July 2014

official publication of SDCMS July 2014

Covered California Three Big Things You Need to Know!

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JuLY

Contents

Volume 101, Number 7

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 SDCMS BOARD OF DIRECTORS OFFICERS PRESIDENT: J. Steven Poceta, MD PRESIDENT-ELECT: William T-C Tseng, MD, MPH (CMA Trustee) TREASURER: Mihir Y. Parikh, MD SECRETARY: Mark W. Sornson, MD IMMEDIATE PAST PRESIDENT: Robert E. Peters, PhD, MD GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORS EAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD, Alt: Susan Kaweski, MD (CALPAC Treasurer) HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD, Alt: Thomas J. Savides, MD KEARNY MESA: Sergio R. Flores, MD, John G. Lane, MD, Alt: Anthony E. Magit, MD, Alt: Eileen R. Quintela, MD LA JOLLA: Geva E. Mannor, MD, Marc M. Sedwitz, MD, Alt: Lawrence D. Goldberg, MD NORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Alt: Anthony H. Sacks, MD SOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD, Alt: Elizabeth Lozada-Pastorio, MD

features 20

Covered California: Three Big Things You Need to Know!

BY THE CALIFORNIA MEDICAL ASSOCIATION

departments

AT-LARGE DIRECTORS Lawrence S. Friedman, MD, Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD

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Briefly Noted: San Diego Medical Office Overview • Calendar • Welcome New & Returning Members • And More …

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AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, Jeffrey O. Leach, MD, Toluwalase A. Ajayi, MD, Phil Kumar, MD, Wayne C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella M. Wilson, MD

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Thank You, Dr. Peters, SDCMS President for 2013–14

Welcome Dr. Poceta, SDCMS President for 2014–15

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14

Protecting Access to Quality Health Care and Ensuring Patient Privacy: Oppose the MICRA Measure

BY Richard Thorp, MD

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Summer Pond

BY DANIEL J. BRESSLER, MD

10

18

Closing or Leaving a Practice? Make Appropriate Arrangements for Medical Records

OTHER VOTING MEMBERS COMMUNICATIONS CHAIR: Sherry L. Franklin, MD (CMA Trustee) YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MD RESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MD RETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MD MEDICAL STUDENT DIRECTOR: Spencer D. Fuller OTHER NONVOTING MEMBERS YOUNG PHYSICIAN ALTERNATE DIRECTOR: Daniel D. Klaristenfeld, MD RESIDENT PHYSICIAN ALTERNATE DIRECTOR: Diana C. Gomez, MD RETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MD SDCMS FOUNDATION PRESIDENT: Albert Ray, MD (CMA Trustee, AMA Delegate) CMA SPEAKER: Theodore M. Mazer, MD CMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MD CMA TRUSTEES: Robert E. Wailes, MD, Erin L. Whitaker, MD CMA SSGPF Delegate: James W. Ochi, MD CMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Mehta, MD AMA ALTERNATE DELEGATE: Lisa S. Miller, MD

BY THE DOCTORS COMPANY

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Physician Marketplace: Classifieds

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Be the Genius You Are

BY HELANE FRONEK, MD, FACP, FACPH 2 j u ly 2014

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.]

/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// Commercial Real Estate Tips & Trends

SAN DIEGO MEDICAL OFFICE OVERVIEW: Q1 2014

By Chris Ross Market Conditions and Trends Real estate activity among the county’s larger health systems remains steady. In particular, Scripps Health, Sharp Healthcare, and UC San Diego Health System have been relatively active in the leasing, acquisition, and/or construction of both acute care and outpatient facilities, especially over the past 24 months.

The county’s demand for healthcare real estate is coming not only from large medical groups and other traditional tenants, but also a growing pool of entrepreneurial and self-pay providers such as plastic surgeons, wellness centers, age management clinics, liposuction and other laser centers, and other cosmetic and cash-based practices whose prevalence is reemerging with the gradually improving economy. Most of these tenants prefer Class A buildings given their target clientele.

Vacancy and Rental Rates Countywide vacancy at the end of Q1 2014 came in at 10.4%, virtually no change from that of Q4 2013 and down from the Q1 2013 rate of 11.3%, a positive sign for the market.

With almost no construction in the pipeline for 2014, continued steady demand will result in a decline in vacancy throughout the rest of the year.

The average gross asking rent was at $2.47 per square foot at the end of Q1 2014, unchanged from Q4 2013 and slightly down from $2.53 per square foot a year ago. Most of this decline is attributed to Class B medical buildings, whose average rate dropped more significantly than Class 4 j u ly 2014

A and C space. This is a result of nearly 70% of the county’s vacancy lying among Class B MOBs, primarily due to the recent flight to quality into newer Class A developments. Class A vacancy shows continued improvement, settling in at 7.5%, reflecting continued tenant demand for quality space and resulting in a 9.5% increase in Class A rental rates since 2011. Asking rents among Class C buildings also increased, up 4.8% over the same period, while asking rents for Class B buildings decreased 8.4%.

Absorption In the first quarter of 2014, net absorption was slightly negative at 1,739 square feet — a classic example of how market statistics “on paper” can be misleading. A number of sizeable transactions stalled in Q1 and will likely be consummated in the second and third quarters. Once this takes place, the overall 2014 numbers will be representative of current demand levels.

Surveying San Diego Submarkets Escondido/San Marcos Leasing activity remains tapered in Escondido/San Marcos, not unlike the rest of the greater inland North County area, although there are signs that this could change throughout 2014. Nordahl Medical Centre, approximately three-quarters of a mile north of the new hospital, has reintroduced its ability to sell individual Class A medical condos. Owner-user opportunities are something all tenants should consider as a solution for long-term cost containment.

The jury is still out as to how much movement this submarket is still expected to see, but we wouldn’t be surprised if more relocation and expansion plans are announced.

Oceanside/Vista The Tri-City area is still making its gradual recovery, one small lease or sale at a time. Net absorption was essentially flat in 2013, and at $2.30 per square foot, the submarket’s average rental rate is $0.18 below the county average of $2.47. Premier Crossing and Vista Pointe Medical Plaza on Melrose Drive, and Creek View Medical Park on Via Centre Drive have reduced pricing enough to see better activity from providers looking for low-cost alternatives with relatively good value — somewhat of a trend that is taking place, particularly among private practices and in certain areas.

North County Coastal Vacancy in coastal North County is extremely tight — by far the lowest in the county at 4.5% and a little more than half of its 8.0% peak from 2008. This continues to limit transaction volume since relocation alternatives are scarce.

Though net absorption was essentially flat in Q1, it was +74,000 SF in 2013, which is highest in the county and about 50% more square footage than what the submarket has vacant today (51,000 square feet). Rental rates are now starting to climb, as evidenced by the county-high

average rental rate of $3.30 per square foot (up from $3.24 in Q4 2013).

I-15 Corridor By the end of 2014, we still expect the three most recently completed buildings — 4S Health Center in 4S Ranch, Pinnacle Medical Plaza in Scripps Ranch, and Pomerado Outpatient Pavilion in Poway — to be nearly all leased up (4S is full now). It is still generally a stable but quiet submarket, but Sharp Rees-Stealy, Palomar Health, and Arch Health all seem to be expanding so as not to lose any ground in this area, as it is one with steady growth and relatively strong demographics.

La Jolla/UTC/Sorrento Leasing activity is strong in the greater UTC submarket.

Scripps’ 383,000-square-foot Prebys Cardiovascular Institute celebrated the completion of its “skin” in September and is scheduled for completion in spring 2015. Scripps also commenced construction of its six-story, 80,000-square-foot MOB earlier this year. UCSD’s new Jacobs Medical Center had its topping out (when the last steel beam is placed) in October and will open in 2016.

While UTC ranked second in net absorption in 2013, behind North County Coastal, it was only the opening of the new Sharp Rees-Stealy in Del Mar that was the difference. UTC also ranked second in average rental rate at $3.08 per square foot in Q1, a number that is

/////////////////////////////////////////////////////////////////////////////////////////////////// expected to rise as vacancy tightens throughout the year.

Kearny Mesa/Mission Valley Kearny was the only submarket in the county to experience negative net absorption in 2013, but it bounced back in Q1 2014 with +3,150 square feet of net absorption and a slight increase in average asking rate. A new 90,000-square-foot Class A development known as Mission West was recently announced.

