May 2016 | Physician Magazine

PLUS:

MAKE YOUR VOICE

COUNT

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OUR ANNUAL

ELECTIONS

O F F I C I A L P U B L I C AT I O N O F T H E L O S A N G E L E S C O U N T Y M E D I C A L A S S O C I AT I O N

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

THE

RIGHT STAFF Staffing, Risky Legal Areas & Contracts for the Employed Physician

MAY 2016

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Here’s to healthy financing for your practice.

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1

Community Reinvestment Act government data, 2002-2014.

2

© 2016 Wells Fargo Bank, N.A. All rights reserved. Member FDIC. SBS60-0550 (2532901_17927)

M AY 2016 | TA B LE OF CONT ENT S

O F F I C I A L P U B L I C AT I O N O F T H E L O S A N G E L E S C O U N T Y M E D I C A L

A S S O C I AT I O N

Volume 147 Issue 5

14

16

6 RISK TIP | Three Options in a Ransomware Attack

FROM YOUR ASSOCIATION

COVER STORY

8

THE RIGHT STAFF

Practicing medicine and running a practice are two very different things.

A lack of training with regard to managing a business and staff can be overwhelming and create problems for doctors, medical staff and patients alike. In this article, we provide expert tips for hiring and retaining top staff members and examine key areas that pose legal risk for doctors. For doctors considering employment themselves, we provide guidance on signing an employment agreement.

4 President’s Letter | Peter Richman, MD 14 LACMA Elections 2016 | We Need Your Vote!

16 CEO’s Letter | Gustavo Friederichsen

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

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

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

lenges of managing a practice.

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

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

Success.

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).

As a physician-directed organization, we understand the realities of running a medical practice, and we are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

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

I R E C E N T LY AT T E N D E D Legislative Day in Sacramento, where we, as members of LACMA and CMA, lobbied for several bills, including SB22.

This bill is to fund 1,000 primary care residency slots in California to replace and expand upon expiring funds from the Song-Brown Program. The Song-Brown Healthcare Workforce Training Act, passed in 1973, pays for family practice residency slots and encourages physicians to practice in underserved areas. It also pays for RN, PA and nurse practitioner educational programs. Physicians tend to stay where they have completed their residency programs. (According to the AMA, nationwide 48% of residents stay where they are trained.)

California has a physician workforce shortage, which will be worsening as older physicians retire and fewer new physician replacements are added for a growing state population. Federal assistance for residency slots was established years ago, with greater numbers allocated to the East Coast. Demographics have continued to change, with California’s population rising.

The federal funding structure was frozen in 1997. A greater number of primary care residency slots will help to address our shortage of physicians, especially in underserved areas.

According to the AMA, 39% of medical students ultimately practice in the same state of their medical school.

California has nine allopathic medical schools and two osteopathy schools. UC Riverside School of Medicine was established in 2008, and Kaiser has announced the formation of a new medical school in Pasadena.

The growth of California medical schools has not kept pace with the population needs. Medical schools are very expensive and our state has budgetary constraints.

Keeping more California premed graduates in California medical schools would help with our state’s physician shortage. Tuition, fees and health insurance at the David Geffen School of Medicine at UCLA is $36,402 for in-state students. The cost at the Keck School of Medicine of USC is $59,932. Living expenses are additional.

The Patient Care Foundation of LACMA provides medical school grants to students who come from underserved areas in Los Angeles County, as they are more likely to stay in California and perhaps practice in underserved areas.

According to a 2005 study from the UCLA/Charles R. Drew University Medical Education Program, students entering UCLA/Drew were more likely to profess a desire

4 P H Y S I C I A N M A G A Z I N E | M AY 2016

to practice in underserved areas and were more likely to continue to pursue that goal when compared to UCLA students. Logically, it would follow that in order to increase physicians in underserved areas, medical schools should take more students who grew up in underserved areas.

Lower socioeconomic areas are more predominantly Latino or African-American. Proposition 209 was passed in November 1996. It prohibited state governmental institutions from considering race, sex or ethnicity in public employment, contracting or education. While first-year enrollment in the UC system for African-Americans remained steady at 3.7%, it was actually closer to 2% at UCLA and UC Berkeley. In 2014, there were 3,381 applicants to medical school from the UC system. Of these, 130 were African-American for a total of 3.8%. UCLA had 981 premed students applying to national medical schools, with 27 being African American for a total of 2.8%. USC fared better with 321 applicants, with 17 being African-American, for a total of 5.3%. According to the Association of American Medical Colleges, the national rate of premed African-American applicants to the total pool of medical school applicants is 7.7%. In 2015 there were 1,349 African-Americans who matriculated at a medical school out of a total of 20,627 medical school positions. There were 793 African-American women and 556 African-American men comprising that number. which represents 6.5% of the total. African-Americans represent 12.8% of the U.S. population. The numbers speak loudly.

