November 2013

T h e O f f i c i a l P u b l i c a t i o n o f t h e Lo s A n g e l e s Co u n t y M e d i c a l A s s o c i a t i o n

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

2013 LA Healthcare Awards HEALTHCARE CHAMPION OF THE YEAR

Patrick Soon-Shiong, MD

personnel • time management • HIPAA CoMPLIANCE

Best Practices Holiday Travel Section NOVEMBER 2013

c

l i a

M a g

a

O

O

i

z

f

i

f

n

e

E

n

f

i

f

z

i

c

l i a

M a g

a

NORCAL Mutual is owned and directed by its physicianpolicyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Contact your broker or call 877-453-4486 today. Visit norcalmutual.com/start for a premium estimate.

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

N o r c A l m u t u A l .c o m

NOV EM B ER 2013 | TA B LE OF CONT ENT S

Volume 144 Issue 11

COVER STORY

10

2nd annual lA healthcare awards

Patrick Soon-Shiong, MD, and others were honored at the annual Healthcare Awards, which celebrate leadership, innovation, education, and community service in Los Angeles County while raising funds for the Patient Care Foundation’s Medical Student Scholarship Program.

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

SPECIAL: Holiday Travel Section

8 Balance | Lifestyle & Wellness

14

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

12 PNN | NEWS IN REVIEW

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

14 SPECIAL SECTION | HOLIDAY TRAVEL

FEATURE

18

From Your Association

BEST PRACTICES

With the wider implementation of health reform just weeks away, Physician Magazine provides a comprehensive overview of key best practices including, personnel, efficiency, time management, and HIPAA-compliance.

4

President’s Letter | marshall morgan, MD

26 CEO’s Letter | Rocky Delgadillo 27 LACMA News | Association Happenings

18

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.

N OV E M B ER 2013 | 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 | sc@physiciansnewsnetwork.com ADVERTISING SALES

display ad sales / director of sales SALES EXECUTIVE

CLASSIFIED ad sales

editorial advIsory board

The Los Angeles County Medi-

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

LACMA Officers President

President-elect Treasurer Secretary

than 100 years, LACMA has

Immediate Past President

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

CMA Trustee

Councilor - District 9

Councilor - District 2

med student Councilor/usc keck Councilor-at-large

young physician councilor

ment relations and community

Councilor - District 5

cma trustee

ethnic physicians committee 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

Councilor - District 7

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

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

areas of public policy, govern-

relations. Through its advocacy

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

Councilor-at-large Councilor - SSGPF

Councilor - District 3

Councilor - District 10 Councilor - SCPMG

Alternate med student Councilor/ucla 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.

at your dental plan It’s Open Enrollment time for the Los Angeles County Medical Association sponsored Group Dental program. This plan is designed to help you, your family and your employees minimize the out-of-pocket expense of regular dental care.

This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money: Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers).

During Open Enrollment only, members may join as an individual or as a group with your employees.

Low, calendar year deductible of $50 per person ($100 per calendar year maximum for families).

Pay no deductible on oral exams, x-rays and routine cleanings.

Remember, the open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period ending on January 1, 2014.

Call a Client Service Representative at 800-842-3761 for more information. Or visit www.CountyCMAMemberInsurance.com to download a brochure and application.

Sponsored by:

Underwritten by:

Underwritten by: (IL) - First Commonwealth Insurance Company, (MO) - First Commonwealth of Missouri, (IN) - First Commonwealth Limited Health Services Corporation, (MI) - First Commonwealth Inc., (CA) - Managed Dental Care, (TX) - Managed DentalGuard, Inc. (DHMO), (NJ) - Managed Dental Guard, Inc., (FL, NY) - The Guardian Life Insurance Company of America. All First Commonwealth, Managed DentalGuard, Inc. and Managed Dental Care entities referenced are wholly-owned subsidiaries of The Guardian Life Insurance Company of America. Products are not available in all states. Limitations and exclusions apply. Plan documents are the final arbiter of coverage.

60985 ©Seabury & Smith, Inc. 2013

AR Ins. Lic. #245544 • CA Ins. Lic. #0633005 d/b/a in CA Seabury & Smith Insurance Program Management 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance.com

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

The lives of large organizations are punctuated by annual meetings, which serve both practical and ceremonial ends.

The CMA House of Delegates (HOD) convened on October 11-13 at Disneyland for a decisionmaking meeting where CMA policy was determined by your elected representatives.

Here are some practical matters considered by the HOD that I believe are important.

CMA has recognized that its governance structure is unwieldy, insufficiently agile, and much too expensive. The report of a Governance Technical Advisory Committee recommended changes that include shortening the House of Delegates, decreasing the size of the Board of Trustees, and adopting a year-round decision-making process in which Reference Committees will function year-round. Most of the delegates consider this to be a necessary and positive development, which is still in process.

Spurred on by the need to protect MICRA against the impending attack by the trial lawyers, delegates contributed a total of $180,000 to CalPAC, a record high for the HOD. A resolution that targeted the UC Medical Schools’ exemption from the Corporate Bar was soundly defeated. The vote was so lopsided that it clearly reflects CMA’s commitment to the medical schools and reaffirms CMA’s mission to represent doctors in all modes of practice and serve as an umbrella organization dedicated to empowering physicians and promoting public health.

Two policy actions (among a hundred others)

4 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

by the House directed CMA: - To sponsor legislation to require insurers to reimburse physicians for telephonic and electronic patient management - To support elimination of the “outpatient observation status” because it places an undue financial burden on patients Also, more in the ceremonial realm, new officers were elected, past presidents were honored, the Nye Award (for advancing physician well-being) and the Meissner Award (for exemplifying the virtues of a rural practitioner) were bestowed on outstanding doctors whose accomplishments and dedication to patient care made me, for one, very proud of our profession.

Closer to home, the 2nd Annual Healthcare Awards Program, presented by the LACMA-affiliated Patient Care Foundation of Los Angeles County, was held on October 17 at the California Club in Los Angeles. This meeting appears to be almost entirely ceremonial; it provides well-deserved recognition to persons and institutions that have made extraordinary contributions to medicine and to healthcare in general. Not incidentally, it also raises the profile and recognition of LACMA among community leaders and physicians.

However, it also has an important “practical” function: the money raised by sponsors of the program support the Foundation’s Medical Student Scholarship Program. As of this writing the accounting is not complete, but we anticipate the Foundation will receive tens of thousands of dollars from the event.

Details of the Awards Program, with photographs of participants and information about the awards and the recipients, can be found elsewhere in the magazine. I urge you to “read all about it.”

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.

Go from residency to a residence

Explore an exciting home financing opportunity for new doctors If you are a medical doctor and have completed your residency within the past three years, you may be able to take advantage of an opportunity to buy a home as you establish your practice.

In order to be eligible for this program, you must agree to meet with one of our bankers, giving you the chance to work with an experienced professional.

Contact us today for more information.

Ghazal Doustar Home Mortgage Consultant 310-312-0312 ghazal.doustar@wellsfargo.com www.wfhm.com/ghazal-doustar NMLSR ID 585135

Examine the benefits • Higher loan amounts — Up to $850,000.

• Low down payment — Less than 20% with no mortgage insurance required.

• Flexible financing

options — Fixed-rate and adjustable-rate mortgages (ARMs) available.

David Eghbali Home Mortgage Consultant 310-445-5626 david.eghbali@wellsfargo.com www.wfhm.com/david-eghbali NMLSR ID 450328

Information is accurate as of date of printing and subject to change without notice. Wells Fargo Home Mortgage is a division of Wells Fargo Bank, N.A. © 2011 Wells Fargo Bank, N.A. All rights reserved.

