June 2015

official publication of SDCMS June 2015

VA San Diego Healthcare System 12

868,035

% of Veterans Served That Are Women

222,736 Veterans in San Diego

78,979

Veterans Enrolled for VA Healthcare

14,823 Veterans From Iraq/ Afghanistan Enrolled

Outpatient Visits in Fiscal Year 2014

7,984 Admissions in Fiscal Year 2014

“Physicians United for a Healthy San Diego”

M EDI CA L

PR OF ESSIONAL

LIABILITY

INSURANC E

GUIDE GUARD ADVOCATE

MEDICAL PROFESSIONAL LIABILITY INSURANCE

CALIFORNIA PHYSICIANS DESERVE Your Guide: Awarding more than 35,000 CME certificates in 2014* Your Guard: Resolving 89%* of claims without indemnity payments Your Advocate: Largest contributor to the No On 46 coalition

Our heart beats in California ... and has for almost 4 decades.

Talk to a NORCAL Mutual agent/broker today. © 2015 NORCAL Mutual Insurance Company. * Based on 2014 data.

844.4NORCAL | CA.NORCALMUTUAL.COM

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

1

2

3

41

52

3

41

52

3

4

6

7

8

96

107

8

96

107

8

9

11

12

13

1411

1512

13

14 11

15 12

13

14

16

17

18

19 16

20 17

18

19 16

20 17

18

19

21

22

23

2421

2522

23

24 21

25 22

23

24

1

2

3

41

52

3

4

6

7

8

96

107

8

9

11

12

13

1411

15 12

13

14

16

17

18

19 16

20 17

18

19

21

22

23

2421

25 22

23

24

26

27

28

29 26

31 5 36 10

32

33

3431

37

38

39 36

30 27 1 35 32 6

28 2 33 7

29 3 34 8

42

43

4441

47

48

49 46

50 47 21 55 52 26 60 57 31 5 65 62 36 10 70 67 41 15 75 72 46 20 77 51 25 56 30

48 22 53 27 58 32 63 37 68 42 73 47 78 52

49 23 54 28 59 33 64 38 69 43 74 48

41 15 46 20

51 52 53 5451 25 56 57 58 59 56 26 27 28 29 29 30 29 30 1 2 326 30 427 1 528 2 326 427 1 528 2 3 41 52 3 4 61 62 63 6461 31 32 33 34 34 33 34 35 6 6 7 6 7 8 8 9 7 831 35 932 1033 831 35 932 10 96 107 66 67 68 69 66 36 37 38 39 36 14 40 37 39 40 36 37 38 39 4011 1512 13 11rents 1538 12 13 14 11trend 15 12will only 13 14 13 14 Supply of medical 11 space 12 is shrinking and are rising.

This continue.

71 72 73 7471 41 doctors 42 43 4441 control 4516 42 of20 43 44 41 45 42costs20 43through 44 owner/user 4516 2017 Forward-thinking are taking their purchases.

16 17 18 19 17 occupancy 18 19 16 17 18 19 18 19 76 77 78 76 46 offi21 47ce sales 48transactions: 49 46 24 50 47 49 50 46 47 48 49 5021 2522 Our recent medical 22 23 21 2548 22 23 24 21 25 22 23 24 23 24 BUYER PROPERTY LOCATION SF 51 52 53 5451 29 5526 52 3053 54 51 55 52 53 54 55 26 27 28 27 28 29 26 30 27 28 2926 3027 28 29 1

Confidential

2

The Super Dentists

4

57 31 Mission Bay Office Group, LLC 61 62 36

5

The Super Dentists

6

Coastal Pain & Spinal Diagnostics

7

Packard Dental

8

Ehsan Nasery, DDS

9

Anthony Scoma, DDS

10

CHP Partners, LP

3

56

Kevin Herold, DDS

66

71

76

67 41 72 46

Fourth Avenue Medical Plaza

58 Aero Drive 59 56Office Building 60 57 32 33 34 31 3558 32 Kaiser Mission Bay Building 63 6461 39 6536 62 4063 37 37 Venture38 Sorrento Office Park 68 Ryan Plaza 69 66 44 70 67 42 43 41 4568 42 Bressi Ranch Medical Plaza

Hillcrest

20,076 SF

Kearny Mesa

27,239 SF

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

69 66 43 74 71 Carlsbad 48

77 51

73 Carlsbad48 7471 7546 72 Medical Village 47 49 Medical 78 Nordahl53 76 Centre 52 5477 51

5073 47 5578 52

Carlsbad

56

57

61

62

Scripps Ranch Retail Building

70 67 44 41 75 72 49 46

Del Mar Heights

76 53

San Marcos Scripps Ranch

77 54 51

58

5956

6057

Chula Vista

58

59 56

63

6461

6562

63

64 61

Doctors Park at Eastlake

58 59 35 32 33 27,395 SF 63 64 40 37 38 2,773 SF 34,600 68 69 45 42 SF 43

71

72

73

7471

Chris Ross +177858 410 786377 76 chris.ross@am.jll.com

Sales ▪ Leases ▪ Renewals ▪ Investments

7572

73

74 71

6031 34 65 3936

3532

33

34

4037

38

39

4542

43

44

5047

48

49

71 45 76 50

61 35 66 40

3,915 SF

73 50 47 3,915 SF 78 55 52

74 48

7041 44 75 4946

5,000 SF

53

5451

5552

53

54

55

60 57

58

5956

6057

58

59

60

65 62

63

6461

6562

63

64

65

6966

7067

68

69

70

73

7471

7572

73

74

75

78

76

77

78

2,795 SF

33,680 SF

JLL Healthcare Practice Group: the market leader in medical office sales and leases.

67 68 6966 7067 68 69 66 70 67 68 Contact us today. 66 Paul Braun +1 858 410 6388 76 paul.braun@am.jll.com

40 37 11 45 42 16

75 72

Kelly Moriarty +1 77858 410 78 6359 76 77 kelly.moriarty@am.jll.com

38 12 43 17

39 13 44 18

53

57

58

62

63

67

68

72

73

77

78

june

Contents

Volume 102, Number 6

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

features

14

Letter From the VA San Diego Healthcare System Director

departments

BY JEFFREY T. GERING, FACHE

4

18

Briefly Noted: Calendar • Welcome New and Returning Members • Featured Member • And More …

What Is Unique About the VA in San Diego?

BY ROBERT M. SMITH, MD

6 The Importance of Testing Your Patients for HIV

20

Challenges Facing the VA in San Diego and Nationwide

BY WILMA WOOTEN, MD, MPH

BY ROBERT M. SMITH, MD

8

22

The Practice of Primary Care in the Veterans Health Administration Setting

BY VA San Diego Medical Staff

ompliance Officers and C Compliance Committees

BY HEIDI KOCHER, ESQ.

10

Shining a Light on Skin Cancer: All Doctors Should Be on the Lookout

12

BY THE DOCTORS COMPANY

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

12

anaging the Computer M in the Exam Room

BY HELANE FRONEK, MD, FACP, FACPh

24

Doing the Medi-Cal Math

BY SHERRY L. FRANKLIN, MD

26 Physician Marketplace: Classifieds 2

june 2015

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

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

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

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

Low down payment available for purchase prices up to to $1,850,000 Refinances with high loan to value also available No mortgage insurance required Competitive fixed rates available No prepayment penalties or additional lender fees

Corey Weber

Mortgage Banking — Mortgage Banking Officer Phone: 760.405.3575 eFax: 205.524.0695 Corey.weber@bbvacompass.com NMLS #567944 Southern California District 4180 La Jolla Village Dr #530 La Jolla, CA 92037

All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC.

////////////Briefly /////////////////Noted /////////////////////////////////////////////////////////////////////////// Pan-Pacific Biomedical Informatics Training Camp AUG 3–13 at the UC San Diego Biomedical Research Facility II, La Jolla (cme.ucsd.edu/ bioinformatics)

calendar SDCMS Seminars & Webinars SDCMS.org

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

10 Ways to Improve Revenue Cycle Management (webinar) JUL 9: 12:15pm–1:15pm Free Physician — SDCMS Member & Nonmember — Networking Opportunity & Mixer (social) JUL 10: 5:30pm– 8:00pm at BJ’s Restaurant and Brewhouse in La Mesa The Leader’s Toolkit (workshop) JUL 11–12: 8:00am– 4:00pm & 8:00am– 12:00pm

“

Taming Outlook Workshop for Physicians AUG 22: 8:00am– 12:00pm 2015 ICD-10-CM Boot Camp (course) AUG 27–28: 8:00am– 5:00pm

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.

