” “OSHA Updates,” and “ICD-10 Transition.” • SDCMS members enjoy: °° 30% savings on medical waste management services. °° Discounted disability insurance, with exceptional discounts for female members of SDCMS. °° Major discounts on website packages. °° Free annual physician mailing list, car insurance discounts, and free California Emergency Driving Emblem. °° Resources to help physicians transition to the new HIPAA 5010 Transaction Standards. °° Savings on accounting services, security prescription pads, billing solutions, IT support, computer hardware, contract negotiations services, practice management consulting, banking, legal services, and collections. COMMUNICATIONS & MARKETING • SDCMS communicated with San Diego’s citizens and decision-makers via op-eds in the U-T San Diego: °° In June 2013 we presented the case for not inappropriately expanding nonphysician scope of practice with “Doctors Should Take Lead on Patient Care.” °° In January 2013 we made the case for not cutting preposterously low Medi-Cal rates with “Medi-Cal Rate Cuts Hurt Healthcare, Access.” • San Diego County’s media outlets routinely turned to SDCMS for comment on the ACA Medicaid expansion access problem, CMA’s Medi-Cal lawsuit, obesity in San Diego County, testing doctors for narcotics, NPs and PAs practicing independently, long ambulance response times, and so much more. • We sent out 16 issues of our biweekly, commercial-free e-newsletter, “News You Can Use” (NYCU). If you’re not getting NYCU, send an email to Gehring@SDCMS.org, and we’ll sign you up. • You can follow the latest healthcare news and updates from SDCMS on Twitter (http://twitter.com/SDCMS). ENGAGEMENT • We continue to offer media training, advocacy training, and leadership training for member physicians and their staffs. • SDCMS spoke at six general staff meetings and medical executive committees — can we speak to yours? INFRASTRUCTURE • After almost a year of preparation, this summer we simultaneously migrated our in-house membership database to CMA’s association management system and launched our new website (which seamlessly integrates with the new database). You can log on to update your profile for our soon-to-publish pictorial membership directory, sign up for our seminars, webinars, and workshops, access our SDCMS practice management FAQ database, get the latest news from SDCMS and the web, stay abreast of upcoming practice management deadlines, and more! Email Membership@SDCMS.org for assistance in logging on. SDCMS & CMA FOUNDATIONS • Volunteer physicians, through the SDCMS Foundation, have averaged $100,000/month in pro bono care to increase access to specialty care for an average of 45 patients each month, resulting in $6.9 million in contributed pro bono care since late 2008. • The SDCMS Foundation has assisted 286 private practice primary care physicians to adopt electronic health records, and 158 have received their CMS incentive payments to date. • Beginning in October, SDCMS and the SDCMS Foundation will provide monthly educational meetings and webinars to physicians and office staff to explain the logistics of Covered California. • On the state level, your CMA Foundation is working on obesity, the role of ethnic physicians, vaccinations, and multiple other public health issues. MEMBERSHIP • SDCMS continues to grow! Scripps Clinic has come aboard as a group, and UC San Diego has extended their agreement for an additional halfdecade. We are now the largest county medical society in California. PREVIEWS OF COMING ATTRACTIONS • ICD-10 transition orientation sessions on Sept. 18 and 19. • SDCMS’ biannual Workforce and Compensation Survey, as well as our annual Office Staff Salary Survey. What are you doing that you’d like us to know about? What more do you need us to do on your behalf? Contact us directly. Our email addresses are President@SDCMS.org and Gehring@SDCMS.org respectively. Finally, we ask for your help in telling your nonmember colleagues what SDCMS and CMA are accomplishing. Please encourage nonmember physicians to join at www.SDCMS.org so that we can fulfill our vision of “Physicians United for a Healthy San Diego.”

Robert E. Peters, MD, PhD SDCMS President

Tom Gehring SDCMS CEO / Executive Director

SAN DI EGO PHYSICIAN.org 9

SDCMS Membership

Your SDCMS Membership Team and Benefits “Physicians United for a Healthy San Diego”

Brandon Ethridge Membership Operations

Your SDCMS Membership Team Marisol Gonzalez Membership Support, Physician Advocate

e continually like to thank our members, as, without you, we would not be able to provide the services we do — so THANK YOU! As a member of the San Diego County Medical Society (SDCMS) and the California Medical Association (CMA), you have ample resources available, and our goal is to assist you and your practice in any way we can. It is not a matter of if you will have a question, but when. We hope that when you have a question, you will contact SDCMS first. We can be reached at Membership@SDCMS. org or by phone at (858) 565-8888. It is now easier than ever to renew your membership online at www.SDCMS.org. We recently migrated our membership database to CMA’s Association Management System, and simultaneously launched a new website that seamlessly communicates with our data. You can log on anytime, at your convenience, and access a wide array of member-exclusive benefits, instantly update your profile for our online physician locator and our soon-to-publish print directories, sign up for our seminars, webinars, and workshops, access our SDCMS practice management FAQ database, get the latest news from SDCMS and the web, stay abreast of upcoming practice management deadlines, and more! For assistance in logging on to www.SDCMS.org, call (858) 565-8888 or email Membership@SDCMS.org.

10 septem b er 2013

Telephone: (858) 300-2783 Email: MGonzalez@SDCMS.org Contact Marisol for general membership assistance or if you have a problem you’re trying to solve. She can provide practice management assistance such as facilitating insurance reimbursements, connecting with experts in the field, helping with legal issues and with incentive program complexities, or support in finding the answers to keep your practice running smoothly.

Telephone: (858) 300-2778 Email: Brandon.Ethridge@ SDCMS.org Contact Brandon should you have questions about your SDCMS membership status or dues, including questions regarding billing and accounting of your dues, or if you would like information about the benefits available to you as an SDCMS-CMA member of our society. Brandon also coordinates the distribution of our communications with members and can easily help ensure your contact information is accurate and up to date.

Brian Gerwe Membership Recruitment and Retention

Telephone: (858) 300-2782 Email: Brian.Gerwe@SDCMS.org Contact Brian should you have questions about joining, if you would like to learn more about the benefits of maintaining membership with SDCMS, or if you’d like to refer a peer or practice to learn more about the benefits and advantages of becoming a member. Let him know if you have suggestions of how SDCMS can increase the value of your membership to better serve you, your practice, and your patients.

