December 2014 | Physician Magazine by Los Angeles County Medical Association

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REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

2014 L.A. HEALTHCARE AWARDS Healthcare Champion of the Year

RICHARD J. RIORDAN

DECEMBER 2014

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M A G

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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

D ECEM B ER 2014 | TA B LE OF CONT ENT S

Volume 145 Issue 12

8 16

FINANCIAL PLANNING & RETIREMENT 6 Your Annual Review Checklist 7 Strategies for Tax-efficient Investing 8 Retiring Abroad? What You Need to Know

DEPARTMENTS

COVER STORY L.A. HEALTHCARE AWARDS

FRONT OFFICE | PRACTICE MANAGEMENT

Association held its annual L.A. Healthcare

The

12 What a Physician Needs to Know about Medi-Medi Patients and Cal MediConnect

standing contributions to community health.

UNITED WE STAND | AT WORK FOR YOU

Los

Angeles

County

Medical

Awards last month, recognizing several out-

The top honor, Healthcare Champion of the Year, was presented to former Los Angeles Mayor Richard Riordan.

14 VICTORY: California Voters Speak Loudly 15 CMA Welcomes New President

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.

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Sheri Carr 559.250.5942 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

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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

ALTERNATE RESIDENT/FELLOW COUNCILOR

COUNCILOR – SSGPF

COUNCILOR – DISTRICT 9 CMA TRUSTEE

CMA TRUSTEECOUNCILOR – DISTRICT 5

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ment relations and community

ETHNIC PHYSICIANS COMMITTEE REP

relations. Through its advocacy

COUNCILOR – DISTRICT 17

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efforts in both Los Angeles

COUNCILOR – USC

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County and with the statewide

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California Medical Association,

COUNCILOR – ALLIED PHYSICIANS

your physician leaders and staff

COUNCILOR – DISTRICT 3

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.

COUNCILOR-AT-LARGE COUNCILOR-AT-LARGE

COUNCILOR – DISTRICT 10

MEDICAL STUDENT COUNCILOR/UCLA

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CHAIR OF LACMA DELEGATION

David Aizuss, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Jack Chou, MD Troy Elander, MD Hilary Fausett, MD Samuel Fink, MD Hector Flores, MD C. Freeman, MD Sidney Gold, MD William Hale, MD Stephanie Hall, MD David Hopp, MD Kambiz Kosari, MD Young-Jik Lee, MD Paul Liu, MD Maria Lymberis, MD Carlos Martinez, MD Nassim Moradi, MD TJ Nguyen Ashish Parekh, MD Heidi Reich, MD Sion Roy, MD Michael Sanchez, MD Heather Silverman, MD Andrew Sumarsono Nhat Tran, MD Fred Ziel, 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, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 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.

Member Benefit News: Open enrollment for the Los Angeles County Medical Associationsponsored dental plan has started! You and your family are eligible to enroll in the LACMA-sponsored dental plan only during open enrollment periods. Apply by December 31, 2014! To be eligible for coverage, applications must be received during the special open enrollment period ending on December 31, 2014.

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

Sponsored by:

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709

777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance.service@mercer.com 65475 (11/14) www.CountyCMAMemberInsurance.com • Copyright 2014 Mercer LLC. All rights reserved.

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

PA I N S TA K I N G WA R O N S C I E N C E :

The Attack on Women’s Sexual Health (The Sham Drug Idea of the Year: ‘Pink Viagra’)

There are two kinds of people in this world: those who look down on other people, and those who don’t look down on other people. And those two groups of people look down on each other. Such is the state of the groups who advocate for and against medical management or prevention of certain illnesses. We have entered a time when even illness and medicine are politicized as aggressively as ideology. And this is unfortunate because unlike ideology, diseases and their therapeutic options are not simple matters of opinion. Pathophysiology of disease is, in fact, a rigorously studied state of biological being. And clinical interventions are, like the diseases they work against, subjects of equally rigorous investigation to which our best and brightest minds devote their careers, and lives. It is of course understandable that the slick, highly produced, and absolutely relentless television advertising for all things medical can make us weary. But for those who suffer from diabetes, dry eyes, depression or whatever illness the medication is hoping to treat, these drugs and their competitors offer options that allow our patients to work, play and function more effectively and efficiently alongside everyone else. Still, as a clinician it’s difficult not to encounter abrupt diversions from scientific issues critical to our health. Childhood immunizations, treatments for genetic disorders, and others have fallen into a malaise of ideological distraction. But arguments based on ideology often discount legitimate health needs and objective clinical evaluations of whether a treatment is safe and effective. We have read in recent months about the refusal of some families, based entirely on this pseudoscience, to vaccinate their children. Sadly, that ideology is creeping into other areas of medicine too, and soon politicized medicine may involve something you need. But for now, let’s add to the mix of crusades the dubious campaign against women’s sexual health. My involvement in the study of male and female sexual dysfunction spans two decades. In the late 1990s, I worked in Dr. Irwin Goldstein’s laboratory at Boston University School of Medicine on various sex4 P H Y S I C I A N M A G A Z I N E | D E C E M B ER 2014