Spine Injuries in Sport JUL 15 at Scripps Green Hospital (www. scripps.org/sparkleassets/documents/ sports_medicine_ seminar_2015.pdf)

Advanced Therapeutic Interventions to Optimize Obesity and Diabetes Care SEP 25–26 at the San Diego Marriott La Jolla (www. scripps.org/events/ advanced-therapeuticinterventions-tooptimize-obesityand-diabetes-careseptember-25-2015) Transforming Medicine: Evidence-Driven mHealth SEP 30 – OCT 2 at the Scripps Institution of Oceanography, Seaside Forum, La Jolla (www.scripps.org/ events/transformingmedicine-evidencedriven-mhealthseptember-30-2015) Surgical Stabilization and Rehabilitation of the Unstable Shoulder NOV 18 at Scripps Green Hospital (www. scripps.org/sparkleassets/documents/ sports_medicine_ seminar_2015.pdf)

Critical Care Summer Session 2015 JUL 23–25 at Paradise Point Resort, San Diego (cme.ucsd.edu/ criticalcare)

quote of the month

june 2015

”

Welcome New and Returning SDCMS-CMA Members!

New Members Michael L. Bishop, MD Anesthesiology San Diego (619) 543-6240 Frederic Butler, MD Occupational Medicine San Diego (858) 277-2744 Leon C. Chang, MD Anesthesiology San Diego (619) 543-5754 Chien P. Chen, MD, PhD Radioisotopic Pathology San Diego (858) 554-4100 Alane B. Costanzo, MD Pain Management (Anesthesiology) San Diego (609) 712-0820 Lynne D-M Do, MD Gastroenterology San Marcos (619) 528-5000 Li Fan, MD Obstetrics and Gynecology Poway (858) 451-7944 Ray F. Gariano, MD, PhD Ophthalmology La Jolla (858) 554-9100 Amanda A. Gosman, MD Plastic Surgery San Diego (619) 543-5887 Ellen K. Heyneman, MD Child and Adolescent Psychiatry San Diego (858) 966-4935

I feel an earnest and humble desire, and shall till I die, to increase the stock of harmless cheerfulness.

— Charles Dickens, English

4

SDCMS-CMA Membership

Writer and Social Critic (1812–1870)

Andrew K. A. Kader, MD Urology La Jolla (858) 822-6178 Alexander A. Khalessi, MD Neurological Surgery San Diego (310) 906-6861

Thomas B. Kinney, MD Vascular and Interventional Radiology San Diego (619) 543-6607 Julianne M. North, MD Family Medicine San Diego (619) 260-4595 Georgios Papastergiou, MD Ophthalmology El Centro (760) 352-7755 Gary R. Polsfuss, MD Emergency Medicine Chula Vista (619) 229-3130 Steven C. Rose, MD Vascular and Interventional Radiology San Diego (619) 543-7964 Elizabeth Rosenblum, MD Family Medicine San Diego (619) 223-1178 Christian A. Tomaszewski, MD Medical Toxicology San Diego (619) 543-3878 Sotirios Tsimikas, MD Interventional Cardiology La Jolla (858) 657-8530 Karen B. Van Hoesen, MD Emergency Medicine San Diego (619) 543-6230 Yvonne E. Vaucher, MD Neonatal-Perinatal Medicine San Diego (619) 543-3759 Lindia J. WilliesJacobo, MD Pediatrics San Diego (858) 496-4800

//////////////////////////////////////////////////////////////////////////////////////////////////////// RETURNING MEMBERs William R. Auger, MD Pulmonary Disease La Jolla (858) 657-7140 Eyla G. Boies, MD Pediatrics San Diego (858) 496-4800 Giovanna Casola, MD Diagnostic Radiology San Diego (619) 543-6768 Edward C. Chao, DO Endocrinology, Diabetes, and Metabolism San Diego (858) 552-8585

Arturo Leon, MD Urgent Care San Diego (619) 556-8114 Monique K. Mahlum, MD Internal Medicine Encinitas (760) 753-1362 Vivian M. Reznik, MD Pediatrics La Jolla (858) 966-4019 Mark H. Sawyer, MD Pediatric Infectious Diseases San Diego (858) 966-7406

Erin R-S Fisher, MD Pediatrics San Diego (858) 966-5841

Overloaded?

We can help - absolutely!

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

in memoriam

Philip R. Humber, MD, SDCMS-CMA member since 1983, passed away on June 5, 2015. SDCMS extends our deepest sympathies to Dr. Humber’s family.

858.256.0351 • www.abs-sol.com FEATURED MEMBER

Congratulations to UC San Diego School of Medicine Medical Student Stephanie D. Garcia!

National Medical Fellowships (NMF) provides scholarships and service-learning programs for underrepresented minorities in medicine and the health professions. Its California Community Service-Learning Program is specifically designed to increase the number of qualified medical providers who have a commitment to improving access to quality healthcare in medically underserved communities in California.

Congratulations to UC San Diego School of Medicine medical student Stephanie D. Garcia, SDCMS-CMA member since 2014, for her California Community ServiceLearning Program award! Visit www. nmfonline.org for further information.

Celebrating

10 years

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

SAN DIEGO PHYSICIAN.org

5

P u b l i c H e a lt h

The Importance of Testing Your Patients for HIV

by Wilma Wooten, MD, MPH

The Epidemic in San Diego County The HIV epidemic in San Diego County is different from that observed at the national level. Here gay, bisexual, and other men who have sex with men (MSM) account for the vast majority of cases (about 85%, which is higher than that seen nationwide), and injection drug users (IDU) account for a smaller proportion of cases than in the

6

june 2015

nation as a whole. Less heterosexual HIV transmission occurs here compared to the nation as a whole, but it is increasing slowly, particularly among older people. By proportion, older people (≼50 years of age) are the fastest growing group of cases but may not be perceived by providers to be at risk for HIV, even if they are MSM. About half of AIDS diagnoses in recent

years have occurred at the same time as HIV diagnosis (i.e., simultaneous diagnosis). In other words, by the time these patients are diagnosed with HIV infection, they have already progressed to AIDS. Older patients, including MSM, are more likely to receive simultaneous diagnoses than younger patients. This indicates that these patients were not receiving necessary testing. The CDC recommends that all patients receive periodic HIV testing as part of routine medical care (1).

For additional information, please visit www.sdhivaids.org.

Diagnosis and Reporting of HIV/AIDS Every healthcare provider is required to report newly diagnosed cases of HIV and AIDS to the County of San Diego Health and Human Services Agency (California Code of Regulations, Health & Safety Statutes, Title 17, Section 2643.5, Section 2643.10 and Section 2500). Providers are also required to report when an individual meets the CDC definition for AIDS (2).

Timely reporting provides more accurate information to guide planning, prevention programs, and needs assessment.

Healthcare providers may have concerns about patient privacy and confidentiality; however, HIPAA recognizes that there are legitimate reasons for reporting to Public Health and permits disclosure of personal health information for this purpose, although the amount of information to be released is limited to what is required by law (3).

Figure 1. Linkage to Care San Diego County, California, and US 100%

100% 100% 100% San Diego

80%

80%

CA

80%

US

80%

By proportion, older people (≥50 years of age) are the fastest-growing group of cases but may not be perceived by providers to be at risk for HIV, even if they are MSM.

60%

Figure 2. Continuum of HIV Care San Diego County, California, and US

40% 100%

100% 100% 100%

20% 80% 0% Diagnoses of HIV Infection

San Diego

Linked to Care

CA

US

60%

Linkage / Continuum of HIV Care For those with HIV to fully benefit from effective antiretroviral therapy (ART), they need to know that they are infected, get linked to and remain in regular HIV care, and adhere to treatment. This begins with testing and making appropriate referrals to care for those who test positive.

Linkage to care is defined as the percent of HIV-infected individuals who receive a CD4 or viral load test within 90 days of diagnosis. Linkage to care is the same for San Diego County, California, and the United States (see Figure 1), but a smaller percentage of San Diegans diagnosed with HIV are retained in care or virally suppressed than those in the United States (4) and California (5) (see Figure 2).

Measuring linkage to care and the continuum of HIV care is the first step to improving engagement in care. Better engagement leads to improved health outcomes for patients and reduces HIV transmission in the community. This effort may also help address engagement disparities seen among various groups in the county.

For example, American Indians, blacks, and Hispanics with HIV infection are less likely to be retained in care or achieve viral suppression compared to whites.

Partner Services Partner Services (PS) assists HIV-positive persons in notifying their partner(s) of HIV exposure. PS staff members are trained professionals who understand the complexities

51% 47%

45%

40%

43% 39%

35%

20%

0% Persons Living With Diagnosed HIV

and challenges of disclosing HIV status. PS includes anonymous partner notification by trained County staff. The partner is advised only that he or she may have been exposed to HIV, and the identity of the HIV-positive person who requested the notification is protected. PS staff members accept referrals from any provider to help with this process.

