January 2016 | Physician Magazine by Los Angeles County Medical Association

THE MANY SUCCESSES OF OUTGOING LACMA CEO ROCKY DELGADILLO

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

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COVER STORY

Changes for 2016

As Los Angeles County’s physicians head into a new year, they can count on on having to deal with regulatory and tax changes that will continue to affect how they manage their practices as they strive to provide high-quality service to patients. To help doctors prepare for these changes, we have turned to experts to address some of the anticipated issues and continuing trends affecting doctors this coming year.

6 The Many Successes of Rocky Delgadillo

6 Overcoming the Stress of Malpractice Litigation 14 The 60-Day Sword of Damocles

FROM YOUR ASSOCIATION 4 President’s Letter | Peter Richman, MD 20 Trouble Getting Paid? CMA Can Help

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine,801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request.

J A N UA RY 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1

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David Aizuss, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Jack Chou, MD Troy Elander, MD Hilary Fausett, MD Samuel Fink, MD Hector Flores, MD C. Freeman, MD Sidney Gold, MD Jinha Park, MD Stephanie Hall, MD David Hopp, MD Kambiz Kosari, MD Sion Roy, MD Paul Liu, MD Maria Lymberis, MD Philip Hill, MD Nassim Moradi, MD Vamsi Aribindi Ashish Parekh, MD Jerry Abraham, MD Po-Yin Samuel Huang, MD Michael Sanchez, MD Heather Silverman, MD Annie Wang Nhat Tran, MD Fred Ziel, MD

lenges of managing a practice. LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are 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, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine 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 Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine 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 Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

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P RES IDEN T ’S LET T ER | P ET ER RIC H M AN, M D

O N J A N UA R Y 1, many bills enacted at the local, state and federal level become official

law. Legislators put forth these bills mostly to address concerns of their constituents. Few legislators have issues of personal importance that they fervently pursue during their career. Most lawmakers are well intentioned and are attempting to meet the needs of their voter base. New issues arise yearly, and some fixes to previously enacted laws are needed due to unforeseen loopholes or clever workarounds. I have an amateur’s interest in politics and have followed the political process for years. In the past, friends would ask me, “How could they do that?”when referring to an intrusive or overreaching regulation. Now as president of LACMA and as a CMA trustee, physicians ask me “How could you let them do that?” when referring to healthcare laws and regulations that are intrusive, expensive and burdensome. I didn’t just let them do that! As a CMA trustee, with incredible assistance and direction from the Council on Legislative Affairs, I vote on policy issues giving direction to CMA lobbyists at the state and federal level. I attended Legislative Day, where LACMA physicians personally met with Los Angeles legislators to discuss healthcare bills of immediate and direct concern during the current legislative period. In Los Angeles I met with state legislators and congressmen at meet and greets, town hall meetings, and at fundraisers to establish ongoing relations. In doing so, LACMA physicians have their voice heard. As of July, I sit on the CALPAC board, which supports legislators who advance well-thought-out and balanced healthcare policies that support public health and sustainable physician practices. I made phone calls to legislators’ offices prior to key committee votes to advance or thwart a bill of concern to medicine. I find the process interesting and challenging and do not mind the time commitment. But I now turn the question around: “How could you let them do that?” Legislators are responding to the needs and desires of their voter base. They measure those needs by tallying contacts to their office and by dollars donated to their campaign funds. Physicians are busy in their practices and don’t have the time to make phone calls. We lose out. Physicians are under financial pressures with diminishing incomes and increased costs and do not donate to politicians. According to the California Fair Political Practices Commission, the California Teachers Association ranked number one in political donations in 2010. Teachers make less money than physicians but see the benefit of political donations. Six Indian tribes individually donated more money than the CMA, which ranked number 23 on the list. As a group, physicians underestimate the benefits of political participation. We should not. We do not lobby for a single issue of self-interest. We lobby for public health, our patients’ access to quality care and for the sustainability of medical practices. We can and should do more. This year, convince colleagues to join LACMA and the CMA. This year make some phone calls to legislators when prompted. This year, donate to LACPAC, CALPAC or a campaign. Then next year you may point to a CMA-sponsored bill and say “I helped them do that!”

