June 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

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

Hospital+ Physician Alignment LACMA Members at CMA Lobby Day Beware of Counterfeit Drugs

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

JUNE 2014 | TA B LE OF CONT ENT S

Volume 145 Issue 6

6 DEPARTMENTS

15 16

6 FRONT OFFICE | PRACTICE MANAGEMENT Tips, hints, advice and resources

8 PNN | NEWS IN REVIEW

The latest headlines impacting the economics of healthcare delivery in Southern California

COVER STORY

10

HOSPITAL + PHYSICIAN ALIGNMENT

The hospital-physician alignment trend is on the rise as medical groups and individuals try to cope with the challenges moving forward. In this article, we’ll take a closer look at different types of physician-hospital integration models, what doctors can expect in this changing industry in terms of compensation, be aware of, and key strategies to consider when aligning technologies.

14 UNITED WE STAND | AT WORK FOR YOU LACMA and CMA membership at work for you

FROM YOUR ASSOCIATION 4

PRESIDENT’S LETTER | MARSHALL MORGAN, MD

16 CEO’s LETTER | ROCKY DELGADILLO

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as well as medical students, interns and residents. For more

PRESIDENT

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Marshall Morgan, MD Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD Samuel I. Fink, MD

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

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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

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.

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

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

A S I SAT down to write my final “President’s Let-

ter,” the Attorney General’s office announced that the trial lawyers’ anti-MICRA initiative, the “Troy and Alana Pack Patient Safety Act,” has qualified for the November 4, 2014 ballot. We expected that, but nonetheless it is not good news. There will be a well-funded, strident, nasty campaign in which physicians will be vilified. Misleading claims will be made, and voters will be beguiled by bogus “patient safety” measures to draw attention from the initiative’s real goal, which is the enrichment of trial lawyers.

Please talk to your patients and your friends about this. Urge them to vote “No.” Don’t spend time arguing against the drug testing issue; it’s distasteful to us, but in the big picture it’s not important. It’s a “sweetener” that polls well. Don’t complain that consulting CURES before writing a prescription would be a nuisance; simply point out that the system is dysfunctional and impossible to use. Emphasize that, should the initiative pass, the cost of healthcare in California will rise dramatically and those costs will be passed on to everyone, including individuals, businesses and local governments in the form of higher costs for care and higher insurance. In addition doctors’ costs will rise so much that many will leave the state or close their offices.

Access to care will be seriously affected for all of us, especially for the poor and underserved; Point out that, as an example, in New York state, which has no MICRA-like protections, there are entire counties that don’t have a single practicing obstetrician. Point out that increased insurance premiums would cost local governments millions of dollars, diverting funds from police and fire protection for all of us.

On an entirely different subject, the other day I spent a chilling hour and a half learning about a product called Crimson, which is about to be de-

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

ployed in the large health system in which I work.

The presenters were an older fellow who was apparently mostly a salesman, a middle-aged guy who was the manager in charge of the group, and three quite young persons who were very eager and bright and had a lot of technical know-how about the product (just guessing, recently graduated MBAs).

The module they presented collects data from the various IT systems used in our healthcare organization, including the electronic medical records, the patient appointment system, and the billing and collections system, all in the service of analyzing the performance of individual physicians. Performance in this case is measured in many ways, but primarily in terms of numbers: numbers of patients seen, numbers of relative value units (RVUs) generated, numbers of dollars collected. I saw nothing there about the quality of the interaction between doctor and patient, or the quality of medical care provided; however, I am sure the system can generate data on patient satisfaction scores and the number of “quality metrics” achieved by the physician. That said, the emphasis seemed to be on RVUs and dollars, with the goal of using those metrics to identify “poor performers” and getting them to either improve or (unstated but clearly implied) leave the organization.

I am not entirely a Luddite. I recognize the possibility that such systems can potentially be used to improve care. However, it seems clear that they are designed primarily to improve the financial performance of very large organizations (the only ones that can afford these extremely expensive systems).