County Partner Services can be reached at (619) 692-8501.

Partner notification plays a key role in reducing HIV transmission by making those who are at risk of HIV aware of their exposures and encouraging testing. Earlier identification of new cases and their linkage to care and treatment leads to reduction in the exposure of others to the virus.

Dr. Wooten, 10-year member of SDCMSCMA, is the public health officer for the County of San Diego, Health and Human Services Agency.

Retention in Care

Viral Suppression

References: 1. Centers for Disease Control and Prevention.

Morbidity and Mortality Weekly Report: Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in HealthCare Settings. Recommendations and Reports/ Vol. 55/RR-14. September 22, 2006 2. Centers for Disease Control and Prevention.

Morbidity and Mortality Weekly Report: Revised Surveillance Case Definition for HIV Infection — United States, 2014. Recommendations and Reports/Vol. 63/No. 3. April 11, 2014 3. United State Department of Health & Human Services, Health Information Privacy, Public Health, 45 CFR 164.512.b, December 3, 2002, and Revised April 3, 2003.

4. Centers for Disease Control and Prevention.

Monitoring selected national HIV prevention and care objectives by using surveillance data-United States and 6 dependent areas-2011. HIV Surveillance Supplemental Report 2013; 18(No. 5). Published October 2013. Accessed December 2013.

5. V. Eckert, California Department of Public Health, Office of AIDS (personal communication, September 11, 2014).

SAN DIEGO PHYSICIAN.org

7

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

Compliance Officers and Compliance Committees

by Heidi Kocher, Esq.

8

june 2015

Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs, and many private payers now explicitly require compliance programs in their physician contracts.

But compliance programs don’t just materialize out of thin air. I have yet to be able to wave a wand or say an incantation that will bring a compliance program into being. In order to implement a functioning, effective compliance program, somebody has to perform specific tasks. In many practices, a physician (or the physician in a solo practice) is named the compliance officer. In other practices, it is a senior staff member, often the office manager. And sometimes the compliance officer does not have any other duties in the organization, particularly in large practices. All of

The compliance officer may have to depend on the representatives of other functions to actually perform or carry out specific duties. these models can work. However, where the compliance officer or manager also has other duties, it is critical that those duties not cause a conflict of interest with the compliance duties. If the compliance officer or manager has other duties in the practice, care must be taken that the individual is permitted enough time to carry out his or her compliance duties. I have seen numerous practices where being the compliance officer takes a back seat to being the office manager or the head of accounting. Those are practices that often run into compliance problems on down the line.

Even more important than having the appropriate amount of time, the compliance officer or manager must be given the authority to implement required policies, procedures, and practices. All too often, the compliance manager or officer is given the responsibility for implementing a compliance program, but not the needed authority. Particularly in solo and small practices, it is not uncommon for the physician to name him or herself as chief compliance officer and then delegate the day-to-day compliance duties to another individual, while the physician remains chief compliance officer on paper. Regardless of whether the individual conducting the day-to-day compliance activities is the actual chief compliance officer or a subordinate performing delegated duties, the most important aspect here is that the compliance staffer not find him or herself constantly overruled or second-guessed by the physician(s). Unfortunately, I have seen too many cases where a compliance officer is not given the required authority to do what needs to be done, or where a physician or group of physicians discounts the sound advice given by the compliance officer.

A physician practice should also implement a compliance committee. A compliance committee has two main functions: First, the compliance committee serves as an oversight body; second, the compliance committee can be a tremendous help in carrying out compliance duties. In a small practice, the compliance committee

might end up consisting of most of the staff members. Conversely, in a large practice, the compliance committee often consists of senior physicians and staff members, such as the head of human resources, the chief financial officer, and representatives of other key departments. The composition of the committee and the number of members is not as important as the committee members’ ability to provide oversight and additional resources and manpower in implementing a compliance program.

In terms of oversight, the compliance committee should meet periodically and receive reports from the compliance officer about the steps he or she has taken to implement the compliance program.

Quarterly meetings are typical. The compliance officer or manager should chair the meetings. The compliance officer can and should report on implementation of policies and procedures, status of training, any incidents, payer audits, and other related matters. The quarterly meetings should be documented and maintained among the practice’s key documents.

In terms of providing additional resources for implementing the compliance program, the compliance officer may have to depend on the representatives of other functions to actually perform or carry out specific duties. For example, the human resources department may be tasked with actually conducting background and sanctions screening or employee training, while the finance or accounting department may help with responding to payer audits or performing internal audits. In addition, other departments and functions can often smooth the way for the compliance officer to implement specific tasks, often by providing input into an initiative or suggesting more cost-effective means of achieving a goal. Finally, these other individuals can help a compliance officer by spreading the compliance message throughout an organization.

In summary, empowering a compliance officer and creating a functioning compliance committee are key to implementing an effective compliance program.

Next month: Basic Policies and Procedures.

Ms. Kocher is counsel with the law firm of Liles Parker.

In addition to serving as a chief compliance officer and chief privacy officer, she has 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 (214) 952-5169.

TrusT A Common sense ApproACh To InformATIon TeChnology Trust us to be your Technology Business Advisor hArdwAre  sofTwAre neTworks emr ImplemenTATIon seCurITy  supporT mAInTenAnCe

(858) 569-0300

www.soundoffcomputing.com

Endorsed by

SAN DIEGO PHYSICIAN.org

9

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

Shining a Light on Skin Cancer All Doctors Should Be on the Lookout Contributed by SDCMS-endorsed The Doctors Company For more patient safety articles and practice tips, visit www. thedoctors.com/patientsafety.

10

june 2015

No matter your specialty, paying attention to abnormalities on your patients’ skin may save lives and protect you from potential liability.

One in five Americans will develop skin cancer in their lifetime (Skin cancer. American Academy of Dermatology. www.aad.org/ media-resources/stats-and-facts/conditions/ skin-cancer. Accessed March 19, 2015). Because early diagnosis is key, all doctors should act upon unusual or ominous lesions or moles on patients’ skin. Suspicious spots should trigger a referral to a dermatologist because the urgency of the situation can only be determined by expert examination and biopsy.

“I once found an unusual dark spot on the sole of a 12-year-old’s foot during a complete skin exam as part of a routine wellchild physical. I sent the patient to a dermatologist for biopsy, which confirmed melanoma.”

When appropriate, educate your patients about what to look for while performing self-exams. Brown spots are usually harmless, but not always. Having more than 100 moles puts a patient at greater risk for melanoma. While many melanomas develop in areas exposed to the sun, they also develop in areas that are usually hidden from the sun. Be sure to examine the areas between the toes, underneath the nails, the palms of the hands and soles of the feet, and the eyes.

Lina Feaster, MD, a family practice physician in St. Augustine, Florida, emphasizes the need for awareness: “I once found an unusual dark spot on the sole of a 12-yearold’s foot during a complete skin exam as part of a routine well-child physical. I sent the patient to a dermatologist for biopsy, which confirmed melanoma. Having caught this early, his life was spared from this particular lesion. I have never forgotten how important it is to watch out for melanomas — not only in adults, but also in children. Performing a complete skin exam entails not just examining sun-exposed areas, but also locations you’d least expect

to find melanoma, like the sole of a foot.”

Here are the “ABCDEs” to look out for in moles or other skin lesions: • Asymmetry: If you draw a line through the mole, both sides should match. If not, the lesion should be evaluated.

• Border: The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

• Color: Having a variety of colors is another warning sign. A melanoma may have brown, tan, black, red, or blue colors.

• Diameter: Melanomas are usually larger in diameter than the size of the eraser on a pencil, but they sometimes may be smaller when first detected.

• Evolving: Any change — in size, shape, color, elevation, or other trait — or any other symptom, such as bleeding, itching, or crusting, points to danger.

Your patients can also take advantage of educational resources from the Skin Cancer Foundation at www.skincancer.org.

Featuring: Daniel Amen, M.D.

REGISTER NOW! Daniel Amen, M.D., popular psychiatrist, nine-time New York Times bestselling author, and PBS television producer

■ ■ ■ ■ ■

Expanded to Four Days Groundbreaking Topics Acclaimed New Speakers CME/CEU/CE Credits Available Early Bird Rate Ends July 31

www.IMMH2015.com

Sign up for our newsletter to stay up-to-date!

SAN DIEGO PHYSICIAN.org

11

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

Managing the Computer in the Exam Room

by Helane Fronek, MD, FACP, FACPh

12

june 2015

At a recent doctor’s appointment, I was ushered into the exam room by an assistant.