4 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2016

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Overcoming the Stress of Malpractice Litigation

SOLUTIONS TO HELP PHYSICIANS STAY HEALTHY AND ENGAGED BY DAVID P. MICHELIN, MD, MPH

Imagine the scene: You’re in your busy office on a typical day when a letter arrives—a patient is suing you for malpractice. If the lawsuit proceeds to trial, the process can be lengthy, dominating your personal and professional life for a year, two years, or more. But as I learned during my own litigation experience, there are steps you can take to ease the strain you’re under, allowing you to continue to serve your patients and maintain healthy relationships with those around you. PREPARE THOROUGHLY | First, take a deep breath—and then prepare. Approach the lawsuit simply as an unfortunate consequence of practicing medicine, the price of being a physician. In today’s medical climate, a lawsuit is essentially inevitable, especially if you conduct procedures. Treat the litigation as another necessary part of your career, and take the same approach as you would toward other hurdles like a board exam. Be meticulous. Go over your chart. Familiarize yourself with every aspect of the case. Be ready for your meetings with your attorney, and take an active role in your defense. Above all, prepare for the witness chair by taking part in litigation education, especially a mock deposition.

MAKE YOURSELF A PRIORITY | Every profession has its stresses, but doctors’ stresses are unique. Overwhelmed patients share with us their innermost thoughts and concerns. To the everyday stresses of our profession, add the stress of fighting a lawsuit to defend your reputation—more than ever, it becomes imperative that you take care of yourself. Don’t hesitate to make yourself your first priority. Do whatever you need to do to unwind. This might be physical exercise like running or biking, or it might simply involve becoming more engaged in other personal interests. If you’re not blocking out time to decompress, you’re doing a disservice to yourself, your case, and your patients.

REACH OUT | Although you can’t divulge the clinical details of a current claim to family members, you can talk with them about how it is affecting you. By opening up to your spouse, children, and other family members, you can help prepare them and ease your own burden. Seek their input and advice. This can help you overcome the feelings of isolation that often accompany a malpractice claim. Doctors often have a tough, go-it-alone mentality. But this is the bottom line: Don’t go into a shell. Talk to somebody.

RISE ABOVE THE CHALLENGE | Ultimately, after two trials spanning two-and-a-half years, I was completely exonerated by the jury. By adopting certain strategies, I was able to mitigate many of the negative effects so many doctors experience. You can still maintain your self-assurance, keep your relationships intact, and continue to provide the vital medical care on which your community relies.

6 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2016

Contributed by The Doctors Company. David P. Michelin, MD, MPH, is a gynecologic oncologist in Traverse City, Michigan.

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As Los Angeles County’s physicians are head into a new year, they can count having to deal with regulatory and tax changes that will continue to affect how they manage their practices as they strive to provide high-quality service to patients. To help doctors prepare for these changes, we have turned to the experts -- a legal expert and two tax consultants who deal with physicians’ issues and specialize in healthcare issues -- to address some of the anticipated key issues and continuing trends affecting doctors this coming year. We’ll address concerns raised over electronic health record usability and how to deal with challenges regarding meaningful use and ICD-10 compliance. The experts will also address considerations by Congress (as of December 2015) to extend some key tax deductions that could affect the planning of equipment purchases and hiring staff. Physicians will also find valuable tips to help them comply with HIPAA rules, learn about changes in the Physicians Fee Schedule 2016 that affect doctors in private practices especially, newly introduced telehealth legislation and general tips to cut expenses and improve efficiencies for 2016.

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Last October also marked the changeover from using ICD-9 codes to the ICD-10 codes, which required healthcare providers and insurers to change out about 14,000 codes for about 68,000 codes. And while a survey of 298 healthcare IT professionals by KPMG suggested that 80% of providers were seeing success with the implementation of the new billing codes, others who encountered problems from rejected claims, clinical documentation issues and coding education issues were likely to face the consequences of reduced cash flow. Jerome French, CPA, CVA, who is the senior manager at Mann, Urrutia, Nelson CPAs and Associates, LLP in Glendale, told Physician Magazine that the successful implementation of ICD-10, dating back to Oct. 1, 2015, was likely more successful for physician practices that planned accordingly compared to those who procrastinated or didn’t implement a solid plan. “We found a lot of practices – if they had pre-planning – had no hiccups, while others had problems with insurance companies who had issues on their side,” French said. ICD-10 was designed to provide more accurate billing, he explained, but some practices saw a decrease in reimbursement of pay, because they didn’t plan for the change accordingly. Having a solid plan in place will become even more critical for 2016. “In 2016, doctors will have to make sure that coding gets more accurate – that is the very definition of what ICD-10 is all about – accuracy,” French said. He added that this is the time when doctors need to look for opportunities wherever they can (within the legal realm) to efficiently maximize their billing. Other experts noted that the mounting changes that have accumulated will require ongoing education of all staff involved in coding, from patient intake to appeals. “The benefit of ICD-10 is that if you do accurate billing,

