May 2014

T H E 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

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

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PRACTICE MANAGEMENT TIPS WEBSITE • LEGAL PRACTICES • INSURANCE • MALPRACTICE RISK • PATIENT SAFETY • MARKETING

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LACMA Annual Elections: Meet Your Candidates

MAY 2014

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NORCAL Mutual is owned and directed by its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Visit norcalmutual.com, call 877-453-4486, or contact your broker.

A N o r c A l G r o u p c o m pA N y

M AY 2014 | TA B LE OF CONT ENT S

Volume 145 Issue 5

14 14 ASSOCIATION HAPPENINGS | LACMA NEWS

LACMA Annual Elections: Meet the candidates and make your voice count

4

COVER STORY

PRESIDENT’S LETTER | MARSHALL MORGAN, MD

17 CEO’s LETTER | ROCKY DELGADILLO

PRACTICE 8 101 MANAGEMENT TIPS

Top tips from experts in their respective fields to help you stay on top of your responsibilities while reducing some of your stressors.

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.

M AY 2014 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1

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sional association representing physicians from every medical specialty and practice setting as well as medical students, interns and residents. For more

LACMA OFFICERS PRESIDENT

PRESIDENT-ELECT

TREASURER SECRETARY

than 100 years, LACMA has

IMMEDIATE PAST PRESIDENT

been at the forefront of current medicine, ensuring that its members are represented in the

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COUNCILOR - DISTRICT 9 COUNCILOR - DISTRICT 2

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ment relations and community

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efforts in both Los Angeles

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County and with the statewide

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your physician leaders and staff

COUNCILOR-AT-LARGE

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strive toward a common goal– that you might spend more time treating your patients and less time worrying about the challenges of managing a practice.

Marshall Morgan, MD Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD Samuel I. Fink, MD LACMA BOARD OF DIRECTORS

areas of public policy, govern-

relations. Through its advocacy

Christina Correia 213.226.0325 | christinac@lacmanet.org Kirk Bennett 925.272.0857 | kbennett@physiciansnewsnetwork.com Dari Pebdani 858.231.1231 | dpebdani@gmail.com David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD

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CMA TRUSTEE (RESIDENT)

David Aizuss, MD William Averill, MD Boris Bagdasarian, DO Erik Berg Stephanie Booth, MD Steven Chen, MD Jack Chou, MD Troy Elander, MD Hector Flores, MD C. Freeman, MD Sidney Gold, MD William Hale, MD David Hopp, MD Fred Ziel, MD Lawrence Kneisley Kambiz Kosari, MD Howard Krauss, MD Maria Lymberis, MD Carlos E. Martinez, MD Nassim Moradi, MD Ashish Parekh, MD Jennifer Phan Heidi Reich, MD Peter Richman, MD Sion Roy, MD Michael Sanchez, MD Nhat Tran, MD Sion Roy, MD

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900.

Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

You have to pay for workers’ compensation insurance. But...

YOU DON’T HAVE TO In California, rates for workers’ compensation insurance are soaring.

In the second half of 2013, rates increased by an average of 8.7%.1 That’s after a 10% increase in the first half of 2013.2 Source: Workers Compensation Insurance Rating Bureau of California, http://www.wcirb.com/sites/default/files/documents/132023_010114_ amended_ppr_filing_complete.pdf

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PR ES I D ENT ’S LET T ER | MA R S HA LL MOR GA N, M D

TH E LO S A NG E LE S County Medical Task Force on Prescription Drug Abuse is a giant step in the right direction.

About two decades ago a consensus developed that 1) there was an “epidemic of untreated pain (chronic non-cancer pain); 2) it was the responsibility of physicians to treat such pain; and 3) that prescription of opioid medications was an effective and safe way to do so. Regulatory agencies agreed; physicians in order to maintain licensure had to complete eight hours of instruction in pain management. Physicians, in good faith, complied.

As we now know, that didn’t work out very well. Over the past several years there has been an explosion in the number of prescriptions for opioids, which has given rise to a new epidemic: widespread prescription drug abuse, addiction and overdose deaths.

The epidemic of prescription drug abuse had a significant negative effect on hospital Emergency Departments: patients came to the ED seeking prescriptions for opioids to manage chronic pain, to satisfy an addiction or to sell. A number of patients presented repeatedly with exacerbations of pain that they insisted could only be controlled with parenteral opioids.

These patients created problems for Emergency Departments. Some emergency physicians would write prescriptions for opioids; others would not.

Often, nurses were not comfortable administering these meds. Inconsistency led to frustration, anger and complaints from patients. Leaders in emergency medicine saw a clear need for a consistent approach to this disruptive and persistent problem.

Following the lead of our colleagues in San Diego, LACMA, along with the Department of Public Health, the Department of Health Services, the California chapter of the American College of Emergency Physicians, the Hospital Association and Kaiser Permanente formed the Los Angeles County Prescription Drug Abuse Medical Task Force. Members of the task force have contacted the medical directors of essentially all of the 77 hospital Emergency Departments in the county, and have obtained a consensus on a set of guidelines regarding

4 P H Y S I C I A N M A G A Z I N E | M AY 2014

the administration and prescription of opioid drugs, which will be applied county-wide. The general principles are: - Patients should receive opioid prescriptions from only one prescriber and one pharmacy; emergency physicians do not ordinarily prescribe opioids for chronic pain.

- Emergency physicians, when they do prescribe, provide only a small number of pills.

- Emergency physicians do not refill lost or stolen prescriptions.

- Emergency physicians do not prescribe long-acting opioids.

- Emergency physicians do not provide missing doses of Subutex, Suboxone or Methadone.

- Emergency physician ordinarily will provide oral medications, not injections, for exacerbations of chronic pain.