It will be located at 1904 Hotel Circle North and is scheduled to deliver early 2016. New vacancies are in the process of being announced at Rady’s 7910 Frost Street medical buildings. It will be interesting to see if they can achieve the lofty rents they are quoting (±$4.25 gross, plus parking charges) and how flexible they are as to whom they are willing to accommodate.

East County Thanks to nearly 10,000 square feet of positive net absorption in the fourth quarter of 2013 and another 3,199 square feet in the first quarter, East County is now down to 9.6% vacancy. With MOBs, achieving single-digit vacancy is typically the benchmark for a healthy submarket, although we need to see steadier activity and a recovery in rental rates before we would describe East County as “healthy.” The leasing of midsize and large blocks of space is playing a large role in the overall strength of the county’s healthcare real estate market; but while East County is the largest submarket by total inventory, the average transaction size has been among the smallest.

*

Uptown/Hillcrest The Hillcrest submarket was incredibly flat in 2013, but we finally saw a slight increase in rental rates in the first quarter.

The boring news is yet another quarter of near-zero net absorption, this time coming in at a mere +84 square feet.

Few tenants have any reason to move, and as dynamic a community as the Hillcrest population is as a whole, we have been seeing very little expansion or new practices.

With two strong hospitals and more than one million square feet of medical office inventory, the submarket is poised for improvement. We are already seeing a lack of mid to large blocks of available space.

South County Six projects in South County contain nearly 70% of the submarket’s vacancy. Since these six MOBs are geographically spread out, the leasing environment is less competitive among landlords than one would think. South County’s net absorption was flat in the first quarter, and it saw a slight uptick in average asking rent.

In general, the submarket remains a quiet but stable one, while its population continues to grow.

Mr. Ross is vice president of healthcare solutions for Jones Lang LaSalle. He is a commercial real estate broker specializing exclusively in medical office and healthcare properties in San Diego County. He can be reached at (858) 410-6377 or at chris.ross@am.jll.com.

FEATURED MEMBER

SDCMS features 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!

calendar SDCMS Seminars & Webinars SDCMS.org

Workers’ Compensation Advanced Part 3: Requests for Authorization, Dispensed Pharmaceutical and DMEPOS Billing for Workers’ Compensation AUG 19: 12:15pm–12:45pm

HIPAA Update (seminar/webinar) AUG 14: 11:30am–1:00pm

Community Healthcare Calendar

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

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.

Cma Webinars CMAnet.org/events What to Expect From a Medi-Cal Audit JUL 30: 12:15pm–1:15pm

31st Annual Primary Care Summer Conference AUG 1–3 (www.scripps.org/ sparkle-assets/documents/ primary_care_summer_2014. pdf)

HIPAA Breach Notification and California Requirements JUL 31: 12:15pm–1:15pm Workers’ Compensation Advanced Part 1: Tips and Tricks for Workers’ Compensation Billing AUG 5: 12:15pm–12:45pm

25th Annual Cardiovascular Interventions OCT 21–24 (www. sdcms.org/Portals/18/ Assets/pdf/seminars/ CardiovascularInterventions Brochure2014.pdf)

Workers’ Compensation Advanced Part 2: Second Bill Review Plus Managing Thirdparty Billers AUG 12: 12:15pm–12:45pm

The 2014 San Diego Day of Trauma NOV 7 (www.sdcms.org/ Portals/18/Assets/pdf/ seminars/Trauma%202014%20 Brochure-.pdf)

“

It is easy in the world to live after the world’s opinions; it is easy in solitude to live after your own; but the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.

”

— Ralph Waldo Emerson (1875–1965)

SAN DI EGO PHYSICIAN.org 5

/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// SDCMS-CMA Membership

Welcome New and Returning SDCMS-CMA Members!

New Members Edita S. Aguilar, MD Pediatrics Escondido (760) 520-8330 Liliana AlvarezMartinez, MD Family Medicine San Marcos (760) 471-2100 Richard L. Austin, MD Anesthesiology San Diego (858) 673-6100 Andrelita D. Barrera, MD Family Medicine National City (951) 662-4254 Claudia Castelnovi, MD Pediatrics San Diego (619) 280-4213 Surya R. Chetlapalli, MD Internal Medicine La Jolla (858) 626-7780 Myrna L. Coronado, MD Family Medicine San Ysidro (619) 428-4463 Kelly R. Culwell, MD Obstetrics and Gynecology San Diego (619) 881-4500 Alejandro L. Diaz, MD Pediatrics San Diego (619) 280-4213 Jennifer W. Doumas, DO General Practice Lemon Grove (619) 456-0033 Jay F. Downey, MD Family Medicine Chula Vista (619) 662-4100 Cesar D. Gomez, MD Family Medicine Chula Vista (619) 662-4100 Kekoa C. Ede, MD Psychiatry Escondido (619) 542-4300

Raheleh Esfandiari, MD Obstetrics and Gynecology Encinitas (760) 943-9994 Nicole E. Esposito, MD Psychiatry San Marcos (760) 736-6700 Pamela E. Fadul, MD Anesthesiology San Diego (858) 673-6100 David P. Fischbach, MD Anesthesiology San Diego (858) 673-6100 Maribel C. Flores, MD Family Medicine San Diego (619) 428-4463 Megan R. Gatlin, DO Anesthesiology San Diego (858) 673-6100 Orna Gil, MD Obstetrics and Gynecology Carlsbad (760) 631-5000 Gwen E. GleasonRohrer, MD Family Medicine San Diego (619) 563-0250 Mark S. Goldsworthy, MD Anesthesiology San Diego (858) 673-6100 Gary D. Gonsalves, MD Anesthesiology San Diego (858) 673-6100 Peter D. Gougov, MD Anesthesiology San Diego (858) 673-6100 William G. Grant, MD Anesthesiology San Marcos (858) 673-6100 Jacob H. Gregerson, MD Pediatrics San Diego (619) 280-4213 Edward M. Gurrola, MD Anesthesiology San Diego (858) 673-6100

6 j u ly 2014

Loraine M. Gutierrez, MD Family Medicine San Diego (619) 280-4213 Mary Jo Harbert, MD Child Neurology San Diego (858) 966-5819 Ralph C. Hernandez, MD Family Medicine San Diego (619) 662-4100 Alexander C-K Hsu, MD Radiology San Diego (619) 528-7752 Chenggang Hu, MD Anesthesiology San Diego (858) 673-6100 Nick S-C Huang, MD Internal Medicine Escondido (760) 520-8100 Doreen I. Ibrahim, MD Internal Medicine San Diego (619) 499-2600 Mickaila J. Johnston, MD Nuclear Medicine San Diego (619) 532-8775 Setareh S. Jones, MD Pediatrics San Diego (858) 279-0925 Mihae G. Joo, MD Internal Medicine La Jolla (858) 626-7780 Hulya Kararli, MD Anesthesiology Encinitas (858) 673-6100 Anne D. Kaufhold, MD Family Medicine San Diego (619) 231-9300 Brian P. Keefer, MD Anesthesiology San Diego (858) 673-6400 Omar M. Khawaja, MD Anesthesiology San Diego (858) 673-6100

Karen N. Kobayashi, DO Obstetrics and Gynecology San Diego (619) 267-8313 Michele A. Lamantia, MD Internal Medicine San Ysidro (619) 428-4463

