September 2014 | Physician Magazine

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

THERE’S AN APP FOR THAT! T H E B E S T A P P S F O R Y O U A N D Y O U R PAT I E N T S

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

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

S EPT EM B ER 2014 | TA B LE OF CONT ENT S

Volume 145 Issue 9

THERE’S AN APP FOR THAT!

6 DEPARTMENTS

8 16

FRONT OFFICE | PRACTICE MANAGEMENT 6 Be Cybersecure: Protect Patient Records, Avoid Fines and Safeguard Your Reputation

8 A Safer Way to Implement and Use EHRs

COVER STORY

UNITED WE STAND | AT WORK FOR YOU

10

15 LACMA Reacts to Ruling Denying Injunction

THERE’S AN APP FOR THAT!

We turn to the experts to find out which apps are considered top grade for medical literature and references and educational for doctors and patients and which ones can help doctors reduce readmission rates in hospitals.

to Stop Cal MediConnect

FROM YOUR ASSOCIATION 4 PRESIDENT’S LETTER | PEDRAM SALIMPOUR, MD 16 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.

S EP T E M EB ER 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

EDITOR

Sheri Carr 559.250.5942 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

DISPLAY AD SALES / DIRECTOR OF SALES CLASSIFIED AD SALES

EDITORIAL ADVISORY BOARD

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

The Los Angeles County Medi-

physicians from every medical

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

specialty and practice setting

LACMA OFFICERS

cal Association is a professional association representing

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

PRESIDENT

PRESIDENT-ELECT

TREASURER SECRETARY

IMMEDIATE PAST PRESIDENT

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

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

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

ment relations and community

ETHNIC PHYSICIANS COMMITEE REPRESENTATIVE

relations. Through its advocacy

COUNCILOR - DISTRICT 17

COUNCILOR - DISTRICT 1

COUNCILOR - DISTRICT 14

efforts in both Los Angeles County and with the statewide California Medical Association, your physician leaders and staff strive toward a common goal– that you might spend more time treating your patients and less time worrying about the chal-

COUNCILOR - DISTRICT 7

CHAIR OF LACMA DELEGATION

COUNCILOR-AT-LARGE

COUNCILOR - DISTRICT 6

COUNCILOR - SSGPF

COUNCILOR-AT-LARGE

COUNCILOR - DISTRICT 3

COUNCILOR - DISTRICT 10 COUNCILOR - SCPMG

ALTERNATE MED STUDENT COUNCILOR/UCLA

RESIDENT/FELLOW COUNCILOR

CMA TRUSTEE

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

D E FE ATING PRO P O S ITI ON 46, the deceptive and expensive attack on the

Medical Injury Compensation Reform Act (MICRA), is front and center on our

agenda. The election to defeat Prop. 46 is now just days away, and we must do all that we can to defeat it to protect patient care.

This week, we launched our television, radio and In-

ternet campaigns. If you haven’t already, you will see and hear them. Please use these as a vehicle to start a

conversation with your friends and family about how important it is to doctors and our patients that this ri-

diculous attack on our profession be defeated, once and for all, at the ballot box.

The Los Angeles County Medical Association

(LACMA) serves more than 6,000 physicians across all modes of practice and specialties in Los Angeles County. United, standing together, our voice will be

heard, and our patient communities will be better for it.

There has never been a more important time than

today to be a LACMA member to support our profes-

sion, patients and practice. Prop. 46 is the latest attack on our profession, and we must confront it together.

Approximately eight years ago, Joy Simmons, our

then-Membership Director, encouraged me to join

LACMA at a District meeting. What I distinctly remem-

ber her saying is “get involved in the work that matters to the patients you serve and to your profession.” And, I’m glad I did.

Today, I am honored to serve as your president at a time when our patients

and profession need us most.

Your membership dollars help fight this fight. I ask you today to please con-

tribute your time and resources to the effort to protect access to healthcare for all Californians by defeating Prop. 46.