Your SDCMS Member-exclusive Benefits: • 5% Discount on Professional Liability Insurance Through SDCMS-endorsed The Doctors Company • Free Site Inspection and Infrastructure Recommendations Through SDCMSendorsed SoundOff Computing • Discounted Prescription Pads Through SDCMS-endorsed American Security Rx • Free Contracting Analysis Through SDCMS-endorsed Coastal Healthcare Consulting Group • Discounted Tickets to Disneyland • Discounted Disability Insurance Through SDCMS-endorsed Wealth Legacy Group • Free SDCMS Seminars and Webinars • Discounted SDCMS Courses: °° Certified Medical Office Manager °° Certified Coder °° Certified Insurance Specialist °° Certified Compliance Officer • Free Coding Hotline • Free Classified Advertisements • Free Emergency Situation Driving Emblem • Free Physician Lists and Labels • Free Directory Listings: °° Online at www.SDCMS.org °° All San Diego County Physician Directory °° SDCMS Pictorial Membership Directory °° San Diego Magazine ’s Annual Health Annex °° Online at www.SanDiegoMagazine.com/San-Diego-Magazine/Find-a-Doctor • Private E-forum for Office Managers and Practice Administrators • Fee Training Workshops: °° Preparing to Practice °° Leader’s Toolkit °° Financial and Legal Life Skills °° Advocacy Training °° Media Training °° Outlook • Free Practice Announcement Ads in San Diego Physician Magazine and Online • 50% Discounts on Display Advertising Rates • Free HIPAA-compliant Messaging System via DocbookMD

Medical Professional Liability Protection, and more!

Your CMA Member-exclusive Benefits: • Free Tracking of CME Credits Through the Institute for Medical Quality • Free Access to CMA’s Center for Economic Service (CES), Which Provides Resources and Guidance to Improve the Success of Your Practice • Free Access to CMA’s Webinars • Free Access to CMA ON-CALL, an Online Health Law Library Containing Over 4,500 Pages of Valuable Information for Physicians and Their Office Staff • Savings of up to 25% on Car Rentals for Business or Personal Travel Through Avis and Hertz • 30% Discount on Medical Waste Services Through EnviroMerica • Up to $1,000 off Website Packages That Can Be Completed Within 30 Days or Less Through Mayaco • 10% Discount on Auto and Homeowners’ Insurance Through Mercury Insurance • 50% off Subscriptions to Hundreds of Popular Magazines Through Subscription Services, Inc.

800-356-5672 www.caPphysicians.com

San Diego orange LoS angeLeS PaLo aLTo SacramenTo

Discover Your New www.SDCMS.org! Turn the page to learn more … SAN DI EGO PHYSICIAN.org 11 CAP_1402.indd 1

2/5/13 11:13 AM

SDCMS Membership

Discover Your New www.SDCMS.org

Resources for Your Patients

Member Resources

Join SDCMS-CMA

Read the Top Stories Renew Your Membership

Discover Your Benefits

Read San Diego Physician Online

Look up Your Profile

Learn About Practice Management Deadlines

Current Advocacy Campaigns SDCMS on Social Media

News From SDCMS & the Web

12 septem b er 2013

Read and Post Classifieds

BOB DESIMONE, MBA, CPA

THE DOCTORS INSURANCE AGENCY CA AGENT #0722131

215 S. Highway 101, Ste. 117 Solana Beach, CA 92075 bdesimone@tdia.com (800) 464-2986 (858) 345-1370 Fax (858) 345-1376

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

SAN DI EGO PHYSICIAN.org 13

Risk Management

What is your responsibility for the information provided by a patient whom you have not seen?

and you don’t take action consistent with the community standard of care, then you are potentially liable. To avoid this risk, place a disclaimer on any datacollecting instrument. The following are recommendations for disclaimers for both electronic and paper forms:

Electronic Form Disclaimer Please be advised that by using this form to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours. This form of communication is not intended for acute, emergency, or life-threatening health conditions. If you believe you are having a health emergency, call 911 or go to your nearest emergency department.

No-show New Patients

May Leave Physicians at Risk by SDCMS-endorsed The Doctors Company —For more patientsafety articles and practice tips, visit www.thedoctors.com/ patientsafety. 14 septem b er 2013

Physicians face certain risks and responsibilities when collecting patient information prior to the patient’s arriving for his or her appointment. A new patient may complete an online intake form but not show up for the appointment. Or a new patient may complete a paper record with an intake history but then leave before being seen. The data that is collected, either electronically or on paper, is in the hands of your office practice. As a physician, you now face a dilemma. What is your responsibility for the information provided by a patient whom you have not seen? Whether or not you review this information, you face a risk if the patient believes that a physician-patient relationship has been established. And if the patient has indicated a serious medical condition

Paper Form Disclaimer Please be advised that completing preliminary health and insurance questionnaires does not establish a physician-patient relationship with this practice. Dr. X will review your health history and conduct an initial evaluation to determine whether you are a suitable candidate and whether the practice will accept you as a patient. Protecting the confidentiality of all patients — whether they are established clients or no-shows — is important to minimize the risk of a malpractice suit. Another way to minimize your practice liability is to do a loss-prevention checkup. The Doctors Company offers a “Patient Safety Interactive Guide for Office Practices,” which includes a checklist to ensure you and your office staff are protecting the confidentiality of all patients under the Health Insurance Portability and Accountability Act (HIPAA).

Helping you deliver quality care, one square foot at a time. In today’s competitive market, we leverage our extensive experience and exclusive specialization in healthcare real estate to achieve valuable savings and provide optimal solutions for our clients. We share your commitment to enhancing the patient’s experience, maximizing resources and planning for the future. As San Diego’s trusted leader in medical office and healthcare properties, we thrive on saving our clients time and money through our persistent and strategic negotiating style. Whether negotiating a 2,000-square-foot lease renewal or acquiring a 50,000-square-foot building, you will always be in good hands. Put our experience and expertise to work. Contact us today: Paul Braun Managing Director +1 858 410 6388 paul.braun@am.jll.com

Chris Ross Vice President +1 858 410 6377 chris.ross@am.jll.com

www.us.joneslanglasalle.com/healthcare Leases ▪ Renewals ▪ Sales ▪ Strategic Planning ▪ Demographic & Patient Analysis

PUBLIC HEALTH

Choosing Wisely

An Initiative of the American Board of Internal Medicine (ABIM) Foundation In the coming months and throughout 2014, we will publish in San Diego Physician various Choosing Wisely® lists of “Things Physicians and Patients Should Question.” Choosing Wisely — see page opposite for the first list — is an initiative of the ABIM Foundation to help physicians and patients engage in conversations to reduce overuse of tests and procedures, and support physician efforts to help patients make smart and effective care choices.

16 septem b er 2013

Originally conceived and piloted by the National Physicians Alliance through a Putting the Charter Into Practice grant, leading medical specialty societies, along with Consumer Reports, have identified tests or procedures commonly used in their fields whose necessity should be questioned and discussed. The resulting lists of “Things Physicians and Patients Should Question” will spark discussion about the need — or lack thereof — for many frequently ordered tests or treatments.