Devarshi Nath, MD Family Medicine San Marcos • (760) 471-2100

Tina Shahidyazdani, MD Pediatrics San Ysidro (619) 428-4463

Thays S. Novikoff, MD Family Medicine Carlsbad (760) 631-5000

Joseph J. Sheridan, MD Child and Adolescent Psychiatry La Mesa (619) 630-1036

Justin E. Laubach, MD Anesthesiology San Diego (858) 673-6100

Lesley A. Nurse, MD Obstetrics and Gynecology Chula Vista (619) 205-1366

Julie R. Sierra, MD Internal Medicine San Diego (619) 428-4463

Scott P. Leary, MD Neurological Surgery San Diego (858) 810-0386

Donald L. Ong, MD General Surgery Vista (760) 631-5000

Loretta S. Stenzel, MD Family Medicine Vista (760) 631-5000

Greg D. Lewis, MD Internal Medicine La Jolla (858) 626-7780

Sue A. Park, MD Pediatrics Vista (760) 631-5000

Alexander E. Stewart, MD Otolaryngology San Diego (619) 532-9600

Huabao B. Lin, MD Anesthesiology San Diego (858) 673-6100

Anthony V. Phung, MD Anesthesiology San Diego (858) 673-6100

Ramon S. Sy, MD Internal Medicine San Ysidro (619) 428-4463

Pierre R. Lotzof, MD Anesthesiology San Diego (760) 746-1755

Jennifer L. Poast, DO Internal Medicine Chula Vista (619) 563-0250

Kulin R. Tantod, MD Family Medicine Lakeside (619) 390-9975

Arthur S. LovgrenMoritz, MD Internal Medicine San Diego (619) 221-9534

Ori Raz, MD Anesthesiology San Diego (858) 673-6100

Selmira TellecheaSanchez, MD Pediatrics Escondido (760) 451-0070

Peter M. Lucas, MD Anesthesiology San Diego (858) 673-6100 Brian S. Luschwitz, MD Pediatrics Vista (760) 631-5030 Michael L. MacMurray, MD Internal Medicine Oceanside (760) 631-5000 Parvin Mani, MD Obstetrics and Gynecology San Diego (619) 583-7555 Anastasios Mavrakis, MD Internal Medicine Imperial Beach (619) 515-2300 Monique C. McCormick, MD Anesthesiology Carlsbad (858) 673-6100 Jamie S. McReynolds, MD Family Medicine Alpine (619) 445-1188

Malini M. Reddy, MD Anesthesiology San Diego (858) 673-6100 Pomai Roberts, MD Family Medicine National City (619) 498-6200 Marco S. Robin, DO Anesthesiology Carlsbad (858) 673-6100 Gabriel Rodarte, MD Psychiatry Escondido (619) 542-4300 Javier Rodriguez, MD Pediatrics San Diego (619) 280-4213 Rogelio S. Samorano, MD Psychiatry Escondido (760) 560-8340 Karin R. Schiff, MD Family Medicine Escondido (760) 520-8100 Kevin J. Schwartz, MD Anesthesiology San Diego (858) 673-6100

Paige A. Thiermann, MD Family Medicine El Cajon (619) 440-2751 Bertha F-C TsaiTulagan, DO Pediatrics Escondido (760) 690-5900 Keith K. Vaux, MD Pediatrics San Diego (858) 966-5840 Sharon F. Velasquez, MD Family Medicine National City (619) 662-4254 Jonathan J. Walters, MD Family Medicine San Diego (858) 279-0925 Stacy E. Wilson, MD, FACOG Obstetrics and Gynecology San Diego (619) 516-6182 Mary C. Yager, MD Internal Medicine San Diego (619) 694-8879

/////////////////////////////////////////////////////////////////////////////////////////////////// Doris A. Yung, MD Pediatrics Ramona (760) 471-2100

Ronald M. Levin, MD Anesthesiology San Diego (858) 673-6100

Rensheng Zhang, MD Anesthesiology San Diego (760) 746-1755

Ramona Master, MD Internal Medicine La Jolla (858) 729-3050

Irene M. Zink, MD Family Medicine San Diego (619) 231-9300

Bill H. McCarberg, MD Family Medicine Poway (760) 520-8100

Returning Members

Deborah M. Mitchell, MD Anesthesiology San Diego (858) 673-6107

Eugene J. Basiliere, MD Obstetrics and Gynecology Bonita (619) 280-4213 Arwinnah Bautista, MD Internal Medicine San Diego (619) 267-0553 James E. Boyd, MD Family Medicine La Jolla (858) 626-7780 Paul J. Cotten, MD Anesthesiology San Diego (858) 673-6100 Mayra M. Dillon, MD Family Medicine National City (619) 336-2300 Terence M. O. Gan, MD Internal Medicine San Diego (858) 626-7780 Brendan J. Kidder, MD Family Medicine National City (619) 474-2284 Anand S. Kunda, MD Hematology San Diego (858) 939-3660 Teri L. Kunin-Rida, MD Family Medicine El Cajon (619) 312-0347 Leng T. Ky, MD Anesthesiology San Diego (858) 673-6100

Margaret G. O’Byrne, MD Internal Medicine San Diego (858) 481-4888 Samuel I. Poniachik, MD Internal Medicine San Marcos (760) 471-2100 Ravindra Prabhu, MD Clinical Cardiac Electrophysiology Chula Vista (619) 482-4333 Timothy D. Sahms, MD Pediatrics San Ysidro (619) 428-4463 Jason D. Silva, MD Family Medicine San Diego (619) 478-5254

Contracting

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Billing Service Business Growth Executive Assistant Financial Management EHR Meaningful Use Support Operational Management Practice Assessment

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William S. Anapoell, MD Internal Medicine San Diego (619) 260-7125

Carie C. Nguyen, MD Family Medicine San Ysidro (619) 428-4463

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Brian P. Snook, DO Family Medicine National City (619) 428-4463 Dean C. Tasher, MD Internal Medicine Escondido (760) 743-6066

lutions So Celebrating

Absolu

Mark C. Adrian, MD Internal Medicine La Jolla (858) 626-7780

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

SAN DI EGO PHYSICIAN.org 7

SDCMS Leadership

Thank You, Dr. Peters!

SDCMS President for 2013–14 1 2 The following is outgoing president Dr. Peters’ speech given at the June 14 installation dinner and dance.

Friends, Family, Fellow

Members, Honored Guests, Medical Society Staff, thank you for joining us this evening.

It is my honor to have had the opportunity to serve as president of SDCMS, one of the best, if not the best, county medical societies in the United States. It has been my pleasure, as the president, to work closely with so many of you as our Society continues its tradition of excellence.

The challenges to delivering quality patient care to each of our patients, on an individual basis, continue. Trial lawyer attacks, scope of practice expansions, declining reimbursements, technology and reporting demands, the simple imperative of maintaining a focus on patient care without being impeded by bureaucratic entanglements … all diverting precious time from our primary purpose: patient care.

We must maintain the quality of patient care while expanding access by carefully expanding the healthcare team to allow everyone to work to the capabilities of their respective training, while keeping the best and most comprehensively trained individual, the physician, at the head of the healthcare team. This is not an easy position to take, but we must because no one else is going to take this position toward long-term, continued delivery of optimal care and safety for our patients. We remain, at the end of the day, the guardians of patient care. Our primary goal and mission as physicians require it.

We must continue to adapt to an ever-changing practice environment. In the midst of these changes, we cannot throw up our hands in frustration; rather, we must work with people forcing these changes 8 j u ly 2014

— who, in general, have good intent — to design and implement, and embrace the new methods and mechanisms of patient care delivery. And, in the process, our job must be to also protect the quality of the patient care that is delivered. If not us, who will do this? It is our responsibility. Ours.

We are, and must be, part of the solution to the American healthcare dilemma regarding cost, access, safety, and quality.

Your voice must be heard in the exam room, in San Diego, in Sacramento, and in Washington, DC. Many talk about protecting the quality of patient care, but we have the perspective, experience, and knowledge to protect the most important person in the equation: the patient.

We must not allow the changes being implemented in our healthcare delivery system to be made by those whose primary focus is anything other than the patient-physician relationship and the most appropriate medical care for each patient.

You are the last line between your patient and lessened quality of care.

It is your responsibility to keep the focus on patient care quality in the midst of rapid, continuing changes.

“First do no harm” has moved from its historic location in the exam room to now include the requirement — and obligation — for us to be protecting our patients from the unintended consequences of well-meaning but too often not-thought-through health policy changes.

The challenges to physicians and to our patients will continue, and they will come from many fronts: well-meaning regulators and legislators who, no fault of their own, will not understand the implications of their efforts without input from those of us with boots on the ground in day-to-day patient care; economists who see medicine first as a general population business rather

3

4 5

6 1. California Senator Mark Wyland presenting Dr. Peters with a resolution 2. SDCMS past presidents Dr. Carol Young, Dr. Susan Kaweski, and Dr. Sherry Franklin 3. Mingling at the reception 4. Dr. Bob Hertzka, master of ceremonies for the evening 5. Barbara Mandel, SDCMS Foundation executive director, Dr. Alberto Bessudo, SDCMS Foundation “Above & Beyond” Award winner, Dr. Al Ray, SDCMS Foundation president, and Dr. Bret Langenberg, SDCMS Foundation “Unsung Hero” Award winner 6. SDCMS past presidents being honored

than a business built on proper care of each individual patient; a public struggling for access to affordable and reliably excellent care in an environment of increasing regulatory burdens and technologies driving the costs of care higher rather than lower; and other professions (and I use the term loosely with regard to some) like malpractice trial attorneys who seek to take a bigger piece of the pie away from patient care for their own gain by promulgating laws and initiatives that play on people’s emotions, such as the upcoming, ill-conceived, and grossly deceptive Medical Injury Compensation Reform Act (MICRA) lawsuit initiative.