4 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

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

BE CYBERSECURE

Protect Patient Records, Avoid Fines and Safeguard Your Reputation

BY DAVID MCHALE, SENIOR VICE PRESIDENT AND CHIEF LEGAL OFFICER, THE DOCTORS COMPANY

Cybercrime costs the U.S. economy billions of dollars each year and causes organizations to devote substantial time and resources to keeping their information secure. This is even more important for healthcare organizations, the most frequently attacked form of business.1 Cybercriminals target healthcare for two main reasons: healthcare organizations fail to upgrade their cybersecurity as quickly as other businesses, and criminals find personal patient information particularly valuable to exploit.

The repercussions of security breaches can be 6 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

daunting. A business that suffers a breach of more than 500 records of unencrypted personal health information (PHI) must report the breach to the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR). This is the federal body with the power to enforce the Health Insurance Portability and Accountability Act (HIPAA) and issue fines. To date, the OCR has levied over $25 million in fines, with the largest single fine totaling $4.8 million.2 A healthcare organization’s brand and reputation are also at stake. The OCR maintains a searchable da-

o Sign-in sheets that ask for only minimal information.

check if you have procedures in place in case of a breach. Taking the proper steps in the event of a breach may help you avoid a fine.

• Insure. Make sure that your practice has insurance to assist with certain costs in case of a breach.

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

David McHale is The Doctors Company’s Chief Legal Officer. He holds a law degree from the University Pacific’s McGeorge School of Law and an MBA from the University of Illinois. He is a Certified HIPAA Compliance Officer (AIHC) and a regular presenter before insurance trade organizations and the National Association of Insurance Commissioners (NAIC).

References 1Visser S, Osinoff G, Hardin B, et al. Information security & data breach report— March 2014 update. Navigant. March 31, 2014. http://www.navigant.com/~/ media/WWW/Site/Insights/Disputes%20Investigations/Data%20Breach%20 Annual%202013_Final%20Version_March%202014%20issue%202.ashx. Accessed June 17, 2014.

2McCann E. Hospitals fined $4.8M for HIPAA violation. Government Health IT. May 9, 2014. http://www.govhealthit.com/news/hospitals-fined-48m-hipaaviolation. Accessed June 24, 2014.

3Breaches affecting 500 or more individuals. U.S. Department of Health & Human Services. http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html. Accessed June 23, 2014.

o Procedures for the handling and destruction of paper records. o Policies detailing which devices are allowed to contain PHI and under what circumstances those devices may leave the office.

• Encrypt all devices that contain PHI (laptops, desktops, thumb drives, and centralized storage devices). Make sure that thumb drives are encrypted and that the encryption code is not inscribed on or included with the thumb drive. Encryption is the best way to prevent a breach.

• Train your staff on how to protect PHI. This includes not only making sure policies and procedures are HIPAA-compliant, but also instructing staff not to openly discuss patient PHI. • Audit and test your physical and electronic security policies and procedures regularly, including what steps to take in case of a breach. The OCR audits entities that have had a breach, as well as those that have not. The OCR will S EP T E M EB ER 2014 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 7

F RONT OF F IC E | P RAC T IC E M AN AG EM EN T

tabase (informally known as a “wall of shame”) that publicly lists all entities that were fined for breaches that meet the 500-record requirement.3 To help safeguard your systems, know the most common ways a breach occurs. The theft of unencrypted electronic devices or physical records is the most common method, accounting for 29% of breaches across all industries in the United States.2 Also common are hacking (23%) and public distribution of personal records (20 %). A breach in the latter category led to the largest OCR fine to date when two affiliated hospitals accidentally made patient records public on the Internet.2 If you think you may not be fully compliant with HIPAA privacy and security rules, consider taking the following steps: • Identify all areas of potential vulnerability. Develop secure office processes, such as:

P RAC T IC E M AN AG EM ENT | F RONT OF F IC E

Physicians Given SAFER Way to Implement and Use Electronic Health Records Problems with electronic health record (EHR) implementation and use are common and can affect patient safety and increase liability risks. Examples of EHR problems include: • Not adequately addressing known problems with EHR use, such as “alert fatigue” as a result of too many alerts.

ations are addressed, the guides apply a structured team approach involving everyone whose professional life will be permanently affected by the EHR. The guides are designed to help healthcare organizations conduct self-assessments to optimize the safe use of EHRs in the following nine areas, the last three of which should be of most interest to physicians:

• Problems locating where lab and X-ray results are filed (or misfiled).

