July 2015 by San Diego Physician

official publication of SDCMS July 2015

Get Ready for ICD-10:

— See page 14

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july

Contents

Volume 102, Number 7

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Sherry L. Franklin, MD, James Santiago Grisolía, MD, Theodore M. Mazer, MD, Robert E. Peters, MD, PhD, David M. Priver, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: William T-C Tseng, MD, MPH President-elect: Mihir Y. Parikh, MD Secretary: Mark W. Sornson, MD Treasurer: David E. J. Bazzo, MD, FAAFP Immediate Past President: J. Steven Poceta, MD AT-LARGE DIRECTORS Thomas J. Savides, MD, Karrar H. Ali DO, MPH, Kosala Samarasinghe, MD, James H. Schultz Jr., MD, MBA, FAAFP (Board Representative), Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Toluwalase (Lase) A. Ajayi, MD, Holly B. Yang, MD (Board Representative) AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, FAAFP, Steven L-W. Chen, MD, FACS, MBA, Erin L. Whitaker, MD, Piyush (Phil) Kumar, MD, Wynnshang (Wayne) C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella (Marci) M. Wilson, MD

features

ystem Dangers: How EHRs S Can Contribute to Medical Malpractice Claims

I CD-10 Resources for SDCMS Members & Staff!

BY DAVID B. TROXEL, MD

ugust 27–28 ICD-10-CM Code A Set Boot Camp at SDCMS

departments

BY HEIDI KOCHER, ESQ.

Basic Policies and Procedures for a Compliance Program

riefly Noted: Calendar • Featured B Member • Volunteer Opportunities • Physician Health and Behavioral Issues • LTTE • Reflecting on the Last Real Estate Cycle • And More …

Thank You, Dr. Poceta: SDCMS President for 2014–15

18 Welcome, Dr. Tseng: SDCMS President for 2015–16 22

he SDCMS Foundation’s T 2015 Health Heroes

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt.), Venugopal Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD Hillcrest: Gregory M. Balourdas, MD, Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD, Anthony E. Magit, MD (Alt.), John G. Lane, MD, Eileen R. Quintela, MD (Alt.) La Jolla: Geva E. Mannor, MD, MPH, Marc M. Sedwitz, MD, FACS North County: Patrick A. Tellez, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Neelima V. Chu, MD (Alt.) South Bay: Elizabeth Lozada-Pastorio, MD (Alt.), Irineo (Reno) D. Tiangco, MD, Michael H. Verdolin, MD OTHER VOTING MEMBERS Communications Chair: Sherry L. Franklin, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Sandeep Prabhu OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Quinn C. Meisinger, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (CMA Trustee, AMA Delegate) Delegation Chair: Robert E. Peters, MD, PhD CMA Speaker: Theodore M. Mazer, MD (AMA Alternate Delegate) CMA Past Presidents: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MD, FACS CMA Trustee: Robert (Bob) E. Wailes, 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

SDCMS / Foundation 2015 White Coat Gala

26 Physician Marketplace: Classifieds 28

reating a Practice C Based on Our Priorities BY HELANE FRONEK, MD, FACP, FACPh

july 2015

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.]

Rents are rising. See how some of our clients are taking back control.

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Hillcrest

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59 60 56 57 33 34 31 Mission Bay/PB 64 61 65 62 38 39 36 Sorrento Mesa

69 66 43 74 71 Carlsbad 48

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// calendar SDCMS Seminars & Webinars SDCMS.org

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

Overview of California’s Workers’ Compensation Billing (webinar) AUG 20: 12:15pm–1:15pm Taming Outlook Workshop for Physicians AUG 22: 8:00am– 12:00pm 2015 ICD-10-CM Code Set Boot Camp (course) AUG 27–28: 8:00am– 5:00pm 10th Annual San Diego Emergency Care Summit (conference) OCT 15: 7:00am– 3:30pm

Community Healthcare Calendar

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

Primary Care Summer Conference JUL 31–AUG 2 at the Loews Coronado Bay Resort (www. scripps.org/events/ primary-care-summerconference-july-31-2015)

“

Pan-Pacific Biomedical Informatics Training Camp AUG 3–13 at the UC San Diego Biomedical Research Facility II (cme.ucsd.edu/ bioinformatics) End Stage Liver Disease AUG 15 at the Estancia La Jolla Hotel (www. scripps.org/events/ end-stage-liver-diseasetraining-program-andtreatment-update-2015august-15-2015) Collaborative Care Summit & ACO Summit West AUG 20–21 at the Hilton San Diego Bayfront Hotel (www. opalevents.org/conferencehtml/current/ collaborative_care_ summit_aco_west/ collaborative_care_ summit_aco_west.php) The California Heart Rhythm Symposium SEP 11–12 at The Omni in San Diego (cme.ucsd. edu/chrs) Early Childhood Mental Health We Can’t Wait Conference SEP 17–19 at the Crowne Plaza Hotel in San Diego (www.earlychildhoodmentalhealth-sandiego. com) New Advances in Inflammatory Bowel Disease SEP 19–20 at the Hilton San Diego / Del Mar (www.scripps.org/ events/new-advancesin-inflammatorybowel-disease-september-19-2015)

Advanced Therapeutic Interventions to Optimize Obesity and Diabetes Care SEP 25–26 at the San Diego Marriott La Jolla (www.scripps.org/ events/advanced-therapeutic-interventions-tooptimize-obesity-anddiabetes-care-september-25-2015) Transforming Medicine: EvidenceDriven mHealth SEP 30 – OCT 2 at the Scripps Institution of Oceanography, Seaside Forum, La Jolla (www.scripps.org/ events/transformingmedicine-evidencedriven-mhealth-september-30-2015) Scripps Cancer Care Symposium: A Nursing & Advanced Practice Provider Collaboration OCT 2–3 at the Doubletree San Diego Mission Valley (www.scripps.org/ events/third-annualscripps-cancercare-symposiumoctober-2-2015) People, Planet, Purpose: Global Practitioners United in Health & Healing OCT 24–29 at Paradise Point Resort, San Diego (www.scripps.org/ events/aihm-annualconference-peopleplanet-purpose-globalpractitioners-unitedin-health-healingoctober-25-2015)

quote of the month

Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.

july 2015

”

— Kurt Vonnegut, Jr., American Writer (1922–2007)

HEALTH & BEHAVIORAL ISSUES

… in Your Medical Staff or Medical Group A new service, launched in June, makes consultants from California Public Protection & Physician Health (CPPPH) available to assist individual medical staffs and medical groups in their own settings as they address physician health and behavioral issues. Consultants with experience and expertise can work with you in your hospital or your group, assisting you to implement your policies and procedures and giving specific, individualized recommendations. For more information, see www.CPPPH.org and contact CPPPHInc@gmail.com or call Ashley Burke at (415) 764-4822.

FEATURED MEMBER

MARIA C. SAVOIA, MD The board of directors of the National Resident Matching Program (NRMP) has appointed Maria C. Savoia, MD, 17-year member of SDCMS-CMA and dean of Medical Education at the UC San Diego School of Medicine, as board chair of the nonprofit organization that oversees the medical resident matching process nationwide. Dr. Savoia received her medical degree from Harvard Medical School and completed her residency training in internal medicine at UC San Diego School of Medicine, with subsequent fellowship training in infectious diseases. In addition to her extensive background in medical education research, she maintains a clinical practice with the Division of Infectious Diseases at UC San Diego Health System. Dr. Savoia began her new role as chair on July 1. Congratulations from SDCMS!