How the AAFP List on Page 17 Was Created The American Academy of Family Physicians’ (AAFP) list on page 17 is an endorsement of the five recommendations for family medicine previously proposed by the National Physicians Alliance (NPA) and published in the Archives of Internal Medicine as part of its Less Is More™ series. The goal was to identify items common in primary care practice — strongly supported by the evidence and literature — that would lead to significant health benefits, reduce risks and harm, and reduce costs. A working group was assembled for each of the three primary care specialties: family medicine, pediatrics, and internal medicine. The original list was developed using a modification of the nominal group process,

with online voting. The literature was then searched to provide supporting evidence or refute the activities. The list was modified, and a second round of field-testing was conducted. The field-testing with family physicians showed support for the final recommendations, the potential positive impact on quality and cost, and the ease with which the recommendations could be implemented. AAFP’s disclosure and conflict of interest policy can be found at www. aafp.org. More detail on the study and methodology can be found in the Archives of Internal Medicine article: The “Top 5” Lists in Primary Care. “Five Things” Sources: 1. Agency for Health Care Research and Policy (AIICPR), Cochrane Reviews. 2. Center for Disease Control and Prevention (CDC), Cochrane, and Annals of Internal Medicine. 3. U.S. Preventive Services Task Force (USPSTF), American Association of Clinical Endocrinology (AACE), American College of Preventive Medicine (ACPM), National Osteoporosis Foundation (NOF). 4. U.S. Preventive Services Task Force (USPSTF). 5. U.S. Preventive Services Task Force (USPSTF) (for hysterectomy), American College of Obstetrics and Gynecology (ACOG) (for age).

Choosing Wisely: An Initiative of the ABIM Foundation

Five Things Physicians and Patients Should Question by American Academy of Family Physicians (AAFP)

Note: These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

Don’t Do Imaging for Low-back Pain Within the First Six Weeks, Unless Red Flags Are Present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes but does increase costs. Low-back pain is the fifth most common reason for all physician visits.

Don’t Routinely Prescribe Antibiotics for Acute Mild-to-moderate Sinusitis Unless Symptoms Last for Seven or More Days, or Symptoms Worsen After Initial Clinical Improvement. Symptoms must include discolored nasal secretions and facial or dental tenderness when touched. Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80% of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual healthcare costs.

Don’t Use Dual-energy X-ray Absorptiometry (DEXA) Screening for Osteoporosis in Women Younger Than 65 or Men Younger Than 70 With No Risk Factors. DEXA is not cost-effective in younger, low-risk patients, but is cost-effective in older patients.

Don’t Order Annual Electrocardiograms (EKGs) or Any Other Cardiac Screening for Low-risk Patients Without Symptoms. There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis. Potential harms of this routine annual screening exceed the potential benefit.

Don’t Perform Pap Smears on Women Younger Than 21 or Who Have Had a Hysterectomy for Noncancer Disease. Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety and additional testing and cost. Pap smears are not helpful in women after hysterectomy (for non-cancer disease), and there is little evidence for improved outcomes.

SAN DI EGO PHYSICIAN.org 17

18 septem b er 2013

General Surgery

Internal Medicine (Non-invasive)

OB/GYN

2012 SAN DIEGO COUNTY MICRA SAVINGS CHART

WAYS SDCMS-CMA IS WORKING FOR YOU!

Average

The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s trial lawyers have launched an attack to undermine MICRA and its protections, and we need your help. Membership has never been so valuable!

savings of $ over 90,000

$190,088 $127,233 $121,321 $146,214

$110,941

Miami & Dade Counties, FL

Nassau & Suffolk Counties, NY

Wayne County, MI

FL-NY-MI Average

MICRA Savings

$28,784

$38,514

$35,139

$34,032

$46,372

$9,730

$130,376

$171,504

$108,020

$204,684

$201,808

$41,128

$90,034

$118,744

$88,160

$121,983

$146,089

$28,710

* Medical Liability Monitor - Annual Rate Survey Issue, Vol. 37, No. 10, October 2012. Annual rates with limits of $1 million/$3 million.

San Diego County Medical Society 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123 Phone: (858) 565-8888 • Fax: (858) 569-1334

ARE YOU AN SDCMS-CMA MEMBER?

San Diego County Physicians Are Saving an Average of $90,034 This Year

$35,273

San Diego County

CMA_MicraCharts_SDCMS_11x17_2013.indd 1

SAN DI EGO PHYSICIAN.org 19

5/20/13 4:44 PM

MICRA

Under Attack!

This Is Not a Test! by the california medical association

Page 21 Please Donate to Defend MICRA and Protect Patient Access to Healthcare! Page 22 Know Your MICRA History: Where Are We Today and How Did We Get Here? Page 24 MICRA’s Key Provisions Page 26 The Trial Lawyers’ Ballot Initiative Page 28 Timeline of California’s Initiative Process Page 30 The Trial Lawyersponsored Changes to MICRA Page 31 MICRA Works! Page 32 Answers to the Tough Questions

20 septem b er 2013

y now, you’ve likely heard that Consumer Watchdog, a political astroturf group backed heavily by California’s trial attorneys, has thrown its weight behind a ballot initiative that seeks to undo major provisions of California’s Medical Injury Compensation Reform Act (MICRA). Should MICRA be touched, it would severely limit access to care for millions of patients across the state. Rest assured, this initiative is misguided and fueled by the trial attorneys’ desire to inflate jury awards as a way to increase the legal fees they can collect from their clients. CMA is ready to meet this challenge, and once again, will defeat this effort to overturn MICRA. In the coming months, a good deal of misinformation is likely to be distributed by MICRA opponents, and CMA would like its members to know exactly what is at stake in this fight. As proposed, the initiative being put forward by Consumer Watchdog would retroactively adjust MICRA’s current $250,000 cap on non-economic damages to reflect inflation based on the Consumer Price Index (CPI) from the year MICRA’s enabling legislation was passed. This action would raise MICRA’s cap to roughly $1.2 million and allow for further increases based on the CPI going forward. The initiative also includes a variety of provisions relating to physician drug testing and prescription drugs, but the primary motivation is to lift MICRA’s cap and give California’s trial attorneys access to the massive jury awards they have sought for almost four decades. While Consumer Watchdog is doing everything in its power to muddle the issue for voters, early polling conducted by CMA suggests that the public trust garnered by physicians will be a large asset in the coming fight. When asked their impression of both their doctor and community clinic, 91% and 70% of respective poll responders noted they held a “favorable” impression. Meanwhile, nearly 40% of those responding said they held an “unfavorable” position of trial lawyers. These statistics are encouraging, but in the coming months, much more will be done to ensure MICRA is not compromised. CMA will be successful in this fight, but victory will not come overnight, and we will need your help. As an SDCMS-CMA member, you will be kept in the loop with the latest developments on the MICRA fight through regularly scheduled updates. Until then, please visit www.cmanet.org/micra for more information, as well as how to donate and help protect California’s historic malpractice protections. We will emerge from this threat stronger than before, but we cannot do it alone.

Protect Patient Access to Healthcare Please Donate to the MICRA Fight Today!

