September 2013

T h e N e w O f f i c i a l P u b l i c at i on o f t h e Lo s An g e l e s Co u nt y M e d i c a l A s s o c i at i on

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

Healthcare IT EHRs • mHealth • The Cloud

What’s Next Adapting to New Technologies The Medical Marriage PLUS

LACMA Board Member Appointed to California Medical Board

SEPTEMBER 2013

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s ept em b er 2013 | TA BLE OF CONTE NTS

Volume 144 Issue 09

FEATURE

14

WHAT’S NEXT FOR HEALTHCARE IT

Doctors are bombarded with talk of EHR implementation, mobile IT, remote device monitoring and cloud-based computing—but what does all these data and all these new technologies mean and how can they benefit your practice?

14 DEPARTMENTS 6 Front Office | Practice Management Tips, hints, advice and resources

8 Balance | Lifestyle & Wellness

8

27

howard r. krauss appointed to california medical board

News, studies, tips and opportunities to help physicians maintain a balanced lifestyle

10 transitions | career management A look at the questions and challenges associated with various stages of your medical career

12 PNN | NEWS IN REVIEW The latest headlines impacting the economics of healthcare delivery in Southern California

Governor Edmund G. Brown Jr. recently announced the appointment of LACMA Councilor Howard R. Krauss to the California Medical Board.

22 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

27 LACMA News | Association Happenings

27

26 CEO’s Letter | Rocky Delgadillo

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.

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editor

Sheri Carr 559-250-5942 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

display ad sales / director of sales CLASSIFIED ad sales editorial advIsory board

The Los Angeles County Medi-

Christina Correia 213-226-0325 | christinac@lacmanet.org Dari Pebdani 858-231-1231 | dpebdani@gmail.com David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD Headquarters

cal Association is a profes-

Physicians News Network Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 Tel 213-683-9900 | Fax 213-226-0350 www.physiciansnewsnetwork.com

sional association representing physicians from every medical specialty and practice setting

LACMA Officers

as well as medical students, interns and residents. For more than 100 years, LACMA has

President President-elect Treasurer Secretary Immediate Past President

been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, government relations and community relations. Through its advocacy

LACMA BOARD OF DIRECTORS CMA Trustee Councilor - District 9 Councilor - District 2 med student Councilor/usc keck Councilor-at-large young physician councilor cma trustee Councilor - District 5 ethnic physicians commitee representative Councilor - District 1 Councilor - District 17

efforts in both Los Angeles

Councilor - District 14

County and with the statewide

Chair of LACMA Delegation

California Medical Association,

Councilor - District 6

your physician leaders and staff

Councilor-at-large

strive toward a common goal–

Councilor - District 10

that you might spend more time

Alternate med student Councilor/ucla

Councilor - District 7 Councilor-at-large Councilor - SSGPF Councilor - District 3

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

Councilor - SCPMG RESIDENT/FELLOW Councilor cma trustee alternate RESIDENT/officer Councilor Councilor-at-large Councilor-at-large 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 Carlotta Freeman, MD Sidney Gold, MD William Hale, MD David Hopp, MD Paul Kirz, MD Lawrence Kneisley Kambiz Kozari, 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 Erin Wilkes, 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, Executive Assistant, 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.

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PRESIDENT ’S LETTER | MA RSHA LL MORGA N, MD

On the day I began writing this month’s Letter, the lead article in the Los Angeles Times featured the Harbor-UCLA Medical Center’s experience with gunshot wound victims, concentrating on the care of one young man who surely would have died but for the skill of his surgeon, and noting that in the three summer months of last year, the hospital treated 107 gunshot victims. Today, as I finish this, the Times’ lead article details an epidemic of gunshot deaths in Pomona, where there have been 19 murders so far this year; all of those killed died of gunshot wounds.

Firearm-related injury and death is a major unaddressed public health problem in the United States. There are on average more than 30,000 firearm-related deaths and twice as many nonfatal injuries in the United States each year. The cost of medical care for these injuries is enormous, as is the cost of lost productivity and social services for those disabled by them.

The abiding psychological, emotional and social consequences suffered by surviving victims and their families are incalculable.

The sheer number of firearms circulating in our society and, more important, their ready availability to persons with criminal records and relevant psychiatric problems create an environment in which essentially no one is safe (although some are less safe than others). In my own recent experience, three incidents have come to strongly illustrate this fact: The son of an attorney I know, an ambitious young man, came home after working a late shift to his apartment in Pomona. Gangsters were lying in wait to kill rivals (which they did) but also shot and killed him. My sister, a physical therapist who does home calls, went to visit a patient in East Oakland and found herself in the line of fire of an attempted assassination in broad daylight. Fortunately she was not injured. A few days later, I was called in to the UCLA Emergency Department to help with the victims of the shooter at the Santa Monica College Campus. Two of those persons died of their wounds.

Compared with other high-income developed countries, the failure of the United States to deal effectively with this epidemic is a national disgrace. The 4 PHYSICIAN MA G A Z INE | s ep t e m b er 2013

majority of European countries, for example, have firearm-related mortality rates less than 1/10th of ours, and none has rates half as great.

I understand that many responsible people wish to keep firearms for self-defense or for sport, such as hunting. In my opinion, the rights of such persons are not infringed upon by sensible regulations designed to prevent the misuse of firearms and reduce the number of deaths and injuries caused by them. I am proud that established California Medical Association policies support the ability of California cities to regulate commerce in firearms (e.g., gun shows), support a requirement for completion of a firearms safety course before purchasing, owning or using firearms, and support a ban on private ownership of semiautomatic weapons with large magazines. CMA lobbyists have taken “support” positions on bills in the Legislature that, when passed, implement these policy positions.

CMA policy also holds that physicians, in appropriate circumstances, should educate patients about the risks of guns in the home.

In addition to using “commonsense” measures to address this public health problem, it is also important to employ a scientific public health approach in which studies of the epidemiology of firearms injuries, and trials of interventions based on the results of such studies will be undertaken.

Unfortunately no such studies have been done in the past several years because the United States Congress has essentially forbidden federal granting agencies to fund them. However, there appears to be, at long last, a change coming. In January 2013, President Obama issued 23 executive orders directing federal agencies to improve knowledge of the causes of firearm violence, the interventions that might prevent it, and strategies to minimize its public health burden. In response, the Centers for Disease Control asked the Institute of Medicine and the National Research Council to develop a research agenda to focus on the public health aspects of firearm-related violence. That report was released on June 5. We can hope that over the next several years research-based, effective interventions to reduce firearm-related violence will be discovered and implemented.

In the meantime, we physicians will continue to treat victims of gun violence, counsel our patients about the dangers posed by firearms and advise those who own guns to store both guns and ammunition under lock and key, preferably in separate locked receptacles, particularly if there are children in the home, and advocate for commonsense measures to minimize firearm injuries.