ual dysfunction projects. Some projects included basic science research on animal cells and tissue others were studies on individuals or populations. All were ethically sound and scientifically robust. So much so that Dr. Goldstein was selected as first author of the New England Journal of Medicine paper on sildenefil citrate, the scientific article that introduced Viagra to the world. For the next few years, I had the opportunity to travel around the world, presenting results of our findings on the burgeoning new science of male and female sexual dysfunction. There was extraordinary excitement around the field. But at times, when I ran into people whom I considered colleagues, I encountered astonishing resistance. On an occasion I’ll never forget, I was asked to speak to an undergraduate psychology class on sexual dysfunction. The professor refused the offer of pizza for the students, saying she didn’t want the class to be swayed by the medical perspective. But the medical and scientific perspectives point to something that cannot be ignored: Sexual dysfunction in women, like that of erectile dysfunction in men, is real and ought to be studied and eventually treated. Almost two decades after I started work in Boston, there are no FDA-approved treatments for women. That, despite the fact that today, for the first time, we have a far better scientific understanding (different from just “knowing”) about the critical role that the human brain plays in regulating a woman’s sexual drive. We finally understand the scientific basis for persistent and recurrent low sexual desire, the root cause of which appears, based on advanced brain imaging, to stem from an imbalance of neurotransmitters in the brain. Yet there are no solutions that address this remarkable biology. All of us deserve to benefit from the advancement of science, including women and men who suffer from something the rest of us may think is funny. The stigma was overcome for men with the unprecedented clinical success of Viagra, which was followed by commercial success (not the other way around). Women still have a little way to go. The advancement of science and medicine coexists in a societal context formulated by everyday points of view, but we all must balance the hyperbole with the facts. Steve Jobs lost his life because he chose to ignore the scientific evidence in favor of the clinical options for his cancer. Too late to turn back, according to his biographer, he regretted his decision. The pseudoscience that has grown up in the Western world is dangerous not because it advocates against the application of science to women’s health. It’s dangerous because it advocates against science. It is human nature to judge. In medicine, we strive to overcome that human temptation through the application of rigorous science to understanding disease and its treatment options. And we don’t judge.

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financial planning & retirement expert advice

your annual review checklist ARTICLE BY WEALTH MANAGEMENT SYSTEMS, INC. AND PROVIDED COURTESY OF MARLENE DIETRICH & EMILIA PIRRO

Preparing for an annual financial review may be easier with a checklist to help you focus on important matters. With that in mind, here is a list of key considerations that you may want to discuss with your financial advisor. • Do I need to rebalance my asset allocation? Depending on the performance of your investments so

far this year, you may want to examine whether your mix of stocks, bonds, cash, and other assets is close to your target. If not, it may be time to rebalance to a mix that more closely resembles your desired exposure to risk and potential return.1 Rebalancing can be accomplished in two ways: You can sell existing assets and use the proceeds to bring your portfolio closer to your desired mix. Or you can leave your portfolio as is and allocate new investments to the areas that you want to increase. Rebalancing may involve tax consequences, especially for non-tax-deferred accounts.

• Am I on track to fund my retirement? Making sure you are on track to amass the assets you will

need for your later years should be one of your key concerns. If you participate in an employersponsored retirement plan, consider investing as much as you can afford. If you do not have access to an employer-sponsored plan, or if you do and can afford to contribute even more, consider funding an IRA.

• What were my yearly capital gains and losses? If your year-end planning entails selling certain

assets, be aware of rules regarding capital gains and losses. Gains on investments held less than one year, known as short-term capital gains, are taxed as ordinary income. Gains on investments held for one year or longer, considered long-term capital gains, are taxed at a maximum rate of 20% for federal income tax purposes. State tax rules may differ. On the federal level, capital losses offset capital gains and are netted against each other. If net capital losses still remain, up to $3,000 may be used to offset ordinary income. Capital losses not used in a given year can be carried forward to future years. Note that different rules apply for gains on the sale of collectibles, or qualified small-business stock.

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

investments receive favorable tax treatment. Employee contributions to traditional 401(k)s, for example, are deducted from your paycheck before taxes are assessed, which lessens taxable income during the year the contribution is made. Contributions may potentially grow free of federal income taxes until qualified withdrawals are made during retirement. If you are age 59 1/2 or older and have maintained the account for a minimum of five years, qualified withdrawals from a Roth IRA are tax free.2 (To contribute to a Roth IRA, investors must meet income thresholds established by the IRS. Learn more at www.irs.gov.)

