October 2018

OCTOBER 2018 OFFICIAL PUBLICATION OF SDCMS

A Tumultuous Year in California Medicine San Diego’s Own Dr. Ted Mazer Reflects on His Year as CMA President

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OCTOBER

CONTENTS

VOLUME 105, NUMBER 10

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Jamie M. Jordan, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD

features

18

10

A Tumultuous Year In California Medicine: San Diego’s Own Dr. Ted Mazer Reflects on His Year as CMA President

departments 4 Briefly Noted • Calendar • Payer Issues and Reimbursement • Drug Prescribing/Dispensing • Commercial Payers

6 Medical Staff Prevails in Legal Battle Over Medical Staff Self-Governance

BY TINA TEDESCO

10 Cybersecurity Insurance for Medical Practices

BY DAVID J. EISMONT

12 Health Net Federal Services Continues to Address TRICARE Transition Issues

BY CMA STAFF

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OCTOBER 2018

13 Your Champions Against the Flu

BY ADAMA DYONIZIAK

14 Making a Difference: Sharp’s Dr. Andres Smith Leads the Tijuana Red Cross to the Next Level

BY SDCMS STAFF

AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

26 Physician Classified Marketplace

28 Key Votes for Doctors: The Dangers of Prop. 8 and the Surprising Importance of the Lt. Governor’s Race

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org.

All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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3

/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// PAYER ISSUES AND REIMBURSEMENT

CMA and AMA Oppose CMS Proposal to Collapse E/M Codes CALENDAR

OCT 11–12: CSU Institute for Palliative Care National Symposium. At Hyatt Mission Bay. OCT 12–14: UCSD School of Medicine Marks Its 50th Anniversary With Alumni Reunion Weekend.

OCT 19: Top Doctors Gala at Farmer & the Seahorse.

OCT 25: SDCMS Physician Networking Opportunity and Social Mixer, 5:30–8 p.m., Rock Bottom Brewery in La Jolla.

NOV 2: Shriners Western Regional Burn Conference.

Shriners Hospital in Sacramento. CME Credit Approved.

NOV 8–10: Cardiovascular, Allergy & Respiratory Summit (CARPS) at Wyndham San Diego Bayside. Optional workshops Nov. 7.

NOV 9: Women in Medicine 2018 Conference at Hotel Irvine, Irvine, Calif.

NOV 10: Champions for Health Annual 5K Solana Beach Walk/Run NOV 16–17: Pain Care for Primary Care (PCPC) with Dr. Bazzo at Wyndham San Diego Bayside.

Optional Addiction workshop Nov. 15.

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OCTOBER 2018

MORE THAN 150 healthcare organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer.

CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several of the documentation policy changes included in the proposed rule would go a long way toward alleviating this problem and we have urged their immediate adoption, including: • changing the required documentation of the patient’s history to focus only on the interval history since the previous visit; • eliminating the requirement for physicians to re-document information that has already been documented in the patient’s record by practice staff or by the patient; and • removing the need to justify providing a home visit instead of an office visit.

Implementation of these policies will streamline documentation requirements, reduce note bloat, improve workflow, and contribute to a better environment for healthcare professionals and their Medicare patients.

However, CMS’s proposal would also modify E/M services through collapsing codes and payment levels. AMA looked at the specific impact on separately reported office visits and summarized the specific E/M impact by specialty. There is a net national reduction given the current

distribution of E/M codes of close to 4%, with some specialties seeing reductions of up to 20%.

CMA and AMA believe there are a number of unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule. We oppose the implementation of this proposal because it could hurt physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care — ultimately jeopardizing patients’ access to care.

The letter also urges that the new multiple service payment reduction policy in the proposed rule not be adopted, as the issue of multiple services on the same day of service was factored into prior valuations of the affected codes.

Positive elements in the CMS proposal include: • New payments for physician services that are not part of a face-to-face office visit (virtual check-ins, remote consults of patient videos and photographs, and online consultations with other physicians).

• Continuation and expansion of the low-volume threshold exception policy to exempt small practices from the Merit-Based Incentive Payment System, but only on a voluntary basis for those who want to participate.

• A reduction in problematic measures in the Promoting Interoperability provisions (formerly Meaningful Use and Advancing Care Information).

• CMA-sponsored geographic payment updates for California physicians.

CMA and AMA have already submitted comprehensive comments on these issues.

////////////////////////////////////////////////////////////////////////////////////////////////// DRUG PRESCRIBING/DISPENSING

CURES Webinar With DOJ Now Available for On-Demand Viewing EFFECTIVE OCT. 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) — prior to prescribing Schedule II, III, or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish, or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. The California Medical Association recently co-hosted a live CURES webinar with the California Department of Justice and the Medical Board of California regarding this new duty-to-consult requirement. The webinar provides an overview of the new mandate and the requirements imposed by the law when checking CURES. It also includes an overview of the registration process and key features of the CURES database.

The webinar is now available for on-demand viewing — free to all interested parties.

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Health Net reports it has resolved all issues related to the misprinted EOPs, except in instances where the enrollee’s cost share may not be correctly displaying a figure that includes any coinsurance amount. Health Net advises that a fix for the cost share problem was implemented on Aug. 31.

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M E D I C A L S TA F F S E L F - G OV E R N A N C E

Medical Staff Prevails in Legal Battle Over Medical Staff Self-Governance

By Tina Tedesco

TULARE, CALIFORNIA is a small town in the Central Valley best known as the milkproducing capital of America. More than half of its 60,000 residents are enrolled in MediCal and served by a small, 108-bed healthcare district hospital — Tulare Regional Medical Center (TRMC) — with a separate medical staff of about 175 physicians.

Two years ago, this small agricultural community became ground zero in a highprofile battle testing the legal scope of a hospital medical staff’s independence and right to be self-governing. Fundamentally, the question was raised who should be in charge of patient care and safety in a hospital: lay administrators or physician leaders?

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In 2016, hospital administrators at TRMC executed a coup to take unilateral control over patient care at the hospital by terminating the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital installed hand-selected individuals to serve as leaders of the new medical staff, dictated standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited members of the terminated medical staff from voting on medical staff matters or holding leadership positions in the replacement staff.

The California Medical Association (CMA) supported the medical staff in its lawsuit against the hospital. CMA and the medical staff sought to enforce California law requiring all hospitals to recognize and honor the self-governance rights of their medical staffs.

Had TRMC’s actions been left unchallenged, it would have created a dangerous precedent that could have had a negative effect on patient care across the country.

This July, a favorable settlement of the lawsuit was reached that dissolved the replacement medical staff and fully reinstated the original medical staff, its officers and bylaws. The hospital also consented to a stipulated judgment agreed upon by the parties and issued by the Tulare superior court that, among other things, expressly recognizes that the 2016 actions of the hospital board violated the medical staff’s rights to self-governance under California law.

“The Tulare case was not just about one hospital medical staff that was being wrongly treated by its governance structure,” says CMA President Dr. Theodore M. Mazer. “It’s about every medical staff. It’s about autonomy of physicians to make medical decisions, and the clear division of power between a governing body, which is administrative, and the medical staff, and making sure that that separation of powers and duties and responsibilities stayed in place was important for Tulare and every medical staff in California and frankly, in the nation.”

“Medical staff is there to oversee the quality of care provided to patients in the hospital,” says Dr. Damodara Rajasekhar, CMA Board Trustee, Organized Medical

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“The Tulare case was not just about one hospital medical staff that was being wrongly treated by its governance structure. It’s about every medical staff.”

