March 2013 by Los Angeles County Medical Association

T H E N E W O F F I C I A L P U B L I C AT I O N O F T H E LO S A N G E L E S CO U N T Y M E D I C A L A S S O C I AT I O N REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

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THE ART OF NAVIGATING YOUR

Medical Career MARCH 2013 L I A

M A G

F C

L I A

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M A RC H 2013 | TA BLE OF CONT ENT S

Volume 144 Issue 03

FEATURES

THE ART OF NAVIGATING YOUR MEDICAL CAREER

After having spent years in medical school, residency and fellowship, new physicians find themselves faced with the challenge of trying to manage their careers to reach their full potential.

FRONT OFFICE | PRACTICE MANAGEMENT

Moving Away from Medicare: How to Opt Out

Many physicians are feeling nervous these days about Medicare. But physicians considering opting out of Medicare should make sure they understand the process and its implications. Failure to comply with the opt-out requirements could result in serious penalties.

DEPARTMENTS 12 BALANCE | LIFESTYLE & WELLNESS

Tips, hints, advice and resources to make your practice run more smoothly.

TRANSITIONS | CAREER MANAGEMENT

Alternative Career Options

The changing health care environment has some doctors rethinking the traditional career path, while others may dream of combining a special interest with medicine.

14 PNN | NEWS IN REVIEW

The latest headlines impacting the economics of healthcare delivery in Southern California 22 UNITED WE STAND | AT WORK FOR YOU

Your LACMA and CMA membership at work for you.

FROM YOUR ASSOCIATION 4

PRESIDENT’S LETTER | SAMUEL FINK, MD

24 CEO’s LETTER | ROCKY DELGADILLO 25 LACMA NEWS | ASSOCIATION HAPPENINGS

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, 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, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.

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strive toward a common goal–

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David Aizuss, MD William Averill, MD Erik Berg Stephanie Booth, MD Steven Chen, MD Jack Chou, MD Hector Flores, MD Sidney Gold, MD William Hale, MD Shelley Han Vito Imbasciani, MD Paul Kirz, MD Lawrence Kneisley Howard Krauss, MD Gideon Lowe, MD Carlos E. Martinez, MD Nassim Moradi, MD Ashish Parekh, MD Jeffrey Penso, MD Heidi Reich, MD Bob Rogers, MD Sion Roy, MD Pejman Salimpour, MD Robert Bitonte, MD Erin Wilkes, MD

time worrying about the challenges 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, Executive Assistant, at lisa@lacmanet.org or 213-226-0304.

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P R ES I D ENT ’S LET T ER | SA M U EL FI NK , M D

G R E E T I N G S! I H O PE that all of you have had a good and productive month. The New LACMA has been working hard on your behalf, and I will tell you more about that later on. First, I’d like to share with you the experience one of my patients just had. It shook me up a bit! I have taken care of an older professional gentleman for the last 25 years. Mr. “Jones” is in his late eighties, but still enjoys working part time. He lives with his daughter, enjoys college football (we have always rooted for different teams), and gets along well, sometimes needing a walker to get around. He has pretty typical problems for someone that age...high blood pressure, coronary disease, mild heart failure, and well controlled diabetes. Mr. Jones was walking in his home one morning, but left his walker in the bedroom. He caught his foot on the edge of a carpet and fell, suffering a fracture of the right humerus. Fortunately, both hips were fine! Mr. Jones was transported by paramedic ambulance to the closest hospital, which was not a facility at which I have admitting privileges. He was placed on observation status, and given Vicodin for pain. The Vicodin promptly caused disorientation (along with probable “sundowning”), which stopped Mr. Jones from being able to care for himself. The condition mildly improved over the next few days, but Mr. Jones suffered a large hematoma related to his fall, and even needed transfusion. Despite these medical problems, he remained on “observation” status (higher Medicare reimbursement, I believe). Because Mr. Jones was not admitted, he was ineligible to be transferred to a Rehabilitation facility. I communicated with the family extensively...fortunately one of the members was an attorney who forcefully convinced the hospital to admit Mr. Jones. But, because he still had some disorientation, and “only” had a broken shoulder, Mr. Jones did not meet the necessary Medicare guidelines for a Rehabilitation transfer. Nor was he well enough to go home. At this point, the hospital decided that the patient should go on hospice care (I guess THAT would prevent a thirty day readmission)! The family, with a now much angrier attorney, “convinced” the hospital that was not going to happen, and eventually Mr. Jones mental status improved to the point

where he was able to be transferred to a good Rehabilitation facility. I am concerned that as we cut Medicare spending, “use dollars wisely,” and try to prevent thirty day readmissions that our older patients will get lost in the process. Many hospitals around Los Angeles are developing and expanding hospice programs. Now, I don’t believe medical dollars should be wasted. But, I also believe that we have to value, respect and care for our senior population. Some of the patients that I have taken care of from other countries tell me of the limited health care resources available to seniors. With time, that philosophy simply becomes ingrained and “accepted” by society. As physicians, we have to make every effort to ensure that doesn’t happen in America. Going forward, I think we will have to advocate louder than ever for all of our patients...especially seniors. LACMA continues to be actively involved in trying to stop the forced transition of Medi-Medi patients to capitated care. Over the past month, our lobbying efforts have continued, and we are trying to build coalitions with other interested partners. Our CEO, Rocky Delgadillo, just met with a group of physicians in Beverly Hills at a meeting kindly arranged by Dr. David Hopp. He listened to their concerns about how Surgicenters have been unfairly targeted by the city with regard to their tax status, and pledged to use LACMA’s resources to assist in this effort. A few weeks ago, LACMA hosted a meeting of the Association of Black Women Physicians. We look forward to working closely with this energetic group, and mutually benefitting from each other’s expertise. It is our hope that the members of this organization will be instrumental in helping us develop our new African American Physician’s Committee. We look forward to their involvement, as LACMA continues its efforts to bring in Los Angeles physicians that have been underrepresented in organized medicine under the banner of the New LACMA. As to my ongoing efforts to achieve Medicare recertification? After my biller Edith and I thought that we had dotted every “i” and crossed every “t”, Medicare told us that we had done just fine in recertifying my solo medical corporation ...but that now we would have to do a complete reapplication under my individual NPI number as well, since I have to again prove my own existence! So far, we have spent around twenty hours or so dealing with this bureaucratic nonsense. Until next month.... Samuel Fink, MD, is an internist in private practice in Tarzana. He is the 141st president of the Los Angeles County Medical Association.

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FRONT OFFI C E | P R AC T I C E M A NAGEM ENT

Moving Away from Medicare: How to Opt Out BY LAURA PODOLSKY, FENTION NELSON

feeling nervous these days about Medicare. There’s the annual SGR drama, in which increasingly severe rate cuts loom unless and until Congress blocks application of the broken formula. Had the SGR been applied for 2013, Medicare enrolled physicians would have seen rates slashed by 26.5%. But, as it has every year since 2003, Congress voted to prevent the reduction—while failing to fix or eliminate the underlying formula, meaning doctors can anticipate another SGR drama next year.