- Emergency physicians will check the CURES database when patients request opiods.

- Emergency physicians, when they do write prescriptions for opioids, may instruct the pharmacist to inspect a photo I.D. before dispensing.

Application of these principles in a uniform fashion across all Emergency Departments in our county will improve the quality of life for Emergency Department physicians and nurses and improve the health and safety of patients who suffer from chronic pain, and one hopes, other patients who misuse these medications.

The work of the task force, which will be made public and officially rolled out in the near future, is a great accomplishment, which I celebrate.

That said, the Emergency Department problems which the task force addresses are only a small part of the problem of opioid overuse, and the resulting harms: overuse, addiction and deaths from overdose. Chronic pain can have a significant negative impact on quality of life and functional status. It should be treated, but when a decision is made to use opioid medications, that should be done cautiously, carefully and with informed consent, good documentation, appropriate use of the CURES database and consideration of referral to pain management specialists when significant doses (a morphine-equivalent dose of greater than 100 mg) are contemplated.

Marshall Morgan, MD, is a professor and chief of emergency medicine at the Ronald Reagan UCLA Medical Center and director of emergency medicine center at the David Geffen School of Medicine at UCLA. He is the 142nd president of the Los Angeles County Medical Association.

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MUSICK, PEELER & GARRETT LLP

ANNOUNCE THE FORMATION OF A WHITE-COLLAR AND REGULATORY INVESTIGATIONS PRACTICE GROUP

The late James E. Ludlam, Esq. represented Seaside Hospital (now known as Long Beach Memorial Center) in a complex tax matter in 1940. Beginning with that first case, Jim became a leader in the efforts to strengthen the tax exempt status of non-profit hospitals and launched a nearly 70-year career in the field of healthcare law. In keeping with that long tradition, Musick, Peeler & Garrett LLP, is pleased to announce the establishment of its WHITE-COLLAR AND REGULATORY INVESTIGATIONS PRACTICE GROUP. MARC R. GREENBERG: Mr. Greenberg is a former Assistant United States Attorney for the Central District of California, who currently concentrates his practice in assisting clients with white collar criminal defense and regulatory compliance issues. Mr. Greenberg has experience handling high profile cases, having prosecuted and defended many matters of public interest, including a wide array of white-collar criminal matters, such as public corruption, tax fraud, money laundering, bribery, antitrust, theft of trade secrets, off-label marketing, importation violations, securities fraud, government fraud, Foreign Corrupt Practices Act, and cyber crimes. Mr. Greenberg has appeared as a prosecutor and/or as a defense lawyer before the Ninth and Third Circuits of the U.S. Court of Appeals. Mr. Greenberg is regularly sought out to advise clients on regulatory compliance, as well as supervise internal investigations. Mr. Greenberg can be reached at 213.629.7823.

WILLIAM W. CARTER: Mr. Carter is a former local and federal prosecutor and high-level public counsel, including serving as the Chief Deputy City Attorney for the City of Los Angeles, an Assistant United States Attorney, the Assistant Secretary for Law Enforcement and General Counsel for the California Environmental Protection Agency (Cal/EPA) and a Special Assistant/Deputy District Attorney with the Los Angeles County District Attorney’s Office. Mr. Carter has developed extensive expertise in and knowledge of the major state and federal environmental, public health and safety, OSHA, and natural resource protection statutes and regulations, as well as laws governing public works, utilities, energy, import/export, land use, municipal governance, civil rights, foreign counter-intelligence and white-collar fraud, including the Foreign Corrupt Practices Act, False Claims Act and unfair business practices. In addition to serving as Chief of the Environmental Crimes Section of the United States Attorney’s Office for the Central District of Los Angeles, where he successfully prosecuted some of the most significant environmental and public health and safety cases in the United States, Mr. Carter served as the Deputy Chief of the Public Corruption and Government Fraud Section in that office, where he successfully prosecuted cases involving, among other things, adulterated foods and drugs, large-scale imports/exports, false claims, tax evasion, defense contracting and health care fraud, foreign-counter intelligence and police corruption. Mr. Carter can be reached at 213.629.7863.

J. ROBERT LISET: Mr. Liset is a Partner in the Healthcare Practice Group at Musick, Peeler & Garrett LLP. Mr. Liset received his A.B. Degree from Georgetown University in 1967 and J.D. from the Georgetown University Law Center in 1970, and is admitted to practice in California, Virginia and Washington, D.C. Mr. Liset’s primary practice area is in the field of medical staff, administrative litigation, litigation, fraud and abuse, defending clients who are the target of False Claims Act in criminal and civil investigations, corporate compliance, licensing, EMTALA investigations, Medicare decertification and bioethics. Prior to entering private practice in 1977, Mr. Liset was a federal prosecutor with the United States Department of Justice (Criminal Division), where he served as a Special Attorney assigned to the Los Angeles Organized Crime and Racketeering Section. The Los Angeles Strike Force was responsible for the federal effort against organized crime in the Southwestern United States. In that position, Mr. Liset successfully prosecuted numerous Mafia-related cases in Las Vegas, Reno and Los Angeles. Mr. Liset can be reached at 213.629.7683.

M AY 2014 | 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 7

PRACTICE MANAGEMENT TIPS

BY MARION WEBB

Your Website Even if you had a chance to do an annual checkup to make sure your website is up-to-date, the following 14 tips will help you do your “spring cleaning” for implementing best practices online.

1

Help patients, including those with disabilities, find your website by ensuring that the name of your practice appears as HTML text, not just as a logo. The practice name should appear at the top of your homepage and every page of your site and in the footer.

2

Your practice location with address and email should be prominently displayed in addition to the ‘Contact Us’ page.

