2014

After almost a decade of

struggle, San Diego County’s GPCI inequity has finally been resolved …

2013 SDcms Annual Report “Physicians United for a Healthy San Diego”

2013 Defending MICRA Eliminating GPCI Once and for All! After almost a decade of struggle, the Geographic Practice Cost Index (GPCI) inequity for San Diego County has finally been resolved!

On April 1, President Obama signed legislation that permanently eliminates this geographic inequity for select California urban counties (like San Diego) while holding rural counties harmless. This is a HUGE HUGE HUGE win for San Diego, which has been getting less than what we actuarially should from Medicare, to the tune of roughly $30 million per year, and 2–3 times that amount for insurance reimbursements denominated in Medicare rates. The GPCI inequity has cost San Diego physicians roughly $100 million per year for more than a decade, or roughly $14,000 per physician per year. While in a perfect world the GPCI elimination would have been immediate, in a political compromise the permanent elimination of the GPCI inequity will be phased in over six years, starting in 2017, but the issue has at last been put to rest, allowing us to focus on other issues. For every individual or organizational member of SDCMSCMA, thanks for your support over the long haul. We literally could not have pulled this off without you.

And for every physician who is not a member, you need to join — today!

A huge huge huge win for San Diego

For four decades, SDCMS and CMA successfully spent your dues dollars and CALPAC contributions to ensure MICRA’s safety in the California Legislature and to defend it in both state and federal courts. In 2013, CMA stopped several attempts by the trial lawyers to eviscerate MICRA in the Legislature — a major CMA victory. The trial lawyers have qualified a November 2014 ballot measure to raise the MICRA non-economic damages cap to $1.2 million, with a permanent and annual cost-of-living adjustment, and to drug-test doctors — among other onerous provisions. In order to win at the ballot box in November, we will need every member to contribute above and beyond his or her dues, and we will need nonmembers to contribute by joining SDCMSCMA — we are all in this together!

Thank you to the following medical staffs and medical groups for their donations to defend MICRA! Alvarado: $10,000 Grossmont: $33,000 Palomar: $33,000 Paradise Valley: $10,000 Pomerado: $33,000 Rady Children’s: $33,000 San Diego Imaging: $12,000 San Diego Pathologists Medical Group: $10,000 Scripps Clinic: $10,000 Scripps Encinitas: $10,000 Scripps Memorial: $33,000 Scripps Mercy (San Diego and Chula Vista): $33,000 Sharp Chula Vista: $10,000 Sharp Coronado: $20,000 Sharp Memorial: $33,000 Tri-City: $5,000 The California Hospital Association matches hospital medical staff contributions 2:1! In other words, medical staffs have raised $918,000, plus the $22,000 from San Diego Imaging and San Diego Pathologists Medical Group, or almost $1 million for San Diego!

To defeat this ballot measure, we will need non-members to join SDCMS-CMA! Protecting Patients CMA stopped nurse practitioners from independently practicing medicine without supervision (SB 491).

CMA stopped optometrists from performing surgical procedures (SB 492).

CMA ensured pharmacists collaborate with physicians (SB 493).

CMA ensured physical therapists continue to work within the legal boundaries of medical corporations (AB 1000).

CMA stopped cancer patients from being inappropriately treated with methods not scientifically proven (SB 117).

CMA kept school district governing boards out of the physicianpatient relationship (SB 312).

CMA stopped legislators from determining standards of care (SB 430).

CMA ensured medical assistants do not perform unsupervised tests or exams (SB 352).

CMA stopped the MBC from limiting a physician’s prescribing authority (SB 670).

CMA supported legislation signed by the governor to expand Medi-Cal coverage to low-income adults (SBX1 1).

Mitigating Cal MediConnect’s Negative Impact

CMA advocacy eliminated the 10% Medi-Cal clawback … a huge win for physicians and patients.