To improve minority participation at the more prestigious schools in the UC system, minority students have to have greater opportunities in K through 12 grades. The United States professes to be a meritocracy with equal opportunities for those who are willing to work. However, higher socioeconomic groups tend to score higher on standardized tests and have more “merit,” with greater chances for extracurricular studies, travel, etc.—things that money can provide. According to the Civil Rights Project at UCLA, African-American (and Latino) students are “intensely segregated” in public schools in Southern California. “This segregation is not only by race and poverty but frequently by language as well and is related to fundamentally different patterns of educational opportunity and achievement.” Segregated schools of color experience a greater shortage of fully credentialed teachers, advanced courses and college preparatory teachers.

How may LACMA physicians help? Mentoring students and encouraging studies in STEM (science, technology, engineering and math) may be done at all school levels. I gave a career day talk to kindergartners years ago.

I personally chose to be a surgeon after seeing a surgeon in scrubs and a cap with my father on hospital rounds one Saturday at age 5. When I found out that one could operate on the heart, I was smitten with surgery. Physicians may donate to programs such as the Charles R. Drew Medical Society Saturday Science Program. Political participation is always important; it may be slow and messy, but important agendas are set for years to come.

DISCOVER ONE OF THE MOST GENEROUS SCHOLARSHIP PROGRAMS.

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As you serve, you’ll enjoy the potential to train, perform research and grow as a leader.

For more information, visit healthcare.goarmy.com/eb22 or call 310-216-4433.

©2014. Paid for by the United States Army. All rights reserved.

RIS K T IP | RANS OM WARE AT TAC K

Three Options in a Ransomware Attack

BY CRAIG MUSGRAVE, SENIOR VICE PRESIDENT, INFORMATION TECHNOLOGY, THE DOCTORS COMPANY

The news made national headlines: Hollywood Presbyterian Medical Center’s computer systems were down for more than a week1 as the Southern California hospital became yet another victim of ransomware—an attack where a business or individual’s computer system is held hostage by cybercriminals until a ransom is paid. Hollywood Presbyterian Medical Center ended up paying $17,000 to restore its systems and administrative functions.

Once ransomware is in your medical practice or hospital system, there are only three basic options: 1. If you have performed frequent backups, restore your system.

2. If you have not performed frequent backups, pay the ransom.

3. Put your system back to the default setting—and lose everything.

If before the attack you’ve performed incremental backups, you can restore the areas affected, with minimal data loss (for example, an hour). If you have point-in-time backups, you can restore with increased data loss (for example, a week). If you have no reliable backups, you can reset the technology back to its “out-of-box,” or default, state and lose all the data, if no paper records exist. The only other option would be to pay the ransom.

Besides loss of business, inconvenience to patients, and damage to reputation, a ransomware attack also poses liability risks. The possibility of adverse events and subsequent claims for professional negligence increases when computerized systems necessary for various functions such as CT scans, documentation, lab work, and pharmacy needs are offline. If hospital systems are down for any significant period of time, certain patients should be transported to other hospitals.

Adverse events can occur when healthcare workers do not have access to EHR systems. However, if this type of case was litigated, the patient would have to prove that something in the records may have had a bearing on the treatment being provided. In the case of emergency care, the claimant would have to successfully argue that the staff should not have undertaken the care until the medical records could be 6 P H Y S I C I A N M A G A Z I N E | M AY 2016

accessed.

Hospitals, medical practices, and businesses should take full precautions to prevent a hack that results in ransomware being installed. Prevention strategies include: • Provide security awareness for all employees.

Over 80% of attacks are made possible by human error or human involvement. Train staff members to avoid downloading, clicking on links, or running unknown USBs on computer systems.

• Block the malware at the firewall, by using intelligent firewalls to stop the malware from downloading.

• Install intrusion detection software to monitor illegal activities on computer networks.

• Stop the malware from executing on desktop computers by installing application whitelisting software, anti-virus, or anti-malware.