DONATE AT www.CMAnet.org/MICRA A large-scale MICRA fight will be an extremely costly undertaking. CMA is urging all physicians to consider a donation to CMA’s political action committee (CALPAC), which for the past 38 years has served as the first line of defense for California’s historic physician protections. Join SDCMS-CMA: By joining SDCMS-CMA, you will help to ensure that the voice of California’s physicians is heard loud and clear in the Capitol and beyond. Together, our unified voice can move mountains. Join today at www.SDCMS.org.

SAN DI EGO PHYSICIAN.org 21

MICRA

1985–2013

Under Attack!

MICRA ensures Californians have access to doctors!

Know Your MICRA History! Where Are We Today, and How Did We Get Here?

Nov. 4, 2014 General Election with Californians voting on a trial lawyer-sponsored ballot initiative to — among other things — raise the MICRA cap on non-economic damages from $250,000 to more than $1.2 million.

What Happens Between Now and Nov. 4, 2014, Depends on California’s Physicians! July 24, 2013 California’s trial lawyers — via Robert Pack, who has aligned himself with Consumer Watchdog and Consumer Attorneys of California — make good on their May threat to ask voters to repeal MICRA by submitting language to the California Attorney General, the first step in a long and expensive process to qualify a measure for the ballot. The trial lawyers must gather 500,000 valid signatures to place the measure before voters in November 2014. The initiative’s main provision would increase the cap on non-economic damages from the current $250,000 to more than $1.2 million, with automatic increases every year. Its other provisions relate to physician drug testing and prescription drugs, but make no mistake — the main purpose is to change MICRA to make it easier for lawyers to file lawsuits against doctors, hospitals, community clinics, and other healthcare providers, thereby generating big paydays for themselves.

May 2, 2013 A coalition — including Consumer Attorneys of California and the trial-lawyerfunded Consumer Watchdog group — announces intentions to seek to overturn MICRA through legislation or, failing that, a ballot initiative. 22 septem b er 2013

Oct. 15, 1985 The California Supreme Court declines to review Lawrence Fein v. Permanente Medical Group, stating, “The appeal is dismissed for want of a substantial federal question.” Ten years after passage, the question of MICRA’s constitutionality is finally settled law. Medical liability premiums stabilize at significantly lower rates for California physicians than for physicians in states without strong MICRA reforms, and MICRA today remains the model for national medical liability tort reform.

1975–1985 Lawsuits challenging the constitutionality of MICRA weave their way through the judicial system.

Sept. 23, 1975 Gov. Brown signs the CMA-supported bill.

Sept. 11, 1975 The Legislature passes AB 1XX, a collection of statutes that is now known as the Malpractice Insurance Compensation Reform Act (MICRA).

May 19, 1975 – Sept. 11, 1975 Special session with negotiations and legislative hearings involving CMA and other healthcare providers, the insurance industry, and trial lawyers.

May 16, 1975 Gov. Brown yields, issuing a proclamation for a special session.

May 13, 1975 CMA leads more than 800 physicians, nurses, lab technicians, and hospital personnel in a Capitol rally calling on Gov. Brown to convene a special session of the Legislature to deal with the crisis.

Early and Mid-1970s California’s physicians are embroiled in a malpractice insurance crisis. Driven by frivolous lawsuits and excessive jury awards, medical liability insurers levy massive insurance premium increases and cancel insurance policies for many physicians across the state, throwing California’s healthcare system into crisis. Following are sample articles published in the winter of 1975: “New Bay Area Crisis in Medical Care: Doctors Might Halt Practice” (San Francisco Chronicle); “Insurance Rates Peril Medical Care” (San Jose Mercury News); “Doctors Face Insurance Crisis — May Affect 8,000 in Southland” (Los Angeles Times).

THIS IS NOT A TEST Trial Lawyers have begun an all-out assault on MICRA, California’s landmark tort reform law.

Join the Fight Today! Every dollar contributed to CALPAC goes directly to protecting MICRA, ensuring that your doors stay open. Visit www.cmanet.org/micra or call 916.444.5532 for more information. SAN DI EGO PHYSICIAN.org 23

MICRA

Under Attack!

MICRA’s Key Provisions Limits on Non-economic Damages: Non-economic damages in a claim against a healthcare provider for medical negligence are limited to $250,000. Economic damages, such as lost earnings, medical care, and rehabilitation costs, are not limited by statute. California Civil Code Section 3333.2

Evidence of Collateral Source Payments: A defendant in a medical liability action may introduce evidence of collateral source payments (such as from personal health insurance) as they relate to damages sought by the claimant. If a defendant introduces such evidence, the claimant may also introduce evidence of the cost of the premiums for such personal insurance. Civil Code Section 3333.1

Limits on Attorney Contingency Fees: In an action against a healthcare provider for professional negligence, an attorney’s contingency fee is limited to 40% of the first $50,000 recovered; 33% of the next $50,000; 25% of the next $500,000, and 15% of any amount exceeding $600,000. California Business and Professions Code Section 6146

Advance Notice of a Claim: To further the public policy of resolving meritorious claims outside of the court system, MICRA requires a claimant to give a 90-day notice of an intention to bring a suit for alleged professional negligence. If the notice is given within 90 days of the expiration of the statute of limitations, the statute is extended 90 days from the date of the notice. California Code of Civil Procedure Sections 364 and 365

Statute of Limitations: In California, a claim for alleged medical negligence must be brought within one year from the discovery of an injury and its negligent cause, or within three years from injury. Code of Civil Procedure Section 340.5 Periodic Payments of Future Damages: A healthcare professional may elect to pay a claimant’s future economic damages, if more than $50,000, in periodic amounts. This avoids a claimant’s wasting of an award prior to actual need. Code of Civil Procedure Section 667.7 Binding Arbitration of Disputes: Patients and their healthcare providers may agree that any future dispute may be resolved through binding arbitration. California statute requires specific language for such contracts and also provides that all such contracts be revocable within 30 days. Code of Civil Procedure Section

24 septem b er 2013

YOU ARE OUR HERO thank you for giving access to healthcare for those without!

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

You are the Heart & Soul of Project Access San Diego Through your support of our flagship program, Project Access San Diego, we have been able to assist over 2,200 uninsured adults in our community to improve their health through access to specialty healthcare services. You have provided over $7 million in contributed healthcare services to community members since our program’s beginnings in December 2008!

Thanks to our Sponsors Sept. 26, 2013 Event

Thanks to more than 625 volunteer physicians providing specialty healthcare services to those who most need our help, we are getting people back to work, and able to care for their families. You are our Heroes! Without the generous support and dedication of all of our physician volunteers, hospitals and outpatient surgery centers, imaging, labs, physical therapy, and other 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!