In these organizations, the physicians are essentially employees overseen by managers who may or may not be physicians but whose primary goal is to improve the bottom line.

I find that scary, but it is clearly a part of our future, as large healthcare organizations continue to consolidate.

Finally, I must say that it has been a privilege and an education to serve as LACMA president. It has given me a great appreciation of the vital role LACMA and CMA play in serving the best interests of doctors and patients.

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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PR ACT I CE M A NAGEMENT | FR ONT OFFI CE

RISK TIP

If the Cost of a Medication Is Too Good to Be True, the Drug May Be Counterfeit IN THE PAST few years, a number of developments have occurred, including drug shortages

and patients having trouble affording their prescriptions, that might seem to justify importing medications from overseas. The world outside of U.S. borders appears to offer a ready supply of cheaper medications easily obtained through unlicensed distributors, trips across the border, or online pharmacies.

The laws that prohibit importing medicines not approved by the Food and Drug Administration (FDA) are designed to ensure that patients receive medications that meet the FDA’s requirements for safety, purity and potency. It is illegal to import unapproved, misbranded, adulterated or foreign versions of U.S.-approved medications into the country. The law also applies to medical devices.

Regardless of the supplier, purchasing or using nonFDA-approved drug products exposes the physician to criminal and civil liability. Medical malpractice insurance may not cover any errors in this area—making physicians personally liable for claims that they provided counterfeit drugs.

The medication doesn’t even have to be counterfeit for the physician to suffer legal consequences: Medications that have the correct ingredients but haven’t been FDA-approved are still illegal to use.

Physicians and their office staff may inadvertently order counterfeit drugs or devices. Follow these tips to protect yourself and your patients from the risks of illegal medications and devices: • Require training for everyone involved in purchasing medications.

• Be wary of fax or email blast offers from an un6 P H Y S I C I A N M A G A Z I N E | J UN E 2014

authorized distributor selling “discounted” foreign medications or devices.

• Have clear policies that dictate how to verify the license of a wholesaler providing medications. For example, require that your staff verify all vendors by checking wholesaler accreditation and licensing at http://safedr.ug/VAWDaccredited and http:// safedr.ug/fdalicense.

• Obtain medications only from secure sources.

• Know the warning signs that a product may be counterfeit: - Are prices or deals too good to be true?

- Was the fax/email offer unsolicited and from an unknown seller?

- Is the labeling in a foreign language when it’s normally in English?

- Is the package damaged or soiled?

- Are all tamper seals present and intact?

• If in doubt, call the manufacturer to check if the lot number is still valid and matches the expiration date.

• Educate patients about avoiding counterfeit drugs with free resources like the S.A.F.E. D.R.U.G. checklist at www.safemedicines.org/safedrugs.html.

Contributed by The Doctors Company and Partnership for Safe Medicines. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

For more information on counterfeit medicines, go to www.safemedicines.org.

Now that Microsoft has stopped supporting the Windows XP operating system, physician practices using Windows XP face threats from viruses, Trojans and other potential security breaches. All PC workstations and laptops using Windows XP that contain protected health information (PHI) are no longer compliant with HIPAA and the HITECH Act. This includes devices used to access PHI via the Internet. HIPAA Security Rule section 164.308(a)(5)(ii)(B) states that practices must implement “procedures for guarding against, detecting, and reporting malicious software.” This is no longer possible with Windows XP. If your practice system currently runs on Windows XP, follow these tips immediately to bring your practice into HIPAA compliance: • Identify all at-risk workstations and laptops.

• Analyze the hardware in all at-risk computers to determine if they are capable of running a new operating system, such as Windows 7 or 8.

• Upgrade all at-risk computers identified as capable of running a new operating system.

• For computers that cannot be upgraded, either replace the hardware or purchase new computers.