M A N Y PH YS I C I A N S A R E

Physicians still face a 2% Medicare rate cut, which was originally set to take effect January 1 but was delayed until March as part of the fiscal cliff deal. Meanwhile, analysts across the political spectrum assert that without significant changes to reimbursement, utilization controls, or both, Medicare will be unable to meet the needs of the growing numbers of beneficiaries and unable to adequately reimburse providers. In light of these grim prognostications, some physicians are wondering if it’s time to withdraw from Medicare altogether. However, the only definitive way to cut ties with Medicare is to disenroll and then make sure that you do not see any Medicare beneficiaries, ever. But with the exception of pediatricians, few physicians can be absolutely sure they do not have Medicare beneficiaries in their patient mix—after all, even younger adults may have Medicare if they receive Supplemental Security Income (SSI) or Social Security Disability Income (SSDI). Physicians who will continue to see Medicare beneficiaries, but still wish to leave Medicare, must follow the process for opting out. Ironically, the same legislation that created the flawed SGR formula, the Balanced Budget Act of 6 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

1997, also established the exit route for Medicare enrolled physicians: the opt-out process. Physicians who complete the opt-out process are not bound by the Medicare charge limits and do not have to submit claims to Medicare; instead, they may—must, actually—enter into private contracts with their Medicare patients. There are four basic requirements for opting out of Medicare: the physician must sign private contracts with Medicare beneficiaries before providing care, file an affidavit with the local Medicare administrator, maintain compliance with the opt-out rules, and renew opt-out status every two years. The order and timing of the process depends on whether one is a participating or a nonparticipating physician. A nonparticipating physician (i.e., those whose enrollment status allows them to either bill Medicare patients directly, at rates of up to 9.25% higher than Medicare rates, or be reimbursed directly by Medicare at Medicare rates) may opt out at any time. The nonparticipating physician should first notify their patients that they are opting out of Medicare. While such patient notice is not a CMS requirement, CMS has encouraged physicians to take this step to ensure patients have time to find a new doctor if they don’t want to enter into a private contract. Next, the physician should file an affidavit with the local Medicare administrator-—in California, Palmetto GBA. The affidavit form is available on the Palmetto GBA website. The affidavit states that the signer understands that during the two-year period covered by the affidavit, he or she may provide services to Medicare beneficiaries only via private contract, and may not receive any Medicare payment whatsoever for such services. (The affidavit may be filed after signing a private contract with a patient, described below; in this case, the affidavit must be submitted within ten days of signing the contract.) Next, the physician should enter into private contracts with each Medicare beneficiary patient, before providing any services to such patients. The requirements for these contracts are set forth in Title 42 of the

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Code of Federal Regulations, Section 405.15. CMS has not published a sample contract, and while several examples are available from other sources online, the safest choice is to read the regulations yourself before devising your patient contract, or seek the assistance of a health care attorney in drafting one. In addition, make sure to discuss the contract and its implications with the patient to ensure the patient understands that he or she may not submit a claim to Medicare for any services you provide, that he or she will have full financial responsibility for these services, and that Medicare limits do not apply to what you may charge for these services. Document this conversation in the patient’s chart. Note that the private contracts may not be entered into when the patient is facing an emergency or urgent health care situation. At the same time you prepare to submit the optout affidavit and establish private contracts FOR PHYSICIANS WHO HAVE DECIDED TO OPT OUT, WE OFFER THE FOLLOWING TIPS: with patients, you should develop office proceDocument your conversation with the patient about the dures to ensure that your private contract in the patient’s chart. office never files a Medicare claim or directs a Make sure to keep a signed copy of the contract in the patient’s chart, and provide the patient with a signed copy. patient to do so. Make sure to educate your ofMark your calendar to be sure you renew your opt-out fice staff so they understatus every two years by sending in your afﬁdavit on time stand your opted-out and updating patient contracts as needed. status and can explain it Make sure your ofﬁce staff understands your opted-out clearly to new and existstatus and can answer patient questions on this topic. ing patients. The opt-out affidaInform physicians in your referral network of your status so vit is good for a period they can advise patients they refer to you in advance. of two years. Once it expires, you must repeat the process described above. Patient contracts should also be renewed as needed. Participating physicians should follow the same steps as nonparticipating physicians, but must be mindful of specific timing requirements. According to CMS, participating physicians must ensure their affidavits are received by Palmetto GBA “at least 30 days before the first day of the next calendar quarter showing an effective date of the first day in that quarter.” That is, if you are a participating physician, Palmetto GBA must receive your affidavit by March 1 if you wish your opt-out period to begin April 1. If you miss that deadline, you must wait until the first day of the next quarter (e.g., July 1) to begin your opt-out period. One common misconception is that a physician can opt-out with regard to certain patients, service sites, or services. There is no such thing as a partial opt-out. Opting out is an all-or-nothing affair. A physician may not opt out with respect to certain patients or covered services but not others. For example, a 8 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

physician who works in a hospital emergency department and also has a private practice may not opt out in her private practice but continue to bill Medicare for services provided in the ED. Similarly, a physician with two separately incorporated practices may not opt out of Medicare for one practice but not the other. For physicians in group practice, the group may not bill Medicare for services provided by the optedout physician. If the opted-out physician grants the group the right to bill and be paid for the physician’s services, however, the group may bill the beneficiary for services provided under the private contract. The group may still bill Medicare for the services of other group members who have not opted out of Medicare. As well, Medicare will pay for covered services ordered but not provided by an opted-out physician. What if you change your mind? You have 90 days to revoke your opt-out decision, but only if you: have never opted out before; notify within 90 days of the effective date all carriers who have received the affidavit; refund any monies in excess of Medicare limiting charges that you collected from patients under private contracts; and notify any patients with whom you have privately contracted of the change and of their right to have claims filed with Medicare on their behalf for covered services furnished between the opt-out effective date and the termination of the opt-out. Physicians considering opting out of Medicare should make sure they understand the process and its implications. Failure to comply with the opt-out requirements could result in serious penalties. Any private contracts with patients will be deemed void, triggering the obligation to submit claims to Medicare for all covered items and services provided for the rest of the two-year period. As well, the physician will be required to refund all amounts above the Medicare limiting charges that were collected from Medicare beneficiaries during the failed opt-out period; CMS may audit the physician to see whether all required refunds were issued. Further, a failed opt-out could attract additional CMS scrutiny, motivating the agency to try to determine if the physician may have engaged in other Medicare violations. And of course there is the hassle and embarrassment of explaining the situation to patients. At present, Medicare may seem an unsteady vessel with a questionable future. But before deciding to jump ship, physicians should be sure they understand the opt-out process and its implications. When in doubt, seek the advice of legal counsel to be certain you understand your options and how to proceed.

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Alternative Career Options BY MARION WEBB

care environment has some doctors rethinking the traditional career path, while others may dream of combining a special interest with medicine. The good news is that, in the changing face of healthcare, nontraditional careers for physicians are exploding. Below are just a few opportunities out there.