• Perform regular system backups. o Ensure that critical systems and business data are backed up—even backed up hourly for critical systems. o Test that the backup restore process works.

• Avoid relying solely on encryption. Encryption does not protect a business from a ransomware attack. If a cybercriminal has your login, encryption doesn’t do anything to stop the hacker.

• Perform penetration testing on a regular basis to determine any existing vulnerabilities that should be patched. _________ Reference: 1Dangerous escalation in ransomware attacks. CBS News.

February 20, 2016. http://www.cbsnews.com/news/ransomwarehollywood-presbyterian-hospital-hacked-for-ransom/.

Accessed March 21, 2016. _________ Contributed by The Doctors Company. For more cybersecurity articles and practice tips, visit www.thedoctors.com/cybersecurity.

A financial safety net for you—

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With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan.

It features: • Benefits up to $1,000,000 • Rates that are designed to remain level for 10 or 20 full years* • Benefit amounts that never change during the level term period provided premiums are paid when due

See For Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

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Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709 777 S. Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.insurance.service@mercer.com • www.CountyCMAMemberInsurance.com * The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days’ advance written notice.

The County Medical Associations & Societies receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

THE

RIGHT STAFF Staffing, Risky Legal Areas & Contracts for the Employed Physician

BY MARION WEBB

Practicing medicine and running a practice are two very different things. A lack of training with regard to managing a business and staff can be overwhelming and create problems for doctors, medical staff and patients alike. In this article, we provide expert tips for hiring and retaining top staff members, keeping employees engaged and diplomatically addressing workplace issues. We also examine key areas that pose the highest potential legal risk for California doctors who choose to run their own practices. For some providers who feel that running their own practice is becoming too difficult — whether for economic or personal reasons — employment by a healthcare organization may appear to be an attractive option. For doctors considering employment themselves we provide guidance on signing an employment agreement.

8 P H Y S I C I A N M A G A Z I N E | M AY 2016

1. Create a comfortable, warm environment with some basic introductions, then ask candidates to tell you about challenging work situations that they tackled successfully.

2. Next, ask them to tell you about challenges they faced where they were unsuccessful.

Encouraging candidates to describe these experiences will show you the level of emotional intelligence they can bring to the workplace, HBR suggested.

“The real difference could even be greater if you factor in other potential costs, such as the spread of the toxicity, litigation fees, lower employee morale and upset customers.”

Kindness Counts As noted above, there is more to hiring than finding employees with great skills and stellar résumés. A highly skilled employee who treats others poorly, for example, often ends up costing a practice more than he or she generates, HBR found.

According to research by Christine Porath, an associate professor at Georgetown University’s McDonough School of Business, a “superstar” employee adds about $5,000 per year to a company’s profits while a toxic one costs an organization $12,000 per year.

“The real difference could even be greater if you factor in other potential costs, such as the spread of the toxicity, litigation fees, lower employee morale and upset customers,” Porath wrote in her report.

MEDICAL PRACTICE PURCHASES, SALES AND MERGERS The main quality to look for to assess

MEDICAL BOARD HOSPITAL STAFF F R A U D / A B U S E MEDI-CAL/M E D I C A R E

toxic employees is lack of civility, Porath said. She suggested the following strategies to assess employees up front: 1. Talk to non-interviewers, including receptionists, the cleaning staff and anyone else who may have observed the candidate, about their impressions.

2. Don’t rely on just the contacts the candidate provides, but also check with contacts within your network to find out more.

3. Listen for tone, pauses and signs that the candidate is holding back information.

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M AY 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 9

T H E RIGH T S TAF F | F EAT U RE

When it comes to hiring employees, emotional intelligence should rank high on the list, according to the experts.

Physicians’ ability to connect with patients is a direct result of emotional intelligence, but empathy and kindness are crucial qualities for all physician staff, FiercePractice Management reported.

A recent study by Inc. showed that team members with high emotional intelligence tend to be empathetic, highly motivated, more focused on the future, able to embrace change and are very compassionate, all positive attributes for any organization but especially for doctors’ offices, where emotions run high.

Because it’s not easy to assess the emotional intelligence of a candidate, the Harvard Business Review offers two suggestions for interviewing:

F EAT U RE | T H E RIGH T S TAF F

Retaining Millennials Given that by 2025, they will make up roughly 75% of the global workforce, according to research by Deloitte, it’s critical to take a close look at what sets millennials — those born in the 1980s, 1990s and early 2000s — apart from previous generations.