She didn’t introduce herself and spent our time together with her back to me, facing a computer screen. As you can imagine, the interaction was far from warm. I felt unseen, uncared for, and less inclined to share information that wasn’t specifically requested.

By introducing herself, she might have created a warmer connection. However, the presence of the computer creates challenges that are more complicated to deal with.

No one likes the computer in the room.

Our patients don’t like it, and neither do most of us. It adds to our workload, gets in the way of direct communication with our patients, and creates the impression in the minds of our patients that we aren’t listening to them.

Project4:Layout 1

9/22/08

11:22 AM

But as much as we don’t like it, EHRs are here to stay. So what are we to do?

We can begin by being transparent with our feelings. We can let our patient know that we, too, are frustrated with our need to look at the computer, instead of at him — but that we are, in fact, listening.

We can also use the computer in a more transparent way. We can tell our patient what we’re doing, whether it’s entering her history, checking her meds, or looking over the note from a recent referral. That keeps her involved in the visit, rather than making her feel we’re more involved with the computer than with her. Periodically, we can paraphrase what we just entered into her record. We’ll make sure that we’ve gotten her history right and also make the point that we are listening.

Situating the computer so we can face the monitor and our patient at the same time is wise. Sometimes it’s just not possible to do that, but every effort should be made to arrange the room so our patients are not staring at our back.

When there are functions of the EHR that can be shared — looking over the trends in lab data, for instance — we can show the Page 1

Tracy Zweig Associates A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Locum Tenens Permanent Placement

monitor to our patient so that he understands that there is a benefit to this new occupant of our medical space.

Finally, we need to be aware of those times when our eyes must be on our patient.

If we want our patient to remember something we’re saying, when we are telling her something serious or difficult, or when our patient is sharing something emotional, eye contact is essential. Especially if we have just spent some time looking at the computer screen, our patient will notice this shift. She will sense the extra attention we are giving to the interaction and understand that, although we do spend more time looking away from her, we are listening and we are there with her when she needs us.

Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.wordpress.com.

Do you have a patient or family member suffering from alcohol or chemical DepenDency? clark smith, m.D., Director an addiction psychiatry, forensic and pain medicine expert.

V oi c e : 8 00-919-9141 or 805-641-9141 FAX : 805-641-9143

ContaCt us today for your free Consultation.

t z weig@ t r acyzweig.com w ww.t r acyzweig.com

recoveryWorkssD.com

recoveryWorks is reaDy to help.

Halt the damage caused by addiction and cure the underlying causes while developing life skills for future growth.

The RecoveryWorks intensive Outpatient Program includes: › Diagnostic evaluation, individual assessment and treatment plan › After work treatment program › Integrated family treatment program › Affordable treatment, most non-HMO insurance accepted

ECO ERY

858.530.9112

ORKS ECOVERY

ORKS

SAN DIEGO PHYSICIAN.org

13

Michael Bell - 12/14/2014

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Military Medicine

San Diego VA Medical Center staff practicing surgical procedures.

14

june 2015

by Jeffrey T. Gering, FACHE

D

uring our last Joint Commission accreditation survey, one member of the survey team made a very profound remark in describing our organization. He said that the VA San Diego Healthcare System is really the community hospital for veterans in San Diego County. Indeed, for the 79,000 veterans we provide care to and for the veteran community as a whole, we are their community hospital. Our mission is to provide the best care anywhere to veterans in San Diego and Imperial counties. The VA San Diego Healthcare System’s 2,900 employees collectively and individually are mission-driven, and we believe the care we provide helps express our nation’s gratitude.

We benchmark our quality against the top local hospitals — which is a very high standard — using the HHS’ HEDIS measures and the Joint Commission ORXYZ measures. Last fall, for the second year in a row, we were designated as one of four Top Performer hospitals in San Diego County as determined by The Joint Commission. Our clinicians and non-clinicians have a strong cultural impetus to connect with each veteran on a personal level on their health journey. This personal connection is of vital importance so that we are perceived not as a large government bureaucracy but as their partner in their healthcare.

With the significant increases in the number of San Diego veterans turning to the VA, providing timely care is a challenge. In response, we have forged strong partnerships with Naval Medical Center San Diego, UC San Diego Medical Center, and medical providers across San Diego County. With the influx of new patients, we are relying more and more on community providers to meet the demand for specialty services.

Our longstanding close medical school affiliation is one of our enduring strengths, and has enabled the San Diego VA to attract high-caliber physicians from across the country who seek to educate the nation’s future physicians and further the body of knowledge in the medical field via research. We have developed strong partnerships with nonprofit organizations, government entities, and the veteran community in carrying out our mission.

I believe the community spirit, collaboration, and support has enabled our VA to remain largely unscathed by the many scandals that have plagued much of the VA nationally.

We are grateful for the service every veteran has given and the sacrifice they have made for our great country, and we want to make sure we are fulfilling the commitment to those veterans in every interaction — through quality care and compassionate, respectful service. We will continue to focus on those values as we serve America’s heroes in 2015 and beyond.

Mr. Gering is director/CEO of the VA San Diego Healthcare System.

SAN DIEGO PHYSICIAN.org

15

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Letter From the VA San Diego Healthcare System Director

NORTH COUNTY’S NEWEST AND MOST

COVETED MEDICAL CAMPUS N O RT H C O A S T M E D I C A L P L A Z A P H A S E I

6 0 1 0 H i d d e n Va l l e y R o a d , C a r l s b a d , C A 9 2 0 1 1

EB LV D

CANN ON RD

LE COL

G

D RT R IRPO AR A M O L A P R CA

B LS D BLV AD

6 0 1 0 H i d d e n Va l l e y R o a d , C a r l s b a d , C A 9 2 0 1 1

FOR MORE INFORMATION, PLEASE VISIT

WWW.NORTHCOASTMEDICALPLAZA.COM

TENANTS WANT TO BE AT NORTH COAST!

Welcome to our Newest and Largest Tenant

SPACE IS GOING FAST AND THERE ARE ONLY 3 SUITES LEFT Join Our Tenants: Synovation Medical Group (Pain Management) Urgent Care (Dr. Bryan Doonan) • Carlsbad Imaging Center Great Smiles (Pediatric Dentistry & Orthodontics) • Price-Rite Pharmacy

16

May 2015

(20,792 SF)

NCMP PHASE I - 3 SUITES REMAINING NCMP PHASE II - 50,000 SF PROPOSED MOB N O RT H C O A S T M E D I C A L P L A Z A P H A S E I I

VISIBLE 363 FEET linear frontage on Palomar Airport Road (4 3 , 4 9 2 C A R S P E R DAY )

ACCESSIBLE 1 MILE from Interstate 5 ( 2 0 2 , 57 2 H O U S E H O L D S WITHIN 20 MINUTE DRIVE)

PA

AR LOM

AIR

A T RO POR

NCMP I 3 Suites remaining

D

S T R AT E G I C

NCMP II 50,000 SF coming 2016

North County’s most affluent demographics ( $ 9 8 , 614 AVG H O U S E H O L D INCOME IN A 5 MILE R ADIUS)

50,000 SF existing medical office building

50,000 SF

proposed build-to-suit opportunity

TRAVIS IVES Director Lic. # 1889097 858.334.4041 travis.ives@cushwake.com CUSHMAN & WAKEFIELD OF SAN DIEGO, INC. CA License No. 1329963 4747 Executive Drive, 9th Floor San Diego, CA 92121 SAN DIEGO PHYSICIAN.org

17

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Military Medicine

What Is Unique About the VA in San Diego?

by Robert M. Smith, MD

VA San Diego Healthcare System

L

incoln’s charge in the concluding paragraph of his second inaugural address was “to care for him who shall have borne the battle, and for his widow and his orphan.” This charge is both the motto of the VA and at the core of what makes the VA a unique place to work. Providing healthcare is a profession that has intrinsic satisfaction, but providing care to those who have served and sacrificed for our country has special meaning to the staff at the VA. It is that dedication to mission and service to those who have served that is a large part of what makes the VA a unique place to work.

Overall, the Department of Veterans Affairs is organized into separate administrations with responsibility for Veterans Benefits, National Cemeteries, and Veterans Health Care. The specific charges to the Veterans Health Administration (VHA) are the provision of medical care, support for medical education, support for medical research, and backup to the Department of

18

june 2015

San Diego has had a long and storied relationship with the military, and that special relationship also carries over to the VA San Diego Healthcare System.

Defense (DoD). San Diego has had a long and storied relationship with the military, and that special relationship also carries over to the VA San Diego Healthcare System (VASDHS).

In addition to its main hospital in La Jolla, VASDHS operates community clinics in six sites within San Diego County and an additional community clinic in Imperial County. VASDHS is categorized as a highly complex facility within the VA and provides comprehensive care to approximately 80,000 veterans and serves as a referral site for other VA Health Care Systems in Southern California and Southern Nevada for cardiothoracic surgery, neurosurgery, and other specialized care.