We, as leaders and practitioners looking out for our patients’ true best interests, have a responsibility and

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SDCMS Leadership

Welcome Dr. Poceta!

SDCMS President for 2014–15

7 8

The following is incoming president Dr. Poceta’s speech given at the June 14 installation dinner and dance.

9 7. Congresswoman Susan Davis and Dr. Peters 8 & 9.

Enjoying dinner

mandate to educate our patients and the public about the negative consequences of these types of actions, and to hold fast our commitment to our patients and to the future of medicine as a profession, not a job. As my last ask of you as SDCMS president tonight, I would first like to give a big thank-you to everyone who made possible the gathering of generous contributions to help defeat the MICRA lawsuit initiative — with your commitment and dedication, I know that we can stop this measure from passing. As the fight is far from over, I ask each of you and all of your colleagues to take the lead and be active in this battle in the next few months, and indeed long after that as new battles arise. We will, and must, prevail in protecting our profession in order that we will be able to continue to protect and serve our patients.

It has been my pleasure to serve this past year. I look forward to continuing to work with each of you as we move forward.

Thank you.

10 j u ly 2014

Good Evening, Ladies and Gentlemen.

We are here tonight not as the San Diego County Doctor Society, but as the San Diego County Medical Society. Just as doctors are a diverse group, the healthcare system is even more diverse. It takes a team to deliver high-quality healthcare.

Despite this diversity, all of us in this room are a united group, united by one thing: a mission to provide healthcare to our patients and our community.

Before health insurance and before Medicare, when someone was sick, they saw the doctor. He had his own practice, sometimes out of his own home, which doubled as a hospital, and he even made house calls.

Now, there is about a 7:1 ratio of medical staff to patient whenever someone goes to the doctor. You need a receptionist to handle the appointments, nurses to go over medicines, an MBA to negotiate contracts, biller/coders, IT people for the electronic medical record, and, of course, the doctor to see the patient.

We stand at a pivotal time in the changing U.S. healthcare system.

It is wonderful that more people than ever have health insurance, and that no one can be denied insurance for a preexisting condition. Although we will have to work together to understand and to implement the Affordable Care Act, the practice of medicine and its devoted members have survived through the Great Depression, two world wars, and HMOs, and will continue with the ACA. While how medicine does its job is changing, its main charge has not: to provide the best possible care for patients and community.

We come together tonight to

celebrate the efforts of all of us for this cause.

While I work in a large, multispecialty group, I know the situation faced by solo and small-practice physicians. Not only do you have to be a doctor, but a businessperson as well — both more than full-time jobs.

Solo practice doctors may or may not be the canary in the coalmine, but they are disappearing as our system consolidates into bigger and bigger groups. But medicine is huge, and its needs many, and I believe there will always be solo practitioners as well as academic researchers. I want to welcome all of you to a medical society that fights for every doctor to do what we have trained for years to do: treat patients, relieve suffering, and cure disease.

For our nurses and medical assistants, you are a critical part of the team, and you have one of the toughest jobs — you are on the front lines every day.

For our nurse practitioners and physician assistants, you enhance the quality of medicine delivered.

For those who run the hospitals — from the lawyers who help us interpret the law, to the boards’ making sure we have enough capital, and to the administrators and managers who support the physicians — we must be united and committed to that great goal, again, of serving our patients and community.

Unity can be hard to accomplish, even among doctors — such as differences between specialists and primary care physicians. True story: One day I was asked to see a patient in the hospital who had weakness of one arm after a surgery. The medicine intern was rotating on neurology and came with me. After I diagnosed a brachial plexus injury, the patient asked me about her constipation.

“I’m sorry,” I said. “You’ll have to ask your surgeon or your hospital doctor.” Then she asked about her

pain medicines. Again I said that I couldn’t give her a good answer.

Then she asked about her IV site, which hurt. Again, “I’m sorry, you’ll have to ask your attending doctor.”

As we left the room, the intern said to me, “I can’t wait to specialize.”

In many ways the primary care physician has the toughest job, but our system does not incentivize medical students to go into general medicine or general surgery. I wonder if there is not more that we could do to support doctors of all types?

I want to take this opportunity to thank some friends and colleagues.

First, I want to thank all the presidents who have served before me and, especially, those coming after me, and all the doctors who are members of the Medical Society and CMA. I want to thank Ms. Shiraz Fagan, CEO of the Scripps Medical Foundation. She is a strong supporter of our Medical Society.

Scripps Clinic and Scripps Clinic Medical Group are an example of the partnership between the hospital and the doctor. Many of the Scripps team are here tonight, including Rebecca Cofinas, Brett Ringler, and Ken Leake. Thank you for being here.

I’d like to thank some of my own staff who kindly attended tonight and who make each of my days a pleasant experience. Celeste, Denise, Ruth, Chris, Mary, Joanie, Gina, Jane, please stand.

I’d like to thank all my physician colleagues at The Clinic, especially Bob Sarnoff, our president, who has supported the Medical Society consistently. Thank you, Bob. I would not be here tonight without my wife and favorite person: Lori Poceta. Lori is a nurse practitioner also working at Scripps Clinic. Those who know her already know that Lori is one of the nicest people on the planet and is a great mother to our two children. Lori’s father is a retired internist — healthcare and service are in her DNA. Thank you, honey, for everything.

Two more people deserve special thanks: our CEO, Mr. Tom Gehring, and his wife, Dr. Cathy Moore. Over the last 12 years Tom has organized us into a viable business, and has grown the Medical Society into the largest in California. Without Tom Gehring, many of us would not be here tonight, and SDCMS would be a weaker Society. Tom does it all, from organizing our advocacy efforts to

1 2

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managing the staff, the member benefits, the budget … and he has almost figured out how to herd cats.

Cathy has been a champion of medicine throughout her career.

She has been president of the San Diego Psychiatric Society and a CMA trustee. Cathy and Tom’s involvement in our medical society has been transforming. It is not an exaggeration to say that Tom has made our medical society what it is today, and I doubt that he could have done it without Cathy. Tom and Cathy, with hope for many more years of partnership, please stand and accept our heartfelt thanks.

Part of our work as a group involves politics, and I will tread lightly on a couple of issues now.

There is a lot going on.

1. President for 2014–15, Dr. J. Steven Poceta 2. Drs. Ted Mazer and Bob Hertzka present Congressman Darrell Issa with an honorary SDCMS membership certificate 3. Listening to Congressman Issa’s acceptance speech 4. Dr. Jim Hay, SDCMS Foundation past president, and Barbara Mandel, SDCMS Foundation executive director, with Nick Macchione, SDCMS’s Presidential “Atlas” Award winner

As we heard earlier, thanks to the Medical Society and CMA, working with our representatives, Washington changed San Diego’s Medicare GPCI designation, which will soon bring millions of additional dollars into our community for healthcare.

This means that more doctors and healthcare practitioners will want to work in San Diego and that Medicare patients can feel secure knowing they will get the care they need.

The coming year is going to be a great year for medicine, but we will have some challenges.

Currently, Medi-Cal rates in California are almost the lowest in the nation, and few doctors can afford to see these patients. California must improve Medi-Cal rates — not cut them — so that the poorest in our community will have a doctor to see.

Also, although few of you know this, up in Sacramento we’ve got a race in November for a seat in the California State Senate. Believe it or not, a doctor running against a lawyer. In this race, one of our own, Assemblymember Dr. Richard Pan, is running against someone with a record of voting anti-medicine on almost every issue. One of my jobs — and many of yours — this year will be to help Richard get elected; it will be a tough race but we must win.