Fighting to Repeal and Replace SGR SDCMS and CMA have been fighting in the courts and in Congress for years to repeal and replace the sustainable growth rate (SGR) formula. Though Congress did kick the can down the road yet again with another 12-month patch, we will continue this fight until we prevail.

CMA Fought Hard to Eliminate the 10% Medi-Cal Cut and Mitigate Its Effects After holding off the cut in the courts for almost five years, CMA is now working to reverse it through the legislative budget process.

CMA advocacy eliminated the retrospective 10% Medi-Cal clawback from the 2014–15 budget, a huge win for California’s physicians and patients.

CMA sponsored two bills to prospectively eliminate the 10% cut to Medi-Cal (SB 640 and AB 900).

CMA filed a request for an en banc review by the Ninth Circuit Court of Appeals to stop California from implementing the cut.

CMA joined an unprecedented coalition of physicians, dentists, healthcare workers, and hospitals to march on Sacramento on June 4.

CMA updated its Medi-Cal Survival Toolkit with a summary of the changes, important dates, options for physicians, and links to important resources.

SDCMS and CMA helped members with the Cal MediConnect (dual eligibles) transition enrollment process, i.e., how to opt out, what the physician rates and payment rules are, how the delivery system works, network adequacy, next steps, and more through seminars, webinars, and one-on-one assistance.

Addressing the Prescription Drug Overdose Epidemic CMA secured ongoing funding for and upgrades to the Controlled Substance Utilization Review and Evaluation System (CURES) database (SB 809).

SDCMS signed up more than 100 physicians on April 12, 2013, to gain access to the CURES database — the largest number of single-day sign-ups in California up to that time.

SDCMS worked with the San Diego and Imperial County Prescription Drug Abuse Medical Task force to publish www.

SanDiegoSafePrescribing.org on the SDCMS website.

SDCMS’s Emergency Medicine Oversight Commission (EMOC) continues to work to reduce prescription pain drug abuse in the ER.

Protecting Hospital Medical Staffs CMA helped kill AB 975, which would have made it extremely difficult for hospitals to be classified as nonprofit — a big issue for hospital chiefs of staff.

CMA updated its annotated model medical staff bylaws for 2013.

CMA stopped a slippery slope of “what specialty physician would be required to be on-call next in every general acute care hospital with an emergency department?

Pediatricians? Ophthalmologists?” etc. (AB 591).

Cultivating Strong Legislator Relations SDCMS physician leaders, medical students, and staff traveled to Sacramento and Washington, DC, on several occasions in 2013 to build and maintain strong personal relationships with all of our state and federal legislators.

Addressing Physician Workforce Issues CMA successfully secured an annual $15 million appropriation to fully fund the University of California, Riverside School of Medicine (SB 21).

CMA sponsored legislation signed by the governor to encourage physicians to locate their practices in underserved regions of the state (AB 565 and AB 1288).

CMA supported statue amended to include physician assistants as primary care providers while maintaining that they must operate under the supervision of a physician (SB 494).

SDCMS conducted its sixth biennial San Diego County Physician Workforce and Compensation Survey in 2013, a critically important gauge of physician workforce trends in San Diego County that we can take to our legislators.

Navigating Healthcare Reform SDCMS and CMA made available the following Covered California resources for members only: one-on-one access to practice management experts patient FAQs, clinician FAQs, staff FAQs participation status tool & assistance with incorrect information understanding the grace period surviving the first/second/third months ON-CALL documents

2013

Bringing the Next Generation Into Organized Medicine

SDCMS and CMA Physician Leaders Dr. Ted M. Mazer was elected speaker of CMA’s House of Delegates in 2013.

Dr. Susan Kaweski was elected CALPAC treasurer.

Grossmont Healthcare feted six SDCMS Foundation volunteers, including Dr. Susan Kaweski.

Dr. Sherry L. Franklin served as president of SDCMS during the first half of 2013, and Dr. Robert E. Peters during the second half.