• Create a transition plan for upgrading or replacing computers.

Internet Explorer 8 is also no longer supported, if your practice is running Windows XP and using Internet Explorer 8, you may be exposed to additional threats.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

FR ONT OFFI CE | PR ACT I CE M A NAGEM ENT

Windows XP Use May Trigger HIPAA Noncompliance

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REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

Program Expands Pharmacists’ Role in Primary Care in LA and OC A program developed by the USC School of Pharmacy enables pharmacists to provide expanded care for patients in the safety net healthcare clinics in Los Angeles and Orange counties, according to the California HealthCare Foundation’s (CHCF) Center for Health Reporting.

According to CHCF the early results are impressive, including a 25% decrease in hospitalizations for nearly 6,000 participating patients, although results are preliminary as the study will continue into next year.

LACMA Installation of President, Officers to Be Held June 19 The Los Angeles County Medical Association (LACMA) invites members and guests to attend the 2014 Installation of President and Officers on June 19. The reception and dinner will honor the 143rd LACMA president, Pedram Salimpour, MD. The installation dinner will be held at the Riviera Country Club in Pacific Palisades. To RSVP, please contact Lisa Le at (213) 226-0304, lisa@lacmanet.org.

Popular Omnio iPad App Now Available for iPhone, Android Physicians Interactive Inc. (PI) announced it is launching free iPhone and Android versions of its popular Omnio application. Both include an introductory offer of a free three-month trial version of The Merck Manual for Healthcare Professionals within the app.

The powerful new versions of Omnio for mobile phones also offer social sharing capabilities through My Pages. This architecture allows for rapid growth of additional content, as third parties with valuable tools and information for clinicians can integrate into the app, where sophisticated engineering will deliver the highest value content to the users who need it, when they need it.

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

MOST READ

LAC+USC Changing Culture of Care in Light of ACA The CEO of the Los Angeles County+USC (LAC+USC) Medical Center, Dan Castillo, says the culture of his hospital is changing as the implementation of the Affordable Care Act (ACA) puts pressure on safety net hospitals like his.

That pressure has shifted the focus toward retaining patients, redirecting ER visitors to primary clinics and making it easier for primary care doctors to have direct communication with specialists to eliminate unnecessary referrals.

“We want to be a provider of choice, not a provider of last resort,” Castillo told PNN. “Because LAC+USC Medical Center has been around since the 1800s, has been a county facility and one of the largest safety net hospitals in the nation, there has been a strong culture that says that you serve everybody who comes through the door regardless of their ability to pay,” said Castillo. “And while we continue this mission, there is a new culture that we are trying to cultivate, one that focuses not just on volume of care but on customer experience as well. There is also an increased awareness that both the patient and the hospital are now at a financial risk, so everyone, including physicians, has to be aware of the cost of care.”

Castillo credited Mitch Katz, who became the director of the Los Angeles County Department of Health Services in 2010, with bringing in a lot of new people who have the necessary background to move into the post-ACA world and focus on patientcentered models of care.

Patient-centric care is nothing new, but it is new for a county hospital like LAC+USC. “Historically, we have been very hospital centric; we have a worldrenowned trauma center where we see roughly 14,000 to 15,000 per month, and our outpatient centers see 15,000 primary care visits a day. So we have the challenge of trying to compete for new Medi-Cal managed care patients, which a lot of people are now trying to do.”

TELE HEALTH

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NEWS NETWORK

WE ARE LISTENING! In response to your suggestions and requests, the iPNN eNewsletter was

replaced with the launch of the TeleHealth News Network on Thursday, May 22. THNN editorials will cover all aspects of telehealth including EHRs and ICD-10, cloud-computing, mobile health and cybersecurity, practice management issues and policy and legislation, as well as telehealth implementation and success stories from around the state and country.