SAN DI EGO PHYSICIAN.org 11

SDCMS Leadership

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Most importantly this year, the Medical Injury Compensation Reform Act, or MICRA, is under attack. In November, voters will be faced with a so-called patientsafety initiative that will jeopardize the privacy of patients’ personal prescription medical information, drive up healthcare costs for patients across the state, and decrease access for patients that need it most. While the initiative may be masked with other provisions by proponents, we know it’s really about increasing the cap on MICRA and pulling money directly out of the healthcare delivery system and putting it into the pockets of trial attorneys.

Now more than ever, we must band together as a unified voice and commit to defeating this trial-lawyer-sponsored ballot measure to protect the future of healthcare and of our patients. We must prevail, and — you can be assured — I will not rest, nor will our Society rest, until this initiative is defeated.

It’s also going to be a great and exciting year because our SDCMS Foundation will increase its efforts in various community health projects. The Foundation facilitates something that we all love to do: prevent illness before it happens.

The Foundation is partnering with San Diego Health and Human Services on its

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5. California Assemblywoman Lorena Gonzalez at dinner 6. California Assemblyman Brian Jones and his wife, Heather, at dinner 7. Dr. Will Tseng, SDCMS president-elect, his wife, Angela Shiau, Dr. Daniel Klaristenfeld, SDCMS board member, County Supervisor Greg Cox, and his wife, Cheryl Cox, mayor of Chula Vista 8. SDCMS past president Dr. Ralph Ocampo, and his wife, Bonnie

initiative called Live Well San Diego! Live Well San Diego!’s vision is a healthy, safe, and thriving San Diego County, and it has the potential to transform health in our county. Together, we can make San Diego the healthiest county in America.

Going forward, I cannot promise a smooth path. But I know that all of us will be working for the good of medicine and for healthcare.

There will be changes to how medicine is practiced.

Yet ours is a group in San Diego that will stand together. Physicians of all specialties and modes of practice, doctors, nurses, and the hospital teams. We need each other going forward.

We live in San Diego. Medicine is our profession, and it must remain our goal to serve our patients and our community.

I want to thank each of you for attending tonight. I deeply appreciate this opportunity; thank you very much. Let’s start some music and dancing.

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The initiative will force doctors and pharmacists to use a massive statewide database known as the Controlled Substance Utilization Review Evaluation System (CURES), which is filled with patients’ personal prescription drug information. Though the database already exists, it is underfunded, understaffed, and technologically incapable of handing the massively increased demands that this ballot measure will place on it.

In just a few short months, voters will be asked to weigh in on the MICRA (Medical Injury Compensation Reform Act) healthcare lawsuit measure, which will hugely jeopardize the privacy of patients’ personal prescription medical information.

Dear San Diego County Physician:

The campaign opposed to the initiative — “Patients and Providers to Protect Access and Contain Health Costs” — is a diverse and growing coalition of trusted doctors, community health clinics, hospitals,

new costs to state and local governments, according to an impartial analysis conducted by the state’s Legislative Analyst. State and local governments face higher costs in two ways: • They provide healthcare for current and retired employees; • They provide healthcare for low-income residents through MediCal and other locally run healthcare programs like community clinics and hospitals.

Someone will have to pay for these increased costs, and that someone is providers, taxpayers, and consumers.

We know that if this measure passes, it won’t just be putting patients’ personal medical information at risk, but malpractice lawsuits and payouts will also skyrocket, adding “hundreds of millions of dollars” in

In recent weeks and months, the coalition to oppose the MICRA healthcare lawsuit initiative continues to grow. Teachers, healthcare workers, local community groups, and hundreds of others have pledged to vote NO on prop 46 in November because they too understand the implications this measure would have on patients, taxpayers, and consumers across the state.

Have you signed up to be a hospital coordinator in your area? We’re always looking for informed and engaged physicians to help educate about the dangers of this initiative. Visit CMA’s MICRA resource page to sign up today www.cmanet.org/issues-and-advocacy/cmas-topissues/micra/join-the-fight.

You’ve been hearing about the campaign to oppose the costly MICRA healthcare lawsuit initiative for many months now, so how can you get engaged?

family-planning organizations, local leaders, public safety officials, businesses, and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals. A full and updated list of groups opposing the campaign can be found at Noon46.com.

Richard Thorp, MD President, California Medical Association

Sincerely,

United as one voice, advocating for patients across the state, we can defeat this ballot measure in November, but we need everyone to commit and become engaged along the way. Thank you in advance for all that you do and all that you’ll continue to do.

Need more information? Check out the campaign website at Noon46.com to learn more about the impacts this ballot measure would have on healthcare and your patients.

Is your name on the growing list of individuals and groups opposed to the MICRA healthcare lawsuit initiative? If not, add it at Noon46.com today.

United as one voice, advocating for patients across the state, we can defeat this ballot measure in November, but we need everyone to commit and become engaged along the way.

As many of you know, the CURES database contains highly sensitive patient information, including personal and potentially stigmatizing details about their health.

Prescription information, including medications used to treat obesity, narcolepsy, conditions related to cancer and AIDS, asthma, and other sensitive information, is all contained within the CURES database. The ballot measure’s massive ramp-up of the CURES database comes with no funding for technological improvements and will lead to unintended problems.

Most concerning, the massive ramp-up of this database will significantly put patients’ private medical information at risk, and the ballot measure doesn’t contain any provisions or funding to help upgrade the system or increase the database’s security standards.

While many of you and your colleagues may find the general concept of the CURES database helpful, this ballot measure will force the program to respond to tens of millions of inquiries each year — something it simply isn’t set up to do in its current form or functionality. A system unequipped to handle these requirements will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing some patients much needed medications.

POETRY AND MEDICINE

Summer Pond

by Daniel J. Bressler, MD, FACP I used to live in a house in Mission Hills whose side yard held an old but active fishpond. The koi did endless lazy laps under the lily pads. The water alternated between a light and a murky green depending on the season and on my attention to its cleanliness.

Each June, the summer began officially with the arrival of the frogs’ nightly calland-response. Every year they somehow found their way back from wherever they hatched and tadpoled. What brought them back every year? And why did they begin croaking on that one particular night? Was it a simple thermal switch that their amphibian hypothalamus read as “game time”? Was it an osmostat in their frog proto-kidneys that detected a level of dissolved solids? Did their eyes transmit a signal to their little froggy pineal gland based on the angle of the sun? Did their tongue or nose pick up a pheromonal signal from fly larvae or female frogs? As a non-frog-biologist, I only speculated.

Clinical medicine contains a concept called Readiness to Change. It first emerged out of studies of alcoholism and has been subsequently applied and validated to a host of health-related behaviors such as drug use, nutrition, sexual activity, sedentariness, and medication compliance. Validated questionnaires have been developed to assess such readiness and to assign a patient to one of the stages labeled as pre-contemplation, contemplation, preparation, action, maintenance, and termination. The literature suggests that change is most effectively achieved by interventions appropriate to the person’s stage.

As physicians, we ourselves tend to be action-oriented and assume that patients are at the action stage on this scale. We advise patients to simply “start exercising,” or “give up Twinkies” or “always use condoms.”

Often patients are not at an action stage, and our words, however earnest, urgent, and scientifically correct, fall on deaf ears.

And yet, recognizing that a patient isn’t 16 j u ly 2014

yet “there” doesn’t mean that guidance and suggestion are a waste of time and breath.

One can plant seeds for change through advice couched in a way that avoids setting the patient up for failure. One can, by meeting the patient where he is, strengthen the bond with him, and, through that bond, guide him through the stages of readiness. This movement often takes place unconsciously for the patient. Like our frog’s croaking, one day he’s not ready to change, the next day he is. If we have reached the patient’s rational unconscious and kept the bond with him respectful and intentional, we can promote the changes that are clearly indicated but not yet doable.

Human biology is built on the principles of threshold (think the action potential of neurons and myocytes), amplification (think of the immune system’s clonal response to a potent antigen), catalysis (think of the enzyme systems of the Krebs’ cycle), and cascade phenomena (think of the clotting system).

These same principles apply in the psychological process of change. Words, events, information, relationship, and emotion all have the capacity to reach thresholds, amplify, catalyze, and create cascades, both conscious and unconscious. Just as we employ the biological principles in the biological portion of our practice, we can use the psychological correlates to promote healthy changes.

Now back to the frogs: One early morning, the frogs’ singing woke me from a dream. I had gone to bed that night ruminating on the old proverb, “When the student is ready, the teacher will come.” I awoke with a new proverb that became the final line of the poem (and, in some ways, the take-home message to the concept of change): “When the pond is ready, the frogs will come.”

