February 2016 by San Diego Physician

official publication of SDCMS February 2016

CMA’s Federal Priorities for

“Physicians United for a Healthy San Diego”

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From San Diego Cardiologist Brian E. Jaski, MD

STAGE A

STAGE B

STAGE C

STAGE D

At high risk for HF but without structural heart disease or symptoms of HF

Structural heart disease but without signs or symptoms of HF

Structural heart disease with prior or current symptoms

Advanced HF

Features: – Includes over 200 color figures and tables – Specific recommendations backed by clinical trial data – Practical algorithms for diagnosis and therapy Topics include: –New therapies: Entresto, ivabradine –Prevention of heart failure –Reversing decompensated heart failure – How to combine lifestyle changes, medications, and devices to improve outcomes – Indicators of advanced heart failure and appropriate treatment options – Outpatient pulmonary artery pressure-guided HF management –Heart transplant, LVAD

Brian E. Jaski, MD, FACC

Director of Clinical Research, San Diego Cardiac Center Medical Director, Advanced Heart Failure and Cardiac Transplant, Sharp Memorial Hospital, since 1985 Team Coach, Sharp Memorial Heart Transplant Recipients, 2012 San Diego Triple Crown 1/2 Marathon Finishers (third from left)

Available at cardiotextpublishing.com and Amazon in print or e-book editions. SAN DIEGO PHYSICIAN.org

february

Contents

Volume 103, Number 2

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 (CMA Trustee) 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

features

CMA’s Federal Priorities for 2016 BY ELIZABETH MCNEIL

departments

ongress Wraps Up a Tumultuous C Yet Productive 2015 BY ELIZABETH MCNEIL

2015 Medicare Meaningful Use Hardship Exception Applications Now Available

22 MACRA, Meaningful Use, and ICD-10: End-of-Year Advocacy

Briefly Noted: Calendar • Volunteer Opportunities • History Thumbnails • Featured Member • Welcome New and Returning Members • And More …

8 Be There San Diego: Making San Diego County Heart-attack- and Stroke-free BY ANTHONY N. DEMARIA, MD 10

eadership Series: L Wendy M. Buchi, MD

BY ELIZABETH MCNEIL

BY SHERRY NOORAVI, PSYD

here’s an App for That: Benefits T and Risks of Using Mobile Apps for Healthcare BY ROBIN DIAMOND, MSN, JD, RN

utting It All Together: P Creating a Functioning, Effective Compliance Program

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt.) • Jay P. Mongiardo, MD • Alexandra E. Page, MD • Venu Prabaker, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt.) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD • John G. Lane, MD • Anthony E. Magit, MD (Alt.) • Eileen R. Quintela, MD (Alt.) La Jolla: Geva E. Mannor, MD, MPH • Marc M. Sedwitz, MD, FACS • Wayne C. Sun, MD (Alt.) North County: Neelima V. Chu, MD (Alt.) • Michael A. Lobatz, MD • Eileen S. Natuzzi, MD • Patrick A. Tellez, MD South Bay: Elizabeth Lozada-Pastorio, MD (Alt.) • Reno D. Tiangco, MD • Michael H. Verdolin, MD AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali DO, MPH • Steven L-W. Chen, MD, FACS, MBA (Alt.) • Stephen R. Hayden, MD • Phil Kumar, MD (Alt.) • Vimal I. Nanavati, MD, FACC, FSCAI (Alt.) • Robert E. Peters, MD, PhD (Alt.) (Delegation Chair) • Carl A. Powell, DO (Alt.) • Peter O. Raudaskoski, MD • Kosala Samarasinghe, MD • Thomas J. Savides, MD • James H. Schultz Jr., MD, MBA, FAAFP (Board Rep) • Karl E. Steinberg, MD, FAAFP (Alt.) • Erin L. Whitaker, MD (Alt.) • Marci M. Wilson, MD (Alt.) • Holly B. Yang, MD (Board Rep) 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 (At-large AMA Delegate) CMA Speaker: Theodore M. Mazer, MD (At-large AMA Alternate Delegate) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate) • Ralph R. Ocampo, MD, FACS CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

BY HEIDI KOCHER, ESQ.

Thank You to the 65+ Physicians Who Attended Our Feb. 4 Social!

26 Physician Marketplace: Classifieds

24 2

february 2016

hysicians: Help CMA Pass the 2016 P Cigarette Tax Initiative

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 //////////////////////////////////////////////////////////////////////// calendar SDCMS-CMA Webinars, Seminar, and Social

For further information or to register for the following SDCMS-CMA webinars, seminar, or social, contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org. HIPAA Compliance: Key Risks All Physicians Should Know (webinar) FEB 24: 12:15–1:15pm Closing a Medical Practice (webinar) MAR 9: 12:15–1:15pm Medicare Updates for 2016 (seminar/ webinar) MAR 10: 11:30am– 1:00pm MACRA Implementation: A Review of the CMS Proposed Rule (webinar) APR 6: 12:15–1:15pm How to Reduce Overhead Expenses and Increase Profitability (webinar) APR 20: 12:15–1:15pm Physician Networking Opportunity & Mixer (social) APR 26: 5–8pm

“

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. AAPP 2016 Spring Summit on Private Pay and Concierge Medicine FEB 26–27 at the J.W. Marriott Marquis San Diego Marina. Offering up to 8.5 CME hours, this spring summit will conduct specialized education tracks for private and concierge medicine, direct primary care, and practice formation. You’re invited to meet and learn from a rapidly growing group of private physicians and medical industry professionals. This conference will continue to focus on core private medicine issues that affect and are of interest to all physicians and practices, such as compliance and emerging medical technology. (http:// aapp.org) San Diego Pulmonary, Critical Care and Sleep Medicine Case Conference & Clinical Updates (Critical Care Content) FEB 29 at VA San Diego, Room 3004 (sjamil@ucsd.edu)

UC San Diego Essentials and Advances in Apheresis Therapies MAR 3–5 at the Marriott Mission Valley New Treatments in Chronic Liver Disease MAR 18 (preconference) 19–20 at the Estancia La Jolla Hotel & Spa San Diego Pulmonary, Critical Care and Sleep Medicine Case Conference & Clinical Updates (Sleep Medicine Content) MAR 21 at VA San Diego, Room 3004 (sjamil@ucsd.edu) Butters-Kaplan West Coast Neuropsychology Conference APR 7–10 at the Hyatt Regency La Jolla 36th Annual Radiology Review Course 2016 APR 10–16 at the Hotel del Coronado San Diego Pulmonary, Critical Care and Sleep Medicine Case Conference & Clinical Updates (Pulmonary Medicine Content) APR 25 at VA San Diego, Room 3004 (sjamil@ucsd.edu)

giving back

VOLUNTEER OPPORTUNITIES Email Your Physician Volunteer Opportunities to Editor@SDCMS.org SDCMS Foundation Project Access: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. 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, contact Andrew Gonzalez at (858) 300-2787 or at Andrew. Gonzalez@SDCMS.org, or visit www. SDCMSF.org. Help Spread the Message of Health by Making a Brief Presentation in Your Community: Educate children, adults, seniors, and employees on how to improve their lives and take charge of their health through the Live Well San Diego Speakers Bureau. Email Andrew.Gonzalez@SDCMS. org at the SDCMS Foundation to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.