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Last October, the Department of Health and Human Services issued the long-awaited final rules changing the requirements of the Meaningful Use program for 2015-2017 and implementing Stage 3 of the program, which has been a major concern for many physicians. Some of the changes include that providers and state Medicaid agencies will now have until Jan. 1, 2018, to comply and prepare for the next set of system improvements. Stage 3 will now be optional until 2017 and will have eight objectives, more than 60% of which will require interoperability, and public health reporting will have more flexibility, according to published reports. The reporting period for 2015 was only 90 days for all providers and will be only 90 days for new providers in 2016 and 2017 and for any provider moving to Stage 3 of the program in 2017. As part of the regulations, there was also a 60-day comment period to gather feedback about the direction of the Meaningful Use program, which will eventually move physicians into a new merit-based incentive payment system (MIPS). The rule implementing that law is expected this spring. Addressing concerns that the rule came too late for providers to report in 2015, Patrick Conway, MD, acting principal deputy administrator and chief medical officer at the Centers for Medicare & Medicaid Services, noted that the deadlines could be extended and that providers can apply for hardship exemptions. The rules do not delay Stage 3, though many stakeholders have been asking that Stage 3 be “paused and reevaluated.” The American Medical Association’s president, Steven J. Stack, reportedly applauded the CMS for listening to the concerns of doctors. “In particular, the agency addressed the delay in issuing the modifications rule by allowing a hardship exemption for physicians who are unable to attest this year, providing needed relief for those uncertain about the 2015 program requirements,” Stack said.

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reimbursement will be more accurate, and though physicians won’t make huge strides in what they will be able to make, it allows them to maximize every last dollar,” French said. No matter where doctors stand on the matter, experts said, ICD-10 is here to stay, and providers must embrace it and move forward. SECTION 179 DEDUCTION | One of the tax incentives that will help doctors become ICD-10 compliant in the coming year is Section 179 of the IRS tax code, said Lynn Boster, CPA, tax practice leader at Vasquez & Company LLP in downtown Los Angeles. Section 179 will allow physician practices to deduct the full purchase price of qualifying equipment such as electronic medical records systems, medical tables, desks, computers and software, or the cost of leased equipment, during the tax year. This is a great opportunity for physicians, French agreed. Section 179 was set to expire, but on December 17, Congress voted to expand Section 179’s maximum deduction of $500,000, and it was then signed into law by President Obama. And this time the rule has been made permanent. “For those practices that are looking to do major upgrades, this is a huge opportunity if the (government) makes the extension,” said French. Another tax provision that will allow a 50% additional first-year bonus depreciation on purchased equipment and machinery was also set to expire in 2015 but was also extended in December. The bonus depreciation percentage is 50% for property placed in service during 2015, 2016, and 2017, but then phases down to 40% in 2018 and 30% in 2019. Boster and French both agreed that for doctors who were planning to make a big equipment purchase, these tax provisions were especially meaningful. Boster gave this example: “If someone buys equipment for $2 million and you take a bonus depreciation of $1 million and they also deduct another $500,000 from Section 179, the remaining $500,000 would be depreciated over five to seven years.”