Millennials have gained a reputation for job-hopping, which is costly for employers. To retain them, experts say, it’s key to keep them motivated and challenged and to also look at their expectations.

According to Kurt Mosley, senior vice president of physician search firm Merritt Hawkins, older providers tend to be Type A personalities, characterized by ambition and high energy, while millennials are largely Type E, or empathetic, which is perfect for the healthcare industry, as they tend to want to spend more time with patients, increasing patient satisfaction.

Millennials also crave work-life balance and tend to look for flexible work hours, which is easy to accommodate, “...when leaders experts said. Managers who reward their best and brightest act selflessly, provwith paid time off, including half days on Fridays and more ing they care more vacation days rather than pay raises alone (on a competitive salary), will reap the benefits of keeping this generation happy, about the group experts cited.

than themselves, workers are more trusting, cooperative, dedicated, loyal, collegial and committed.”

Engaged Employees When it comes to employees’ happiness in the workplace, having a sense of purpose, good physical health, social relationships and community are all key factors, experts said.

For many doctors’ offices, creating a sense of purpose by involving employees in volunteer work or fundraisers for a charity inspires selflessness on and off the job, experts found.

“Studies have shown that when leaders act selflessly, proving they care more about the group than themselves, workers are more trusting, cooperative, dedicated, loyal, collegial and committed,” Emma Seppaelae, science director of Stanford University’s Center for Compassion and Altruism Research, wrote in HBR. On the flipside, when employees become disengaged, an organization’s growth and survival, whether it’s in a hospital setting or small physician office, is at risk.

That’s why experts say it’s important to spot disengaged workers early on and then take action.

There are clear signs of a disengaged worker, experts wrote in a recent article in Becker’s Hospital Review. Findings include that when employees suddenly start withdrawing from conversations, cancel meetings, are unusually silent or tardy and show a general lack of energy or enthusiasm for work, it’s a clear sign they are not happy.

A shift in behavior from being helpful and going above and beyond to not caring over an extended period of time should also be an indication to managers that something is not right.

Barbara Reilly, senior vice president of employee, nurse and physician engagement at Press Ganey, advises leaders to pay attention to these red flags and listen.

People who are disengaged tend to hold on to the same problems and situations and spend a lot of time complaining, blaming or sharing their story, which leaders should tune in to and address, she said.

“A disengaged employee is suffering, and it takes a skilled leader to spot it, understand and address it,” Reilly said.

An uptick in tardiness and calling in sick more often, declining quality of work and not meeting deadlines or a shift in attitude from a normally happy employee to being negative are also red flags.

T H E RIGH T S TAF F | F EAT U RE

While the cause of these behaviors could be personal, highlighting the importance of communication and developing a healthy rapport with the staff are key to staying ahead of roadblocks to happiness, said Cord Himmelstein, vice president of marketing and communications for Michael C. Fina Recognition.

Finally, there is often a fine line between an employee being stressed out and being burned out. When an employee comes back from vacation and is not refreshed, rejuvenated and ready to go, that’s typically a cue for burnout as well, said Loretta Samaniego, MD, vice president of physician practice development at TeamHealth.

When it comes to good practice management, doctors need to learn how to look for and retain the right staff to help the practice be successful on its own and be sure staff stays abreast of new laws and regulations to avoid potentially serious consequences. Those who choose to work for a healthcare organization must examine their contracts carefully to make sure they can be successful and thrive as well.

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M AY 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 11

F EAT U RE | T H E RIGH T S TAF F

CONSIDERING EMPLOYMENT? Many doctors may feel that employment by a healthcare organization would be more to their liking than running their own practice, but the legal experts recommend that doctors weigh their options carefully and understand the legal implications. Before signing on the dotted line, healthcare experts say, doctors need to consider how much they actually will be paid, how many hours they will be expected to work, what their clinical quality expectations will be, and other issues that can vary greatly from one employer to another. Here are 10 tips from the legal experts Kane Russell Coleman & Logan PC as cited on Lexology.com to help doctors better understand that process: 1. Read and understand the document carefully before signing: Hiring an experienced healthcare attorney can help with the decision-making process.

2. Negotiations: Doctors need to evaluate their negotiation power based on their subspecialty and area of practice and supply and demand. But being too aggressive can label a doctor too difficult at the front end, the experts caution.