Telehealth Reimbursement Policies Under Fire

Telehealth industry stakeholders recently called on Congress to update Medicare reimbursement policies for telehealth services, recommending expansion of telehealth reimbursement into urban areas.

“Reimbursement for telemedicine services has been largely limited to rural areas in order to meet the legitimate unmet needs of rural and remote communities, while large groups and population segments in major urban areas have similar unmet needs,” said Rashid Bashshur, executive director for eHealth at the University of Michigan Health System, in testimony before the House Energy and Commerce Health Subcommittee.

The subcommittee is seeking feedback on efforts to expand telehealth access until June 16, according to published reports.

The practice guidelines cover the provision of direct-to-patient, primary and urgent care services delivered by licensed healthcare providers using real-time, two-way videoconferencing and mobile devices.

These standards will accelerate the adoption of telemedicine by payers, administrators and providers who are full partners with the ATA along with other stakeholders.

Doctors Must Check Licensing Requirements When Delivering Telehealth Across State Lines

Physicians who use telehealth technologies across state lines may need to be licensed in more than one state.

Most states require doctors to be licensed to practice in the originating site’s state, and some states require doctors to be licensed in the state where the patient is located.

Physicians who consult with patients across state lines or prescribe medications across state lines should establish licensure in those states, according to HealthIT.gov.

ATA Looking for Input on Clinical Guidelines for Telemedicine

The American Telemedicine Association (ATA) is updating its clinical guidelines fortelepathology and wants providers and stakeholders to give their input by June 12.

J UN E 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

NEWS I N R EV I EW | PHY S I CI A NS NEWS NET WOR K . COM

NEW FROM PHYSICIANS NEWS NETWORK

hospital+physician alignment

BY MARION WEBB

The hospital-physician alignment trend is on the rise as medical groups and individuals to try to cope with the challenges moving forward.

Some of the key forces behind this trend are increasing demands on both hospitals and doctors. Hospitals must deal with reporting requirements, focus on increasing market share and ensure service line stability and call coverage. Doctors face growing concerns surrounding economic, regulatory and administrative pressures to run their own practices as well as the desire, especially by younger doctors, to achieve a greater work-life balance.

According to American Hospital Association statistics on hospital-based physician alignment models comprising 2012 data from 4,999 community hospitals, more 1 0 P H Y S I C I A N M A G A Z I N E | J UN E 2014

than one-third of all community hospitals use the integrated salary model today.

That is followed by open physician-hospital organizations (12.4%), independent practice associations (9.9%), management service organizations (8.8%), medical foundations (5.4%), closed physician-hospital groups (4.4%), group practice without walls (3.3%) and the equity model (1.7%), according to the AHA survey published in the 2014 edition of AHA Hospital Statistics.

In this article, we’ll take a closer look at different types of physician-hospital integration models, what doctors can expect in this changing industry in terms of compensation, what trends as well as structural and legal issues they need to be aware of, and key strategies to consider when aligning technologies.

models

1. Customer Service Programs - These programs provide support and services to physicians in technology, revenue cycle, medical malpractice insurance, training, co-marketing programs and other administrative support services.

The focus here is on improving customer service functions via new programs and using technology, specifically electronic medical records (EMRs).

To ensure success and mitigate disruptions to physicians’ daily work flow, the authors say it’s important that physician leaders have input on selecting and implementing new technologies.

2. Contractual Ventures - These alignment options involve contracts where physicians or physician groups either buy services or provide services to health systems.

These ventures can range from programs such as payfor-performance initiatives to comprehensive management services organizations.

They have a limited scope and traditionally have been short-term focused on initiatives, with a half-life of about two to three years.

These types of agreements can help build trust and establish basic performance requirements to make the transition to value-based care.

Among the most common contractual agreements are the following: • Professional services arrangements (PSA), which often include radiology, pathology and anesthesiology services provided by doctors.

• Physician-hospital organization (PHO) is a legal entity formed by a hospital and one or more physicians or physician groups for the purpose of negotiating and obtaining contracts with insurance plans and employees.