• High Priority Practices

• Difficulty correcting progress note entry errors.

• Contingency Planning

• Unnecessary operational complexity.

• System Configuration

• Failure to use a team approach involving physicians and other healthcare professionals in leadership positions to ensure that their clinical concerns are met.

• System Interfaces

• Unwillingness by vendors to modify their systems to meet the complex workflows of the real-world practice setting.

To assist in the implementation and use of EHRs, the Office of the National Coordinator for Health Information Technology recently released a practical, useful and comprehensive suite of tools: the Safety Assurance Factors for EHR Resilience (SAFER) Guides. It’s recommended that all physicians, medical groups and healthcare institutions that are considering implementation or replacement of an EHR visit the SAFER Guides website and spend an hour becoming familiar with those guides that address the areas of greatest interest or concern.

These free guides—which can be downloaded or used online at www.healthit.gov/safer—provide a well-organized work plan for tackling the organizational complexities of EHR implementation and use.

In order to ensure that clinically important consider-

8 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

• Organizational Responsibilities

• Patient Identification • Computerized Provider Order Entry with Decision Support • Test Results Reporting and Follow-Up • Clinician Communication The guides are designed to help deal with safety concerns created by the continuously changing landscape that healthcare organizations face. When using the guides, changes in technology, clinical practice standards, Meaningful Use, and/or HIPAA Security Rule requirements should be taken into account.

Because the guides are designed to help organizations prioritize EHR-related safety concerns, clinician leadership in the organization should be engaged to assess whether and how any recommended practice affects the organization’s ability to deliver safe, high-quality care. To optimize EHR-related safety and quality, collaboration between clinicians and staff should lead to a consensus about the organization’s future path.

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

How to Talk to Your Patients Prop 46 - A costly threat to people’s personal privacy Californians can’t afford.

By now, many of you are familiar with the MICRA lawsuit initiative that will appear on the November 4, 2014, ballot. Proposition 46 is being opposed a coalition of doctors, community health clinics, Planned Parenthood Affiliates of California, local governments, working men and women, business groups, taxpayer groups, hospitals and educators, all of whom know that the measure will lead to more lawsuits and higher health care costs. What’s more, it will threaten personal privacy and jeopardize people’s access to their trusted doctors or clinics.

This information is intended to be useful for coalition members who are on the ground working to defeat Prop.

46. To that end, please also visit www.NoOn46.com for updated campaign information and to find out what you can do to join the efforts as an individual or organization.

TALKING TO YOUR PATIENTS Communicating the No on 46 message to your patients will be critical to defeating the trial lawyers’ attacks on the medical profession. As a trusted medical expert, you are in a unique position to share how Prop 46 would truly affect all health care users and taxpayers. Please use the Frequently Asked Questions (FAQ) below to guide your conversation with patients.

WHAT WILL PROP. 46 DO? Prop 46 does three things: • Quadruples the limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums – reducing access to care.

• Threatens your privacy by requiring a massive expansion of a personal prescription drug database.

• Requires alcohol and drug testing of doctors, which was only added to this initiative to distract from the main purpose.

Proposition 46 uses alcohol and drug testing of doctors to disguise the real intent – to increase a limit on the amount of medical malpractice lawsuit awards.

WHO OPPOSES PROP. 46?

Thousands of organizations and individuals representing doctors, nurses, community clinics, local governments, labor unions, business groups, education groups, taxpayer groups, hospitals, community groups and many others oppose Prop. 46 because it will lead to more lawsuits, higher health care costs, threaten people’s access to their trusted doctor or clinic, and jeopardize people’s personal prescription drug information.

WHO SUPPORTS PROP. 46?