In three words I can sum up everything I’ve learned about life. It goes on.

february 2016

— Robert Frost, American Poet (1874–1963)

/////////////////////////////////////////////////////////////////////////////////////////////////// History Thumbnails

Dr. Remondino, SDCMS Founding Member By George W. Kaplan, MD

Peter C. Remondino, MD, was one of the founding members and the 10th president of SDCMS. Born in Turin, Italy, in 1846, he immigrated to this country in 1854. The family eventually settled in Wabasha, Minnesota, where he attended the local one-room school. In 1862 he was apprenticed to Francis H. Milligan, MD, and then graduated from Jefferson Medical School in 1865. He served in the U.S. Army during the Civil War, first as a medical cadet and then as an acting assistant surgeon. During this time he developed malaria, which subsequently affected his career decisions. After the war he returned to Wabasha in practice with Dr. Milligan but experienced recurrences of malaria. He then joined the French Army as a surgeon, serving from 1870 to 1871. After a brief tour of medical centers in Europe, he returned to practice with Dr. Milligan in Wabasha. Once again malaria recurred, causing him to seek a better climate, which led him to San Diego to be a rancher. A classmate from medical school, A.J. Gregg, persuaded him to resume the practice of medicine, which he did in 1874, opening an office on 5th Avenue between B and C streets. In 1879 he and Thomas Stockton, MD, established the first private hospital in San Diego, located at Columbia and F Street. He was a prolific writer on topics that included sanitation, longevity, and the effect of climate on health. His The History of Circumcision From the Earliest Times to the Present, published in 1891, sold over a half million copies and was reprinted four times. He was appointed editor of The National Popular Review by Nathan Smith Davis, MD (one of the founders of AMA) and often used that publication to condemn charlatanism, commercialism, and hypocrisy in medicine. He was the first president of the San Diego Board of Health and was county physician for several consecutive terms. He amassed a library of roughly 15,000 volumes of which 3,000 were medical; the library is now part of the Loma Linda University Library collection. He also had a large collection of weapons (over 250) and had planned to produce but never finished a treatise that would illustrate the type of wound produced by each weapon. Two other unfinished projects included a history of medicine, for which he had accumulated two large filing cabinets of notes, and a history of Mary Magdalene, for which he accumulated more than 600 copies of paintings and statues of her. He was entrepreneurial, purchasing the Santa Rosa Hotel (at the corner of 6th Ave. and E Street), adding a $25,000 addition, and renaming it the St. James Hotel. Once the telephone became available in 1881, he was one of its first physician subscribers. A contemporary described him as a scholar and a bibliophile with a remarkable memory. He “upheld the finest traditions of his calling by paying devoted attention to many cases when little or no monetary remuneration for his services could be expected.” He retired from practice in his late 60s, but during the influenza pandemic of 1918 took charge of an improvised hospital in the Mission Brewery near Five Points. He continued his literary efforts until his demise in 1926, two months before his 81st birthday.

BIOETHICS UPDATE More than 32 members of SDCMS’s Bioethics Commission met at SDCMS on Wednesday, January 27. Guests Dr. Lase Ajayi — three-year SDCMS-CMA member — and three others from the Rady Children’s Hospital Pediatric Palliative Care and Scripps Pediatric Hospice teams — Lisa Newby, RN, Ryan Sey, MDiv, and Christine Quilles — led a robust and at times emotional discussion around ethical challenges in pediatric hospice and palliative care, including, for example, how to help families make meaning of what’s happening, how to reframe decision-making from a right or wrong decision to a loving one, whether palliative care will replace ethics consultations, and how best to facilitate some sort of moral understanding of what’s going on. Before the panel discussion took place, takeaways from the Washington and Oregon experiences were shared among the group, including the demographics of those who seek aid in dying in Washington and Oregon, noncompliant and destination patient case debriefings, Dr. Pete Reagan’s experiences as the first doctor to prescribe under Oregon’s Death With Dignity law, whether aid in dying can occur on hospital premises, whether or not whole systems can opt out, and much more. SDCMS’s Bioethics Commission comprises physicians, nurses, pastors, social workers, professors, attorneys, students, and others from across the county who meet quarterly to promote best and innovative practices in bioethics, including clinical, organizational, systems issues, and bioethics committee functions. Our next meeting is on Wednesday, April 27, from 6pm to 8pm at SDCMS’s offices — with dinner available. If you would like more information on how you can get involved, email Kyle Lewis at KLewis@SDCMS.org.

FEATURED MEMBER

Richard Unger, MD, Named New Chief of Staff at Scripps Memorial The physicians at Scripps Memorial Hospital La Jolla have elected anesthesiologist Richard J. Unger, MD, 28-year member of SDCMS-CMA, as the new chief of staff of the 444-bed campus, which includes the Prebys Cardiovascular Institute. Dr. Unger took over as head of the 975-member physician team on January 1, 2016. During his twoyear term, Dr. Unger will serve as medical staff liaison to Scripps La Jolla’s administrative staff and Scripps Health’s board of directors. Congratulations, Dr. Unger! SAN DIEGO PHYSICIAN.org

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TrusT

SDCMS-CMA Membership

Welcome New and Returning SDCMS-CMA Members! NEW MEMBERS Masoud Afshar, MD Nephrology El Centro (760) 353-0404 Ramin Berenji, MD Nephrology El Centro (760) 353-0404 Kristian L. Brown, MD Nephrology San Diego (858) 637-4800

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Kalpana Chalasani, MD Internal Medicine Pediatrics San Diego (858) 499-2770 Matthew V. Cronin, MD Diagnostic Radiology San Diego (866) 558-4320 Sarah R. Daniels, MD Pediatrics Oceanside (760) 547-1010 Adam K. Horeish, MD Nephrology Chula Vista (619) 427-1144 Kim Hui, MD Obstetrics and Gynecology San Diego (619) 688-0770 Shahid Hussain, MD Nephrology El Centro (760) 353-0404

Karin C. Kordas, MD Internal Medicine Escondido (760) 432-6644

Steven E. Gardner, MD Infectious Disease San Diego (858) 616-8099

Horacio A. Rodiles, MD Nephrology El Centro (760) 353-0404

Sarmistha Kumar, DO Physical Medicine and Rehabilitation Vista (760) 806-5890

Kathleen M. Torres, MD Internal Medicine Carlsbad (760) 901-5030 Robert L. Uslander, MD Emergency Medicine Del Mar (858) 925-7554 Eric M-K Yuen, MD Internal Medicine Encinitas (760) 230-2251 RETURNING MEMBERS Mario M. Bialostozky, MD Pediatrics Chula Vista (619) 482-3090 David M. Chang, MD Internal Medicine San Diego (619) 452-7400 Gordon C-J Cheng, MD Pediatrics San Diego (858) 566-4444 Varuna K. Gadiyaram, MD Geriatric Medicine Del Mar (619) 260-7125