Marshall Morgan, MD, is a professor and chief of emergency medicine at the Ronald Reagan UCLA Medical Center and director of the 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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Implementing EMR in Your Practice by lisa thomsen, md

As a so lo family physician in California, I have always believed that if you practice good medicine,

the patients will come, and you will be successful in your endeavors. With all the technological advances in medicine, one must be a stellar physician as well as a bit of a technology geek. Today, physicians and their staff must learn to embrace and master the technological tools that are essential to modern medicine and crucial to the survival of their practice.

One of the most frequently used and vital tools in most practices that physicians and their office staff need to master is the electronic medical records (EMR) system. There are certain facts you should know prior to implementing a system in your medical office.

Select a system that works best with your technological talents and limitations.

I activated an existing office EMR in 2011, and this was quite painless as the system was set up by the vendor and the IT support was well-known and responsive to the office. In fact, this vendor was proactive in the Medicare incentive programs, including Meaningful Use, and was interface-ready with other systems.

I chose a gradual transition, which allowed minimal interruption to patient flow and billing.

Know the system and any restrictions, and learn a work-around: electing a gradational transition had its pros and cons. This approach allowed the staff at my practice to address and fix “electronic issues” as they

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arose, without seriously affecting productivity. But, we also discovered that this EMR software and the other vendors that were evaluated had a challenging flaw that we needed to address. We had to master an issue regarding the ability to allow multitasking in real time.

Train your office staff to be the best geeks: Every office event requires electronic availability.

Therefore, training your office staff to contact the EMR vendor’s IT department to explore the system’s capabilities and troubleshoot problems will allow you and your practice to function more efficiently.

Educate your office staff to know the cyber risks and how to avoid them: The benefits of EMRs are well publicized, but physicians must also be well informed of the multiple risks and how to avoid them. Excellent medical documentation has always been a major part of a physician’s work, but with the advent of EMRs come new challenges. A new liability emerges with the introduction of EMR involving computer inexperience, misunderstood sign-lock functions, metadata that is never lost, and countless other pitfalls all occurring at cyber speed. And, physicians must be hyperaware of protecting patient data against the barrage of unforeseen events ranging from lost passwords to stolen mobile devices, unencrypted laptops, and collaboration with outside entities’ cyber issues. Physicians must take the time to educate and inform themselves as well as their staff about these electronic issues that come with the benefits of EMRs. The bottom line is know thyself, thy practice and thy medical office staff when selecting and implementing one’s EMR. It is a brave new technologically savvy world, but with the right knowledge and determination, your practice will thrive.

Lisa Thomsen, MD, FAAFP, a Cooperative of American Physicians, Inc. (CAP) member since 2003, and CAP board member since 2011.

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l i f esty l e & welln es s | BA LA NCE

The Medical Marriage

by Liz Ferron, MSW, LICSW, Senior Consultant and Manager of Clinical Services, Physician Wellness Services

Accor ding to a 2 010 survey by the American College of Surgeons, surgeons with other phy-

sicians as their domestic partners experience greater challenges balancing personal and professional life than surgeons whose domestic partner is working outside medicine or stays at home.

Surgeons with non-working domestic partners tended to be older and appeared most satisfied with their careers.

Surgeons whose domestic partners were physicians tended to be younger, newer to practice, were more likely to delay having children and: • Were more likely to believe that child rearing had slowed their career advancement.

• Were less likely to believe that they had enough time for their personal and family life compared with their colleagues who had non-working or non-physician domestic partners.

• More often experienced a recent career conflict with their domestic partner and a work/home conflict than surgeons whose domestic partners either didn’t work outside the home or were employed, but not as physicians.

All relationships take work and commitment—so do medical careers. Ultimately, it’s how individual physicians balance and prioritize their work and life challenges that ultimately dictates their satisfaction with their lives and careers, regardless of whether or not their partners or spouses are also physicians or other healthcare providers.

Healing a Fractured Relationship: Practical Solutions for Physicians

If you’re in a relationship damaged by the demands of your career or your spouse’s or partner’s inability to

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accept the demands of your career, chances are you won’t repair it overnight—but you can get the process started today.

Start Talking: Ask for what you need and ask your spouse or partner what he or she needs to make the relationship healthier and happier.

Make Life Balance a Priority: Put improving your relationship on your agenda. Don’t expect it to “happen naturally”—make time for it, and give it the effort and attention it deserves.

Act Affectionately: A good exercise is for you and your spouse or partner to resolve to remember three things you like about each other and find a quick way of showing it each day—a compliment at breakfast, a text message from work, a chocolate from the gift shop to take home.

Get Healthy: If you’re constantly tired and cranky, chances are it’s not your partner’s fault. Take the same advice you give your patients about eating and sleeping well, getting daily exercise and reducing stress.

Support your spouse or partner in their stress management efforts whenever possible.

Share Your Frustrations: Start telling each other about your days. Respect your partner’s frustrations and stresses as you would have your spouse respect yours.

It’s not a competition to see who had the worst day.

Lower Expectations: The phrase “That doesn’t work for me” is underutilized by medical professionals. A physician’s spouse or partner has no control over the physician’s agenda, but the physician does.

Unless someone’s life is literally on the line, the physician has a right and responsibility to carve out time for self-care and family life.

Disconnect and Reconnect: Unless you’re on call, turn off your phone and computer and have at least an hour a day where work can’t reach you and you can either relax alone or in the company of your loved ones.

Try Couples Counseling: When resentments have built up over years, it can be very difficult to initiate constructive conversations without first establishing some ground rules. An objective counselor can make the process less stressful.

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ca reer M ANAGE M ENT | tr a n s i t i on s

Adapting to New Technologies by marion webb

Th e t e ch n o lo gy ta k e - ov e r has begun and physicians are slowly acclimating to the

new rapidly evolving healthcare environment where using electronic health systems, e-prescriptions and their smartphones will become the norm. To help doctors adapt to this new environment, the experts recommend taking the following key steps.

1. Build Your Office Team

To successfully integrate new technologies into the doctor’s office requires that all staff members fully understand why the technology is being integrated, how the process will unfold, what challenges to expect and what their roles will be.

The experts recommend using a formal problem-solving approach such as a Plan Do Check Act to ensure its success.

Most practices, with new technologies in place, will reap the results of better marketing communication, higher efficiencies and more accurate record keeping.

2. Plan for Integrating the Technology

The plan should include collecting baseline data for the measures of success that it has identified, such as how the technology will increase productivity and patient safety.

The American Medical Association said it would do so, but the experts recommend that each site should go beyond the research reports and measure its own success in implementation. Physicians should also measure patient and customer satisfaction and how electronic health records affect both.

3. Provide an Environment that Accommodates Trial and Error

For some physicians, especially those who have practiced for a long time and aren’t technology savvy, adapting to the new environment will be challenging. Experts foresee that it will take a lot of work and dedication to integrate technologies into a daily routine. By offering doctors room to grow and fostering career opportunities, medical practices can attract and retain loyal, productive and innovative physicians.

4. Provide Support Services and Training

Physicians should provide training for their staff and provide a comfortable environment where staff members can get used to the new environment, adapt to the workload and work on a preferred schedule.

With two out of three physicians foreseeing that the integration of EHR will be challenging, according to national statistics, having a game plan will help ease some of the growing pains.

