March 2015 | Physician Magazine by Los Angeles County Medical Association

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REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

TELEMEDICINE LICENSING

REIMBURSEMENT

E XPANSION

LIABILIT Y

MARCH 2015 L I A

M A G

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M A R CH 2015 | TA B LE OF CONT ENT S

Volume 146 Issue 3

6 COVER STORY

TELEMEDICINE We look at the latest develop-

ments in telemedicine, focusing

on trends starting with physician licens-

Source: The Doctors Company

6 Telemedicine Improves Access to Care But Creates Liability Risks 14 6 Action Steps to Protect Your Heirs and Cut Estate Taxes

ing requirements and the latest legisla-

tive actions surrounding the interstate licensing compact, reimbursement is-

sues, expansion of mHealth and its challenges. We also provide an analysis of

successful program implementation for

FROM YOUR ASSOCIATION 4 President’s Letter | Pedram Salimpour, MD 16 CEO’s Letter | Rocky Delgadillo

physicians looking to deliver or increase healthcare services via telemedicine.

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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Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD William Averill, MD Marshall Morgan, MD

than 100 years, LACMA has been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, govern-

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your physician leaders and staff

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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.

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P RES IDEN T ’S LET T ER | P EDRAM S ALIM P OU R, M D

T H E O P E N I N G PA R AG R A P H to my dad’s biography reads: “I miraculously survived my mother’s difficult labor at the hands of a midwife. In the years that followed, I fought and survived measles, mumps, rubella, chicken pox, typhoid fever, whooping cough, dysentery (three times), malaria (twice) and tuberculosis, but I lost two of my siblings to tetanus and measles.” For his time, his story is not unique. But it has not been time that has cured us of these ills. It has been, and remains, science. Science is not a company. It is not a country. It is not even an idea. Science is a process. And that process has given us a lot, including vaccinations. There has been endless debate around the importance and need for vaccinations over the last several weeks, starting with a terrifying outbreak of a once-eradicated disease right here in California. As a practicing physician of fifteen years and as the son of a pediatrician of fifty years, having witnessed the calamity that unvaccinated children experience and that their communities have to bear, I’m here to put an end to the debate. Immunizations have been a cornerstone of medical advancements in this century, eliminating the fear of death and permanent disability from diseases that still threaten many communities across the world. Because of a recent Southern California outbreak of measles, I find myself answering more questions about the disease in recent weeks than I have in the combined years I’ve been practicing medicine. Unfounded misinformation available on the Internet, coupled with the craze in Hollywood to give attention to the anti-vaccine movement, has developed into a real concern for the public’s health. All this, as new parents get caught up in a vulgar campaign of misinformation against a routine that is scientifically proven to protect their children from a multitude of unimaginably horrific diseases. For years, the rates of unvaccinated children have been slowly rising for the reasons mentioned. However, we are starting to see headway with legislation that passed recently in California. In 2014, for the first time in a decade, the number of parents who filed personal belief exemption forms to exempt their kindergartners from vaccinations declined. Assembly Bill 2109, which was sponsored by the California Medical Association and authored by Sacramento pediatrician and state Sen. Richard Pan, MD, requires a parent or guardian seeking a 4 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

personal belief exemption from school immunization requirements to first obtain a document signed by a licensed healthcare practitioner. In the form, the practitioner is asked to attest that the parent or guardian has been informed of the benefits and risks of the immunization, as well as the health risks of the diseases that a child could contract if left unvaccinated. AB 2109 was born out of a rising concern around the increased personal belief exemptions in California and what that could mean for outbreaks of diseases like measles, mumps and pertussis. Exposure to these diseases puts not only individual children at risk, but also the community as a whole, including infants too young to be immunized, those whose immune systems are compromised, and the elderly. Reduced numbers of personal belief exemptions lead to decreased numbers of preventable outbreaks. It is imperative for the health of our state that we continue in this direction. Despite the progress, the recent measles outbreak at Disneyland shows us that more needs to be done. As a community, we must continue to advocate for the health and safety of not just individual children, but the public as well. Last night I was invited to speak to a group of parents at my son’s school. Stu Work, the headmaster at St. Matthew’s Parish, reminds me a lot of the headmaster of my own school as a child. He is calm and pensive. But in action, he is deliberate. Mr. Work set up the program, I imagine, knowing that on LA’s Westside he may encounter some passionate voices of opposition. To be honest, I did, too. But I was incredibly and pleasantly surprised. What I found was that, quite contrary to national press reports about LA’s Westside parents caring more about following what Jenny McCarthy says than what doctors and scientists write, these parents came to the program with real questions. And they came with a real desire to learn how to protect not just their own children but, incredibly, also others of those most vulnerable amongst us—infants, the elderly and anyone, adult or child, with a compromised immune system. Let’s ensure that our kids won’t have to see images of sick and disabled children who could have been kept healthy by vaccines. For children who are too young to be immunized or seniors and people with compromised immune systems, let’s keep on track and continue reducing the number of personal belief exemptions to ensure that our families and our communities are healthy and protected. As for my father, five decades into his clinical career, what he wishes is that he remain one of the few clinicians in the Western world to have seen firsthand and treated as a doctor, and faced the unbearable agony of a mother at the loss of her child to, tetanus, measles, mumps, rubella, diphtheria, polio or the other scourges of days gone by.

