OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION
Plus: Making Your Voice Heard HOW TO BE AN EFFECTIVE HEALTH ADVOCATE S E P/O C T 2 0 1 9
TIPS DOCTORS AND THE REST OF US CAN USE TO REACH RETIREMENT GOALS Gavin Shea, SVP, National Director, Healthcare
In my 18 years of helping health care professionals with financing options, I’ve learned that many doctors struggle to build a nest egg – just like many average Americans. One reason for this could be a higher debt load due to student loans. The average debt for medical school graduates in the U. S. in 2017 was $192,000, up from $173,000 in 2011, and according to the American Dental Education Association, the average student loan debt for a 2017 dental school graduate was $287,3331. Additionally, many physicians don’t start earning or saving until their 30s, meaning fewer years of compounded savings than other professionals who may enter the workforce sooner. The good news is that achieving retirement goals is doable through planning, discipline, and working with the right people. Here are some tips to consider with your financial advisor when preparing for your next chapter of life. INVEST IN A RETIREMENT PLAN | In the Wells Fargo retirement
study, 36 percent of interviewees said they didn’t have a retirement savings plan. Meanwhile, people with 401 (K) plans, on average, started saving for retirement earlier and saved more consistently than those without them. Plans like Simplified Employee Pension IRAs (SEP IRAs) and small business 401(k)s enable you to accumulate wealth on top of the assets from your business and may offer tax benefits*. Other tools like non-qualified retirement plans can help you retain employees during a transition, as well as build retirement.
CREATE A REALISTIC RETIREMENT BUDGET | Your planning should include a budget for your retirement lifestyle. Health care expenses can be higher in retirement than while in the workforce. A 2018 analysis by the Kaiser Family Foundation estimates that out-ofpocket health care costs for Medicare beneficiaries are likely to take up half of their average Social Security income by 2030. Moreover, 50 percent of retirees in a Wells Fargo study said their expenditures on healthcare are higher than anticipated. Life expectancy should also factor in, as many advisors recommend that people who retire at age 65 should plan to live 30 years in retirement. Work with a financial advisor to ensure your retirement plan helps you achieve your goals for the future. CONSULT WITH A TAX ADVISOR | Talking to a tax professional can
help you effectively manage your investments from a tax perspective. A tax expert can help you maximize retirement income by protecting your retirement funds and investments from capital gains taxes. Using tax law to your benefit is a great way to help you reach your retirement goals. Remember, the longer you wait to start saving, the more you’ll need to save. Your future retirement options depend on you making the right choices now.
Running a small business takes big insights There are a lot of moving parts to running a successful small business — optimizing cash flow, increasing efficiency, and growing revenue. You’ll find the strategies and solutions you need to run your business better at wellsfargoworks.com. Let’s get started. Visit your local branch or find a time that works for you at wellsfargo.com/appointments.
Gavin Shea is Senior Vice President, National Director, Healthcare for Wells Fargo Practice Finance, the only practice and commercial real estate lender recommended for members of the American Dental Association. *Wells Fargo Practice Finance does not provide tax or legal advice. Please see your tax advisor to determine how this information may apply to your own situation. This information and any information provided by employees and representatives of Wells Fargo Bank, N.A. and its affiliates is intended to constitute investment education under U.S. Department of Labor guidance and does not constitute “investment advice” under the Employee Retirement Income Security Act of 1974. Neither Wells Fargo nor any of its affiliates, including employees, and representatives, may provide “investment advice” to any participant or beneficiary regarding the investment of assets in your employer-sponsored retirement plan. Please contact an investment, financial, tax, or legal advisor regarding your specific situation. The information shown is not intended to provide any suggestion that you engage in or refrain from taking a particular course of action.