The Doctors Insurance Agency

Bob DeSimone

Get Involved San Diego County Medical Society Foundation needs you! Join us to volunteer for Project Access, or provide specialty consultations to primary care physician colleagues through eConsultSD, our HIPAA-compliant, web-based system from the comfort of your home or office. Attend an event, assist us to recruit fellow physicians, or provide educational opportunities for primary care physicians or medical students. We hope you will join us at the Aces for Health Golf Tournament at Del Mar Country Club on Thursday, March 13, 2014. And please consider making a contribution to SDCMS Foundation to support our efforts at www.sdcmsf.org, or contact Kristina Starkey, Resource Development Director, at 858.565.7930 or Kristina.Starkey@sdcms.org.

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

MEDICO

Professional

www.sdcmsf.org SAN DI EGO PHYSICIAN.org 25

MICRA

Under Attack!

The Trial Lawyers’ Ballot Initiative “Troy and Alana Pack Patient Safety Act of 2014”

• Requires a physician (and allows any person) to report to the Medical Board of California (MBC) any information that appears to show that a physician may be or has been impaired while on duty. • Requires a physician to report to the MBC any physician responsible for care and treatment who failed to follow the standard of care when an adverse event occurs. • Hospitals shall conduct testing for drugs and alcohol on physicians on a random basis for those with admitting privileges, and immediately upon the occurrence of an adverse event, including those who treated or prescribed within 24 hours of the event. • The physician is responsible for being tested as soon as possible after learning of the adverse event. Failure to submit to testing within 12 hours after learning of the event may be cause for suspension of the physician’s license. The hospital shall bill the physician for the costs of testing, which cannot be passed on to patients or their insurers, should the MBC direct a test to be completed. • Hospitals shall report any positive tests or refusal to submit to the MBC, which shall refer it to the Attorney General, suspend the physician’s license pending an investigation and hearing on the matter, and notify the physician and all facilities at which the physician practices that the license has been suspended.

26 septem b er 2013

• If the MBC finds the physician was impaired while on duty or during an adverse event, or the physician refused testing, the MBC shall take disciplinary action, which may include required addiction treatment, additional testing during probation, and/or suspension of licensure until the MBC is satisfied the physician can return to work.

• The adjusted cap will apply to any action that has not been resolved by final settlement, judgment, or arbitration as of Jan. 1, 2015.

• If the patient has an existing prescription, the practitioner shall not prescribe or dispense unless the practitioner determines there is a legitimate need.

• A physician who tests positive for drugs or alcohol or refuses to comply with testing in any action shall be presumed negligent.

• The practitioner is presumed professionally negligent for failure to comply with this section and shall be subject to disciplinary action by the MBC.

• If the MBC finds a physician was impaired during an adverse event, it shall notify the patient or family of a deceased patient of the finding.

• Prior to prescribing or dispensing a Schedule II or Schedule III controlled substance for the first time to a patient, the healthcare practitioner shall consult CURES database.

• Any legislative changes should this act be approved shall require a two-thirds vote of the Legislature and signature by the governor.

• The MBC shall assess an annual fee on physicians to pay for the costs to the MBC and the Attorney General for this program.

Join the Fight Today! Every dollar contributed to CALPAC goes directly to protecting MICRA, ensuring that your doors stay open. Visit www.cmanet.org/micra or call (916) 444-5532 for more information.

• Amends the MICRA provisions in the Civil Code relating to non-economic damages to say: On Jan. 1, 2015, the cap on damages shall be adjusted to reflect the increase in inflation based on the Consumer Price Index (CPI) SINCE THE CAP WAS ESTABLISHED. Note: This will raise the cap to approximately $1.25 million. The cap will be adjusted annually based on the CPI going forward.

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MICRA

Under Attack!

Timeline of California’s Initiative Process Election: Nov. 4, 2014

The 2014 General Election will be held Tuesday, Nov. 4, 2014. For the initiative to qualify for the 2014 General Election ballot, all signatures must be submitted by Thursday, June 26, 2014.

28 septem b er 2013

Trial Lawyers Submit Ballot Initiative to the Attorney General (July 24, 2013) • requires request for title and summary • $200 filing fee • signed certification with contact information The initiative may be withdrawn or amended with the attorney general’s office; this may be done several times.

Attorney General Has 15 Days to Either Provide Title and Summary to the Secretary of State, or Request a Determination of Fiscal Estimate or Opinion From the Department of Finance • The Department of Finance and Joint Legislative Budget Committee have 25 working days to complete a fiscal estimate of the amount of increase in costs to the state or local government. • The attorney general then has 15 days to provide title and summary to the secretary of state.

The Attorney General Submits Final Title and Summary to the State Senate and Assembly for Potential Public Hearings, and Proposition Number Is Attached • The title and summary will also be sent to the trail lawyers, establishing the “Official Summary Date.” °° This is the date the secretary of state will use to calculate calendar deadlines for the initiative. °° No petition may be circulated for signatures prior to the official summary date.

4 5

The Title and Summary Process May Take up to 55 Days to Complete, but Every Time the Initiative Is Withdrawn or Re-filed, the Clock Starts Over

Trial Lawyers Begin to Collect Signatures to Qualify the Initiative • The trial lawyers will have 150 days from the “Official Summary Date” to collect 500,000 valid signatures to qualify the initiative. • Signatures must be submitted 131 days prior to the election.

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MICRA

Under Attack!

The Trial Lawyer-sponsored Changes to MICRA … 1

Increase Meritless Lawsuits and Lawyer Fees!

• A look at who is supporting this change is all you need to know. Groups representing trial lawyers have amassed a multimillion-dollar war chest for a political campaign to change the law. • Trial lawyer-sponsored changes to increase (or eliminate) MICRA’s non-economic damages cap will make it easier and more lucrative for trial lawyers to file meritless lawsuits and collect more in legal fees. That’s why they’re behind this change. • A higher limit (or no limit) on noneconomic damages gives trial lawyers incentive to take on non-meritorious cases because the possibility of an outof-court settlement is more likely. • There’s also more incentive for lawyers to wait longer to settle a questionable suit, in hopes the defendant will settle out of fear because time devoted to fighting a meritless claim is time taken away from patient care. Time may be more valuable to the provider and his patients than the cost to settle.

Increase Healthcare Costs!

• Meritless lawsuits waste precious healthcare resources. The end result is

30 septem b er 2013

increased healthcare costs for patients, and operating costs for doctors, hospitals and community clinics that are already struggling to keep their doors open. According to a 2010 study by California’s former independent, nonpartisan Legislative Analyst, merely doubling the non-economic damages cap to $500,000 would increase healthcare costs in California by $9.5 billion annually.

Won’t Improve Quality!

• Meritless lawsuits don’t improve healthcare quality, they only increase costs and enrich trial lawyers at the expense of everyone else.

create even longer lines in emergency rooms, long waits to see specialists, reduced access to women’s services like OB-GYNs, and increased demand will make it harder for patients to see their own doctor.

Will Reduce Patient Access to Healthcare Services!