Include a connection to MapQuest or YahooMaps to make it even easier for patients to find you.

3

Highlight your practice hours, after-hours and urgent care hours prominently on your homepage and let patients know what to do in case of an emergency.

4 5

Provide links to hospital affiliations, if appropriate.

List insurance companies that your practice accepts and include your phone number so patients can call if they have questions. State your policy regarding fees and billing and which credit cards you accept and whether you offer payment plans.

8 P H Y S I C I A N M A G A Z I N E | M AY 2014

Good practice management is key for every successful physician’s practice no matter what size. In this issue we’ve collected 101 top tips from experts in their respective fields to help you stay on top of your responsibilities while reducing some of your stressors. You’ll find the hottest tips for mitigating your malpractice risks, the best advice for creating a company website and vital legal tips to protect you personally and professionally from harm.

Read about patient safety, what types of insurance policies you should consider and why RX cards are good for patients and your business. In this competitive environment, every doctor needs to implement a marketing plan and strategies to stand out in the crowd. You’ll find them here. You’ll also learn about ways to cut your overhead costs and how to build trusting relationships with your patients.

6

Create prominent links on your homepage to your online patient history and web portal login area and highlight these in-demand services with a graphic.

7

Offer new patients the convenience of a downloadable, printable “fact sheet” in an Adobe PDF format with your practice name, address, phone number, hours, directions, a map and insurance plans.

8

Get patients’ attention with free education with TransforMED’s core list of online patient education resources. These links draw patients and improve your search engine rankings.

9

E-services such as e-visits, e-lab results and e-prescriptions are in high demand by patients and are key parts of the TransforMED Medical Home.

10

An anonymous online patient satisfaction survey (in a PDF format) or using a survey service provider like SurveyMonkey or a newsletter service are great ways to get patients’ feedback.

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Provide instructions for prescription refills and preferred methods of requesting prescription refills.

Outlining your policies for referrals on your website can save your staff valuable time.

Promote expanded services on your website in terms that patients can understand, such as “same-day appointments” instead of open access scheduling.

14

Promote your practice by giving a clear mission statement, a short bio of doctors, nurses and your friendly staff.

Henry Fenton, managing partner at the Fenton Law Group LLP, offers these 14 critical tips to help doctors avoid any legal troubles.

15

Always have a chaperone present for physical exams to reduce the risk of sexual abuse complaints to the Medical Board— which are far too common.

16

Don’t self-prescribe.

Maintain medical records and document exams with friends and family members—including outside the office—and the reasons for prescriptions.

17

Use the state’s CURES/ PDMP Network to check on patients with chronic severe pain to ensure they aren’t getting multiple prescriptions from multiple doctors.

18

Don’t rely on your staff to accurately fill out credentialing questionnaires, because ultimately you are held responsible. Failure to disclose a previous malpractice award or

another matter can be regarded as being dishonest and have disastrous consequences.

19

Don’t drink and drive.

Any alcohol or drug-related conviction—even for a misdemeanor—can have the Medical Board breathing down your neck and lead to discipline, or possibly revocation, depending on the circumstances.

20

Document in your medical records everything of consequence including but not limited to, any oral informed consents, exams and advice for patients. In the legal world, if it isn’t documented, it may be argued that it didn’t happen.

21

Don’t be employed by non-physicians and don’t go into medical practice with unlicensed individuals—there is a

ban against the corporate practice of medicine in California.

22

You may not open a medical practice in a fictitious name unless you obtain a fictitious name permit from the Medical Board.

23

Always ensure your bills are properly prepared and review them. You are ultimately held responsible for improper or fraudulent billing.

24

If you use email to communicate with patients or send protected health information, be sure to set up electronic safeguards to ensure compliance with patient privacy rules (HIPAA).

25

If you dispense controlled substances from your office, the DEA has the right to conduct an in-office audit without notice. Hence, familiarize yourself with all DEA regulations:

Maintain proper dispensing logs, locked medicine cabinets, proper record keeping, etc.

26

If either controlled substances or your prescription pads are stolen, report it to the DEA.

27

Maintain copies of all signed managed care and insurance contracts. Be wary of contract provisions that require you to participate in all of the payor’s current and future products. You don’t want to find out that you inadvertently agreed to participate in California Health Benefit Exchange plans, or others, that force you to assume certain obligations or conditions.

28

Log important lease renewal and contract dates. For example, if your lease requires that you notify the landlord by a certain date that you want to extend or renew the lease, have a calendar reminder system in place so you don’t lose out on any documented rights.

Malpractice Risk While there is no way to completely eliminate your risk, there are ways to mitigate it. One out of every six physicians has been threatened with a lawsuit, while 35% of doctors have actually been sued, according to the Physicians Practice’s 2013 Great American Physician Survey based on more than 1,200 physician responses.

Here are key recommendations from the experts to mitigate your risk:

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Be proactive. The No. 1 reason for malpractice allegation is failure to diagnose or delayed diagnosis. Here are three ways to mitigate this risk: Create a tracking system for lab tests, diagnostics and consults either through electronic records or a logbook. Require one staff member to check that the appropriate doctor reviewed the tests. Let your patients know when they can hear back from you regarding results.

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Since physicians can be held accountable if a patient fails to adhere to critical follow-up recommendations, doctors need to be able to show they have made every attempt to provide the patient with proper care. A follow-up trail is M AY 2014 | 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 9

101 PR ACT I CE MA NAGEM ENT T I PS | FEAT UR E

Legal Practices

FEAT UR E | 101 PR ACT I CE MA NAGEM ENT T I PS

key, including a letter via certified mail asking the patient to contact the office immediately to schedule an appointment.