Staff Section. “That role is not designated to the CEO of the hospital or the board members.”

“What the hospital was doing was a blatant violation of very clear law in California that requires hospitals to honor a medical staff’s independence and self-governance,” says CMA’s director of litigation, Long Do. CMA worked with the medical staff’s attorneys and filed two amicus briefs to support the medical staff and take on the hospital, which had loaded up its defense from three different law firms.

“This was a case involving 125 doctors — there’s no possible way they could have afforded to prosecute the case themselves,” says John Harwell, the medical staff’s attorney. “It’s only by the collective action of organized medicine through the California Medical Association that this was possible.”

“This case moved quickly in large part because we were there to help the medical staff and then to seek outside resources and help in getting this resolved,” Dr. Mazer says.

In collaboration with CMA, the litigation center of the American Medical Association (AMA) and state medical societies provided significant legal and financial support in the California medical staff’s lawsuit.

“The narrative, when the case started, was that this was a group of troublemaking doctors who were making it impossible for the hospital to run as an efficient hospital,” says lead trial attorney Michael Amir. “We had to dispel that notion.”

TRMC filed for bankruptcy before closing arguments in the medical staff’s trial could take place, closing its doors and significantly challenging the availability of care to the community.

“It was very devastating for the community to have the hospital close,” says Dr. Anil Patel, immediate past chief of staff of Tulare Regional Medical Center. “But they knew that they had to wipe out all the previous administration and the board.” Patients

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SAN DIEGO PHYSICIAN.ORG

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M E D I C A L S TA F F S E L F - G OV E R N A N C E

seeking care at other hospitals reportedly had to wait 10 to 15 hours for care.

The lawsuit, however, enabled the medical staff to get its story out to the community. In turn, the community changed hospital leadership, which ultimately resulted in the favorable settlement.

As part of the settlement, TRMC has also agreed to: • not recognize the replacement staff, its leaders or bylaws; • reinstate the original medical staff, its duly elected officers, with all the privileges, rights and status that existed before the Jan. 26, 2016 termination; • reinstate the preexisting medical staff bylaws, rules, and policies; • pay $300,000 for the TRMC medical staff’s attorneys’ fees and costs • waive all rights to appeal or challenge the settlement’s validity.

Perhaps most importantly, the settlement allows for the hospital to begin the process

of reopening its doors and once again serving its community.

“The importance of this case is it’s an example of what will happen to a hospital and the hospital’s leadership when it tries to trample the rights of the medical staff,” Amir says. “Doctors can take comfort that when their rights get trampled, and their autonomy and self-governance is questioned, they have a remedy.”

This case sends a message well beyond Tulare; it will likely have ramifications statewide, if not nationwide.

The support of CMA and AMA enabled the medical staff to stand up to a large and well-funded hospitals. In fact, AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA. “I learned a lot what CMA means. It’s not only an organization, it is a partner,” says Dr. Abraham Betre, chief of staff of Tulare Regional Medical Center.

The Importance of Medical Staff Self-Governance Medical staff self-governance is a vital part of a carefully crafted system designed to ensure the delivery of quality patient care.

This system recognizes that the hospital’s medical staff is the only body with the medical expertise to conduct quality assurance activities integral to the health and welfare of the public.

Under state law and Medicare regulations, hospitals are required to have an independent, self-governing medical staff charged with the professional work of the hospital. The medical staff works with the hospitals to ensure quality of care and insulate medical decision makers from undue influences driven by profit motives or other reasons unrelated to patient care.

To preserve this autonomy, medical staffs have a variety of rights provided for under California law, including the ability to retain legal counsel, elect leadership, conduct peer review, and manage a separate bank account dedicated to medical staff funds. Medical staff associations also have the option to sue a hospital, should they feel their right to self-governance has been violated.

“Many physician members of a hospital’s medical staff often are not fully aware of the California laws that establish medical staff self-governance,” says Long Do, CMA’s director of litigation.

“CMA offers informational materials and makes speakers available to educate medical staffs of the importance of self-governance.”

CMA provides hospital physicians with a variety of resources to help medical staffs maintain and assert self-governance. If you are interested in consulting with representatives from CMA’s Center for Legal Affairs or who would like to schedule a CMA speaker on this topic, contact the CMA Member Service Center at (800) 7864262 or medstaffhelp@cmadocs.org.

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OCTOBER 2018

“The litigation fund that is housed in the CMA Center for Legal Affairs is the bloodline of our work. Without the support from medical staffs and individual physicians, CMA would not be able to advocate for doctors,” Do says.

It cannot be overstated how grave the consequences could have been on patient care and safety if the hospital’s illegal actions were left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic.

If your medical staff is interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, please email Nathan Skadsen at NSkadsen@cmadocs.org.

Tina Tedesco is a Sacramento-based writer.

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9

R I S K M A N AG E M E N T

Cybersecurity Insurance for Medical Practices The Basics By David J. Eismont

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OCTOBER 2018

MORE MEDICAL PRACTICES are purchasing — or at least considering — an insurance policy to cover the substantial costs of a data breach. Medical malpractice policies often provide basic coverage for this threat, but many practices find their risks have grown to the point where they are looking to a standalone cybersecurity policy to better meet their needs.

The following provides an overview of what your practice can expect from a cybersecurity policy. Keep in mind that not all policies are the same and actual coverage will be determined by a policy’s terms, conditions, and exclusions.

Coverages are typically split into two types— first-party and third-party: First-Party Coverage First-party coverage addresses the costs and expenses your practice incurs from a data security or privacy breach event, such as:

• A physician comes to the office one morning and logs in to the computer, but the screen goes blank and a message pops up claiming to have hijacked the data and demands payment to get it back.

The “extortion threat” section of a cybersecurity policy may assist with this type of breach. Professional experts hired by the carrier will contact the cyber criminals to attempt to get the data released, including potentially paying the ransom.

You should also be concerned with not only the financial impact to your practice, but also the impact on the treatment of your patients if your systems are down for any length of time due to a breach. The business interruption section of a cyber policy may provide reimbursement of lost profits during your downtime. Many standard property policies do not cover this exposure, since there was no physical damage to the equipment.

• A physician discovers her system has been hacked and worries her patients’ personal health information may have been compromised.

If you discover your system has been hacked, your carrier can provide data breach response services to work with your IT staff to ascertain what happened. These forensic experts assess the nature of the hack and evaluate how much data has been compromised. This section of your coverage can assist with the costs of required patient notification. If you have records of patients from outside your home state, your insurance company should know the notification requirements for those states. You may also be required to provide those patients with credit monitoring services. Your coverage should help set up these services and cover the costs. The costs to notify patients and set up credit monitoring is approximately $8-$10 per patient record.

If patient records are compromised, the data recovery and restoration section of your coverage could reimburse you to unencrypt, recover, restore, re-create, or recollect data.

• The CEO of a company sends an e-mail to the CFO instructing the movement of funds into an account. The CFO makes the transfer, only to discover that the CEO’s email was a spear phishing attack in which the email address was a clever fake, and those funds are long gone.

Your coverage’s cybercrime section may cover the cost of the funds that were transferred. Employees who click on such phishing links could compromise your system. This section of your policy may also assist in those situations.

Third-Party Coverage Third-party coverage provides protection from claims made against you by outside parties.