Richard H. Lovell, MD Family Medicine Vista (760) 806-5600 Maria P. Murillo, MD, FACOG Obstetrics and Gynecology Oceanside (760) 901-5200 Tammy V-T Pham, MD Obstetrics and Gynecology San Diego (619) 497-2433 Philip A. Sanderson, MD Family Medicine Solana Beach (858) 554-9800 Roxane M. Santiago, MD Pediatrics Chula Vista (619) 426-7910 Ruey-Shiuan T. Tsang, MD Pediatrics San Diego (858) 495-0500 Russell R. Zane, MD Family Medicine Carlsbad (760) 827-7210

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YOUR SDCMS FOUNDATION AT WORK During the 2015–16 flu season, the SDCMS Foundation provided approximately 1,100 free flu immunizations at convenient locations across San Diego County. This initiative is made possible through a partnership with the County of San Diego’s Health and Human Services Agency and agencies hosting our flu shot clinics, including the Mexican Consulate of San Diego, Northgate Gonzalez Markets, Our Lady of Guadalupe Church, St. Mark’s Episcopal Church, Hi-Tech High, and more. Created in 2012, the SDCMS Foundation’s flu immunization initiative targets low-income, uninsured/underinsured San Diego County residents who often lack a medical home, and the program was designed to reach people where they live, work, play, and pray.

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P u b l i c H e a lt h

To learn more, visit www.betheresandiego.org or contact Kitty Bailey, executive director, at k3bailey@ucsd.edu.

Be There San Diego Making San Diego County Heart-attack- and Stroke-free

by Anthony N. DeMaria, MD

Independent practitioners. Public servants. African American pastors. One unprecedented initiative brings these constituencies together to work toward one ambitious goal: Make San Diego County the nation’s first heart-attack- and stroke-free zone in the nation. A group of physicians from private, public, and nonprofit healthcare organizations launched this initiative after deciding to continue and expand an initial pilot project begun in 2009. Although members of competing healthcare organizations, all participating physicians agreed to collaborate to prevent heart attacks and strokes, regardless of affiliation or type of practice. This cooperation represents the best of medicine.

Early on we received generous support from the Judith and Jack White Foundation because they personally have been affected by heart attacks and strokes and believed in our goals. We chose a name for the initiative, Be There San Diego, that would, in a simple and powerful way, communicate our goal: to help at-risk individuals survive and “be there” for the loved ones that mattered in their lives. The Be There San Diego initiative has forged strategic partnerships with three constituencies: patients and communities, healthcare providers, and the healthcare system. In our Heart Attack and Stroke Free Zone Project, patients with significant cardio-

vascular risk factors — such as an ASCVD risk score of 7.5% or greater — are prescribed optimal treatments and paired with health coaches who phone them regularly to see how they are doing as they adjust their diet and lifestyle and take their medications. We recommend a medication bundle that includes an aspirin, thiazide, ACE/ARB, and statin. Research shows that this approach eliminates up to 50% of heart attacks and strokes in the target population. For more information, please view the video on our website at betheresandiego.org/healthproviders-professionals. Funding is from the Centers for Medicare and Medicaid’s Innovation Center, Healthcare Innovation Awards. We also decided that to reach our goal we would need to focus on the community with the highest rates of cardiovascular disease in the county. The Southeastern San Diego Cardiac Disparities Project engages two influential groups serving residents in those low-income neighborhoods: faith organizations and healthcare providers. Working in partnership with the United African American Ministerial Action Council (UAAMAC), we have brought together 15 churches of various denominations to develop and implement individual “HeartHealth” plans to reduce cardiovascular risk factors among their members. The Rev. Gerald Brown, the council’s executive director, sees this partnership as a natural one. “For African Americans, the church has always been the nucleus of the community, starting from the time of slavery all the way to now,” he says. “It’s the place where we went for an education on many subjects.” Since African Americans are disproportionally affected by heart disease, he adds, “How could we not agree to collaborate?” In addition, the project is engaging 40

By the Numbers

Number of seconds between occurances of heart attack in the U.S. 8

february 2016

Number of people that die each year in the U.S. from stroke

130,000

7,555

Number of residents in San Diego County that suffer heart attacks each year

Number of residents in San Diego County that suffer strokes each year

6,725

Percentage of heart attacks and strokes that are preventable

community-based healthcare providers to develop their own plans to reduce cardiovascular risk factors in their patients. The physicians and church members will come together to share their experiences and learn from one another as they pursue their common goal of reducing and managing risk factors. The project is made possible by a Racial and Ethnic Approaches to Community Health (REACH) grant from the CDC. On a professional level, the initiative convenes a monthly University of Best Practices. There, a wide variety of medical, pharmacy, and quality leaders gather to learn about the latest research on such topics as hypertension, diabetes, and ethnic and racial disparities, and how it can be applied in real-world clinical practice. Additionally, the Data for Quality Committee collects and shares aggregate intermediate clinical data, such as blood pressure control rates, that we use to track progress in reaching region-wide targets. Funding for these efforts includes a contract from the County of San Diego. Beyond the participating physicians and organizations, Be There San Diego encourages the entire healthcare community to share in the spirit of the initiative, enhancing their efforts to dramatically reduce risk factors for heart attacks and strokes for all of their patients. Dr. Janet Wright, executive director of Million Hearts, spoke at our annual summit last summer. “From the development of a common hypertension protocol to regular sharing of performance metrics among clinical systems, Be There San Diego is finding innovative ways to reduce the burden of heart disease and stroke for San Diegans,” she said. “Cardiovascular diseases kill nearly 800,000 people in the U.S. each year — that’s one out of every three deaths — so this type of effort is integral and could pave the way for similar progress nationwide.” Dr. DeMaria, 23-year member of SDCMSCMA and chair of Be There San Diego, is the Judith and Jack White Chair in Cardiology and founding director of the Sulpizio Cardiovascular Center at UC San Diego.

10,000

Number of heart attacks and strokes that can be eliminated in San Diego County annually by working together

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L e a d e r s h i p — 2 nd i n a S e r i e s

Wendy M. Buchi, MD by Sherry Nooravi, PsyD

have a very democratic style of leadership at the board level. Sometimes it takes a little longer to get things accomplished, but everyone takes ownership of our decisions, and I believe this method improves our job satisfaction and has allowed us to remain independent and to personalize the style of healthcare we deliver. As far as leading the staff, my philosophy is to lead by example and to make sure that I am always fair. If the staff is not happy with a decision, it’s important that they at least understand that it’s fair. I strive to be sure that everyone realizes they are a valuable member of the team and that I value their input. I believe that happy employees are a huge asset to our practice. We have a low turnover rate and a stable staff. I also have help from the physicians in our practice, and we have a great administrator, Sheila Hendry, who was the SDCMS practice administrator of the year last year.

Dr. Buchi, CEO, IGO Medical Group

The following interview is part two of an eight-part leadership series, with interviews conducted by organizational psychologist Dr. Sherry Nooravi. See the January 2016 issue for an interview with Dr. Paul E. Bernstein, medical director and chief of staff at Kaiser Permanente San Diego.