Experts expect that in time most practices, with new technologies in place, will reap the results of better marketing communication, higher efficiencies and more accurate record keeping.

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phy s i c i an s n ew s n et wo r k . co m | NEWS i n r ev i ew

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The LOS ANGELES County Medical Association PNN | LOCAL • TIMELY • RELEVANT

reporting on the economics of healthcare delivery most read

LACMA, CMA Disagree with CAPG and AARP; Praise Defeat of Controversial Bill On Aug. 6, the California Medical Association, LACMA and other physician groups nationwide won a victory when California lawmakers defeated a bill that sought to increase the scope of practice for nurse practitioners.

Backers of the bill, however, such as the California Association of Physician Groups (CAPG), AARP and the California Primary Care Association, are hopeful that the bill will be reconsidered.

LA Company Offers Virtual CMO Opportunities The Institute for Medical Leadership, based in LA County, recently launched a nationwide program that places virtual chief medical officers into smaller hospitals and accepts applications from local doctors who are interested in becoming virtual CMOs. Dr. Susan Reynolds, president and CEO of Pacific Palisades-based Institute for Medical Leadership, a company that specializes in consulting services for health providers, said that unlike larger hospitals, smaller ones often don’t have the resources to hire a full-time physician executive. editor’s pick

CMS Outlines Plans to Resolve Overpayments for Incarcerated Beneficiaries The Centers for Medicare and Medicaid Services (CMS) recently outlined in an email to PNN how it plans to address improper recoupment of payments for claims of services provided to incarcerated beneficiaries. CMS said that the resolution of claims that were filed by doctors who provided medical services to incarcerated beneficiaries will “require a series of complex actions, including the restoration of the original data on the Medicare Enrollment Data Base, the identification of the overpayments that will need to be abated and refunded, and the creation of claims processing system utilities to effectuate the necessary changes.”

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CMA Files Amicus Brief on Behalf of Centinela Physicians The California Medical Association announced on July 15 it filed an amicus brief in the California Court of Appeal in Centinela Freeman Emergency Medical Association vs. Health Net on behalf of numerous healthcare providers that weren’t paid after La Vida Independent Practice Association (IPA) went bankrupt.

‘Herculean Effort’ Moves SGR Reform Legislation Forward The U.S. House Energy and Commerce Committee recently approved legislation to appeal and replace the Medicare Sustainable Growth Rate (SGR) physician payment formula, a move the California Medical Association called a “herculean effort.” The approval is also the first hurdle cleared to achieve locality reform.

“CMA is pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment loyalties,” CMA said in a press release. At the same time, CMA cautions doctors that they still have a long way to go to achieve permanent reform.

AHA Summit Introduces New Perspective “Constant change is the new norm” was the message from every presenter at the American Hospitals Association (AHA) Summit in San Diego recently, giving physicians an idea of things to come as the Affordable Care Act rolls out. Donald Crane, CEO of the California Association of Physician Groups (CAPG), who attended the summit, told PNN that he was amazed at the content presented this year. “If you look at the titles of the sessions: ‘Innovations in Managing the Health of Populations,’ ‘Succeeding in the Business of Accountable Care,’ ‘Transition from Volume to Value,’ ‘Physician Comanagement’—all are tracks about managed care,” said Crane. “They are all part of the same business model. It is all about managed care.”

Pharmaceutical Content in EHRs Will Benefit Outcomes, Costs The top official at healthcare company Mitochon Systems Inc., which recently exited its free electronic health record system business and switched focus to providing pharmaceuticaldriven content for EHR vendors, told PNN its aggregated content can help doctors improve outcomes and reduce costs. Chris Riley, president and CEO of Laguna Niguel-based Mitochon Systems, said the rising numbers of free EHR solutions has created pressure on EHR vendors to introduce services doctors can use to run their own practices more efficiently while sharing information with patients, a requirement under meaningful use.

Independents Eye UCLA’s Plans for Clinically Integrated Option After years of strategic planning to prepare for health reform changes, the University of California, Los Angeles Health System is now in the planning stages of developing a clinically integrated provider network option. Dr. Patricia Kapur, executive VP of UCLA Health System and CEO of UCLA Faculty Practice Group, said that independent doctors in Los Angeles County have expressed interest in affiliating with UCLA without having to give up their own practices, and she expects that such a clinical integration will be happening soon.

LA Employers Saying No to Pricey Research Hospitals and Insurance Plans A new study shows that more Los Angeles employers, in an effort to trim costs, are avoiding high-priced academic and research institutions to provide health coverage for their employees.

reporting on the technology of healthcare delivery

Read Full Stories and Subscribe to the PNN eNews Bulletins at www.PhysiciansNewsNetwork.com/iPNN

EPGL Medical Invents Self-Powered Contact Lenses Irvine-based EPGL Medical announced that its engineers have invented the world’s first self-powered, self-contained, power source for contact lenses.

“Using cutting-edge technology, EPGL has invented a self-perpetuating power source for lenses which does not require external energy such as RF,” said David Markus, PhD.

LA County Team Is mHealth X Challenge Finalist A Los Angeles Countybased company is among 12 finalists of the Nokia Sensing X Challenge who will be moving on to the final round of a competition focusing on breakthrough mobile health technologies that are poised to change the way doctors practice medicine.

On Aug. 6, a panel of experts announced the names of the finalists including Los Angeles-based Holomic, which creates photonics-based technologies for mobile health applications

iPhone Device Detects Heart Rhythm Problem Special iPhone case and app can be used to quickly and cheaply detect heart rhythm problems and prevent strokes, according to University of Sydney research.

The research found the AliveCor Heart Monitor for iPhone (iECG) was a highly-effective, accurate and cost-effective way to screen patients to identify previously undiagnosed atrial fibrillation (AF) and hence help prevent strokes.

Read Full Stories at PhysiciansNewsNetwork.com

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n ews i n r ev i ew | phy s i c i an s n ew s n et wo r k . co m

Ruling May Prompt Insurers to Ban Arbitration Option The U.S. Supreme Court’s ruling that doctors’ payment disputes can be arbitrated as a group for cases in which contracts are silent on this issue may be welcome news for doctors who want to challenge underpayments by insurers, as PNN reported in a story last month. But some legal experts and health leaders believe the decision could prompt insurers to limit dispute resolution options, such as class arbitration, during contract negotiations with physicians.

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Healthcare IT EHRs • mHealth • The Cloud

What’s Next

By Marion Webb

These days, doctors are bombarded with talk about EHR implementation, mobile IT, remote device monitoring and cloud-based computing.

But many doctors may be asking themselves what all these data and all these new technologies will mean and how can they benefit their own practices.

The good news is that these technologies will transform the way doctors practice and communicate with patients and other healthcare providers. They are also expected to provide benefits ranging from payers’ incentives and shared savings to helping doctors run a more efficient practice.

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EHRs

By 2015, all doctors are required to use electronic health records (EHRs) or face penalties. Health experts have long said that the patient data generated by EHRs used by insurance companies, researchers and large health systems will provide better managed care for patients, increase efficiencies and cut waste.