• It would not be unusual to have claims brought by regulatory agencies, such the U.S. Department of Health and Human services in the case of an alleged HIPAA violation involving a breach of patient records. Cybersecurity coverage for regulatory fines and penalties may allow for payment of fines on your behalf.

• If your practice accepts credit card pay-

ments and is not PCI-compliant (adhering to all the Payment Card Industry Data Security Standards), you could be subject to fines from the credit card companies.

Policies with payment card industry coverage may provide payment for those fines.

• Some patients may bring claims against you for violating applicable privacy laws.

The data security and privacy section of your cybersecurity policy may help in providing a defense and make payment to these claimants, if necessary. Employees of your practice could file such claims if their information was compromised.

• If you maintain a website or social media platforms, you might have a claim brought against you in the event someone believes your site or media content is defamatory or reveals private information about them. The cyber media section of a cybersecurity policy may also provide coverage in this case.

Healthcare accounted for 53 percent of reported data breaches in 2017, more than double the total of any other industry, according to Privacy Rights Clearinghouse.

With healthcare data breaches on the rise, cyber liability insurance can help you recover faster in terms of financial coverage and remediation. In 2015, U.S. healthcare data breaches cost companies an average of $363 per record, the highest of any industry, according to the Ponemon Institute.

Depending on the size and scope, fines and damages for a HIPAA violation related to a breach of unencrypted personal health data can run into the millions of dollars.

Ask your agent or underwriter for more details about what’s included in your policy and whether it meets your needs. If you have cyber insurance, check your liability limits to determine if you need to increase your coverage.

To learn how to comply with HIPAA rules in the event of a breach, how to thwart ransomware attacks and prevent spear phishing, and more, download the free guide Your Medical Practice Is at Risk of a Data Breach from The Doctors Company. More resources are available on the company’s cybersecurity page.

Mr. Eismont is senior director of business development, The Doctors Company.

SAN DIEGO PHYSICIAN.ORG

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PAY E R C O N T R AC T I N G A N D R E I M B U R S E M E N T

Health Net Federal Services Continues to Address TRICARE Transition Issues

By CMA Staff

AS PREVIOUSLY REPORTED, Health Net Federal Services (HNFS) has experienced implementation issues since taking over as the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region on Jan. 1. In recent discussions with the California Medical Association (CMA), HNFS said it continues to address the breakdowns in process and resulting consequences that have impacted TRICARE providers in the areas of provider contracting and credentialing, beneficiary reassignment, and provider directory inaccuracies. Updates are as follows: Contracting and Credentialing Because of staffing and operational issues, physicians may have experienced problems during the contracting and credentialing process including the following: • completed provider contracts not entered into the HNFS system

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OCTOBER 2018

• HNFS unable to locate countersigned provider contracts • cases where the contracting or credentialing processes were never completed HNFS shared with CMA that it has identified the providers impacted by the breakdowns and is nearing completion of the credentialing and contracting cleanup for these impacted providers. Additionally, HNFS will begin scaling back efforts to contract with former United Military and Veteran Services (UMVS) providers except to address network adequacy requirements.

Physicians with questions about their contracting and/or credentialing status with HNFS can check the HNFS credentialing status tool at www.tricare-west.com.

Physicians experiencing challenges with the credentialing or contracting process should contact Megan Herrera, director of HNFS Provider Network Management, at (619) 285-3607 or megan.herrera@hnfs.com.

Beneficiary Reassignment to New PCMs During the TRICARE transition, DHA allowed TRICARE Prime beneficiaries to receive care from primary care managers (PCMs) previously in the UMVS network who were not yet in the HNFS network, without incurring out-of-network fees through June 30. The purpose was to allow HNFS additional time to contract with providers, develop its provider network, and address operational challenges within the contracting/credentialing process. When the transition ended, approximately 44,000 California enrollees, assigned to 3,800 outof-network PCMs, were reassigned to HNFS network PCMs. This large number was due in part to the contracting/credentialing problems described above. HNFS reports that to date, 15,000 of those members have been reassigned to their original PCMs with approximately 23,500 members still assigned to new PCMs. Physicians with concerns, or who have been affected by the reassignment of their patients to a HNFS network PCM, should visit the HNFS TRICARE West website for more information.

Provider Directory Inaccuracies HNFS continues efforts to correct the significant number of provider directory inaccuracies through its third-party vendor, LexisNexis. While improved accuracy of its provider directory is expected over the next 30–120 days, HNFS reports that the error rate of several directory samplings remains high. Practices are encouraged to check the HNFS online provider directory to confirm participation status and demographic information.

If demographic updates are needed, physicians can submit updates via HNFS’s online tool with routine changes to be completed within 14 calendar days, and urgent or high priority updates processed within 24 hours.

CMA is working with HNFS to ensure these issues are resolved quickly and adequately. HNFS has advised that updated transition information is available via the HNFS TRICARE Transition FAQ on the HNFS west website. Physicians with questions or concerns can contact Megan Herrera, director of Provider Network Management, at (619) 285-3607 or megan.herrera@ hnfs.com.

C O M M U N I T Y H E A LT H

Here is the current list of the flu vaccination clinic locations: In partnership with Northgate Market: Oct. 14, 21 1–4 p.m.

Northgate Market 1058 Third Ave., Chula Vista 91911

Your Champions Against the Flu! Champions for Health Launches Immunization Program for Influenza and Hep A for Underserved Communities

By Adama Dyoniziak

CHAMPIONS FOR HEALTH, in partnership with the County of San Diego Health and Human Services Department and the San Diego Housing Commission, holds flu clinics annually each fall in numerous county locations. Last year, 2,063 area people received the vaccine through these free clinics.

The county’s first immunization clinic offering free immunizations to targeted San Diego communities was held Sept. 19 at the Central Library for underinsured, uninsured, and homeless people from the San Diego region. As part of Binational Health Week, Champions for Health is partnering with the Mexican consulate to provide immunizations in October. Another longstanding partner for flu vaccination host locations is Northgate Gonzalez Market.

This year, Champions for Health and the County Health Department will also be providing Hepatitis A vaccines to administer. “Last year’s hepatitis outbreak is still fresh in people’s minds, and people who were immunized last year are due for the second dose,” says Andrew Gonzalez, volunteer coordinator at Champions for Health. “We are working closely with the County and the Housing Commission to

ensure we reach the homeless population and providers that treat uninsured patients with a reminder about this clinic.”

Champions for Health’s free immunization clinics are part of the organization’s ongoing programs that provide preventive and specialty medical care aimed at reducing the risk of preventable diseases including the flu, colorectal cancer, diabetes, and more. A huge thanks to United Healthcare for sponsoring the supplies and privacy screens for the 2018–19 vaccination season.

Our immunization clinics are one of the best ways we carry out our mission of improving health and changing lives. San Diego medical professionals volunteer their time to administer the vaccines, so with the County and all of our partners, we are able to reach the greatest number of people to help them stay healthy!

For an updated list of flu vaccination clinics, call (858) 300- 2787 to speak with Andrew Gonzalez, volunteer coordinator, or visit our website at www.championsforhealth.org.

Ms. Dyoniziak is executive director of Champions for Health, the charitable arm of the San Diego County Medical Society.

Nov. 4 1–4 p.m.

Northgate Market 1410 South 43rd St., SD 92113 Nov. 18 1–4 p.m.