A Successful Medical Practice It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

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Source: The Doctors Company

Telemedicine Improves Access to Care But Can Create Liability Risks T E L E M E D I C I N E I N VO LV E S T H E delivery of

healthcare to patients in remote locations and to underserved patient populations through audiovisual, online, and wireless applications. This leads to improved access to medical care and consultation, more efficient treatment plan implementation, cost savings for patients, and increased patient satisfaction. The use of telemedicine is growing, and the Centers for Medicare and Medicaid Services recently announced that in the 2015 physician fee schedule, Medicare payments to telehealth originating sites will increase by 0.8 percent.1 However, numerous federal and state statutes have created significant liability risks for medical practitioners who engage in any form of telemedicine. The Health Insurance Portability and Accountability Act (HIPAA) established national standards for the use and disclosure of personal health information (PHI) and the prevention of healthcare

6 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

fraud and abuse. The Health Information Technology for Economic and Clinical Health (HITECH) Act implemented government-mandated requirements for breach notification, authorized random audits, substantially enhanced penalties for statutory violations, and specified that all transmissions of PHI must be “secure” (encrypted). Practices that engage in telemedicine must strictly comply with the various statutory requirements of HIPAA and HITECH or risk an investigation and potential fines. Physicians who engage in telemedicine across state lines face serious considerations. The scope of practice is generally determined by the location of the patient. Providing care to a patient located in a different jurisdiction requires the practitioner to satisfy the licensing requirements of the state in which the patient is located. Without proper licensure, adverse consequences might include criminal prosecution for the unlicensed practice of medicine or disciplinary action by a medical board. Physicians should also be aware that their professional liability policy may not cover a claim that is filed outside a specific territory or jurisdiction. To reduce these liability risks and enhance patient safety: • Comply with HIPAA, HITECH, and state-specific laws when transmitting all PHI. • Ask your system vendor to provide training to you and your staff on how to protect and secure your data. • Ensure robust and reliable high-speed broadband connectivity to support clinical functions. • Check practice requirements and legal limitations in states where you anticipate providing care to patients. Understand reimbursement practices for telemedicine services. • Use telemedicine carefully—and understand any limitations on the reliability and accuracy of the information. • Communicate directly with your professional liability insurer to make certain that your policy extends coverage to all jurisdictions where you provide services. Reference 1. Wicklund E. CMS boosts telehealth in 2015 physician pay schedule. mHealthNews. http://www.mhealthnews.com/ news/cms-boosts-telehealth-2015-physician-pay-schedule. Accessed November 25, 2014. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

HEALTHCARE VIRTUALLY ANYWHERE

TELEMEDICINE

O BY MARION WEBB

ne of the top healthcare trends for 2015, telemedicin

and hospitals, to legislation and licensing and accessi

technologies to patients who need them has been stif

could be a breakthrough year in removing some longstanding

some of the latest developments in telemedicine trends starti

surrounding the interstate licensing compact. Weâ&#x20AC;&#x2122;ll also discuss

of telemedicine and provide and an analysis of successful pro

via telemedicine or trying to increase their existing telehealth s

ne is significantly impacting all aspects of healthcare from private practice

sibility and research. Telehealthâ&#x20AC;&#x2122;s promise to deliver life-saving breakthrough

fled by regulatory hurdles for years. But some experts believe that this year

g legal, financial and regulatory impediments. In this issue, we will discuss

ing with physician licensing requirements and the latest legislative actions

s the newest on reimbursement issues. Finally, we will look at the challenges

ogram implementation for physicians looking to deliver healthcare services

services.