© 2019 Wells Fargo Bank, N.A. All rights reserved. IHA-24683
EDITOR Sheri Carr | editor@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com
VOLUME 150 ISSUE 5 | SEP/OCT 2019
EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org LACMA OFFICERS PRESIDENT | Sion Roy, MD PRESIDENT-ELECT | Diana Shiba, MD TREASURER | Jeffery Lee, MD SECRETARY | Omer Deen, MD IMMEDIATE PAST-PRESIDENT | C. Freeman, MD, MBA, FAPA LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD (1) Jack Chou, MD, CMA Trustee Samuel Fink, MD (6) Jerry P. Abraham, MD, MPH, Chair of the LACMA Delegation Sunny Jha, MD (1) Peter Richman, MD, CMA Trustee Karen Sibert, MD (5) Valencia Walker, MD (5) COUNCILORS Robert Bitonte, MD, JD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Marc Mendes, MD (D6) David Hopp, MD (D7) Steven Sawelson, MD (D9) Christine Phan, MD (D10) William Hale, MD (D14) Nancy Ellerbroek, MD (D17) Lisa Firestone, MD (SCPMG) Roxana Yoonessi, MD, JD (SCPMG) Heather Silverman, MD (SSGPF) Muntu Davis, MD (LA County) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Anna Yap, MD (Resident Councilor) Cecilia Leggett, MD (Alt. Resident Councilor) Ali Tafreshi (Student Councilor, USC) Stacy Songco (Alt. Medical Student Councilor, UCLA)
LACMA’s Board of Directors consists of a group of 31 dedicated physicians working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, VP of Operations and Strategic Initiatives, at lisa@lacmanet.org or 213-226-0304. SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Los Angeles Medicine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Los Angeles Medicine, 10755 Scripps Poway Parkway, Suite 615 | San Diego, CA 92131. To inform us of a delivery problem, email editors@physiciansnewsnetwork.com. Acceptance of advertising in Los Angeles Medicine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Los Angeles Medicine, LACMA Services Inc. or the Los Angeles County Medical Association. Los Angeles Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Los Angeles Medicine is not responsible for unsolicited manuscripts.
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PRESIDENT’S LETTER
Sion Roy, MD
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A MESSAGE FROM LACMA CEO
Gustavo Friederichsen
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Does Your Healthcare Practice Have a Data Breach Emergency Plan?
Los Angeles Medicine (ISSN 1533-9254) is published bimonthly (Jan/Feb, Mar/Apr, May/Jun & Jul/Aug, Sep/Oct, Nov/ Dec) by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 1055 West 7th Street, Suite 2290 Los Angeles, CA 90017-2548. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Copyright ©2017 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Los Angeles Medicine, 1055 West 7th Street, Suite 2290, Los Angeles, CA 90017. Advertising rates and information sent upon request.
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LACMA PRESIDENT
S I O N R O Y, M D
Taking Action The beginning of my presidency has been fast moving, and I’m excited about the direction of our organization. In terms of our Docs4LA initiative, we continue to meet with legislators to educate them about our organization and interest in allying on a wide breadth of legislation that positively impacts the healthcare outcomes of our patients. In response to the series of mass shootings that tragically occurred in El Paso, Dayton and California’s own Gilroy this summer, LACMA has proudly taken strong stances to pressure our legislators to act wake of our gun violence epidemic. At the state level, “Going forward, we are inwethe have sponsored AB 879, which will regulate 3-D printing asking our members to of firearm parts. Nationally, we are advocating that every person who buys a gun gets a background check; that highwrite more resolutions capacity weapons and ammunition should not be available as part of the year- to civilians; that gun trafficking be a federal offense; and that there is increased transparency and ability for the NIH and round process to help CDC to do gun violence research. LACMA will work with any and legislators to search for answers to this crisis. stimulate discussion groups The California Medical Association House of Delegates is and action on topics coming up in October, and the major topics of focus include cannabis and homelessness — topics that certainly fall under that affect our patients.” our Docs4LA initiative. Going forward, we are asking our members to write more resolutions as part of the year-round process to help stimulate discussion and action on topics that affect our patients. You can read more about Docs4LA and how you can get involved on page six of this issue of Los Angeles Medicine. This past month, we also celebrated LACMA’s collaboration with the Martin Luther King Jr. Hospital’s new medical foundation with a celebratory dinner. The dinner was attended by LACMA leaders, MLK Hospital leaders and the foundation’s new physician hires, as well as Assemblymember Mike Gipson. Through this partnership, LACMA will help improve care for the patients served by MLK. We are looking forward to several great events the next few months including the Celebration of Women event and the Los Angeles Healthcare Awards. Thank you to all our LACMA members for all the hard work you do to help your patients! LACMA is here to support you in your efforts.
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HR Policies
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The Cooperative of American Physicians, Inc. (CAP) is pleased to offer The 2019 Human Resources Manual for Medical Practices to help physicians and their staff implement proper HR procedures and policies that can help improve every aspect of your business operations. As a leading California medical professional liability provider, CAP is committed to protecting our physician members with superior coverage. CAP members also receive valuable risk and practice management benefits specially designed to help physicians succeed! Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.