NMLSR ID 399801 AS989185 Expires 8/2013

P R ACT I CE M A NAG EMENT | FR ONT OFFICE

Marketing to the Newly Insured

By Raquel Baldelomar

M a ny d o c tors a n d medical institutions have yet to create marketing plans that specifically tar-

get the newly insured--those Americans now enrolling in plans provided under the Affordable Care Act . Yet if the ACA is as successful as its proponents hope, it would be naïve to assume these new consumers will respond positively to strategies that were successful with previous patients. dentials with a human touch, such as telephoning the patient after procedures or offering a prompt response to their emails and texts.

Easy Access & Location

A large number of the newly insured will be working two or more jobs or will be freelancing, implying a more unpredictable workday. Therefore, the ease of making appointments will be vitally important, and the ability to book online will be expected. Many of these consumers will not end their day at the traditional 5 or 6 o’clock, so providing extended office hours, especially later at night, and offering to text them if a delay is imminent will be helpful in establishing loyalty.

Expectation of Web & Social Media Presence

Many factors differentiate the needs and wants of the newly insured from those currently receiving care, and their choice of care providers will reflect these differences.

Who are the newly insured? According to a brief prepared by a Kaiser Commission study [footnote], 60% of the uninsured population is comprised of childless adults, and of these, 41% are under 35 years of age. Patients under 35 have much different expectations and doctor loyalty than those in older age brackets—for example, they are much more likely to switch doctors and hospitals—but under-35 consumers have additional requirements.

Value

Many of these first-time purchasers will be spending what they see as a significant percentage of their income on insurance. Consequently, they’ll insist on value for their money and will seek out doctors and hospitals that appear to provide it. It will be important for physicians and hospitals to create marketing materials that heavily emphasize their expertise and use of the most cutting-edge and effective techniques while at the same time complementing these services and cre-

6 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

Having grown up using and relying on social media for almost every type of decision making, the newly insured will put greater emphasis on information gained via Facebook and blogs than more established patients. Having a positive, strong and active Facebook presence can make a significant difference.

Websites will have a major influence on the patient’s decision making process. The look and tone of the site: warm, empathetic and bursting with real-life success stories, friendly blog posts written in a conversational style, videos of the doctors explaining their roles and telling stories will win out over cold clinical language and confusing medical terms.

Office Environment

Not being used to medical environments, the newly insured will respond to waiting rooms , hospitals and clinics that create an office atmosphere that feels familiar and comfortable. Amenities such as free mineral water, wi-fi and coffee bars will definitely be appealing and distract from long wait times.

In conclusion, using these insights to create a targeted marketing plan will inevitably allow a medical provider to stand out from their competitors and to easily interest a fresh new market.

Raquel Baldelomar, is founder and managing director of Quaintise, www.Quaintise.com

The TrueBeam™ radiotherapy system unlocks treatment opportunities...

...for even the most complex cancer cases.

For Physicians

For Patients

Advanced Radiation Centers is proud to be

TrueBeam was designed to treat your

TrueBeam was designed to ensure the

area offering TrueBeam. We enhance this

patient’s cancer with unparalleled

most comfortable treatment tailored to

cutting-edge therapy with unparalleled

ease, precision, speed and specificity:

your type of cancer:

comfort and service, including an inviting,

•

•

Fast, precise treatments take just minutes a day.

•

Advanced communications systems keep you in close contact with the technologist.

•

Music feature creates a soothing treatment environment.

•

Delivers advanced treatment techniques including IMRT, IGRT, SBR and SRS with gamechanging flexibility.

Expands treatment options for even the most challenging cancers, including prostate, head/neck, lung, breast, brain and abdomen.

•

Sophisticated motion managmement synchronizes beam delivery with respiration.

•

Generates high-quality, 3-D, cone-beam CT images 60% faster* using 25% less x-ray dose. *Compared to earlier generations of Varian imaging technology.

among the few providers in the Los Angeles

easy-access facility; bright, spacious treatment rooms; and a dedicated Cancer Navigator to guide each patient through the treatment process.

Rosalyn Morrell, MD Radiation Oncologist

Advanced Radiation Center of Beverly Hills is a multi-lingual facility.

8929 Wilshire Boulevard, Suite 100 Beverly Hills, California 90211 424.249.7500 arcbeverlyhills.com

l i festy le & wellness | B A LA NCE

Coping with Grief and Loss LIz ferron

D e a ling w ith d e ath and dying—it’s among the most stressful experiences most humans en-

counter, but the first lesson taught in medical school is not to care too much. Emotionalism is viewed as unprofessional and thought to interfere with patient care.

What about the health and well-being of the physician? Are caring and empathetic doctors at a higher risk for burnout and “compassion overload”? The research suggests not: • In a recent study of palliative and hospice-care clinicians, frequent exposure to death and dying was largely a positive experience that added meaning to their lives.

• In a 2009 study, participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care.

• A 1995 study found that oncologists who expressed an inability to communicate with patients had greater stress and more symptoms of burnout.

Experiencing Grief & Loss: It’s Not All Sadness

Physicians often underestimate the toll that death and dying takes on their emotional health and well-being.

Just because you “don’t have time” to think about your emotions doesn’t mean you aren’t experiencing them.

To master this unstated curriculum, medical students have historically developed an emotional armor shielding them from feeling too much and disguising any depth of emotion experienced. By graduation from medical school, physicians have gained experience with death and dying patients. While studies show that they’re far less apprehensive about communicating with dying patients and their families than first-year students, their degree of empathy has dropped.

Detachment In Practice: How Physician Empathy Affects Patient Care

While a certain amount of emotional detachment is necessary, how much is too much? Studies conducted over the past 20 years suggest the emotional detachment that physicians work so hard to develop isn’t helping patient outcomes: • Numerous studies suggest that patients who perceive their doctors as emotionally distant when giving a cancer diagnosis are less apt to adhere to their treatment plans and seek subsequent care.

• In a three-year study of 891 diabetic patients, patients whose physicians had high scores on the empathy scale were significantly more likely to have good control of hemoglobin A1c (56%) than patients of physicians with low empathy scores (40%).

• In a 2010 study, when patients perceived their clinicians as empathetic, the severity, duration and objective measures of the common cold significantly changed.

8 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

In many instances, it’s not only the intensity of the emotions that upsets a physician, it’s also the nature of those emotions.

In addition to sadness over the loss of a patient, most doctors feel a wide mix of emotions, including anger and guilt. It’s not unusual for them to lose confidence, blame the patient, worry that they did something wrong, or worry about getting blamed for something they couldn’t have prevented.

Though those reactions are commonplace, it’s also quite normal for physicians to think they’re “the only ones” that ever experienced them. Physicians are typically somewhat competitive with their colleagues and concerned about appearing less than competent. It’s not unusual for them to isolate and suffer in silence.

Here are ways that physicians can deal more constructively with their emotions—and regain the empathy they might have lost: • Accept that it’s normal—and healthy—to have these feelings, and take time to examine them.

• Talk about them, perhaps with a physician peer coach or colleague who understands the pressures faced by physicians today—and the mix of anxiety, concern, self-doubt, justifiable/unreasonable irritations and grief involved in dealing with critically ill patients and their families.

• Understand that others on the care team are probably experiencing similar emotions. Having your organization conduct sessions such as Schwartz Center Rounds can provide a way for colleagues to share experiences, thoughts and feelings.