Recognized on three occasions by the Joint Commission for the Accreditation of Hospital Organizations as a “Top Performing Hospital,” VASDHS prides itself on the scope and quality of its services. As part of the ongoing efforts to assure comprehensive care for veterans who have served in the post-9/11 conflicts,

Dr. Smith, SDCMS-CMA member since 2015, is chief of staff/medical director for the VA San Diego Healthcare System.

SAN DIEGO PHYSICIAN.org

19

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

VASDHS opened the ASPIRE Center in 2014, which houses both a novel residential treatment program focusing on veterans suffering from post-traumatic stress or mild traumatic brain injury, as well as a regional center for Tele-Mental Health whose goal is to be able to deliver therapies to veterans regardless of their ability to travel to a clinic site for appointments.

VASDHS also serves as a major training site not only for physicians but also for student and post-graduate trainees in a wide range of disciplines, including nursing, pharmacy, dietetics, audiology, and dentistry, among others. With approximately $44 million in annual research expenditures, the VA San Diego Health Care System has one of the largest and most innovative research programs in the VA. Recent or ongoing projects include: • the coordination of the multicenter trial that resulted in the approval of Zostavax for prevention of shingles; • novel gene therapies for heart disease, spinal injury, and brain injury; • and trials demonstrating the equivalency of telehealth modalities in comparison to face-to-face visits.

VASDHS houses the Center for Excellence in Stress and Mental Health, which is one of three such centers nationally within the VA. The San Diego Center has been a leader in the development and implementation of evidence-based therapies for post-traumatic stress and continues to support groundbreaking research into the causes and therapies for this condition. In partnership with the Naval Medical Center San Diego, the San Diego VA has worked to develop seamless transition programs for seriously injured veterans and to assure ongoing shared care programs to assure consistency in therapy.

The VA as a whole and VASDHS in particular have been pioneers in the development and implementation of electronic health records (EHRs). While many healthcare systems are still working on full implementation of an EHR, the VA has had a fully implemented EHR since the late 1990s. Not only is the VA’s EHR seamless across the continuum of care between inpatient and outpatient locations within the San Diego VA Healthcare System, but that same record of care can be reviewed at any other VA location where a veteran might be traveling.

VASDHS was the key site for implementation of the VA EHR in Southern California and has continued to serve as a test and development site for electronic health technology for VHA. This development has included the early implementation of barcode technology for bedside inpatient medication administration, development of e-screening tools intended to allow patientgenerated information to be collected while in a waiting room, and ongoing efforts to expand wide-scale health information exchange with DoD records and with private sector healthcare providers.

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Military Medicine

Challenges Facing the VA in San Diego and Nationwide

by Robert M. Smith, MD

D

espite success in the quality of its clinical programs, the VA has been challenged nationally in its ability to provide timely care for veterans, particularly within geographic areas where there might not be a VA facility or where there has been disproportionate veteran population growth. These pressures are being felt across the nation but are particularly acute in San Diego.

In the face of overall downsizing of the military across the country, there has actually been an increasing military presence in the San Diego region and a concomitant increase in defenserelated programs, personnel, and expenditures. Because of the concentration of these programs, it should not come as a surprise that the San Diego region is one that has some of greatest numbers of separations from active duty and that many of those men and women separating from service choose to stay in San Diego and are eligible to receive healthcare from the VA. For this reason, the VA San Diego Health Care System (VASDHS) has one of the largest populations of enrollees who have been deployed to one of the Middle East conflicts and has seen consistent workload growth exceeding regional population growth rates as well as VA national averages. This growth is in contrast to national veteran population projections that predict a plateauing and then reduction in the total veteran population as veterans who served in World War II, Korea, or Vietnam age.

Funding for the VA facilities is distributed using a capitated model with corrections for patient acuity, but current-year funding is based on the workload from two years prior. For this reason, within regions such as San Diego that are experiencing consistent workload growth, local funding can lag behind the population care needs by 5–10% overall. This reality, coupled with constraints in capital investment, means that both funding and facility space resources have been limited.

Despite these challenges, the VASDHS has been working to stay in front of the workload growth by opening new sites of care (such as the Oceanside Community Clinic in 2010 and the Sorrento Valley Community Clinic in 2014), and expanding or relocating existing community clinics, such as those in Chula Vista and Mission Valley. Remodeling and expansion of the VA hospital itself has also been underway both to meet state-mandated seismic requirements (the VA was the first hospital in the county to meet current seismic standards) and to meet the workload growth.

Funding for a new Spinal Cord Injury Center with a co-located Skilled Nursing Home Unit was part of the president’s budget and

20

june 2015

Speaking with a patient in the San Diego VA Medical Center Community Living Center.

will allow construction of a new building on a part of the hospital campus. This new building is intended to offload work currently requiring space in the main hospital building to allow expansion of other programs.

While workload growth overall has been a challenge, an even larger challenge has been the disproportionate growth in the need for certain services, notably those associated with injuries from recent military service. Rates of workload growth in VASDHS mental health programs have exceeded 10% per year over the past five years.

Veterans of recent conflicts have often been engaged in multiple deployments and exposed to circumstances creating post-traumatic stress or concussive injuries leading to traumatic brain injury.

The positive counterbalance to this trend is that evidencebased therapies for PTSD (many developed at the San Diego VA) have a much greater success rate than their historical counterparts. Prolonged exposure, cognitive processing, and eye movement desensitization therapy have demonstrated effectiveness when compared to other treatments. The challenge

for VASDHS has been to recruit sufficient numbers of staff to deliver those therapies when needed by veterans.

Most recently, the Veterans Access Choice and Accountability Act of 2014 created new options for veterans by authorizing care within the community for veterans who live more than 40 miles from a VA facility or who cannot be scheduled for needed care within 30 days of the date clinically indicated for that care. The Veterans Choice Program, which began Nov. 5, 2014, was the outcome of that legislation. As defined by the act, the Choice Program allows veterans whose care is delayed to request care through an external administrator, TriWest Healthcare Alliance, who then arranges for that care at a contracted provider. This program has ramped up very quickly but not without a fair amount of confusion among veterans and community providers about what the program means and how to access it.

Dr. Smith, SDCMS-CMA member since 2015, is chief of staff/medical director for the VA San Diego Healthcare System.

SAN DIEGO PHYSICIAN.org

21

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Most recently, the Veterans Access Choice and Accountability Act of 2014 created new options for veterans by authorizing care within the community for veterans who live more than 40 miles from a VA facility or who cannot be scheduled for needed care within 30 days of the date clinically indicated for that care.

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Military Medicine

Meeting with a patient at the VA San Diego Oceanside clinic.

The Practice of Primary Care in the Veterans Health Administration Setting

by VA San Diego Medical Staff

22

june 2015

The once solitary status of a small number of generalists has given way to a thriving interdisciplinary community committed to team-based primary care.

W

hen I first set out on my journey in internal medicine, I did not envision a career serving veterans. But as I gained experience in the Veterans Health Administration (VHA) settings both as a medical student (UC San Francisco) and a resident (UC San Diego), I was drawn to the veterans I cared for and recognized that my vision for a generalist career was well suited to the unique opportunities provided by the VHA. In the years since I accepted my first — and only — career position in 1992 at the VA San Diego Healthcare System, my professional journey has mirrored changes in VHA that have transformed its approach to the delivery of primary care.

In the beginning (the early 1990s), VHA was a system of hospitals that delivered inpatient and specialty care with a limited capacity for primary care. Visionary leadership — including then Under-Secretary Dr. Ken Kizer — recognized the need to build an integrated healthcare system and began investing in primary care capacity. Ensuing years have witnessed rapid expansion in primary care personnel and enrolled patients, expansion that continues to the present. This has transformed the experience of veterans, who now relate to an identified primary care provider who is supported by an interdisciplinary team of nurses, clerks and pharmacists. The once-solitary status of a small number

SAN DIEGO PHYSICIAN.org

23

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

of generalists has given way to a thriving interdisciplinary community committed to team-based primary care.

The commitment to primary care growth was coupled to a commitment to access. In the late 1990s, VHA partnered with the Institute for Healthcare Improvement to implement accessimprovement strategies. Since that time, VA San Diego’s primary care program has aimed to provide timely access to veterans in response to routine and urgent concerns. Through a collaborative approach involving facility leadership, practice managers, and frontline clinicians, we have succeeded in creating practices with available appointments usually the same or next day. “Open” access to care is not only helpful to our patients but is enhancing the experience of clinicians.