G U S TAV O F R I E D E R I C H S E N
LACMA CEO
Tribal Leadership I recently read the New York Times bestseller “Tribal Leadership” by Dave Logan, who is now the CEO of the California Medical Association’s Well Physician California program. If you haven’t read it, it’s an insightful look into successful and failed tribes. Every organization is composed of tribes, naturally occurring groups of 20 to 150 people. The book helps one understand how to assess, identify and upgrade their tribe’s culture, one stage at a time. The result is an organization that can thrive in any economy. One takeaway from the read is that tribes are the most powerful vehicles within an organization, while culture is the engine. There are five stages of tribal leadership that range from stage one, which is full of hostility (think of street gangs), to stage five, which is full of wonderment, what’s possible, joy. I believe LACMA has transitioned from stage two (apathetic) to stage four. It is an exciting time to be part of something that has turned the proverbial corner from a culture of dismay to one that, well, has promise.
That promise began with an “apology tour” three years ago and has entered into a stronger, more vibrant lane. I want to be clear that I’m a pragmatist at heart; no rose-colored glasses sit on my desk. When I say we are in a better place culturally, I will add we have a long way to go before we reach stage five status, where a noble cause is our compass. I see LACMA as possessing something intrinsically unique, a cause to help physicians — any physician, anywhere, anytime — and solving almost any problem (or at the very least finding a solution). While our focus is also about financial strength (one of our key pillars) and profitability, our true value stems from helping our members and prospective members. This notion of service is what was lacking in the past and why there wasn’t pride, passion or energy relative to membership. For the record, I haven’t cracked the code regarding membership growth, but a collaborative, inspired and motivated “village” of physician leaders, from our executive committee to our board to our previous presidents, has done some heavy lifting when it comes to outreach and sharing a
Join us for a Celebration of
WOMEN IN MEDICINE
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9 th , 2 0 1 ber 28 e p te m S , y a pm S a tu rd a 1 1 a m -2 M o n ic a S a n ta D e lf in n ie d d ri o B lv Le Me 5 3 0 P ic 0405 a, CA 9 M o n ic ta n a S e th e m m it te te d b y acy Co p re se n Advoc d n a s su e ia n s Is P h y si c omen be rs r M em FR EE fo em be rs ts of m r gu es rs fo 5 $2 m em be on N r $5 0 fo ai la bl e iti es av un po rt hi p op .o rg on so rs et sp an d cm an lis a@ la Ti ck et Em ai l:
This event is free to LACMA members; $25 for guests of members; $50 for nonmembers. Contact Lisa Le, lisa@lacmanet.org, for more information or to RSVP. 4 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 9
Please join the Los Angeles County Medical Association starting at 11 a.m. on Saturday, September 28, for a very special event at the Le Meridien Delfina Hotel in Santa Monica – our annual Celebration of Women in Medicine! Sponsored by the Women Physicians Issues and Advocacy Committee (WPIAC), this event will honor women physicians in Los Angeles who have distinguished themselves in service to their patients and their profession. Our keynote speaker will be Valencia Walker, MD, MPH, the Assistant Dean of Equity and Diversity Inclusion at the David Geffen School of Medicine at UCLA. A neonatologist by training, Dr. Walker is a past president of the Association of Black Women Physicians, and has chaired the CMA Council on Legislation. She is a nationally recognized expert on the subject of unconscious bias. Here are this year’s honorees: • Anna Yap, MD, a resident in emergency medicine at Olive View – UCLA Medical Center, will
“I see LACMA as possessing something intrinsically unique, a cause to help physicians — any physician, anywhere, anytime — and solving almost any problem (or at the very least finding a solution).
narrative, a value proposition that yields results, one doctor, one practice, one group or one hospital at a time. I can think of so many examples of selfless leadership: Dr. Sion Roy, current LACMA president, and his role reaching out to prospective member organizations, meeting with key legislators, engaging with nonprofits tied into our innovative Docs4LA initiative. I am proud to share that Dr. Roy has received the 2019 Local Champion Award from the Santa Monica Democratic Club; Dr. Hector Flores and his huge impact with several historic partnerships that are close to becoming reality; Dr. David Aizuss, current CMA president, who took the time to reach out to the board president of a prospective group to educate him about the value of joining LACMA and CMA; and Dr. Diana Shiba, LACMA president-elect, who constantly weighs in on how she can help us to grow, expand our reach and work more closely with other medical societies. We continue to build new, industry-leading relationships with companies that fundamentally help physicians and their patients. We are addressing physician burnout by offering
retreats for members in partnership with the Four Seasons Resorts and California Health and Longevity Institute. We look for innovators in healthcare like VIP Remote Health, which has developed a smart health band that monitors heart rate and vitals and features a velocity monitor (for falls) with accompanying HIPAA-compliant analytics via a physician dashboard. The result is improved patient engagement, healthier patients and a fully reimbursable product the physician can prescribe. With a handful of weeks before we close out 2019, it’s critical that more physicians see the value in being part of something special and that we continue to move away from what “isn’t possible” to what “is absolutely achievable.” History-making outcomes will continue to form our narrative that each of you is helping to create. When a colleague asks, “What is LACMA?” how will you respond? I hope it’s an answer comprised of optimism, confidence and pride because, after all, our members are the best ambassadors for this great organization as we strive to reach stage five in 2020.