physician licensing requirements

igh on the list of breakthrough de- telemedicine,” describing it as a “net positive for velopments this year will be bring- patients, doctors and taxpayers.” But not all states are on board. ing the state physician licensing In Florida, for instance, House members suprequirements, currently controlled by 50 state medical licensing boards, under one ported a bill that would expand telehealth serspecial compact designed to expedite the vices, while the state’s Senate sought to limit the medical licensure process for physicians practice to licensed physicians in Florida only. Neither bill passed, but there is growing supseeking licensure in multiple states. As it stands, Medicare reimburses pro- port for Florida to join other states, the Orlando viders at its regular rates for caring for pa- Sentinel reported on Jan. 10. Meanwhile, in Iowa, the Iowa Board of Meditients remotely either by phone or video for only about one-fifth of the population cine recommended that Iowa join the Interstate Medical Licensure Compact. But Iowa lawmakers living in rural areas. Over the last decade, however, tele- in late January remained hesitant to join the agreehealth has expanded far beyond those ment, which supporters said would have facilitated services and now includes remote read- physicians licensed in Iowa and neighboring states ings and consultations as well as telephone such as Illinois and Nebraska to practice medicine outreach services by accountable care or- across state lines. At the same time, legganizations and private islation already introduced physicians. It is also being in Congress to address used in medical homes, issues of licensure, such hospitals and other faciliThe federal governas H.R. 3077 (the Teleties across state lines and medicine for Medicare even globally. ment has been slow to Act), which would allow Last November, the treatment under Medicare American Medical Asembrace telehealth, and across state lines, continsociation put its support ues to win backers. behind a special compact CMS still does not reBut experts note that to expedite the mediconcerns remain. cal licensure process and imburse for services in Among them is provowed to work with the fessional accountability Federation of State Medimetropolitan areas. as well as the thousands cal Boards (FSMB) and of dollars it can cost phyother stakeholders to cresicians to get multiple ate an Interstate Medical licenses. These are all poLicensure Compact. The good news is that at least 10 state medical tential stumbling blocks for physicians and firms boards have adopted the compact, according to that employ health professionals to jump on the AMA President-elect Steven Stack, MD, in a news compact bandwagon. Some states also have imposed restrictive rules release last November. As of January, some 33 states had already en- on telehealth practices, requiring patients receivacted telehealth parity laws that required private ing the service to have had prior physical contact insurers to cover remote care at the same rate as with a physician at least once. their public insurance counterparts. But other than the Veterans Affairs Department, the federal government has been slow to embrace medicare reimbursement telehealth, and the Centers for Medicare & Medicaid Services (CMS) still does not reimburse for services in metropolitan areas. urrent law remains extremely restrictive, and On Jan. 12, New York State became one of the Medicare reimbursement for telehealth is latest states to enact a telehealth parity law. only available at clinical sites in rural areas New York State Senator Catharine Young, who and for patients living in metropolitan areas unsponsored the law, applauded Governor Andrew able to access health services. Cuomo for signing the bill. The restrictions have led to low Medicare reimShe said the bill will “remove the financial bur- bursement rates for telehealth encounters. dens of travel, lost work time, and more by reHealth experts believe that modernizing the quiring private insurance and Medicaid to cover regulatory framework for Medicare reimburse-

“

”

1 0 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

ment will be a primary focus of upcoming congressional action. Representative Fred Upton, chairman of the House Energy and Commerce Committee, reportedly embarked on a “21st Century Cures Initiative,” a bill that would require the CMS to come up with a methodology within four years for reimbursing hospital and physician telehealth services “to the same extent and amount” as comparable to in-person services. In the recent final yearly physician payment rule, telehealth won a victory when CMS included new billing codes for telemedicine services for which providers can bill Medicare. Under the new codes, doctors can seek reimbursement for psychoanalysis, family psychotherapy and annual wellness visits using telehealth. In the 2014 CMS Physician Fee Schedule Rule, CMS also included Medicare beneficiaries who have multiple and significant chronic conditions as eligible for separate payments for doctors providing non-face-to-face chronic care management. Then last October, CMS also finalized a rule for CY 2015 that allows physicians to employ distant site clinical staff either directly or under contract to provide general supervision at all times, not just after hours. And last December, CMS also proposed to give Accountable Care Organizations “flexibility to use telehealth services as they deem appropriate for their efforts to improve care and avoid unnecessary costs,” according to the National Law Review. Supporters view this as a big step toward providing additional access to telehealth services. Some health experts believe that getting Medicare reimbursement is huge because GOLD private SHIELDinMEDICAL surers tend to follow the government’s lead.