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// commercial real estate

Reflecting on the Last Real Estate Cycle … and Figuring Out How to Take Advantage By Chris Ross Fourth of July barbecues, weeklong vacations, and sand on the floor mats of our cars. We can now appreciate — especially after the nasty May gray and June gloom — summer being in full swing. I think we can also safely say that the economic (and real estate) recovery is also in full swing. The unemployment rate in San Diego has now dropped to 4.9%, the consumer confidence index is up, and our median home value has reached $506,000 — up 35% from year-end 2011 and within $30,000 of its 2005 peak. Let’s think about how this relates to your office space. When making real estate decisions — whether on a long-term strategic basis or when analyzing one particular need or transaction — it is never a bad idea to take a step back and think about the bigger picture. Most of us think about times like now, during stable market conditions, as having just completed a real estate cycle. This is a good time to reflect on how significantly medical office vacancy, absorption, prices, rental rates, and other fundamentals were affected by the recession, why certain parts of the county were affected more than others, how all of this impacts market conditions today, and what this means to your medical practice. Every stage of a real estate cycle creates its own opportunities, so let’s figure out what those are in the summer of 2015 and going forward. When things fell through the floor in 2008 and 2009, most of the buildings and submarkets that felt the biggest impact were those whose developers had lost sight of some very basic principles. Everything in real estate ties to supply and demand. In areas like Tri-City and South County, developers found readily available land and got caught up in the buzz that surrounded the growing popularity of medical real estate as it started to pick up momentum in 2006 and 2007. The first couple developers to break ground were able to capitalize on the lack of supply of newer medical buildings and the pent-up demand from physicians who needed to expand or upgrade into better quality space. But other developers focused too closely on their colleagues’ successes without

july 2015

considering the looming threat of oversupply. Some areas experienced expansions in base inventory (the total amount of property in an area by square footage) of 25–50% over a three- to four-year period. In the healthcare community, save for large primary care clinics that occasionally absorb large chunks of space, we do not typically see waves of demand to support this kind of overbuilding. Even places like Escondido/San Marcos, where the district hospital was relocated from downtown Escondido to a new facility nearly 15 minutes away, there was never a surge in leasing activity. Of course there were plenty of other factors such as Obamacare, demographics, and volatile reimbursement rates that affected healthcare real estate in different communities; but, all else being equal, even if the recession had not occurred, some submarkets had set themselves up for failure. Areas that were less affected were those that have more dynamic hospital campuses, stronger payer mix, and lack of developable land, such as UTC and Coastal North County. These areas of course still felt the impact of the downturn — UTC, for example, had multiple traditional office buildings decide they wanted to convert large amounts of office space to medical space, flooding it with vacancy — but they were not hit nearly as hard as others. So again, sitting here in mid-2015, how does this impact you? No matter where you

practice, opportunities are out there and you should be strategizing accordingly. If you are in one of the areas where overbuilding occurred, medical buildings are likely still in the recovery stages even though other parts of the county have approached or surpassed peak rents and prices. Needless to say, this means there remain great opportunities to buy or lease space at a discounted cost, sometimes with large tenant improvement allowances to help minimize the cost of moving. Meanwhile, even the healthiest submarkets have their own opportunities. In 2005 through mid-2008, most of our central and coastal healthcare communities saw a sharp rise in activity from private practice physicians and medical groups who built out brand-new medical space. Most of these physicians signed 10-year leases, which means we will see a greater amount of attractive, fully improved medical office space hit the market over the next few years. This will create unique opportunities of significant savings in construction costs for those who are ready and willing to take advantage. We are also experiencing an uptick in properties hitting the market for sale. Now that many sellers feel they are no longer leaving so much money on the table, they have a little more confidence about their future and are in a better position to expand or relocate (and put their former property on the market), or they are finally retiring now that their investments have bounced back. So write yourself a note or put a reminder in your smartphone to spend some time thinking about whether you are in an optimal situation with your lease or real estate. If your answer is “no” or “not sure,” consider the fact that there are great opportunities out there, regardless of your location or the phase of the real estate cycle. If nothing else, have your broker use those opportunities as leverage to save you money on your next lease renewal. And whenever making real estate decisions, remember to always consider the bigger picture. Just because we had an ugly June gloom this year doesn’t mean we should move to Florida. Sources: Bureau of Labor Statistics, Zillow, JLL Research 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. Mr. Ross can be reached at (858) 410-6377 or at chris.ross@am.jll.com.

/////////////////////////////////////////////////////////////////////////////////////////////////// giving back

VOLUNTEER opportunities

Overloaded?

We can help - absolutely!

SDCMS Foundation Project Access: Volunteer specialty physicians are needed for the following specialties: pulmonology, urology, general surgery, ENT or head and neck, ophthalmology, GI, rheumatology, and endocrinology. We are seeking these specialists throughout all regions of San Diego. Commitment can vary by practice. The mission of the SDCMS Foundation’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Help us help the most vulnerable population seek care. For more information, please call Barbara Mandel at (858) 300-2780 or email Barbara.Mandel@SDCMS.org, or visit our website at www.SDCMSF.org.

Billing Service Includes: Billing, Auditing, Financial Review & Reporting, and Technological Advances Consulting Includes: Contracting, Credentialing, Business Growth, Practice Management, Relocation Management

Flying Samaritans of SDSU: Established in 2011, Flying Samaritans of SDSU provides free healthcare to the underserved community of Ejido Matamoros, Mexico (15 minutes from the border) through monthly medical and dental clinics (every second Saturday of the month), seeing 60–80 patients per medical clinic and 10 per dental clinic. Visit www.sdsuflyingsamaritans.org for details or email FlyingSamaritansSDSU@ gmail.com.

858.256.0351 • www.abs-sol.com Celebrating

LETTER TO THE EDITOR

10 years

Dear Editor: Kudos to Dr. Sherry Franklin [see June 2015 San Diego Physician: “Doing the Medi-Cal Math”]. One could not, in a brief essay, more clearly show the barriers to medical care with Medi-Cal coverage. Everyone, especially those in leadership positions in California, who reads this must recognize this insurance is as close to useless as you can get. Would physicians be further ahead financially to give such patients free care and claim it as a charitable contribution at tax time? With the facts portrayed in this fine piece, is it more a sham than a shame? Thanks, Larry Schmitt, MD

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

SAN DIEGO PHYSICIAN.org

R i s k M a n ag e m e n t

User factors contributed to 64% of these EHRrelated claims, and system factors contributed to 42%.

System Dangers How EHRs Can Contribute to Medical Malpractice Claims David B. Troxel, MD

In 2013, The Doctors Company began coding closed claims using 15 electronic health record (EHR) contributing factor codes (for system and user factors) developed by CRICO Strategies and back-coded all claims to 2007. EHR-related claims frequency is increasing. Twenty-six such claims closed in the first two quarters of 2014, 28 claims closed in 2013, 22 closed in 2012, 19 closed in 2011, and two closed between 2007 and 2010. These 97 EHR-related claims that closed from January 2007 through June 2014 are the subject of this analysis. User factors contributed to 64% of these EHR-related claims, and system factors contributed to 42%. The tables on this and the next page and representative claims illustrate how EHR system and user factors contributed to the 97 closed claims. Some claims contained more than one contributing factor. Claim: Lack of EHR Drug Alert A dialysis patient transferred to a skilled nursing facility. There was an active hospital transfer order for Lovenox. A physician evaluated the patient on admission but made no comment about the Lovenox order. During the first dialysis treatment, there was active bleeding at the fistula site. Heparin (anticoagulant) had not been given. Nursing did not inform the physician of the bleeding. During the second dialysis treatment, there was uncontrolled bleeding from the fistula. The patient exsanguinated and expired. Experts were critical that there was no EHR High-Risk Medication Alert.

july 2015

EHR System Factors: Technology, Design, and Security Issues 10 %

Failure of system design.

Electronic systems/technology failure.

Lack of EHR alert/alarm/decision support.

System failureâ&#x20AC;&#x201D;electronic data routing.

Insufficient scope/area for documentation.

Fragmented EHR.

Lack of integration/incompatible systems.

Failure to ensure EHR security.

EHR User Factors: EHR-Related Issues Attributable to Users 16 %

Incorrect information in the EHR.

15 %

Hybrid health records/EHR conversion.

13 %

Prepopulating/copy and paste.

EHR training/education.

EHR user error (other than data entry).

EHR alert issues/fatigue.

EHR/CPOE workarounds.