T H E C H A N G I N G H E A LT H

Medical Services Bureau Recruitment Unit, said he’s currently actively recruiting internists, family practitioners, gynecologists, radiologists, and other specialty doctors to help meet the medical needs for the rising inmate population. “The population in jail is rising because of prison overcrowding,” Dr. Waliany said. Waliany said treating inmates is no different to him than working with any other population. “I don’t even look at their criminal record,” Dr. Waliany said. “They get the same standard of care as anyone else,” he said. And, he added, “I get to practice medicine the way I want to.” DOCTORS WITHOUT BORDERS

MILITARY PHYSICIAN

Military physicians and surgeons represent all of the major fields of medical specialization and are the chief providers of medical services to military personnel and their dependents. Advanced courses and programs in medical specialties are available to military medical personnel, and scholarships for advanced medical training are available in return for an obligated period of military service. A Navy Medical Corps doctor described the professional opportunities for doctors in the military as numerous for “those willing to step out of their comfort zone a little.” As part of the Navy Health Care team, Navy doctors might contribute to medical relief efforts in the U.S. and globally and serve victims in combat or in disaster areas. Navy doctors use breakthrough technologies, such as LED probes, to help heal wounds faster, and practice the most upto-date procedures, such as “forward surgery.” JAIL OR PRISON DOCTOR

The number of medical, mental health and dental workers in the prisons more than doubled over six years, from 5,100 in 2005 to 12,200 last year, and California prison doctors have the secondhighest pay rate In the nation. Chief Physician Dr. Raymond Waliany, who works for the LA County’s Sheriff’s Department 1 0 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

Doctors Without Borders is an international medical humanitarian organization created by doctors and journalists in France in 1971. Today, the group provides help in 60 countries to people threatened by violence, natural disasters, armed conflict and in other areas of tremendous medical need. These doctors are willing to work in extreme conditions with limited resources, have at least two years of relevant professional experience and availability for a minimum of 9 to 12 months. NONCLINICAL CAREERS

Many doctors, disillusioned with traditional medicine, are turning their attention to nonclinical fields where a medical degree comes in handy. The vast areas of opportunities include insurance, pharmaceuticals, biotechnology, health systems, risk management, occupational health, and academia. Nonclinicaljobs.com has job listings. HIGH-TECH AND BIOTECH MEDICAL FIELDS

Stanford University School of Medicine is known for actively encouraging medical students to explore high-tech medical fields, including entrepreneurship. Some students prepare for such a career early by earning “dual degrees” such as an engineering degree, to learn how to design a medical device, and their medical degree, to understand its potential practical applications. Others combine an MBA in health administration or business with their medical degree to position themselves for leadership positions in management.

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BAL A NC E | L I FEST YLE & WE LLNES S

Hobby Development Helps Combat Burnout BY MARION WEBB

lives in training, dealing with long hours and intense situations with patients every day, which can take its toll on the family life and stress barometer. A large national study on physician burnout conducted by the American Medical Association Physician Masterfile found that out of 7,288 surveyed doctors, 45.8% reported at least one symptom of burnout, with the highest rates being family practitioners, internists and emergency doctors, JAMA Internal Medicine reported in its October 2012 issue. D O C T O R S S PE N D U N B A L A N C E D

As the AMA points out, physicians are important role models for their patients and peers, which makes their own personal health an influential factor in health promotion and disease prevention. Recent studies have shown that physicians who practice healthy behaviors for themselves are more likely to talk to their patients about these topics.

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It is imperative to recognize and support personal health at each stage of professional development, as medical students, residents, and practitioners. Making time to explore hobbies that give doctors enjoyment and help relieve stress is likely the answer to find more balance. Here are a few options for doctors to relieve some stress:

The idea of training for three sports—swimming, biking and running—may sound incomprehensible. In reality, many physicians are drawn to the sport of triathlon. It takes discipline, commitment, perseverance and competitiveness to train for a triathlon event, all attributes that most doctors cherish. To complete a sprint distance triathlon (750-meter swim/12.4 mile bike ride and a 3.1 mile run) requires roughly 10 hours of weekly training. Moreover, it’s not uncommon for races to benefit medicine. In 2012, the Nautica Malibu Triathlon raised $1.2 million for Children’s Hospital Los Angeles.

Yoga More than 11 million Americans practice yoga to seek the mind-body benefits of increased flexibility, strength, balance and muscle tone. A University of Wisconsin La Crosse study compared the benefits of performing Hatha yoga, the most beginner-friendly yoga, to a non-yoga control group. Of 34 healthy, but sedentary women who participated in 55 minutes of Hatha yoga classes three times a week for eight weeks, 13 percent had greater flexibility in the shoulder and trunk. Participants showed greater muscle fitness and had a 17-second increase in their one-legged stance time.

Photography Photography is a great hobby for those wanting to create true art and explore the world in a whole new way. Beginner classes are offered at many colleges and online.

P HYSI C I A NS NEWS NET WOR K | EXPA ND ED COV ER AG E

Training for a Triathlon

Cooking Many people actually find it relaxing to scour cookbooks for new recipes, buy ingredients they have never tasted before, come home, turn on some music and make cooking fun. The experience may be enhanced when cooking with a significant other and then enjoying a wonderful home-cooked meal.

Joining a Health Club With the many proven benefits of physical activity, for most people time is the biggest obstacle to enjoying a regular exercise routine. Finding a group exercise class or workout partner in a health club, then treating the time in the gym like an appointment is often the key to adherence. Hiring a personal trainer also keeps people accountable, on track with a regular exercise routine, and can help doctors achieve a particular fitness goal.

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REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

Termination of Hospital Insurance Contracts Reversed

Postoperative Coaching Program Introduced at MemorialCare JRC

Former President Clinton Discusses Health Data Superhighway

ALERT

Woodland Hills-based Health Net Inc. ended contracts with Tenet Healthcare Corp.’s Lakewood Regional Medical Center and five other hospitals in Southern California, effective Dec. 31, 2012. A new agreement was reached to reinstate and retroactively cover the hospitals in late January.

On Jan. 14, Los Angeles County physicians attending the Patient Safety, Science and Technology Summit heard from former President Bill Clinton, who discussed a planned “health data superhighway” which is being created by medical device companies.

Specialty Physicians Navigate In a Sea of Economic Uncertainty

The Affordable Care Act is not as complex as brain surgery, but navigating its waters can be disorienting for any physician. The California Association of Neurosurgeons (CANS) held its annual meeting this year in Long Beach on The Queen Mary, and brought together a panel of experts who addressed many of the economic issues relevant to specialty physicians.

GAO Denies Protest Against Medicare Contract Award

On Jan. 18, the Government Accountability Office (GAO) said it had denied a protest filed by Palmetto GBA, after a Medicare contract was awarded to Noridian Administrative Services (NAS) for Medicare Parts A and B in California. The switch, which as of Jan. 22 was still in flux, should not have a significant impact on doctors in Los Angeles County, according to a CMA official.

Companies, Physicians and Lawmakers Address Prescription-related Deaths

The issue over opioid-related deaths has been widely discussed in recent local newspaper articles. The problem has captured doctors’ attention and led lawmakers to call for more oversight. Various groups, from law officials to technology companies, are also coming out with innovative solutions.

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The MemorialCare Joint Replacement Center (JRC) at Long Beach Memorial is offering a coaching program that encourages patient family members and friends to help with the postoperative recovery process. Under the new program, the rehab coach stays with the patient from the preoperative into their hospital discharge and recovery at home.