Dr. Buchi, 22-year member of SDCMSCMA and board-certified in obstetrics and gynecology, is CEO of IGO Medical Group, which has a team of 10 physicians, one nurse practitioner, and 40 client care staff, and provides comprehensive gynecological and obstetric care to women of all ages. Dr. Buchi can be reached at (858) 455-7520 or at wbuchi@gmail.com. Question: What is your leadership philosophy? Answer: The physicians in our practice are all equal owners and want to be involved in decision-making. For this reason, we

february 2016

Question: What should physicians do to prepare for the future of healthcare? Answer: Since we don’t really know what is evolving and because there are so many moving parts, it’s important for us to be open to what’s changing and to be willing to shift if we think we’ve gone down the wrong path. What is most important is that no matter what happens in the future, our primary responsibility is to provide highquality healthcare. Question: What advice do you have for young/incoming physician leaders? Female leaders? Answer: Remember why you went into medicine, and don’t get caught up in any negativity. It’s easy to get discouraged by red tape and politics. You can tailor the way you practice medicine to have a nice work-life balance by exploring your options. There is a perception that you can’t have it all, and that’s probably true, but you can figure out a way to have a lot — to have a rewarding career and time with your family. My advice for female physicians is to set your long-term goals and then look for

a practice setting or model that will help you achieve these goals. There is a way to balance being a good physician, mother, and wife, but you are going to have to make some sacrifices in all three arenas. Everybody has their own personal way of achieving balance. Talk to other women and see how they are doing it. Question: What does organizational culture mean to you, and how do you drive it? Answer: Organizational culture means the values that we have established in our practice that determine how we behave and how we treat each other and our patients. I want everyone in the organization to want to come to work and to know that we value them, their opinions, and their input into the practice. The key is a team approach, and everyone’s voice counts, and we are all in this together. I won’t ask an employee to do something I won’t do myself. I have no problem scrubbing exam tables or spotcleaning the carpet if that is what needs to be done. “There is no ‘they.’ ‘They’ is us.” Question: What has worked for engaging your staff that CEOs and leaders in other industries can learn from? Answer: I am constantly trying to come up with ways to engage the staff, and borrowing ideas from other companies — Google, Pirch, and Apple, for example — that have done it well. We created an employee appreciation day, which has included, among other things, physicians making ice cream sundaes for the staff. We provide and pay for education for the staff; paying for education is always a good thing. There is a program in place where a staff member can recommended that a colleague receive a certificate for a free lunch if she sees that colleague going above and beyond her job

“You can tailor the way you practice medicine to have a nice work-life balance by exploring your options. There is a perception that you can’t have it all, and that’s probably true, but you can figure out a way to have a lot — to have a rewarding career and time with your family.”

description. Every Friday, the staff can wear Padres or Chargers shirts to show their San Diego spirit. We have theme lunches several times a year, which include trivia games and prizes. We put together and sponsored a team of our staff for the SDCMS Foundation’s 5K run for the past two years. I want the staff to know they are part of our team and there is more to the job than just punching the time clock. Dr. Nooravi is an organizational psychologist and CEO of Strategy Meets Performance, a leadership consulting firm that focuses on helping CEOs of fast-growth companies shape engaging, innovative, and customer-driven cultures through executive coaching and senior team facilitation. She has been named “Trailblazer of the Year” for her research on the best practices of CEOs of high-performing organizations. She can be reached at sherry@ strategymeetsperformance.com or at (312) 286-0325.

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Points to Consider 2 1 3 Role-model What You Want Do you lead by example and “walk the talk?” Do you know it’s one of the most motivating actions you can take to engage your teams?

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Learn Resilience What are you doing to prevent burnout and negativity in your fast-paced evolving healthcare system? Have you identified activities that relax and recharge you like spending time with family, hobbies, exercise, meditation, etc.? Do you have a plan to regularly engage these activities?

I Hear You Do you seek input from your staff so they have a sense of ownership and participation in your practice?

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May 13 - 15, 2016

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Physicians, nurses, medical practice managers and all other health care industry professionals—Join us in the heart of San Francisco to prepare for changes affecting your profession, your practice and your economic future.

Health care power players will share strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. Speakers include Dr. Atul Gawande, distinguished surgeon, teacher and writer – named one of TIME magazine’s 100 most influential thinkers; Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush; and Donna Brazile, Al Gore campaign manager and Democratic National Committee Vice Chair.

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february 2016

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

There’s an App for That Benefits and Risks of Using Mobile Apps for Healthcare

by Robin Diamond, MSN, JD, RN

With more than 100,000 mobile health apps now available — in addition to many new tools that allow physicians to remotely monitor their patients’ conditions — physicians now have to handle an increasing amount of constant data and patient information that they did not have in the past. Mobile apps offer many potential benefits to doctors and patients: • Mobile apps can help patients selfmonitor their conditions and can alert them and their physicians to problems before they become serious medical issues.

• Mobile apps help patients remember important information about their healthcare. • Mobile apps can engage patients in their healthcare. But not all of the apps currently on the market are approved or regulated by the FDA, and the use of mobile apps does not come without liability risks. Physicians could face allegations of failing to educate the patient/family about the risks and limitations of the app or failing to act appropriately if the app goes offline or malfunctions. Injuries could occur if:

• The physician receives information from a mobile app and does not act on this information. Physicians have a legal duty to review real-time data direct from the patient and respond. Mobile apps raise a patient’s expectations of how a physician will act — the patient/ family expect that the patient is being monitored 24/7 and that the physician will respond “within a moment’s notice.” • The readings received from a mobile device are wrong and treatment is prescribed based on the wrong data. Consider limiting your patients to one mobile app that you agree to monitor. This will make it easier to control the incoming data and help make the best use of the app. Other important considerations include: • Consider whether the two-way communication between you and your patient is secure and, therefore, HIPAA/ HITECH-compliant. Ask the vendor for assurance that the app is HIPAAcompliant and that data is encrypted for security. • Know the app: °° Vendor information, such as updates, downtime, and critical value alerts. °° How will it interface with your EHR? °° Is the device regulated by the FDA as a medical device? °° Will you get alerts by email or a phone call from the vendor when the app isn’t working? • Clearly communicate and educate the patient/family about the purpose of the app and how and when the data is transmitted to the clinician. • Avoid assuring the patient that the app will “take care of everything.” Educate the patient/family about the limitations of the app, with specific examples of instructions for the patient to follow. • Identify a contact person within your organization to troubleshoot and be available to address technical problems. • Have the patient/family sign a consent form that describes the risks, benefits, and purpose of the app. • Do not do this alone! Avoid utilizing medical apps without support from your organization. Ms. Diamond is senior vice president for patient safety and risk management for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety. SAN DIEGO PHYSICIAN.org

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c o m p l i a n c e p r o g r a m s — 9 th i n a s e r i e s

Putting It All Together Creating a Functioning, Effective Compliance Program

by Heidi Kocher, Esq.