My career journey has paralleled a remarkable transformation of VHA’s approach to health information. At the beginning of my career, I struggled through a pile of thick charts filled with sometimes difficult-to-decipher handwriting. Patient information was fragmented and difficult to access, making the care of complex patients challenging. An early adopter of the electronic health record (EHR), VHA began in the late 1990s to “go paperless.”

My early experience of thick charts has been succeeded by an environment in which virtually every action related to patient care (scheduling, orders, charting) is captured electronically. This has allowed VHA at every level — national, regional, and local — to mine extensive data to track and improve quality and to develop proactive approaches customized to patients’ personal health needs. New innovations are focusing especially on the veterans’ experience: secure messaging (email access to clinicians and teams), telehealth (disease-specific monitoring of health status using telephone-based systems), and the novel virtual modalities that harness the capacities of smart phones and other technologies accessible to patients.

My early determination to pursue a career in VHA has been justified by my experience in a dynamic organization that has grown and innovated to improve access to and quality of care.

In the context of great change, however, the most important and satisfying aspect of working in VHA is constant: the veteran. It has always been and continues to be a high privilege to work with an outstanding group of patients unified by their common valor, patriotism, and self-sacrifice. I have marveled listening to their stories that span our country’s military history, from a World War I veteran encountered as an intern to others from every conflict since: World War II, Korea, Vietnam, Desert Storm, the Global War on Terrorism (Operation Iraqi Freedom, Operation Enduring Freedom, Operation New Dawn). To serve them is a profound honor.

H e a lt h c a r e F i n a n c i n g

Doing the Medi-Cal Math

by Sherry L. Franklin, MD

12.2 MILLION

Californians now have MediCal. For simplicity, that is 1 in 3 Californians. Unfortunately, 2 in 3 Californians, as well as many people working to assure coverage for these patients, still believe that Medi-Cal is for very few people and should simply be left for the physician community to provide as a courtesy.

The problem has had some light shed in a recent state auditor’s report, requested by the Legislature and released June 16th of this year. We can thank the legislative teams at SDCMS and CMA for the illumination

and increased attention. I would also like to point out that your San Diego leaders sat in on several meetings during the inception of Covered California and warned Mr. Peter Lee (executive director of the board) of this as a current crisis of healthcare that would only be exacerbated by the expansion in numbers if not addressed. If I might quote Mr. Lee, “This is not something that the board is here to manage.

This will be left to the current overseeing entity, the Department of Managed Healthcare.”

The audit report conclusion, signed by State Auditor

Elaine Howel, was as expected, “Without verifying the data received from health plans, Health Care Services cannot ensure that health plans had adequate provider networks to serve Medi-Cal beneficiaries.”

In response, Jennifer Kent, director of the Department of Health Care Services, disagreed (SHOCKING). Ms. Kent states that her department has many ways to monitor Medi-Cal besides reviewing doctor directories. Further, Ms. Kent reports, “To date, we have not identified disparities in plan adherence to these network adequacy requirements, and, in fact, most are surpassing them.”

Thanks to Paul Sisson at The San Diego Union-Tribune, public reaction to the audit was reported swiftly. Paul is always very clear that the solution to the problem is to improve the rate of payment to physicians seeing Medi-Cal patients. June 15th of this year, the Legislature pledged to cancel a previous 10% cut to Medi-Cal reimbursements. But even with that action, Medi-Cal Continued on page 28

24

june 2015

SATURDAY, NOVEMBER 14 FLETCHER COVE, SOLANA BEACH

Physicians: You are a Health Role Model Model healthy living to patients and staff by inviting them to JOIN YOU at San Diego County Medical Society Foundation’s Solana Beach Sunset 5K Run/Walk November 14 at 3 PM! Lead a team of 20 or more patients and staff and receive FREE your own team t-shirts with your practice/team identification.

For more information please contact Carlos Medina at carlos.medina@sdcms.org or 858.565.7930 Benefiting

Improving Health…Changing Lives

In Partnership With

PRESENTED BY:

5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.sdcmsf.org 858.300.2777 SAN DIEGO PHYSICIAN.org

25

classifieds PHYSICIAN POSITIONS WANTED SHORT-TERM LOCUMS AVAILABLE! D. (Doyle) Eugene Johnson, family physician with a wealth of experience, looking for short-term locums, preferably in North County. Have been a full-time practicing certified family physician for 50+ years and would like to continue seeing patients on a parttime basis. Had one of the largest solo family practices in San Diego for 25+ years. Excellent references! Continually certified in family practice, ACLS, BLS, regularly use computerized records. Please email d.eugenejohnsonMD@ gmail.com with particulars. [301] PHYSICIAN POSITIONS AVAILABLE PART-TIME URGENT CARE PHYSICIAN OR PA: Privately owned and operated urgent care located in San Diego County seeking a physician or PA with at least two years urgent care experience. Conveniently located off I-15. Please send CV to kevin@mdtodayurgentcare.com or fax to (858) 6221417. [370a] FAMILY PRACTICE PHYSICIAN — FT / URGENT CARE PHYSICIAN — PER DIEM: Arch Health Partners is an award-winning medical foundation in North San Diego County. Family Practice hours 8:00am–5:00pm. Urgent Care hours 9:00am–9:00pm. Send CV to catherine.jones@ archhealth.org or fax to (858) 618-5820. [366] SPANISH-SPEAKING PRIMARY CARE PROVIDER: Spanish-speaking family medicine or internal medicine physician sought for Chula Vista group practice. The practice is growing and needs to hire two new physicians over the next year and a half. Position is employed with salary, benefits, and bonus. The group has 10 physicians plus mid-levels, EMR. See patients in office or urgent care setting. Stable office with little to no turnover of employees. Community care with a large multi-ethnic patient base. Autonomy in scheduling is a great part of the practice. Contact Rick at (757) 460-1299 or at rick@medstaffmatters.com. Visit www.medstaffmatters.com. [364] SEEKING EXPERIENCED HOSPITALISTS: Prestigious, 400-physician, multispecialty group seeks experienced hospitalists to be part of an established hospitalists program at Scripps Memorial Hospital, La Jolla. Board-certified internal medicine physicians with superior clinical skills and willing to work in a team environment. Excellent communication skills a must. Outstanding salary, bonus, and benefits. Please send CV to Yvonne Montelius/XiMED Hospitalists at ymontelius@ ximedinc.com or fax to (858) 587-1642. [363] PEDIATRIC NEUROLOGY: Sharp Rees-Stealy Medical Group is looking for a part-time BC/BE pediatric neurologist. This position requires the ability to read EEGs and participation in after-hours on-call coverage. Unique opportunity for professional and personal fulfillment. Please send CV to Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 2334730. Email: lori.miller@sharp.com. [359] OPHTHALMOLOGY: BC/BE fellowship-trained glaucoma specialist needed to join collegial and well established ophthalmology division with all major sub-specialties, general ophthalmology, and optometry represented. Fluency in Spanish is a plus. Competitive compensation and benefits package, commensurate with training. Unique opportunity for professional and personal fulfillment. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com.

[360] FAMILY MEDICINE: Sharp Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking full-time or half-time (job share) BC/BE family medicine physicians to join our staff. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori. miller@sharp.com. [361] FULL-TIME PEDIATRIC POSITION AVAILABLE: Mountain Health & Community Services (MHCS) is seeking an energetic and enthusiastic pediatrician to help us start our new Pediatric Clinic in Alpine, near beautiful San Diego beaches,

mountains, hiking trails, fishing, and great schools. Rare opportunity to start and grow your own practice in an exciting, growing community health organization. We offer excellent benefits, NHCS loan repayment eligibility, and competitive salary. Qualifications: License from the State of California (MD or DO); current CPR; board certified or board eligible. Salary negotiable. If interested, please submit your CV to Tabitha Findahl at tabitha.findahl@mtnhealth.org, or call CMO, Dr. Blain, at cell (619) 374-7221 for more information. [357] FULL-TIME FAMILY MEDICINE POSITION AVAILABLE: Mountain Health & Community Services (MHCS) is seeking energetic and enthusiastic family medicine providers at several of our clinics, near beautiful San Diego beaches, mountains, hiking trails, fishing, and great schools. We offer excellent benefits, NHCS loan repayment eligibility, and competitive salary. Qualifications: License from the State of California (MD or DO); current CPR; board certified or board eligible. Salary negotiable. If interested, please submit your CV to Tabitha Findahl at tabitha.findahl@mtnhealth.org, or call CMO, Dr. Blain, at cell (619) 374-7221 for more information. [356] PART–TIME CARDIOLOGIST NEEDED for outpatient cardiac consults and follow-ups in an established cardiology practice in East County. Call Debbie at (619) 6680039. [354] PSYCHIATRISTS NEEDED: Part-time or full-time psychiatrists needed to work at San Diego County jails. Work as an independent contractor with very competitive pay.