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

O n O c tob e r 17, Patrick Soon-Shiong, MD,

joined last year’s Healthcare Champion of the Year awardee, Los Angeles County Supervisor Mark Ridley-Thomas, in the new Healthcare Hall of Fame. Dr. Soon-Shiong, chairman of the Chan Soon-Shiong Family Foundation, leading medical researcher and scientific inventor as well as prominent philanthropist, was named by the Los Angeles County Medical Association (LACMA) and the Patient Care Foundation the recipient of the annual Healthcare Awards, which celebrate leadership, innovation, education, and community service in Los Angeles County.

1 0 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

LACMA’s second annual Healthcare Awards dinner provided the opportunity to recognize outstanding physicians in the community while raising funds for the Patient Care Foundation’s Medical Student Scholarship Program, which gives students from underserved areas the funds to fulfill their dream of going to medical school.

Troy Elander, MD, president of the Patient Care Foundation of Los Angeles County, said the event is a “win-win.”

“There are a lot of worthy people, but it’s wonderful to recognize these people who have done such significant things,” Dr. Elander told PNN. “They are so inspiring, and in the process of recognizing these great achievements, we are also raising funds for medical school scholarships.”

Dr. Elander describes this year’s Healthcare Champion, Dr. Patrick Soon-Shiong, as a wonderful selection.

Dr. Soon-Shiong is the chairman of the Chan SoonShiong Family Foundation and a leading medical researcher, scientific inventor and philanthropist.

“He’s done so many things not only in the field of medicine, but also as a philanthropist,” Dr. Elander said.

His new company, NantOmics, aims to change the way cancer is attacked. In 2007, Dr. Soon-Shiong also founded NantHealth, which uses a supercomputer-based system and network that analyzes genetic data. The goal is to share the genomic data among sequencing centers, medical research hubs and hospitals to advance cancer research.

The event also featured the winner of a scholarship program who has dreamed of going to medical school. Thanks to the foundation, her undergraduate and medical degree programs at Brown University are fully funded.

“The foundation doesn’t only give money, but they treat students like family and offer them emotional support,” Dr. Elander noted.

Other Honorees at the Event Include (pictured above in order, left to right):

Christopher Crisera, MD, and Kodi Azari, MD, co-directors of UCLA Operation Mend, were honored with the Innovation Award for Community Service. Operation Mend provides returning military personnel with severe facial and other medical injuries access to the nation’s top plastic and reconstructive surgeons and comprehensive medical and mental health support for the wounded and their families.

Eric Savitsky, MD, UCLA Emergency Medicine Center, was honored with

the Hospital Physician Leadership Award for his outstanding service to the community and patients.

Patrick Soon-Shiong, MD, Healthcare Champion of the Year awardee, Richard Zapanta, MD, Eastside Orthopedic Medical Associates received this year’s Independent Physician Leadership Award for his contributions to professional groups and health communities and service to patients.

Westside Family Health CenteR (represented by Ms. Debra Farmer, President/CEO) a leader in women’s and family health, received the Innovation Award for Facilities for delivering quality patient care, improving the health of its patients and promoting a healthier community.

Carmen Puliafito, MD, Office of the Dean, Keck School of Medicine, USC, was honored with the Innovation Award for Technology for his contributions to academic medicine and diagnosing and treating retinal disease.

Matthew Lin, Md, founder of Pacific Orthopedic Medical Group and

president of Central Health Plan and AHMC International Cancer Center received the Innovation Award for Public Education. His leadership in education initiatives and international and local relief efforts has a profound impact in his community.

Rocky delgadillo, CEO LACMA

N OV E M B ER 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 11

phy s i c i ansnewsnetwor k . com | NEWS i n revi ew

Read Full Stories and Subscribe to the PNN eNews BulletinS at www.PhysiciansNewsNetwork.com A SERVICE OF

NEWS NETWORK

The LOS ANGELES County Medical Association

PNN | LOCAL • TIMELY • RELEVANT

reporting on the economics of healthcare delivery

Decision in Favor of MICRA Huge Victory for LACMA In a published opinion, the 2nd District Court of Appeal recently upheld the constitutionality of California’s Medical Injury Compensation Reform Act (MICRA), which marks a huge victory for LACMA and other groups trying to preserve the landmark law.

In Rashidi v. Dr. Moser, the jury awarded the plaintiff $125,000 in economic damages and $1,325,000 in non-economic damages.

The new LACMA advocacy campaign to defeat California’s trial lawyers’ threat to go to the ballot box and repeal MICRA continues to win supporters.

LACMA’s District 9 president, William Averill, MD, told PNN last week that the Torrance Memorial Medical Executive Committee approved an immediate allocation of $100,000 toward the campaign and plans to provide additional funding.

St. Vincent Medical Center, Facey Medical Group and Providence Holy Cross each donated $5,000 as of Oct. 14, 2013.

Policies Set on Important Issues at CMA House of Delegates The California Medical Association’s (CMA) annual House of Delegates convened in Anaheim on October 11-13. LACMA delegates along with physicians from across the state debated and set policy on important healthcare issues including vaccinations, the Affordable Care Act, health information technology and public health.

During the three-day meeting, the 500 delegates addressed nearly 90 resolutions on these and other key issues that affect the practice of medicine.

LA County Physicians Buck Trend to Leave Private Practice Two LA County private practitioners say they have no plans to enter into hospital employment, contrary to the trend of the fleeting solo practice.

Drs. Lisa Thomsen of Glendora and Dr. Emil 1 2 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

Avanes of Glendale rank among several private practitioners who, according to the 2012 Physician Benchmark Survey published by the American Medical Association (AMA), run opposite to media reports and experts forecasting the shrinking solo practice and a consolidation trend.

LACMA Follows Up Town Hall Meeting with Letters to Health Plans With the implementation of Covered California gaining traction, LACMA continues its efforts to help its physician members navigate the unknowns and represent doctors’ concerns.

“We have a direct connection to Covered California representatives and the health plans that attended the Sept. 17 town hall meeting, and we are doing our best to represent physicians and the concerns of our doctors and facilitate a response,” said Rosario Ortega, LACMA’s membership outreach representative.

Another Big Affiliation to Bridge Academia and Primary Care UC Irvine Health and MemorialCare Health System are entering into an affiliation agreement to begin a new collaboration with a partnership to open new primary care health centers in Los Angeles and Orange Counties.

According to the joint announcement made by the two health systems, this is the only healthcare partnership in Orange and Southern Los Angeles counties that includes the entire continuum of care. Services range from an academic medical center, teaching and research hospitals, a children’s hospital and community hospitals to scores of physician practices, outpatient centers, imaging facilities, ambulatory surgery centers, urgent care, a health plan and retail health.

City of Hope and Providence Partner to Expand Oncology Services in LA County Los Angeles-based City of Hope and Providence Health & Services, Southern California, announced their intent to affiliate in order to expand access to

Change in Sponsorship of Saint John’s Center Providence Health & Services Southern California announced recently it signed an agreement with SCL Health Systems (SCLHS) to assume sponsorship of Saint John’s Health Center in Santa Monica.

The deal is pending approval from the Archbishop of Los Angeles, Vatican officials and the Attorney General of California in the next three months. If the agreement is approved, Providence is expected to assume sponsorship and management of Saint John’s at year-end or the first quarter of 2014.

Concierge Groups Looking to Add Sites in Los Angeles Personalcare Physicians, which manages concierge medical groups and was recently ranked among Orange County’s fastest-growing private companies, is rapidly expanding with plans to make its way into Los Angeles.

“We plan to open at least two practices with a maximum of four a year in the next four years,” said Troy Medley, CEO and co-founder of Personalcare.