february 2016

We have now spent the better part of a year discussing various elements and aspects of a solid compliance program. To refresh your memories, we reviewed the outline of a basic compliance program (May 2015), discussed the importance of selecting a compliance officer (June 2015), reviewed recommended basic policies and procedures (July 2015), deliberated on the importance of exclusions/sanctions screenings (August 2015) and how to perform sanctions screening (September 2015), reviewed certain types of audits to implement in your practice (October 2015), and debated the merits of a hotline (last month). If you focused on each month’s topic and implemented it in your practice, you now have the bones of a solid, functioning compliance program in place. But why worry so much about a compliance program? Well, for one, the Department of Justice (DOJ) this past fall issued “the Yates memo” (www.justice.gov/dag/ file/769036/download), named after its author, Sally Quillian Yates, the No. 2 attorney at the DOJ. In this memo, the DOJ tweaks its different approach to individual responsibility for corporate wrongdoing. While charging individuals for crimes committed by their corporations has always been part of the DOJ’s arsenal, the DOJ now argues it needs to do more to bring individual malfeasors to justice. And while the DOJ will take into account the existence of a corporate compliance program, the Yates memo states that in order for a company to receive any credit for cooperation or having a compliance program, the corporation must provide all relevant facts about an individual’s participation in potentially problematic conduct to the government. (In fact, this step has some commentators fearing it will be the end of the attorney-client

A strong corporate compliance program is one that has shown strong, consistent support from management, one that communicates the company’s expectations. • privilege.) The DOJ clarifies that this means identifying all individuals involved, regardless of their position, status, or seniority. A strong corporate compliance program is one that has shown strong, consistent support from management, one that communicates the company’s expectations. If practice leadership has been consistent in its support of the compliance program, then there should not be any concerns about disclosing a person’s involvement in a particular matter. Furthermore, part of that management support should be support for conducting a thorough investigation, one that would lead to discovery of all relevant facts about any given individual’s participation. If there are individuals who have participated in misdeeds, then a thorough investigation will help reveal all of the details. Thus, a strong compliance program transforms from being a means of protecting the practice to becoming a major tool in protecting the practice leaders themselves! In addition to the Yates memo, the DOJ has hired a compliance counsel, who is an experienced compliance officer. Ms. Chen, the new compliance counsel, was specifically hired to provide expert advice and knowledge in the compliance program of a company that is under scrutiny. In a recent presentation, Ms. Chen said that she will focus on four questions in evaluating a compliance program: 1. How thoughtful was the design of the compliance program? 2. How operational is the compliance program? 3. How well do your stakeholders communicate? 4. Is the compliance program well resourced? These are excellent summary questions, and these questions or variations thereon should be utilized to evaluate your compliance program. So, let us explore these questions. 1. How thoughtful was the design of the compliance program? In other words, does your compliance program acknowledge and address the specific risks to your industry and company. For example, if your practice accepts Medicare, does your audit program

specifically look at Medicare medical necessity guidelines? Make sure that your compliance program specifically addresses the particular risks for your practice. 2. How operational is the compliance program? In other words, does it exist only on paper? Or are there specific activities that occur as part of the daily practice? One easy way to test this out is to ask lower-level staff open-ended questions about the compliance program. All employees should be able to identify specific compliance activities. 3. How well do your stakeholders communicate? Ask not just whether management sends out consistent messages in support of compliance. Different areas or departments should be ready, willing, and able to reach out to and support other departments in achieving their compliance goals. 4. Is the compliance program well resourced? Ms. Chen was clear that a well-resourced program does not necessarily mean a program that has significant financial resources. Indeed, a well-resourced program might not spend a single new penny on compliance. Rather, the question looks to see if management has correctly empowered the compliance personnel. Or is it a set of principles that are observed more when something goes wrong, as opposed to being an intrinsic part of how people operate? Thus, utilizing Ms. Chen’s four questions to evaluate your practice’s compliance program is a significant step to developing real protection for the individuals in your practice. Finally, in announcing Ms. Chen’s hiring to a group of compliance professionals, Assistant Attorney General Leslie Caldwell has echoed Ms. Chen’s questions in another recent speech. • Does the company ensure that its directors and senior managers provide strong, explicit, and visible support for its corporate compliance policies? • Do the people who are responsible for compliance have stature within the company? Do compliance teams

•

get adequate funding and access to necessary resources? (Ms. Caldwell did state that she does not expect a small company will have the same amount of resources for compliance as a very large corporation.) Are the company’s compliance policies clear and in writing? Are they easily understood by employees? Are the policies translated into languages spoken by the company’s employees? Does the company ensure that its compliance policies are effectively communicated to all employees? Are its written policies easy for employees to find? Do employees have repeated trainings, which should include direction regarding what to do or with whom to consult when issues arise? Does the company review its policies and practices to keep them up to date with evolving risks and circumstances? Are there mechanisms to enforce compliance policies? Do they include both incentivizing good compliance and disciplining violations? Is discipline evenhanded? °° AAG Caldwell added that the DOJ does not look favorably on situations in which low-level employees who may have engaged in misconduct are terminated, but the more senior people who either directed or deliberately turned a blind eye to the conduct suffer no consequences, because such action sends the wrong message — to other employees, to the market, and to the government — about the company’s commitment to compliance. Does the company sensitize third parties like vendors, agents, or consultants to the company’s expectation that its partners are also serious about compliance?

Ms. Kocher is counsel with the law firm of Liles Parker, which has hosted SDCMS’s Certified Medical Compliance Officer (CMCO) certification course. In addition to serving as a chief compliance officer and chief privacy officer, Ms. Kocher has nearly 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 at (214) 952-5169. SAN DIEGO PHYSICIAN.org

CMA

CMA’s Federal Priorities for

Regulatory • Implementation of the CMAsponsored California Medicare Geographic Payment Locality Reforms — aka, the California GPCI Fix • Implementation of the MACRA Medicare Payment Reform Law • Achieving Additional Reforms to the Meaningful Use Program and the Physician Quality Reporting System (PQRS) • Changing a Department of Education Regulation to Al-

low Non-employed California Physicians to Be Eligible for a Student Loan Forgiveness Program That Began in 2008

Sponsored Legislation Because 2016 is a presidential and congressional election year, Congress is not expected to have a productive year. CMA-sponsored legislation includes: • Meaningful Use Reform: °° proportional credit for measures met °° expanded hardship

by Elizabeth McNeil, Vice President, Federal Government Relations, California Medical Association

february 2016

exemptions, particularly for physicians near retirement °° vendor interoperability accountability • Medicare RAC Audit Reform: °° more transparency and physician education of billing mistakes °° advance notice of an audit °° payment for documentation requests °° penalties on auditors for inaccurate findings °° recoupment not allowed until the appeals process is final • Palliative Care Medical Home Pilot Projects: °° end-of-life palliative care medical home pilots that employ a multidisciplinary team-based approach to caring for Medicare patients in multiple settings 1–2 years from end-of-life

Supported Legislation • GME: Expanding Funding Residency Positions • Protecting Medi-Cal Funding • Opioid Abuse Prevention and Treatment; Funding for State Monitoring Programs • Expanding the Number of J-1 VISA Waiver Physicians in California • Telemedicine: Protecting State Licensure

SAN DIEGO PHYSICIAN.org

CMA

Congress Wraps Up

a tumultuous Yet Productive 2015 O

Passage of Bipartisan Medicare Payment Reform Legislation and a Bipartisan Budget Deal Coincide with Major Leadership Changes

n the last day of the congressional session, Congress passed major legislation to fund government programs through Sept. 30, 2016 — right before the presidential election — and exempt physicians from the 2015 EHR Meaningful Use Stage 2 penalties. CMA-AMA won several important victories in the year-end legislation.