• Co-management agreements typically involve a contractual agreement between a hospital and management services or a group of doctors. Doctors agree to perform clinical and management services with specific improvement targets in exchange for a predetermined fee.

• Management services organization (MSO), where a hospital or health system forms a new division or company (“Newco”) to manage a defined set of activities for their members of medical staff, have gained popularity in the areas of clinical technologies and physician revenue cycle. This model allows significant investment in infrastructure to be spread by healthcare groups across a larger physician base and typically includes both physicians and management professionals.

• Clinical integration (CI) programs involve collaborations between private practice and employed physicians and hospitals aimed at increasing quality and efficiency of patient care. They allow for joint contracting with fee-for-service health plans subject for review by regulatory agencies.

3. Joint Venture/Share Equity Arrangements - These arrangements can be short-term or long-term with risk-and-benefit sharing between a hospital or health system and one or more physician groups or individual physicians to form and operate a common enterprise.

Typically, such ventures involve ambulatory surgery centers, imaging facilities, endoscopy centers, urgent care centers and other outpatient diagnostic and treatment facilities started by either the hospital and health system or physicians.

The Stark Law (Stark III), which limits certain physician referrals, has made joint ventures more complicated, making the notion of “dating” or “testing” more difficult.

4. Physician Employment - Physician employment can take many forms, including direct employment, employment by a wholly owned tax-exempt subsidiary or wholly owned taxable entity, an independent or joint-venture and an independent financially aligned foundation.

An organization’s selection of a specific model should be based on the integration strategy and take into consideration how it will impact the organization’s financial and operating performance.

NONEMPLOYMENT MODELS The other option is the nonemployment model, which can range from hospitals and physicians simply working together on a limited contractual basis to full forms of alignment without employment.

COMPENSATION Experts believe that developing an effective physician compensation framework is the single most important factor in driving the future performance of a hospital’s physi-

J UN E 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 11

H OS P ITAL + P H Y S IC IAN ALIG N M EN T | F EAT U RE

In today’s environment, hospitals and health systems have several options for alignment, with others still being tested.

In “The Guide to Physician Integration Models for Sustainable Success” published by Health Research & Educational Trust and Kaufman, Hall & Associates, Inc., Chicago, the authors discuss four primary models: customer service programs, contractual ventures, joint-ownership ventures and employment.

We’ll take a closer look at each model.

F EAT U RE | H OS P ITAL + P H Y S IC IAN ALIGNM EN T

cian enterprise.

An efficient compensation design needs to follow key principles that support the organizational goal while providing doctors a fair and stable income, according to the authors of the physician integration model study.

The most important principle will be to develop consistent compensation standards and metrics that can be applied across physicians, locations and specialties and cover work effort/productivity, quality and cost-effectiveness and patient access.

Such productivity-based methods of structuring compensation programs include: • Compensation per work relative value units (wRVUs), which remains the preferred compensation method to date • Compensation as a percentage of gross charges • Compensation as a percentage of net collections • Compensation per encounter • Compensation based on panel size or panel-size equivalencies

trends

With physician-hospital alignments continuing to grow, there are some key trends that experts say physicians should be aware of: 1. Although larger physician groups are interested in aligning with hospitals, many prefer entering professional service agreements or contractual relationships over full employment.

2. Larger physician groups may consider institutional investors a viable source providing greater financial gain.

3. With more payers becoming investors in physician practices they can offer doctors alternatives to traditional alignment strategies.

4. With group mergers and overall consolidation rising, more hospitals and health systems will want to find ways to partner with physicians.

5. More hospitals will develop a pluralistic approach to alignment.

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

6. To develop a successful integration, hospital senior management and physician leaders need to align and develop a broadly shared institutional culture rooted in a jointly developed common vision, which opens the door to greater physician leadership.