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Practice good communication to help patients adhere to follow-up care. Discuss barriers to find alternatives, apologize for being late to unhappy patients, comply with state laws relating to informed consent, implement a communication protocol for patient calls and encourage your staff to speak up if they have concerns.

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Establish boundaries in your office regarding scope of practice by providing on-going orientation and education on what’s within the scope of practice.

33

Document staff competencies annually via a checklist of skills and qualifications required for each staff member based on the guidance of your medical association, specialty group and/or state laws and regulations.

Insurance Frank Blackwell, an insurance expert with Mercer Health & Benefits Insurance Services LLL, considers it critical for practicing physicians to buy multiple types of insurance policies as part of their overall financial plan. Doctors who

Patient Safety The following top 5 tips, courtesy of The Doctors Com-

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Provide effective communication. Don’t ask patients if they understand; rather, ask them to repeat back the information. Document their understanding of instructions, provide them with written instructions and use a translator whenever necessary.

pany, gives physicians the tools they need to reduce risk and keep their practices safe.

35

Train your staff on how to properly handle lab tests and referrals.

Your staff should know how to reconcile tests, referrals and consult orders with results when received. You should also have a process in place to deal with discrepancies.

36

Incorporate a process to ensure that all imaging, laboratory and consultants’ reports are always dated and initialed by the physician. This serves as proof for a physician’s review.

37

Stay abreast of FDA prescription drug warnings and recalls. The PDR Network is a great reference for FDA-approved drug labeling and drug safety information.

38

Avoid relying too heavily on intuition and rule-of-thumb techniques. Don’t stop at the first diagnosis; always question “what else could happen” or “what else it could be.”

are business owners with employees need to consider additional insurance types to be adequately covered.Here are 5 strategies for a physician’s overall financial plan.

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Disability insurance, while often overlooked, allows physicians to be financially covered for a lengthy period of time in cases where they can’t make a living.

40

Life insurance offers the immediate family financial protection in case of an early death.

41

Long-term care insurance provides finances for assisting in the activities of daily living.

42

Professional liability insurance provides legal and financial support for liabilities that arise from a physician’s actions within the medical profession.

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Health insurance, now mandated by law, provides financial reimbursement for medical services received.

RX Cards

Business owners should consider these 4 additional strategies:

Stephen Rice, senior VP of Business Develop-

Workers’ compensation, mandated by law, protects employees from work-related injury or illness.

their uninsured or underinsured patients and

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Group health insurance, while not required by law, offers doctors a tax benefit to provide employee compensation and protection from non-workrelated injury or illness.

46

Group life, disability and dental insurance offer limits that are many times greater as buying individual coverage.

The benefits are also better with a group plan.

47

Employment practices liability insurance protects against discrimination, sexual harassment and wrongful termination claims by employees.

1100 PPH HYYSSIIC CIIA AN NM MA AG GA A ZZIIN NEE || M MAY AY 2014 2014

ment at United Networks of America, Inc., believes that physicians who provide RX cards to families are providing a great benefit to not only their patients but also to their overall practice.Here are five reasons why:

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Giving RX cards gives underinsured and uninsured patients access to the medications they need through discounts, and it guarantees best pricing.

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RX cards help practices retain patients and draw new patients.

They also help practices remain HIPAA-compliant.

RX cards play a key role in helping doctors lower hospital re-admission rates for patients.

They strongly encourage patients’ prescription compliance.

Patients will tell you their entire story, if you just listen, found Gregory Taylor II, MD, medical director at the Keck School of Medicine at the University of Southern California in Los Angeles.

Building Physician-Patient Relations Effective patient communication will become ever more impor-

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Taylor, MD, also found that if the story doesn’t make sense, it probably isn’t true.

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The medical director also reminds doctors to ask patients about their oneyear goals and to follow up on their progress in six months.

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Lead by example. If you want your clients to change their lifestyle, then you must change yours first, he said.

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This happens when people know that their physician believes in their ability to change. Taylor’s advice:

nition of symptoms and behaviors related to illness.

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Be deliberate about the nonverbal cues you send. Lean forward, maintain eye contact and nod appropriately when talking to patients.

Crossed arms signal distance, according to the American Academy of Family Physicians Division of Medical Education.

Assess your own biases when encountering patients who may cause you frustration, grief or anxiety. If this is the case, you may want to examine your own feelings, according to the American Academy of Family Physicians Division of Medical Education.

Offer concrete feedback. The best way to do this is by summarizing what you’ve heard and trying to identify patients’ feelings.

Demonstrate to patients that you understand their situations and feelings by showing empathy during patient interviews.

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63

Be aware of cultural values, beliefs and assumptions when providing care. Understand the impact of culture on your patient’s recog-

Seek to minimize distractions and interruptions when visiting with patients, such as setting your cell phone on silent mode, closing the door

64

Keeping a patient diary can help doctors reflect upon what they’ve learned and the progress they’ve made in building doctor/patient relationships.

tant. These 13 tips will help doctors establish a quick rapport.

Tell them that you believe in them and watch them deliver.

and allowing your patients to tell their story.

65

Enhance your counseling and listening skills by using this five-step process: Gather information about the context of the patient’s visit by asking 1) What is going on in your life? 2) How do you feel about that? 3) What about the situation troubles you most?

4) How are you handling that?

Then show understanding: 5) That must be very difficult for you. The technique is identified by the acronym BATHE (which stands for background, affect, trouble, handling and empathy), according to the American Academy of Family Physicians medical education division.