One hundred percent of the reported contributions to pay for signature gathering to place this on the ballot in November 2014 came from trial lawyers and their allies.

HOW WILL PROP. 46 INCREASE HEALTH CARE COSTS? There is no question that more lawsuits against health care providers will increase costs, and someone has to pay. And that someone is consumers and taxpayers.

California’s former Legislative Analyst found Prop. 46 would increase health costs for consumers and the state by about $9.9 billion annually.

This translates to more than $1,000/year in higher health care costs for a family of four.

California’s current independent, non-partisan Legislative Analyst Office (LAO) said impacts to state and local

THERE’S AN APP FOR THAT!

BY MARION WEBB

1 0 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

ple’s App Store and Google Play—from tracking, monitoring and

evaluating medical problems to getting patients to take control of their own health—it can be tough to decipher which medical apps are truly legitimate and useful. To narrow it down, we have turned to the experts to

identify some of the top mobile apps for physicians and their patients

on the marketplace today.

Medical Literature/ Reference Apps

The editors at iMedicalApps give the QxMD and Docphin apps top ratings for giving providers access to their favorite medical jour-

nals on their phone.

Both apps come in a magazine format, automatically update a feed with the latest journal articles and store articles as well, all with one click and without the need to repeatedly log into the institutional portal.

And best of all: These medical journals are free for iPhone users.

MicroMedex is iMedicalApps’ top choice for looking up drug monographs, but the editors said it lacks support for iPhone 5 users.

The app will work on the iPhone 5, but the screen is not optimized for it. Still, MicroMedex received high marks for content, including the toxicology and clinical teaching sections.

Epocrates is still considered the king of all medical apps when it comes to drug references, including the right dosing for adults and children and warnings about harmful interactions. The app is touted as the New Age Physicians Desk Reference.

Medscape, WebMD and MedPage Today all offer providers one-stop shopping on a website or a mobile app.

The editors at iMedicalApps rated the apps’ breadth and depth of content impressive and gave it high marks for providing well-referenced content as well as for disclosing conflicts of interest.

UpToDate offers even more comprehensive

information and comes with evidence-based recommendations, mobile optimized calculators and a CME tracker.

Doximity, a professional network for physicians, enables doctors to connect with each other and comes with HIPAA-compliant faxing, emailing and text messaging.

When it comes to free medical calculator apps, only one app rules and that is the QxMD app, according to the editors at iMedicalApps.

“From our research, QxMD’s Calculate is the only free medical app worth looking at,” the editors noted. “The other free medical calculator apps have a terrible user interface or aren’t comprehensive enough.”

When it comes to language translators, MediBabble is the best one in the Apple Store, paid or free. The editors said if providers choose to pay for another one, they’re making a mistake.

Isabel App allows doctors using their iPhone, iPad or iPod touch mobile devices to enter symptoms and possible diagnoses and medications that could cause symptoms.

The app was developed by the parents of Isabel Maude, a British girl who nearly died at the age of 3 in 1999, after being misdiagnosed.

Experts believe that the Isabel App gives doctors possibilities and it’s then up to the doctor to work out the probabilities.

Another app, VisualDx, covers more than 1,200 pediatric and adult conditions with more than 25,000 images.

It aims to help doctors identify dermatologic, infectious, genetic, metabolic, nutritional and occupational diseases, benign and malignant growths, drug-induced conditions and other injuries.

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T H ERE’S AN AP P F OR T H AT | F EAT U RE

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ith the now hundreds of medically themed apps available in Ap-

F EAT U RE | T H ERE’S AN AP P F OR T H AT

Education

With more app developers looking at medical education, here are three apps used by neurologists and other physicians to help them with their specific needs.

Resolution MD, which is cleared by the U.S. Food and Drug Administration, gives doctors instant access to radiology diagnostic images and reports from mobile devices. The app is being used by neurologists at the Mayo Clinic in Phoenix for remote consultations.

In 2012, a study at the Mayo Clinic found that radiologists using the app vs. a traditional PACS workstation were able to access CT scans of stroke

victims 24% faster, according to Calgary Scientific, which developed the app.