LA Public Health Department Issues TB Alert to Physicians

The Los Angeles County Department of Public Health recently issued an alert to local physicians, advising them of a continuing outbreak of tuberculosis within the homeless community, concentrated in the downtown/metro region.

$100,000 Price Mobile Health App Competition Launched

The University of California, Los Angeles, Heritage Provider Network, and Open mHealth recently joined forces by launching a $100,000 health price competition.The competition will focus on developing mobile applications that will enable patients to track conditions in real time, help them manage chronic diseases, and improve outcomes.

Medical Robot Tested at UCLA Wins Clearance from FDA

A medical robot that was put through trials at the Ronald Reagan UCLA Medical Center recently won clearance from the Food and Drug Administration for emergency use. That makes the RP-Vita (Remote Presence Virtual and Independent Telemedicine Assistant) developed by iRobot and InTouch the first remote robot caregiver to win such clearance.

Physicians Use Web Service to Access Specialists

L.A. Care Health Plan has announced initial outcomes data from the Web-based service for general practitioners dubbed eConsult. Funded by the health plan, the service is designed to enable primary care doctors to gain expedited access to specialists and better coordinate care for their patients.

Study Offers Physicians Patient Population Insights

The recently released results of a 2012 study of U.S. healthcare consumers conducted by the Deloitte Center for Health Solutions provides physicians with new insights into patient populations.

UCLA Conference Highlights East-West Medicine Benefits

A recent daylong conference at the UCLA Center for East-West Medicine focused on clinical careers in integrative medicine, therapies, research and healthcare policies. Attendees learned that training in alternative medicine can enhance the doctor-patient relationship and generate additional income.

MemorialCare Partners with Surgical Care Affiliates

Tustin-based MemorialCare Medical Foundation announced on Feb. 8 it had entered into a joint venture with Birmingham, Ala.-based Surgical Care Affiliates to develop, buy, and operate ambulatory surgery centers throughout Orange and Los Angeles counties.

HealthCare Partners Seeks License to Operate as Managed Care Plan

Torrance-based HealthCare Partners Medical Group, which employs hundreds of primary care physicians and specialists and contracts with hundreds of independent primary care doctors, recently announced it is seeking a state license to operate as a managed care plan.

“Frailty Project” Follows Growing Trend

Cedars-Sinai hospital’s newly announced “frailty project” follows a growing trend by local hospitals to identify high-risk groups of patients and develop strategies to avoid lengthy hospital stays, cut overall costs, and prevent readmissions.

Medical Associations Win Support to Stop Pay Cut

In February, California hospital and medical associations won support from local and national organizations in their attempt to prevent a 10% pay cut in Medicaid from taking effect. The cut is a major concern for Los Angeles County doctors who are faced with a high influx of patients due to become eligible for Medi-Cal under healthcare reform.

INFRASTRUCTURE AND INVESTMENT MemorialCare Takes Over Former Bookstore Site MemorialCare Medical Group, part of MemorialCare Health System, recently moved into a new building that was formerly occupied by a Borders bookstore, according to news reports.

Children’s Hospital Los Angeles Outpatient Center Children’s Hospital recently announced the opening of a new outpatient care center in the South Bay, providing a community with a medical facility staffed by 14 physicians with expertise in 10 pediatric specialties. The hospital is expected to benefit children living in Torrance, Palos Verdes, the beach communities and surrounding areas. The 6,138-square-foot space includes 11 exam rooms and walk-in X-ray facilities. Children’s Hospital physicians reportedly have great relationships with South Bay community pediatricians, who will now gain access to the hospital’s pediatric specialists.

Kaiser Permanente Medical Complex Opens Kaiser Permanente Foothill Ranch Medical Offices, a single-story, 36,000-square-foot office building located at 26882 Towne Center Drive, in the community of Foothill Ranch, is now open. The new medical offices include family medicine doctors, pediatricians, and a full nursing staff, as well as a blood-draw lab and diagnostic, radiology and pharmacy services for Kaiser Permanente members, Kaiser reported. Urgent care services are provided at Mission Viejo Medical Offices and Sandy Canyon Medical Center.

Construction Begins on Homeless Veterans Facility The VA Greater Hospital Los Angeles Healthcare System recently broke ground on a three-story, 51,500-square-foot building, which will serve as a therapeutic and supportive residence for chronically homeless veterans. The building, dubbed Building 209, will primarily serve patients whose combination of chronic mental health or other medical needs necessitate residential treatment, or for whom previous recovery attempts have failed. The building is scheduled to be completed in the spring of 2014.

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The Centers for Medicare and Medicaid Services (CMS) has published the long overdue final regulations on the Physician Payment Sunshine Act, which requires medical industry companies to disclose consulting fees, grants and gifts to doctors greater than $10.

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Sunshine Act Puts Physicians in the Spotlight

navigating you r career | featu re

The Art of Navigating your

Medical Career By Marion Webb

After having spent years in medical school, residency and fellowship, new physicians find themselves faced with the challenge of trying to manage their careers to reach their full potential. The good news is that in today’s technology age, doctors have many more options at their fingertips to learn the critical skills to navigating their careers. Taking online courses, earning a professional degree, leveraging social media and apps, using online resources to gain instant access to key clinical data, or even quick fact-checking at the patient’s bedside–these are all options worth exploring.

New Skills and Certifications

Rosario Ortega, LACMA’s membership outreach representative, said that while medical school prepares doctors for becoming great practitioners, many doctors lack the business skills they need to succeed in running their own individual practices or a group practice. “You can be a great physician, but if you don’t manage your office effectively, you can’t make money,” Ortega said. “Even if you hire a third party to manage your office, you should have a general understanding of what to do.” An office manager certification course, which typically runs six to eight weeks, can provide a general understanding of billing codes, managing employees, and other key skills doctors need in order to run a small business. Courses in advertising, guerilla marketing, small business, and social media are all critical to running a successful practice. “Learning how to use the Internet and how to position yourself online through marketing is really key,” Ortega said. Today’s tech-savvy consumers, especially younger people with families, will turn to the Internet to find a physician of their choice. Doctors who provide information online about their educational background and overall philosophy, and who have earned positive reviews from happy patients, are more competitive in the marketplace.

Continuing Medical Education

Doctors also need to focus on their continuing medical education (CME) training, which differs in every state. Dr. Christian Fox, professor of clinical emergency medicine at the University of California, Irvine School of Medicine, and a frequent speaker at medical conferences, feels that the Internet is the wave of the future for continuing education. “We are seeing less attendance at conferences, because everyone is turning to the Internet for continuing formal education,” Dr. Fox said. Traditionally, doctors have attended conferences to earn their continuing medical education credits, but the Internet has gained significant market share. In California, all general internists and family physicians who have a patient population of which more than 25% are 65 years of age or older shall complete at least 20& of all mandatory continuing education hours in geriatric medicine or the care of older patients, according to the State Medical Licensure Requirements and Statistics from 2006. All physicians and doctors also must complete 12 credit hours in pain management, according to the report. According to a study conducted by ON24, a virtual commu-

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nication vendor with headquarters in San Francisco, and MedDataGroup, an interactive content and database marketing services company in Topsfield, Mass., that surveyed 971 physicians across a variety of specialties, 84% of doctors now would prefer attending CMA events online. CME training is increasingly moving to mobile devices and smartphones. The American Medical Association offers CME courses online arranged by topic or format and Webinars at www.ama-assn. org/ama/pub/education-careers/continuing-medical-education. page. Medical schools, including the University of California, Irvine and University of California, Los Angeles also offer CME coursework. UCLA’s office of Continuing Medical Education (www.cme.ucla.edu) lists about 60 courses each year.