Contact Steve at steve@cpmedgroup.com or at (619) 8853907. [353] PHYSICIAN WANTED: Semi-retired or working part time elsewhere to fill in for vacations, long weekends for active family practice, urgent care, occupational medicine practice in Mission Valley area. No weekends or nights. Salary negotiable. Call cell phone at (619) 846-8156 or email at drpohl@ missionvalleymedical.com. [351] FULL-TIME PRIMARY CARE PEDIATRIC POSITION AVAILABLE in beautiful San Diego, California, to provide coverage for newborn care in Maternal Child Health Unit and community outpatient pediatric clinic. Job duty includes supervision and teaching of residents and medical students.

Average 20–25 patients daily. No evening or weekend calls or attendance of deliveries. Centrally located in San Diego with easy access to gorgeous beaches, parks, hiking trails, San Diego Zoo, and fine dining. Opening available now. Must be certified for PALS and NRP. BC or BE. An additional parttime position is also available. Please submit inquiry and CV to Kam.Cherise@scrippshealth.org. [350] PHYSICIAN FAMILY MEDICINE: North County Health Services (NCHS); Job Title: Physician Family Medicine; Location: Riverside, CA. An established, award-winning organization.

Our employees work smarter, and we are looking to hire the best talent. We look for people who embrace diversity, love challenges, and welcome big changes. We have a need for a lead physician to provide comprehensive medical services for patients of NCHS. Qualifications: License from the state of California (MD or DO); CPR; Minimum two years of experience; Board certified or board eligible. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact: Araceli Mercado, araceli.mercado@nchshealth.org. [349] GENERAL, FAMILY, OR INTERNAL MEDICINE PHYSICIAN NEEDED IMMEDIATELY: This opening is an independent contractor position. We are a house-call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Monday–Friday, 10–12 patients per day. No rounds or hospital duties. If interested please submit your CV to julie@sandiegomobiledoctor.com. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [348] INTERNAL MEDICINE PHYSICIAN WANTED — PRIVATE PRACTICE OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unusual and exceptionally attractive outpatient IM opportunity newly available in North San Diego County. This is a rare opportunity to experience the best of private practice with the added bonus of flexibility and simplicity. Work environment is a highly regarded singlespecialty group with >30 years in the community. Office staff are exceptional, quality of patient care also exception-

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

26

june 2015

al, and office location is easily accessible from anywhere in the county. Multiple scheduling options available, allowing for optimal life-work balance. Seeking BC or BE applicants.

Interested? Please email CV to portofino3@aol.com or call (619) 248-2324. [345] SEEKING PART-TIME PRIMARY CARE / URGENT CARE PHYSICIAN: For a busy, well-established primary care family practice / urgent care medical practice in Pacific Beach.

This position could lead to an associate physician position of the practice for the right person. The candidate must be able to provide compassionate care in a fast-paced environment. Knowledge of musculoskeletal medicine and X-Ray is required. Must be able to suture and have experience with wound care. We have a state-of-the-art medical facility.

Please send your CV in confidence for consideration to pbyrnes@andersonmedicalcenter.com. Compensation: Excellent Pay Rate [317] SEEKING A FULL-TIME INTERNAL MEDICINE PHYSICIAN: Palomar Medical Group is seeking a full-time internal medicine physician to join our well-established, multi-specialty practice. This position involves the practice of primary care internal medicine in an office setting. PMG has just been awarded PCMH status by the NCQA. All applicants must hold current California license and board certification. Please send all inquires and CVs to lware@palmedinc.com. [340] BE IN CHARGE OF YOUR OWN DESTINY! If you are a general internist interested in becoming your own boss, this may be the opportunity for you. Patients from a recently retired general internist on the campus of Scripps La Jolla need a new physician. Share an office and overhead with another general internist who is well established on the campus and will help you grow your practice, as well as help in all the business aspects of private practice. Guaranteed salary for the first year, allowing you time to build up your panel.

Great opportunity to practice medicine the way you want to.

Interested? Email XimedMD@gmail.com. [337] PHYSICIAN NEEDED: Seeking a California-licensed physician to cover contrast injections at an imaging center in Imperial County, 2407 Marshall Ave., Suite A, Imperial, CA 92251. Please call (760) 730-3536 for more details, or fax (760) 720-4833. [335] SEEKING FULL-TIME BC/BE EMERGENCY MEDICINE OR FAMILY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking full-time BC/BE emergency medicine or family 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. [330] PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org. [046a] SEEKING A FOOT/ANKLE SPECIALIST: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broadbased primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to lisas@sdsm.net. [326] SEEKING URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician.

Good pay and working conditions along with the potential to become a full-time position. Please send CV to jeff@eastcountyurgentcare.com. [306] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330

or email CV to drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [037] PHYSICIANS NEEDED: Internal medicine and family medicine physician positions currently open. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County with openings for full-time, part-time, and per-diem positions. Current CA and DEA licenses required. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@ vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EEO Employer / Vet / Disabled / AA [912] OFFICE SPACE AVAILABLE MEDICAL OFFICE SPACE AVAILABLE IMMEDIATELY at 9339 Genessee, San Diego, CA. 1,800ft2 at $3.60/sf. Buildout required, TI available. Please contact Synergy Specialist Medical Group at (858) 412-6080. [362] SHARED SUBLET AVAILABLE: Large, nicely furnished office space available for shared sublet 1–2 days per week, on Scripps Encinitas campus. Contact Frank at (858) 3619377. [358] HILLCREST OFFICE SPACE: Office space available in beautiful, updated Hillcrest medical office that also houses a fully accredited ambulatory surgery center. Great opportunity for a plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatological surgeon. Office is conveniently located minutes from freeway access and downtown San Diego. Please contact via email at info@drhilinski.com. [355] OFFICE SUITE — APROXIMATELY 1,650 SQ. FT. IN OFFICE BUILDING ADJACENT TO SHARP CORONADO HOSPITAL: Large, newly refurbished waiting area, a business office and six exam /consultation rooms. The space is ideal for primary care physicians or a specialty group wishing to expand to Coronado. Pharmacy and parking are available on premises. The suite is largely furnished, and tenant improvements are available depending on the length of the lease. Part-time tenants are available to share lease expenses. Base rent $2.38 / sq. ft / mo, $1.28 / sq. ft. / mo operating expenses. Email John Kerley, MD, at kerjo100@gmail.com or call (619) 435-2060. [344] NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free parking for patients and staff, conference room in building. Several minutes from Sharp Memorial Hospital and Children’s Hospital. Convenient freeway access to 163 and 805. Multiple half-day clinics available days, evenings, and weekends. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more information. [343]

ances • Existing tenants include imaging, pharmacy, orthodontics, urgent care, and pain management • Highly visible to over 43,000 vehicles per day along Palomar Airport Road • Interstate 5 is less than a mile away providing access to over 200,000 households within a 20-minute drive • North County’s most affluent demographic with average household income of $98,614 within a 5-mile radius. For further information, please contact: TRAVIS IVES, Cushman & Wakefield, (858) 334-4041, travis.ives@cushwake.com, Lic. # 1889097 [332]

variety of patients. SDMG envisions an incoming nurse practitioner who has direct experience with the practice of internal medicine, is capable of immediate management of patients, can quickly learn and use SDMG’s EMR (eClinicalWorks), is positive, outgoing, compassionate, and a hard worker. The position is Monday through Friday, 8am–5pm (some flexibility) with a competitive six-figure salary, health benefits, retirement benefits, life insurance, paid continuing education, and paid vacation. There is no call. Interested applicants, please send your resume to sdmg@sdmedgroup.com. [365]

ALISO VIEJO — 5 JOURNEY: Multi Tenant Medical Building with highly successful medical and dental practices. 2 ground floor medical spaces approx. 2,135, 2,225 & 1,742 rsf available for lease. $2.75 PSF NNN. Beautifully designed. Tenant Improvement Allowance to customize suite is available. For further information please contact Lucia Shamshoian @ 769931-1134x13 or Shamshoian@coveycommercial.com. [298]

PSYCHIATRIC NURSE PRACTITIONER: Part- or full-time psychiatric nurse practitioner needed to work at San Diego County jails. Work as an independent contractor with very competitive pay. Contact Steve at steve@cpmedgroup.com or at (619) 885-3907. [352]

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/UTC area. Reception and staff may be available. Complete ultrasound lab on site for scans or studies. Full-day or half-day timeslots. For more information, call Irene at (619) 840-2400. [154] NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Welldesigned office space available, 2,100SF, at the 477-D Bldg.