M MAY AY 2014 2014 || W WW W W. W.PPH HYYSSIIC CIIA AN NSSN NEEW WSSN NEETT W WO OR RK K.C .CO OM M 11 11

101 PR ACT I CE MA NAGEM ENT T I PS | FEAT UR E

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FEAT UR E | 101 PR ACT I CE MA NAGEM ENT T I PS

Marketing Your Practice In this changing healthcare environment, many physicians will need to rethink their marketing strategies and find new ways to connect with patients. Below, find 21 expert tips how to successfully market your practice, including tips for leveraging social media.

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Develop a marketing plan outlining selling points, target geography, competition and potential referral sources, and then streamline the process.

Understand the target audience and do your research to see how to reach out to patients.

When using social media, it’s key to learn about the boundaries of communication and patient privacy issues first as well as educating your staff to see what formats of communication are acceptable.

68

Start a blog on your website, including the services you provide, philosophy, information about your background and your office team. This will give patients a good understanding about your office team and can give you a competitive edge.

69 70

If you don’t feel comfortable implementing your own marketing plan, hire an expert.

Twitter can be a great way for physicians to create an online presence and get a following. The text-based posts up to 140 characters can be fed directly to patients.

71

Dr. Taylor also believes that medicine is a service industry and the people you serve are your clients—people expect value out of an interaction with doctors.

Don’t expect payment or respect for providing low-value service, according to Taylor.

If you have a free-standing sign to promote your practice and it becomes invisible to passers-by, it may be a good time to change the size, shape or color to attract more attention.

78

Not all doctor’s offices are the same. Taking a deep look into your practice and determining what makes your practice different from others can help encourage clients to go out of their way to see you.

79

With the use of smartphones and tablet use on the rise, it’s a good idea to format your website to fit on mobile devices. If you don’t know how, ask a developer.

80

Doctors are more likely to make a referral when they know a specialist personally. A good way to reach out is via lunch presentations, attending hospital fund-raisers or simply visiting the physician lounge.

Don’ts: Never use the Internet to post about patients. Keep your business pages separate from your private pages, ensure a high level of Consider free services security and implesuch as a monthly flu ment a media policy. clinic where you offer free vacKeep plugging away. To You also want to stay cines to the first 10 patients. The be successful, physicians away from giving out cost is minimal and can attract must continuously market and infree medical advice. patients who otherwise would troduce themselves and display to visit a pharmacy clinic. others enthusiasm and dedication.

Doctors are busy, but so Retail clinics are conare your patients. By venient, so rethink your making it convenient patient service by creating a fast for patients to come track for patients coming in for into your practice, adlab work and emailing forms to padressing patients by name and tients before the visit. making an effort to see patients as soon as possible, referrals will come.

A great way to market your practice is to contact your local Chamber of Commerce Face-to-face contact beats 1,000 emails every and their networking contact. Ask if you can host an event and introduce your practice to members. time says Taylor.

81

86

72

73 74

Focus on providing extraordinary service to patients to increase retention and patient referrals by resolving disputes to patients’ satisfaction and paying attention to problems.

1 2 P H Y S I C I A N M A G A Z I N E | M AY 2014

82

83

84 85

Send out newsletters to create credibility and stimulate interest.

Get published by sending articles to your local newspaper or participate in a speaking engagement.

Do away with unnecessary expenses and ask yourself if you really require certain services, such as a costly answering service or a paid background music service. Pay for things that help improve patient care and efficiency.

With reimbursement for professional services declining, physicians will be looking for new ways to reduce costs. Cost reduc-

87

Staff is the biggest cost and likely the biggest opportunity. By identifying what each employee does, you can find out how big a staff you really need.

98

Eliminate overtime pay. Issue a policy that no one works overtime without your permission.

tion opportunities fall into

99

a few major categories and

Put one person in charge of all purchases and finding the best deals, and then make a decision together.

the tips below can help

95 100

any practice achieve that goal.

88

Ask yourself if you employ the right kind of staff. Do you employ a registered nurse when a licensed practical nurse could properly handle the responsibilities?

89

Look at your office space. Medical office space demands premium rent that could be moved to less-costly surroundings.

Use your utilities wisely: Turn off all the lights at the end of the day, set thermostats on timers, weather-proof your office and find ways to make your office more “green.”

96

Look for bargains when buying new office furniture. Check out hospital surplus outlets.

Reduce staff turnover. Replacing one employee with another can cost you significant dollars in terms of lost productivity, training time and identifying a new employee. If you’re happy with your staff members, show your appreciation.

101

Offer a cash bonus to staff members who suggest ways to cut costs. It will save you money in the long run.

90

Supplies are another way to trim costs. Typically medical supplies are bought by a clinical assistant, and the local sales rep for the medical supply vendor wants to maintain a good relationship.

Identify high-cost items and then find out what other vendors charge.

91 92

Automate what can be automated.

Review your miscellaneous expenses, such as bank charges and penalties, outside billing, telephone costs and professional fees. Controlling operating expenses requires constant monitoring, but can reap significant payoffs.

93

Maximize tax deductions. Talk to your accountant about ways to maximize your deductions for business expenses, such as business property expenses, health insurance costs, retirement plan contributions and journal subscriptions.

94

Minimize inventory. Only stock medical supplies you really need for day-to-day patient care.

M AY 2014 | 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

101 PR ACT I CE MA NAGEM ENT T I PS | FEAT UR E

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Reduce Overhead

A S S OCI AT I ON HA PPENI NGS | LACM A NEWS

LACMA MEMBERS: WE NEED YOUR VOTE!

MAKE YOUR VOICE COUNT IN OUR ANNUAL ELECTIONS

The Los Angeles County Medical Association is holdings its 143rd Annual Election this coming June. This year, there is one vacancy each for the positions of Secretary, Councilor-at-Large and Solo Small Group Practice Forum (SSGPF) Councilor on the LACMA Board of Directors. Two candidates have been nominated to fill the Secretary vacancy, three candidates have been nominated to fill the Councilor-at-Large vacancy, and two candidates have been nominated to fill the SSGPF Councilor vacancy. Proposed changes to the LACMA Bylaws will be voted upon as well.