Meaningful Use An hour after Congress adopted the $1.1 trillion omnibus spending package, Senate and House leaders worked frantically to hold their members in Washington, DC, to pass a last-minute Medicare bill for physicians. The bill allows CMS to grant a blanket exemption to all eligible doctors from the 2015 Meaningful Use (MU) Stage 2 requirements. Most physicians would not have met the 2015 MU requirements because CMS issued the Stage 2 regulations too late in the year for physicians to report for the full 90 days. While physicians must still apply for an

exemption, the bill fast-tracks and simplifies the process to allow CMS to automatically provide the exemptions, rather than doing it on a case-by-case basis. This action prevents physicians from receiving a 2% MU penalty for 2015. CMA worked with AMA the last few weeks of the session to get an exemption. CMA extended its deep appreciation to Congressman Tom Price, MD (R-GA) for introducing the bill, and to Majority Leader Kevin McCarthy (R-CA) and Minority Leader Nancy Pelosi (D-CA) for their work to achieve a bipartisan agreement and for keeping the House in session long enough to pass the bill on unanimous consent.

IPAB, RAC, and Planned Parenthood In the omnibus package, Medicine also won a provision to defund the CMA-opposed Medicare Independent Payment Advisory Board (IPAB) that was created in the ACA yet never implemented. We successfully fought off efforts to defund

by Elizabeth McNeil, Vice President, Federal Government Relations, California Medical Association

february 2016

Planned Parenthood and reduce physician Medicare payments. And finally, Congress adopted a CMA-supported mandate for CMS to reform the Medicare RAC audit program that has unfairly treated physicians for years.

Omnibus Spending and Tax Legislation During the week of Dec. 14, Congress passed two sweeping legislative packages before they adjourned for the holidays. The president signed the legislation into law. One package is a $1.1 trillion omnibus appropriations spending bill that will fund federal programs through Sept. 30, 2016. The other is a $650 billion tax package. The package of bills includes delays to the Affordable Care Act funding sources, including a two-year delay for the medical device tax, a two-year delay for the “Cadillac tax” on health plans offering rich health benefits, and a one-year delay in the health insurance tax for 2017. There was also a strict mandate for CMS to reform the Medicare RAC audit program that has plagued physician practices for years. CMA, AMA, and many of the state medical associations worked aggressively to achieve this audit package. It requires CMS to provide more

transparency and consistency, to address the backlog of appeals, to provide more education to physicians on billing mistakes, and to more aggressively review contractor audit practices, including the bounty-hunterbased system. It also mandates CMS to report back to Congress on its findings and activities. Finally, there is substantial new funding for efforts to combat antibiotic resistance, to address opioid abuse and treatment, to expand mental health services, and fight chronic diseases. The annual ban on using CDC funding for gun violence epidemiological research was extended.

Leadership Elections Last fall, after failing to unite the Republican Caucus, Congressman John Boehner (R-Ohio) stepped down as the Speaker of the House. Unfortunately, his heir apparent, California Congressman Kevin McCarthy, pulled out of the race for Speaker but will remain the Majority Leader. After substantial infighting, newly bearded Congressman Paul Ryan (R-Wisconsin) was finally elected Speaker. His tenure so far has been fairly smooth. He is credited with the successful passage of a massive omnibus appropriations package and a tax bill. Speaker John Boehner helped pave the way with the passage of several major bills, including the debt ceiling bill, prior to his departure. Ryan’s main job in 2016 will be to keep his caucus together and to avoid the public infighting and intransience that could harm the outcome of the 2016 elections. California Congresswoman Nancy Pelosi will continue in her position as the House Minority Leader and the powerful head of the Democratic Caucus.

2015 Medicare Meaningful Use Hardship Exception Applications

Now Available Applying for a Meaningful Use Exception Because of a delay in the publication of regulations governing the Medicare meaningful use program, CMS is allowing eligible physicians and hospitals to apply for an exception under the “extreme and uncontrollable circumstances” category. Physicians are urged to preemptively file for a 2015 hardship exception to avoid penalties in 2016. Physicians are encouraged to apply even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. CMA will continue to monitor this situation.

Action Physicians who wish to apply for an exception under the “extreme and uncontrollable circumstances” category need to do the following: 1. Download an Application From the CMS Website (www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/paymentadj_hardship.html) 2. Complete the Application and Check Box 2.2.d in Order to Avoid a Penalty Under the Meaningful Use Program 3. Submit the Application The Deadlines for Submitting Applications for Hardship Exceptions Are: • For Eligible Physicians: March 15, 2016 • For Eligible Hospitals: April 1, 2016

Background New rules released in 2015 stated that eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. However, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until Oct. 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.

For More Information For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, “EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015” (www.cmanet.org/files/assets/news/2015/12/12-215-tips-for-2015needtoknowep.PDF).

SAN DIEGO PHYSICIAN.org

CMA

MACRA Meaningful Use and ICD-10

End-of-the-Year Advocacy

MACRA The highlight of 2015 for CMA physicians was the monumental bipartisan passage of HR 2, “The Medicare Access and Children’s Health Insurance Reauthorization Act” — known as MACRA — which will begin in 2019. MACRA repealed the Medicare Sustainable Growth Rate (SGR) formula and established new payment pathways for physicians. The first payment pathway, a fee-for-service system, restores annual payment updates and reinstitutes 9–20% potential payment bonuses for the three reporting programs: PQRS, Meaningful Use, and the Value Modifier, which are slated to be consolidated and simplified. The second payment pathway includes alternative payment models (APMs) to be developed by physicians. APMs will pay physicians 5%

annual bonuses but will require some downside financial risk. And finally, MACRA provides millions in direct funding assistance to help physicians transition to new payment models or participate in the fee-for-service quality reporting programs. In October 2015, the Centers for Medicare and Medicaid Services (CMS) sent out a Request for Information (RFI) on the implementation of MACRA. CMA is participating in the AMA MACRA Task Force with the other major national specialty societies and state medical associations. CMA and the MACRA Task Force

CMA and all of organized medicine will be pushing CMS to delay Stage 3 and to adopt further reforms for Stage 2.

by Elizabeth McNeil, Vice President, Federal Government Relations, California Medical Association

february 2016

responded to the RFI (email Editor@SDCMS.org to read those comments). CMA will continue to work with the AMA MACRA Task Force to help organizations share information and resources and remain unified in our advocacy before CMS. Many of the large national specialty societies — ACS, ACP, AAFP, Oncology — have begun development of their own specialty-specific models, which CMA will share more widely with physicians once they can be officially released. CMA will be extremely active in the implementation of the new payment systems to help

physicians best position their practices for MACRA. Please see the CMA Strategic Plan for a more detailed description of CMA’s proposed MACRA advocacy activities for 2016 (email Editor@SDCMS.org).

Meaningful Use At CMA’s and AMA’s urging, CMS issued regulations to partially fix Meaningful Use Stage 2: CMS reduced the number of measures, reduced the reporting timeline from one year to 90 days, and will only require one patient to use a physician’s patient portal. While these reforms are

important, CMA and all of organized medicine will be pushing CMS to delay Stage 3 and to adopt further reforms for Stage 2. Email Editor@SDCMS.org to read several joint AMA-CMA letters to CMS and Congress.