How to Make EHRs Work for You Most providers are still focused on implementing EHRs with some doctors who already have a system in place, collecting and reporting certain data to meet requirements of the meaningful use incentive program.

In this article you’ll find expert advice on how to use EHRs to identify improvements on the business side and how you may be able to seize opportunities to participate in new payment models.

To identify what data to use and to analyze it is a three-step process: you want to identify goals, measure accomplishments and change operations, said Bill O’Byrne said in recent published reports. O’Byrne is executive director of the New Jersey Health Information Technology Extension Center, the state’s regional center, a frontrunner in helping practices understand patient data.

Identify Goals Identifying goals is critical. “Even small practices need medical records that are readable, accessible and up-to-date,” said Laura Jacobs, executive VP of the Camden Group, a Los Angeles-based healthcare consulting group.

EHRs can help doctors track whether patients have received preventive care or need it, identify patients who are at risk for diseases, and identify which patients need to come in for follow-up visits.

As physicians start to manage their practices in a data-driven world, preventive care and chronic care management are good places to start, the experts said.

“The first use of EHRs is the ability to do some population health management using registry of patients where doctors can reach out to patients and provide care and use the data to help patients,” said Sajid Ahmed, Chief Information and Innovation Officer at Martin Luther King Jr. Hospital.

“Now you know how many patients need a flu shot or a mammogram and so forth.”

To get this process started, O’Byrne advised creating a full practice profile.

The profile could include lists of patients with certain chronic conditions and a count of how many patients are being treated for the condition or need intervention and lists of patients within certain age and gender demographics to see how many of them have received preventive services.

When the profile is done, doctors and their staff can hone in on specific diseases or patient populations and try to identify measurements that need improvement.

Physicians can also use the meaningful use program as a guide. While Stage 2 of the meaningful use program has 64 measures that physicians can track, the experts advise focusing on specific ones to create a baseline report as a starting point, and then set goals with specific targets.

One example would be to track diabetics who are struggling to keep A1c levels under control. If reducing A1c levels becomes a goal, then the practice may decide what percentage of patients they target and in what time frame they hope to achieve that goal.

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Measure Accomplishments Before EHRs, measuring progress was limited to data collected through claims data, the expert noted. With EHRs doctors can get a snapshot of specific dates and times.

Most experts believe that it will take doctors some time to learn how to analyze data and measure success. By creating checkpoints, they can see successes along the way.

For instance, if a practice wants to increase the number of colorectal cancer screenings, they could use the EHR to identify patients based on age who should have a colorectal cancer screening done but have not yet come into the office.

The office could then send a postcard to remind patients to get their screening done. Having data of patients who came in and actually had a polyps removed isn’t only potentially life-saving for patients, but could also translate into financial rewards for doctors from payers.

Much of the data can be used to measure not only productivity and rate of follow-up care, but also waste and redundant care, which will be key for doctors planning to participate in sharedsavings models.

Change Operations Certainly, uncovering the data and acting upon it is likely to change the way doctors are running their daily practices.

Some doctors already use EHR data to re-create the way they handle appointments.

One option is to use a problem data list to assign a level of acuity to each patient with level 1 being assigned to healthy patients, who come in for general appointments, and thus, would rank low on the priority list of same-day appointments; level 2 patients could be those with chronic illnesses who are given priority when they call in with symptoms and complaints; and level 3 would be patients with severe illnesses who need the most attention.

The data could also be used to identify business opportunities or additional services, such as the need to hire a dietician. It can also lead physicians toward participation in ACOs, O’Byrne said, adding that he notices that practices are discovering new ways to use data every day.

Challenges Ahmed, however, noted that many answers remain unclear.

“I believe we won’t have real data until we enter into Stage 3 of the meaningful use requirement,” he said.

Return of investment is also unclear. According to a recent survey using data from 49 community practices in a large EHR pilot (the Massachusetts eHealth Collaborative) to project fiveyear returns on investment, the average physician would lose $43,743 over five years with 27% of practices achieving a positive return on investment and 14% coming out ahead had they received $44,000 in federal meaningful-use incentives.

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mHealth

With the implementation of EHRs, researchers predict that integrated mobile applications will also see tremendous demand by doctors, especially smartphone users. Global market revenue for mobile health technology is predicted to reach $26 billion by 2017, according to a report from Berlin-based market research firm research2guidance.

According to the report, published March 8, the market for mobile health tools is growing in three phases: the initial trial phase, a commercialization phase (which is the current phase) and integration phase.

Many tools are already commercialized with 15% of mHealth applications on the market being intended for use by healthcare professionals, including continuing medical education, remote monitoring and healthcare management applications, according to the report.

Another survey published in May by the research firm Black Book Ratings also found that while 89% of primary care and internal medicine doctors currently use their smartphones to communicate with staff and 51% of clinicians use tablets to perform independent medical references and online research, less than 1% estimate they are maximizing their mobile clinical and business applications.

One of the big challenges remaining for vendors is how to better integrate mHealth applications into EHRs. The majority (95%) of doctors who used mHealth apps complained that the iPhone/Android screen size was too small; 88% had trouble with the ease of movement within the chart; 83% said they were concerned about replicating their EHR system on a mobile device, preferring simplified versions; and 77% didn’t like the non-optimized touch screens.

“The vast majority of all survey respondents favored mobile applications that focus on the patient data and core parts of medical practice most needed when a physician is away from the office setting,” said Doug Brown, managing partner of Black Box Research, in a company statement.

Doctors said they preferred EHR mobile apps that allowed for remotely reviewing and updating charts, assigning tasks and viewing scheduling and appointments, enabled them to send messages to their staff and the lab allowed for, eprescribing, patient encounter documentation and inputting of vital signs.

The Cloud

While client-servers continue to dominate the market—in 2011, 55% of office-based physicians were using EHRs and 59% were using them as stand-alone systems according to a July 2012 report from the Centers for Disease Control and Prevention—health experts predict that cloud-based products will also soon become more commonplace in doctors’ offices.

“The big trend for this year is the cloud,” said Mary Pat Whaley, owner of Manage MyPractice, a healthcare consulting firm, in recent news reports. “That’s a real game changer, either for physicians going into practice or small practices getting ready to add an EHR.” A recent study by the firm MarketsandMarkets also indicated that the healthcare cloud computing market—currently only 4% of the industry—is expected to grow to nearly $5.4 billion by 2017.

While privacy concerns have kept some doctors from migrating to the cloud, some health experts note that the cloud offers several major benefits, including:

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• Security: With online medical records storage being the main reason for using cloud computing, doctors should know that cloud service providers are now as liable for HIPPA compliance as the healthcare entities they serve. All data must be encrypted, securely backed up, easily recovered and use permission-based data access.

• Scalability: Healthcare service providers generally must keep records for at least six years. Considering the volume of patient data, cloud server or storage solutions are able to adapt to EHR load quickly and store terabytes of your patients’ data in secure, redundant cloud storage.

• Mobility: With cloud solutions being readily available, doctors can review medical records, tests or do research anywhere, anytime.