telemedicine expansion

s more hospitals, healthcare organizations and private practitioners look to improve efficiencies and quality of care, digital technologies, especially mobile devices, will play a key role in meeting these goals, experts said. mHealth, defined as the practice of medicine and public health supported by mobile devices, is projected to be a $26 billion industry by 2017, according to Physicians Practice. And as global acceptance of the Internet across patient segments continues to rise and more patients embrace using technologies to meet their medical and healthcare needs, doctors, in turn, will use available tools to make real-time decisions, consult

and monitor patients and use electronic records to capture patient data and communicate with patients. Skip Fleshman, a partner with Asset Management Ventures, told Forbes Magazine that telemedicine may just be the biggest trend in digital health this year. He said that virtual consultations, for one, have matured where doctors can now offer patients a good experience, driven in part by faster Internet connections, better software in video chatting and the ubiquity of mobile devices allowing patients and doctors to connect with ease. Convenience is another factor, including patients’ ability to visit their neighborhood pharmacies for routine and non-emergency care or setting up patient monitoring from the convenience of their own home. Dr. Steve Ommen, associate dean at the Center for Connected Care at the Mayo Clinic, told Forbes that the fastest-growing demographic for social media is the 60-plus population, which often has the greatest mobility challenge to see a doctor. He noted that a telemedicine solution may be exactly what they need.

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Top 5 Challenges of Telemedicine Telemedicine is the diagnosis, consultation, monitoring, or transferring of encrypted medical data via telecommunication services and, therefore, it is important to set continuing educational standards for physicians who seek to practice it. Before raising all other questions there might be about the use and effectiveness of telehealth, patients first must be confident that it is safe. Research firm Kalorama Information (http://www.kaloramainformation.com) named telemedicine one of its top five health trends for the past year, while IDC Health Insights projects that some 65% of transactions with healthcare organizations will be mobile by 2018. The Global Telemedicine market in 2016 is predicted to be $27 billion, with Virtual Health Services making up $16 billion of that amount. By 2018, 70% of them will have apps, offer wearables, do remote health monitoring, and even offer virtual care. More than one-third of the money Google Ventures invested in 2014 went to healthcare and life-sciences companies. The benefits of using telemedicine include increased access to specialist consultations, improved access to primary and ambulatory care and reduced waiting times. And even though telehealth is set to grow considerably in the immediate future, there are some obstacles to overcome: 1. Integrated data - The telehealth system requires integration of techniques, including interoperability of medical devices, EHRs/EMRs, personal health records, and other technologies. Providers should not rely on a single system or product but should invest in scalable models capable of integrating data from a variety of devices. 2. Electronic patient records - Before telemedicine can be practiced, it

More hospitals and healthcare systems are also rolling out virtual visit programs, which save patients time and cost and offer benefits of coordinated care. While reimbursement remains an issue, telemedicine supporters continue to push for legislative action, with several bills already in place as others are being crafted.

“

The time of telehealth

is necessary to invest in developing an electronic medical record and in receiving training for this type of service, which can be a further disincentive to using this approach. Patients need to be able to access their own records and also have access to their doctor or a nurse.

is here, and both providers

3. Trust - Trust management is crucial to adoption and sustainability of systems. Interference-resistant wireless networks and secure, dependable, real-time communication networks with quality-of-service guarantees are needed to increase the adoption of telehealth systems.

embrace new technologies

4. Prescription of drugs - In some states the law says that physicians

cannot prescribe medication without first performing a “physical” examination, while other states limit telehealth prescribing to only certain classes of drugs. In the current regulatory environment, telehealth providers that wish to prescribe drugs without a prior in-person encounter with the patient will need to carefully review the prescription drug laws in the states where they operate as well as the states where their patients are located, and may need different procedures and protocols across states in order to comply with each state’s laws.

5. Post-treatment care - Most telehealth visits end after a diagnosis has been made and the treatment plan has been discussed with the patient. However, follow-up care days and/or weeks after the initial visit will be needed to ensure the patient’s needs were met and all issues were resolved. Integration with the patient’s entire medical record is essential for continuity of care.