• California already has a shortage of doctors, and with federal healthcare reform expanding coverage for millions of uninsured Californians this shortage will become even more severe. • Doctors and healthcare providers say raising MICRA’s cap by 400% will dramatically increase healthcare costs and we will see fewer doctors practicing in California. • As a result, the doctor shortage will

Comes at the Worst Possible Time!

• California is leading the nation in implementing federal healthcare reform to bring coverage and expand access to millions of Californians. • We should be focused on lowering healthcare costs, not on policies that make lawyers richer at the expense of everyone else. • The higher costs resulting from triallawyer-sponsored changes to MICRA will increase operating costs for doctors, hospitals, and community clinics, jeopardizing the ability of providers to take on more patients.

MICRA Works! 1 2

3 4

The Trial-lawyer-sponsored Changes Are Opposed by 700+ Groups! • MICRA is supported by a coalition of more than 700 organizations representing doctors, nurses, hospitals, community clinics, labor unions, local government, schools, emergency providers, police, and many others.

MICRA Fairly Compensates Patients! • MICRA’s provisions include UNLIMITED recovery for all economic or out-of-pocket costs including: °° UNLIMITED recovery for any and all past and future medical costs. °° UNLIMITED recovery for any past and future lost wages °° UNLIMITED recovery for punitive damages °° UP TO $250,000 in non-economic damages • Lawyers are paid on a sliding scale so more money goes to patients, not their lawyers. • Under MICRA, payments to patients are going up at a rate more than twice that of inflation. • The reasonable $250,000 cap reduces incentives to file meritless lawsuits, while at the same time ensures that legitimate claims can move forward.

MICRA Helps Lower Healthcare Costs! • Fewer meritless claims against providers helps maintain and stabilize medical liability rates. • Because of MICRA’s protections, California has lower medical liability rates than many other states. According to 2012 figures from the Medical Liability Monitor [see center spread for a San Diego County MICRA savings chart].

MICRA Improves Patient Access to Care! • Lower medical liability rates means doctors, hospitals and community clinics can remain operational, keeping their doors open to treat patients, especially our poorest and most vulnerable patients. A look at two other states helps illustrate this: • Texas: Instituted reforms, now has thousands more physicians including in underserved areas. According to the Texas Alliance for Patient Access, Texas enacted medical liability reforms in 2003 and has since added more than 14,000 in-state, active physicians. Additionally, 35 rural Texas counties have added at least one obstetrician, including 16 counties that previously had none; 46 counties that did not have an emergency medicine physician now do; 15 counties that did not have a cardiologist now do. • New York: No reforms, suffers physician shortages in many counties. In New York, 19 counties are without obstetricians, 22 are without internal medicine specialists, and 15 do not have surgical specialty doctors, according to a 2010 study by The Center for Health Workforce Studies. According to a July 2012 story in The New York Times, several hospitals in NYC are partially or completely without liability insurance due to the high cost of liability premiums.

SAN DI EGO PHYSICIAN.org 31

MICRA

Under Attack!

Answers to the Tough Questions QUESTION: Has the $250,000 cap on non-economic damages (“pain and suffering”) kept up with inflation? It was passed 38 years ago, and that $250,000 is now only worth $60,000. Shouldn’t it be increased? ANSWER: First of all, let’s remember that under MICRA patients receive unlimited compensation for all economic damages, or out-of-pocket costs. Wages, medical costs, and punitive damages are all paid on an unlimited basis, and these payments are going up at more than twice the rate of inflation. The discussion today is about whether trial lawyer-sponsored changes to MICRA are good policy. Healthcare providers and many others don’t think so because trial lawyers seeking to change MICRA’s non-economic damages cap might benefit lawyers, but we all pay through higher healthcare costs and reduced access to doctors, hospitals, and clinics. That’s why the changes are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

QUESTION: Those who don’t have high economic damages — like babies, seniors, and low-income Californians — are limited to just $250K in non-economic damages. How do you feel about that?

32 septem b er 2013

ANSWER: First of all, let’s remember that under MICRA patients receive unlimited compensation for all economic damages, or out-of-pocket costs. Wages, medical costs, and punitive damages are all paid on an unlimited basis. These payments are going up at more than twice the rate of inflation. Changes being proposed by trial lawyers to make it easier and more lucrative to file more meritless lawsuits will especially hurt low-income Californians and seniors because it will increase healthcare costs and make coverage less affordable for them, and reduce access to care. More meritless lawsuits do nothing to improve healthcare. They just enrich trial lawyers at everyone else’s expense through higher healthcare costs and reduced access to doctors, hospitals, and clinics. That’s why trial-lawyer-sponsored changes are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

QUESTION: Changing MICRA by increasing the non-economic damages cap will help improve quality by holding doctors more accountable. Aren’t there tens of thousands of medical deaths each year due to error? ANSWER: First, we believe even one medical error is too many. But changes being pro-

posed by trial lawyers — to make it easier to file more meritless lawsuits and make more in legal fees — won’t improve quality. More meritless lawsuits do nothing to improve healthcare; they just increase healthcare costs, reduce access, and enrich trial lawyers at everyone else’s expense. That’s why trial-lawyer-sponsored changes are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

QUESTION: Under MICRA, if a baby is unable to make it past delivery and fault is found with the provider, MICRA limits the family to $250,000 in non-economic damages. What are your thoughts on that? ANSWER: My heart goes out to any parent who loses a child, no matter how young or old. I’m sure everyone would agree there’s no amount of compensation that could make up for the loss of a loved one. But changes being proposed by trial lawyers — to make it easier and more lucrative to file more meritless lawsuits — won’t help. More meritless lawsuits do nothing to improve healthcare. They only enrich trial lawyers and we all pay. That’s why trial-lawyer-sponsored changes are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

QUESTION: Insurance companies are fighting changes to MICRA because giving injured patients justice cuts into their profits. Insurance companies are beholden to their shareholders, not to people. Isn’t it time to change that? ANSWER: It’s clear who has the profit motive: trial lawyers. Their changes to MICRA will make it easier and more lucrative to file more meritless lawsuits and collect more in legal fees. Trial lawyers are simply looking for a way to attach a profit motive to anyone

but themselves. This argument is a red herring and unsupported by a quick look into how the market in California really works. In California, about half of our healthcare providers work for entities that are self-insured (local governments, public hospitals, Kaiser, schools, etc.). Selfinsured entities don’t buy insurance coverage; claims are paid using existing resources. For public entities, existing resources equals taxpayer funds. These insurers are heavily regulated by the California Department of Insurance through Prop. 103. Under Prop. 103, rates charged to healthcare providers must be justified and approved by the California Department of Insurance. They will not approve rates that are unsupported by data provided by the insurer. Insurers can only increase rates with their approval. More meritless lawsuits do nothing to improve healthcare. They only enrich trial lawyers and we all pay. That’s why trial lawyer-sponsored changes are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

San Diego Physician Magazine Advertisers: We Appreciate Your Support!