This November, the company will open a site in Aliso Viejo. A fifth site is planned in Newport Beach next summer, then San Diego in 2014 and Los Angeles in 2015.

ACA Will Bring Major Changes to Addiction Care in LA County With the Affordable Care Act’s recognition of drug addiction and alcoholism as chronic diseases that must be covered by health insurance plans, healthcare systems and providers in Los Angeles County and elsewhere anticipate major changes in addiction care.

The biggest change is that 40 million people could enter substance abuse treatment, which opens a huge market for addiction care, according to news reports.

N OV E M B ER 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1 3

news i n rev i ew | phy si c i ansnewsnetwor k . com

oncology services within the Southern California communities served by Providence. The two organizations signed a letter of intent last week.

This may be an indication of an accelerating trend of academic medical centers forming partnerships with healthcare organizations that have a strong primary care emphasis. Only last week PNN reported on an affiliation of MemorialCare with UCI Medical Center, which had a similar goal.

S P ECI A L S ECT ION | HOLIDAY T R AV EL

Why Should I Use a Travel Agent?

Tama Taylor Holve

O h , com e o n a n d a s k . . . You won’t hurt our feelings! We’ve heard all the questions before and

truly appreciate the opportunity to answer! Uh...why should I use a travel agent? There are many reasons why clients use our services and for holiday, as well as business and vacation travel, yet, there are times when even we feel it’s not necessary and we’ll let you know when that is the case!

1. We will make sure that all the components of your business trip or vacation come out “together.” It’s way beyond airlines and hotels; it’s passports, visas, insurance, inoculations, transfers, parking, restaurant and spa reservations, tickets to events, metro passes, tour guides, and so, so much more.

2. We will strive to make you a client for life. We will not sell you just anything; we will search to find what’s the perfect “fit” for you.

3. We will advise when we believe something is better than what you may have chosen or agree when we think you’ve found what’s best!

Hasn’t the Internet put all Agencies out of Business?

Sixty-eight percent of all airline travel is still booked by travel agents.

Business people, who are the “road warriors” of lore, overwhelmingly use travel agents, as they recognize the value we bring to the travel reservation, purchasing process and on-theroad support.

Can you cook? Let’s assume your answer is “yes,” then why do you go to a restaurant, paying a premium for food that could be made at home?

Dining out is easier than cooking at home, isn’t it?

Is the chef the expert at preparing what you’d like to experience...making it all come out at the same time, as you hoped it would? Do you become a steady customer if it’s just what you wanted? Isn’t it the total experience? Having someone wait on you, describe the dishes, and clean up afterwards are all integral parts.

Would you frequent this restaurant if they didn’t “cater” to your likes and dislikes or if you felt they were not delivering value for the money paid? What if the wait staff knew that the Blue Plate Special was really not good but sold it to you anyway, they didn’t seem to appreciate your business?

Now, let’s talk about shopping. Specifically, let’s talk about the very special times in a woman’s life when she’s shopping for an important occasion, her prom dress, her wedding gown. Does she go it alone?

Well, usually not. She will most often ask a close friend whose taste she appreciates, her sister or her mother to go with her to give her advice as to whether or not it’s perfect for her.

Are you getting the drift? We can save you enormous time.

1 4 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

In a word, no. What most people don’t realize is that when they go online to search for travel options, they are nearly always going on a travel agent’s website. It may be an individual sitting in their bedroom in Florida with a super website or a mega travel agency using any number of business aliases. But, unless you are on the official website of the cruise line, hotel, or airline, you’re looking at a travel agency’s website. Expedia, Travelocity and others are travel agencies that have chosen to distribute their product over the Internet. And, what did they do when their business model started to fail? They put in call centers for the human touch, and their business has improved.

Sixty-eight percent of all airline travel is still booked by travel agents. Business people, who are the “road warriors” of lore, overwhelmingly use travel agents, as they recognize the value we bring to the travel reservation, purchasing process and on-the-road support.

What we have found in the current economy is that travelers are looking for security, trust, relationships, and value. They simply don’t want to gamble with either their time or money.

Please do what we do—research on the web, do some looking around, but before purchasing that travel experience, visit our website for ideas; www.WillettTravel.com and then call us for the personal attention you deserve.

Doesn’t it cost more to go through a travel agent?

Sometimes, yes, but, usually, no. If you’re the traveler who strives for the cheapest price above all else,

Many prefer to travel independently, and our expertise in designing customized itineraries offer flexibility, ease, security and value.

What’s the difference between a travel agent & consultant?

The title “travel agent” was very accurate when for decades you could purchase airline tickets, rail travel, and steamship passages only from agents directly licensed by these entities. Through the years, the role of the agent has grown into that of a consultant. Although “agent” is still widely used, we actually work on behalf of our clients, not the travel suppliers.

A travel consultant’s career is dependent upon building trust with clients, developing knowledge of what the client values, and counseling on the absolute best way to spend precious vacation dollars, and their even more precious time. A company or website that is not looking at being your “travel agent for life” may sell you anything—regardless of whether it’s right for you. We won’t.

Tama Taylor Holve, CTC, CTIE,WILLETT TRAVEL, 818-762-0676 ext 234 * 818-763-7806-fax, www.WillettTravel.com

Avoiding Travel Stress Marion Webb

If you’re feeling stressed just thinking about traveling during this holiday season, you’re not alone.

Here are six simple tips to ease your travel pain: 1. Do Your Research - If you’re driving to visit family this holiday season, giving yourself an extra day to travel or taking the less scenic route could make for a more pleasant drive. When flying, make sure to check airline restrictions early, arrive way ahead of time and avoid checking in luggage whenever possible.

2. Travel Outside Peak Days - With Wednesday before Thanksgiving being the biggest travel day of the year, a better option may be leaving on Thanksgiving Day or a few days ahead of schedule to avoid record traffic and travel.

3. Plan for the Unexpected - If you have only an hour before connecting to your next flight, you may want to consider booking another flight. Leaving extra time before and between flights to deal with security, long lines, flight delays due to extreme weather, and other unexpected events is especially critical during the holiday travel time.

4. Travel Early or Late in the Day - Flight statistics show planes traveling earlier in the day have a better ontime performance. And if your flight is cancelled, you have the option of taking a flight later that same day, which eases the stress of traveling as well.

5. Don’t Abandon Healthy Habits - ‘Tis also the season for overindulging and letting go of healthy habits like your exercise regimen. Realizing that bad habits will only add to your stress level, let alone your waistline, follow these easy tips before going to your next holiday party: • Bring a healthy dish to the party.

• When consuming alcohol, drink one glass of water after consuming alcohol to stay hydrated and avoid overindulging • Make it a point to exercise before going to a party • Stay away from the dessert tray • Avoid second helpings 6. Stick to an Exercise Routine - This is the time of year when many people abandon their exercise routine.

Don’t let this happen to you. Hiring a personal trainer, working out with the entire family by going for walks or hikes together or playing outside, and going for walks after your big holiday dinners as a family will not only de-stress you, but bring the entire family together.

Follow these easy tips and you’re guaranteed to have a happier, healthier holiday. Happy Holidays!

N OV E M B ER 2013 | 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

H OLIDAY T R AV EL | S PECI A L S ECT I ON

then you’re probably not going to appreciate what we do.

On the other hand, if you’re the traveler who wants the best price for the experience that fits you perfectly, then you are the client who would appreciate our service and the emphasis we place on value. (You can return the cheap sweater that you realize you don’t like; the time you spent on a vacation, or business trip can’t be returned.)