7. Yet, there is also a growing need for physician leaders with training in leadership and management skills who can represent physicians collectively and make decisions endorsed by all parties.

legal issues

Though hospitals and physicians have come a long way toward realizing the proposition of alignment, legal and structural issues remain.

Here are some of the key issues: 1. Though hospitals have come a long way toward realizing a value proposition in alignment, acquiring ancillaries developed by private practice doctors paying at fair market value rates and capturing the revenue stream going forward, the federal government often pays hospitals that bill for the same types of services more—at least for now.

2. Bundling and shared savings programs are expected to rise, but measuring values among participating providers will become an issue.

3. Governance and leadership initiatives are moving to a dyad structure.

4. Experts have found that the most successful organizations form an “integrated leadership committee” (ILC) or “clinical enterprise board” that meets regularly and discusses all organizational decisions. To ensure success, the experts say the board should have representatives from hospital senior management and staff and elected representatives of the practicing physicians in roughly equal proportion.

experts believe that developing an effective physician compensation framework is the single most important factor in driving the future performance of a hospital’s physician enterprise.

5.

There is a need for more rapid development of physician organizations and physician hospital groups capable of accountable self-governance and collective management of quality and cost and the have ability to create and award incentives to share in the overall organization’s operational management.

technology

Most hospitals have already started to adopt a broader approach to physician-hospital alignment, which includes a stronger emphasis on information technology and clinical integration to ensure continuity of care.

Hospitals that have equipped community physician groups, for instance, have found that equipping doctors with the hospital’s EMR system is attractive to both parties ,as exchanging information data improves patient care, manages cost and realizes greater quality outcomes.

To leverage technology across the physician enterprise—employed and independent physicians—requires interoperability across the spectrum of physician activities, including clinical, business and customer service domains, noted the authors of “The Guide to Physician Integration Models for Sustainable Success.”

For physicians to use and interface with hospital/health system technology, the following criteria must be met: • The technology should enable and improve clinical workflow.

John Calderone, the recently appointed Chair of the Hospital Association of Southern California and CEO of the Los Angeles-based Olympia Medical Center, acquired

by Alecto Health Services in December 2013, said doctors are not alone in facing uncertainty.

“We are all wondering where we are going,” Calderone said. “Physician organizations and hospital organizations haven’t worked that closely in the past, but I think everybody is realizing that we have to work closer together. Our objectives are not that far apart.”

Experts agree, saying that while challenges certainly remain, doctors and hospitals should assume a broad approach, considering options and alternatives that allow both to be responsive to their individual needs and situation.

• It should require a low-to-moderate level of investment.

• It should allow two-way information flow between the physician and hospital/health system.

• It should eliminate duplication of work effort.

• It should be proven technology.

SUMMARY Alignment strategies are in place and are being considered by virtually all physicians and hospitals in the United States.

J UN E 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

H OS P ITAL + P H Y S IC IAN ALIG N M EN T | F EAT U RE

Experts agree that technology will be among the most successful tools to engage physicians with hospital and healthcare systems.

“physician organizations and hospital organizations haven’t worked that closely in the past, but I think everybody is realizing that we have to work closer together. Our objectives are not that far apart.”

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

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

Average

(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

Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017 Phone: (213) 683-9900 Fax: (213) 226-0353 * Medical Liability Monitor - Annual Rate Survey Issue, Vol. 37, No. 10, October 2012. Annual rates with limits of $1 million/$3 million.

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

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

LACMA & CMA

Physicians Travel to Sacramento for Lobby Day

BY CMA STAFF

As part of the California Medical Association’s (CMA) 40th Annual Legislative Leadership Conference, more than 400 physicians, medical students and CMA Alliance members came to Sacramento on April 22 to lobby their legislative leaders as champions for medicine and their patients. They lobbied for a package of CMA-sponsored bills that will increase access to healthcare throughout the state.