The Electronic Preventive Services Selector (ePSS) is a longstanding favorite at iMedicalApps.

It lists USPTF recommendations as well as calculators and screening tools for various situations.

The Grand Rounds app, developed by an Indiana University neurosurgeon in collaboration with the American Association of Neurological Surgeons and the Neurosurgical Atlas, impresses with two types of content: an interview with an operating surgeon discussing a case and a narrated video with various topics in neurosurgery. iMedicalApps’ editors said this app could also be applied to other specialties.

The proliferation of healthcare and medical news on the Internet can make it tough for doctors to distinguish medical fact from fiction. The following websites presented by Medscape and other physician experts offer doctors the education, research and scientific know-how they can use in their everyday practice.

Web M&M (http://webmm.ahrq.gov/): Web M&M, presented by the US Agency for Healthcare Research and Quality, offers residents valuable education, reviewing the factors behind medical errors and incorrect decisions through anonymous cases, evidence-based discussions and commentary from leaders in the field of patient safety.

The Incidental Economist (http://theincidentaleconomist.com/): The Incidental Economist, led by health policy researchers Aaron Carroll and Austin Frakt, offers short, thoughtful posts and asks tough questions about U.S. healthcare.

Life in the Fastlane (http://lifeinthefastlane.com/): LITFL offers critical care physicians and nurses key insight into emergency medicine, critical care, ultrasonography, physical exams, and ECGs. HealthcareScene.com (http://www.healthcarescene.com/): HealthcareScene.com was founded by entrepreneur and health IT expert John Lynn in 2005. The site has 15 blogs containing more than 7,000 articles covering HIPAA, EMR, HER and other health IT news.

Choosing Wisely (http://www.choosingwisely.org/): Choosing Wisely, an initiative by the ABIM Foundation, aims to start a conversation between physicians and their patients. The American Board of Internal Medicine has partnered with more than a dozen other specialty societies to curb unneeded testing and interventions. Physicians can browse the list of 45 tests, including nine specialties, that are frequently ordered despite proof that they don’t change patient management or improve outcomes.

WebMD (http://www.webmd.com/): WebMD has been providing reliable health information services since its founding in 1996. It’s a great resource for physicians and consumers alike for drug information, medical information, symptom checklists and trendy articles on health.

1 2 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

With hospitals facing financial penalties under the Patient and Affordable Care Act for patients returning to the hospital within 30 days of discharge, developers feel that providers are increasingly willing to test new technologies to monitor patients’ health post-surgery, according to HealthIT Outcomes.

With this year’s penalties including readmissions for patients with COPD and total hip and knee replacement, developers have created the following apps to engage patients and keep healthcare costs down.

Madison-based start-up Propeller Health, founded by David Van Sickle, a former epidemiologist for the Centers for Disease Control and Prevention, developed a mobile app that allows patients with COPD and asthma to track inhaler use by transmitting data to physicians about when and where the medication is being used and thus prevent an attack or exacerbation.

The app is currently being tested in Phoenix with about 200 Medicare patients with the Arizona Care Network, an accountable care organization. Propeller Health reportedly is pursuing FDA clearance for the device.

SeamlessMD, founded by a 26-yearold medical resident in Ontario, Canada identifies post-surgery complications by asking patients to enter information about temperature or pain levels. Patients can send photos of surgical wounds to a provider for evaluation as well. The app then pushes out alerts based on recommendations made by an algorithm that the company developed.

The GetWellNetwork system can be used in a doctor’s office, an ambulatory setting or a home via a mobile device or computer to help patients with diabetes or undergoing heart or orthopedic treatments access information about the treatment plan and medication.

CareAtHand is an app for non-skilled community caregivers to assess and track elderly patients’ medical issues. It also offers support and will alert nurses about issues that may require a doctor visit.

Vocera, a developer of communication technology used within hospitals, launched Vocera Care Experience, a system that allows nurses and caregivers to record audio and video discharge instructions for patients. Patients can then access that information any time via their phone, mobile device or computer.