Top Allegations in EHR Claims 27 %

Diagnosis-related (Failure, Delay, Wrong)

19 %

Medication-related:

Ordering Wrong Medication

Ordering Wrong Dose

Improper Medication Management

Claim: Incorrect Information in EHR A patient was seen by her cardiologist for hypertension. In the written medical record, her blood pressure medication had been increased to 25mg once a day. Office staff entered the order into the EHR as twice a

day. The prescription was filled. The patient missed her follow-up appointment. Seven months later, she went to the ER with numbness and weakness. Her potassium level was low. The cardiologist corrected the prescription error and gave her potassium.

EHR Claim Events by Specialty 20 %

Internal Medicine Specialties —Cardiology/Hospitalist/Oncology/GI

16 %

Primary Care— Family/Internal Medicine

15 %

Obstetrics/Gynecology

14 %

Surgical Specialties (other than cardiac surgery)

Nursing

Radiology

4 % each

Anesthesiology and General Surgery

2 % each

Pediatrics, Emergency Medicine, Psychiatry, and Orthopedics

Pathology

We also analyzed the 97 EHR claims to determine the most common allegations. The 2011 Institute of Medicine report Health IT and Patient Safety: Building Safer Systems for Better Care concluded that the information needed to analyze and assess health IT (HIT) safety and use was not available and that our understanding of the benefits and risks of EHRs was anecdotal. The report recommended creating a government agency that would systematically and uniformly collect data to investigate harm and safety events related to HIT. The Office of the National Coordinator for Health Information Technology is now developing a plan to create a Health IT Safety Center.

Locations Where EHR Claim Events Occurred 43 %

Hospital Clinic/Doctor’s Office

12 %

Ambulatory/Day Surgery

10 %

Patient’s Room

Operating Room

Emergency Room

Labor and Delivery

Radiology/Imaging

Dentistry/Oral Surgery

1% each

Pathology, ICU, Neonatal ICU, Radiation Therapy, and Special Procedures

Dr. Troxel is medical director of SDCMSendorsed The Doctors Company. He is clinical professor emeritus, School of Public Health, at the University of California at Berkeley. He is past president of the American Board of Pathology and the California Society of Pathologists. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.

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P r ac t i c e M a n ag e m e n t

Ineligible Persons and Sanctions Screening: This policy states that you will not employ, contract with, accept referrals or prescriptions from, or make referrals to individuals or entities that are sanctioned, excluded, or debarred from federal and state healthcare programs.

Licensure Status: Like the ineligible persons policy, this policy should address which individuals must maintain licensure and state that the practice will not employ, contract with, accept referrals or prescriptions from, or make referrals to individuals and entities that are not properly licensed. The policy should also indicate how you will verify licensure status and what actions will be taken if you cannot validate proper licensure status.

Basic Policies and Procedures for a Compliance Program by Heidi Kocher, Esq.

Now that you have appointed an individual to be responsible for your compliance program [May 2015 San Diego Physician] and created a compliance committee to help the compliance officer [June 2015 San Diego Physician], the focus should turn to basic policies and procedures. If an effective compliance program is like a house with a solid roof to protect the inhabitants from bad weather, policies and procedures function as the studs and support structure. Like walls, policies and procedures establish the outlines of a program, delineating areas of focus. Another way of looking at this is that the basic policies and procedures serve as the constitution of your compliance program. Accordingly, every compliance

july 2015

Hotlines and Reporting Methods for Employees, Patients, and Others: This policy should clearly establish how individuals can report concerns and ask questions or request guidance. A key component must be a statement that the reporter may remain anonymous and will not face retaliation for good-faith reports.

Investigations: This policy should outline the general steps that will be taken to investigate a report of possible problems. The policy should include direction for how to document the results of the investigation and what, if any, corrective actions were required and implemented.

7 program should have certain policies at a minimum. The most important ones are (in no particular order):

Code of Conduct: This is the basic commitment to comply with federal, state, and local rules and regulations applicable to healthcare and your practice. The importance of this policy cannot be overstated. To put it very simply, this policy must say you will not lie, cheat, or steal.

Appointment of a Compliance Officer and Description of Duties and Powers: If the compliance officer is like the president, then this policy describes what executive powers that individual has.

Training: We all know how much the rules and regulations in healthcare are changing. This policy should indicate how you will be training staff, general topics, frequency of training, and how you will document completion of the training. This policy should also include the repercussions for failure to complete the training as required.

Audits: This policy should outline your process for conducting audits. If you are billing any insurer, whether federal or private, you should be conducting audits routinely. Identify what the risk areas are for your practice. The risk areas could be related to particular services, CPT codes, or a particular insurer. As with the investigations policy, this policy should also detail what actions you will take in response to results that reveal a possible issue.

Conflicts of Interest: It is not possible to eliminate potential conflicts of interest unless you live on a desert island, isolated from contact with the rest of the world. Accordingly, the first step is to identify possible conflicts of interest (for example, family or business relationships, outside employment, ownership interests, etc.). The policy should require that all potential conflicts of interest be disclosed. Once disclosed, the policy should provide a method for addressing the potential conflict of interest. Some conflicts of interest are so significant or impact the practice in such a way that the underlying situation must be unwound — for example, a contract might have to be terminated or a relationship ended. Other conflicts of interest can be managed. Again, the policy should provide for documentation of the disclosure and what actions are taken to end or manage the conflict of interest.

Waivers of Copayments and Deductibles, Discounts, Charity Care, and Beneficiary Inducement: One of the fastest ways to get into trouble is to inconsistently apply and collect copayments and deductibles or offer discounts, as insurers will take the position that this is an improper beneficiary inducement of the federal and state anti-kickback laws. There are ways to provide free or discounted care, but it must be done thoughtfully and following established procedures. In addition, this is a key area to develop documentation demonstrating adherence to the requirements.

Overpayments: Since audits are likely to result in overpayments, you must commit to promptly returning any identified overpayments. A good place to start is with the Medicare policy manuals, particularly those of the Medicare Administrative Contractor (MAC). Likewise, private insurers often have policies on refunding overpayments. Don’t forget that the Affordable Care Act requires that Medicare and Medicaid overpayments be returned within 60 days from the identification of the overpayment.

HIPAA: Actually, HIPAA policies are more an entire set of policies that address compliance with the Privacy Rule, the Security Rule, and the Breach Notification Rule. I will address HIPAA policies in more detail in a future article.

Document Retention: This policy should outline what your document retention and destruction policy and procedures are. Not every document needs to be kept forever, and you should create retention time periods for different kinds of documents (including patient medical records). Don’t forget to include electronically maintained documents. One provision the policy absolutely must contain is a requirement that if the practice is under audit, investigation, or any other form of scrutiny, that no documents relating to that matter be destroyed, including deletion of emails.

This baker’s dozen of basic policies is only a starting point. A practice’s book of policies should include additional policies that address its particular needs or risks. In fact, I would be extremely worried if I walked into a practice and did not find at least half a dozen more policies specific to the practice. Also, the policies book need not be limited to compliance policies. The practice should also have HR policies, finance policies, patient care policies, and OSHA policies. All policies should be reviewed on an annual basis and updated as necessary. This includes eliminating policies that are no longer appropriate or relevant and writing new ones. All policies should be written in a template that permits you to document when a policy was last reviewed and when it was last changed. And finally, policies should not be like the recipe for Coca-Cola, kept in a vault and only known to a few. All staff members should have access to and understand the policies, so a best practice is to place the policies in a binder in a common area, easily accessible by all staff members. If you have an intranet, post them on the intranet. Post them on a bulletin board in the staff break room. Make them widely available. Train on them, repeatedly. Never be in a situation where a staff member can say, “Oh, I didn’t know that was our policy”! Next month we’ll examine exclusions and why they are so important in more depth. Ms. Kocher is counsel with the law firm of Liles Parker. In addition to serving as a chief compliance officer and chief privacy officer, she has almost 20 years of experience advising and defending clients on legal and regulatory matters affecting providers of all sizes. Ms. Kocher can be reached at hkocher@lilesparker.com or (214) 952-5169.