HIRING TAX CREDITS

Going into 2016, physicians in private practices will also still be able to take advantage of certain hiring tax credits under the Enterprise Zone Program, said French, despite the program’s replacement by a new law that phased out some of the old tax credits. “And some of these hiring tax credits can be expansive — $20,000 to $30,000,” he noted. Practices that are located within one of the 40 economically struggling areas under the program and hired employees that meet certain criteria, such as being a U.S. military veteran or displaced worker, continue to generate hiring credits under the old program for years to come, he noted. The hiring tax credits encourage retention of new hires that will be claimed on employers’ income tax return for 2015, Boster added. “The drawback is that it is a lot harder for employers to qualify for these tax credits and the employer has extensive disclosure requirements,” she added. WOTC PROGRAMS | Another provision that is related to the hiring tax credit is the Work Opportunity Tax Credit, which was included in the 2016 federal budget proposal released by President Obama. This tax credit offers another opportunity for doctors to reduce taxes, French and Boster agreed. The tax credit, which would apply to wages paid to qualified individuals who started working after Dec. 31, 2014, was up for consideration by Congress (before press time) to be permanently extended. The federal program encourages businesses to recruit and retain staff from certain populations, such as veterans receiving social assistance and qualified youth, and aims to raise the employment rate of this specific population. For each hired individual, the business may qualify for a tax credit up to a maximum of $9,600 per individual during their first year of employment. French said the program isn’t dependent on where the business is located. “We are waiting to see if Congress is going to extend it,” Boster told Physician Magazine in late November. “It relates to getting a credit for hiring qualified veterans and that’s important for our country. They can get qualified professionals with experience and then also get a credit.” French added, “It’s one area in the law that basically says you can discriminate and look at people with disadvantaged backgrounds and if you help them, you get a tax credit.”

HIPAA

Jeremy Miller, attorney at Miller Health Law Group in Los Angeles, said doctors in smaller practices and even solo practices can expect to see more aggressive action by the Health and Human Services Office of Civil Rights’ to make sure they comply with HIPAA privacy and security rules. “I see an acceleration of that trend,” Miller said. “I had a number of physicians in the last year who in the past wouldn’t have been subject to audits and investigations.” He said in some cases, the doctors were penalized for their wrongful actions. 1 0 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2016

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He cited cases where doctors posted testimonials for patients on their website with the patient’s permission, but later learned that it wasn’t the right kind of authorization to comply with HIPAA rules. He believes that doctors need to be especially careful and take action to ensure that patients’ privacy is protected. That includes ensuring that computer data is encrypted and protected and doing gap assessments. Before signing agreements with third-party vendors and business associates such as website developers, doctors also need to ensure that these parties are also HIPAA-compliant.

MEDICARE

PHYSICIAN FEE SCHEDULE CHANGES FOR 2016 | The CMS finalized rules as part of the Medicare Physician Fee Schedule for the year 2016, which took effect Jan. 1, 2016, will cover some new services, but the final rule could mean less money for certain specialties. Below is a snapshot of some of the new rules for Medicare reimbursement for physicians: • A move that has been welcomed is that providers will be reimbursed for providing advance care planning as part of a patient’s annual check-up. Physicians can also continue to be reimbursed for such discussions that occur during a patient’s initial visit after enrolling in Medicare, which is already covered under the program, according to The Advisory Board Company website. • Primary care doctors, on the other hand, will see the primary care incentive payment program, which provided doctors with a 10% bonus quarterly incentive pay, go away in 2016. • Across the board, physicians could potentially make less, because of required fee reductions under the Protecting Access to Medicare Act of 2014. Under the law, CMS is expected to cut overall spending on medical care by 1% every year, according to the Central Penn Business Journal. Miller said one of the ways doctors can prepare now, as CMS moves toward value-based performance, is to capture electronic data that will give doctors insight into whether they would qualify for incentive pay or could be subject to penalties. “They need to understand how they are doing, because it they don’t have that data, they are flying blind,” he said.

TELEHEALTH

The move to expand telehealth across the healthcare system in an effort to serve underserved communities better and potentially lower costs while improving patient outcomes, will continue in 2016. In December 2015, Sens. Gary Peters (D-Mich.) and Cory Gardner (R-Colo.) introduced a bipartisan bill (S 2343) to expand Medicare coverage for telehealth services in rural areas by boosting telehealth projects at the Center for Medicare and Medicaid Innovation, mHealth Intelligence reported last month. Sen. Brian Schatz (D-Hawaii) was expected to introduce a separate bill that would allow providers to use telehealth tools in alternative payment programs overseen by CMS, mHealth Intelligence reported. Reimbursement for telehealth services will remain one of the big trends that drive healthcare transformation in 2016 and beyond, experts said. CONCLUSION | The reality is that smaller practices are facing more challenges with all the changes under the Affordable Care Act, French said. But that doesn’t mean that independent physicians can’t be successful in this new healthcare environment. He believes that physicians should try to seize all opportunities to save money and cut spending. “They need to look at personnel costs in a way where they still maintain quality of the staff (and practice management), look at their billing practices and ensure that collections like co-pay and upfront pay like deductibles for insurance are being made,” French said. Miller advises physicians who are contemplating joining physician groups or hospitals to seek expert legal advice. “There are a lot of business considerations to get fair value for their practice and also to get a good employment agreement for fair compensation and job security,” Miller said. He agreed with French by saying that “smaller groups need to do what they can to operate as efficiently as possible to make sure that billing collection is robust and to reduce overhead where they can.” A great way to make connections and get involved is to join a physician association like LACMA and to network, French said. Another issue that’s especially critical for physicians in private practice, he feels, is that they need to be on top of their marketing efforts and ensure that their reputation in the community is in good standing. “You always need to make sure in this day and age that your reputation with patients at large has to be really, really good,” he noted. “I watched a physician explode at a meeting where they talked about Yelp. You have to worry about your marketing and social presence especially when you deal with PPOs — this all has an effect on income,” French said.