Active members of LACMA and CMA have the privilege of voting for their preferred candidates. On the following pages you will find campaign statements from each candi-

date running for the open positions. When reviewing each statement, it is important to remember that the ultimate responsibility of the Secretary, Councilor-at-Large and SSGPF Councilor includes serving as an advisor and advocate for LACMA and its members to the LACMA Board of Directors.

At the end of May, you can expect to receive a voting ballot via email or mail, and you will be able to cast your vote for your preferred candidate. Voting will be performed online. Please be sure to keep an eye out for your ballot and submit your vote.

For additional information about the candidates or the election process, please call Lisa Le at 213-226-0304 or email at lisa@lacmanet.org.

THE CANDIDATES BELOW HAVE BEEN NOMINATED FOR THE OFFICE OF

SECRETARY

WILLIAM AVERILL, MD

I seek your vote for Secretary of the Los Angeles County Medical Association Board and I will strive to keep LACMA moving forward and engaged in its important work on your behalf.

I am a cardiologist in Torrance. Having trained locally (at UCLA and USC), and having lived in Los Angeles County throughout my professional career, I am very familiar with the special challenges and opportunities that we face in our region during a time of rapid change in the healthcare system.

As a solo practitioner I have first-hand experience with the demands involved in managing a medical practice, and I am involved daily in direct patient care. As a past Chief of Staff at Torrance Memorial Medical Center and a past President of South Bay Independent Physicians Medical Group, I have experience working with other physicians in multiple specialties and practice modes to get things done.

Through my service as a District President and Board Councilor, I am aware of the resources and attention that LACMA can bring to bear regarding critical issues such as protecting MICRA from the trial lawyers, preserving access to their physicians for dual eligible Medicare patients, and representing patients and physicians when health plans may attempt to inappropriately encroach in medical decision making or deny appropriate reimbursement.

I am proud to take part as LACMA grows in influence and stature and recruits a broad diversity of physicians to its ranks. Now more than ever is the time for all physicians to be involved. I am ready and will be honored to represent you, and I need your vote to do so.

1 4 P H Y S I C I A N M A G A Z I N E | M AY 2014

STEPHANIE BOOTH, MD

My name is Stephanie Booth. I am running for Secretary of LACMA and asking for your vote.

I always find ways to ask physicians about their LACMA membership status.

Most nonmembers seem intrigued by LACMA benefits, yet rarely join. Their reason?

They feel LACMA does not represent them.

THIS MUST CHANGE! We LACMA doctors are stretched thin ascertaining and managing the ramifications of the Affordable Care Act. We are preparing to fight the upcoming, deceptive ballot initiative to overturn MICRA, which is so highly effective in keeping malpractice costs low. Simply put, LACMA physicians work to ensure we may continue providing our patients the high-quality medical care they deserve. Nonmembers share this exact sentiment. Thus, whether they recognize it or not, LACMA represents them. I am dedicated to demonstrating this. Your support and my history with LACMA, noted below, will allow me to do so.

EXTENSIVE LEADERSHIP EXPERIENCE: LACMA CMA Medical Student Alternate Delegate / Delegate to CMA, LACMA District President - 6 years; LACMA Board Member - 8 years; Member of LACMA Committees - Bylaws, Resolutions, Medical Services, Nominations, LACMA Delegate to CMA House of Delegates - 7 years; member Reference Committee, leader or member in a multitude of hospital Medical Staff functions, most demanding role: a highly engaged Medical Staff President at Kaiser South Bay - JCAHO survey year BROAD PRACTICE EXPERIENCE: Small Private Practice, Very Large Group Practice, Indian Health Services, Locum Tenens, Associate Professor Family Medicine - USC Keck I have the experience, knowledge, determination and, most importantly the time for this position. With your support, my fresh perspective will allow me to lead in a way that reflects how well LACMA represents all of us.

Please vote for me as your next Secretary of LACMA.

COUNCILOR-AT-LARGE

PAUL WALLACE, MD

This is my 24th year as a LACMA member and I am honored to be nominated as a Candidate for the Board. I was born and raised in Los Angeles. I attended Hamilton High School, UC Berkeley, Harvard Medical School and School of Public Health, Oklahoma University and University of Missouri-KC. After a decade of serving in appointed and elected NMA, CMA and LACMA offices, I took a respite from the frontline of medical politics.

During the past 10 years I’ve concentrated on my Beverly Hills Cosmetic Dermatology private practice and two Central Los Angeles General Dermatology clinics. The services provided in these significantly different practice settings are not mutually exclusive and have reinforced my appreciation of physician empowerment via education and advocacy. LACMA is more important and relevant today than at any other time in our history.

The practice of medicine is facing historical changes. Solo practitioners, small group practices, and in particular, specialists are threatened with fiscal extinction. Health plan panel selection, limited networks, reimbursement and contract negotiations are but a few of the issues that could literally determine our livelihoods and standards of living. Accordingly, it is essential that medical leadership possess intricate comprehension of the aforementioned issues, in order to formulate effective policy positions. I possess the necessary comprehension and political skills.

If elected, it is my intent to focus on what I believe to be five key issues immediately before us: Improving Risk Adjustment in Exchanges; Allied Health Professional Relationships; Specialty Access; Physician Education inclusive of new IT (EHR) requirements; and the Integration of new and young physicians into LACMA. My commitment, focus and dedication to quality healthcare, patient advocacy and physician empowerment are unassailable. We must be proactive. I stand ready to take on the fight. Carpe Diem!