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SDCMS Leadership

Thank You, Dr. Poceta! SDCMS President for 2014–15

I was approached by many young physicians who told me that they were disillusioned practicing medicine.

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The following is outgoing president Dr. Poceta’s speech given at SDCMS’s June 13 White Coat Gala. Thank you. Last year up on this stage, I predicted a great year for medicine, and it has been even better than I hoped. Yes, our goals were accomplished: We elected Dr. Richard Pan to the California State Senate, and Proposition 46 was defeated. In the coming year we will again have issues in Sacramento and DC, we will work with

our legislators, and we will succeed. But there were some unexpected events this year, and one of them was Ebola. In order to be prepared, SDCMS organized a meeting of the leaders of the County HHS and every healthcare system in San Diego to be sure that a doctor would know what to do if one encountered a patient with Ebola. Tom Gehring made this happen — something that probably no other medical society CEO could have done. I think that San Diego County was the most prepared county in the country for a possible Ebola outbreak. I want to thank Tom Gehring for taking the initiative and organizing this response. I was surprised this year by another frequent event: I was approached by many young physicians who told me that they were disillusioned practicing medicine. Now, getting into medical school requires hard work; completing medical school requires hard work, including forgoing many activities and delaying life events. Training as an intern and resident is more than a full-time job, but all physicians signed up for these things, to stay up at night to learn about disease and to help people. Its part of our profession; it’s in our DNA. But now it seems that a type of burnout is occurring in young physicians only a few years after starting practice, and a lot of what they complain about is documentation. Almost all the young doctors who have approached me say the same thing: After a full day in clinic, they spend two to four hours at home in the evening working on the electronic medical record. Its one thing to be

awake at night treating patients, but its another to sit at home and click on a screen, an inanimate screen that doesn’t smile back at you or say thank you. Of course, over a career, physicians have always faced burnout from working too hard and taking on the stress of being responsible for a patient’s health, but I believe that an upcoming challenge to keeping the best doctors working is to fight what might be called “administrative burnout.” The electronic medical record is wonderful and it is here to stay, but if we don’t harness it to help our practices — and soon — our profession will become increasingly a job in which measures of success are not the faces and the health of our patients and our community, but the number of boxes checked on a computer screen. This problem won’t be solved simply by a ballot measure or a new law; it will require physicians to engage with, work with, and maybe even fight with other members of the provider system, including government, insurance companies, and healthcare systems. We can and we should determine ourselves the way we work and what the limits are. Physicians, through organized medicine, can and will make a difference in this critical issue. Thank you for the privilege to serve as president of the San Diego County Medical Society. I especially thank the board members of SDCMS for helping me, and I thank my colleagues at Scripps Clinic and Scripps Health for supporting the Medical Society and allowing me to have enjoyed this year.

SAN DIEGO PHYSICIAN.org

SDCMS Leadership

Welcome, Dr. Tseng! SDCMS President for 2015–16

The following is incoming president Dr. Tseng’s speech given at SDCMS’s June 13 White Coat Gala. Ladies, Gentleman, Colleagues, Friends, and Family. Welcome everyone to the 145th annual White Coat Gala! I want to first thank my SCPMG and Kaiser Permanente colleagues for all their support through the past 15 years. And many thanks to our honorary guests, sponsors, my executive team, and the team at the Medical Society / Foundation. Last

july 2015

but not least, Angela, my wife, who helps me find humor in things that stress me out! I’m honored to be standing here because, unquestionably, SDCMS is one of the finest medical societies in California. Just take a look at our all-star lineup: Dr. Bob Hertzka, Dr. Jim Hay, Dr. Ted Mazer, Dr. Bob Wales, and the list goes on …. How did I end up here? These are big shoes to fill, with enormous responsibilities as the president of our Medical Society. Uniting physicians for a healthy San Diego in the eighth largest city of our nation, and improving a healthcare system that’s undergoing an extreme makeover! In retrospect, perhaps it was inevitable that I am here today. I remember back in med school, when I was still covered under my parents’ health insurance plan, going from class to class on my skateboard in sweats. Like most medical students, I dreamed of saving lives and changing the world. The complexities of the profession and the realities of the world never even crossed my mind. Perhaps if I knew then what I know now … I may be telling a very different story to a very different group of people today! Imagine breaking the news to a young medical student the intense pressure that physicians must face every day in choosing from more than 69,000 diagnosis/ICD codes; 11,000 surgical procedures; and at least 4,000 different drugs. Not to mention thousands of pages of regulations, hundreds of frivolous lawsuits, accreditations, tests, board exams, maintenance of certifications, CMEs, and so forth. Luckily, I like challenges, and I was young and

foolish, so I rushed in. Back in med school, I volunteered every weekend at the homeless clinic. After two years, I was even promoted as the student in charge of opening and closing the clinic! However, after three years of volunteering at the clinic, I felt dejected. I was caring for the same homeless patients every Saturday. Treating them temporarily, only to see them back with the same issues week after week … feeling like I wasn’t really making a difference at all. The in-out treatments made me feel “trapped” inside a revolving door. I eventually had a conversation with my father — who was at the time a professor of anesthesiology. I thought he was going to tell me to follow in his footsteps, complete the MD, and get a PhD. Pursue a career in academics, where I can continue to be idealistic, with my dreams of saving the world. However, to my surprise, he advised me to look into a school of public health. Then, again, maybe I shouldn’t have been surprised since more school and more education was the answer most Asian parents gave their kids, right?! Back then all I knew about public health programs were projects relating to digging ditches for clean water. As lost as I was, I took my father’s advice, took a year off medical school, and went to Baltimore for a combined MD and master’s in public health. I was secretly hoping that digging ditches was going to be therapeutic for me! At Hopkins, an assignment I had was to lobby for the passing of the seatbelt law. After a week in DC, I found myself having passionate discussions with representatives on

T–B: Vanessa Chuang and Russel Chuang, Dr. Tseng’s niece and nephew, and Dr. Tseng’s daughter, Daphnie Tseng.

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Dr. Tseng and his wife, Angela Shiao.

research-based public policies that made sense and could save lives. I remember the rush and how empowered I felt as a young physician advocate — influencing public policy from a doctor’s vantage point, impacting millions! In short, digging in the ditches of public health advocacy while making way for floods of changes rejuvenated my love for a career in medicine, a career to make a difference. Ever since, I have been hooked on the importance of political engagement through a systems approach — from a very personal and individual standpoint of a physician — to have an impact on healthcare in our community. I returned to Baltimore for my medical residency training, and, upon graduation, set out to look for work that offered opportunities to a systems-based approach to healthcare. I found my family at Kaiser Permanente and the San Diego County Medical Society. For 15 years and counting now, the commitment is strong and the relationship thrives. Since my involvement with SDCMS, I have seen our Medical Society triumph as a team. From solo practice physicians to mediumsized to large-group practice physicians, at SDCMS we are physicians united. We are successful because we collaborate as a cohesive unit. Locally, this Medical Society (under the leadership of Dr. Ted Mazer)

prevailed over the GPCI bill and with it an equity of compensation for all our San Diego physicians. Statewide, this Medical Society (under the leadership of Dr. Steve Poceta) helped lead a united front opposing Prop. 46, preserving MICRA to contain runaway malpractice cost for all our San Diego physicians. Nationally, SGR (under Drs. Bob Hertzka and Jim Hay) has been overturned and progress for a sustainable payment is underway for all our San Diego physicians. While holding our ground — on issues such as scope of practice, malpractice premiums, and fair compensation — has brought many of our physician members closer together, it is statewide propositions like Prop. 46 that chips away at the joys of caring for my patients. Issues such as medical liability, skyrocketing costs, inefficiencies in healthcare delivery, and Medicaid underpayment hardens me in my practice of medicine and leaves me with scars after each struggle. I did not go into medicine for this. None of us went into medicine for this.