1 2 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2016

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CALL FOR NOMINATIONS

LACMA Representative on the L.A. Care Board of Governors The Los Angeles County Medical Association (LACMA) is pleased to announce the call for nominees to serve on the 2016 L.A. Care Board of Governors as the LACMA representative. The L.A. Care Board of Governors is explicitly responsible for achieving the mission of L.A. Care Health Plan through its stewardship role, which includes fiscal accountability, policy development and approval, establishment of the overall strategic direction of the organization and general oversight of management. This is a voluntary position for which members report spending at least 10-12 hours per month, including meeting attendance and preparation time. The following are criteria and characteristics of a Board member: • Must reside, be employed or provide services within L.A. County. • Must be a LACMA member.

• Have the vision and objectivity to act in the best interests of L.A. Care and its members.

• Be familiar with the needs of and have an interest in MediCal, Medicare, and health services for vulnerable populations in L.A. County. • Have knowledge of the healthcare delivery structure in L.A. County and issues associated with implementing managed healthcare services. • Have an understanding of the diverse geographic and

multicultural makeup of L.A. Care’s members.

• Be committed to supporting a healthcare system funded by the public for the public good. • Be committed to being a responsible, active and contributing participant of the Board of Governors.

• Have excellent interpersonal skills to work effectively as part of a group, communicate with fellow Board members and staff, and maintain dialogue among L.A. Care’s stakeholders. • Be committed to regularly attending meetings.

• Be committed to attend all LACMA Board meetings and communicate updates.

For more information on how to submit your name for consideration please visit

www.lacmanet.org/lacareboard Deadline to submit your nomination is Friday, February 6, 2016

THE 60-DAY SWORD OF DAMOCLES [You’ve Got 60 Days to Pay Up — or Else!] BY: JEREMY N. MILLER

Consider the following scenarios involving medically necessary services for Medicare or Medicaid patients: (1) a medical group learns that its outside billing service has incorrectly used the physician’s office site of service code when billing Medicare for hospital consults; (2) an imaging center finds out it did not have adequate physician supervision when performing MRIs using contrast media; (3) a physician discovers it was improper to mark up tests purchased at a discount from an outside lab; and (4) a hospital realizes it has failed to make annual CPI adjustments to the rent under a physician’s office lease. What do these scenarios have in common? First, in each case, the provider or supplier improperly billed Medicare or Medicaid resulting in an overpayment. Second, the overpayments appear to have resulted from innocent billing errors. Third, the provider or supplier must report and refund the overpayment within 60 days of identifying it or risk penalties under the False Claims Act of up to $11,000 per claim, plus treble damages, and possible exclusion from the Medicare program. How could this be? Prior to the passage of the Affordable Care Act, providers and suppliers were obligated to refund overpayments. However, many chose to wait and see if Medicare asked for the money back, but did not voluntarily refund it. The calculus for treating overpayments has now changed. If a provider or supplier does not