YOUNG-JIK LEE, MD

I am running for the Councilor-atLarge position in Los Angeles County Medical Association.

Since 2003, I have been practicing internal medicine in Los Angeles.

Currently, I am a district 1 president.

Also, I am a member of the governing board at the Hollywood Presbyterian Medical Center and served on the Medical Executive committee in Good Samaritan Hospital. I have been active in both inpatient and outpatient medical practice. In addition, I am serving as a board member in the Seoul Medical Group.

I have been involved in the Korean American Medical Association as a Liaison chair since 2005. I have hosted numerous educational seminars with LACMA/ CMA to better inform local physicians about Medicare billing issues and the dual eligible pilot program. I have helped community physicians

SAMUEL FINK, MD

“The New LACMA.” I coined this phrase when I took office as the 141st President of LACMA in 2012. I pledged to the organization, my board of directors, and staff that we would reenergize and recommit LACMA to advocating for its member physicians, and ensure that we brought true value for the membership dollars we were asking. We sued Aetna for denying their insureds the right to use their out of network benefits, as well as Health Net for their refusal to pay claims for medically necessary and life-saving procedures. We began to communicate weekly with our members, using the Physician News Network. In line with my belief that LACMA needed to represent the unique diversity seen among Los Angeles physicians, we formed the Latino, African American, and Women’s Physicians Advisory Committees.

With our hardworking LACMA staff, the local districts were revitalized, and now meet regularly. An ongoing project has been to stop the forced transition of 300,000 of our county’s dual eligibles to managed care plans…we will not give up this fight! Nor will we give one inch in the battle to preserve MICRA! To save our members money, we formed a purchasing alliance with Medline and Provista that is guaranteed to save you at least 10% on your medical supplies each year. Medical student scholarships, jury duty transfers, economic advocacy…I am proud of all we have to offer. For the first time in many years, our membership numbers are up! I’d like to ask for your vote so that I can continue to serve on our Board of Directors and take part as we grow a dynamic organization. I am endorsed by our current President, Marshall Morgan, MD, incoming President, Pedram Salimpour, MD, CMA Vice Chair of the Board, David Aizuss, MD, and LACMA Past President, Robert Bitonte, MD, Thanks for your support!

organize and join LACMA/CMA to deliver our messages to local politicians to protect physicians’ interest and to better serve our patients.

Today, private medical practitioners are faced with numerous issues such as reimbursement cuts, more regulations on our practices, weakening of organized medicine, and expansion of corporate medicine. As a result, we have seen that for the past 10 years more doctors are giving up their own practices. In addition, the above issues at times have adversely affected the care of patients of different ethnic groups. With changing demographics of the Greater Los Angeles area, we must accommodate and listen to the different needs pertaining to the care of our patients of different ethnic groups.

If I am elected, my primary goal is to better organize our medical community by increasing our membership to protect our patients’ and physicians’ interest. I will work hard and represent LACMA to influence policies that directly affect our patient care so that these policies are more favorable to our patients and physician practices.

M AY 2014 | 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

LACM A NEWS | A S S OCI AT I ON HA PPENI NGS

THE CANDIDATES BELOW HAVE BEEN NOMINATED FOR THE OFFICE OF

AT WOR K FOR YOU | UNI T ED WE STA ND

THE CANDIDATES BELOW HAVE BEEN NOMINATED FOR THE OFFICE OF

SSGPF COUNCILOR

ROBERT BITONTE, MD

I am seeking your vote for the trustee position to the Los Angeles County Medical Association from the Solo and Small Group Forum.

My focus has been and is vigorous and vocal advocacy for our members and the public they serve. This includes public support, legislation and litigation if warranted. Under my Chairmanship of the Legal Affairs Committee we have filed suit on our members’ behalf for unlawful intimidation of physicians and unlawful denials of medically necessary care.

I am unapologetic for my fervor in physician advocacy. I have been so during my past service on the board as president and currently as Chairman of the Legal Affairs Committee of the Los Angeles County Medical Association. If as a section member you want undivided loyalty to physician advocacy, I need your vote to continue to serve you.

HEATHER SILVERMAN, MD

In the current wave of enthusiasm towards selling off individual and small group practices into higher volume corporate shaped treatment settings, it may seem ill advised to promote the virtues of solo and small group practice. Reasoned voices that argue on the basis of quality of practice, practice satisfaction and the sense of personal autonomy are easily drowned out.

Once entered into contractual relationships, physicians may find themselves handcuffed into situations where they have few options; payouts and related salaries going forward are often predicated and contingent on major practice expansions both in terms of group members and patient volume. Doctors may quickly find out how hard and fast they work, and what they actually do, are no longer matters over which they have control.

While there are exceptions to this dark scenario, many physicians soon discover that they have sacrificed that which makes their professional lives most meaningful for gains that may well be illusory and/or come at great personal price. In the meantime those who remain in solo and small group have to deal with the impact of this encroachment on their patient population as do patients themselves.

If you choose to vote for me, I promise to work in a steadfast manner to maintain and enhance the solo and small group practice model. Further, however difficult it may be to obtain, I will work hard to collect accurate information on physician issues as they transition into and/or attempt to adjust to large group practice models in their communities. For those who steadfastly persevere in solo and small group practice and perhaps resist the current wave of practice consolidation, be assured I am available to hear your concerns and work with you to preserve the longstanding medical tradition of prioritizing the patient-doctor relationship and physician autonomy.

FINANCIAL EXPERIENCE AND SOLUTIONS FOR HEALTHCARE PROVIDERS

BY JOHN WILCOX, SENIOR VICE PRESIDENT, CITY NATIONAL BANK

The healthcare industry now has a financial quarterback on its side: City National Bank.