Though there are advantages to getting counseling on demand and in the comfort of one’s own home, there are limits to what doctors can do when unable to diagnose a patient in person — including restrictions on tests and prescription drugs. If those challenges are met, technology has the potential to improve the quality of healthcare and to make it accessible to more people. Source: http://drsocial.org

1 2 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

and patients will continue to such as wearables, implant-

”

ables and other devices. moving forward

xperts say that despite the regulatory hurdles, which are likely to become more complex as innovation of more sophisticated technologies moves forward, the time of telehealth is here, and both providers and patients will continue to embrace new technologies such as wearables, implantables and other devices. Innovation is expected to continue to outpace regulation. To date, there is no federal standard for clinical guidelines in telehealth, and medical boards and state regulatory boards across the nation are responsible for setting their own standards. Efforts in Congress to modernize the regulatory landscape will continue in 2015 and are expected to reach significant outcomes. We will follow these trends here and bring you the latest news at the Telehealth News Network.

10 Critical Steps to Implement a Successful

TELEMEDICINE PROGRAM W

ith consumers and providers having the financial incentive and technological ability to make telehealth a reality, many experts believe that it’s merely a matter of time before innovation will take hold. To find out which characteristics appear to be common to a successful telemedicine and telehealth program, AMD Global Telemedicine conducted a study of more than 60 telemedicine programs in three different countries. Here are their 10 key findings of what it takes to maximize your success in implementing a telehealth program:

Set a clear vision Understand the strategic and tactical goals and vision of your overall organization and how telemedicine fits into this vision depending on your business model. Examples include delivering care remotely, providing alternative care delivery to save costs or expanding into different markets. Build a long-term financial plan Develop a financial plan and define measurements that will be used to drive the achievement of your outlined goals and make sure management is on board. Look for ongoing revenue and long-term sustainability. Create a convenient and effective work environment Successful telemedicine providers have equipment near where care is provided and where the consulting physician works. Thus, the sending room should be similar to a typical exam room with the same table, tools and supplies patients are familiar with and not be an “impressive” room with lots of visible cables. The receiving room should be equipped similarly to the sending room and ideally be integrated with the physician’s desktop. Mainstream telemedicine into standard care Delivering care using telemedicine should be the same as delivering standard care and comprise a patient’s chart and documentation and include simplified scheduling, measurement and billing protocols and systems. Plan and assure effective training Providers should be well trained in the communication technology, the clinical technology, the diagnostic device, workflow and protocols of care and procedures for use of the devices’ documentation. And they should know how to troubleshoot and access technical support. The most successful programs provide training in layers with lessons, materials and tests and offer a certificate of completion. Experts caution that buying cheap equipment often comes at a high price. Hire a full-time coordinator or effective leader A frequent mistake is that people underestimate the personnel requirements of implementing telemedicine. All successful programs have a full-time coordinator responsible for day-to-day operations and support to serve the users. That person must schedule sessions, ensure everything works properly, encourage users, address issues and remove obstacles. Good Project Planning All successful programs have a plan in place that is simple to manage, sets milestones and involves parties, but not everyone gets a vote.

Horizontal vs. Vertical Implementation The most successful sites are not horizontal addressing a broad audience nor vertical with a few sites with extensive capabilities, but rather a mix of both. Establishing a limited number of reasonable capable sites (10-20% of the anticipated total) appears to work best, the study found. It focuses attention, keeps the audience manageable and simplifies communication and support. Good marketing Successful programs know that good marketing starts with understanding the needs and wants of their users and organizing and building positive messaging around them. Successful techniques involve keeping management involved, making all surprises good news and marketing to opponents who will listen. Publish or perish Writing and presenting what you’ve learned and what you’ve done in articles, abstracts and posters involves members, and involving members of your telemedicine team at least once a year brings a level of self-awareness, self-discipline and self-assessment, and that is a critical value. M A RC H 2015 | 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 3