Dr. Robert Peters, SDCMS president, leads the UC San Diego commencement ceremony procession.

Dr. Mark Sornson, SDCMS board member, leads the UC San Diego White Coat Ceremony.

SDCMS signed up the entire first-year class of UC San Diego medical students in 2013!

SDCMS continued signing up resident physicians at a brisk rate in 2013, adding all UC San Diego resident physicians to our membership roster.

SDCMS held its annual “Preparing to Launch Your Medical Practice” workshop in February with almost 80 residents attending.

SDCMS sent UC San Diego medical students up to Sacramento twice in 2013 to meet with our San Diego County legislators.

Saving ER Funding CMA co-sponsored SB 191, legislation signed into law that will extend ER (Maddy) funding to 2017, allowing counties, hospitals, and physicians to continue providing emergency services to their communities.

Physician Professional Development SDCMS Held the Following Workshops: 1. How to Be a Better Lobbyist 2. Financial and Legal Life Skills for Financially and Legally Clueless Docs 3. Media Training 4. Preparing to Launch Your Medical Practice 5. Taming Microsoft Outlook 6. The Leader’s Toolkit (offered four times in 2013)

SDCMS-CMA Seminars, Webinars, and Courses

SDCMS and CMA conducted more than 70 seminars, webinars, and courses in 2013 — with nearly 600 physicians and office staff attending SDCMS’s seminars alone! A broad range of topics were covered, including auditing documentation, and coding, Cal MediConnect, contracting, Covered California, EHR implementation and conversion, ICD-10, meaningful use, and more!

18 apri l 2014

Office Manager of the Year Congratulations to the winner of SDCMS’s fifth annual “Outstanding Medical Office Manager” contest, Pat Russell. Ms. Russel was nominated by the SDCMS-CMA members of Internal Medicine Associates: Paul F. Speckart, MD, Raymond G. Pigeon, MD, Deanna K. Price, MD, Brian J. Lenzkes, MD, and Theresa R. Bohun, MD.

Your SDCMS Physician Advocate at Work In 2013, your physician advocate solved more than 450 member problems, among them …

A health plan was denying a member physician’s services.

After the physician got nowhere with the appeals process, CMA stepped in, got the denials overturned, and $16,000 plus interest was released.

A member physician not contracted with any health plans was concerned when she received an EOB from a silent PPO at a 50% discount. After reaching out to SDCMS, the physician was able to send a letter to the silent PPO to get her name cleared from their system.

After a member’s prescription pads were stolen, we were able to provide the physician with the information needed to get this quickly reported to the proper authorities.

A practice administrator had concerns about an agreement a commercial plan wanted them to sign. CMA’s legal team recommended a language modification to the plan, which agreed to make the change. As a result, physicians nationwide will benefit from the revised language.

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

Tangible Member Benefits More than 985 SDCMS physicians saved nearly $346,183 with The Doctors Company, SDCMS’s endorsed professional liability carrier, which offers a 5% members-only discount on professional liability insurance.

SDCMS members enjoy discounted disability insurance, a free annual physician mailing list, car insurance discounts, free classified ads, a free California Emergency Driving Emblem, and significant savings on medical malpractice insurance, accounting services, security prescription pads, billing solutions, IT support, computer hardware, contract negotiations services, practice management consulting, and legal services.

CMA Guide: Getting Started with the Physician Quality Measure System (to avoid a 1.5% PQRS fee schedule penalty in 2015) SDCMS helped its members promote their conferences, seminars, symposia, fundraising events, new practices, new medical staff and more in 2013.

Member physician office managers and practice administrators continued to use SDCMS’s private e-forum in 2013 to get answers to their practice management questions, share best practices, stay abreast of upcoming deadlines, and much more!

EHR Implementation Assistance at No Cost Free Help for Primary Care Practices to Complete Meaningful Use Attestation SDCMS completed its second Medical Office Salary Survey in 2013.