Our buying power is enhanced by our membership in Signature Travel Network, the leading Travel Agency Cooperative in North America. With sales of over $5 billion and 320 offices, we are proactive in offering discounts and added value amenities that are incomparable. Proudly, we are a Four Seasons Preferred Partner; you will receive much better rates and inclusions through us than if you were to book their hotels directly.

For our Travel Management Fee, travel details are anticipated and you are accorded our attention from long before the initial deposit is made, during your journey, and until after your return.

By

M

ar

io

n

W eb

b

feature | B EST PR ACT ICES

With the rollout of Covered California under way and the wider implementation of health reform being merely weeks away, efficiency, quality and optimal healthcare delivery are more critical than ever for physician practices. This article provides a comprehensive overview on making the best hiring decisions, identifying tools to run a more efficient and effective practice, optimizing your time management and finding ways to increase your revenue stream. It also offers practical steps to become HIPAA-compliant as well as how to use mobile health to your advantage.

Resources for Practice Success

• Will it help you improve accuracy?

• Will it help you become more efficient?

• Will it help you minimize compliance risk while improving your bottom line?

Coding and Billing Resources

Every practice must have the most-up-to-date coding and billing tools to make sure every dollar is collected without claiming non-billable services.

The typical practice purchases include the Physicians’ Current Procedural Terminology, International Classification of Disease (ICD-10), Healthcare Common Procedure Coding System, The National Correct Coding Initiative and the Resource-Based Relative Value Scales.

Additional resources include Practice Management, which provides physicians outside managerial advice, and Compliance, which satisfies state and federal requirements of the Office of Inspector General (OIG).

Adopting an OIG compliance plan is voluntary, but it shows a good faith effort to comply with standards set by public and private payers. An OIG fraud and abuse compliance plan has the following six elements: • • • • • •

Standards of Conduct Training and Education Appointment of a Compliance Officer Open Lines of Communication Monitoring Enforcement

Other compliance areas to consider are OSHA (Occupational Safety and Health Administration), which sets and enforces standards for employees and patient safety, and HIPAA (Health Insurance Portability and Accountability Act), which sets standards for transactions between providers and payers, patient privacy, and security for electronic data.

When it comes to maintaining reimbursement and compliance, your greatest resource is your staff.

Professional certifications and credentials and the education and training that come with them can help ensure that your staff is competent, productive and up-to-date on the complex rules and regulations, which will be pivotal during this time of change.

The following organizations offer certification programs for practice staff, often for free: • The Medical Group Management Association (www.mgma. com) offers certification for physician office managers through the American College of Medical Practice Executives (ACMPE).

• Practice Management Institute (www.pmimd.com) offers certifications for medical office managers, medical coders, and medical insurance specialists.

• DecisionHealth offers certification and education for specialty practice coders through its Board of Medical Specialty Coding (www.medicalspecialtycoding.com).

• The American Academy of Procedural Coders (www.aapc. com) offers various medical coding certification exams for physician practices and the outpatient facility environment, and specialty certification.

Consultants

A consultant can serve as a physician’s physician diagnosing and curing practice ailments.

Look for consultants with practical experience, have a good understanding of your expectations and long-term goals, and who can help you with your revenue cycle management, regulatory compliance and operational efficiency.

The best way to find a consultant is via a referral, but you can also check with your state, county or specialty society or professional organizations such as LACMA, who have vetted referral sources for you and may be able to provide discounts.

Medical Associations

While it has always been critical for doctors to become members of their local and state medical associations, the current health environment with its uncertainties and challenges demands it.

Together, physicians can get their voices heard by lawmakers, for-profit health industry members, government regulators and others trying to interfere with their ability to care for their patients.

LACMA and other associations are partners working every day to develop and maintain a physician-led, patient-centered health environment. Association members also get valuable discounts on resources.

N OV E M B ER 2013 | 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

B EST PR ACT ICES | feature

Every practice is different, but each requires basic resources to ensure that a l l claims are submitted accurately to insurance companies the first time around, which cuts the delays in accounts receivable and can increase practice viability.

In today’s world, physicians can get many resources for practice management for free, but that doesn’t mean they should. Often, buying a superior product will improve accuracy and productivity, because they are easier to understand and easier to use. Therefore, you want to consider the following three items before making your purchase:

feature | B EST PR ACT ICES

Whether it co me s to seeking a new receptionist, biller or office manager, making the right hiring decision is key to any successful physician practice.

The right individuals should not only possess the needed skills, knowledge and experience, but also have a positive attitude and work well with other employees and management.

Here are some of the key considerations for hiring the best person for the job.

hiring qualified personnel

Job Description

A well-written job description lays the foundation for improved performance management of employees.

A good job description should define all tasks and responsibilities of the position and follow these guidelines: • • • • • •

Be precise in the descriptions.

Include only pertinent information.

Define salary, hourly range for the position .

List all required skills (Microsoft Word, Excel, etc.).

Explain work relationships and boundaries.

Describe the tools and equipment used at the job.

Recruitment

Once a job creation is developed and the employment needs are identified, your search begins.

Experts recommend narrowing down applicants to three people, taking into account their experience, salary expectations, skills and most important the proper chemistry to work well with your team.

A good way to weed out candidates and save time in reading resumes is to grade them with letters A, B and C. Ideally, you’re looking for candidates who are committed and want to grow with your practice. However, remember that some candidates may have valid reasons for gaps in employment, such as wanting to stay home to raise children or caring for a loved one.

Once you find a good candidate, schedule a phone interview first. This is particularly important for hiring a receptionist. You want your receptionist to have a friendly voice and sound professional.

2 0 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

Interview

If you find a good fit, schedule your first face-toface interview.

Experts recommend that you come prepared by writing a list of standard questions that you ask all candidates and take notes. Ask only job-related questions and try not to ask closed-ended questions.

Good questions to ask are the following: • • • •

Tell me about yourself.

What are your short-term and long-term goals?

What are your strengths and weaknesses?

How would you describe your current supervisor and co-workers?

• What is it about this job that interests you?

Be aware that questions related to race, national origin, gender, age, sexual orientation, marital status, children, religion, residency, physical and mental condition or disabilities, and foreign languages spoken at home are illegal.

Checking References

Similarly, when checking references, you want to avoid the following common pitfalls: • Employers may be sued for defamation of character if found giving inaccurate or false information.

For this reason many employers will now only verify only basic information, such as title held and dates of employment.

• References are often mere opinions.

• You may end up screening out an excellent candidate because of personality conflicts or disagreements with a previous employer.

Training

Training new employees is absolutely necessary, no matter how much experience the person brings to the table. You want to ensure that the new staff member clearly understands the responsibilities of the new job, gets a chance to review the office policies and procedures manual with the office manager and signs and dates it, and that all necessary paperwork has been completed at this time.

Keep in mind that everyone learns at his or her own pace.

But it’s always a good idea to praise your employees for a job well done. Consider giving bonuses to show your appreciation to ensure that the goals are attainable and clearly communicated.

A great team that works well together can do wonders for improving your practice and growing your business, both of which will be ever more essential in this changing health environment.

Looking at Your Practice with the Eyes of Your Patient

The first step in doing so is to take a close look at where your practice is succeeding and where it needs improvement. To do this requires you to put yourself into the shoes of a patient undergoing registration and check-in.

Therefore, you want to experience what it’s like to be a patient in your own practice. Experts recommend the following five steps for assessing your practice: 1. Find and review your documentation you have for check-in and registration procedures and make a list of all forms.