• Cost: Small practices often don’t have the financial means to invest in on-site hardware infrastructure and maintenance to securely store patient information. The cloud often makes a more sophisticated tool available to doctors who otherwise may not be able to afford it, noted Jacobs.

• Doctors who use the cloud can submit prescriptions and refills electronically to pharmacies and increase the accuracy of reimbursement coding. According to a report in Healthcare Financial Management, saving benefits of EHRs can amount to upwards of $37 million over a five-year period.

• Sharing: Cloud computing solutions keep physicians connected with patients and their colleagues, including specialists who can access patient history from the referrals online and thus, avoid repeat diagnostic testing.

Precautions However, before jumping onto the cloud bandwagon, experts said, doctors should evaluate their purchasing decisions closely, evaluating cost, functionality, convenience, security and applications.

In addition, with cloud computing and infrastructure security continually evolving to meet growing security requirements, legitimate cloud service providers have strict security protocols designed to comply with different regulatory mandates, including SEC, the Sarbanes-Oxley Act and HIPAA, according to Forbes magazine.

Under HIPPA, (Health Insurance Portability and Accountability Act), and the American Recovery and Reinvestment Act, everyone in the healthcare industry is required to migrate patient records and other data to cloud computing.

Still, the experts advise that doctors should verify that their chosen cloud service provider is HIPAA compliant before signing up with the service.

Whether you’ve already implemented an EHR system or are in the process of evaluating systems, the experts said, one thing is for sure: the technology revolution is coming.

“The challenge and opportunity will be to take the data and with the help of analytics turn it into something actionable that doesn’t just describe a particular situation, but also provides information that can predict outcomes and trends,” noted Dr. Henry Johnson, VP and medical director of Midas + Solutions based in Tucson, Ariz. in an recent article.

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THE ACA | WH AT YOU NEED TO KNOW

The Affordable Care Act:

What You Need to Know

By Roy S. Lyons, Managing Director, Marsh

Th e r e i s n o doubt that the ACA is the most transformational change in health insurance since

Medicare. It’s survived a Supreme Court challenge, presidential election and continuing congressional attempts at repeal, modification or defunding (40 attempts at last count). One thing is for certain: while there may be delays in implementing certain parts of the law, it is not going away. You’ll need to know the basics to evaluate how it influences your medical insurance buying decisions. The following will help with your decision making-process that lies ahead. o In 2015: the greater of $325/individual (3 per family), or 2% of income o In 2016: the greater of $695/individual (3 per family), or 2.5% of income • Guaranteed Issue – Insurance companies must sell coverage to everyone, regardless of preexisting conditions, and can’t charge more based on health or gender.

• Health Insurance Exchange – Individuals without access to affordable, employer-sponsored plans that provide qualifying coverage can enroll in plans offered either through the individual insurance market or through Covered California, the state-based exchange, with coverage beginning January 1, 2014. Open Enrollment for Covered California commences on October 1, 2013. If individuals don’t enroll with the exchange during the initial open-enrollment period, they will have to wait until next year’s open-enrollment period to obtain coverage.

Healthcare Reform: The Basics for Individuals

Beginning January 1, 2014, new regulations provide most Americans access to affordable health insurance that covers essential care. The regulations that facilitate this include: • Individual Mandate – Most individuals are required to have and maintain health insurance effective January 1, 2014. There are exceptions for certain individuals.

• Penalty – If you elect not to purchase coverage, you are required to pay a penalty: o in 2014: the greater of $95/individual (3 per family), or 1% of income

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• Subsidies – Individuals and families may qualify for federal tax credits and benefit subsidies only through Covered California. Tax credits are available to those who meet certain income requirements and do not have access to affordable health insurance that meets minimum coverage standards offered through their employer or another government program.

Eligibility for tax credits is based on family income and size. Individuals and families who make between 138% and 400% of the federal poverty level (FPL) may be subsidy eligible. Benefit subsidies will also be available to provide assistance with co-pays and out-of-pocket amounts for individuals who earn less than 250% of the FPL. • Premiums – Premiums can only vary by age,

• Annual or lifetime limits: Not permitted on essential benefits.

• Out-of-pocket expenses: Limits out-of-pocket expenses for co-pays, co-insurance, deductibles, etc., to $6,350 per individual to a maximum of $12,700/family annually.

Options for Coverage

The impact on individuals depends on a variety of factors.

• No coverage in place: Individuals must purchase and maintain qualifying health coverage or instead pay a penalty. If their income is between 138% – 400% of the federal poverty level and they have no other coverage available to them that is affordable and qualifying, they could be eligible for a tax credit in the exchange. In 2013, the range is between $15,860 – $45,960 for individuals and for a family of four between $32,500 and $94,200.

eligible to move to a new plan at possibly lower costs without having to be concerned about underwriting considerations. The individual should look very carefully at the provider networks available under each plan to ensure they are still able to seek care from their personal physician and hospital.

Learn More

Let Marsh be your partner on this new adventure. For more healthcare reform communications, including information on Marsh’s private healthcare exchange for members, please call Marsh at 800-8423761 or go to www.marshhealthoptions.com.

Marsh and the association do not provide tax or legal advice. Please consult with your own advisors to determine how the law’s changes and your decisions impact your personal situation. d/b/a in CA Seabury & Smith Insurance Program Management • CA Ins. Lic. #0633005 • AR Ins. Lic. #245544 1-340 (8/13) ©Seabury & Smith, Inc. 2013 • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance

Individual plans in and out of the exchange will provide guaranteed issue coverage and include essential benefits and plan designs that meet the four metal levels: platinum, gold, silver and bronze. A silver plan is meant to cover 70% of an average person’s expenses with the insured expected to pay 30% for deductibles, co-pays, co-insurance, etc.

• Existing coverage: If you currently have an individual policy in force, one of two things can occur. o If the plan was in place prior to the ACA signing on March 23, 2010, and has not undergone any significant change since, it may be continued. o If an individual’s plan is not grandfathered, and the plan of benefits does not meet one of the tiered metal levels, the benefits will be modified.

This will likely have an impact on plan premiums as well.

Individuals trapped in old, high-priced plans due to health conditions are now

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WHAT YOU NEED TO KNOW | THE ACA

geography, and family composition in California.

They may not vary by gender or health conditions.

at wo r k fo r you | uni t ed we stand

IMPORTANT REMINDER

The Medicare Transition CMA STAFF

S e pt e mb e r 16 , 2 013, is the cutover date for transition of the Medicare Part B fee-for-service contrac-

tor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after transition, physician practices will have to make some changes in their processes, including but not limited to:

Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after transition, physician practices will have to make some changes in their processes

1. Electronic claim submitters must change the Contractor ID (Payor ID) on their transmissions. The new ID for Northern California jurisdiction is 01112, and for the Southern California jurisdiction it is 01182. Please note, the change to the Contractor ID should not be made before September 12 for Part B claims.

2. Paper claim submitters will submit claims to a new address. These will be announced in upcoming articles and in CMA Medicare Transition Guide.

3. There will be a new toll-free telephone number, (855) 609-9960, for all telephone inquiries to Noridian (this number will not be activated until September 16, 2013).