Northgate Market 1950 Main St., SD 92113 Nov. 25 1–4 p.m.

Northgate Market 2909 Coronado Ave., SD 92154 Dec. 2 1–4 p.m.

Northgate Market 1346 Mission Rd., Fallbrook 92028 Dec. 9 1–4 p.m.

Northgate Market 1150 East Vista Way, Vista 92084 Dec. 16 1–4 p.m.

Northgate Market 606 N Escondido Blvd., Escondido 92025 In partnership with the Mexican consulate for Binational Health Week: Oct. 15–19 9–11 a.m.

Mexican Consulate 1549 India St., SD 92101

In partnership with community organizations: Oct. 24 10 a.m.–2 p.m.

Father’s Joe’s Villages 1501 Imperial Ave., SD 92101 Oct. 27 10 a.m.–2 p.m.

East County Transitional Living Center 1527 East Main St., El Cajon 92020 Nov. 1 5–7 p.m.

Paradise Creek Apts 2120 Hoover Ave., National City 91950 Nov. 3 9 a.m.–1 p.m.

Lemon Grove Athletic Field (Grossmont Healthcare District health event) 3131 School Lane, Lemon Grove 91945 Nov. 7 10 a.m.–1 p.m.

Community Christian Service Agency 4167 Rappahannock Ave., SD 92117 Nov. 8 1–3 p.m.

Chavez Resource Center 605 San Diego St., Oceanside 92056 Nov. 15 2–5 p.m.

Wyndham San Diego Bayside 1355 North Harbor Dr., SD 92101 Nov. 21 10 a.m.–2 p.m.

Father Joe’s Village Day Center 299 17th St., SD 92101 Jan. 19 8:30 a.m.–12:30 p.m.

Copley Family YMCA 4300 El Cajon Blvd., SD 92105

SAN DIEGO PHYSICIAN.ORG

13

PROFILE

Making a Difference Sharp’s Dr. Andres Smith Leads the Tijuana Red Cross to the Next Level By SDCMS Staff

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OCTOBER 2018

THE RELATIONSHIP of the Tijuana Cruz Roja and Dr. Andres Smith is a remarkable one. Each has transformed the other, leaving an indelible mark that has benefitted thousands of patients on both sides of the border.

The TJ Red Cross has been at the center of Dr. Smith’s life since he turned 18. That year he offered to be an EMT for the charitable organization. Now 53, Dr. Smith is still deeply involved with Tijuana’s Red Cross after 35 years in medicine. Even more impressive is how Smith has turned around the group financially while taking it to unprecedented heights in both technological capabilities and patient services as its chairman of the board for the past two years.

Dr. Smith was born and spent his early life in Tijuana. He immigrated to the U.S. when he was a teenager because of his parents. He started high school in Chula Vista and attended UC San Diego as a biology major. Anxious to see if medicine was what he

wanted to do with his life, Dr. Smith heard about Cruz Roja and took an EMT course in Tijuana to explore his interest in pursuing emergency medicine. Smith’s curiosity expanded to the point where he volunteered in the Cruz Roja Operating Room, and later, in its ER. A call one night as an EMT caused Dr. Smith to figure out his life’s course. “One particular case that helped me decide that my passion was in medicine occurred in the slums of TJ, in Cartolandia, where people are living in carton houses,” he says.

“We were called in the middle of night, for a woman in labor. My partner and I were both UCSD students. We realized we had no time to take her to the hospital. Neither of us had ever taken care of a delivery before. It was incredible. It was magic to see the beauty of watching a birth and being able to take care of the mother and the child. We cut the umbilical cord, cleaned the baby, and later took the baby to the local county hospital. That’s when I knew I wanted to be an emergency doctor.”

Dr. Smith’s classmate and fellow EMT that night is now ER director and chief of staff for a New Mexico hospital. Smith has been the ER director at Sharp Chula Vista Hospital for the past 14 years.

During those days at UCSD, Dr. Smith created a pre-med club in school to help strengthen the idea of going into medicine.

A group of his fellow pre-med club members were all involved in the Tijuana Red Cross, and all ended up in medicine. They include Dr. Gil Ungab, a cardiologist, Dr. Rene Lopez, an ER doctor in El Paso, Texas, and Dr. Jaime Rivas, an ER doctor at Palomar Hospital and now a regional director for emerging medicine company, Vituity.

Dr. Smith attended medical school at the University of Illinois and did his residency at Martin Luther King Jr. Hospital at UCLA while continuing to volunteer for the TJ Red Cross. He did a regular one-month emergency medicine rotation in TJ while in medical school.

Dr. Smith started to practice in San Diego after his residency and stayed active with the Tijuana Red Cross. Two years ago he was asked to serve as chairman of the Cruz Rojas Board.

The Red Cross in Tijuana is unique. It differs significantly from the services the Red Cross provides in the United States. It does manage a blood bank and is in charge of support for any disaster, with a large group of volunteers standing by in many areas. But

it also has a 30-bed hospital with a pediatric ICU and adult ICU, two operating rooms, a pediatric hospital ward, a new cardiology lab, and Tijuana’s first STEMI center.

The operation also has an EMT school and a nursing school, and is the only certified American Heart Association training center in Mexico.

Most impressively, the Tijuana Cruz Roja also manages 100% of the ambulance care of the city of TJ, and the ambulances are provided free of charge!

But in the last two years, the hospital was in financial crisis because it was only taking care of the indigent population and trying to survive on donations alone. The model had become obsolete. It was simply not working.

As board chairman, Dr. Smith decided he had to restructure the hospital and open it

to private insurance companies as an option to manage their patients. That change has proven to be a very successful and significant one. The Cruz Roja hospital has emerged as an appealing hospital option to manage patients because it does so at a less expensive price. The hospital now also offers many elective surgical procedures, which has helped create the income needed to cover managing the unfunded population.

The other major improvement to the hospital’s operation that Dr. Smith has implemented is to create a state-of-the-art cardiac care center, a $1.5 million project done in conjunction with Medtronic. Dr. Smith credits Medtronic’s support and the instrumental work of Sharp cardiologists Dr. Genaro Fernandez and Dr. Ramiro Lopez for making the cardiac center possible.

SAN DIEGO PHYSICIAN.ORG

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PROFILE

Dr. Smith says, “Even in the Tijuana community, the Red Cross hospital has not been well known historically. But in the last two years, the hospital has been remodeled. We have increased our visibility and people are overwhelmed when they see it because the facility is now so impressive.”

Dr. Smith has helped transform a small medical hospital with very limited supplies to a facility that is state-of-the-art in terms of both medical care and the technology that is being offered to the community. One area where this is particularly true is in the Cruz Roja ambulance services.

“The hospital has a system in place with ambulances where EKGs are transmitted directly to the cloud and sent from the ambulance to the cardiologist on call,” Dr. Smith says. “This was only possible with a grant from LifeNet. We’ve been trying to do this in San Diego and haven’t been able to get it done here with 100% success, but we were able to do it in Tijuana.”

Dr. Smith credits what he’s learned from the culture at Sharp for being central to one of the key improvements that has been made at the Tijuana Cruz Roja: a dramatic increase in the level of patient satisfaction. “In the U.S., patient satisfaction

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is central but that’s not the way it’s been in Mexico,” he says. “It’s a very new concept, one that has only evolved in the last few years. We have worked with staff on this.