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SDCMS Leadership

Yet these legislations have forced many us to practice defensive medicine. I know we are all in this struggle together because we want to preserve our beloved profession. I am here today because, fortunately, I still enjoy a challenge, I still feel young, and I still love practicing

Like most medical students, I dreamed of saving lives and changing the world. The complexities of the profession and the realities of the world never even crossed my mind. medicine “to cure sometimes, treat often, and comfort always.” As president of SDCMS, I promise to go to battle to preserve the integrity of our profession, the interest of

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our patients, and the independence in our medical judgment. As president of SDCMS, I also want to make it a priority to promote education, outreach, and a healthy lifestyle. In Latin, the word “doctor” means “to teach.” So I would like our Medical Society to be involved in public health education. Through our Society and its Foundation, I would like to keep our legislators well informed and educate our community members. We must deliver evidence-based facts and not give into myths and/or fears. I’m happy to announce that through the work with Nick Macchione and Dr. Nick Yphantides of the County of San Diego Health and Human Services Agency, we have already started our journey to reach out to our kids, schools, local companies, and community partners.

In time, we will make San Diego the healthiest county in the nation. In our effort to reach out, we must also include our young physicians and medical students. They are why we build our Medical Society: for the future. We need to involve them in setting outreach goals and interests. We need them to be stakeholders and to be prepared on issues such as SB129, as well as the upcoming Supreme Court decision regarding the Affordable Care Act (ACA). They need to know we are here for them, we are here to remind them that our ideals are worth fighting for. It is possible to love our chosen profession for a lifetime. So here’s a toast to medicine: “It takes every breath, leaves every scar, speaks through your soul, and sings to your heart, but if I knew then what I know now, I would fall in love again.”

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SDCMS Foundation

2015 Health Heroes

Genesis Healthcare Partners — in Particular, Dr. Stephen Bridge, Dr. Brian Dicks, and Dr. Mark Pe and why we went into medicine. The Foundation is most appreciative of the support and generosity of time and talent of the physicians in the work we do to improve the health of community members. Each year, we recognize the efforts of a few physicians who have made a significant impact in the lives of our patients. To tell you about our 2015 Health Heroes, I would like to introduce our executive director, Barbara Mandel.

L–R: Dr. Dicks, Dr. Pe, Patricia Coleman, and Dr. Bridge.

The SDCMS Foundation’s 2015 Health Heroes awards were presented at the SDCMS and SDCMS White Coat Gala on June 13. Dr. Albert Ray, SDCMS Foundation President: Good evening. I’m Al Ray, family physician at Kaiser Permanente and president of your San Diego County Medical Society Foundation. I say your because the Foundation is the creation of the Medical Society. The Foundation connects the physicians to the community because we care about our community. Caring is what we do

july 2015

Barbara Mandel, SDCMS Foundation Executive Director: Thank you. In 2014, through the support of the physicians, hospitals and surgery centers, and ancillary partners, we facilitated care for 821 patients, valued at almost $1 million. A key partner last year was Genesis Healthcare Partners, and, in particular, Dr. Stephen Bridge, Dr. Brian Dicks, and Dr. Mark Pe. We would like to present Genesis Healthcare Partners with the 2015 Project Access Health Heroes Above and Beyond Award. Patricia Coleman is a remarkable and resilient woman who has been an SDCMS Foundation Project Access patient for the past two years for a number of issues. Patricia wanted to tell you how her life has been improved through your help. Patricia Coleman, SDCMS Foundation Project Access Patient: Imagine having pain every day and

not knowing what it is from. I know you can because most of you are doctors. Continual kidney infections for more than 10 years, and great pain caused me to go to the emergency department many times and spend weeks at a time in the hospital before I was referred to Project Access in early 2014. I am trained as a CNR because I believe in helping others, so I greatly appreciate the help that genesis physicians give to people like me every day. Dr. Pe saved my life. Every time I see Dr. Pe I try to tell him how much I appreciate their kindness and generosity. I call the doctors at Genesis a little piece of diamond. So I am proud to help present this diamond to Genesis Healthcare Partners. Dr. Ray: Thank you physician community for all you do. Of course, there would be no Project Access without all of our physicians who so generously provide pro bono medical services. Nor would there be a Project Access without the comprehensive case management, translation, transportation, medications, and other necessary parts of patient care that cost us cold, hard cash. If you like what we do, whether you are a specialist or not, you can support the work of the Foundation by becoming a member of the Health Champions Council — for further information, visit www.SDCMSF.org. Thank you for your time!

HEALTH HERO

SATURDAY, NOVEMBER 14 FLETCHER COVE, SOLANA BEACH

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 November 14 at 3 PM! Lead a team of 20 or more patients and staff and receive FREE your own team t-shirts with your practice/team identification. For more information please contact Carlos Medina at carlos.medina@sdcms.org or 858.565.7930 Benefiting

Improving Health…Changing Lives

In Partnership With

Presented By

Special thanks to John Han, PharmD, Regents Pharmacy in La Jolla for his help to assure patients are able to comply with physician orders. Project Access recently partnered with Alison Gordon Cohn, MD, and Elizabeth Viriya, MD, of Gordon-Weiss-Schanzlin Vision Institute; ASMG; and Outpatient Surgery Center of La Jolla, to assure that eight patients regained their sight with cataract surgeries. But the necessary prescriptions would have cost Project Access a prohibitive $600 per patient! John Han was able to facilitate reduced cost prescriptions down to $175 per patient, a 70% savings! John and his wife also provide ongoing support for Project Access through their Charity Support Program; for each prescription filled by Regents Pharmacy for any of a provider’s patients, Regents will donate a small portion to help support prescriptions for Project Access’ uninsured patients. Since Regents both delivers and mails prescriptions, they are able to serve the entire county. For more information, contact SDCMS Foundation, or Regents Pharmacy at regentsrx.com, 858-281-5200. It takes the partnership of the entire medical community to reach our vision of improving health and changing lives. Thank you to all our Project Access San Diego physician volunteers, hospitals and surgery centers, and ancillary partners! With your help, we facilitated care for 821 uninsured patients in 2014, getting folks back to health, back to work and caring for their families, and improving their quality of life!

SAN DIEGO COUNTY MEDICAL SOCIETY FOUNDATION 5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.sdcmsf.org 858.300.2777

SAN DIEGO PHYSICIAN.org

L–R: Cheryl Ray, Dr. Bob Wailes, and Debbie Lobatz.

SDCMS & SDCMS Foundation

Dr. Steve Hayden and his wife, Marina.

L–R: Dr. Mark Sornson, Dr. Keerti Gurushanthaiah, Dr. Mihir Parikh, and Andrew Lowe.

White Coat Gala, June 13, 2015

Nick Macchione and his wife, Lisa.

L–R: Congressman Scott Peters, his wife, Lynn Gorguze, Angela Shiao, and Dr. Will Tseng.

Dr. Tseng photobombing Dr. Stu Cohen and his wife, Dana.

California State Assemblymember Shirley Weber and her daughter, Dr. Akilah Weber.

Dr. Bob Hertzka at the podium, with Dr. Tseng below.

L–R: Dr. Bob Hertzka, California State Assemblymember Lorena Gonzalez, Dr. Steve Poceta, California State Assemblymember Rocky Chavez, and California State Assemblymember Shirley Weber.

Dr. Tom Lian and his wife, Terrie Littwin.

Dr. Lobatz and his wife, Debbie.

Dr. Jim Hay and his wife, Tricia.

L–R: Dr. Lase Ajayi, Dr. Kyle Edmonds, and Francine Maigue, district director for California State Assemblymember Lorena Gonzalez.

july 2015

L–R: Dr. Steve Poceta, Dr. Will Tseng, Dr. Steve Chen, and Dr. Jim Hay.

Dr. Ted Mazer and his wife, Marcy.

Dr. Marcella Wilson and her partner, Dr. Donna Mills.

Dr. Pat Tellez and his wife, Carole.

Dr. Geva Mannor.

L–R: Dr. Mihir Parikh, Dr. Mark Sornson, and Dr. Parikh’s wife, Dr. Keerti Gurushanthaiah.