3. Non-compete obligations: Doctors should presume that certain non-compete requirements are enforceable if they are part of the employment arrangement, even if the employer terminates a doctor without cause.

4. Non-solicitation and non-ownership obligations: Experts recommend that doctors negotiate these obligations narrowly.

5. HIPAA, privacy and trade secret confidentiality: Doctors need to observe all employment policies including HIPAA and patient privacy laws at the outset of the employment relationship and avoid forwarding information to personal devices or take hard copy information to non-office locations.

6. Income guarantee or recruitment component: Funds received from their employers to build their practice can be forgiven as long as they practice in a certain area for a certain period of time. When the employment is terminated or circumstances change, this arrangement can become complicated. It’s advisable to consult a healthcare attorney to explain the benefits and risks.

7. Logistics: When doctors become employees, the employer dictates the location of the practice and hospital and healthcare associations, holidays and vacation, and often measures clinical quality using algorithms.

Understanding what is being measured becomes critical.

8. Making a good match: Besides looking for salary, bonuses and shifting administrative expenses, doctors want to look for employers with a good reputation and spend time doing their research to ensure it’s a good fit.

9. Recognize red flags: If a relationship isn’t working due to economics, personalities or other issues, addressing these red flags with an experienced healthcare attorney allows doctors to address these concerns early on.

10. Resist the urge to resign: If there is a crisis, doctors should consult a legal expert to help avoid serious issues such as unwittingly triggering an affirmative report by resigning when there is an “investigation.”

RISKY LEGAL AREAS

When asked about the average doctor’s management skills, Keith Gray, chief of surgical oncology and co-creator of a medical leadership training program at the University of Tennessee Medical Center, said that doctors “do very, very well independently, but we don’t know how to engage the people around us. We don’t know how to delegate, we don’t know how to empower, we don’t know how to add value to others.” And running a practice has a particular challenge because, unlike managers in most other businesses who can delegate important tasks to others, the doctor is the central figure responsible for both patient care and running the business. Sometimes it can be difficult to separate the two areas, but legal experts say it’s critical that doctors stay abreast of new laws and regulations to avoid potentially serious problems such as sanctions by the state medical board and postings of said sanctions on its website for consumers and patients to see.

ness also must hire the right staff and assure that staff is knowledgable about the laws as well.

National Law Review reported the five top areas that pose a potential risk for doctors’ offices: 1. THEFT | Stealing can take many forms, but even minor indiscretions can have big consequences. Steps to avoid theft include making sure no single employee handles all transactions. When cash is recorded in the daybook as having been removed from the office, there always needs to be a signature recorded as well to track it. Also, a signature should be required when it comes to personal use of even seemingly minor items like stamps, which the attorneys advise strongly against. The bigger side of theft is when doctors don’t record cash payments or they keep a double set of books, which can result in prosecution.

2. STATE MEDICAL BOARD REGULATIONS | While it is not uncommon for doctors to fail to read messages sent from the state board, they are still accountable for the requirements they impose. The legal experts say it’s critical to stay abreast of the new regulations to avoid potential legal penalties and fines.

3. WAIVING DEDUCTIBLES OR COPAYS | While it can be tricky when empathy or emotions get in the way, the state board is very specific when it comes to waiving fees or substituting products that are not covered under provider care. It could be construed as fraud or grounds for litigation when a pattern of waiving fees can be shown, the experts say.

4. BAIT AND SWITCH, GUARANTEES | When doctors advertise a product or service, it is improper to switch or substitute a different product or service without giving the consumer or patient proper notice. When a product becomes unavailable, patients need to be notified so they can make informed decisions. Similarly, doctors need to be careful with offering patients guarantees.

5. FAILURE TO PAY PROPER TAXES | When it comes to paying taxes — state, federal and local — the legal experts say it’s key to pay them by the actual due date. Failure to pay employment taxes can result in serious repercussions and have long-lasting negative effects on the practice.

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T H E RIGH T S TAF F | F EAT U RE

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AT WORK F OR Y OU | LAC M A ELEC T ION 2 0 1 6

LACMA Members: We Need Your Vote!

Make your voice count in our annual elections The Los Angeles County Medical Association is holding its 145th Annual Election this coming June. This year, there are three vacancies for the position of Councilor-at-Large on the LACMA Board of Directors. Four candidates have been nominated to fill three Councilor-at-Large vacancies. Active members of LACMA and CMA have the privilege of voting for their preferred candidates. When reviewing each candidate statement, it is important to remember that the ultimate responsibility of the Councilor-at-Large includes serving as the 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.