The bills include: AB 1805 (Skinner) restores a 10% cut made to California’s Medicaid program (Medi-Cal) in 2011. Medi-Cal reimbursement rates are among the lowest in the nation, often reimbursing providers below the cost of care. Many Medi-Cal patients have difficulty finding providers able to care for them. As millions of new patients enter the healthcare delivery system, reimbursement rates must be sus-

tainable so that patients have real access to care.

AB 1759 (Pan) extends through 2015 and beyond the reimbursement increase for certain Medi-Cal primary care providers, currently mandated under the Affordable Care Act, but set to expire on December 31, 2014.

AB 1771 (V. Manuel Perez) increases access to care, especially in underserved areas, by requiring health insurance companies licensed in the state of California to pay contracted physicians for telephone and electronic patient management telehealth services.

AB 2458 (Bonilla) creates additional residency positions to train very much needed primary care physicians by establishing the framework to administer grants to medical education residency programs at hospitals and teaching health centers.

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Thanks to the LACMA leaders in attendance, we had a very successful Legislative Leadership Day! We met with over 20 legislators and/or their staff and effectively advocated on behalf of physicians!

J UN E 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

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

CEO’s LETTER

THIS JUNE , L ACM A will be starting a new chapter with the installation of its 143rd president, Dr. Pedram Salimpour.

Dr. Salimpour’s top agenda for the coming months will be to fight a measure that is certain to drive up healthcare costs for every consumer in California.

That is because last month, the initiative to raise the cap on medical malpractice damages has officially made its way to the ballot for November.

Rather than voting on the real issue of increasing the Medical Injury Compensation Reform Act’s (MICRA) cap on speculative non-economic damages, however, Californians will be voting for a proposition that headlines “Drug and Alcohol Testing for Doctors.”

As patient advocates, it will be up to LACMA and its partnering organizations to educate voters about the real issue behind the measure and its devastating impact on all Californians.

If this measure is approved by voters, malpractice lawsuits and payouts will skyrocket, adding “hundreds of millions of dollars” in new costs to state and local governments, according to an impartial analysis conducted by the state’s Legislative Analyst. Someone will have to pay, and that someone is providers, taxpayers and consumers. Other estimates show that increases in healthcare costs across all sectors could cost a family of four up to $1,000 more per year for health coverage.

This proposal also forces doctors and pharmacists to use a massive statewide database known as the Controlled Utilization Review and Evaluation System, or CURES, filled with Californians’ personal medical prescription information – a mandate our government will find impossible to implement, and a database with no increased security standards to protect your personal prescription information from hacking and theft. Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. Also of concern is that the massive ramp-up of this database will significantly put patients’ private medical information at risk. The ballot measure contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government intrusion, hacking, theft or improper access by nonmedical professionals.

In the state of New York, where MICRA-like laws do not exist, 19 counties are without obstetricians due to sky-high malpractice insurance rates. There is not a worse time to be reducing access to care for patients who need it most.

As you can see, this initiative is fraught with problems and would prove detrimental to California’s healthcare system. I’m asking each of you to join the effort to defeat this costly threat to our state, and in doing so, protect access to care and prevent higher costs for all Californians. Together, I’m sure we will be victorious. The measure is bad for patients, taxpayers and healthcare as a whole, and there has never been a greater need for physicians to band together and fight for our patients.

A tremendous patient advocate and leader, Dr. Marshall Morgan has led the way to preserve MICRA and has been instrumental in the ramp-up to defeat the ballot measure.

This month, Dr. Morgan will hand over the reins to Dr. Salimpour, who will be installed as LACMA’s 143rd president at the Installation of President and Officers dinner on June 19.

Dr. Salimpour will become the youngest president in LACMA’s history. He brings enormous energy to the role, and we are looking forward to great things from him in the coming year.

On behalf of LACMA, I want to thank Dr. Morgan for his outstanding leadership and for successfully raising LACMA’s membership numbers. He is also a highly effective and gifted speaker.