APPS FOR YOUR PATIENTS Educational

When it comes to communicating medical problems or procedures to patients, medical apps can offer providers a great new tool for visualizations or explanations as well as enticing patients to take control of their own health.

Heart Decide is an app that allows physicians to drive conversations between healthcare providers and their patients. Their short videos on various

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T H ERE’S AN AP P F OR T H AT | F EAT U RE

Hospital Readmissions

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topics ranging from angina to heart failure are a “nice adjunct for patients to review in the waiting room,” iMedicalApps’ editor noted. When the patient comes in the office, the doctor and patient can then look at the app together to go over certain procedures.

The editors also feel that the First Aid app by the American Red Cross is also a well-designed app to provide information on urgent and emergency care. It offers both preventive strategies and common sense input, such as how to deal with an anaphylactic allergy to bees, as well as pointers on how to manage urgent care situations.

Alivecor, a portable heart monitor and app, can run on a patient’s smartphone to produce electrocardiograms. Eric Topol, MD, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif., told the Wall Street Journal he recommends Alivecor to patients who have irregular heart rhythms often just for reassurance.

Another app, iHealth Wireless Pulse Oximeter, allows people who have trouble sleeping to record their blood oxygen level during the night, which in turn can help doctors diagnose possible sleep apnea. To use the app, patients go to bed wearing a fingertip sensor that wirelessly links to the phone and keeps track of blood oxygen levels, according to news reports.

Behavioral Health Apps for Patients

More developers of mobile apps are also looking at behavioral health to tackle issues such as helping patients detect mood disorders earlier to enable earlier intervention by their health providers and finding a matching therapist personality type.

A new app, Cloud 9, still in testing, offers a directory for patients with behavioral health issues that is similar to Yelp to help them find the right psychotherapist personality.

The app has built-in assessment tools that generate matching criteria for therapist specialization, even cultural and personality preferences, to find the right therapist match, according to iMedicalApps.

Another new app, Ginger.io, seeks to help patients with mental illnesses detect symptoms earlier by keeping an “automated diary” of their mental state. The app is designed to help both the patient and healthcare provider keep tabs of symptoms and intervene when necessary.

Similarly, the Optimism app aims to help people with mood disorders, such as bipolar disorder, to track their daily mood and other aspects of life that could attribute to their mood.

Conclusion

Medical phone apps, while still in their infancy, are quickly growing in popularity.

According to a recent report from Research2Guidance, more than half a billion smartphone users are expected to use mobile medical apps in 2015, and that number is expected to climb to more than 1.7 billion by 2018.

Among the biggest challenges facing the industry are regulatory issues, reimbursement and adoption by both physicians and patients, experts noted.

1 4 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

BY MARION WEBB

LOS ANGELES COUNTY Medical Association CEO Rocky Delgadillo said that LACMA will

appeal last month’s ruling by a California Superior Court judge to continue the implementation of the ill-founded demonstration project for dual eligibles. A California Superior Court judge ruled on Aug. 4 that the state will continue its demonstration project for dual eligibles, which could affect 456,000 Californians who are eligible for both Medicare and Medi-Cal. In Los Angeles County, more than 200,000 residents have been targeted to be transitioned into the program. LACMA has long said that this untested program is moving too fast and is too aggressive.

“Every physician I spoke with agrees that if you move 200,000 patients to a new physician and health system—and in many cases patients that have never seen the doctor before—puts the patient at great risk for being harmed,” Delgadillo said.

Earlier this year, LACMA joined other organizations, including the Los Angeles County Podiatric Medical Society, in expressing their concerns to the state Department of Health Care Services that the program threatens the care of mostly elderly, low-income and disabled patients in LA County and their disapproval of the department’s failure to provide opt-out forms to patients.

The Department of Health Care Services said it would provide opt-out forms to patients in an effort to prevent patients from being automatically reassigned from their current doctors to healthcare plans managed

by LA Care or Health Net. However, the confusion remained.