Practices are encouraged to review the resources available regarding the transition: • CMA’s Medicare Transition webpage – CMA has created a dedicated Medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the ability to access updates and important information regarding the transition in one easyto-access location. All resources related to the Medicare transition will be accessible through this page.

• CMA’s Medicare Transition Guide: What physicians need to know – This guide, which members can download free from the CMA website, includes an FAQ that contains information on the transition dates, what will remain the same with the transition and what will change, Noridian’s online provider portal, what practices can do to prepare for the transition, and links to additional resources and ways to stay apprised of new information on the transition.

• Noridian’s transition website: The Noridian transition website includes information on what’s new/changing and what will remain the same during and after the transition.

• CMA Practice Resources – CMA Practice Resources (CPR) is a free monthly newsletter from CMA’s practice management experts that focuses on critical payor and healthcare industry issues, including the Medicare transition, and how these issues directly impact the business of a physician practice. To sign up, visit the CMA website or contact CMA Member Services at (800) 786-4262 or memberservice@cmanet.org.

• Content alert updates – The CMA website allows registered users to create custom content alerts on the topics that are of interest to you. Once signed up, you will be notified anytime there is new content posted in one of your interested areas, including Medicare issues. To sign up, users should visit their account dashboard on the CMA website and click on “my alerts,” then under “New Content Alerts,” click on the “Alert Settings” tab, and select “Insurance Reimbursement -> Medicare.”

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The Coding Corner:

The Top Five Essential Tips for Successful Appeals How you present appeals to your carrier can make a difference between success and failure. Here are the top five tips to achieve success.

5. Be prepared Anyone speaking with the carrier regarding an appeal – whether coder, biller, office manager or physician – should have the knowledge and specific information necessary to discuss that appeal in full. The caller should be able to review the operative note with the payer, to explain the rationale for the coding/billing and to demonstrate why the claim should have been treated differently.

4. Write a proper appeal letter Don’t just send an explanation of benefits (EOB) with a balance bill. The payer shouldn’t have to guess the problem. Instead, you should spell out for the payer exactly what you wish them to review (such as fees, coding denials, etc.). You’ll have to spend a few extra minutes to put your request in writing, but it can make a big difference.

3. Correct the claim before you appeal If the original claim was incor-

rect, appealing with the same claim will not change your results. Double-check the claim’s EOB, CPT® coding, diagnoses and documentation to be sure it is correct. Be absolutely certain you are applying modifiers appropriately. Adding modifiers (e.g., modifier 59 Distinct procedural service) to a claim does not guarantee payment, and may lead to accusations of fraud or abuse.

When you’ve finished reviewing the claim, make the necessary changes and/ or documentation addenda before resubmitting.

2. Code only what documentation supportS If you are billing a surgery, review the body of the operative note to be sure that all the procedures reported actually were performed. A common mistake is to code from the “list of procedures performed” at the beginning of the operative note. As payers and auditors know, these lists often do not accurately reflect what occurred in the operating room. A careful reading of the operative note might even reveal separately reportable procedures that would have been missed if relying only on the note summary.

Similarly, coders shouldn’t rely on a physician’s recommended coding, but should instead review the documentation to be sure they are reporting the correct codes. If necessary, the physician should be prepared to amend the record to better reflect the nature of the service and/or the patient’s condition.

1. Avoid obvious mistakes Payers will tell you (and audits confirm) that a

staggering number of denials are the result of obvious errors, such as missed timely filing deadlines; illegible claims; claims not properly filled out (e.g., incorrect patient identifier info); failure to obtain pre-authorization; and wrong, insufficient or non-existent documentation. These errors can be avoided easily by double-checking claims prior to submission. It’s worth the time: You’ll receive payment quicker, and the payer does not have to process a denial EOB for an avoidable error. It’s a win/win.

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For more coding tips, visit CMA’s resource library at www.cmanet.org/resource-library and search “Coding Corner.”

“Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of healthcare.

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uni t ed we stan d | at wo r k fo r yo u

WE TREAT DOCTORS RIGHT!

at wo r k fo r you | uni t ed we stand

PAYeR UPDATES

Aetna unable to locate contracts for some SoCAL providers CMA has learned that over the next year, Aetna will be reaching out to 1,200 Southern California physicians requesting verification of their executed PPO contracts. Aetna indicates that while its records show that these physicians are participating providers, the plan has been unable to locate a written contract. As a result, Aetna will be making initial outreach by phone to approximately 100 physicians each month to request that physicians provide copies of their contracts with Aetna.

If a physician is unable to provide a copy of the contract, Aetna will mail a follow-up notification letter and current 2013 contract to the physician. Physicians will have 30 days to consider whether they wish to sign the new agreement.

Physicians who choose to sign the new agreement should be aware that the contract includes participation in the Aetna PPO and Medicare Advantage products. Aetna has advised that physicians who wish to opt out of the Medicare Advantage product have the ability to do so.

For those physicians who choose not to sign the new agreement, the notice will serve as a 90-day notice of termination from the Aetna network.

Physicians with questions are urged to contact Aetna Network Management at (818) 9326270 or SoCalNM@aetna.com for assistance.

Anthem Blue Cross notifies nearly 1,000 practices of intent to terminate Medicare Advantage PPO contracts On July 25, Anthem Blue Cross notified 973 practices advising of its intent to terminate the practices’ Medicare Advantage PPO contract.

According to the notice, Blue Cross has decided to narrow this network of providers and is exercising its right to terminate the agreement without cause, per the terms of the contract.

Two different notices were issued to practices.

The first went to 881 practices who, according to Blue Cross, had a low volume of claims billed to Blue Cross. The other went to 92 practices who, Blue Cross reports, had a higher cost of care relative to other network providers.

The termination becomes effective on January 31, 2014. Physicians whose contracts are terminated can, however, continue to see Blue Cross Medicare Advantage patients on an out-of-network basis and be reimbursed by Blue Cross at Medicare rates. Physicians are reminded that out-of-network services typically result in higher out-of-pocket costs for patients. Practices are encouraged to discuss their network status with patients in advance.

Practices who wish to appeal the termination may do so by sending written notice and supporting documentation to: Anthem Blue Cross, P.O. Box 292187, Nashville, TN 37229.

Questions can be directed to Blue Cross Network Relations at (855) 238-0095 or networkrelations@wellpoint.com.

Anthem Blue Cross announces changes to reimbursement policies and claims software

In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013.

Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated.

Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies.

Changes include: denial of 3D rendering CPT codes 76376 and 76377; assistant surgeon and co-surgeon codes eligible for payment; qualitative drug screen codes eligible for payment; frequency edits on certain codes; denials on invalid match of diagnosis and procedure code; several 2 4 PHYSICIAN MA G A Z INE | s ep t e m b er 2013

changes pertaining to durable medical equipment frequency and rental; and denials of attended sleep studies billed with place of service of 21 (home), among others.

Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies and reimbursement rates to understand how the changes will affect their individual practices.

Physicians can also access the information in the mailer via the Blue Cross website. (Select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section.)