SDCMS Events The SDCMS/SDCMS Foundation 2013 White Coat Gala was held on June 8: Dr. Robert Peters was installed as SDCMS president for 2013–14.

Outgoing president Dr. Sherry Franklin was honored for her service.

Almost 200 people attended, including Sen. Mark Wyland, Sen. Marty Block, Assemblymember Rocky Chavez, Assemblymember Brian Jones, Assemblymember Shirley Weber, and Former Assemblymember Martin Garrick.

The 2012 Presidential Award winners were Dr. Roneet Lev, longtime SDCMS member chair of the Emergency Medicine Oversight Commission, and Tom Gehring, SDCMS CEO. The 2013 Top Docs — “Physicians of Exceptional Excellence” — blacktie gala was held on Nov. 9 with more than 500 attendees. The Top Doctors selection process was refined in 2013 to further balance the selection opportunity for all modes of practice.

2013 April coverage of SDCMS’s CURES sign-up event (KPBS, KUSI, CW, Daily Transcript), and San Francisco Chronicle interview on dual eligibles.

May interviews for Voice of San Diego on long ambulance response times and on the ACA. June U-T San Diego op-ed titled “Physicians Should Take the Lead on Patient Care.”

July KGTV interview on falling Medicare/Medi-Cal reimbursements, U-T San Diego interview on physician workforce and access to care, and California Healthline interview on MediCal cuts.

September KPBS interview on Medi-Cal patients’ going to the EDs, KPBS interview on vaccinations, 10News interview on health exchanges, and Fox and KUSI interviews on Covered California.

October Los Angeles Times interview on Covered California.

Communications to, for, and From Physicians A sampling of media turning to SDCMS for comment in 2013: January U-T San Diego op-ed titled “Medi-Cal Rate Cuts Hurt Health Care, Access,” and KPBS interview on Medi-Cal cuts.

February KPBS interview on NPs and PAs practicing independently, and Fox scope of practice interview.

December California Healthline interview on Covered California and narrow plans.

We sent out 25 issues of our commercial-free e-newsletter, “News You Can Use,” to a growing circulation of more than 5,000 physicians, staff, and healthcare stakeholders.

We published 12 issues of San Diego Physician on varied topics, including “Remembering David Knetzer, SDCMS CEO From 1979 to 2001,” “The Death of Fee-for-Service,” “Prescription Drug Abuse,” “Infectious Disease,” and more!

SDCMS delivered a treasure trove of daily healthcare news updates to its followers via its @SDCMS Twitter feed.

San Diego Magazine again listed SDCMS (and only SDCMS) physicians in its annual “Health Annex” and online in its Find a Doctor tool.

2013: 2,813

2012: 2,683

2011: 2,670

2010: 2,652

2009: 2,578

2008: 2,562

2007: 2,419

2006: 2,390

2005: 2,195

2004: 2,163

2003: 2,056

2002: 2,029

SDCMS Membership Continues to Increase!

SDCMS members at the end of 2013: 541 Medical Students 2,813 Physicians 1,236 Resident Physicians 4,590 Total Members SDCMS gained enough new resident physician members in 2012 to allow us to take eight new resident physician delegates to CMA’s 2013 House of Delegates.

CMA grew by almost 5% in 2013, its membership increasing to 39,462!

SDCMS Financials

8%

Physician Engagement

10%

15%

Governance

Rent: 11% Credit Card/Bank Charges: 2% Insurance: 1% Miscellaneous Expenses: 3% Telephone: 1% Staff Time G&A: 8%