We do surveys every month. For Sharp, patient satisfaction is very important — it’s the number one goal. I’ve learned that from Sharp and brought that to Cruz Roja and demonstrated the positivity of that.

Now, patient satisfaction is vey high at the Tijuana hospital.

“It’s been a learning curve to be able to manage services to the community,” Dr. Smith continues. “It’s very expensive because of the technology involved but that’s what we are now able to provide at Cruz

Roja. I’ve been able to come back to my community, where I was born, to volunteer and help make it a better city. There’s also a benefit to the people of San Diego.

Many of the patients we see at Sharp Chula Vista are from TJ. Creating a better medical infrastructure in TJ helps our patients in San Diego because there is less demand placed on the medical infrastructure in San Diego. Everybody benefits.”

Given the dramatic transformation of the Cruz Roja over the past two years and the resulting successes, one can only imagine what new achievements the organization and Dr. Smith will reach together in the next two years.

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18

OCTOBER 2018

A Tumultuous Year in California Medicine San Diego’s Own Dr. Ted Mazer Reflects on His Tenure as CMA President

BY TED MAZER, MD

AS I PASS THE GAVEL as president of the California Medical Association, I find it mind-boggling that my term is almost over. It has been an amazing journey, not only leading the physicians of this great organization, but also having been given this honor during a year of tremendous turmoil in California medicine, and even more tremendous accomplishments by CMA. I have thoroughly enjoyed the ride, and frankly, I am not ready to get out of the car! But that is the process that makes CMA perhaps the most influential and respected state medical association in the country.

This year saw the emergence of what will be an ongoing discussion in California, and likely the nation, of serious, if greatly flawed, efforts to impose a single payer healthcare system. We started with SB 562, an extraordinarily costly and poorly structured attempt to take all dollars in California healthcare, including federal Medicare and Medicaid programs and premiums paid by individuals and employers, and centralize them in Sacramento, which in turn would define benefits and payments. While this proposal played a significant role in the ongoing gubernatorial campaign, it was rightly held in the State Assembly as needing far more reality check and definition, especially with a price tag twice the entire budget of the state and requiring unlikely federal waivers.

But single payer is not a discussion that stopped with the demise of SB 562. This was quickly followed by an even less reasoned approach to altering healthcare financing, AB 3087, essentially a complete state price fixing of all healthcare services, which would have closed hospitals and caused not only a decline in the ability to recruit new physicians to our state, but a likely avalanche of early retirements and an exodus from California of practicing doctors. I am proud to have had a role in testifying and helping to defeat this measure.

But behind all of this action has been the work of CMA’s Executive Committee and staff in trying to redefine the problem not restricted to financing or single payer, but focused on creating a system that will give universal

SAN DIEGO PHYSICIAN.ORG

19

Top: Dr. Mazer and his family at the CMA Foundation President’s Gala. Bottom: Dr. Mazer with Dr. Ellen Mahoney, recipient of the 2017 Frederick K.M. Plessner Memorial Award.

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OCTOBER 2018

and timely access to needed health services to all Californians. Universal access, as I had the pleasure of discussing with CMA’s endorsed candidate for governor, Gavin Newsom, does not require a single payer approach. CMA has been working on, and continues even through this year’s House of Delegates to work on options to reach the goal of universal access in a sustainable system that does not cede control of healthcare and payment to Sacramento, retaining and improving practice viability while improving affordability for all. This will undoubtedly be the key focus of a new governor and legislature over the next few years, and we must not only be at the table, but at the lead.

This year’s political scene, including the governor and lieutenant governor races, have consumed significant CMA time in determining how to act in the best interests of the House of Medicine. While some members took exception to our endorsement, the fact remains that candidates were well vetted, and both CalPAC and the CMA Board of Trustees (BOT), weighing pros and cons, acted accordingly, and we believe that despite some inevitable rhetoric during a campaign, CMA has made proper choices in its effort to protect the future of California’s doctors and patients. Only time will tell, however, and I look forward to continuing to work with the CMA leadership in achieving our goals.

My year started out with the threat of major reductions to reimbursement, including Anthem’s efforts to reduce payment for services coded with -25 modifier. I am proud of our AMA delegation, and the new and expanded Pacific Rim caucus, in leading the way, with Dermatology, to reverse that ill-conceived plan. I spent months in that battle, both in dialogue with Anthem California and in cooperation with the AMA, in discussions with Anthem as a whole.

And I must give a nod to the California Podiatric Medical Association (CPMA) and their leadership for their involvement and assistance in our ultimate success. As an aside, I was honored to be invited to address the American Podiatric Medical Association in DC early this year, alongside then-AMA President Dr. David Barbe, and to more recently be given the honor of a recognition award by CPMA for persistent effort in this and other endeavors in which we have commonalities.

Of course just after forcing Anthem to reverse itself, HealthNet California decided to try the same wrong reductions, plus a hammer ap-

proach to perceived ER upcoding. With the help of CMA’s Centers for Legal Affairs Economic Services, along with Dr. Frank Kase, a legend at CPMA, we quickly met with HealthNet to discuss this wrong approach. The result was a reversal of the physician cuts, and in more collaboration to arrive at an educational rather than financial penalty resolution. And more recently, after years of lost liaison with Anthem, I had the pleasure of finally arranging a meeting with Anthem California leadership, and we have now begun the process of reestablishing liaison for both reimbursement issues and policy issues.

That fulfilled a goal on which I have personally been working for several years now.

And I must mention one of the most important items that began just as I was stepping up to the President’s cycle at CMA, and which has, with much effort from our CMA legal department and with great help from the AMA Litigation Center, resulted in an important legal settlement that sustains the neces-

sary autonomy of medical staffs and medical staff self-governance. The Tulare Regional Medical Center suit, in which the elected medical staff was removed and replaced, wrongly, by the hospital governing board, has been settled with the reinstatement of the original elected medical staff, acknowledgement of the error of the actions by the governing board, and a monetary settlement that partly offsets costs that made possible only by CMA, medical staffs from across the state, and the financial support of the AMA Litigation Center.

As we go to press with this article, I am headed to Tulare to celebrate with the physicians the planned reopening of the hospital and the return of medical services to the local community. And I will, for the third time, present on the subject to the Litigation Center at the AMA interim meeting in November, exemplifying the importance of this now-ended threat to all medical staffs nationally.

On other AMA issues, I have had the pleasure of presenting to the AMA group looking at maintenance of certification (MOC) and the concerns of physicians nationwide, and continuing to challenge the AMA and CEJA on their positions on end of life care in light of California’s End of Life Act, currently back in the courts on a technicality of how it passed in special session.

There are many individual battles that your CMA has waged this year, with unheralded successes. But this has also been a banner year in developing new long-term programs that will benefit CMA and our members.

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SAN DIEGO PHYSICIAN.ORG

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Dr. Mazer speaking to the members of the 2017 House of Delegates

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OCTOBER 2018

While much of this came to fruition during my watch, I must acknowledge that it is due in large part to the outstanding administrative leadership of CMA CEO Dustin Corcoran, the incredible staff at CMA, as well as the constant work of the CMA Executive Committee.