QUESTION: Has MICRA been changed at all in the past 30-plus years? ANSWER: Interestingly, MICRA was changed only once. It was a change sought by trial lawyers to increase their fees, which left less for injured patients. MICRA has remained intact because the law has been successful and lawmakers realize that more meritless lawsuits and higher payouts to lawyers don’t equate to better health care. More meritless lawsuits mean higher healthcare costs and reduced access to care. That’s why trial-lawyer-sponsored changes to MICRA are opposed by more than 700 healthcare groups and others who strongly support MICRA because it fairly compensates patients and increases access to care.

BBVA-Daniel Schroeder Cooperative of American Physicians The Doctors Company Imaging Healthcare Specialists Jones Lang LaSalle Law Offices of Matthew D. Rifat, LLP Norcal Riviera Real Estate Scout Revenue Soundoff Computing University Compounding Pharmacy

SAN DI EGO PHYSICIAN.org 33

classifieds PHYSICIAN POSITIONS AVAILABLE JOIN HOUSE CALL DOCS INC., a dynamic group of pioneering healthcare practitioners striving for excellence while developing sound socioeconomic models of healthcare delivery. Our mobile primary care / specialty practice complements our panoramic outpatient practices in primary care, oncology, cardiology, gastroenterology, gynecology, infectious diseases, and psychiatry. Pay is among the best in the country, with part-time income in the $150K range (exclusive of incentives / bonuses). A good fit is essential. Interview questions should be directed to Dr. Wolfram Forster, Senior Partner, House Call Docs Inc. (1855 B Street, Suite 200, San Diego, CA 92101, phone 619-793-7988) [167] INTERNAL MEDICINE OR FAMILY PRACTICE, FULL-TIME OR PART-TIME, FLEXIBLE HOURS: National Health Service Corps — Loan Repayment Eligible Site Imperial Beach Community Clinic. A community-focused health center committed to being responsive to the healthcare needs of our area. Physician needed with license to practice medicine in the state of California. Board-certified. Imperial Beach Health Center Attention: Jorge Gutierrez — Human Resources Director, 949 Palm Ave., Imperial Beach, CA 91932. Phone (619) 628-5564. Email jorgeg@ibclinic.org. [166] PHYSICIAN OR NURSE PRACTITIONER TO PERFORM HOUSECALLS: In North San Diego County Monday through 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. NPs: Home health experience a plus. Please respond by email only to mobiledoctor@sbcglobal.net. Thank you. [165a] ADULT PRIMARY CARE OPPORTUNITIES: Family medicine, internal medicine, and urgent care openings throughout Southern California. The Southern California Permanente Medical Group (SCPMG) boasts nearly 60 years of experience in delivering high-quality, innovative healthcare. With sub-specialists in virtually every area of medical and surgical practice, SCPMG is home to more than 6,000 physicians serving over 3.3 million members. SCPMG prides itself on attracting outstanding physicians and offers them the opportunity to have sustained, fulfilling careers in their practices while enjoying the benefits of a large, stable medical group. Full-time physicians have access to a compensation and benefits package that’s designed to impress you. Per diem opportunities offer flexible schedules as well as the chance to earn supplemental income. For consideration, please visit and apply at our website at http://physiciancareers.kp.org/scal, call (877) 608-0044, or email professional.recruitment@ kp.org. We are an AAP/EEO employer. [164] DERMATOLOGIST: Arch Health Partners is an award-winning medical foundation affiliated with the Palomar Health System in North San Diego County. The state-of-the-art New Palomar Medical Center, the country’s largest hospital construction project and the first new North County hospital in 30 years, opened August 2012. Arch Health Partners employs 80 providers in 11 locations, with new offices opening Fall 2013. Arch Health Partners seeks to bring together the best physi-

cians, hospitals, and employees to provide care of the highest clinical quality. Our focus is to provide an exceptional patient experience where healing begins and health is restored. BC/BE dermatologist to join a busy dermatology practice with Arch Health Partners. Send CV to catherine.jones@ archhealth.org. [162] FULL-TIME OR PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a full-time and/or part-time physician. Good hours (mostly 9:00am–5:30pm weekday shifts with some weekends from 9:00am–4:00pm and closed on major holidays) plus good pay. Please send CV to jeff@eastcountyurgentcare.com or fax to (619) 442-2245. [161] PSYCHIATRIC CENTERS AT SAN DIEGO (PCSD) IS LOOKING FOR A PSYCHIATRIST: to work for the George F. Bailey Detention Facility, full-time, Monday–Friday, 8:00am–4:30pm. Must be licensed to practice medicine in the State of California by the Medical Board / Osteopathic Board of California. Must maintain a BLS and DEA. Must have a valid certificate in psychiatry. Salary DOE. PCSD will cover malpractice insurance. Medical, dental, 401k offered. If you are interested in making a difference and becoming part of the PCSD team of professionals, please fax your cover letter and CV to Jada Brathwaite, director of operations, at (619) 528-4625. EOE (157) PSYCHIATRIC CENTERS AT SAN DIEGO (PCSD) IS LOOKING FOR A PSYCHIATRIST: to work for the Las Colinas Detention Facility, part-time, Monday–Friday, 1:00pm–4:30pm, and every other Saturday 8:00am–4:00pm. Must be licensed to practice medicine in the State of California by the Medical Board / Osteopathic Board of California. Must maintain a BLS and DEA. Must have a valid certificate in psychiatry. Salary DOE. PCSD will cover malpractice insurance. If you are interested in making a difference and becoming part of the PCSD team of professionals, please fax your cover letter and CV to Jada Brathwaite, director of operations, at (619) 528-4625. EOE (158) PHYSICIAN WANTED FOR OUR GROWING ORGANIZATION: Full- and part-time, flexible schedules available. Variety of locations in San Diego. Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our patients and community. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 9064591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. To apply, visit our website and apply online at www. fhcsd.jobs. [046] FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN NEEDED to help two physicians in Chula Vista. Reasonable salary and package, four weeks’ leave, light call commitments, and cheerful work environment. Nursing home, hospital,

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 septem b er 2013

and teaching opportunities optional. Please send CV or questions to geriatricpractice@gmail.com. [156] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fastgrowing 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 (619) 9925330 or email CV to drhunt@thehousecalldocs. com. Visit www.thehousecalldocs.com. [037] PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www. vistacommunityclinic.org. EOE/MF/D/V [912] 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) 5045830 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 MEDCLINIC: 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 LEASING MEDICAL OFFICE SPACE IN ESCONDIDO: 2,450 square-foot office building in downtown Escondido, adjacent to large imaging center. Three examining rooms, two consulting rooms, and an office designed to be completely HIPAA compliant. Also, a leaded room suitable for radiographic services. Available for rent February 1, 2014. Apply to Physicians’ Medical Building, 355 E. Grand Ave., Excondido, CA 92025. [169] ENCINITAS OFFICE SPACE TO SUBLEASE — 345 SAXONY ROAD, ENCINITAS: Shared office space available, 1700 square feet total. Occupied by one dermatologist. Easy-to-find location just off the I-5 with all new decor. Spa-like waiting room and friendly, professional front desk staff. Will sublease one or two exam rooms, half or full day. Exam rooms complete with electronic fully adjustable chair, cabinets, and sink, and great windows provide ocean views and plenty of light in the rooms. Plenty of free parking. For more information, call Elizabeth at (760) 230-2537. [163]