For more than three years now, City National has had a Healthcare Services Team of bankers who are specifically trained to serve the healthcare industry with specialized lending, account and treasury management solutions to meet the unique needs of this industry.

From financing to payment and collection solutions, whether you are an individual provider, specialty healthcare service provider or a hospital – City National has customized solutions for you.

“Healthcare is a special business – you can’t treat it like any other industry,” said John Wilcox senior vice president and co-chair of the Healthcare Council for City National Bank. “We understand the complexities and challenges that healthcare providers are currently facing. Our team of healthcare bankers provides banking solutions and products that help providers to be more efficient while saving them money.”

Specifically, City National has: • A suite of products to enable your business to control expenses through instant transaction origination, customized reports and much more.

• Product on hold

1 6 P H Y S I C I A N M A G A Z I N E | M AY 2014

• The Phreesia patient check-in solution, which replaces the patient clipboard with a wireless touch-screen tablet, the PhreesiaPad, which electronically captures the patient’s intake and consent form in the waiting room. It also will verify insurance and calculate co-payments at check-in.

• Working capital management tools, with lending products that include term loans and revolving lines including secured healthcare receivables financing.

• Leasing strategies for medical equipment including healthcare specific information technology systems.

• Real estate financing for medical office properties.

• Our wealth management solutions to determine the right strategy for your personal wealth as well as your business.

City National was founded in 1954 to support entrepreneurial businesses like the healthcare industry and has grown to become one of the larger financial service providers in the country. Deposit products are insured by the FDIC. Wealth management investment products are not FDIC insured, are not guaranteed by the bank and may lose value. Credit products are subject to credit approval.

THIS MONTH, L ACM A’S focus will be on two initiatives in particular: We will solicit support to fight both the ballot measure to change MICRA and the rushed implementation of the Cal MediConnect demonstration project in Los Angeles County.

Proponents of a measure to raise the cap on medical malpractice damages reportedly submitted 830,000 signatures to qualify for the November ballot, which is more than the 504,000 verified signatures needed. Everyone believes that the ballot initiative will qualify ,and we are in for a costly fight!

MICRA is a critical component of California’s healthcare infrastructure. The ballot measure is bad for patients and California’s healthcare system, and if it were to pass, it would drive up the cost of healthcare for every patient. Hence, between now and November, we will be talking to providers and patient advocacy groups to deliver the message that this ill-founded initiative to eradicate MICRA will hurt all Californians.

The Cal MediConnect Demonstration Pilot Project also remains on the forefront.

LACMA recently expressed our concerns to Toby Douglas, Director of the California Department of HealthCare Services, that the passive enrollment of individuals who qualify for both Medicare and Medi-Cal in Los Angeles County is simply too aggressive, and asked him to delay its implementation until January 1, 2015, at the very earliest.

With Los Angeles County constituting over 40% of duals’ enrollment, the complexity and size of the healthcare delivery system is simply not prepared, and it’s too much too soon. We will continue to fight on behalf of patients to protect their health, their rights and their futures.

I also want to take this opportunity to wish all of our members and their staffs a Happy Mother’s Day.

Rocky Delgadillo Chief Executive Officer

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M AY 2014 | 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 17

LACM A NEWS | A S S OCI AT I ON HA PPENI NGS

CEO’s LETTER

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Located in Vista, California, Vista Community Clinic is a private, nonprofit outpatient community clinic located in North San Diego County serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.

POSITION Part-time Psychiatry MD or DO or part-time or full-time Family Medicine/Psychiatry MD or DO. RESPONSIBILITIES Provide consultation-liaison services for patients suffering from both psychiatric and medical disorders by focusing on the evaluation and treatment of patients serving adolescents, adult, seniors and their families. Preferably able to serve children as well, but not required.

REQUIREMENTS · Graduation from a recognized school of medicine · Valid California medical license as MD or DO; Board certified or eligible · Authorized to practice psychiatry in California · Certified as a diplomat in the American Board of Psychiatry and Neurology in psychiatry · Completion of a psychiatric residency or family medicine/psychiatry residency in an ACGME approved residency program · Psychiatrist with Medicare and California Medicaid numbers prior to start of employment · Valid DEA certificate · 2 years experience working fulltime as psychiatrist and MD or DO in child and adult psychiatry CONTACT US: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760 414 3702.

EOE/M/F/D/V

Located in Vista, California, Vista Community Clinic is a private, nonprofit outpatient community clinic located in North San Diego County serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.

POSITION: Full-time, Part-time and Per Diem Family Medicine Physicians.

RESPONSIBILITIES: Provides outpatient care to clinic patients and ensures quality assurance. Malpractice coverage is provided by Clinic.

REQUIREMENTS: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred.

CONTACT US: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760 414 3702.

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savings of $ over 84,000 The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s Trial Lawyers have launched an attack to undermine MICRA and its protections and we need your help. Membership has never been so valuable!

WAYS LACMA/CMA IS WORKING FOR YOU! Los Angeles physicians are saving an average of $84,770 this year.

Are you a LACMA/CMA member?

2012 LOS ANGELES COUNTY MEDICAL ASSOCIATION MICRA SAVINGS CHART General Surgery

Internal Medicine

OB/GYN

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(Non-Invasive)

Los Angeles County

$41,775

$10,343

$49,804

$33,974

Miami & Dade Counties, FL

$190,088

$46,372

$201,808

$146,089

Nassau & Suffolk Counties, NY

$127,233

$34,032

$204,684

$121,983

Wayne County, MI

$121,321

$35,139

$108,020

$88,160

FL-NY-MI Average

$146,214

$38,514

$171,504

$118,744

MICRA Savings

$104,439

$28,171

$121,700

$84,770

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