These projects include a joint project with Blue Shield of California to help small practices and to develop the office of the future, already starting in pilots in Butte and Monterey Counties, with a $30 million investment by Blue Shield; the rebirthing and stabilization of the former CMA Foundation, now Physicians for a Healthy California, with a major new administrative project in GME, related to Prop 56 funds; continued work with DHCS to move Prop 56 tobacco tax funds to Medi-Cal providers, resulting in reimbursement rates now at roughly 100% of Medicare rates for preventive services and 85% of Medicare for office visits — an amazing $1 billion increase that should be attracting more physicians to open their doors to more Medi-Cal patients; and, in addition to other projects in the works, a major new physician wellness program

“[CMA has] continued work with DHCS to move Prop 56 tobacco tax funds to Medi-Cal providers, resulting in reimbursement rates now at roughly 100% of Medicare rates for preventive services and 85% of Medicare for office visits — an amazing $1 billion increase ” that at the time of this writing is just about to be announced. This wellness program, in association with recognized wellness expert Dr. Tate Shanafelt and Stanford, is the most innovative, broad scope and highly resourced wellness program in the nation, aimed at helping address what we all know as burnout, from the beginning of training in medical school, through residency and practice, to retirement. It is scalable, and portends to be the model of physician wellness programs in California and beyond. And it is

projected to pilot here in San Diego!

There was so much more done, and so much still in progress this year. We are looking at reforming the Modes of Practice Forums and revitalizing the Solo Small Group Practice Forum as soon as this year’s pre-HOD BOT meeting.

We continue to work with DHCS on improving the physician experience and improving MediCal payment and access. CMA is working with the Medical Board of California to deal with issues surrounding the opioid dilemma of over- vs. under-prescribing, including recent investigative letters looking back to 2012–2013 prescribing. And the list goes on.

I have been privileged to be a part of all of this, not only this year but for many years now.

And while this year involved a great deal of time dedicated to my role as president, with lots of time on emails, phones, and away from the office and home, I can only say that it has been a

Following the tradition of many past Speakers, Dr. Mazer was known to get a little silly toward the end of the annual meeting.

blast! And I wish I could do more! I have had the opportunity to meet with so many colleagues and staff all over the state, be more involved with individual legislators and legislation as well as legal challenges, and to represent you proudly.

With an incredible communications staff, I have lost track of the number of online, radio, print, and television opportunities that have given me a chance to be the voice of CMA. Your support over the years has not been forgotten or taken for granted. I owe much of what I have been able to attain to many of you. And I will never be able to repay you or say thank you to each of you individually. But rest assured I am grateful to each and every one of you.

This has, of course, never been a one-man show. I have been gifted with a dedicated CMA staff, and the trust and confidence of Dustin Corcoran, among others. I have continued to be guided by former CMA leadership, including many San Diegans such as Drs. Jim Hay and Bob Hertzka. And I have been truly blessed with a CMA Executive Committee of which I could not be more proud and to whom I give my heartfelt thanks. I have another year on the CMA Executive Committee to work with these amazing folks, from the newest member, Dr. Udovic-Constant, to my longer-term rightand left-hand men and women now and in the recent past. But I am already lamenting having to move on and turn over leadership to those who follow. I do so knowing that my successor, Dr. David Aizuss, will be an incredible CMA president, and that the entire CMA Executive Committee has at its core the best interests of our California Medical Association. We will all be in great hands, and that is the only reason I can smile as my time as president comes to an end. I just hope I have done you all proud, and that maybe our future leadership will still allow me to play a role in advocating for California’s physicians and patients.

Dr. Mazer is an ear, throat and nose specialist, a former chief of staff at Alvarado Hospital, and a former Chief of Surgery at Sharp-Grossmont Hospital. In addition to Mazer’s service this past year as president of the California Medical Association, he has a long record of leadership in the medical community, including as a former president of the San Diego County Medical Society and a former speaker of the CMA’s House of Delegates.

SAN DIEGO PHYSICIAN.ORG

23

ADVERTORIAL

Three Ways That Any Doctor Can Become an Entrepreneur

BY JESSICA HIGGINS

micro-partnerships, and shared medical office spaces.

MICRO-PARTNERSHIPS

Many doctors are creating micro-partnerships with physicians already inside of a group practice. A micro-partnership is one in which a new doctor partners with a member of a physician’s group to rent excess medical space on a part-time basis. Retiring physicians may only practice a few days each week, leaving excess space available. If you are a doctor looking to open your own practice, it is a good idea to contact physicians you know and offer a flexible micro-partnership. A micro-partnership gives you the ability to rent medical space on a short-term, part-time basis, saving you from a long commercial lease as you start your own practice. You may be surprised to find that a low-cost practice is more open to you than you think.

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STEP 2: YOU NEED THE RIGHT TOOLS.

Many physicians dream of one day opening their own practice, but the barriers for doing so hold them back. The steady paycheck of a hospital system may feel comforting to many physicians, but not all.

Some doctors have the spark of entrepreneurship inside them, and for these rare folks, the ability to open your own practice may be far easier than you think. Thanks to innovative new business models, any doctor is simply one phone call away from becoming an entrepreneur in many areas.

George Scopetta of WeShare MD, a provider of co-sharing medical suites, shares his tips on how to open your own practice.

STEP 1: YOU NEED A PHYSICAL SPACE.

In the past, a group of physicians would have to partner together and enter into a commercial lease to have a space to

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OCTOBER 2018

practice medicine. This could set any physician back years from becoming their own boss, as it takes time and money to put this sort of business deal together.

Commercial medical space is hard to find, and often too large for any single practicing physician. These problems fostered the rise, and fall, of physician practice groups. A group of physicians would partner, take on a 10-year commercial lease, and then hope that the practice maintained the patient flow to keep everyone in business for the next ten years.

In some of these practices, the doctors would find themselves in a disagreement at some point, and one person leaving might cause legal issues for the entire physician’s group.

Luckily, today there are great alternatives available for any single physician to open their very own practice. These are

Most existing medical groups that you may micro-partner with, as well as WeShareMD, should have a full surgical suite of tools available to their physicians. However, if these options are not available to you, do not worry. Most surgical tools and machines can be leased on a commercial lease basis with a simple credit check.

Before going into debt by purchasing the medical tools needed, seek out commercial leasing options available to you in your area. There are many options available online, including Lease Corp and Direct Capital, among others. This is another area in which contacting a physician who is already part of a medical practice is a good idea, as they can provide you with detailed guidance.

STEP 3: YOU NEED PATIENTS.

For physicians, marketing and advertising initiatives can feel unbearable. Medical school simply did not prepare most physicians in the business basics needed to

attract new patients. The good news is, a physician-specific marketing firm can create all the basics for you for attracting new patients. Note that this method requires upfront budget on your part.

If budget is constrained, marketing your new practice can be as simple as word of mouth. Your existing patients may be happy to hear that you are opening a new location closer to where they may live or work. If your patient trusts you, they will be happy to tell friends and family members about you. Please keep in mind, however, that the Compliance Program for Individual and Small Group Physician Practices prevents any physician from offering a “friends and family” type of discount to their patients. This means that while you can ask your patients and friends for referrals, you may not offer any discount or payment in exchange.

Finally, thanks to modern social media, you can market your practice for free online. All this strategy takes is the time and effort on your part to build social media profiles and spread them to your target audiences. If you aren’t social savvy, Facebook ads are a low-cost and easy way to get started. Facebook’s FAQ section is very helpful on how to do this.