Physician Database

26%

22%

12% Expenses

Benefits

Specialty Societies

Foundation

3%

3%

Foundation

4%

Advocacy

Income

Credit Card Commission

56%

19%

Infrastructure

Communications

1%

5%

Investments

16%

Advertising and Sales

Dues

2013 ANNUAL REPORT

Improving Health…

Changing Lives SiNcE 2008

PROJECT ACCESS

BOARD OF DIRECTORS 2012-2013 Executive Committee Stuart Cohen, M.D., Board President Will Tseng, M.D., Vice President Al Ray, M.D., Treasurer & Secretary Carol L. Young, M.D., Immediate Past President Tom Gehring, CEO Board of Directors Ellen Beck, M.D. Family Medicine, UC San Diego Stuart Cohen, M.D. Pediatrician, Children’s Primary Medical Group Robert DeSimone Doctors Insurance Company Tom Gehring CEO, San Diego County Medical Society James Hay, M.D. Family Medicine, PASD Leadership Committee Chair Oscar Medina Founding Partner, Strategic P.E.T. Solutions International Ron Mitchell, CPA AKT CPAs and Business Consultants Al Ray, M.D. Family Medicine, Southern California Permanente Medical Group

Our Mission:

Improving community health, access to care for all, and wellness for patients and physicians through engaged volunteerism.

Will Tseng, M.D. Internal Medicine, Southern California Permanente Medical Group Jeffrey Willmann Opprime’ Investments, Inc. Carol L. Young, M.D. Internal Medicine/ Rheumatology, Arthritis Medical Clinic Mary Robberson, Esq. Partner, Higgs Fletcher & Mack, LLP Ex Officio Rosemarie Marshall Johnson, M.D. Medical Liaison James Schultz, M.D. Medical Director Barbara Mandel, MBA, Executive Director

RESTORING VISION, RENEWING LIFE: Glen Cook, M.D. For most of us, driving to work, reading the paper, watching your child’s soccer game, are all second nature. But if your vision had diminished for years due to cataracts to the point you were considered legally blind, cataract surgery to restore your vision would allow you to regain the life you had: independence, employment, and connection with the world around you.

Financial Highlights During fiscal year 2013 we assisted 451 low-income and uninsured adults access healthcare services through Project Access San Diego.

Ophthalmologist Glenn Cook, MD, anesthesiologist Babak Abedi, MD, and their team at Surgery Center of Del Mar gave a new meaning of Thanksgiving to eight low-income individuals on the Saturday in late November. Maria Maldonado arrived totally blind, and her unusually thick cataracts caused after diabetic coma were a challenge to the team. Upon awakening Maria, Dr. Cook asked what color she saw. Initially, the answer was “black.” But just minutes later, Maria exclaimed that she could see Dr. Cook’s hand. When he asked how many fingers he was holding up, Maria correctly answered “two.” The entire surgical team burst into cheers and high-fives! They had accomplished something they did not see every day; restoring vision to a sightless person who had become so isolated and dependent due to her blindness. Maria can now leave her apartment by herself, grocery shop and cook for her family, and enjoy the antics and activities of those around her. Thanks to Dr. Cook and team for changing the lives of Maria and others like her.

Total Revenue 2013: $749,447 Total Assets as of 9/30/13: $396,190 Contributed Medical Services: $1,675,114

Project Access exists due to the dedication of our volunteer physicians, such as those helping Maria. We are here for patients like Maria so that we can improve health and change lives in our community.

LIFE SAVED DUE TO COLORECTAL CANCER EARLY DETECTION Total 2013 Expenses: $997,992

Program Services: 85% Fundraising & Event Expense: 12% Management & Administration: 3%

This information extracted from Audited Financial Statements year ended September 30, 2013. SDCMSF received an unmodified opinion on these audited financial statements from Leaf & Cole, LLP; this is the highest designation from an independent audit.

Through our partnership with Kaiser Permanente, SDCMSF has provided 211 colorectal cancer diagnostic colonoscopies and sigmoidoscopies to uninsured community clinic patients with positive screening tests or symptoms since 2008. Yuk Ja Chan is one of those whose positive FIT test brought her to Project Access San Diego, and to a Kaiser Permanente Saturday Surgery Day on October 19, 2013.