6 Action Steps to Protect Your Heirs and Cut Estate Taxes BY DAVE DENNISTON, CFA

YO U WA K E U P in the middle of the night, gasping for breath while cold sweat drips down your

face. You’ve just had a nightmare… about lawyers. With our litigious society, physicians have a lot to be worried about—malpractice lawsuits and a government breathing down your neck. Those nightmares could easily become reality—leaving your spouse or your kids with only half of your assets or perhaps virtually nothing for months while your estate is settled. You may be wondering, how can I protect my family? How can I make sure this doesn’t happen to me? Many of us grow so focused on our families, careers and growing wealth (then one day spending it) that we become so caught up in our busy lives and we don’t take the time to ensure that our estate is set up properly. There are many pitfalls if you don’t take the proper steps. Some common mistakes—that easily can be avoided—could make settling your estate a time-consuming hassle and possibly cost your heirs a fortune. Here’s a brief guide how to maximize protection for your family and minimize legal fees and taxes. HAVE AN UP-TO-DATE WILL Your will lets you decide how you want to distribute your assets and your estate. Without it, the state gets to figure out who gets what rather than you! The laws that govern what happens if someone does not have a will are called “intestacy laws,” and they can vary wildly from one state to another. In general, current spouses and kids receive the inheritance in the event of not having a will. But what if instead you are single or don’t have kids? Then the state gets to figure out which blood relatives get what. Have your will reviewed every 10 years to keep up with current laws and regulations. However, if you have been through a major life event such as divorce, marriage, new baby, new stepchildren, or death of a 1 4 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

child, then you will need to revise your will. AVOID PROBATE Probate is the process of transferring property at the death of a person to their heir(s). A lawyer has to file various documents and place notices in newspapers to fulfill legal requirements. Lawyers often charge a percentage of the estate value, which can range from 1% to 10%, depending upon the work required. That could add up to a lot of money! Basically, it’s a scheme by our legal system. Fortunately, there are several incredibly cheap and even free ways to avoid probate. It’s often as easy as titling assets properly, such as using a transfer on death designation or titling an account jointly with a spouse and/or kids. FEDERAL ESTATE TAXES In 2014, there is a federal exclusion for the first $5.34 million of an estate. If your estate is larger than that, then you need to be concerned with federal estate taxes, which can be very hefty, up to 40% of an estate! Here are some tax-reduction strategies to consider: Annual Gifting. You can gift up to $14,000 a year to any person tax-free. A married couple can thus give

FINAL THOUGHTS With estate planning, what Keep in mind that IRAs, you don’t know can and will Spend Your Assets. Enjoy life! 401ks, annuities, and hurt you. Education is the key. Take a few more trips. Check off life insurance policies all Seek help from a capable fiyour bucket list. Give to charnancial advisor or estate plandeclare specific benefiity. Just be careful that you have ner that can know your specifciaries—and that’s who’ll enough to take care of your dayic situation and is familiar with get the assets, regardless to-day needs until you are 90 or these concepts. 100 years old. what your will says. Get empowered! Take acIrrevocable Life Insurance Trust tion today and put this knowl(ILIT). You can remove money edge to work. This way you from your estate by gifting annucan dream only sweet dreams, and those pesky lawally to an ILIT. The death benefit from the insurance yer nightmares can bother another doctor. policy owned by an ILIT becomes separate from your estate. This will reduce your estate tax as long as you Dave Denniston, Chartered Financial Analyst (CFA), is a profesplay within the rules required by the administration of sional wealth manager and financial advisor. He is also the author of 5 Steps to Get Out of Debt for Physicians, The Insurance Guide the ILIT. for Doctors, The Tax Reduction Prescription, and his new book, The away $28,000 a year to any individual.

REVIEW BENEFICIARIES Go over each and every one of your accounts that have named beneficiaries to ensure that all is in order. Keep in mind that IRAs, 401ks, annuities, and life insurance policies all declare specific beneficiaries—and that’s who’ll get the assets, regardless what your will says. On the other hand, if you don’t have any listed beneficiaries, the assets are controlled by your will, and they won’t bypass probate. Most people, I find, have named their primary beneficiaries. But many folks fail to name their contingent beneficiaries—who would inherit the assets if the primary beneficiaries are deceased. IRAs, 401(k)s, annuities, and life insurance policies all require specific beneficiaries. Have your spouse (if applicable) as the primary beneficiary and the kids (or their trust) listed as the contingent beneficiary. I strongly suggest consulting a financial advisor or estate planner to ensure that the beneficiaries are properly named.

Freedom Formula for Physicians. He’s glad to answer any questions about estate planning or other financial matters. You can contact him at (800) 548-1820, at dave@daviddenniston.com, or visit his website at www.DoctorFreedomBook.com to get a copy of The Freedom Formula for Physicians.