Questions about any of the claims editing rules or payment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.

UNITED: United Healthcare Military & Veterans (UMVS) will be hosting a series of educational webcasts about TRICARE topics for the provider community through the month of October. Each webcast will include an introduction to TRICARE as well as information regarding referrals and authorizations, claims, provider resources and important contact information. Each session will last approximately 90 minutes. Practices wishing to register should visit www.unitedhealthcareonline.com or contact their United Healthcare Physician Advocate.

ANTHEM BLUE CROSS: Blue Cross has announced that effective October 1, 2013, the following clinical guidelines and medical policies will require prior authorization/precertification review for the following services: • Microprocessor Controlled Lower Limb Prosthesis (New code added to the existing Medical Policy – L5859) • Wheeled Mobility Devices Wheelchairs-Powered Motorized, With or Without Power Seating Systems and Power Operated Vehicles (POVs) (New code added to the existing Clinical Guideline – K0013) For more information, see the July 2013 Professional Network Update on the Blue Cross website at www. anthem.com/ca.

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uni t ed we stan d | at wo r k fo r yo u

BLUE SHIELD: Blue Shield announced updates to its drug formulary effective June 20, 2013, to include the addition of Brilinta, Effient and Lialda. Being removed is Asacol HD. For more information visit the Blue Shield website. Blue Shield also announced changes to some medication coverage policies for office-based drugs covered in the medical benefit. Changes are effective June 20, 2013, and include policy changes to Avastin, Cimzia, Humira and Rituxan, among others.

a s s oc i at i on ha ppeni ngs | lacm a new s

ceo’s letter

W ith th e i mple m e n tati o n of the Affordable Care Act getting closer, LACMA will keep a very close eye on new developments and continue to fight for doctors’ and patients’ rights.

The implementation of the hastily and ill-conceived Cal MediConnect Demonstration Project in Los Angeles County raises fundamental concerns.

LACMA and its new partner, the Los Angeles County Podiatric Medical Society, recently created a task force dedicated to persuading federal and health officials to cancel the ill-founded pilot program.

In a recent letter to Ms. Jane Ogle, the Deputy Director of Health Care Delivery Systems at the Department of Health Care Services, we outlined the most pressing issues below.

Nine months is simply not enough time to implement a pilot program comprising 200,000 patients in one county. We also proposed downsizing the project to a specific zip code in Los Angeles County, and monitoring and assessing the results, rather than trying to encompass the entire LA County of 4,084 square miles.

We also noted a quality issue. To date, there exists no proof that either LA Care or HealthNet—which have been chosen to manage the two private health plans for dual eligible enrollees—has the necessary expertise, staff and financial resources to properly provide an education campaign.

We have asked for a response to these concerns, which we will share with LACMA members as soon as they become available.

Next month will be critical as it marks the initial open-enrollment period for the new exchanges.

While it’s too soon to predict how its design will impact doctors and medical care, many doctors are anticipating more crowded waiting rooms.

Doctors in Los Angeles County are nervous for good reason.

With an expected 500,000 to 700,000 newly insured in Los Angeles County and the longstanding physician shortage, this is a sure recipe for difficult times ahead.

The exchange implementation is also uncertain.

We believe that more resources are needed to promote community outreach and to better communicate to our physician providers and patients how the exchange implementation will affect them.

Finally, LACMA will continue its fight to preserve MICRA. As California’s trial lawyers are working on gathering the required 500,000 signatures to place the measure to repeal MICRA before voters in November 2014, we will continue our efforts to defeat them by uniting physicians across the state.

Summer may be coming to an end, but for LACMA doctors, many critical issues will be heating up. We will be sure to follow all developments closely and keep members informed.

Rocky Delgadillo

Rocky Delgadillo Chief Executive Officer

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Governor Edmund G. Brown Jr. has announced the appointment of LACMA board member Howard R. Krauss, MD, to the California Medical Board. Krauss has been director of neurosurgical ophthalmology at Saint John’s Brain Tumor Center since 2007, director of ophthalmology for Pacific Eye and Ear since 2002 and an ophthalmologist in private practice and clinical professor of ophthalmology and neurosurgery at the University of California, Los Angeles David Geffen School of Medicine, since 1984. He was an assistant professor at the University of Texas from 1982 to 1984 and a systems engineer at Hughes Aircraft Company from 1972 to 1974. Krauss is an American Board of Ophthalmology diplomat and founding member of the North American Skull Base Society. He earned a Doctor of Medicine degree from New York Medical College and a Master of Science degree in aeronautics and astronautics from the Massachusetts Institute of Technology. This position requires Senate confirmation. Congratulations, Dr. Krauss!

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LACMA NEWS | A SS OCIATI ON H A PPE NI NGS

LACMA’s Howard Krauss, MD, Appointed to California Medical Board

LACMA NOW GUARANTEES SAVINGS LACMA NOW GUARANTEES SAVINGS Preferred PreferredPartner PartnerProgram Program

The Preferred Partner program marks LACMA’s first-ever initiative designed to provide exclusive The on Preferred Partner programthat marks LACMA’sinfirst-ever initiativerely designed to provide exclusive discounts products and services physicians private practice on to run a successful and discounts on products and services that physicians in private practice rely on to run a successful and sustainable business. sustainable business.

Clinic Supply Program Clinic Supply Program

Medline manufactures andand distributes more than 350,000 medical Medline manufactures distributes more than 350,000 medicaland andsurgical surgicalproducts productstotohealth healthcare care institutions andand retail markets.

Medline’s market advantage ranks institutions retail markets.

Medline’s market advantage ranks#1#1across acrosshealthcare healthcarecategories, categories,including including exam gloves, OROR kits,kits, andand textiles. exam gloves, textiles.

Members areare guaranteed a minimum savings ofof10%, Members guaranteed a minimum savings 10%,and andup uptoto47% 47%on onclinical clinicalsupplies. supplies.

Insurance InsuranceServices Services As the world leader in delivering riskrisk and insurance services and As the world leader in delivering and insurance services andsolutions solutionstotoitsitsclients, clients,Marsh Marshdesigns, designs, develops, andand implements insurance plans available only to to members develops, implements insurance plans available only members– –with withdiscounted discountedpricing, pricing,enhanced enhancedcoverage coverage or or both. both.

Marsh assists members andand their office managers byby providing information, Marsh assists members their office managers providing information,programs, programs,and andguidance guidancetotoassist assistwith with insurance insurance buying decisions. buying decisions.

Secure Textingfor forHealthcare Healthcare Secure Texting TigerText is the leader in secure real-time messaging healthcare.TigerText TigerTextallows allowshealthcare healthcareproviders providers to to TigerText is the leader in secure real-time messaging forfor healthcare. create a private and secure mobile messaging network with their own smartphone.

This controlled create a private and secure mobile messaging network with their own smartphone. This controlled platform is HIPAA compliant replaces unsecured SMStext textmessage messagethat thatleaves leavesprotected protectedhealth health platform is HIPAA compliant andand replaces thethe unsecured SMS information other confidential data risk. information andand other confidential data at at risk.