Occupied by Vascular & General Surgeons. Excellent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day. Will consider subleasing the entire suite, totally furnished, if there is a larger group interest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates.

Email inquiries to kathysutton41@yahoo.com. [173]

PSYCHIATRIST WANTED TO SUBLEASE OFFICE in a 3700ft2 beautiful cardiology group practice office next to Tri-City Medical Center in Oceanside, CA. Consultation room available with access to a new BRAINSWAY DEEP TMS machine with H1 and H10 coils to be used for drug-refractory MDD, and chronic pain or MS syndromes. Pease call Kenneth Carr, MD, at (760) 941-9440 or Yvonne Fraser, Esq., at (619) 368-2180. [339]

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]

WOMEN’S HEALTH / WELLNESS OFFICE HAS SPACE AVAILABLE FOR SUBLEASE: Exam room, office, and/or shared staff optional. Fully furnished exam rooms available and ready for use. Location features onsite billing, reception, medical assistants, potential use of in-office procedure room, and a rooftop lounge. If you are interested, please reply with the heading “Space for Sublease” outlining the details of space and/or staff use desired, with your contact information, and we will contact you to set up a showing. Reply to Mrs. Kim at cvwh858@gmail.com. [288]

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]

MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE/ SHARE IN UTC/LA JOLLA AREA: Established orthopedic surgeon seeks tenant to share office space. 4675ft2 in Chancellor Park, near Scripps Memorial Hospital. Completely rebuilt in 2009. Six exam rooms, digital X-ray onsite.

Beautiful finishings, spacious waiting room, conference room, break room. Ample space for support staff and a private office for physician. Available immediately, full or part time. Ideal for primary or satellite office. Excellent freeway access (1-5 and 805), first-floor suite located off lobby near main building entrance. For further information, please contact Georgana Bradley at (858) 457-0050 or at gbradley@ jpbamc.com. [334] CARLSBAD MEDICAL OFFICE FOR LEASE: • Space from 1,000–50,000 SF • Competitive lease rates and TI allow-

NONPHYSICIAN POSITIONS AVAILABLE PART-TIME URGENT CARE PHYSICIAN OR PA: Privately owned and operated urgent care located in San Diego County seeking a physician or PA with at least two years urgent care experience. Conveniently located off I-15. Please send CV to kevin@mdtodayurgentcare.com or fax to (858) 6221417. [370b] SAN DIEGO MEDICAL GROUP SEEKS A NURSE PRACTITIONER: San Diego Medical Group (SDMG) is a well established and thriving internal medicine private practice located in Hillcrest directly across the street from Scripps Mercy Hospital in the prestigious Mercy Medical Building. The office is staffed by two internists, one nurse practitioner, and seven staff. SDMG seeks another experienced, full-time nurse practitioner to manage patients in our growing practice. This is a unique opportunity to work in a small private practice with seasoned, excellent providers and staff in an efficient, cohesive work environment providing medical care to a wide

SEEKING PA for well-established orthopaedic surgeon practice in San Diego. Orthopedic clinic experience. Prefer full-time, will consider part-time. Please contact Nancy at (619) 980-9801 or at nantowne@yahoo.com. [347] DENTIST: North County Health Services; Job Title: Dentist; Location: San Marcos, CA. An established, award-winning organization. A top place to work. A mission to serve. Come be awesome with us! We’re looking for people who support our mission and who want to be employed at NCHS — and not just for right now, but for the long term. We have a need for a talented dentist! Qualifications: CA DDS or DMD license; CPR, NRP; two years of experience. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact Araceli Mercado at araceli.mercado@ nchs-health.org or at (760) 736-6780. [341] SEEKING PA/NP AND RN: Medical spa in the Del Mar / Solana Beach area is seeking PA/NP and RN. Should have experience with laser hair removal, IPL, CO2 laser, Botox and fillers, and sales. Positive attitude, ability to multitask, perform patient treatment, sales, consultations, effective communicator, work in a team environment, focused on client care, knowledge of lasers and laser theory, quick learner, self motivated. PA/NP will perform consultations and goodfaith examinations. Minimum requirements: PA, NP, RN California license. This is a part-time position, 1–2 days a week.

Please email résumé / cover letter to synergyamasb@gmail. com or fax to (858) 259-0864. [289] RURAL HEALTH CLINIC MANAGER: Manager will provide management, planning, coordination, and expansion of southern California rural health clinics. Manager is responsible for supervision of clinic staff, billing procedures, patient services, and regulatory and reporting requirements, including compliance with State and CMS. Previous experience with management of rural health clinic is required. Full time with benefits. Must have at least three years experience in RHC clinic setting and/or BA. Resume to: P.O. Box 3632, El Centro, CA 92244. [333] FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org. [046b] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs. com. Visit www.thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 9925330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [038] MEDICAL EQUIPMENT / OFFICE FURNITURE INTERNAL MEDICINE OFFICE CLOSING: Small private practice closing on 8/29/15, and all items for sale, including medical equipment, office furniture, office equipment, office supplies, and medical supplies. Includes: Marquette GE EKG, Welch Allyn spirometer, ophthalmoscopes, Baumonometers, exam tables, scales, computers, waiting room furniture, bookshelves, desks, chart racks, etc. Please call Cathy for more information at (619) 829-5583. [367]

SAN DIEGO PHYSICIAN.org

27

H e a lt h c a r e F i n a n c i n g

I live and breathe for the day that all San Diego physicians know how much work we do at the legislative level to improve care for all Californians and the physicians who tirelessly care for them.

Continued from page 24

will continue to have one of the lowest reimbursement rates among similar programs in the United States. So, let’s put this into words everyone can understand …

For a 15-minute visit with a child, I am paid approximately $24 (this is assuming that the 10% cut remains cancelled). If I see 20 patients, this provides a reimbursement rate of $480 a day. Let’s assume I double-book and see 40 patients instead of 20 (we will assume that I am not ready to scream or cry by the end of the day). Now we are up to $960 for the workday (all 14 hours of it, including lab review, prior authorization for medications, denials for almost everything, and EMR documentation). Ok, let’s get back to reality. I can’t see 40 patients a day. So now we’re back to our 20 patients so that I can provide good care to my patients.

28

June 2015

Now imagine I pay three staff people: one person to do all the paperwork associated with delivering care, prior authorizations for medications, prior authorizations for each and every managed Medi-Cal visit, eligibility assurance for insurance within three days of the appointment as is required by law, etc.; a second person to sit at the front, answer the phone, check patients in and out, collect copays and money due for deductibles (which is near impossible to collect); and a third person to run the business side and take care of the IT associated with the practice.

Then imagine I have to hire a billing company to submit all the claims and fight for payment if the insurance company decides not to pay.

Then imagine I have to pay for an electronic medical record.

Then imagine I pay for a patient portal so that patients can get into the medical record.

Then imagine I pay rent for the office space.

Then imagine I have to purchase medical supplies.

Then imagine that I purchase paper, toner, printers, screens, ergonomic keyboards, and mice.

Then imagine the Medical Board wants me to pay a huge fee to remain board certified.

Then imagine that I am required to pay for continuing medical education each year.

Then imagine the money paid for maintenance of certification (don’t get me started on this one … moving on).

Then imagine I pay for malpractice insurance.

Then imagine that I pay healthcare for my employees.

Then imagine that I pay bonuses to my employees.

Then imagine the employees may want raises each year (well deserved).

Then imagine I might want to be paid a little bit so that I can

support my own family.

Then imagine I’m paid $24 a patient, $480 a day, to do all of this. Sadly, there is no imagining this in California, resulting in an access to care crisis for 1 in 3 Californians.

CMA, with a strong coalition, has pushed for higher Medi-Cal reimbursements to physicians so that more of us are able to afford to see these 12.2 million or 1 in 3 Californians. We have long understood that Medi-Cal rates must be raised to at least Medicare rates. The coalition is committed to raising the tax on tobacco, either through legislation or via a ballot measure. CMA has also sponsored legislation (SB 243) that repeals the recent cuts to Medi-Cal provider reimbursement rates, increases reimbursement rates for most outpatient providers to Medicare levels (for both fee-for-service and Medi-Cal managed care providers), and increases hospital Medi-Cal rates on a one-time basis, requiring annual increases thereafter.

For those who bother to read yet another article on the problems we face in healthcare, I live and breathe for the day that all San Diego physicians know how much work we do at the legislative level to improve care for all Californians and the physicians who tirelessly care for them.

Dr. Franklin, 14-year member of SDCMS-CMA, is a former president of SDCMS and its current communications chair.

Success.

It’s what California’s finest physicians strive for... and what CAP can help you achieve.

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

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

Request your free electronic or hard copy today!

800-356-5672 CAPphysicians.com/icd10now