NORTH COAST HEALTH CENTER OFFICE SPACE TO SUBLEASE — 477 EL CAMINO REAL, ENCINITAS: Beautiful office space available, 2100 square feet, at the 477/D Building. Occupied by vascular and general surgeons. Great window views and location with all new equipment and furniture. New hardwood floors and exam tables. Full ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day. 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 (858) 452-0306. [153]

the week. Contact Nerin at the office at (858) 5210806 or at mzarei@cox.net. [873]

SCRIPPS XIMED MEDICAL CENTER BUILDING OFFICE SPACE TO SUBLEASE — LA JOLLA: 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, Scripps XiMed Medical Center Building is the office space location of choice for anyone doing surgeries at the hospital or seeking a presence in the La Jolla area. Support staff may be available if needed. Full ultrasound lab on site / procedure room. For more information, call Irene at (619) 840-2400 or (858) 452-0306. [154]

SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@SDCMS.org for more information. [867]

OFFICE SPACE AVAILABLE IN SANTEE: We are located at 9456 Cuyamaca St., #102, Santee, CA 92071. There are 2 exam rooms and 2 doctors offices, private bathroom and a patients bathroom, kitchenette, large waiting room, a front office area, and a billing office area. Our parking lot is huge! It would be ideal for a psychiatrist or psychologist. Please email stacey.sdgi@gmail.com or call (619) 270-5665. Or contact Dr. A. Reddy at (619) 5655138 or via email at areddyp.ca@gmail.com. [150] SUBLEASE IN PRESTIGIOUS UTC BUILDING: Sublease beautifully appointed 2100-square-foot office in prestigious building in UTC, starting on July 1, 2014. Ideal for plastic surgeon, urologist, orthopedic surgeon, or pain specialist. Direct access to AAAASF-certified surgical center with existing contracts with Blue Cross, UnitedHealthcare, workers’ compensation, and Aetna. Fraxel repair laser, hand fluoro, endoscopic and powerassisted liposuction equipment available at premises. Please call or email Ines Ustare at (858) 4578686 or ines@solteromd.com. [145] 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 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] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sq-ft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / satellite location, flexible days of

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) 5045830. [835]

NONPHYSICIAN POSITIONS AVAILABLE / WANTED

PART-TIME PA OR NP NEEDED FOR FAMILY PRACTICE: Located in Eastlake / Chula Vista area. Must have 1–2 years experience in family practice. Will perform complete physical exams, including pap smears, must be able to diagnose and treat acute and chronic problems. This includes ordering and interpreting diagnostic tests. Patients of all ages. We are open Monday through Friday, 8:00am to 5:00pm. Seeking part time, 16+ hours. Days and times are negotiable. Hourly rate is competitive. Physician may require more coverage if out of office. Please contact Norma at (619) 946-4073. [170] FULL-TIME PHYSISIAN’S ASSISTANT: Looking for a physician’s assistant to join a busy academic private spine surgeon’s practice in La Jolla area. Preferred candidate should have 3–5 years of previous experience. Responsibilities to include but are not limited to: Examine patients to obtain information about their physical condition; provide physicians with assistance during surgery or complicated medical procedures; interpret diagnostic test results for deviations from normal; visit and observe patients on hospital rounds or house calls; update charts; order therapy; and report back to physician. Compensation based on experience. Please send CV to icuellar@sandiego-spine.com. [168] PHYSICIAN OR NURSE PRACTITIONER TO PERFORM HOUSECALLS: In North San Diego County Monday through 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. NPs: Home health experience a plus. Please respond by email only to mobiledoctor@sbcglobal.net. Thank you. [165b] PART-TIME NURSE PRACTITIONER: A concierge internal medicine practice in La Jolla is hiring a part-time nurse practitioner, to ultimately transition to full-time with benefits. 20% clinical visits + 20% health coaching + 30% phone calls / emails + 30% care coordination. Preferred Skills: excellent bedside manner, articulate communicator, electronic charting experience, detailoriented, ability to function autonomously, and experience in geriatric medicine. Requirements: current California registered nurse license and nurse practitioner certificate from the State of California, with furnishing license; DEA number; American Heart Association Healthcare Provider

BLS card required by hire date; participation in after-hours call. Salary is based on qualifications; long-term commitment rewarded. Email Kirstin at admin@pambrarmd.com. [160] 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 / résumé to paindoctorstaff@hotmail.com. [094] PART-TIME OR FULL-TIME NP OR PA: Island Family Medicine is looking for a part-time or fulltime NP or PA who loves primary care and wants to work with both adults and children of all ages. Busy practice in Coronado with a small-town feel. Experience preferred, but I am willing to consider a motivated new graduate. Compensation based on experience. 401K for PT and FT. Vacation pay and health insurance for FT. Apply by sending resume to CoronadoMedPeds@gmail.com. [155] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [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]

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SAN DI EGO PHYSICIAN.org 35

San Diego Physician Celebrates 100 Years!

The Bulletin of the San Diego County Medical Society August 21, 1942

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 â&#x20AC;&#x153;Bulletinâ&#x20AC;? 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

medWe do not hear much agitation for socialization of has icine these days. Our system of private medicine that s ement achiev great many so for sible been respon the demands for revolutionary changes are not given . people ng support of thinki , However, proposals are occasionally made which exwould , sound cially superfi seem may though they which tend a measure of political control over medicine of ntation regime or zation sociali for way would pave the the doctor at some future date. al A recent example of that is found in the propos make that the Social Security Laws be broadened to their health insurance compulsory for all workers and families. If this proposal were made into law, the doctor l would have to look to the insurer, a branch of Federa r insure The ood. livelih his of much for government, and would determine the fees which he might charge

36 septem b er 2013

he that, in turn, would determine the amount of time would could give each patient. The future of all doctors perdepend, in part, on a bureau whose policies and g tides sonnel are directly affected by the ever-changin lsory of politics. And, most important by far, if compu logisickness insurance became a national policy, the evg makin law a of e passag the be would step cal next of the erything concerned with public health a function sostate. And that would be nothing more or less than cialized medicine. If private medicine had failed, a case could be made been a for this. But the plain truth is that America has ery. discov al medic in and sick the of care in leader world finest The man with little or no money can command the much medical talent, and the most famous doctors give reaof their time to patients who cannot pay. What valid given has which system a ting disrup for be there son can the American people the finest average health on earth?

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