ICD-10 And finally, at CMA’s and AMA’s urging, CMS adopted a grace period for the transition to ICD-10 coding; fortunately, since the Oct. 1, 2015 start date, very few physicians have experienced problems. In fact, CMS reports a 98% success rate in California.

The first payment pathway, a fee-forservice system, restores annual payment updates and reinstitutes 9–20% potential payment bonuses for the three reporting programs.

PHYSICIANS NEEDED FOR GROWING TELEHEALTH MEDICAL GROUP! We are an established multidisciplinary medical group looking for additional physicians to join our team, especially telepsychiatrists! Telemedicine can fit into your schedule whether you have a busy practice or you’re just starting out. You decide the number of days/hours you want, and whether you work from the office or home. To learn more, contact us at 661-840-9270 or send your CV to jobs@telehealthdocs.com.

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SAN DIEGO PHYSICIAN.org

Thank You to the 65+ Physicians Who Attended SDCMSâ&#x20AC;&#x2122;s Feb. 4 Physician Networking Opportunity and Mixer! SDCMS would like to extend a heartfelt thank you to all the physicians and guests who attended our February 4 Physician Networking Opportunity and Mixer at the Handlery Hotel in Mission Valley â&#x20AC;&#x201D; a good time was had by all!

february 2016

OR VISIT WWW.THEDOCTORS.CO We would also like to thank the following vendors who made this event possible:

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Congratulations to long-time SDCMS-CMA member Joseph Leonard, MD, who won the grand prize giveaway of a one-night stay for two at the Lodge at Torrey Pines, along with dinner for two at A.R. Valentien — provided by The Doctors Company.

Save the Dates for Our Future SDCMS Physician Socials!

Tuesday, April 26 • Friday, August 5 • Friday, November 4

SAN DIEGO PHYSICIAN.org

classifieds PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE FOR SALE: Established for many years. Ideally located on busy street near Alvarado Hospital and SDSU. Ideal for internists, family physicians, or other medical specialists. No agents, only for seriously interested parties. Please forward your specialty, name, and phone number to csmred2014@gmail. com. [454]

FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN: La Jolla Village Family Medical Group, located in San Diego near the UCSD campus, has been caring for patients of all ages for 27 years, providing comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence-based chiropractic care, and weight management. We are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. Call responsibilities relatively minor. Hours consistent with healthy work-life balance. This is a real family practice. Board-certified MD and DO physicians interested should contact Tricia/send CV to triciaberkoff@gmail.com. [445]

SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multispecialty group in San Diego, is seeking full-time BC/BE emergency medicine physicians to join our urgent care staff. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp.com. [459]

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, and on-call pager one week every three weeks, telephone call only. No rounds or hospital duties. If interested, please email 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. [435]

SEEKING FAMILY MEDICINE PHYSICIANS: SHARP ReesStealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE family medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp.com. [458]

seeking full-time BC/BE Occupational Medicine physicians: Sharp Rees-Stealy Medical Group — a 500+ physician multi-specialty group in San Diego — is seeking fulltime BC/BE occupational 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. [441]

SEEKING INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE internal medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp.com. [457]

seekING experienced, highly motivated family physician: Federally qualified health center (FQHC) clinic site in Linda Vista seeks an experienced, highly motivated family or internal medicine physician with a vision for the future of community medicine. San Diego Family Care operates seven clinic sites in San Diego to serve the primary care needs of our diverse communities. PCMH model operational and EHR system in place. NCQA recognized. Visit our website at sdfamilycare.org. Must have CA license. Competitive salary/benefits with retirement match. Looking for a special doctor, committed to our mission! Send CV to Arthur “Tony” Blain, MD, MBA, FAAFP, Medical Director, at aablain@lvhcc. com or call (858) 248-1509. [440]

PHYSICIAN POSITIONS AVAILABLE

PHYSICIANS: RETIRED WITH LICENSE? Alternative care office in North San Diego and South Orange County 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. [455] UC SAN DIEGO, DEPARTMENT OF PEDIATRICS, AND RADY CHILDREN’S HOSPITAL-SAN DIEGO is seeking clinicians to provide patient care at the Urgent Care Clinics of the Division of Emergency Medicine. Clinicians should be board-certified pediatricians with a minimum of two years’ experience in general pediatrics/urgent care. RCHSD, a level 1 Trauma Center, is the major regional primary and tertiary pediatric hospital, and is the clinical home of UCSD Department of Pediatrics. The Division has a strong commitment to clinical care, teaching, and research. Interested persons should contact Dr. Katherine Konzen, Director, Pediatric Urgent Care, at kkonzen@rchsd.org. [451] Seeking full-time Pediatrician: Busy pediatrics private office in El Centro — approximately two hours east of San Diego. Seeking a highly motivated pediatrician to join our staff. Great salary package. Please send CV to juliekapoorpediatrics@yahoo.com. [450] Family Physician needed at north San Diego county Urgent Care office: Day, night, and weekend hours available. We have a friendly, helpful staff at our busy office. You will see a variety of patients in a family practice setting. There is no call. Please email your CV to gcwakeman@sbcglobal.net or fax your CV to (760) 603-7719. [448] Looking for Psychiatrist: Indian Health Council (IHC) is looking for a psychiatrist. IHC, a Native American healthcare facility located in North San Diego County, provides a full spectrum of onsite and outreach services and programs. The incumbent must hold a current California license and be board-eligible. Two days per week. Rate: $210–$240 per hour. Excellent benefits package and work environment. For consideration, please visit our website at indianhealth.com. Email résumé to dfreeman@indianhealth.com. [447]

Internal Medicine or Family Practice Physician to provide quality patient care for a full-time practice. The physician will provide outpatient evaluation, diagnosis, and treatment while representing the highest standards for clinical capability, professional education, quality improvement, and overall patient care. The incumbent must hold a current California license and be board certified or board eligible. Located in Liberty Station in Point Loma, we are a fast-paced, primary care clinic that uses Allscripts. Please email CV to erica.christensen@smartcaremd.com. [438] FAMILY OR INTERNAL MEDICINE PHYSICIAN: Graybill Medical is one of the region’s largest independent, multispecialty groups. We are currently looking for a general family medicine physician (Escondido or Temecula) and an internal medicine physician (Temecula) to provide quality patient care to all ages of patients in a full-time, traditional practice. Conduct medical diagnosis and treatment of patients, including surgical assist, flexible sigmoidoscopy, and basic dermatology. The incumbents must hold a current California license and be board-eligible; bilingual Spanish/English preferred. Check out a full list of our benefits at www.graybill. org. Send CVs to humanresources@graybill.org, apply online, or fax to (760) 738-7101. [436/437] PSYCHIATRISTS NEEDED: Full-time or part-time positions available for a well-managed program at San Diego County correctional facilities. Telepsychiatry position also available. Flexible hours with very competitive pay. Send CV to steve@ cpmedgroup.com or call (619) 885-3907. [272] Interested in becoming a preceptor for osteopathic medical students? Midwestern / AZCOM osteopathic medical school in Phoenix has third- and fourthyear medical students in San Diego looking for clinical rotations, particularly in pediatrics, psychiatry, general surgery,