Conferences

Conferences organized by medical societies and related organizations are a staple item of the academic, professional, and social lives of physicians. These events come in all sizes, from relatively small, local gatherings, workshops, and symposia to large international mega-congresses and can be an important factor in successfully navigating your medical career. Although it is gaining marketshare when it comes to continuing education, “the Internet will never be able to compete with conferences in the areas of fostering critical human connections, live discussions and medical learning,” said Dr. Fox. “Sharing things online is no replacement for medical learning in the same room.”

Professional Degree/Certification Courses

Leah Vriesman, a professor and director of executive education programs in Health Policy & Management at University of California, Los Angeles, said that professional students, including about 25% of doctors who pursue a master’s degree in public health (MPH) at UCLA, learn in a classroom setting for several reasons. “We put an emphasis on management and policy,” Vriesman said. “You can’t do that, if you’re not a good communicator and don’t build a network.” The 21-months long university program is geared toward the working professional, including doctors, policymakers and lawyers, who meet every other Friday (from 1 p.m. to 9 p.m.) and Saturday (from 8 a.m. to 5 p.m). Students are put together into “cohorts” of 30-35 people, so they can learn as much from each other as from the professor. Classes cover topics such as biostatistics, finance, ethics and

You can be a great physician, but if you don’t manage your office effectively, you can’t make money. Even if you hire a third party to manage your office, you should have a general understanding of what to do.

FEAT UR E | NAV I G AT I NG YOUR CA R EER

law. Vriesman said the program offers a path for career advancement for physicians who want to position themselves for leadership roles. The contacts made within the cohorts can have a lasting career impact as they often lead to job opportunities before students graduate. “Last year, in our graduating class, one of our students who is the chief medical officer for the All Princess Cruise Lines hired a classmate to run everything that had to do with medical records and financing,” Vriesman said. UCLA is currently accepting applications for the upcoming program, which starts this September. The total program cost is $54,000, which is expected to rise by 5% to 7%, according to Vriesman.

Social Networks and Apps

Mentors are critical helpers for doctors at the very early stages for career development and networking. For medical students who want to do well on their exams, reaching out to their professors is key to gain knowledge and expertise.

For every newly minted doctor, simply getting to see more patients at the bedside is key, Dr. Fox noted. However, with the rapidly changing economics of health care and readily available technology, doctors are now turning increasingly to their iPads and smartphones to stay up-to-date with clinical work. “Every specialty has their own website,” Dr. Fox said. “As an emergency room physician, I turn to www.uptodate.com and www.pubmed.com to find answers.” Another physician-recommended website is Sermo, used as a way to network with “highly intellectual people and a live community of doctors.” Sermo also allows doctors to explore job opportunities, share clinical information, do case studies, and earn honoraria while having their voices heard, according to published reports. The site is exclusive to doctors and also allows doctors to interact with drug experts, participate in forums with members of Congress and take advantage of numerous other opportunities to get involved, learn, and earn money. Ozmosis is another network for “verified U.S. physicians” only, and is similar to Sermo, though less established. Dr. Fox said he’s a fan of www.sonosim.com, an online ultrasound training program he feels is remarkably live like. “That kind of technology can cut down on hours one needs to spend in the classroom,” he noted. As someone who spends a lot of time with medical students and residents, Dr. Fox observed that the younger students are attached to their iPads and embrace digital technology, including apps. “I’m the first to admit that we have a textbook shelf in the ER that hasn’t been used in two years,” Dr. Fox noted. One of the reasons is that several textbooks are now readily available as apps. Apps can provide doctors with instant up-to-date information

on therapies and other clinical data, which in turn allows doctors to make treatment decisions much quicker than ever before. He gave as an example the 5-minute Consult Series, a popular textbook turned app. Other popular apps include PubMed on Tap, an application for the iPhone, IPod Touch, and iPad, which lets doctors search for PubMed and PubMed Central while on the go. For drug information on the go, Dr. Fox recommended Micromedex and Epocrates Rx, which can be downloaded on Android phones for free. But while technology makes practicing medicine more efficient, the human connection remains critical for career advancement.

Mentor

Mentors are critical helpers for doctors at the very early stages for career development and networking and can be invaluable in navigating a successful career. Dr. Fox said for medical students who want to do well on their exams, reaching out to their professors is key to gain knowledge and expertise. “It really can advance their career with letters of recommendations, providing a reference and opportunity to conduct research and publish papers,” Dr. Fox said. LACMA provides mentoring programs and networking events to help young doctors connect with Los Angeles County’s top doctors and influencers.

Attitude

Attitude may not be at the top of the list for future success, but Dr. Fox feels it’s a character trait that all revered doctors seem to have in common. “When I look around the hospital and look at people, I admire those with a consistent reputation,” he said. “Everyone trusts them, loves them, they are reasonable and honest and upbeat people who have a positive and can-do attitude.”

Joining Organizations

Finally, to advance in their careers doctors need to shake a lot of hands. Joining organizations like LACMA opens the door to meetings with top doctors in their respective fields, he said. “It is especially important for young doctors,” Ortega said. “Many doctors join specialty organizations, but you need to join the county physicians organizations and actively participate in the networking events and district planning meetings,” Ortega said. “It’s not enough to put your profile on the Internet.”

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LACMA/CMA Board Member Meets with Members of Congress D R . DAV I D A I Z U SS ,

Los Angeles County ophthalmologist at Ophthalmology Associates in Encino and West Hills and vice chair of the board of trustees for the California Medical Association (CMA), recently travelled to Washington, D.C. to meet with 32 members of Congress. The purpose was to discuss a variety of issues under healthcare reform.