2. After you have reviewed the documentation, you can begin interviewing your staff by having them walk you through the process. You want to take notes to see if your staff is knowledgeable, identify bottlenecks and inefficiencies, create an updated job description (if needed) and create new training tools and education to bring your staff up-to-date and give your staff the opportunity to provide comments and feedback.

3. Next, watch your staff conduct patient registration and check-in twice a week for several weeks during peak hours, which will give you a very good idea about shortcomings and how your practice is doing. However, don’t make suggestions just yet— just listen and observe.

4. Have different staff engage in role-playing during peak hours several times during the month and take notes. Honestly assess your waiting room to see if it’s truly clean, friendly and well functioning in all aspects, then observe the people in the waiting room and take note of remarks.

5. Once you’ve completed all the steps, deficiencies will become apparent and you can take steps.

Outline recommendations, determine the cost to make changes, meet with your staff to discuss recommendations and fine-tune the process and monitor progress over time.

Identify and Eliminate Variances

Variance in the ways tasks are performed can contribute significantly to breakdowns in processes, which can create inefficiencies.

Here are five recommendations to eliminate variances, increase practice productivity and reduce work.

1. Define Roles: Successful businesses maintain manuals that clearly define employee roles and provide step-by-step instructions on how to complete tasks.

2. Front-End Processing: Reduce inaccuracies by verifying all patient information at the time of scheduling and verify the information again at check-in.

3. Appointment Scheduling and Check-In: Ensure that your appointment calendar is optimized and that your staff is trained in learning online tools.

4. Collecting: Collecting co-pays, coinsurance, deductibles, and past due balances from the patient at time of service is often the most overlooked task in a physician’s practice. Remember that copays alone can represent as much as 20% of a physician’s income.

5. Manage Call Volume: Instituting better processes will be increasingly important for successful practice. Putting patients on hold for long periods of time or not responding in a timely manner will turn patients off and prompt them to go elsewhere.

U n d e r he alt h r e fo r m, small practices will face more scrutiny regarding HIPAA policies, documentation and procedures.

New Rules—What It Means for Your Practice

hipaa compliance

While March 26 marked the effective date for the 563-page “omnibus” privacy and security rule, most aspects of the rule became effective on Sept. 23.

In case you missed it: Doctors who had a HIPAAcompliant business associate agreement in place before the new rule’s Jan. 25 2013 official publication date in the Federal Register, and whose contract didn’t need to be renewed between March 26 and Sept. 23, have a one-year grace period; those who didn’t have a contract in place prior to Jan. 25, 2013, needed to get a contract compliant with the new rule in place by Sept. 23.

Another big change involved the policies and technologies needed to comply with a patient consent management provision.

Under the ARRA, a patient who pays out of pocket for treatment can ask a provider not to share a record of that treatment with the patient’s health insurance plan, and a provider must comply with that request, which means staff need to be made aware and trained to never pass on that information.

N OV E M B ER 2013 | 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 2 1

B EST PR ACT ICES | feature

time management

D u r in g this time of change, when doctors are expected to do more with less, time management and cost control are pivotal.

The best way to learn whether your practice is running as efficiently and effectively as possible, it’s crucial to review how your day-to-day work is performed and then develop an action plan to optimize tasks.

feature | B EST PR ACT ICES

HIPAA Enforcement

HIPAA enforcement is real. Data from the Office of Civil Rights (OCR) show that complaints and investigations are on the rise. HIPAA complaints have risen since 2003 by 117%, according to the experts. Most complaints come from disgruntled employees.

For this reason, it’s key for physicians to review their current policies and procedures and upgrade them if needed.

Federal law does not create what is known as a private cause of action under HIPAA, which means private individuals cannot sue for a privacy or security violation citing HIPAA regulation.

Only the federal government can enforce HIPAA and take covered entities to court for violations.

However, some states have allowed private parties to bring actions seeking remedies for violations of HIPAA.

How Can You Lower Your Risk?

The best defense against HIPAA-related action is not to have a privacy or security violation occur.

Here are five tips to help lower your risk, including medical identify theft: 1. Periodically review your HIPAA privacy and security compliance efforts.

2. Ensure that all staff members are up-to-date on training.

3. Ensure that your business associates have a written agreement in place.

4. To protect medical information, contact your vendor to see who has access to which information online.

5. If an employee is terminated, make sure all health records are protected immediately upon termination.

Compliance Review and Investigation

Physicians should be aware that in the case of a complaint or investigation, HIPAA requires cooperation from covered entities, including allowing investigators access to facilities, records and other information at any time and without any notice.

With the government likely focusing on more audits as an educational tool, doctors are well served to stay prepared. To learn more about the HIPAA audit program, visit http://bit.ly/HIPAA-Program.

Understanding Your Revenue Stream

In today’s environment of decreasing reimbursement, consumer-directed healthcare and increasing complexity around payer-specific payment rules and medical policies, it’s ever more critical for solo practitioners and small practice owners to understand and manage their revenue streams.

To prevent shortfalls, you want to proactively

2 2 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

monitor incoming pay, in particular your accounts receivable (AR) by measuring your days in accounts receivable (DAR) by payer, service and provider and managing self-pay.

Measuring DAR: The first step in understanding your revenue is to look at how long it takes for you to receive pay for services you provided.

Here are five ways to analyze your payer DAR: 1. To understand where outstanding revenue sits by payers, run a standard AR aging report. This will give you a snapshot of your AR by payer and how long it takes each payer to correctly pay a claim.

2. Run the aging report to show outstanding AR by payer. If the total amount in the over-60-days category does not reflect the same percentage as your overall charge volume with that payer, you need to examine the payer more closely.

3. Report by service/CPT code tells you how long it takes to receive pay for each service you perform and allows you to identify trends that have a negative impact on your AR. 4. Report by rendering provider helps you to identify providers that have a higher outstanding AR amount relative to their peers with a given payer.

5. Use the information in renegotiating contracts or in trying to improve payment times, which in turn will help you run a more efficient billing system.

Managing Self-Pay: Analyzing your self-pay will become increasingly important, as much of the cost of co-payment, coinsurance, deductibles and out-ofpocket expenses are increasingly being shouldered by patients. This, in turn, could make it more difficult to collect pay.

In reviewing your self-AR, you want to analyze the amount represented by self-pay and determine which payers contribute the most to your self-pay business.

Here are five tips for managing self-pay in your office: 1. Determine which payers contribute the most to self-pay and which tools they make available to assist you and help you estimate patient responsibility. Sometimes it’s easier to issue a patient a refund than to chase the dollar.

2. Create a well-documented office policy and set clear expectations with your staff and patients.

3. You want to collect full pay at time of service with the account being automatically flagged in your practice management system when balances are due.

4. If your practice offers payment plans, you want to collect partial pay before providing new services

5. Verify coverage of each patient and clearly define your collection policy.

These techniques are key for staying in the black

A m o n g the gre atest challenges for providers and payers will be the ability to keep business transformation models moving forward.

The requirements for addressing healthcare delivery to the sickest population with chronic diseases will become an even greater concern for organizations hardest hit with practitioner skill-level deficiencies.

To prepare for these business transformation challenges, every component of the healthcare universe will turn to mobile health, or mHealth, capabilities.

Already, glucometers have been shipping en masse since the 1990s, but providers have found these devices to be less than perfect. Problems include loss of key data, false patient submissions and nonprescribed episodic use.

Health experts predict that mobile devices with the following characteristics will become increasingly important:

will not only improve quality of care, but also cost less.

There are a number of provider organizations that have pilot programs under way.