I have attended many hearings, but Dr. Morgan’s testimony at the state Capitol last month against the ill-conceived Cal MediConnect pilot project was simply masterful.

Happy Father’s Day! And don’t forget to exercise your power at the ballot box.

Rocky Delgadillo Chief Executive Officer

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

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

DISTRICT 2 ALLIANCE

‘Doctors and Sweethearts’

BY HALAINE ROSE

The LACMA District 2 Alliance recently brought together 65 physicians and spouses, members and prospective members, to relax, connect, and enjoy a fine lunch. Joanne Sasaki directed the mini silent auction with maximum results for four health-related philanthropies. The Maestros trio played for the sold-out event in Pasadena.

Our annual “Doctors and Sweethearts� party is one of the rare occasions when physicians from across the medical specialty spectrum enjoy camaraderie, connect, and socialize--to briefly escape the rigors of medicine today.

LACMA President Dr. Marshall Morgan (chief of emergency medicine at UCLA) was introduced. Dr. Morgan alerted us to the gravity of the antiMICRA November ballot proposition that would inevitably decrease access to care and increase costs. Later, Dr. Morgan took the time to send a wonderful message of thanks for the event experience and warm welcome he and his wife received from D2 Alliancers and dedicated physicians Sweetheart participants included Dr. Bill Caton and Cathy; Dr. Dave Moritz and Jan; Dr. Ronald Wu and Georgiana; Dr. Gordon Sasaki and Joanne; Elizabeth Wright; Dr. Paul Gilbert and Cindy; Dr. Bill Foran and Vivien; Dr. Milton Smith and Sherry; Dr. Dawn Hills and Kevin Coughlan, Dr. Dave Rhodes and Nancy; Dr. Robert Henderson and Marilyn.

Four nonprofits benefited from the Alliance Sweetheart auction: HMRI — Huntington Medical Research Institutes; Haven House shelter in Pasadena; District 2 Medical Student Scholarship Fund; Friends in Deed (Ecumenical Council of Pasadena Area Congregations).

Top: LACMA President Marshall Morgan, MD and wife Jean with Halaine Rose (D2 Alli president).

Bottom: Alliance Sweetheart Libby Wright with William Foran, MD and Vivien Foran.

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City of Hope welcomes internationally acclaimed pancreatic surgeon, researcher and author Yuman Fong, M.D., as the new chair of the Department of Surgery. Come meet Dr. Fong at this special CME event and reception:

Join us for this extraordinary four-day conference designed for healthcare professionals to enhance their ability to care for older adults. With more than thirty case-based presentations, smaller interactive sessions and discussion with faculty on issues in geriatrics, emphasis is on the clinical “how to,” and Board Review preparation for physicians and pharmacists.

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

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

FREE CME & Educational Resources CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with membership.

In addition, LACMA provides access to important and local CME-accredited events.

FREE Legal Assistance

Legislative Advocacy LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy at the local, state, and federal level on behalf of our members.

FREE Reimbursement Assistance Tired of fighting with payors? CMA’s Economic Services experts recovered over $7.8 million for members since 2010.

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

SAVE Thousands of Dollars GUARANTEED Through an exclusive partnership with MEDLINE and DANIELS, LACMA saves members on medical waste services and a guaranteed minimum of 10% on your medical supplies and equipment.

Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!

FREE Networking & Referral Events Socialize and network with members of the medical community Find or create opportunities for your practice Engage with legislators and policymakers

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

Access to your Physician Advocate If you come across a challenge and you are not sure what to do, call 213-226-0356 to support your practice and professional needs.

is the best time to join LACMA and CMA For more information on member benefits and resources, visit lacmanet.org/Membership or call (213) 226-0356 Los Angeles County Medical Association  707 Wilshire Blvd, Suite 3800  Los Angeles, CA  90017  FAX: (213) 226-0353

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