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make a timely refund of an identified overpayment, it runs the risk of potentially ruinous penalties. An overpayment is identified (starting the 60 day clock for a refund) when “the person has actual knowledge of the existence of an overpayment or acts in reckless disregard or deliberate ignorance of the existence of an overpayment.” In other words, you cannot stick your head in the sand and ignore evidence of a possible overpayment. But what if you have evidence of upcoding of office visits but you do not know how many? If a hospital employee reports potentially improper claims, does the 60-day period start from the date of the employee’s report or only after the hospital has had an opportunity to complete its investigation? In the recent case of Kane v. Healthfirst, Inc., a federal district court in New York held that the clock starts “when a provider is put on notice of a potential overpayment, rather than the moment when an overpayment is conclusively ascertained.” This standard could impose a very heavy burden on providers where the nature, existence and scope of a potential overpayment cannot be readily ascertained. Once you have identified a possible overpayment, how far back do you have to look for similar overpayments subject to refunding? Most people assumed the “look back” period extended three or four years in the absence of fraud. But in its 2012 draft regulations, CMS said that the look back period is ten years! Hopefully, this will be

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Disclosure Protocol for Stark Law violations) to changed in final regulations expected in The calculus for treating report the overpayment and resolve potential February 2016. Overpayments must be reported to your overpayments has now civil monetary penalties and possible exclusion Medicare Administrative Contractor (e.g., changed. If a provider or from the Medicare program. In light of the foregoing risks, providers Noridian in California) using a form specified supplier does not make and suppliers should: by the contractor. The report must include -Implement a robust compliance program, how the error was discovered, the reason for a timely refund of an including regular self-audits, to reduce improper the overpayment, the corrective action plan identified overpayment, billing leading to overpayments, and to promptto ensure the error does not occur again, it runs the risk of poten- ly identify any overpayments. Federal enforceand a claim-by-claim listing of the overpaid ment officials look favorably upon good faith claims. Where claims are too numerous to tially ruinous penalties. compliance efforts. list individually, a statistical sample can be -If you uncover a possible overpayment situused to determine the amount of the overation, proceed with all deliberate speed to depayment. The statistically valid methodology must be described. The refund is also sent to the contractor. In the termine whether an overpayment exists and, if so, its size and scope. -Once an overpayment has been identified, make a timely report case of large overpayments, a provider or supplier can request an extended repayment schedule based upon its ability to pay, which is and refund to your Medicare contractor. If the overpayment is the result of fraudulent billing, consider utilizing the OIG’s Self-Disclosure subject to review. If the overpayment resulted from the intentional filing of a false Protocol to report the overpayment, or CMS’ Self-Referral Disclosure claim, a voluntary refund will not prevent the HHS Office of Inspec- Protocol for overpayments resulting from Stark Law violations. If you have an overpayment problem and choose to ignore it, there tor General (OIG) from initiating an enforcement action under the False Claims Act or Civil Monetary Penalties Law. In fact, the Medi- is a fair chance that a whistleblower in your organization will do the care contractor to whom the report is made can refer the matter to reporting for you, and that is a situation you definitely want to avoid. the OIG. The alternative to reporting to the Medicare contractor is Jeremy Miller is the founder of Miller Health Law Group, APLC. 1901 Avenue of the to utilize the OIG’s Self-Disclosure Protocol (or CMS’ Self-Referral Stars, Suite 1750, Los Angeles, CA 90067. 310.277.9003. jnm@millerhealthlaw.com

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THE MANY SUCCESSES

ROCKY When Rocky Delgadillo became LACMA’s CEO in 2012, he wanted to be a game-changer that would elevate the organization and help shape its long-term success. LACMA’s leadership counted on Delgadillo to catapult the organization to new heights in terms of membership and organizational direction and increase its presence in the medical and business communities, as well as with legislators and the public as a whole. Looking back at his tenure, both Delgadillo and LACMA’s leaders would agree that the vision they had for the NEW LACMA has really created change. “Today, LACMA stands as the strongest medical society in the state, likely larger and poised for even more growth than many state medical societies around the country,” immediate past president of LACMA, Pedram Salimpour, MD, told Physician Magazine. “With Rocky’s unwavering leadership, we have turned the organization, and today it boasts not just momentum for continued growth, but also the most robust membership we’ve had in over a decade. The leadership and vision that Rocky brought were essential to our new position, and to our renewed posture.” In a recent interview with Physician Magazine Delgadillo said, “I think LACMA had suffered from tunnel vision, looking backward and not forward, and all the while the world around LACMA was changing dramatically. Being part of LA, one of the most diverse cities in the country and in human history, we needed to make an effort to break those shackles.” To mirror the diversity of the community, Delgadillo established the first-ever Latino Physicians Advisory Committee, which was the first of a series of advisory committees that was launched by the NEW LACMA to expand the reach to physicians and their patients. “It definitely delivered a message to let physicians know that everyone is welcome at LACMA,” Delgadillo noted. Realizing that physicians should be the ones honoring their peers, not others, Delgadillo also founded the annual LA Healthcare Awards, now LACMA’s biggest annual event to honor outstanding physicians and medical groups, and to raise critical funds for scholarships and loan repayment for disadvantaged medical students, residents and fellows. In the summer of 2012, LACMA made national headlines, drawing the attention of doctors and patients alike, with a lawsuit against health insurance companies Aetna and Health Net, which Delgadillo said sent a clear message that PHOTOS Top: Delgadillo at an August 2012 press conference regarding the lawsuit against health insurance companies Aetna and Health Net. Center: Delgadillo pictured with the late Marshall Morgan, MD, 2013 Healthcare Champion of the Year Patrick Soon-Shiong, MD, and Troy Elander, MD. Delgadillo interviews LA mayoral candidate Eric Garcetti when LACMA hosted “Conversation with the Candidate” in April 2013. 1 6 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2016