This comes on the heels of a recent report by the Congressional Budget Office that showed the cost of a permanent fix to the Medicare SGR as dramatically lower than previous estimates. The estimated price tag is $138 billion over 10 years, $100 billion less than previous estimates (see CBO story). Currently there are several bills in Congress that would adopt a new Medicare payment system. With Medicare spending growth down to the lowest levels in decades, CMA urged members of Congress to seize the opportunity to enact longterm physician payment reforms so California physicians can meet their commitments to their patients. Among the topics Aizuss and other members of CMA’s executive committee addressed were the implementation of the Medi-Medi dual eligibles demonstration project and J-1 Visas for interna2 2 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

tional medical graduates who want to practice in health profession shortage areas (rural and urban) and Medicare payment reform. In addition, the group previewed for Congress an alternative Medicare payment system that CMA, the American Medical Association and health care organizations have been working on over the past year. With the goal of creating a stable payment system that promotes quality and value in health care, the proposed system would provide a menu of payment methods and health delivery models in which physicians could choose to participate, such as primary care medical homes and patient registries to track outcomes. “We met with Congressman Ami Bera (a former UC Davis professor and past medical director for primary health services in Sacramento County) and Congressman Raul Ruiz (a doctor who previously worked at Eisenhower Medical Center in Rancho Mirage),” Aizuss noted. “They are both doctors and committed to Medicare payment reform.” Among the big concerns are the impending federal budget sequester cuts. If Congress doesn’t act by March 1, the sequester will trigger a 2% cut to Medicare physician payments and Medicare financing for graduate medical education. The cuts would take effect April 1 and last for nearly a decade, AMA reported. CMA executives also had an opportunity to meet with leaders at the U.S. Department of Health and Human Services to discuss the implementation of the Affordable Care Act in California. Aizuss said CMA will now address some of the specific issues in letters and provide members of Congress with requested information. He and other CMA executive committee members plan to return to Washington, D.C. in May to lobby on specific bills that were introduced, he said. “It’s a very intense continuous process that makes it worthwhile to be a member of LACMA and CMA,” Aizuss said.

A large number of national health care organizations have filed amicus curiae briefs in support of the California Medical Associationâ&#x20AC;&#x2122;s (CMA) request for an en banc review by the Ninth Circuit Court of Appeals. The review is part of an effort to stop the State of California from implementing a 10% cut to Medi-Cal provider reimbursement rates. Last month, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in CMA et al. v. Douglas et al. â&#x20AC;&#x201C; California Hospital Association, California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response â&#x20AC;&#x201C; argue that reducing payments in the Medi-

Cal system will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system. Those organizations signing the briefs include: National Health Law Program, AARP, National Senior Citizens Law Center, Public Interest Law Project, Asian Law Alliance, California Advocates for Nursing Home Reform, Western Center on Law and Poverty, Arizona Center for Law in the Public Interest, Disability Rights Center, Disability Law Center of Alaska, Disability Rights Idaho, Hawaii Disability Rights Center, Disability Rights California, Alaska State Hospital and Nursing Home Association, American Hospital Association, Arizona Hospital and Healthcare Association, Healthcare Association of Hawaii, Idaho Hospital Association, Montana Hospital Association, Nevada Hospital Association, Oregon Association of Hospitals and Health Systems and the Washington State Hospital Association. The lawsuit to prevent the cuts was originally filed by CMA in November 2011.

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Amicus Briefs Filed in Support of CMAâ&#x20AC;&#x2122;s Suit to Prevent State Cuts to Medi-Cal Reimbursement

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CEO’s LETTER CEO’

LACMA WANTS YOUNG DOCTORS IN LEADERSHIP RANKS D U R I N G T H I S T I M E of changing economics of healthcare and healthcare laws, increasing costs and declining reimbursement, many newly minted doctors are concerned about their future. After having spent so many years in medical school and training for a successful career in medicine, many young doctors are now faced with the challenges of building their own medical practice and all the business practices that come with it. Others are worried about the influx of patients once the healthcare law goes into full effect and what it means for them.Yet others may be contemplating what career path is right for them and looking for a mentor to guide them. We want young doctors to know that we understand their concerns and are here to support them. The New LACMA has stepped up its efforts to create special events and programs specifically designed to address such critical issues as advocating for your rights. Just recently, at a dinner event, young doctors shared their concerns about the dual eligibles demonstration project, which at its centerpiece requires patients who are eligible for Medicare and Medi-Cal to enroll into managed care plans. Some worried that the implementation of this program would end their dreams of starting a medical practice. I was pleased to share with these young physicians that LACMA’s leaders have met with key legislators in Washington D.C. , to remove Los Angeles County from this healthcare project. I was pleased to return to Los Angeles knowing that doctors’ voices were heard loud and clear. The California Podiatric Medical Association has now invited LACMA to join them in revisiting the effort in Washington, D.C., possibly this March. We are also continuously putting on networking opportunities with Los Angeles County’s most influential leaders and top doctors. Just last month, LACMA invited young physicians to an evening panel discussion to help them navigate health reform. LACMA is currently evaluating several service organizations to identify which ones can offer young doctors the best business skills they need to succeed. Once the program is in place, physicians will be able to take advantage of formalized education in banking, accounting, insurance and other business practices during the evenings and weekends. LACMA’s outreach representative is here to support young doctors looking to start their own or a small group practice. This March issue is dedicated to helping physicians manage their medical career path and maximize success through career advancement and promotion, identify secondary career opportunities and provide guidance for stress relief and balance. All these efforts are geared toward helping young doctors find their path.The greater the participation of young doctors in LACMA, the greater our chances to rise to the challenge. We embrace young doctors’ energy, drive, enthusiasm and technological savvy and hope that you will join LACMA in even greater numbers this year.

Rocky Delgadillo

Rocky Delgadillo Chief Executive Officer

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Four Californians will be honored with Excellence in Medicine awards by the American Medical Association (AMA) Foundation during AMAâ&#x20AC;&#x2122;s upcoming National Advocacy Conference in Washington, D.C. The awardees are Olivia Marie Campa, University of California, Davis School of Medicine; Joseph E. Li, University of Southern California, Keck School of Medicine; Debraj Mukherjee, M.D., M.P.H., neurosurgery resident at Cedar-Sinai Medical Center; and Jean Sun, University of Southern California, Keck School of Medicine. Two students from the USC Keck School of Medicine will receive recognition from the AMA. LACMA student member Jean Sun is a third-year medical student pursuing a career in health policy and administration. Joseph Ethan Li is a second-year medical student, who plans to pursue a career in adult oncology. Both have served as chairs of USCâ&#x20AC;&#x2122;s studentrun clinic providing comprehensive care to the underserved populations in the Los Angeles area. Sun, who founded the clinic, served as chair last year and Li is the current chair. This unique inter-professional model was nationally recognized by the U.S. Department of Health and Human Resources in 2012.

Debraj Mukherjee, M.D., M.P.H., a LACMA member and neurosurgery resident at Cedar Sinai Medical Center in Los Angeles, worked on health policy and program development as a C. Everett Koop Scholar at Dartmouth College and served as a Washington Health Policy Fellow with U. S. Surgeon General Richard Carmona. He studied clinical design as a Sommer Scholar and a Schweitzer Fellow at Johns Hopkins University, where he was later awarded a grant from the Center for Innovative Medicine to lead the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory. Since its inception, the AMA Foundation has awarded over $60 million in medical scholarships to high-performing medical students and physician scholars.

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L AC M A NEWS | ASSOC I AT I ON HA P P ENI NG S

LACMA Members To Be Honored With 2013 Excellence in Medicine Awards

A S S OC I AT I ON HA P P ENI NGS | L AC M A NEWS

LACMA District Meetings Address Physician Concerns recently at two LACMA-sponsored district events that addressed local issues impacting healthcare delivery. The topics of a January event in Beverly Hills and a February event for LACMA District 5 members reflected the range of issues facing physicians. PH YS I C I A N M E M B E R S M E T

medicine at the AIDS Healthcare Foundation in Hollywood, said he appreciated learning about some key changes affecting doctors under the Affordable Care Act. “It was useful to talk about the importance of detailed documentation to support CPT Medical Billing Codes for billing,” Chen said. “We also learned about the current increase in primary care reimbursement in Medicare and Medi-Cal, which is important, given the difficult environment primary care physicians are facing.” Chen, a new LACMA member, said he’s looking forward to learning about shared experiences from doctors and hopes to benefit from LACMA’s resources. “LACMA can represent the interests of the community of physicians to help us survive the reimbursement cuts and regulatory burdens,” he said. “Physicians have to be business-minded and be aware of changes under healthcare reform. We need to be involved in LACMA and vocalize our opinions.”