receive the Rising Star of Physician Leadership Award for her work as an active participant and upcoming leader in organized medicine. • Elaine Batchlor, MD, MPH, will receive the Rose Talbot Bullard Award as a “Woman Physician Champion and Trailblazer.” She is the founding chief executive officer of Martin Luther King, Jr. Community Hospital, which opened in 2015. • Christina Ghaly, MD, will receive the award for “Extraordinary and Inspirational Achievement.” Dr. Ghaly, an internist, was appointed by the Los Angeles County Board of Supervisors as the Director of the Department of Health Services (DHS) on September 25, 2018, after having served in the role as Acting Director since October 2017.
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With nearly four months under our belt, Docs4LA has hit the ground running, making significant movement in the areas of public health and civic engagement throughout Los Angeles County. While LACMA will certainly continue to advocate on behalf of healthcare delivery issues that we have always championed, Docs4LA has positioned LACMA as a leader and partner on other topical issues that affect the healthcare outcomes of our patients. Additionally, LACMA has recommitted to our history of service through civic engagement initiatives and events. LACMA encourages our physician members to be part of the solution to our county’s most prevalent public health issues, because as physicians we are not solely healers, we must be community leaders as well.
HOMELESSNESS GUN VIOLENCE VAPING COLLISIONS ENVIRONMENT
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HOMELESSNESS
At the beginning of the summer we met with leaders from Skid Row Housing Trust, the epicenter of the Los Angeles homeless crisis, to discuss its current programs, pain points and trajectory. The Skid Row Housing Trust provides permanent supportive housing so that people who have experienced homelessness, prolonged extreme poverty, poor health, disabilities, mental illness and/or addiction can lead safe, stable lives in wellness. On average, nearly three homeless people are dying daily in Los Angeles County, nearly double the rate of deaths by homicide. Illness, addiction, accidents, suicide and the ravages of being unsheltered are among the primary causes of death. One way Skid Row Housing Trust is impacting homelessness in Los Angeles is by delivering new technology in the form of a telemedicine kiosk to servethose who face mental and physical health challenges, addiction and social isolation. The kiosk, represented by one of LACMA’s partners, InHealth, helps assess patient vitals and creates a bridge to a medical home. While LACMA can’t solve the homelessness crisis, we can at least bring attention to how technology can be a resource for those living in managed housing. We will provide updates on these and other discussions going forward.
GUN VIOLENCE
We are taking a strong position on gun violence and are in full support of 64th District Assemblyman Mike Gipson’s bill, AB 879. This bill would require a state background check for people seeking to buy firearm frames and receivers. It requires the Justice Department to electronically approve the purchase of firearm parts through a parts vendor. On a national level, we are advocating that a background check be completed for anyone looking to purchase a gun and that high-capacity weapons and ammunition not be sold to civilians. We believe that with the increased activity of gun trafficking, there should be a federal anti-trafficking law in place.
VAPING
Another one of Docs4LA priorities is to combat vaping amongst teens in Los Angeles County. In light of the more than 200 cases of severe pulmonary disease and multiple associated deaths to date, we have partnered with the Los Angeles Pediatrics Society (LAPS) and Los Angeles County Department of Public Health (DPH) to launch a campaign in the fall to address the dangers of marketing flavored electronic cigarettes to kids. The DPH recently announced that 30% of LA County high school students have reported ever using e-cigarette products and 10% of high school students regularly use e-cigarette products, according to the latest data from the 2017-18 California Student Tobacco Survey and the California Healthy Kids Survey. This is up from 6.4% last year. Docs4LA is eager to work with LAPS and DPH to reverse this trend to ensure a tobacco-free generation.
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COLLISIONS
Another preventable epidemic in the county is traffic deaths. Traffic collisions are a leading cause of death for both adults and children in Los Angeles County. Pedestrians and older adults are at greater risk of death and severe injury in the event of a highspeed traffic collision. In addition to the human costs, there are significant financial impacts, with medical costs of traffic collisions involving pedestrians and/or bicyclists in LA County estimated at approximately $63.4 million. We are in conversations with the Los Angeles County Department of Public Health and its Division of Chronic Disease and Injury Prevention to support their innovative “Vision Zero” campaign. Our physician members have an opportunity to support Vision Zero by engaging patients in conversations about practicing safe transportation behaviors and sharing their firsthand experiences about victims of traffic collisions to promote culture change, local policy changes, and encouraging patients to get involved with advocacy efforts.