OF OUTGOING LACMA CEO

DELGADILLO “physicians in LA weren’t backing down to mega powerful entities and that they were on the side of right in protecting the patients they serve.” Later on, under his watch, LACMA would also take a stance to protect LA’s most vulnerable population by trying to stop the ill-conceived Cal MediConnect demonstration project. And he worked closely with the late Dr. Marshall Morgan to stop the attempt to modify MICRA. Delgadillo was also instrumental in providing members with key benefits such as the new purchasing group, exciting new educational opportunities and muchneeded modern tools to stay informed. “The tunnel vision that gave us a lack of diversification also gave us antiquated communication tools,” he said. “Today, we have provided state-of-the-art information physicians can use immediately on a weekly basis (breaking news via Physicians News Network and the revamped monthly Physician Magazine), in addition to recognizing a formal way of achievements (LA Healthcare Awards).” Delgadillo is particularly proud of his legacy of diversifying the organization and drawing, among others, physician groups made up of predominantly AsianAmerican and Latino physicians serving the community in LA County. “LACMA is now in a great position to capture the future, and I’m hopeful that LACMA will continue to be an aspirational place for the views of physicians and the physicians’ place for the advocate for the patient.” He considers his biggest accomplishment the turnaround of LACMA itself. “LACMA is consistently called upon by business leaders, which didn’t happen in the past, and is now a regular place for press, elected leaders and business leaders to call upon,” he said. “Rocky came to LACMA at a crucial time,” said Troy Elander, MD, Patient Care Foundation president. “His guidance helped steer us in the direction we needed to go. We should all be thankful for his vision. He showed us how to stand up for our beliefs — doing what’s right for our patients and for medicine.” LACMA President Dr. Peter Richman added, “As CEO, Rocky led LACMA through a transitional period. He made permanent structural reforms to improve efficiency and established forums for improved and inclusive physician representation. He initiated the HealthCare Awards to bring more funding to the Patient Care Foundation for Los Angeles medical school scholarships to improve access in underserved areas. He leaves LACMA with a stronger footing to confront the ongoing challenges of healthcare.” PHOTOS Top: (left to right): Pedram Salimpour, MD, Troy Elander, MD, 2014 Healthcare Champion of the Year Richard J. Riordan with Delgadillo at the 3rd Annual L.A. Healthcare Awards. Bottom: Delgadillo addresses the crowd at Good Samaritan Hospital at “Conversation with the Candidate” in April 2013.

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CALIFORNIA MEDICAL ASSOCIATION

TROUBLE GETTING PAID? CMA CAN HELP! I’VE RECOVERED In the past five years, CMA’s Center for Economic Services has recovered over $10 million from payors on behalf of CMA members.

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CMA’s Center for Economic Services is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Assistance ranges from coaching and education to direct intervention with payors or regulators.

CMA members can call on CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

• Do you have questions about Covered California?

• Do you need help with Medicare related issues?

• Are your claims not being paid in a timely manner?

• Are your claims being denied after obtaining prior authorization?

• Are you not being paid according to your contract? • Have you been presented with a managed care • Are you receiving unreasonable requests for medical records? • Are you receiving untimely requests for refunds or is a payor recouping money from your check without

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