For instance, the Veterans Administration Medical Center has been the leader in this space with 35,000 connected health devices deployed to date that are actively managing and improving patient care for veterans.

Meanwhile, private and public companies are also developing products they hope will ultimately improve population health, disease management and personalized medicine.

Whether it’s hiring new staff or trying to find the right electronic health system and other tools to optimize your business, implementing some of these strategies above will set you on the path to improving operational efficiencies, reimbursement, collections and growing your business to success.

Mobile health

• Those that support health information exchange across the care continuum and care delivery enterprise, robustly supporting organization-to-organization patient information exchange • Devices that are patient-centric with active patient engagement

• Devices that meet and can adapt to established mHealth standards

• Technologies that enable broad connectivity and interchange of data Experts predict that technologies with end-to-end capability will experience the most rapid demand and growth.

These technologies will allow for secure, shared information and can be accessed from many different locations. Patients will be able to use these technologies at their convenience through new service models that

B EST PR ACT ICES | feature

and will greatly reduce your administrative hassles.

With millions of newly insured accessing healthcare services in 2014, experts predict that hospitals, health systems, payer organizations and physicians will be faced with major disruptions, including frontend and back-end business operations, information systems and clinical services.

feature | B EST PR ACT ICES

In t he day-to-day operations of a professional practice, physicians focus on providing care to their patients, and with the mandates of the Affordable Care Act, that focus is expanding to managing the continuum of care for a patient, in essence moving from a quantitative methodology to a qualitative one.

One of the physician’s tools is to apply best practices to the ongoing care for their patients. At its simplest, a best practice is a method or technique that has consistently shown results superior to those achieved with other means and is used as a benchmark.

A series of best practices is used to create systems that allow care to be delivered effectively and efficiently while meeting the overall goal to provide quality of care to patients.

Just as the theory behind best practices can improve delivery of care, best practices can also improve the business aspects of the professional practice.

Together, best practices for treatment as well as for business results can have a tremendous impact on the bottom line of the business, and in turn increase its value.

To understand how these can impact value, a brief background on how value is determined when looking at a professional practice is necessary.

Most professionals are familiar with the idea of multiples. In short, multiples are simply an expression of market value of an asset relative to a key statistic that is assumed to relate to the value. That statistic, whether it is gross revenues, net income, EBITDA or some other measure, must bear a logical relationship to the market value observed.

The problem with multiples when valuing professional practices is that they no longer express value with any sort of accuracy that is worthwhile in today’s complex and volatile marketplace.

In order to appropriately determine the value of a professional practice, each practice must go through a rigorous analysis that considers three different methodologies: the market approach, the cost approach and the income approach.

The market approach focuses on a comparison of the business enterprise being valued to similar businesses that have actually been sold or have marketable shares of stock traded on an active market. If actual sales transactions of stock or equity interest have recently been valued at arm’s length, the prior transaction should also be considered in a determination of value based on the market approach.

In the context of professional practices, sales transactions of comparable business enterprises usually do not occur in a public market, but in private transactions. Information about transactions can frequently be obtained from trade associations, brokers, or other databases. However, those databases rarely contain sufficient information to infer a conclusion of value. Often this methodology is

relegated to a rule of thumb when looking at privately held, professional practices.

Under the cost approach, value of a professional practice is based on the net aggregated fair Jerome French market value of the underlying net assets (assets less liabilities) of the business entity.

This approach consists of restating the balance sheet of the enterprise by substituting the fair market value of its tangible and intangible assets and liabilities for the corresponding book values of such assets and liabilities. Since intangible assets are frequently not reflected on the historical balance sheets prepared on a cost basis, a methodology must be employed to estimate the fair market value of intangible assets.

This method often does not reflect the value of a successful going concern, as it does not take into account the synergistic value of the assets operating in conjunction.

The income approach measures the value of an asset as the present value of the future economic benefits to be derived from the asset. When applied to business ownership interests, value indications are developed by either capitalizing historical normalized earnings, or by discounting to present value of expected cash flows or projected earnings.

When valuing professional practices, the discounted cash flow method is most commonly utilized to address the uncertain nature of reimbursement and rapid changes in the healthcare industry.

If the methodology utilized is to discount to present value future cash flow, or future earnings, the future income stream is discounted using a discount rate.

The discount rate is determined by reference to the current market risk-free rate for the use of capital, plus a premium for the risk associated with the particular type of business or enterprise, plus an additional factor for the risk associated with the particular business, and an additional factor that represents the expected growth rate over time.

It is in the realm of the discount rate that the impact of best practices in place can have a dramatic impact.

At the heart of the discount rate is the concept of risk.

The implementation, monitoring and adjustment of best practices, creates a system of efficiency and stability, and stability decreases risk.

In an environment where decreasing reimbursement is a constant concern, the likelihood of a professional practice being able to make significant positive changes on its bottom line in the short-term is unlikely. The best way to positively impact the enterprise value of your practice is to take control of both the care you provide as well as the efficiency with which your business runs by implementing a system-wide use of best practices.

Best Practices and Their Impact on Enterprise Value

2 4 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

Jerome French, CPA, CVA, is the head of the Healthcare Division for Mann Urrutia Nelson, CPAs..

“When it comes to Meaningful Use, athenahealth did all the legwork… and then they made it easy for me to do.”

–Dr. Reavis Eubanks

This is how Dr. Eubanks

got paid for Meaningful Use.

A

fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months.

With guidance every step of the way and proven, cloud-based services.

 Best in KLAS EHR*

 Free coaching and attestation

 Seamless clinical workflow  Guaranteed Medicare payments**

85% of eligible athenhealth providers attested to Stage 1 Meaningful Use. And we’re ready for Stage 2.

Visit www.athenahealth.com/SCA or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians ** If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply.

Cloud-based practice management, EHR and care coordination services

associ at i on ha ppen i ngs | lacma news

ceo’s letter

H a ppy Th a n k s giving . Enjoy the holiday with your family and friends.

This fall season, LACMA will be ever more vigilant in following the many new developments affecting all physicians and the patients they serve in Los Angeles County.

The rollout of California’s Health Exchange on October 1 was mired in problems: computer issues, long wait times, misinformation and other glitches that prompted Covered California to shut down its online enrollment system twice. These challenges only reinforce the great need for all doctors to stand united behind LACMA and advocate on behalf of their patients.

With 700,000 newly insured patients expected to sign up via the exchange in Los Angeles County alone—the equivalent of all of San Francisco County’s population coming online as newly insured—and not enough physicians to take care of these patients, doctors in Los Angeles are rightly concerned and anxious.

To draw a comparison, imagine handing 700,000 Los Angeles County residents who have never owned a car before the keys to a new car. Then put them on the road.

Meanwhile, we do not add any new freeways, improve our streets, install new traffic lights or add safety traffic officers. It simply does not make sense.

But this is the new reality.

At this point, we remain hopeful that the country’s largest state-run health insurance exchange will eventually move in a more positive direction. We will keep a watchful eye on new developments.

LACMA and the Patient Care Foundation are doing their part in a small way to solve the physician shortage in Los Angeles County. Last month the LA Healthcare Awards reached a new milestone, raising over $100,000 to help support medical school student scholarships. We honored Dr. Patrick Soon-Shiong as the 2013 Healthcare Champion of the Year.

We continue to keep a pulse on other critical issues of the day.

While the delay of the dual-eligible demonstration project, or Cal Medi-Connect— with its earliest implementation now being slated for April 2014—marks a victory for LACMA and its newly created taskforce, challenges remain.