Dr. Rosemarie Johnson and her husband, Joe Marshall.

Dr. Mihir Parikh.

L–R: Sabrina Bazzo, Dr. David Bazzo, and Dr. Amy Kakimoto.

SDCMS Past Presidents — Top Row, L–R: Dr. Bob Hertzka, Dr. Al Ray, Dr. Bob Wailes, Dr. Rosemarie Johnson, Dr. Jim Hay, Dr. Ted Mazer, Dr. Ralph Ocampo, Dr. Stu Cohen; Bottom Row, L–R: Dr. Susan Kaweski, Dr. Steve Poceta, Dr. Sherry Franklin, and Dr. Bob Peters.

Dr. Ralph Ocampo and his wife, Bonnie.

Dr. Bob Peters.

Dr. Bob Peters talking with Dr. Jim Schultz (right) and his wife, Shelley. Dr. Steve Chen in the background.

Dr. Steve Poceta presenting Dr. Susan Kaweski with SDCMS’s Atlas Award.

Dr. Steve Poceta presenting Dr. Rosemarie Johnson with SDCMS’s Atlas Award.

Dr. Bob Peters honoring Dr. Steve Poceta, outgoing SDCMS president, with Drs. Sherry Franklin and Jim Hay in the background.

SAN DIEGO PHYSICIAN.org

classifieds PHYSICIAN POSITIONS WANTED SHORT-TERM LOCUMS AVAILABLE! D. (Doyle) Eugene Johnson, family physician with a wealth of experience, looking for short-term locums, preferably in North County. Have been a full-time practicing certified family physician for 50+ years and would like to continue seeing patients on a part-time basis. Had one of the largest solo family practices in San Diego for 25+ years. Excellent references! Continually certified in family practice, ACLS, BLS, regularly use computerized records. Please email d.eugenejohnsonMD@gmail.com with particulars. [301] PHYSICIAN POSITIONS AVAILABLE MD / DO WANTED: Alternative care clinic in San Diego area looking for CA-licensed MD / DO. Full-time or part-time, excellent compensation. Contact (619) 779-8024 or greencrossdr@gmail.com. [380] PHYSICIANS: RETIRED WITH LICENSE? Alternative care office in San Diego area looking for California-licensed MD for consultative work. One or two days a week. Part-time, excellent compensation. Contact James at (760) 703-3767. [375] CALIFORNIA STATE UNIVERSITY SAN MARCOS PHYSICIAN (11/12 PAY PLAN): Provides primary healthcare in a university clinical setting to regularly enrolled and extended learning students of California State University San Marcos. The incumbent works in a collaborative, team environment with other physicians, psychiatrist, nurse practitioners, physician assistant, nurses, pharmacist, psychologists, and health educators. Under the direction of the director, will participate in quality improvement efforts, support health promotion and outreach efforts, work collaboratively with university athletic trainers, and may serve in leadership or consultative roles. For more information and to apply, visit http://apptrkr. com/632137 EOE [374] SPANISH-SPEAKING PRIMARY CARE PROVIDER: Spanish-speaking family medicine or internal medicine physician sought for Chula Vista group practice. The practice is growing and needs to hire two new physicians over the next year and a half. Position is employed with salary, benefits, and bonus. The group has 10 physicians plus mid-levels, EMR. See patients in office or urgent care setting. Stable office with little to no turnover of employees. Community care with a large multi-ethnic patient base. Autonomy in scheduling is a great part of the practice. Contact Rick at (757) 460-1299 or at rick@medstaffmatters.com. Visit www.medstaffmatters.com. [364] KAISER PERMANENTE — SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP IS CURRENTLY LOOKING TO HIRE EXCEPTIONAL PHYSICIANS FOR FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, AND URGENT CARE OPPORTUNITIES IN SAN DIEGO: As part of our practice, you’ll be working in a progressive environment that encourages cross-specialty collaboration, professional autonomy, and work-life balance. We offer a competitive salary and one of the most comprehensive benefits packages. If you would like to work with an organization that gives you the tools, resources, and freedom you need to get the best outcomes possible for your patients, come to Kaiser Permanente. For consideration or to apply, please visit our website at http:// physiciancareers.kp.org/scal. For questions or additional information, please contact the recruiter Bettina Virtusio at (877) 608-0044. [372] FAMILY PRACTICE AND INTERNAL MEDICINE NEEDED: Part-time or full-time physicians needed to work at correctional facilities. Work as an independent contractor with very competitive pay. Contact Steve at steve@cpmedgroup.com or at (619) 885-3907. [371] FAMILY PRACTICE PHYSICIAN — FT / URGENT CARE PHYSICIAN — PER DIEM: Arch Health Partners is an awardwinning medical foundation in North San Diego County. Family Practice hours 8:00am–5:00pm. Urgent Care hours 9:00am–9:00pm. Send CV to catherine.jones@archhealth. org or fax to (858) 618-5820. [366] SEEKING EXPERIENCED HOSPITALISTS: Prestigious, 400-physician, multispecialty group seeks experienced hospitalists to be part of an established hospitalists program at Scripps Memorial Hospital, La Jolla. Board-certified internal medicine physicians with superior clinical skills and willing to work in a team environment. Excellent communication skills a must. Outstanding salary, bonus, and benefits. Please send

CV to Yvonne Montelius/XiMED Hospitalists at ymontelius@ ximedinc.com or fax to (858) 587-1642. [363] PEDIATRIC NEUROLOGY: Sharp Rees-Stealy Medical Group is looking for a part-time BC/BE pediatric neurologist. This position requires the ability to read EEGs and participation in after-hours on-call coverage. Unique opportunity for professional and personal fulfillment. Please send CV to Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 2334730. Email: lori.miller@sharp.com. [359] OPHTHALMOLOGY: BC/BE fellowship-trained glaucoma specialist needed to join collegial and well established ophthalmology division with all major sub-specialties, general ophthalmology, and optometry represented. Fluency in Spanish is a plus. Competitive compensation and benefits package, commensurate with training. Unique opportunity for professional and personal fulfillment. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [360] FAMILY MEDICINE: Sharp Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking fulltime or half-time (job share) BC/BE family medicine physicians to join our staff. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [361] FULL-TIME PEDIATRIC POSITION AVAILABLE: Mountain Health & Community Services (MHCS) is seeking an energetic and enthusiastic pediatrician to help us start our new Pediatric Clinic in Alpine, near beautiful San Diego beaches, mountains, hiking trails, fishing, and great schools. Rare opportunity to start and grow your own practice in an exciting, growing community health organization. We offer excellent benefits, NHCS loan repayment eligibility, and competitive salary. Qualifications: License from the State of California (MD or DO); current CPR; board certified or board eligible. Salary negotiable. If interested, please submit your CV to Tabitha Findahl at tabitha.findahl@mtnhealth.org, or call CMO, Dr. Blain, at cell (619) 374-7221 for more information. [357] FULL-TIME FAMILY MEDICINE POSITION AVAILABLE: Mountain Health & Community Services (MHCS) is seeking energetic and enthusiastic family medicine providers at several of our clinics, near beautiful San Diego beaches, mountains, hiking trails, fishing, and great schools. We offer excellent benefits, NHCS loan repayment eligibility, and competitive salary. Qualifications: License from the State of California (MD or DO); current CPR; board certified or board eligible. Salary negotiable. If interested, please submit your CV to Tabitha Findahl at tabitha.findahl@mtnhealth.org, or call CMO, Dr. Blain, at cell (619) 374-7221 for more information. [356] PART–TIME CARDIOLOGIST NEEDED for outpatient cardiac consults and follow-ups in an established cardiology practice in East County. Call Debbie at (619) 668-0039. [354] PSYCHIATRISTS NEEDED: Part-time or full-time psychiatrists needed to work at San Diego County jails. Work as an independent contractor with very competitive pay. Contact Steve at steve@cpmedgroup.com or at (619) 885-3907. [353] PHYSICIAN WANTED: Semi-retired or working part time elsewhere to fill in for vacations, long weekends for active family practice, urgent care, occupational medicine practice in Mission Valley area. No weekends or nights. Salary negotiable. Call cell phone at (619) 846-8156 or email at drpohl@ missionvalleymedical.com. [351] FULL-TIME PRIMARY CARE PEDIATRIC POSITION AVAILABLE in beautiful San Diego, California, to provide coverage for newborn care in Maternal Child Health Unit and community outpatient pediatric clinic. Job duty includes supervision and teaching of residents and medical students. Average 20–25 patients daily. No evening or weekend calls or attendance of deliveries. Centrally located in San Diego with easy access to gorgeous beaches, parks, hiking trails, San Diego Zoo, and fine dining. Opening available now. Must be certified for PALS and NRP. BC or BE. An additional parttime position is also available. Please submit inquiry and CV to Huza.Callie@scrippshealth.org. [350] PHYSICIAN FAMILY MEDICINE: North County Health Services (NCHS); Job Title: Physician Family Medicine; Location: Riverside, CA. An established, award-winning organization. Our employees work smarter, and we are looking to hire the best talent. We look for people who embrace diversity, love challenges, and welcome big changes. We have a need for a lead physician