NHAT TRAN, MD | It has been an honor for me to serve on the Los Angeles County Medical Association Board of Directors for the last three years. Since that time, I helped establish the Young Physicians Advisory Committee. Our committee aims to encourage more participation of young and future physicians who will be practicing in Los Angeles County. With the unprecedented change in the healthcare delivery system in the United States, we need more physician involvement to help shape this new landscape. That is why it is essential for young physicians to get involved, because they will be the ones who will inherit the privilege of being doctors to care for those in need.

I hope to have the opportunity to serve another three years on the Board, to further the missions of the Los Angeles County physician community. I plan to introduce new ideas and innovation to help move our profession forward. Opportunities exist within the technology industry and public health sector for LACMA to collaborate, in order to better care for our patients and move forward with care coordination and population health. Thank you for your consideration.

1 4 P H Y S I C I A N M A G A Z I N E | M AY 2016

JEFFERY LEE, MD | Healthcare is rapidly changing, and the change is only getting faster.

Many of these changes are being driven by non-physicians to the detriment of physicians and the patients to whom we are dedicated. Physicians are being squeezed for their time and compensation. I believe there is no time more important than the present for physicians to be actively involved in the Los Angeles County Medical Association. As your District Councilor-at-Large, I will fight for you and your patients. I have been a Primary Care Internist with Facey Medical Group in the San Fernando Valley for 13 years. During my career at Facey Medical Group I have been successful in quality improvement processes that help physicians deliver high-quality care with the utmost cost effectiveness. I am highly-skilled with new technology both inside (electronic health records, Dragon dictation, natural language processing) and outside of healthcare (social networking, wearable technology). I am a graduate of the California HealthCare Foundation Leadership Fellowship (Cohort 12), a member of the American Association of Physician Leaders (formerly ACPE), a Certified Professional Coder (CPC), and currently serve as the Assistant Medical Director for Facey Medical Group. I believe as a Councilor-at-Large I can actively represent the interests of my fellow colleagues in LA County without compromising the quality care we all strive to deliver.

ERICK EITING, MD | It is with great enthusiasm that I announce my candidacy for LACMA Councilor-at-Large, and I hope to earn your support and your vote. We are currently at an inflection point in the House of Medicine, and we see this every day with our patients in Los Angeles. More patients have insurance coverage, but we have done little to improve access to medical care. Our dual-eligible “Medi-Medi” patients get thrown into managed care plans without notice or under false pretenses, cutting them off from the doctors who have helped keep their chronic conditions under control for years. Maintenance of certification efforts force us to practice “merit badge medicine,” charging us thousands of dollars for the “privilege” of taking tests that do nothing to improve our ability to care for our patients. Rate increases designed to help physicians providing primary care services for Medicaid patients get taken away, and our governor continues to threaten to balance the budget by cutting physician payments even further. All of these stand in the way of what truly matters in medicine: the patient-physician relationship and our ability to provide good medical care. I have an extensive track record of experience in organized medicine, and I hope to have the opportunity to use this experience to fight for physicians in Los Angeles County. I served as a Councilor for the Medical Society of the state of New York for six years, where I also served as Assistant Commissioner of Medical Education and Assistant Commissioner of Government Relations. I have served on the CMA Board of Trustees and serve on the LACMA Delegation to the CMA House of Delegates. Currently, I sit on the CMA Council on Legislation and Council on Membership, Governance and Bylaws, and I was recently appointed as chair of its Diversity Technical Advisory Committee. I have also been in the AMA House of Delegates since 2005, where I also served on its Council on Medical Service. Lastly, I serve as the Faculty Advisor for the AMA Chapter at the USC Keck School of Medicine. I believe I can represent you and your needs well, and I hope to earn your support and your vote for LACMA Councilor-at-Large.