B E V E R LY H I L L S D I N N E R E V E N T, JA N 3 0 (Pictured) Beverly Hills plastic and cosmetic surgeon Dr. David Hopp hosted the Jan. 30 event, which focused on political issues affecting Beverly Hills doctors, and the concerns of young physicians entering practice. The event drew wide support from local area physicians, according to LACMA. Beverly Hills Mayor William Brien, MD, who also serves as the director of Cedars Sinai Orthopedic Center and executive vice chairman, Department of Surgery, welcomed the group to his city. He emphasized that doctors are dynamic and important members of the community and its economy. “It was a positive event and we are very excited about doctors united,” said Rocky Delgadillo, LACMA’s CEO. Topics of discussions were LACMA’s key initiatives, including filed court cases against Aetna and Health Net, dual eligibility of Medicare and Medi-Cal patients, and efforts to prevent the city from imposing taxes on surgery centers. Dr. Wayne Chen, a geriatrician and acting chief of

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D I S T R I C T 5. “ M A N AG I N G M E D I C A R E I N 2 013 ” I N T E R AC T I V E D I S CU SS I O N , F E B . 5 Santa Monica psychiatrist and LACMA District 5 president Dr. Heather Silverman hosted an interactive discussion for local members titled “Managing Medicare in 2013” on Feb. 5 in Santa Monica. The event featured Dr. Arthur Lurvey, a board-certified internist and endocrinologist, as the keynote speaker. Dr. Alex Gold, a geriatrics physician in private practice in Santa Monica, described the meeting as very informative and said it led him to become an LACMA member. “As a geriatrics doctor who works with Medicare patients, I want to be more involved in what’s happening with healthcare reform, particularly in Los Angeles,” Gold said. “I’m in private practice and want to stay in private practice to have a doctor-patient relationship. Everybody is going into ‘Walmart-type’ services without personal attachment. I want to participate in organized medicine and a professional group to keep the private practice running and share my thoughts and come together with colleagues.” LACMA member physicians of all specialties are invited to present topics for upcoming events.

L AC M A NEWS | A SSOC I AT I ON HA P P ENI NG S

Los Angeles Physicians Urged to Apply for CMA Committee Seats Dr. David Aizuss, vice chair of the board of trustees at CMA, said now is the time for Los Angeles County physicians to apply for open seats at CMA committees.The following CMA committees are looking for new members: The Council on Legislation The Council on Medical Services The Council on Ethical Affairs The Council on Scientiﬁc Affairs The Council on Information Technology “This is a great opportunity for young physicians to get appointed,” Aizuss said. “I want to see some strong candidates from Los Angeles.” The selection process begins now and the deadline for application submission is May 25. Submit applications to Carolina Velasquez at LACMA by emailing carolina@lacmanet.org.

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LACMA Districts BACK IN ACTION!

LACMA’S 10 GEOGRAPHICAL DISTRICTS ARE LOOKING FORWARD TO A FULL YEAR AHEAD In June, each District will appoint their President and Board Members for July 2013 – June 2014. Each District Board will meet to discuss and plan local upcoming learning functions, local advocacy involvement and membership opportunities. The goal is to create awareness and involvement among the LACMA members and promote LACMA’s role in advocating for physicians to take back their profession District leadership is an amazing opportunity to mold what you want out of your membership. You gain valuable leadership skills and prestige in your profession. Interested in leading your LACMA District and creating an impact? Nominations are due to LACMA by March 11, 2013. Email Margaret Vieira, District Manager, at Margaret@lacmanet.org for more information.

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HAVE YOU RENEWED YOUR 2013 MEMBERSHIP?

IF NOT, GO TO WWW.LACMANET.ORG AND RENEW YOUR MEMBERSHIP ONLINE OR CALL 213-226-0313!

YOUR DUES DOLLARS HARD AT WORK! In 2012, LACMA: Filed major lawsuits against Aetna and Healthnet for abusive business practices against physicians and patients. Implemented a vendor vetting program, offering you exclusive discounts on best in class products and services. Vendors include UPS, Tredway, Lumsdaine and Doyle, and Los Angeles Collection Service. Launched an all new www.lacmanet.org with greater functionality to keep you informed and involved. Launched Physicians News Network (PNN), written and edited by professional healthcare journalists offering breaking local news, information, and data about the economics of healthcare delivery. Reestablished legitimacy in local policy matters. Supported candidates elected to serve in the Congress and State Legislatures. Those candidates ensure that LACMA’s mission of enhancing patients’ health and physicians’ ability to practice medicine is protected.

In 2013, LACMA will also: Offer exclusive members-only access to a Group Purchasing Organization to streamline your supply chain operations and save you valuable dollars on your everyday products and services. Work with Congress members to remove LA County from the Dual Eligibles Demonstration Pilot Project. Work to initiate free membership for your office managers to become a member of PAHCOM, the Professional Association of Healthcare Office Management. Host a series of informative and educational seminars to keep you updated on the most recent changes in California’s healthcare delivery system. Host a series of mixers for effective networking and fun interaction amongst your local peers.

Your physician leaders work tirelessly to ensure that LACMA continues to serve physicians in LA County! BE PART OF THEIR EFFORTS AND RENEW TODAY! 2 8 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

CMA CENTER FOR ECONOMIC SERVICES Webinars At-A-Glance

March 6: Fraud and Abuse: Dangers and Defenses

DHCS • 12:15 – 1:15 p.m.

March 7: Essentials for ICD-10-CM: Part 1

AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

March 13: Utilizing the New SDI Online System Employment Development Dept. • 12:15 – 1:15 p.m. March 14: Essentials for ICD-10-CM: Part 2 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. March 20: EHR Selection – Top 10 Tips for Success David Ginsberg • 12:15 – 1:15 p.m. March 21: Essentials for ICD-10-CM: Part 3 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. March 27: Successful Medi-Cal Provider Enrollment DHCS • 12:15 – 1:45 p.m.

WWW.LACMANET.ORG

2013 Education Series

New Tools to Take Action, Get Involved, and Manage Your Practice NEW FEATURES INCLUDE

April 3: Strategic Planning From Vision to Action Rachel Smith • 12:15 – 1:15 p.m.

Members-only portals

April 10: Preparing for EHR Implementation David Ginsberg • 12:15 – 1:15 p.m.

Physician community networks

April 17: Valuing, Selling, Buying a Practice Debra Phairas • 12:15 – 1:15 p.m. April 24: California’s Health Beneﬁt Exchange Brett Johnson • 12:15 – 1:45 p.m. May 1: The Physician’s Responsibility in Prescribing and

Referring for Medi-Cal Patients DHCS • 12:15 – 1:15 p.m.