NEED A TRUST? Many people are very concerned with how their kids will spend money they inherit. They want to protect it from divorces and greedy spouses, and sometimes from the kids themselves. This is why various forms of trusts exist. For example, your trust can specify at your death the formation of an irrevocable trust for the care of a given beneficiary who can only spend 3% or 4% (whatever you choose) annually.

M A RC H 2015 | 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 5

AS S OC IAT ION H AP P ENINGS | LAC M A NEWS

CEO’s LETTER

SPRING IS THE SE A SON for new opportunities, and LACMA is already gaining momentum.

Thanks to LACMA’s leadership and tireless efforts, some 200,000 Los Angeles County residents who are eligible for Medi-Cal and Medicare were finally able to opt out of the illfounded duals demonstration project, or Cal MediConnect. Los Angeles County has the state’s highest number of dual eligibles, and we have fought hard to stop the passive enrollment of patients, many of whom have been enrolled in the program without their consent or knowledge. The statistics prove that patients and providers agree that this project is deeply flawed. According to the Department of Health Care Services, 55% of patients in Los Angeles County have opted out of Cal MediConnect—and their numbers are expected to grow even further. The Governor’s Budget Summary also acknowledged problems with the project. It states that 69% of the overall patient population in the state of California have opted out of the program, which is significantly higher than the anticipated 33% opt-out rate for the state. A recent Los Angeles Times article underscored that point. It noted that some $300 billion is being spent every year on patients who qualify for Medicare and Medicaid, acknowledging that the rollout in California has “been marred by widespread confusion, enrollment glitches and a revolving door of health officials.” It also stated that doctors had warned early on that the state’s initiative was simply too big and too overly complicated. Dr. William Averill, a LACMA member, was quoted in the article as saying, “If the state had listened to doctors in the trenches giving this care, this scenario wouldn’t have happened.” We applaud Dr. Averill and other LACMA members for making their voices heard in the media and for letting their patients and the public know that they are looking out for their best interest. The Governor’s Budget Summary suggests that the program will be reviewed to determine if this ill-founded effort should continue, since it provided no savings to the state. LACMA will be watching those developments very closely. That said, we are excited about the upcoming 41st annual CMA Legislative Advocacy Day on April 14 at the Sheraton Grand Hotel in Sacramento. For decades, this conference has given California physicians the opportunity to meet with their local legislators to discuss the latest and most pressing healthcare issues in Sacramento. More than 400 physicians, medical students and CMA Alliance members will be coming to Sacramento as champions of medicine and their patients, and we are proud to represent Los Angeles County’s providers. Stay tuned, there will be more exciting developments, events and leadership coming your way soon.

Rocky Delgadillo Chief Executive Officer

1 6 P H Y S I C I A N M A G A Z I N E | M A RC H 2015

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CME

THE 28TH ANNUAL “HIV/AIDS ON THE FRONT LINE” CONFERENCE UC Irvine Student Center, Irvine, CA Wednesday, April 22, 2015 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, Hep C, Retention & Care, STD’s, Acute HIV Care, Incarceration & HIV, and Prevention

For more information & to register, please visit: WWW.HIVCONFERENCE.ORG Blanca Guardado (714) 456-7734

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Benefits & Discounts

Aimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!

TOP REASONS

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LACMA/CMA IS THE VOICE OF PHYSICIANS score

Legislative Advocacy

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LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy to end abusive practices. In addition, LACMA has sued health care plans on behalf of members to stop intimidation tactics.

• Socialize and network with members of the medical community • Find or create opportunities for your practice • Engage with legislators and policymakers

9 State-of-the-Art Communication

Tired of fighting with payors? CMA’s Economic Services experts have recovered nearly $8 million for members since 2010!

Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.

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LACMA can help you: • Reschedule your date • Relocate for your convenience • Reduce number of call-in days from 5 to 1!

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Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.

CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with membership. In addition, LACMA provides access to important and local CME-accredited events.

FOR JOINING LACMA AND CMA

When you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need—be it help with a problematic payor, or details about your member discounts—just call the member helpline at (800) 786-4262 or visit www.lacmanet.org

RIGHT NOW

is the best time to join LACMA and CMA For more information on member benefits and resources, visit www.lacmanet.org/Membership LOS ANGELES COUNTY MEDICAL ASSOCIATION 707 WILSHIRE BLVD, SUITE 3800 LOS ANGELES, CA 90017 PHONE: (213) 683-9900 FAX: (213) 226-0353