On July 2, LACMA joined three independent living centers—Communities Actively Living Independent & Free, Westside Center for Independent Living and Southern California Rehabilitation Services, Inc.—and Dr. Manuel PuigLlano in Chula Vista in filing a lawsuit that asked the court for a preliminary injunction to stop the passive enrollment PHYSICIAN – FAMILY MEDICINE and to disenroll patients who have been enrolled, often Located in Vista, California, Vista Community Clinic is a priwithout their knowledge or consent. vate, nonprofit outpatient community clinic located in North With regards to filing the lawsuit, Delgadillo noted that San Diego County serving people who experience social, the Department of Health Care Services was mandated to cultural or economic barriers to health care in a comprehensive, high quality setting. provide notices and opt-out choice forms written below a sixth-grade reading level but failed to do so.

POSITION: “We believe that there was insufficient notice given to Full-time, Part-time and Per Diem Family Medicine Physicians. the most vulnerable population in the state and that the maRESPONSIBILITIES: terials prepared by the state were too high of a reading level, Provides outpatient care to clinic and thus, violated the directives given by the Legislature,” patients and ensures quality assurance.

Delgadillo said. “Furthermore, the opt-out mechanism is at Malpractice coverage is provided by Clinic. best unclear.”

REQUIREMENTS: Delgadillo said that LACMA will continue to fight on beCalifornia license, DEA license, half of patients, because it is the right thing to do.

CPR certification and board certified in family medicine.

Bilingual English/Spanish preferred.

“We want effective and sufficient notices to patients, an easy opt-out mechanism for patients who want to continue CONTACT US: seeing their doctors, and we want to eliminate the expoVisit our website at www.vistacommunityclinic.org sure of an enormous volume of patients to the confusing Forward resume to hr@vistacommunityclinic.org or fax resume to 760 414 3702.

Cal MediConnect program,” Delgadillo said. “The passive enrollment will interrupt patient care and puts the burden EEO/AA/M/F/Vet/ Disabled on the patient’s shoulders.”

S EP T E M EB ER 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

U NIT ED WE S TAND | AT WORK F OR Y OU

LACMA Will Appeal Ruling Denying Injunction to Stop Cal MediConnect

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

CEO’s LETTER

IT’S BACK TO SCHO OL and for LACMA this means jumping back into action after the summer break.

This fall, physician members will find a whole slew of exciting LACMA events that will be educational and informational and provide ample opportunities for networking and professional engagement.

We will also continue with our most important mission to advocate on behalf of our patients.

On Aug. 4, Superior Court Judge Shelleyanne Chang denied LACMA’s request for a preliminary injunction to stop the the implementation of the ill-founded duals demonstration project, Cal MediConnect, and its passive enrollment of dual eligibles.

While the members of LACMA are disappointed by the court’s ruling to move forward with the Cal MediConnect demonstration project—which jeopardizes the health of the county’s and state’s most vulnerable population—we will continue our fight and appeal the decision.

At least 200,000 Los Angeles County residents are affected by this ill-designed and ill-conceived program. The judge’s decision will devastate patients who will lose their trusted physicians and risk the disruption of their medical care.

It is up to us to put this program on hold until it can be fixed.

On a lighter note, this month LACMA members will find many exciting opportunities to start a discourse and collaborate.

I’m thrilled to present LACMA’s inaugural Asian American Physicians Empowerment dinner on Sept. 3, a highly anticipated event that promises an exceptional turnout.

On Sept. 11, LACMA will hold its annual Resolutions and Nominations Committee meeting, an evening to discuss LACMA’s key legislative agenda.

On Sept. 15, LACMA will present yet another breakthrough event—the first ever Cassidy Turley Golf Tournament—to support LACMA’s medical scholarship program.

You don’t want to miss this all-day fun outing. All proceeds from the Closest to the Pin Challenge will support LACMA’s Patient Care Foundation.

Knowing that the changing healthcare environment presents many challenges for private practitioners, LACMA invited the experts to help our members reduce conflict in their practices and manage difficult employees successfully.

Learn key strategies for motivating, managing and leading your staff during an expert workshop on Sept. 17.