May 8:How to Quickly Make Decisions on What Matters Most

Rachel Smith • 12:15 – 1:15 p.m.

May 15: Enforcement Provisions of the Medical Practice Act Medical Board • 12:15 – 1:15 p.m. May 16: Essentials for ICD-10-CM: Part 1 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. May 22: Documentation and Coding Auditing AAPC • 12:15 – 1:15 p.m. May 23: Essentials for ICD-10-CM: Part 2 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. May 30: Essentials for ICD-10-CM: Part 3 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

Office manager online forums Physician directories

New online marketplace showcasing vendors offering exclusive money-saving discounts on products and services geared towards efficient practice management operations.

C L A S SI FI ED | J OB BOA R D

TO PLACE A CLASSIFIEDS AD, VISIT WWW. PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231. 130

OFFICE FOR LEASE - GLENDALE -

FINANCIAL SERVICES

CPA FOR MEDICAL PROFESSIONALS CPA with extensive tax and business experience working with medical professionals. Tax Preparation, Financial Statements and Business Consulting

Call Josh Nyholt, CPA 805-729-1021 www.nyholtcpa.com

135

LEGAL SERVICES

Newly built and furnished medical office available for 2 -3 days /week. Best way to start seeing your private patients without investing any capital. For additional information call 323 202 5228. 520

OPENINGS—PHYSICIANS

PRACTICE DERMATOLOGY IN TARZANA

PT/FT CA licensed Dermatologist needed to join busy 4 doctor practice specializing in general dermatology and skin cancer. Located in the San Fernando Valley of Los Angeles across from a major hospital; 6 medical buildings (soon to be 7) within our block. Training in Cosmetic dermatology and laser is also desirable. Excellent compensation with partnership potential. An opportunity to practice medicine in which you can still have some control of your destiny. Please forward CV to valleyderm@sbcglobal.net

TRACY ZWEIG ASSOCIATES

LEGAL REPRESENTATION FOR PHYSICIANS

Former Deputy Attorney General, Law Professor & Administrative Law Judge specializing in Administrative & Medical Board matters. Free initial consultation RONALD S. MARKS A Professional Law Corporation

• Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

21900 Burbank Blvd., Suite 300 Woodland Hills, CA 91367

(818) 347-8112

RonMarks@prodigy.net ww.ronmarks-law.com

205

OFFICE FOR LEASE/ SUBLEASE/SHARE

CEDARS SINAI MEDICAL OFFICES FOR LEASE

Professional Psychiatrist/Therapist Offices-prime location 750sf space with beautiful views, small kitchen/waiting room/secretarial area. Will consider leasing individual office on a daily basis. Please contact Dr. Vida Nikzad for more information: 310-804-6118

530

OPPORTUNITY WANTED

FILM READING

Carl H. Boatright, MD, DABR, 30 years’ experience, rapid turn-around. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.

RADIOLOGIST

Board certified. Have own malpractice insurance. Available for part-time position or film reading. Call 310-477-4257.

Place Your Classiﬁed Ad Online Today! Visit the ALL NEW WWW.PHYSICIANSNEWSNETWORK.COM

3 0 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

540

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TRACY ZWEIG ASSOCIATES

• Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

Marketplace

PLACE YOUR AD ON THE ALL NEW

WWW.PHYSICIANSNEWSNETWORK.COM CME THE 26TH ANNUAL “HIV/AIDS ON THE FRONT LINE” CONFERENCE

Course Date & Location: UC Irvine Student Center, Irvine, CA Wednesday, April 10, 2013 8:00am-5:00pm This activity is approved for a maximum of 6.5 AMA PRA Category 1 credit.Topics Include: HIV Update, Global Epidemiology, Substance Abuse & HIV, HIV Meds, Affordable Care Act, Women & HIV, Aging & HIV, and HIV & Hep C For more information & to register, please visit: www.hivconference.org Blanca Guardado (714) 456-7734

Get Noticed! FOR MAXIMUM visibility for your product and services that will reach thousands of readers monthly place your ad online today! WWW.PHYSICIANSNEWSNETWORK.NET Or Call DARI PEBDANI Phone: 858-231-1231 | dpebdani@gmail.com

To place a marketplace ad, visit WWW.PHYSICIANNEWSNETWORK.COM contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231

Advertiser Index Athena Health ..........................................................................................................................7 California Wine Club................................................................................................................3 Cooperative of American Physicians ...................................................................................... 27 The Doctors Company ........................................................................................................ C4 Fenton Nelson ...................................................................................................................... 25 Los Angeles County Sheriff ’s Department .................................................................................9 Marsh .......................................................................................................................................5 NORCAL ............................................................................................................................ C2 Office Ally ........................................................................................................................... C3 UC Irvine............................................................................................................................... 23 UCLA .................................................................................................................................... 11

M A RC H 2013 | 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 3 1

C L A SSI FI ED | J OB BOA R D

TO PLACE A CLASSIFIEDS AD, VISIT WWW. PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231.

TOP 10

service area窶的nternal Medicine, Family Practice/Primary Care, Pediatrics, Anesthesiology, Psychiatry, OB/GYN, Emergency Medicine, Radiology, Surgery, Cardiology/ Cardiovascular - represent more than 60% (66.34%) of all U.S. physician specialties.

45-50

Average number of hours spent seeing patients per week by Anesthesiologists, cardiologists, gastroenterologists, surgeons, and urologists. By contrast, primary care physicians spend a median of 30-40 hours per week in direct patient care.

One Third

SIXTY $ 481,000 ONE According to a salary survey for the 10 highest paying specialties, none of the most popular specialties was also the highest paying, and showed orthopedic surgeons heading the list with a median income of

3 2 P H Y S I C I A N M A G A Z I N E | M A RC H 2013

The median amount a typical physician partner in a private practice earns, followed by physicians in single-specialty and multispecialty group practices.

SIXTY SIX

Average retirement age for physicians (all specialties), with internal medicine having the highest age average at 70.6

BY T HE NU M BER S | SP EC I A LT I ES

Total number of specialty areas recognized by the American Board of Medical Specialties for board certification. Within those 24 specialty fields are more than 145 subspecialty areas.

$ 275,000

Twenty Four

of physicians rated their happiness level at a 5 on a scale of 1-5 (5 being the happiest). Rheumatologists had the highest overall average at 4.09.

The highest average number of hours worked each week (anesthesiology). Pathology and dermatology tied for the lowest average with 45.5 hours per week.

California group health premiums will cost up to 10% more. What about your plan?

In 2013,

For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to cover the business side of your practice, too. From health benefits to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today. One of our experts can help you choose the right health plan to protect your employees and your family—while controlling costs.

Call (800) 852-8872 today for a quote or a complimentary insurance assessment. n n n n

Medical Malpractice Workers’ Compensation Health and Disability Property and General Liability

License #0677182

4065_SoCalPhysician_Mar2013.indd 1

n n n n

Employment Practices Liability Directors and Officers/Management Liability Errors and Omissions Liability Billing Errors and Omissions Liability

www.thedoctors.com/TDCIS

2/11/13 2:58 PM