M AY 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1 5

LAC M A ELEC T ION 2 0 1 6 | AT WORK F OR Y OU

MARIA LYMBERIS, MD | My fellow LACMA members, three years ago you trusted me with your vote to serve you as your representative on the LACMA Board. It is an honor to serve you. I have done so during a difficult time for LACMA and for our profession. I actively participated during these difficult years when the need for internal change was confronted and implemented. The changes that took place aim to improve our LACMA’s fiscal health, revitalize and strengthen our internal operations so that LACMA’s work with CMA can effectively confront a relentlessly challenging external environment that is often hostile to our patients, our practices and our profession. In addition my reports detailing my participation at the HODs of both CMA and AMA offered you my perspective and opinions on the workings of our profession while your feedback helped me learn of your concerns. I believe that my work during these years has demonstrated my commitment to transparency, accountability and respectful service to and for our members. We live in a rapidly evolving world where change is the norm and life has become “work in progress.” Our challenge is to maintain our core values and stay focused on patient care as science and technology are transforming medical practice. Now, I am asking for your vote to continue my work on the LACMA Board with our elected officers under the able leadership of our new highly energetic CEO and CFO Mr. Gustavo Friederichsen. Having worked in support of this very positive change for our LACMA, now I am eager to continue contributing on your behalf. I would be honored to have your vote for my reelection.

Since assuming the role of CEO of LACMA two months ago, I have been speaking with and hearing from physicians – both members and non-members – representing various specialties, regions and interests, about how we need to evolve to represent the current needs of physicians across the county. I am encouraged by the initial strides we are already making to change the course of this great organization and recognize that we still have much to do.

“I ask all of our members to let me know your thoughts: What can we do better?

Whom can we engage in a relevant way?

Where are the opportunities and missed opportunities?”

1 6 P H Y S I C I A N M A G A Z I N E | M AY 2016

Each day I hear from our members about issues central to your ability to care for your patients. In the weeks and months ahead, I will share those insights through various channels, and where there are challenges, I’ve made it my mission to galvanize the membership, solve problems, communicate as often as possible and attract new members.

As I journey through this initial phase of my tenure, I’m constantly reminded of why I wanted this position: To serve the needs of our physicians, to defend and support your livelihood, your passion, your calling. That said, you will hear from me when it comes to what we are doing specifically to impact the practice of medicine. The process begins with listening and ends with action. You may have seen emails recently asking you to participate in a survey. These surveys are important as we ask our members questions based on topics our members are talking about. We are also building a baseline so we can measure member engagement over time. At times, you will see a survey based on what’s on your mind, and other times we simply need to know what you think before we act.

I ask all of our members to let me know your thoughts: What can we do better? Whom can we engage in a relevant way? Where are the opportunities and missed opportunities?

Growth • Physician Engagement Plan (PEP) developed and being rolled out. Features solo practices and group targets, tactics and key deliverables (ongoing process).

• Establishment of Growth Task Force composed of four to six members. Focus will be to manage and review PEP success and opportunities for improvement and share best practices.

• Weekly collaboration with CMA to review campaigns, messaging, joint-value propositions and “wins” to share relative to advocacy.

• Meetings being coordinated with AltaMed, Cedars-Sinai Medical Group as we continue to target and engage groups across the region with a relevant message.

Member Experience • Redesign of our web portal will “go live” this summer to coincide with our campaign to engage new members and retain current membership.

• Weekly Survey Results (some highlights): Open rate for week 1 was 18.6% and open rate for week 2 was 22.4%. Each week, we collect invaluable insights on topics ranging from your preferred channels for receiving communications to describing LACMA’s ability to meet your needs. We will conduct member and non-member focus groups in the fall and, eventually, we will develop core metrics tied to engagement, awareness and loyalty.

Accountability • We have started to create a more integrated organization where Districts, Advisory Committees, the Board and Operational Priorities are synchronized in a consistent way to reduce redundancy and exceed goals. For example, we will have a June Strategic Planning Retreat to discuss and set priorities for the coming year based on what’s important for LACMA membership going forward. All tied to metrics and executable (not theoretical) outcomes.

Strategic Partners • I’ve begun to engage the Los Angeles Rams football franchise to discuss areas of mutual interest. The initial round of meetings took place the week of April 18. As this relationship grows, I will provide updates to members. If successful, this can be a transformative partnership to inspire current members and attract new ones.

• IMAT Solutions, Inc., a healthcare technology company providing expedient electronic health record and data mining solutions for medical group practices and accountable care organizations, is officially a partner at the $10,000 level ($5,000 with renewable option after six months).

As always, if it’s important to our members, it’s important to me.

Gustavo Friederichsen Chief Executive Officer M AY 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 17

LAC M A C EO | GU S TAVO F RIEDERIC H S EN

I’m also segmenting the milestones into key categories based on discussions with the Board of Directors and members across the organization:

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