Finally, we are all looking forward to our annual LA Healthcare Awards, where we will honor Los Angeles’ top physicians and outstanding community leaders.

As in past years, the proceeds will benefit the Patient Care Foundation of the Los Angeles County Medical Student Scholarship Program.

We look forward to a collaborative and engaging fall season and hope that many of you will join us and invite other physicians in the community to unite behind LACMA.

Rocky Delgadillo Chief Executive Officer

1 6 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

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

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

Are you a LACMA/CMA member?

2012 LOS ANGELES COUNTY MEDICAL ASSOCIATION MICRA SAVINGS CHART General Surgery

Internal Medicine

OB/GYN

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$41,775

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$35,139

$108,020

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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.

S EP T E M EB ER 2014 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 17

JOB B OARD | C LAS S IF IED

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TRACY ZWEIG ASSOCIATES, INC. • Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

1 8 P H Y S I C I A N M A G A Z I N E | S EP T E M B ER 2014

Psychiatrist MD or DO

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

POSITION Part-time Psychiatry MD or DO or part-time or full-time Family Medicine/Psychiatry MD or DO.

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

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

RESPONSIBILITIES: Provides outpatient care to clinic patients and ensures quality assurance.

Malpractice coverage is provided

by Clinic.

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

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

EEO/AA/M/F/Vet/ Disabled

PLACE YOUR CLASSIFIED AD ONLINE! PHYSICIANSNEWSNETWORK.COM

RESPONSIBILITIES Provide consultation-liaison services for patients suffering from both psychiatric and medical disorders by focusing on the evaluation and treatment of patients, serving adolescents, adults, seniors and their families. Preferably able to serve children as well, but not required.

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

EOE/M/F/D/V

OFFICE FOR LEASE/ SUBLEASE/SHARE

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Freestanding office building for sale or lease in busy location. Has been medical office for over 30 years. Four examination rooms, waiting room, reception area, break room. Ample parking, Call Joe 714 724-8832 Broker.

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PM Marketplace Surgeons Needed for Expanding Nationwide Surgical Practice • Full or part-time positions • Competitive Pay • Add revenue to your current practice

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CITY OF HOPE PRESENTS:

MULTIDISCIPLINARY APPROACHES TO CANCER TREATMENT November 6th to 9th, 2014 The Cosmopolitan Hotel, Las Vegas, NV

REGISTER NOW for this exciting conference featuring prominent oncology experts who will discuss clinical and technical advances, promising clinical trials data, national guidelines and key controversies in the management of breast, sarcomas, gastrointestinal, melanoma, genitourinary, lung and hematologic cancers.

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

LEARN MORE AND TO REGISTER AT:

cityofhope.org/macconference

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S EP T E M EB ER 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 9

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TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231.

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:

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Reschedule your date

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Relocate for your convenience

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Reduce number of call-in days from 5 to 1!

10% in SAVINGS GUARANTEED Through an exclusive partnership with MEDLINE, LACMA saves members 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



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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 o 707 Wilshire Blvd, Suite 3800 o Los Angeles, CA o 90017 o FAX: (213) 226-0353

and the life-changing experience you’ll find nowhere else.

THE STRENGTH TO HEAL

There are few experiences more rewarding than serving as an officer and a surgeon with the Army Reserve. You will work with professionals at the top of their fields, be exposed to new technologies and points of view, and even have the opportunity to take part in humanitarian missions that stretch and sharpen your skills. You can also receive up to $250,000 in student loan repayment and $75,000 in Special Pay. See how the time you invest with the Army Reserve can enhance everything you do from Monday through Friday — and throughout your professional career.

To learn more, call (310)216-4433 or visit Culver City Medical Recruiting Center 400 Corporate Point, STE 570 Culver City, CA 90230 Email: usarmy.knox.usarec.list.9e2c@mail.mil

SCAN THIS CODE TO WATCH A VIDEO. LTC Hustead describes what it means to him to be part of a team of professionals and to have the honor to care for our nations heroes and their families. *Certain requirements and eligibility criteria apply. ©2014. Paid for by the United States Army. All rights reserved. Information subject to change.