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.

july 2015

to provide comprehensive medical services for patients of NCHS. Qualifications: License from the state of California (MD or DO); CPR; Minimum two years of experience; Board certified or board eligible. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact: Araceli Mercado, araceli.mercado@nchs-health.org. [349] GENERAL, FAMILY, OR INTERNAL MEDICINE PHYSICIAN NEEDED IMMEDIATELY: This opening is an independent contractor position. We are a house-call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Monday–Friday, 10–12 patients per day. No rounds or hospital duties. If interested please submit your CV to julie@sandiegomobiledoctor.com. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [348] INTERNAL MEDICINE PHYSICIAN WANTED — PRIVATE PRACTICE OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unusual and exceptionally attractive outpatient IM opportunity newly available in North San Diego County. This is a rare opportunity to experience the best of private practice with the added bonus of flexibility and simplicity. Work environment is a highly regarded single-specialty group with >30 years in the community. Office staff are exceptional, quality of patient care also exceptional, and office location is easily accessible from anywhere in the county. Multiple scheduling options available, allowing for optimal life-work balance. Seeking BC or BE applicants. Interested? Please email CV to portofino3@aol.com or call (619) 248-2324. [345] SEEKING PART-TIME PRIMARY CARE / URGENT CARE PHYSICIAN: For a busy, well-established primary care family practice / urgent care medical practice in Pacific Beach. This position could lead to an associate physician position of the practice for the right person. The candidate must be able to provide compassionate care in a fast-paced environment. Knowledge of musculoskeletal medicine and X-Ray is required. Must be able to suture and have experience with wound care. We have a state-of-the-art medical facility. Please send your CV in confidence for consideration to pbyrnes@andersonmedicalcenter.com. Compensation: Excellent Pay Rate [317] SEEKING A FULL-TIME INTERNAL MEDICINE PHYSICIAN: Palomar Medical Group is seeking a full-time internal medicine physician to join our well-established, multi-specialty practice. This position involves the practice of primary care internal medicine in an office setting. PMG has just been awarded PCMH status by the NCQA. All applicants must hold current California license and board certification. Please send all inquires and CVs to lware@palmedinc.com. [340] 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 a recently retired general internist on the campus of Scripps La Jolla need a new physician. Share an office and overhead with another general internist who is well established on the campus and will help you grow your practice, as well as help in all the business aspects of private practice. Guaranteed salary for the first year, allowing you time to build up your panel. Great opportunity to practice medicine the way you want to. Interested? Email XimedMD@gmail.com. [337] PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd. org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org. [046a] SEEKING A FOOT/ANKLE SPECIALIST: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broadbased primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to lisas@sdsm.net. [326] SEEKING URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Good pay and working conditions along with the potential to become a full-time position. Please send CV to jeff@eastcountyurgentcare.com. [306] 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: Internal medicine and family medicine physician positions currently open. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County with openings for full-time, part-time, and per-diem positions. Current CA and DEA licenses required. 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] OFFICE SPACE AVAILABLE GENESEE/ BALBOA AVE., CLAIREMONT 92117, SAN DIEGO: Fully furnished turnkey office 2,600ft2. Recently modern remodeled. Immediate availability. Very central, close to Sharp and Scripps Memorial hospitals. Computers; EHR-compatible with cable internet and securely networked fax, printer, scanner, and digital phone system. EKG, treadmill, urine analyzer, automated exam procedure table. Can comfortably accommodate from 2–4 providers. Five exam rooms. Lab room; storage space and business office. Take over remaining rent lease of $6,592/month expires Dec. 31, 2015. Landlord will work with you on new lease. Take over fax/scanner printer lease $341/ month. Purchase of all furniture, equipment $20,000 obo. Contact Gary for details at drglevinson@gmail.com. [376] OPHTHALMOLOGY: Pacific Beach solo practitioner planning to vacate 767ft2 office space. One lane equipped with Reliance Pendulum System that includes work desk, slit lamp, keratometer, phoropter, TVA visual acuity testing. Office furniture includes desk, wooden cabinet, metal file cabinet, chart cabinet, chairs, stands. Free patient parking. One block to the ocean. Dr. Kartsonis. Email: dartmouthman@gmail.com. [373] DEL MAR MEDICAL OFFICE AVAILABLE: Turnkey office available in Class A medical office building in prime location in Carmel Valley, San Diego. Full- or part-time occupancy for medical professional. Dedicated parking garage for patients / clients. 1,000ft2-suite with two large treatment rooms, breakroom, photography, and reception area. Rates dependent on use. Contact Margaret O’Byrne, MD, at mobyrne61@gmail. com, (619) 218-8980 (mobile), (858) 481-4888 (office). [369] $3,147 / 1,701FT2 — 1,701FT2 MEDICAL OR BUSINESS USE FLEX SPACE (5330 CARROLL CANYON RD.): 1701 sq foot office space available approved for medical or business use. Fully built out. First floor with extensive window line. Two entrances. Excellent highway access. Short- or long-term lease available. Easy patient / client parking. Contact Margaret O’Byrne, MD, at mobyrne61@gmail.com, (619) 218-8980 (mobile), (858) 481-4888 (office). [368] MEDICAL OFFICE SPACE AVAILABLE IMMEDIATELY at 9339 Genessee, San Diego, CA. 1,800ft2 at $3.60/sf. Buildout required, TI available. Please contact Synergy Specialist Medical Group at (858) 412-6080. [362] SHARED SUBLET AVAILABLE: Large, nicely furnished office space available for shared sublet 1–2 days per week, on Scripps Encinitas campus. Contact Frank at (858) 361-9377. [358] HILLCREST OFFICE SPACE: Office space available in beautiful, updated Hillcrest medical office that also houses a fully accredited ambulatory surgery center. Great opportunity for a plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatological surgeon. Office is conveniently located minutes from freeway access and downtown San Diego. Please contact via email at info@drhilinski.com. [355] OFFICE SUITE — APROXIMATELY 1,650 SQ. FT. IN OFFICE BUILDING ADJACENT TO SHARP CORONADO HOSPITAL: Large, newly refurbished waiting area, a business office and six exam /consultation rooms. The space is ideal for primary care physicians or a specialty group wishing to expand to Coronado. Pharmacy and parking are available on premises. The suite is largely furnished, and tenant improvements are available depending on the length of the lease. Part-time tenants are available to share lease expenses. Base rent $2.38 / sq. ft / mo, $1.28 / sq. ft. / mo operating expenses. Email John Kerley, MD, at kerjo100@gmail.com or call (619) 435-2060. [344] 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 Hospital and Children’s Hospital. Convenient freeway access to 163 and 805. Multiple half-day clinics available days, eve-