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

Summer Pond

Sunrise on the summer pond Ripples yield to rounded edges Fertile water feeds the fishes Reflecting fronds.

First among the natural laws: Life moves where the sunlight kisses In the dark where sunlight misses Life must pause.

Unrelenting green caress Budding strings from plant to pod Swirling algal streams of fog Waves of photosynthesis.

Hummingbird hovers over Whirling blur of contradiction Movement, stillness, flight and friction Translucence sips a flower.

Although I have not counted one While skimming leaves I listen daily A dream said: when the pond is ready The frogs will come.

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Risk Management

Closing or Leaving a Practice?

Make Appropriate Arrangements for Medical Records

Contributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

When a practice closes, the physician or group is responsible for making appropriate arrangements for the disposition of all medical records — regardless of whether the records are in paper or electronic format. The possibility of a lawsuit always exists after a physician has left or a practice has closed. To help defend against any future claims, proper retention of records is vital. To help reduce risks when making arrangements for medical records: • Know the guidelines or laws in your state concerning the time period for retaining records.

18 j u ly 2014

• If you turn your practice over to another physician, have agreements in place that address recommended retention time and access capability.

• When choosing to destroy clinical records after a set period of time, use a record destruction service that guarantees records are properly destroyed without releasing any confidential information.

• If you make custodial arrangements for retaining records, make sure these arrangements are in writing and guarantee future access to the records for

both physicians and patients.

When a practice closes and medical records are transferred, notify patients that they may designate a physician or another provider who can receive a copy of the records. If a patient does not designate a physician to receive the records, the records may be transferred to a custodian (a physician or a commercial storage firm). Custodial arrangements for retaining records are usually entered into for a fee.

Any arrangement for retaining records — either with a physician designated by the patient or with a custodian — should include the following points: • The medical records will be retained for the amount of time required by the state.

• No one can access the information contained in the medical records without a signed release from the patient or an authorized representative or a properly executed subpoena or court order.

• The original physician or physician’s personal representative will be notified of any change in the custodian’s or designated physician’s address or phone number.

• The terms apply to all persons in the custodian’s or designated physician’s employment and facility.

• Copies of medical records will be released to a person designated by the patient only with the patient’s written request.

• The custodian or designated physician will comply with state and federal laws governing medical record confidentiality, access, disclosure, and charges for copies of the records.

• There is an agreed-upon fee for maintaining the records (in the case of a custodian).

• The agreement includes language that addresses any personal practice decisions made by the custodian or designated physician (such as retirement, selling, or moving) to ensure the safety of and continued access to the records by the original physician or physician’s personal representative

SAN DI EGO PHYSICIAN.org 19

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Covered California

Three big Things you need to Know

A

by the California Medical Association

At the close of this year’s open enrollment period, nearly 1.4 million consumers had completed the Covered California enrollment process, which significantly surpassed initial expectations. This makes it critical that physicians and their staff understand these new insurance products to minimize the inevitable frustration and confusion that has resulted from such a large-scale change to the health insurance industry.

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//////////////////////////////////////////////////////////////////////////////////////////// 1

Know Your Participation Status In late April 2014, the California Medical Association (CMA) surveyed physicians about their contracting experience with Covered California plans.

Eighty percent of respondents reported that they had been confused about their participation status in a Covered California plan and that they believed such confusion had negatively impacted patient care.

Unfortunately, checking your practice’s participation status is not as straightforward as it might seem. Plagued with inaccuracies, Covered California took down its cross-plan provider directory earlier this year. Add to that the fact that some exchange plans have used vague contract terms and amendments that rope physicians into participating in their exchange networks, often without their express consent or knowledge, and you’ll see that “do you take my insurance” is not always an easy question to answer.

Physicians are encouraged to verify their participation status on the individual exchange plans’ online provider directories.

When searching, it’s important to select the correct exchange product type, as Anthem Blue Cross and Blue Shield of California are utilizing significantly narrowed networks for their exchange products.

It is also important that front-office staff have a clear understanding of their physicians’ participation status. With all of the new exchange plans added to the mix, it is no longer satisfactory to simply accept “I have Blue Shield” as an indication of whether the patient can be seen in-network.

Checking your practice’s participation status is not as straightforward as it might seem.

It is important when scheduling to determine in advance if the physician is indeed in the patient’s network. When scheduling an appointment, practices should request that the patient provide the office with a copy of the front and back of their insurance ID card. Having a copy of the ID card in advance will allow the practice to clearly identify whether they are in the patient’s network and also to verify patient eligibility before the visit. Taking these steps could help patients avoid out-of-network costs for and frustration from patients when they are faced with larger-than-expected bills.

Exchange Plans and Products For a detailed list of the exchange plans and products, see “Qualified Health Plan Networks for Covered California” available in the CMA exchange resource center at www.cmanet.org/exchange.

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Be Aware of Mirror Products Every plan offered in the exchange must also be offered outside of the exchange, using the same provider network.

This has resulted in a number of practices unknowingly seeing patients out-of-network for products that use an exchange network, as these ID cards will not have the Covered California logo on them. The issue is specific to just Anthem Blue Cross and Blue Shield of California because they are the only two plans offering narrowed networks. Practices must review patient ID cards and eligibility information closely to identify whether the practice is in or out of network for that particular plan.

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Understand the Grace Period Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months after they have stopped paying their premiums. This is known as the “federal grace period.” In the first 30 days of the grace period, federal law requires plans to pay for services incurred, but in months two and three of the grace period plans can pend and deny claims. So it will be extremely important that practices

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SAN DI EGO PHYSICIAN.org 21

//////////////////////////////////////////////////////////////////////////////////////////// Resources Available to members

The following resources (and many more) are available free to SDCMS-CMA members at www.cmanet.org/exchange: ❚ Covered California: Know Your Participation Status This document provides detailed instruction on how to check your participation status with the various exchange plans. ❚ Surviving Covered California Tip Sheets These documents contain tips on what to expect from and how to survive the first year of Covered California. ❚ Qualified Health Plan Networks for Covered California This document will help both physicians and patients decipher the new exchange product networks. ❚ Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees This document contains answers to frequently asked questions about the Covered California grace period. ❚ CMA’s Got You Covered CMA’s comprehensive exchange toolkit for physicians. ❚ Frequently Asked Patient Questions About Covered California Available in both English and Spanish, this document provides answers to the most common patient questions.

The following resource is available free to SDCMS-CMA members: ❚ A Matrix to Help Answer Questions Like “Am I contracted to see Covered California patients?”

“Which health plans are participating in Covered California?” “How do I check my participation status with these plans?”

Email Membership@SDCMS.org.

The following resources are available to all physician practices: ❚ In-office Education for Staff Provided by the SDCMS Foundation Email Victor.Bloomberg@SDCMS.org. ❚ Covered California Consumer Materials for Your Office Waiting Room Call (858) 300-2789.

22 j u ly 2014

verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible. If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive or otherwise suspended.

Insurance cards for exchange enrollees do not indicate whether the enrollee is subsidized. Current enrollment trends predict that nearly 90% of those with exchange coverage will be subsidized and receive the three-month grace period. In other words, if you see a Covered California logo on the ID card, you should assume they will have the three-month grace period.

Unsubsidized exchange patients and those with a mirror product are not entitled to the 90-day federal grace period; rather, they only receive the 30-day grace period called for under state law.

CMA queried Anthem Blue Cross, Blue Shield of California, and Health Net — which account for approximately 75% of the total Covered California enrollees — on exactly what to look for in eligibility verification to identify patients who are in months two and three of the grace period.

They report the following:

If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive or otherwise suspended.

Plan Name

Grace Period Eligibility Status Indicator

(Days 31–90 of Grace Period)

“Inactive Pending Investigation”

Blue Shield of California

“Pended”

Health Net

“Eligibility Suspended”

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////////////////////////////////////////////////////////////////////// ////////////////////// Current enrollment trends predict that nearly 90% of those with exchange coverage will be subsidized and receive the three-month grace period.

Practices should have policies in place regarding how they will handle patients who are in months two or three of the grace period. Patients should ideally be made aware of this policy in advance. If a patient’s eligibility verification comes back indicating his or her coverage is not active, the practice should treat the situation as they would any other patient who has had a lapse in coverage.