Members receive a free subscription the TigerTextapplication applicationon ontheir theirmobile mobiledevice. device.

Members receive a free subscription toto the TigerText

Shipping Shipping

UPS is the world's largest package delivery company and a leading global provider of specialized transportation UPS is the world's largest package delivery company and a leading global provider of specialized transportation and logistics services. and logistics services.

Members can save up to 37% on shipping through UPS. Members can save up to 37% on shipping through UPS.

Prescription Savings For Patients Prescription Savings For Patients

GoodRx works to save your patients up to 80% on their prescriptions. Every time your patient uses GoodRx, they GoodRx works to save your patients to 80% Medical on their School prescriptions.

Every &time uses GoodRx, they donate a portion of the revenue toup LACMA’s scholarships loanyour debtpatient relief program to increase donate a portion the revenue to LACMA’s School scholarships & loan debt relief program to increase the number of of physicians serving patients inMedical Los Angeles. the number of physicians serving patients in Los Angeles.

The Preferred Partner Program consists of carefully vetted, industry leading vendors who share LACMA’s goal to advocate The Preferred Partner Program consists vetted, vendors whoofshare LACMA’s goal to advocate quality health careof forcarefully all patients and industry serve theleading professional needs its members. quality health care for all patients and serve the professional needs of its members.

TO ACCESS THESE SERVICES, PLEASE VISIT WWW.LACMANET.ORG TO ACCESS THESE SERVICES, PLEASE VISIT WWW.LACMANET.ORG 2 8 PHYSICIAN MA G A Z INE | s ep t e m b er 2013

LACMA NEWS | A SS OCIATI ON H A PPE NI NGS

MICRA PROTECTION

MICRA SAVES LA COUNTY PHYSICIANS AN AVERAGE OF $87,000 ANNUALLY

Trial Lawyers have begun their assault on MICRA, a statute enacted by the California Legislature in 1975 intended to lower medical malpractice liability insurance premiums for healthcare providers by decreasing their potential tort liability. If they are successful, malpractice insurance rates will quadruple.

Your membership ensures our victory against the self-serving trial lawyers trying to generate more in legal fees.

PRACTICE MANAGEMENT SERVICES LACMA AND CMA STAFF MEMBERS HELPED MEMBER PHYSICIANS RECOUP OVER $7 MILLION IN UNPAID/UNDERPAID CLAIMS SINCE 2010

How much could you be saving? Receive access to free Reimbursement Assistance, Jury Duty Assistance, Medical-Legal Resources, and E.H.R./H.I.T. support for your practice.

SAVINGS AND DISCOUNTS REALIZE $1,000s IN SAVINGS WITH LACMA’S NEW PREFERRED PARTNER PROGRAM

Offering you a guaranteed 10% and up to 30% to 40% savings on key purchases from surgical gloves and medical supplies to insurance and prescriptions.

IN 2013, LACMA ALSO - Challenged the State’s Dual Eligible Demonstration Project and was victorious in delaying its implementation - Filed major lawsuits against Aetna and Healthnet for abusive business practices against physicians and patients - Launched its first-ever dedicated resource center for solo and small group practice physicians and surgery centers

OUR WORK IS NOT DONE.

Only through your continued support will LACMA and CMA be able to serve members first and foremost through our advocacy efforts and services that will help serve patients and improve your bottom line.

Medical Professional Liability Protection, and more!

800-356-5672 www.caPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo

job b oa r d | cla s s i fi ed

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LEGAL REPRESENTATION FOR PHYSICIANS

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or contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.

CME City of Hope’s 6th Annual How the Experts Treat Hematologic Malignancies

PM Marketplace Surgeons Needed for Expanding Nationwide Surgical Practice

September 18 to 20, 2013 Casa Del Mar Hotel, Santa Monica, CA JOIN US for this two-and-a-half-day conference for the opportunity to learn about the most recent advances in the treatment of multiple myeloma, lymphoma and leukemia. Updates on improved curative and palliative treatments, evolving molecular and immunologicallybased systemic therapies and clinical trials, will be profiled and discussed.

To learn more and to register, visit www.cityofhope.org/hematologicconference2013

• Full or part-time positions • Competitive Pay • Add revenue to your current practice

• Flexible schedule, complete autonomy • No Call

Please contact us for more information: Phone: 1-877-878-3289 Fax: 1-877-817-3227 or email CV to: Jobs@AdvantageWoundCare.org

www.AdvantageWoundCare.org

CME

Physicians News Network introduces

City of Hope’s 13th Annual Women’s Cancer Conference: Progress in Women’s Cancers from Treatment to Survivorship November 8 to 10, 2013 The Venetian/Palazzo Resort Hotel, Las Vegas, NV

REGISTER NOW for this exciting conference featuring prominent oncology experts who will address clinical and translational research, prevention, practical issues, current standards of care, controversies and evolving new treatment recommendations for women’s cancers.

Attendees will learn new tools to optimize decision making to help improve patient outcomes.

If you are currently receiving the PNN eNews Bulletin, look for iPNN to be delivered to your inbox every week, If not

To learn more and to register, visit www.cityofhope.org/womensconference2013

www.PhysiciansNewsNetwork.com

Reporting on the technology of healthcare delivery

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Advertiser Index Athena Health...........................................................................................................5 BBVA.....................................................................................................................25 Cooperative of American Physicians ...................................................................... 29 The Doctors Company ........................................................................................ C4 Fenton Nelson ...................................................................................................... 21 Marsh.......................................................................................................................3 Medline....................................................................................................................7 NORCAL ............................................................................................................C2 Office Ally ........................................................................................................... C3 Summit Lending.....................................................................................................23 Wells Fargo...............................................................................................................9 Zuma Capital..........................................................................................................27

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cla s s i fi ed | job b oa r d

To place a classified ad visit www.physiciansnewsnetworK.com

b y t he n umb er s | TE CHNOLOGY

By The Numbers Many tools are already commercialized with 15% of mHealth applications on the market being intended for use by healthcare professionals, including continuing medical education, remote monitoring and healthcare management applications.

24%

mHealth

80% 80% of doctors use mobile devices; 40-50% are using tablets

24% of surveyed patients say they would be happier receiving prescriptions for an mHealth application rather than a pill.

90% of patients were willing to accept a prescription for an mHealth app, compared to the 66% of patients who wanted a traditional doctor’s order for their respective medications.

It is projected that only 27% of practices will achieve a positive return on their EHR investment over 5 years

EHRs

The overall cloud computing market in healthcare will grow to $5.4 Billion by 2017

$5.4 3 2 PHYSICIAN MA G A Z INE | s ep t e m b er 2013

27%

The largest difference between practices with a positive return on their EHR investment and those with a negative return was the extent to which they used their EHRs to increase revenue, primarily by seeing more patients per day or by improved billing that resulted in fewer rejected claims and more accurate coding.

2012, physicians faced over 10,500 alleged HIPAA violations. Make sure you’re prepared.

In

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For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.

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

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

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

*Source: Health Information Privacy/Security Alert

CA License #0677182

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