nings, and weekends. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more information. [343] PSYCHIATRIST WANTED TO SUBLEASE OFFICE in a 3700ft2 beautiful cardiology group practice office next to TriCity Medical Center in Oceanside, CA. Consultation room available with access to a new BRAINSWAY DEEP TMS machine with H1 and H10 coils to be used for drug-refractory MDD, and chronic pain or MS syndromes. Pease call Kenneth Carr, MD, at (760) 941-9440 or Yvonne Fraser, Esq., at (619) 368-2180. [339] CARLSBAD MEDICAL OFFICE FOR LEASE: • Space from 1,000–50,000 SF • Competitive lease rates and TI allowances • Existing tenants include imaging, pharmacy, orthodontics, urgent care, and pain management • Highly visible to over 43,000 vehicles per day along Palomar Airport Road • Interstate 5 is less than a mile away providing access to over 200,000 households within a 20-minute drive • North County’s most affluent demographic with average household income of $98,614 within a 5-mile radius. For further information, please contact: TRAVIS IVES, Cushman & Wakefield, (858) 334-4041, travis.ives@cushwake.com, Lic. # 1889097 [332] ALISO VIEJO — 5 JOURNEY: Multi Tenant Medical Building with highly successful medical and dental practices. 2 ground floor medical spaces approx. 2,135, 2,225 & 1,742 rsf available for lease. $2.75 PSF NNN. Beautifully designed. Tenant Improvement Allowance to customize suite is available. For further information please contact Lucia Shamshoian @ 769931-1134x13 or Shamshoian@coveycommercial.com. [298] 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] 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. Full-day 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: Welldesigned 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] 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] BUILD TO SUIT: 950SF 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 six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: Two 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 Physician Assistant position in Pain Management under the direction of the Physician: Apply and modify the principles, methods, and techniques of medicine to provide comprehensive pain management, medical services, and procedures. Diagnose and treat a variety of injuries, chronic and acute pain symptoms. Full-time position. Competitive salary, sign-on bonus, and vacation package bonus after one year. Education: Physician assistant applicants must have certification and degree from an accredited college organization. Experience: Previous experience in pain management

preferred. License / Certification: Certification of physician’s assistants; current / valid CA state PA license, DEA, and NPI. Current CPR, BLS, and ACLS certifications. EOE / Minorities / Females / Vet / Disability. Email hillycarr1@yahoo.com. [379] SAN DIEGO MEDICAL GROUP SEEKS A NURSE PRACTITIONER: San Diego Medical Group (SDMG) is a well established and thriving internal medicine private practice located in Hillcrest directly across the street from Scripps Mercy Hospital in the prestigious Mercy Medical Building. The office is staffed by two internists, one nurse practitioner, and seven staff. SDMG seeks another experienced, full-time nurse practitioner to manage patients in our growing practice. This is a unique opportunity to work in a small private practice with seasoned, excellent providers and staff in an efficient, cohesive work environment providing medical care to a wide variety of patients. SDMG envisions an incoming nurse practitioner who has direct experience with the practice of internal medicine, is capable of immediate management of patients, can quickly learn and use SDMG’s EMR (eClinicalWorks), is positive, outgoing, compassionate, and a hard worker. The position is Monday through Friday, 8am–5pm (some flexibility) with a competitive six-figure salary, health benefits, retirement benefits, life insurance, paid continuing education, and paid vacation. There is no call. Interested applicants, please send your resume to sdmg@sdmedgroup.com. [365] PSYCHIATRIC NURSE PRACTITIONER: Part- or full-time psychiatric nurse practitioner needed to work at San Diego County jails. Work as an independent contractor with very competitive pay. Contact Steve at steve@cpmedgroup.com or at (619) 885-3907. [352] SEEKING PA for well-established orthopaedic surgeon practice in San Diego. Orthopedic clinic experience. Prefer fulltime, will consider part-time. Please contact Nancy at (619) 980-9801 or at nantowne@yahoo.com. [347] DENTIST: North County Health Services; Job Title: Dentist; Location: San Marcos, CA. An established, award-winning organization. A top place to work. A mission to serve. Come be awesome with us! We’re looking for people who support our mission and who want to be employed at NCHS — and not just for right now, but for the long term. We have a need for a talented dentist! Qualifications: CA DDS or DMD license; CPR, NRP; two years of experience. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact Araceli Mercado at araceli.mercado@nchs-health. org or at (760) 736-6780. [341] FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd. org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org. [046b] 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) 9925330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [038] MEDICAL EQUIPMENT / OFFICE FURNITURE OFFICE FURNITURE/EQUIPMENT FOR SALE: Excellent condition. Exam tables, reception chairs, computers, otoscopes, EKG, treadmill system, urine analyzer, sphygmanometers. Desks, office chairs. Contact Gary for details drglevinson@gmail.com. [377] CANON MULTIFUNCTION PRINTER: FREE-STANDING, ONE YEAR OLD: EHR-compatible for print, scan, and fax. Free-standing unit, small footprint, quiet. Take over lease $341/month, four years remaining. Contact Gary for details at drglevinson@gmail.com. [378] INTERNAL MEDICINE OFFICE CLOSING: Small private practice closing on 8/29/15, and all items for sale, including medical equipment, office furniture, office equipment, office supplies, and medical supplies. Includes: Marquette GE EKG, Welch Allyn spirometer, ophthalmoscopes, Baumonometers, exam tables, scales, computers, waiting room furniture, bookshelves, desks, chart racks, etc. Please call Cathy for more information at (619) 829-5583. [367]

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P e r s o n a l & P r o f e s s i o n a l D e v e lo p m e n t

What results is a feeling of congruence and authenticity that transforms our work into the human and spiritual practice that inspired us to become physicians in the first place.

Creating a Practice Based on Our Priorities by Helane Fronek, MD, FACP, FACPh

My father had his first MI at age 42, and, as his problem list grew, he saw many physicians. Not surprisingly, each had a unique personality that was reflected in the care they provided. As a physician coach, I speak with many clients who are unhappy working in situations that don’t suit them. When you value collaboration, it’s distressing to feel excluded by a culture of authoritarianism. If innovation is important to you, working in a group that demands uniformity feels claustrophobic. The ability to practice in a way that’s congruent with our values is as important to our satisfaction as which specialty we choose. Taking the time to contemplate who we are, what we want to be known for, and what feeling we want to create in our offices allows us to create a practice based on these priorities and prevents this type of

july 2015

conflict in our lives. It’s probably true that all of us want to provide up-to-date and technically excellent care. But what else is important to you? Do you pride yourself in offering cutting-edge medical procedures or services? Do you believe that complementary and alternative medicine should be offered to each patient — perhaps even before pharmaceuticals — if indicated? Where do you stand on evidence-based vs. individualized care? If you had to choose between efficiency and compassion, which would you emphasize? Small-group or solo practices allow physicians to more easily tailor their practices to their interests. This is one reason why I have preferred to work in these settings. However, most physicians work in corporate-type settings, with less control or ability to individualize their practice.

Still, there are ways in which individual physicians and even the group itself can demonstrate important values. Knowing that patients would be upset when many physicians in her system were moved to other facilities, one of my clients convinced her group to display photos and bios of the outgoing and incoming physicians in the lobby in order to help patients understand the transition. The large-scale patient care model offered by Kaiser Permanente aims to create a friendly and intimate feeling by appointing “Directors of First Impressions.” Kaiser emphasizes to greeters and receptionists that their first interactions with anyone visiting the facility are crucial and trains them in the art of customer service. By prioritizing these individual connections, Kaiser helps patients feel welcomed and acknowledged, even in the midst of a large system. Medical education filled our heads with knowledge, and the experiences of training developed our clinical judgment so we could become competent physicians. But our philosophy — how we view our role and the experience we wish to provide our patients and staff — also affects our practice. By understanding our priorities, we can mold our practice to reflect who we are as doctors and individuals. What results is a feeling of congruence and authenticity that transforms our work into the human and spiritual practice that inspired us to become physicians in the first place. 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 works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.wordpress.com.

Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE! On October 1, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action Guide for Medical Practices has the answers you need to successfully make the transition.

Request your free electronic or hard copy today!

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