STRENGTH IN NUMBERS
How do you imagine your retirement?
Docs4LA is busy developing relationships in these areas and more, but we know that there is strength in numbers. Email us to share events, causes and potential topics for Docs4LA to support! info@lacmanet.org.
If you’re dreaming about retirement, you’re probably not thinking about all of the complexities of closing down your primary care practice. Continuity of care. Patient notifications. Recordkeeping responsibilities. We can help. MDVIP has an experienced team dedicated to assisting primary care physicians retire. Our services are complimentary, and we have already facilitated more than 60 successful retirements. Our team can: • Aid with retirement planning and continuity-of-care options • Send state-required communications • Host a retirement event for you and your patients Stop dreaming. Start retiring. Call (657) 231-3788 today and let our retirement experts help.
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LACMA PA RTN E R
Does Your Healthcare Practice Have a
DATA BREACH EMERGENCY PLAN? The term “data breach” has become so familiar due to the sheer number of incidents in which consumers have had their sensitive information breached and then placed for sale on the dark web. Healthcare practices take many precautions to secure the protected health information (PHI) of their patients, but experience has shown that this doesn’t always prevent data breaches or protect the sensitive information. In every healthcare practice, the physicians and their staff are prepared to respond to a medical emergency, but now there’s another threat that can be just as intense, a data breach emergency. There’s only so much that the IT department can do to try to prevent such a disaster, so a plan needs to be put in place for a data breach emergency. The healthcare practice’s IT department needs to be right 100% of the time, but the criminals need to be right only once in order for those bad guys to be able to gain access to that information. Changing the mind-set of IT security personnel along with acknowledging the inevitability of a data breach will help your practice prepare, and hopefully survive, an incident if the worst occurs. Small and midsize practices will need a well-rehearsed breach response plan and pre-identified breach response solution. You may be able to take steps to mitigate a data breach, such as: • Implementing an Information Governance policy • Developing an Incident Response Plan/Business Continuity Plan • Understanding what type of employee, customer, and member data is being collected, stored, and protected • Constantly assessing and testing your organization’s needs and requirements • Knowing your organization’s cybersecurity and information governance strengths, weaknesses • Implementing baseline safeguards and controls • Staying vigilant – including pre-employment screening • Requiring regular information security training and education at least twice per year No one can guarantee that you are 100% protected against a data breach. The best that you can do is to have a response plan in place and the resources available to assist with the response plan’s implementation. The Los Angeles County Medical Association has partnered with LibertyID for Small Business to provide the members of LACMA access to data breach planning and response services and LibertyID’s fully managed identity theft restoration services. This is not only a valuable membership benefit but also an extremely valuable service to have in place for your patients should your practice experience a data breach. In the event your practice has a data breach, LibertyID for Small Business will provide fully managed identity theft restoration and recovery services for up to 5,000 of your patients, thereby helping to retain patient trust. 1 0 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 9
LibertyID for Small Business is an expert service for identity theft restoration. Their professionally trained certified restoration specialists can save affected patients hundreds of hours of work. This enables you, your staff, and your patients to maintain the practice’s daily routines. Steps taken on behalf of those compromised include: • Placing fraud alerts at the three major credit bureaus • Initiating single bureau credit monitoring, which will be in place through the recovery process and for a full year after your case is resolved • Researching public record databases to find and correct erroneous noncredit related information • Contacting the Social Security Administration, U.S. Postal Service, Internal Revenue Service, Department of Motor Vehicles, and other agencies as needed, to reverse any wrongful information, transactions, or misuse of official documentation • Submitting disputes to credit card companies, banks, lending institutions, utility companies, cell phone carriers and more • Researching and documenting any fraudulent transactions, false accounts, or contracts signed with creditors, banks, utility companies, leasing agents, medical facilities, etc., and follow up to make sure all erroneous information is removed from credit files • Providing copies of credit reports from all these credit bureaus and reviewing the reports with those affected to identify fraudulent activity • Creating and maintaining a law enforcement grade case file to assist local and federal law enforcement in the prosecution of the perpetrators
“
Small and midsize practices will need a well-rehearsed breach response plan and preidentified breach response solution.
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• If personally identifiable information (PII) is lost, a restoration specialist will be available to assist in addressing and replacing the lost documentation, such as credit cards, licenses, passport and/or government-issued documents • Providing a complete copy of credit reports and scores from one of the major credit reporting agencies, once per year Visit libertyid.com/business/LACMA for additional information or call 844-445-4237 and be sure to mention that you are a LACMA member for special pricing on this valuable service.
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