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.

february 2016

and OB/GYN. Requirements: Either MD or DO; physicians interested must commit to minimum one four-week rotation per year / or more as desired (2–3 preferable) and to FT hands-on training for each student as is reasonable for the duration of the rotation. Compensation and CME provided. If interested, please contact Dr. Kevin Considine at kconsidine@sbcglobal.net for more information. [408] 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 SCRIPPS RANCH / MIRA MESA MEDICAL OFFICES: Newly remodeled medical office building located off of busy I-15 and Mira Mesa Blvd. at 9878 Hibert Street. 1,879 usable square feet of shell space, build to suit. High visibility location within a Trader Joe’s and multiple restaurant complex. Please call (858) 220-1628. 2,242 rentable square feet in a Class A medical office building located off of I-15 and Scripps Poway Pkwy. Office space was built out in 2008. Plenty of free parking for patients and easy accessibility to the freeway. Other medical specialties, dentists, and Sharp (including lab) also located in the building. The building is full and this is the only suite available for lease. Please call (858) 220-1628. [460] Medical Office Space for Sublease Within 4,000ft2 Established Family Practice in UTC / La Jolla Area: Ideal location between I-5 and I-805. Only a few blocks from UCSD and Scripps. Spacious ground floor space with ample parking within a professional medical complex. Up to two modern, private exam / treatment rooms available, nurses station, shared or own receptionist. Clean, contemporary design, ADA compliant, built-in laboratory. Excellent, in-house referral base from four busy and respected practitioners. Ideal for OB/GYN, dermatology, aesthetic medicine, neurology, ENT, or other complimentary specialty. Please email thbdesigninc@gmail.com or call (858) 9995153. [453] $3,500 / 1,701FT2 MEDICAL OFFICE Fully built out: First floor with extensive window line. Two entrances. Excellent highway access. Option for aesthetic practice acquisition available. Easy patient / client parking. 5330 Carroll Canyon Rd. Contact Margaret O’Byrne, MD, at mobyrne61@gmail.com, (619) 218-8980 (mobile), or (858) 481-4888 (office). [444] Psychiatric Office to Share/Sublet: Ideal location and opportunity for early career or established psychiatrist seeking a furnished, well-maintained, UTC/La Jolla, class-A office at Regents/LJ Village Drive, close to UCSD/VA and Scripps. Plenty of sunlight streams into this third-floor office with waiting room, underground parking, and contemporary art and furnishings. Costs negotiable and could include receptionist services. Most important factor is personal and professional compatibility. Interested? Please email me at karl@karljacobsmd.com. [439] Campus of Scripps Encinitas: One-half of 1,800ft2 office to share in nicest building (320). Available March 1, possibly earlier. Ob-gyn primary, but excellent for aesthetic physician / surgical specialty as it is abutting surgical center. Valet parking, imaging center, perinatology here. Vaginal laser and SculpSure laser presently being used. 220 volt available. Ultra hs Cox internet. New three-year lease with Scripps planned. Call Kristi at (760) 753-8413 for more info. [433] 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) 3200525 and ask for the secretary, Sandy. [127] 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 SEEKING NURSE PRACTITIONER: Internal medicine, part-time position available. Seeking nurse practitioner with primary care and EHR experience. Private practice located in beautiful North San Diego County, single specialty group, collegial work environment. Please contact (619) 248-2324 or email resume to portofino3@aol.com. [456] Physician Assistant / Nurse Practitioner (Bankers Hill): An opportunity for a physician assistant / nurse practitioner in pain management under the direction of the physician supervisor. 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. Provide leadership, direction, and coordination of all clinical activities involving professional medical judgment. Work closely with staff to ensure comprehensive quality patient care. This is a full-time position, Monday–Friday, with competitive salary, sign-on bonus, retention bonus, and vacation package bonus after one year. Please submit CV with cover letter to claudiaee50@yahoo.com. [452] Physician Assistant / Nurse Practitioner NEEDED: Busy family medicine office is in need of a physician assistant / nurse practitioner to provide medical treatment and services customary to primary care medicine, including evaluation and treatment of new patients and revisits, performing physical examinations, diagnosing conditions, developing treatment plans, and providing health counseling, while maintaining patient confidentiality. Multi-generational, solo practice. Several years of experience preferred but not necessary. Graduate of accredited program with valid California State-issued certificate. DEA license eligible. Please respond with resume to p.fortuna@efpmg.com. [449]

MEDICAL EQUIPMENT / FURNITURE FOR SALE Clearwave Office Waiting Room Check-In Kiosk With TableTop Stand: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. Liberty Tabletop Kiosk with 17-inch, built-in, all-in-one touchscreen computer with privacy filter. Intel Celeron Dual Core, E1500, 202 GHz processor, 2GB RAM, 160GB hard-drive, ID Tech swipe magnetic credit card reader mounted on right side of the screen. Copays and accounts receivable payable upon check-in. Windows 7 OS, LogMeIn Pro2, IE 9, and McAfee. eClinicalWorks kiosk software included. Original cost new $5,199. Sell for only $2,499. Email KLewis@SDCMS.org. [443] Executive desk for sale: Solid wood • no particle board • weight testimony to solid wood • three spacious file drawers • three regular drawers • 6x3x3ft. • custommade glass cover • $500.00. Call (619) 585-0476. [442] Legal Services Offered

PSYCHIATRIC NURSE PRACTITIONER NEEDED: For part-time or full-time work at San Diego County correctional facilities. Flexible hours and very competitive pay. Send CV to steve@cpmedgroup.com or call (619) 8853907. [273]

Medical Board and Hospital Peer Review Legal Representation Legal representation before Medical Board of CA; Medical staff privileges issues & peer review investigations, proceedings, and appeals. Harvard/Cornell Law School.

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]

Law Offices of David Young, Esq. 310.575.0308 dyounglaw@verizon.net

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Tracy Zweig Associates

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

REGISTRY

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Locum Tenens Permanent Placement V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

t z we i g @ t r a c y z we i g . c o m www. t r a c y z we i g . c o m

SAN DIEGO PHYSICIAN.org

PHYSICIANS:

HELP CMA PASS THE 2016 CIGARETTE TAX INITIATIVE CMA is collecting signatures to qualify an initiative for the November 8, 2016, ballot. The initiative — also known as the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 — will increase California’s cigarette tax from its current $0.87 per pack (one of the lowest in the nation) by $2.00.

WHAT WE’RE ASKING:

1 2 3

Email your name and physical mailing address to SDCMS@SDCMS.org — SDCMS will mail you a petition with a return prepaid envelope. Collect the signatures of eight registered San Diego County voters. Mail your completed petition back to SDCMS in the return prepaid envelope by March 31, 2016.

The initiative will help to reduce smoking, save lives, and fund critical healthcare programs in California. For more information, visit SaveLivesCalifornia.com or call SDCMS at (858) 565-8888.

www.SaveLivesCalifornia.com

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PAID DENVER, CO PERMIT NO. 5377

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