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Services include, Onsite MRI, Onsite Xray Onsite lab, Onsite ultrasound, Onsite procedure room, Onsite endoscopy room, Onsite Fluoroscopy, Onsite coffee shop, Onsite Physical therapy, Onsite DME, Onsite Conference rooms, Onsite Employee lounge, Onsite billing service, co-branding opportunities with other doctors practicing in the building, HIPAA compliant servers, and WiFI Affiliated JCAHO surgery centers. The network includes 5 medical centers strategically located throughout San Diego and Riverside Counties. Through a range of medical office formats, as well as growing mobile, virtual office, and surgery centers, the company enables doctors to see and take care of their patients where they want, when they want, how they want, and at a range of price points without the traditional capital costs and long term leases.

CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

SAN DIEGO PHYSICIAN.ORG

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CLASSIFIEDS VOLUNTEER OPPORTUNITIES PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ ChampionsFH.org.

CHAMPIONS FOR HEALTH 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 to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care.

Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.Gonzalez@ChampionsFH.org, or visit www.

ChampionsforHealth.org. [282] SHORT-TERM MEDICAL VOLUNTEERS NEEDED FOR HAITI: Global Health Teams is looking for physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti every February, June, and October. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically under served area.

GHT is an experienced U.S.-based nonprofit and has been operating these clinics since 1998. We coordinate all in-country travel and logistics.

Please contact Bob Downey at (619) 905-7157 or at bob@globalhealthteam.org if you are interested in applying. Visit www.globalhealthteam.org to see what we do and learn about the clinics and volunteer experience.

PHYSICIAN OPPORTUNITIES

SURGEONS NEEDED FOR EXPANDING NATIONWIDE SURGICAL PRACTICE FT/PT positions available.

Competitive pay and flexible schedule with complete autonomy. Add revenue to your current practice. For more information, contact us: P: 1-877-878-3289 F: 1-877-817-3227 or email CV to: JOBS@ADVANTAGEWOUNDCARE.ORG www.AdvantageWoundCare.org PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCare-affiliated practice, is looking for physicians for our San Diego County practice sites.

SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients.

Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement.

For more info visit www.sharp.com/sharpcare/ or email interest and CV to glenn.chong@sharp.com PART-TIME MEDICAL DOCTOR WANTED IMPERIAL RADIOLOGY: Our company is an outpatient diagnostic radiology facility in search of a part-time Medical Doctor to help cover contrast administration. All Candidates must have an active California Medical License. Please contact via email info@carlsbadimaging.com with your resume if this position is of interest to you.

FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Primary care physician wanted for established private practice in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 29 years in the UTC/La Jolla area of San Diego. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence-based chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with a healthy work/life balance.

Our office is modern, clean, and well appointed.

Our staff is supportive, cohesive, and friendly. This a real family practice. Board-certified, California licensed MD and DO physicians who are passionate about medicine and interested in this opportunity should send their CV and cover letter addressed to Tricia at officemanager@ljvfmg.com. Let us grow your practice according to your unique specialty interests and style. Responsibilities include: Provide excellent care, become part of a cohesive team, light call, maintain accurate and detailed medical records using HER, comply with all laws applicable to family practice/internal medicine, including HIPAA, recommend lifestyle changes as appropriate to improve quality of life, Full-time, Part-time.

MEDICAL DIRECTOR, CALIFORNIA CHILDREN’S SERVICES: The County of San Diego invites qualified individuals to apply for the position of MEDICAL DIRECTOR, CALIFORNIA CHILDREN’S SERVICES (Job Classification: Public Health Medical Officer). Under the direction of the Deputy Public Health Officer or designee, this unclassified management position will be responsible for the medical oversight of County of San Diego, Health & Human Services Agency, California Children’s Services Division. Residency in Pediatrics or Family Medicine is highly desirable.

Please view the detailed brochure for information regarding the position, duties, and benefits. | Job Number 18412807CCSU | PHYSICIAN NEEDED: Family Practice MD. San Ysidro Health is looking for an MD for our Family Practice center. The Family Practice MD manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, prenatal OB/ GYN, pediatrics and internal medicine. Bilingual preferred but not required. Medical school graduate, CPR, CA MD and DEA License, board certified or eligible in primary care specialty. For more info on San Ysidro Health, visit: http://www. syhealth.org/ If interested, please email CV to Meagan.underwood@syhealth.org.

DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/ part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at (858) 761-7362 or email jmaas12@ hotmail.com for more information.

PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE FOR SALE: Internal Medicine practice for sale near SDSU and College Area that has been in practice for thirty years. This practice has great street exposure and very accessible parking. For immediate consideration, forward your details including your contact phone, your specialty and current professional status to: chandrasmreddy@gmail.com.

Only Doctors will be considered, no brokers.

HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN: Southern California | Asking Price: $1,050,000 | Cash Flow: $410,419 | This profitable and expandable company performs non-invasive cosmetic procedures, including dermal fillers, Botox, and laser treatments. Experienced staff plans to stay, and protects current physician/ owner at 30 hours/week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: (208) 7623451. doug.miller@goexio.com.

OB/GYN PRACTICE FOR SALE IN SAN DIEGO: Asking $480,000,00. FY 2017 Gross $1,445,688,00. Established practice for 38 years.

Suburban district. Easy freeway access. Dedicated and experienced staff able to stay on board through sale. Situated within a modern, high-end building.

The region’s fast-growing population assures for an expanding client base. Features 3200 sq ft of working space; 6 fully equipped patient rooms (5 exam & 1 surgery rooms with surgical lighting and fully adjustable treatment tables). Furnished waiting room and reception area; doctor’s private office, sterilization area, staff lounge and storage. ADA compliant. Contact: dixon@cwmc4women.com PRACTICES WANTED PRIMARY OR URGENT CARE PRACTICE WANTED: Looking for independent primary or urgent care practices interested in joining or selling to a larger group. We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call (858) 832-2007.

PRIMARY CARE PRACTICE WANTED: I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call (858) 257-7050.

TO SUBMIT A CLASSIFIED AD, email Editor@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.

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OFFICE SPACE / REAL ESTATE AVAILABLE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals.

Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4. It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach.

Contact Kristi or Myra 760-753-8413. View Space on Website:www.eisenhauerobgyn.com. Looking for compatible practice types.

SHARED OFFICE SPACE AVAILABLE: Shared Office Space: Very attractive 1 or 2 exam rooms available, medical spa office ‘Exquisite Md Spa’ in Bankers Hill near Balboa Park. Available 5 days per week. Reasonable rates. Call Claudia at 619-501-4758.

OFFICE SPACE AVAILABLE: 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 1-5 and 1-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 344-9024.

OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on useage. Contact Jo Turner (619) 733-4068 or jo@siosd.com.

OFFICE SPACE AVAILABLE IN MISSION VALLEY: Unique space for lease in Mission Valley.

1300 sq. ft office space in medical/surgical office building, single story, ample free parking. Is currently in use as physical therapy suite with reception area, small waiting room, private treatment room, separate office, bathroom in suite and hook ups for washer/dryer. Easy access to all freeways. Available approximately August 1, 2018. Please contact Joan McComb, Executive Director, CA Orthopaedic Institute. (619) 291-8930 or cell (619) 840-0624.

NORTH COUNTY MEDICAL SPACE AVAILABLE: North County Medical Space Available: 2023 W. Vista Way, Suite C, Vista, CA 92083. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, décor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele.

Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: Digital X-ray suite, multiple exam rooms, access to a kitchenette/ break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is NOT

included. Contact Harish Hosalkar at hhorthomd@ gmail.com or call/text (858) 243-6883.

SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity. Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps. Extensive referral base, EMR/”paper-light” office, experienced MA/surgery scheduler/referral coordinator. Please call Lisa Vaughn, practice administrator, at (858) 278-8300 or email lmvomg@ yahoo.com.

SCRIPPS ENCINITAS CAMPUS OFFICE: 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra (760) 753-8413. View Space on Website: www. eisenhauerobgyn.com. Looking for compatible practice types.

MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located in the center of “Hillcrest/Bankers Hill”. Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom. Additional security gate and mailbox.

Separate address. Wood floors, refinished windows, natural light, quiet street, walkable to restaurants.

On-site parking with up to 8 parking spaces available!

Asking: $3,000/month. Terms are negotiable.

This will rent fast so hurry!. Please contact: hillcrestofficerental@gmail.com | (858) 775-5075 OFFICE SPACE FOR RENT: La Jolla -- LEASE -- Medical or dental related practice or business in a small boutique office space located in the center of beautiful La Jolla, California. Perfect opportunity for Psychiatrist, Psychologist, Counselor, Dentist, Physician, Surgeon. Any dental or medical related occupation welcome. Located in medical/dental building. Come join these great practices. Classy second floor suite with elevator. Perfect for entrepreneur. Partially equipped for dental or surgical practice. Terrific opportunity. | 612 sq feet | $4.90/sq ft per month | triple net lease. Contact Kevin Gott: dynamold@aol.com OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time.

Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com.

MEDICAL EQUIPMENT/FURNITURE FOR SALE HIGH TECH FACIAL IMAGING FOR SALE: New Reveal® Imager for sale. Ideal for MedSpa or cosmetic practice. The Reveal® Imager clearly demonstrates sun damage, brown spots, red areas and more. Create a personalized printed

treatment record for the patient. Contact info@ restoresdplasticsurgery.com or 858-224-2281 if interested.

MEDICAL EQUIPMENT AVAILABLE FOR DONATION: Carlsbad Imaging has medical equipment available for donation. Afinion, HbA1c Used, Siemens, clinitek, status+Used, FastPackUsed. Please contact info@carlbadimaging.com if interested.

NON-PHYSICIAN POSITIONS AVAILABLE PLASTIC SURGERY AND FRONT DESK COORDINATOR: The ideal position for someone with a background in plastic surgery, dermatology, ophthalmology, or medical spa. Will consider those with a background in a high-end hospitality setting.

The Coordinator is primarily responsible for the dayto-day creation of an office environment that fosters highly personalized customer service. Responsible for the front/back office daily operations including patient care, scheduling, and optimizing surgical closure rates and sale of skin care lines. Contact info@restoresdplasticsurgery.com with resume.

Salary commensurate with experience.

MEDICAL OFFICE MANAGER/CONTRACTS/ BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice.

Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work.

PRODUCTS / SERVICES OFFERED DATA MANAGEMENT, ANALYTICS AND REPORTING: Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries. Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and processrelated outcomes and establish benchmarks, and the production of automated reporting. (619) 9137568 | info@rudolphia.consulting | www.rudolphia. consulting A VALUABLE EDUCATIONAL RESOURCE: Extensive Medical Articles File for sale. Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes. Will accept offers for 30 days after the publication of this newsletter. View in person at a North County location by appointment. (858) 451-6517.

PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source.

Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara.Mandel@ChampionsFH.org or call (858) 300-2780. [559]

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ELEC TION 201 8!

Key Votes for Doctors The Dangers of Prop. 8 and the Surprising Importance of the Lt. Governor’s Race By SDCMS Staff

OUT OF THE DOZENS of decisions to be made, two votes on this November’s ballot will have particular importance for the medical community.

One is Proposition 8, which would wreak havoc with kidney dialysis patients across California. The other, quite surprisingly, is the historically sleepy post of California lieutenant governor, and whether Eleni Kounalakis, the California Medical Association’s endorsed candidate, is elected to that state constitutional office.

Proposition 8: Limits on Kidney Dialysis Clinic Profits Prop. 8 was put on the ballot by a labor union, SEIU-UHW West, which is unhappy it’s been unable to unionize workers at the state’s two largest dialysis businesses. So in an act of political vengeance, the union placed a measure that would cap dialysis clinic profits at 115% of spending on “direct patient care and healthcare improvements.”

But the initiative’s definition does not

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cover legitimate expenses such as clinic coordinators, professional services, regulatory compliance, and security. Consequently, the clinics believe that only 70 percent of their expenses would be counted against that limit, resulting in numerous clinic closings.

That’s particularly ominous for California’s 70,000 dialysis patients, a caseload that is growing by 5 percent a year. The lives and health of patients who require regular and frequent access to dialysis clinics would be threatened.

Prop. 8 plays politics with the lives of innocent patients to serve the financial agenda of a special-interest group. That’s why the California Medical Association and more than 150 healthcare and community organizations strongly oppose Proposition 8.

California Lt. Governor: Eleni Kounalakis Historically, the LG’s office has been considered a job with an impressive title but

not much else. Sure, the occupant is only a heartbeat away from the governorship of the nation’s most populous and economically important state, but the last time a governor vacated office was in the 1950s.

The dim view of the value of the LG’s office first changed with the election of then-Lieutenant Governor Gray Davis to the governorship, and its role as a steppingstone was confirmed by Lieutenant Governor Gavin Newsom’s position as the heavy favorite to win the Governorship in November. Furthermore, there is strong speculation that a Governor Newsom could end up on the national ticket in 2020 or resign to join a future cabinet.

California’s “Top-Two” June primary to succeed Newsom resulted in two Democrats, former Ambassador Eleni Kounalakis and state Senator Ed Hernandez, capturing the top two spots and facing off in the November election.

So why should doctors care which Democrat wins?

Senator Hernandez is an optometrist and former president of the California Optometric Association. He has been a frequent adversary of the California Medical Association in the legislature, particularly on scope-of-practice issues. A Lieutenant Governor Hernandez could well find himself holding the most powerful office in the state and using that position to undermine California’s medical doctors.

In contrast, Eleni Kounalakis is an impressive businesswoman and diplomat, appointed by President Obama to be ambassador to Hungary in 2010. She’s been an advocate for early childhood education as a member of California’s First 5 Commission and was appointed by Gov. Jerry Brown to lead the California International Trade and Investment Advisory Council.

As CMA President Theodore M. Mazer, M.D. put it when announcing CMA’s endorsement of Kounalakis, “Today’s political environment demands leaders focused on pragmatic solutions to improve quality access to healthcare, address our looming physician shortage crisis, and champion public health initiatives. We believe Eleni has the passion, temperament, and experience to represent California’s citizens and interests.”

The choices on both Prop. 8 and lieutenant governor are clear ones for California’s doctors.

Are Your Patients Giving You FIVE STAR REVIEWS? CAP’s Free Guide Can Help You Optimize Patient Experience and Improve Your Ratings!

The Physician’s Action Guide to an Outstanding Patient Experience is about optimizing the fundamentals of your medical practice so patients: • Feel cared for • Are fully prepared to comply with your course of treatment • Feel confident of your expertise and the ability of your staff • Are happy to recommend you to friends and in online reviews As a leading California provider of superior medical malpractice coverage, the Cooperative of American Physicians (CAP) is pleased to offer California physicians this important guide free for the asking.

Request your free copy today!

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SAN DIEGO PHYSICIAN.ORG

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