Yuk Ja was born in Hong Kong, emigrated with her family to Panama at age five, and was finally reunited with her brother in Escondido 2000 as a widow with young children. She now cares for her brother’s children, whose mother died of cancer. Her colonoscopy, performed by Payan Afshar, MD, revealed colon cancer and needed surgery. Marco Tomassi, MD (seen with Chan), performed a colon resection to remove the cancer, saving her life! Yuk Ja is now cancer-free, and grateful for the life-changing care she received. And true to our efforts to improve access, she became eligible for health insurance in January 2014 due to the expanded benefits of the Affordable Care Act.

San Diego County Medical Society Foundation | 5575 Ruffin Rd., Suite 250 San Diego, CA 92123 | 858.300.2777 | www.sdcmsf.org | foundation@sdcms.org

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Mobile Mammograpy Creates Community Access Our partnership with We Support U, a grassroots group focused on breast and cervical cancer prevention, allowed us to expand our prevention efforts in 2013. Funded by Susan G. Komen for the Cure, we provided 84 free clinical breast exams and mammograms in one day at Chargers Stadium, and 824 during October through December. Many of the women served had never had a breast exam or mammogram previously.

Adults Will Remain Uninsured After Full Implementation of the Affordable Care Act Project Access Serves Those Most Vulnerable

2013 HEALTH HEROES 2013 marked the inaugural Health Heroes awards for SDCMSF. We acknowledged the remarkable contributions of: Wendy Buchi, MD Imaging Healthcare Specialists SurgeryOne/ASMG Champion Award Unsung Heroes Award Spirit Award Rosemarie Marshall Johnson, MD Kaiser Permanente Legacy Award Above & Beyond Award

2013 Project Access San Diego Highlights Number of uninsured 2,357 patients receiving specialty care 2008 2009 2010 2011 2012 2013 services Number of 1,324 patients receiving preventative 2008 2009 2010 2011 2012 2013 services

Members of the SurgeryOne/ASMG team received Wendy Buchi, MD received Champion Award at the award at the 2013 White Coat Gala fall Heroes de la Salud event.

PHYSICIAN WELLNESS PRIORITY FOR SDCMSF

2013 ACES FOR HEALTH The 451 patients who received specialty medical services through Project Access in FY 2013 say thank you to the golfers and sponsors who contributed to the success of our first annual Aces for Health Golf Tournament at Del Mar Country Club in February 2013. Based on its great success, the 2nd annual tournament on March 13, 2014, followed suit!

SDCMS Foundation hosts tri-annual regional workshops for the California Public Protection and Physician Health, Inc. (CPPPH), a non-profit developed by the CMA, CHA, California Psychiatry Association and California Society of Addiction Medicine. Bringing together the members of the Physician Well Being Committees from area hospital medical staffs and medical groups, participants share experiences and resources, mentor newer members, and learn about developments in the area of physician wellness. CPPPH also develops guidelines for Well Being functions and educates and connects physicians across the state who treat doctors with medical, substance abuse, or mental health issues that potentially put patients at risk.

SDCMSF Board member James T. Hay, MD, chairs CPPPH, and facilitated this important partnership. For more information visit www.

CPPPH.org.

Number of specialty care appointments Number of donated surgeries & GI procedures

7,139 2008 2009 2010 2011 2012 2013

754 2008 2009 2010 2011 2012 2013

MEDICAL STUDENT SUPPORT SDCMSF continues to support UC San Diego School of Medicine students through scholarships for both students and residents, and legislative advocacy training. In Spring 2013, Steven Rojas, MD, was awarded the resident scholarship for his impressive commitment to caring for the medically underserved and mentorship of minority undergraduates. Steven says of his residency in Family Medicine, “I think primary care is the most relevant with the direction medicine is heading; prevention is critical for keeping folks out of the hospital, so everyone wins.” First-years John Waggoner and Lindsey Youngquist were awarded scholarships to provide support during their four-year med school studies.

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