We will voice our concerns and seek details regarding the planned implementation of the demonstration project in Los Angeles County specifically during a meeting with Jane Ogle, deputy director at the California Department of Health Care Services, this month. We are hopeful that she will listen to the doctors regarding the many challenges this presents to our underserved patients.

Many doctors have indicated that they would leave the profession if the demonstration project becomes a reality. Disruption of care is a serious concern for all doctors but more importantly for their patients.

This fall, we will continue to reach out to large physician groups to stand with LACMA. Whether you are in a small practice or large group, all physicians in Los Angeles County need to unite to add to our strength and to fight for the patients they serve.

Once again, Happy Thanksgiving and remember to give thanks for the many blessings physicians contribute to our lives.

Rocky Delgadillo

Rocky Delgadillo Chief Executive Officer

2 6 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

LACM A NEWS | A S S OCIAT I ON H A PP ENI NG S

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 selfserving 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 $1,000’S 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.

Medical Professional Liability Protection, and more!

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

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

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.

PaLo aLTo SacramenTo

RENEW TODAY!

By now, all LACMA and CMA Members have received their 2014 dues statements. Dues are due by December 31, 2014. Please be sure to renew your membership to ensure continuation of your benefits.

Dues can be renewed conveniently online at www.lacmanet.org Thank you for supporting your profession and your patients by supporting organized medicine!

2 y s i c i a n s n e w s n e t w o r k1/23/13 N OV E M BCAP_1402_diplay_vert.indd ER 2013 | w w w. p h .c o m2:25 2 7PM

2 8 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

attention lacma/cma members

RENEW TODAY

WE TREAT DOCTORS RIGHT!

By now, all LACMA and CMA Members have received their 2014 dues statements.

Dues are due by December 31, 2013.

Summit Lending is a direct lender, which specializes in assisting physicians with all their mortgage needs. Our programs are very aggressive. Following are features of some different programs:

Please be sure to renew your membership to ensure continuation of your benefits.

Dues can be renewed conveniently online at

www.lacmanet.org

Thank you for supporting your profession and your patients by supporting organized medicine!

Looking to Draw Blood?

If you’re talking to LACMA physician, Paul Wallace, MD, this could open up a discussion that could knock you on your feet—literally.

On Oct. 19, Dr. Wallace became the first physician ever to be inducted into the California Boxing Hall of Fame. His name now ranks among such boxing legends as George Foreman, Harold Lederman, Andre Ward, Abel Fernandez, Joey Giambra and Loui Loy. Dr. Wallace was appointed as a California Ringside Physician in 1989.

He is now the Chief Ringside Physician of the California State Athletic Commission, chairman of its Medical Advisory Committee and the chairman of the World Boxing Council of the Medical Advisory Board, and lectures for the IBF and WBO. He is the founder and current board member of the Association of Ringside Physicians and the California Association of Professional Ringside Physicians.

Along with being co-chair of the WBC Medical Congress 1 and 2—the most comprehensive medical meetings in boxing history—Chief Ringside Physician, Dr. Wallace also served as the Technical Medical Advisor for seasons 1 and 2 of the reality TV series “The Contender.”

Dr. Wallace is a retired veteran of the U.S. Army (National Guard and Reserve) specializing in military trauma and wound ballistics.

He ranks as his most influential fight Chavez vs. Taylor 1 and most controversial fight Vitali Klitschko vs. Lennox Lewis.

Dr. Wallace was inducted into the California Boxing Hall of Fame 2013 on Oct. 19 at the Sportsmen’s Lodge in Studio City. LACMA congratulates Dr. Wallace on his honor and all of his achievements in the boxing world.

1. Purchases with minimal to No Down Payment 2. Offering Lowest Interest Rates in the Market 3. More Lenient on Credit 4. As a direct lender, we close loans fast and efficiently The Best Always Deliver!!!

You may visit our website at www.gowithsummit.com or call us at the number below

TEL: (888) 762‐0220 NMLS: 339255 CA. DRE: 01864758 As heard on KFI

N OV E M B ER 2013 | 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 2 9

job board | class i fi e d

To place a classified ad visit www.physiciansnewsnetwork.com or contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.

118

consulting & services

Shorr Healthcare Consulting

Consultants to Healthcare Providers

Practice Appraisal & Sales Partnership Buy-In / Buy Out

Medicare Certified ASC

TRACY ZWEIG ASSOCIATES

Ideal for bariatric, plastic, general surgeons, and other specialties. Medicare certified, fully-equipped surgery center, unmatched location & luxury for patient and surgeon. Convenient scheduling available. Inquiries: info@rdps.com 520

• 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

openings—Physicians

Supporting Southern California Physicians Since 1983 Call for a Courtesy Consultation

818-693-7055

530

avishorr@gmail.com 135

FILM READING

Carl H. Boatright, MD, DABR, 30 years’ experience, rapid turn-around. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.

legal services

LEGAL REPRESENTATION FOR PHYSICIANS

RADIOLOGIST

Board certified. Have own malpractice insurance. Available for part-time position or film reading. Call 310-477-4257.

Former Deputy Attorney General, Law Professor & Administrative Law Judge specializing in Administrative & Medical Board matters.

Free initial consultation RONALD S. MARKS A Professional Law Corporation

540

21900 Burbank Blvd., Suite 300 Woodland Hills, CA 91367

locum tenens available

TRACY ZWEIG ASSOCIATES

(818) 347-8112

RonMarks@prodigy.net ww.ronmarks-law.com

205

oPPORTUNITY WANTED

• 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

office for lease/ sublease/share

office space in Lakewood

2250 sq. ft with 11 RMs office space in Lakewood. Close to local hospital.

Conact Brent or Matt at 562-690-0200.

ONLINE. IN PRINT. ONE PRICE. Place Your Classified Ad Today!

Visit the ALL NEW

PhysiciansNewsNetwork.com 3 0 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

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

PM Marketplace Surgeons Needed for Expanding Nationwide Surgical Practice • 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

Physicians News Network introduces

Reporting on the technology of healthcare delivery

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

SUBSCRIBE TODAY www.PhysiciansNewsNetwork.com

Advertiser Index Advanced Radiation .................................................................................................7 Athena Health.........................................................................................................25 BBVA.....................................................................................................................13 Cooperative of American Physicians ...................................................................... 27 The Doctors Company ........................................................................................ C4 Fenton Nelson ...................................................................................................... 23 Marsh.......................................................................................................................3 NORCAL ............................................................................................................C2 Office Ally ........................................................................................................... C3 Summit Lending.....................................................................................................29 Wells Fargo...............................................................................................................5 Willet Travel...................................................................................................... 16-17

N OV E M B ER 2013 | 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 3 1

class i fi ed | job board

To place a classified ad visit www.physiciansnewsnetworK.com

b y t he numbers | best pract i ces

By The Numbers

30% Staffing Costs HIPAA

Staffing costs are inching upward toward an alltime high of nearly 30% for primary care physicians

HIPAA complaints have risen since 2003 by 117%, according to the experts.

Most complaints come from disgruntled employees.

117%

Collecting

Collecting: Collecting co-pays, coinsurance, deductibles, and past due balances from the patient at time of service is often the most overlooked task in a physician’s practice.

Co-pays alone can represent as much as 20% of a physician’s income.

20% 3 2 PHYSICIAN MA G A Z INE | N OV E M B ER 2013

$xx

physician’s office, a malfunctioning thermostat ruined $51,000 in refrigerated vaccine.

Make sure you’re covered.

In a Del Mar

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

CA License #0677182

n n n n

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

www.thedoctors.com/TDCIS