For non-emergent services, patients may be given the option to either pay cash at the time of service or reschedule to a later date when their coverage is effective. The office policy should include how patients will be triaged to determine whether their condition is emergent or urgent, and the policy should be approved by the physician.

Having Trouble Finding an In-network Provider or Facility?

Patients who are having trouble finding an in-network physician or facility are encouraged to contact the Department of Managed Health Care’s Help Center at (888) 466-2219 for assistance.

We also ask that physicians notify CMA if they are experiencing difficulties finding in-network providers to whom they can refer patients so that we may raise the issue with Covered California and the appropriate regulator.

Contact CMA’s physician helpline at (888) 401-5911 or at economicservices@ cmanet.org.

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24 j u ly 2014

Still Have Questions?

SDCMS-CMA members and their staff have free access to CMA’s reimbursement helpline at (888) 401-5911 or economicservices@ cmanet.org.

SDCMS members and their staff can contact Marisol Gonzalez as well, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@SDCMS.org.

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Physicians: You are a Health Role Model Model healthy living to patients and staff by inviting them to JOIN YOU at San Diego County Medical Society Foundation’s Solana Beach Sunset 5K Run/Walk September 27!

Lead a team of 20 or more patients and staff and receive FREE your own team t-shirts with your practice/team identification.

Visit www.sdcmsf.org/5K to sign up.

For more information email kathleen.kramberg@sdcms.org.

Benefiting

Improving Health…Changing Lives In Partnership With

PRESENTED BY:

5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.sdcmsf.org/5K 858.300.2777

SAN DI EGO PHYSICIAN.org 25

classifieds PHYSICIAN POSITIONS WANTED LOOKING FOR PART-TIME POSITION IN PEDIATRICS: My name is Rafael Garcia, and I have been a board-certified pediatrician since 1996. I am looking for a part-time, outpatient position in pediatrics. I can work Tuesdays from 1pm to 11:00pm, and I can also work evenings from 5pm to 11:00pm (Monday– Wednesday). I have been in practice for 20 years, recertified in pediatrics in April 2013. My phone number is (619) 990-6218 (I can be reached after 5pm), and my email is garadr@cox.net. [246] PHYSICIAN POSITIONS AVAILABLE PHYSICIAN WANTED — LA MESA / EL CAJON: Busy internal medicine practice with strong focus in geriatric patients is currently hiring a physician. Efficient, team player with compassion towards patient care is expected. Ability to use computerized EHR is important; Speech recognition Program is available for efficient documentation. Weekly / biweekly education program, including specialists’ topic discussion as well as patient case presentation are provided. Hard work, dedication, compassion, and communication skills are required. Job satisfaction will be guarantied. Opportunity to enhance the income by rounding at Grossmont Hospital and skilled nursing facilities is provided. Internal medicine work experience is desired; compensation is competitive and partnership opportunity is offered. You can apply with your CV to vprabaker@yahoo.com. [261] 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, pain management, oncology, cardiology, gastroenterology, 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., at 1855 B Street, Suite 200 B, San Diego, CA 92101; phone (619) 793-7988; or email house.call. physician@gmail.com. [260] SEEKING P/T PEDIATRICIAN to join fun, well established pediatric practice. Opportunity to grow and long-term commitment for the right candidate.

Office has EMR and stable staff. No nighttime call and occasional weekend clinic. Great family location. For more information, send CV to cvp315@ sbcglobal.net. [259] SEEKING EXPERIENCED URGENT CARE / PRIMARY CARE PHYSICIAN (MD/DO) FOR AN URGENT CARE POSITION: You will be paid commensurate with your level of experience. I will carry your malpractice (with tail) assuming you are insurable by our malpractice company. 33–40 hours per week. Position is immediately available. Please email your CV to coronadobayurgentcare@gmail.com or fax your CV to (619) 423-0120. [256] OPHTHALMOLOGIST NEEDED: Part-time to work in a North County office, 2 to 3 days per week. Potential for full-time or buy-in. If interested, please respond to sd_I_doc@yahoo.com. All replies confidential. [257] BE IN CHARGE OF YOUR OWN DESTINY! If you are a general internist interested in becoming your own boss, this may be the opportunity for you. Patients from the practice of a retiring general internist

on the campus of Scripps La Jolla need a new physician. You would be sharing an office and overhead with another general internist who is well established on the campus and can help you make all the connections to accelerate and grow your practice. Part-time practice is even possible. Interested? Please email XimedMD@gmail.com. [254] PART-TIME INTERNIST NEEDED: Work in an outpatient office on the campus of Scripps La Jolla. Must be board certified and have had experience treating in the primary care setting. Available immediately, with flexible hours and days. For more information, please send a CV or request for more information to XimedMD@gmail.com. [255] DERMATOLOGIST NEEDED: Board-certified or board-eligible dermatologist is needed for busy, wellestablished East County San Diego (La Mesa) private practice. We currently have an immediate opening for a CA-licensed dermatologist to work 2–3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service dermatology office providing general, cosmetic, and surgical services, including Mohs surgery, and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV to swagner@virtualdermatology.com. [253] PHYSICIANS: RETIRED WITH LICENSE? Alternative care office in San Diego area looking for California licensed MD for consultative work. One or two days a month. Part time, excellent compensation. Contact James at (760) 703-3767. [208] LOOKING FOR FULL-TIME FAMILY PRACTICE PHYSICIAN: Neighborhood Healthcare is an awardwinning organization that is known for excelling at its mission. The mission has remained the same over the years: to provide quality healthcare and promote wellness to everyone in our communities. We are looking for a full-time family practice physician to provide comprehensive medical services for members of the community, regardless of age or sex, on a continuing basis at our busy healthcare clinic in Temecula. Great benefits. Requirements: CA license, DEA license, CPR certification, obtain and maintain board certification. To apply please send your resume to jobs@nhcare.org. [247] PHYSICIAN WANTED, BEAUTIFUL NORTH SAN DIEGO COUNTY: Ambitious and attention to detail general family medicine / geriatrics / long-term care physicians to join our team of professionals that make “housecalls.” We serve chronically ill patients in their homes. No hospital call, M–F, 8–5, independent contractor, occasional on-call pager, 10–12 patients per day. We are a very relaxed, professional practice environment. We very much look forward to your call at (760) 591-9975. [242] SEEKING PER-DIEM, BOARD-CERTIFIED FAMILY MEDICINE PHYSICIAN: The Sycuan Band of the Kumeyaay Nation, located in east El Cajon, is seeking a per-diem family medicine physician for our medical clinic. Must have current, unrestricted CA and DEA licenses, at least three years of experience working as a medical physician, and CPR certification. Bilingual English / Spanish preferred.

Salary commensurate with experience, malpractice coverage provided. Please email CV to Teresa Mogielnicki, MD, at teresam@sycuanmed.org or fax to (619) 445-0988. [243] LOOKING FOR A DERMATOLOGIST: Medical spa located in East County looking for a dermatologist who would like to buy into a very lucrative practice or willing to be a medical director. For more information, please call Dr. Shirin Dorin at (619) 456-4555. [238]

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.

26 j u ly 2014

LOOKING FOR A RETIRED PHYSICIAN: Medical spa located in East County looking for a retired physician for a part-time position as a medical director.

For more information, please call Dr. Shirin Dorin at (619) 456-4555. [239] BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229a] SEEKING A PART-TIME BC/BE INTERNAL MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine physician to join our staff at our Genesee location. We offer a first-year competitive-compensation guarantee and an excellent benefits package. Please email CV to lori.miller@sharp.com. [204] SEEKING A PART-TIME BC/BE INTERNAL MEDICINE / PEDIATRICS OR FAMILY MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine / pediatrics or family medicine physician to join our staff at our Carmel Valley location. We offer a firstyear competitive-compensation guarantee and an excellent benefits package. Please email CV to lori. miller@sharp.com. [205] 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] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140– $220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required.

Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 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.

EEO Employer/Vet/Disabled/AA [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) 504-5830 or at venk@gpeds.sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 fulltime). [778]

PRACTICE FOR SALE SOLO OPHTHALMOLOGIST PRACTICE FOR SALE IN NORTH COUNTY: Physician retiring. Earn-out possible. If interested, please respond to sd_I_doc@ yahoo.com. All replies confidential. [258] LOW-STRESS, GYNECOLOGY-ONLY PRIVATE PRACTICE FOR SALE: Turnkey operation. One employee and low overhead, month-to-month lease.

Minimal HMO. Perfect part-time work or add obstetrics. Various arrangements available. Email drjenma@ pacbell.net. [203] PRACTICE FOR SALE: Comprehensive Sleep Medicine Practice with Integrated American Academy of Sleep Medicine-accredited Sleep Testing Center. 2013 revenue $550,000. Well-known for expertise in the diagnosis and treatment of sleep disordered breathing and offering the full range of treatment options (PAP therapy, dental appliances, surgery). Both facilitybased and home sleep testing performed with active referrals. Attractively furnished with up to date equipment and furnishings. Third-party appraisal available.

Selling due to health issue, and offered for quick sale at a very attractive price. Small practice subset in minimally invasive nasal and sinus treatment may also be included in any transaction. Please contact adowslt@ gmail.com. [250] OFFICE SPACE WANTED 3998 VISTA WAY, IN OCEANSIDE: Four medical office spaces approximately 1,300–2,800SF available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at shamshoian@coveycommercial.com. [234] HAND SURGEON LOOKING FOR PART-TIME OFFICE LOCATION: Looking for space to share in La Jolla to Del Mar areas. Limited space and time needs.

One-half to one day per week. We have flexibility to accommodate your schedule and staffing. Please contact me at greg@thehanddoctor.com. [231] OFFICE SPACE AVAILABLE DEL MAR / CARMEL VALLEY MEDICAL OFFICE FOR SUB-LEASE: Available October 2014 (4765 Carmel Mountain Rd., San Diego, CA 92130). 1,000SF. Two treatment / consultation rooms / office reception / photography room / break room. Unlimited patient free parking. Call (858) 481-4888 or email mobyrne61@gmail.com. [252] FREE MEDICAL OFFICE SPACE AVAILABLE (SAN DIEGO): Looking for a self-starting and highly motivated general practitioner who is a Tricare/ United provider to share medical office with a chiropractor. The doctor is needed to treat our existing and future medical patients. We are centrally located off 163 and Mesa College Drive by Sharp Memorial Hospital. This is great for a doctor who wants to have a satellite office. If interested, please email us at meyhpa@yahoo.com. [249] SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/ UTC area. Reception and staff may be available. Complete ultrasound lab on site for scans or studies. Fullday or half-day timeslots. For more information, call Irene at (619) 840-2400. [154] NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2,100SF,

at the 477-D Bldg. Occupied by Vascular & General Surgeons. Excellent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. 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 interest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153] LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free parking for patients and staff, conference room in building. Several minutes from Sharp Memorial and Children’s Hospitals. Convenient freeway access to 163 and 805. Multiple half-day clinics available.

Please contact Lisa Vaughn at (858) 278-8300, ext.

210, for more information. [235] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@yahoo.com. [173] 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, 1,467SF furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at mzarei@ cox.net. [873] BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@ SDCMS.org for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE / WANTED POSITION OPEN FOR A CALIFORNIA LICENSED PSYCHIATRIC PA/NP IN IMPERIAL COUNTY: The ideal candidate is a self-driven individual interested in relocating to Imperial County, who is able to communicate in Spanish, computer skilled, and likes the challenge of working in an underserved community. Experience is not required; we will train you. Relocation expenses are covered. Base salary plus productivity

bonus. Our community qualifies for loan repayment program. Part-time positions also available. For more information, contact Cruz Lopez-Castleberry at (760) 355-0161 or at orclc@sunvalleyb.com. [251] MEDICAL OFFICE MANAGER / ADMINISTRATOR: General surgery practice consisting of five physicians actively searching for a medical office manager / administrator to join our fast-paced office! The candidate will have a minimum of three years experience in healthcare management with an emphasis on the following: recruitment of office staff, on-boarding, and supervision; management of compliance; policy development and compliance; AP/AR functions, including patient billing and medical coding; insurance contracting; maintenance of all office and medical equipment as needed; credentialing; patient triage; management of medical practice needs and payments. Enjoy a competitive salary and benefits, including health insurance, 401(k) plan, and paid vacation. Qualified candidates please send resume to Cristina Montoya at cristina@coastsurgical. com or fax to (619) 827-0400. [248] BEHAVIORAL HEALTH CONSULTANT: The behavioral health consultant, as part of the primary care treatment team, identifies, triages, and manages primary care patients with medical and behavioral health problems. In addition, the BHC will provide skill training through psycho-education and patient education strategies and develop specific behavioral change plans for patients. The BHC assists primary healthcare providers in recognizing and treating mental disorders and psychosocial problems, assists in detection of “at-risk” patients, and assesses the clinical status of patients referred by the PCP. Education / Certification: PsyD/PhD in psychology or LCSW; CPR certification (including BLS). Contact Araceli Mercado at araceli.mercado@nchs-health.org or at fax (760) 736-870. [244] SUPERVISORY RN — MISSION MESA PEDIATRICS: Under the direction of the health center director / practice manager, and in collaboration with the nursing services director, supervise the delivery of quality medical care with optimal efficiency and patient satisfaction. Job Skills: Ability to relate to and work with people of all ages, social and ethnic backgrounds, and maintain patient confidentiality.

Ability to work independently and as part of a team.

Knowledge and Education: Current California state registered nurse license, current CPR certificate required. Bilingual (English / Spanish), baccalaureate level of conceptual thinking. Experience: Four or more year’s general nursing experience in ambulatory care, including one year supervisory experience. Please apply at https://rew31.ultipro.com/NOR1021/JobBoard/ ListJobs.aspx. [241] BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229b] PHYSICIAN ASSISTANT WANTED FOR SPORTS, SPINE, AND ARTHRITIS REGENERATIVE MEDICINE PRACTICE (ENCINITAS): Please reply with resume, letter of interest, and salary requirements to ssbunyak@hotmail.com. [199] 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] SAN DI EGO PHYSICIAN.org 27

Personal & Professional Development do everything, that no one should be doing anything for us. But as Albert Einstein wisely remarked, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”

In What Ways Are YOU a Genius?

Although we receive more feedback focused on improving our shortcomings, research shows that people perform best when they play to their strengths. Make sure that your strengths show up often and in high profile in your life. A happy life includes lots of activities that make us feel competent or that honor our fundamental values. Values can be a part of your workday or you can include them in one of your outside activities. (To find out what your values are, see my blogpost (http://helanefronekmd.wordpress. com/2011/10/24/your-own-personal-secret-to-work-life-balance/.)

Be the Genius You Are “If you judge a fish by its ability

to climb a tree, it will live its whole life believing that it is stupid.”

by Helane Fronek, MD, FACP, FACPh

After 12 years in group

practice, I opened my own office in August 1997. Laughingly, I told everyone that I spent the summer learning things I never had any interest in: OSHA regulations, how to create an employee handbook, accounting — the list was long but I dove in with great enthusiasm.

But after struggling to set up the accounts in my new QuickBooks program, I knew I needed help. I found a young accountant and hired him to finish setting up the program. Initially impressed with what 28 j u ly 2014

Sometimes we feel as if we need to do everything, that no one should be doing anything for us.

I seemed to have done, he later told me that he quickly saw how badly I needed his skills. What I had done made no sense and it took him many hours to correct my errors. So much for omnipotence.

In the course of our career, we gain many competencies. We learn to diagnose and treat, perform procedures, communicate with different people, and sometimes even manage employees and colleagues.

This often makes us feel that there is nothing we cannot learn to do. And sometimes we feel as if we need to

Are There Trees in Your Life That You Shouldn’t or Don’t Need to Be Climbing?

Take a look at all the things you’re doing in your life. Then make a list of those things that aren’t meaningful, fun, or interesting, as well as those that are a struggle because you’re just not good at them. If there are items on that list that you want to learn about or become better at, take them off your list. But with everything that’s left, ask yourself who might do them better than you. Who might learn something from being given that job? Then delegate or hire someone to take over and cross them off your list.

A happy life doesn’t just happen; we have to take time to know how we are feeling, look critically at how we are living, and then make choices to create the life we really want to be living. We don’t have to spend our lives struggling to climb a tree; we can happily swim in the ocean, feeling our competence and enjoying the sights, sounds, relationships, and activities that bring us the most joy.

Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who

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

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

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