You may have additional concerns unique to your situation, but this checklist may help you keep your investment portfolio in order. Asset allocation and rebalancing do not assure a profit or protect against loss in a declining market. There may be a potential tax implication with a rebalancing strategy. Please consult your tax advisor before implementing such a strategy. For nonqualified withdrawals, restrictions, penalties, and taxes may apply. Article by Wealth Management Systems, Inc. and provided courtesy of Marlene Dietrich & Emilia Pirro Morgan Stanley and its Financial Advisors do not provide tax or legal advice, are not “fiduciaries”( under ERISA, the Internal Revenue Code or otherwise) with respect to the services or activities described herein, and this material was not intended or written to be used for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Individuals are urged to consult their tax or legal advisor before establishing a retirement plan or to understand the tax, ERISA and related consequences of any investments made under such plan. The authors are not employees of Morgan Stanley Smith Barney LLC (“Morgan Stanley”). The opinions expressed by the authors are solely their own and do not necessarily reflect those of Morgan Stanley. The information and data in the article or publication has been obtained from sources outside of Morgan Stanley and Morgan Stanley makes no representations or guarantees as to the accuracy or completeness of information or data from sources outside of Morgan Stanley. Neither the information provided nor any opinion expressed constitutes a solicitation by Morgan Stanley with respect to the purchase or sale of any security, investment, strategy or product that may be mentioned. Morgan Stanley Financial Advisors, Marlene Dietrich & Emilia Pirro engaged Wealth Management Systems, Inc. to feature this article. Marlene Dietrich & Emilia Pirro] may only transact business in states where they are registered or excluded or exempted from registration FINRA Broker Check http://brokercheck.finra.org/Search/Search.aspx]. Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Marlene Dietrich & Emilia Pirro are not registered or excluded or exempt from registration. © 2014 Morgan Stanley Smith Barney LLC. Member SIPC. CRC 914101 05/14

FOR MORE INFORMATION CONTACT

Emilia Pirro

310.285.2691 Emilia.Pirro@morganstanley.com

Marlene Dietrich

310 285-6544 Marlene.Dietrich@MorganStanley.com MORGAN STANLEY 9665 Wilshire Blvd., Suite 600, Beverly Hills, CA 90212

strategies for tax-efficient investing ARTICLE BY WEALTH MANAGEMENT SYSTEMS, INC. AND PROVIDED COURTESY OF MARLENE DIETRICH & EMILIA PIRRO

One area of investing that is easy to overlook is the effect of taxes on a portfolio. Yet most investors can improve a portfolio’s bottom line by employing a few simple tax-efficient investment strategies. With higher top tax rates now in effect, it may be time to ask yourself: Are you doing everything possible to improve your portfolio’s bottom line through tax-efficient investing? Here are five tried-andtrue strategies to help lower your tax bill while improving your net return.

50, you can contribute an extra $1,000. For employer-sponsored retirement savings vehicles such as 401(k) or 403(b) plans, you can contribute up to $17,500 in 2014 and an additional $5,500 if you’re over 50. But keep in mind that most withdrawals prior to age 59½ from a qualified retirement plan or IRA may be subject to a 10% federal penalty in addition to any taxes owed on contributions and accumulated earnings.

Take Advantage of Tax-Sheltered Accounts To

In today’s low-rate environment, finding yield can be a challenge. Rates on high-quality corporate bonds have hovered at historical lows, and the yield on US Treasuries has not topped 4% since 2008. While municipal bonds, or “munis,” are no exception, they carry one significant advantage: Interest paid by muni bonds is generally exempt from federal and, in some cases, state and local taxes. Consider this: A municipal bond yielding 4% translates to a tax-equivalent yield of 5.33%, assuming a 25% tax rate. In other words, you would need to earn 5.33% on a taxable bond to receive the same after-tax yield as a 4% municipal bond. Remember, however, that any capital gains arising from the sale of municipal bonds are still taxable (at capital gains rates), and that income from some municipal bonds may be taxable under alternative minimum tax rules.

encourage Americans to save for retirement, Uncle Sam offers tax incentives in the form of IRAs, 401(k)s, 403(b)s and other qualified retirement savings plans. These accounts provide the opportunity to defer paying tax on contributions and earnings or to avoid paying taxes altogether on earnings, depending on the type of vehicle you choose. By contributing as much as possible to these accounts, you can realize significant savings over time. For instance, contributing $400 per month to a traditional IRA (assuming deductibility rules apply) will save you nearly $22,000 in taxes over 20 years, assuming a 5% annual return and 25% tax rate.1 (Taxes, however, will be due on distributions at the time you make withdrawals.) For 2014, you can contribute up to $5,500 to a traditional or Roth IRA. And if you’re over

Turn to Municipal Bonds for After-Tax Yield

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F INANC IAL P LANNING & RET IREM EN T | F EAT U RE

• Am I taking full advantage of tax-advantaged accounts? Remember that certain types of

F EAT U RE | F IN AN C IAL P LANNING & RET IREM EN T

Avoid Short-Term Gains Before you sell an investment, check to see when you purchased it. If it was less than one year ago, any profit will be considered a short-term gain. If it was more than one year ago, the profit will be considered a long-term gain. That’s important because long-term capital gains are taxed at significantly lower rates than short-term capital gains, especially if you’re in a high tax bracket.

• Short-term capital gains are taxed at ordinary income rates which can be as high as 39.6%. • Long-term capital gains are taxed at a maximum rate of 20% in 2014.2 Considering those different rates, it can pay to look at the calendar before you sell a profitable investment. Selling just a day or two early could mean that you’ll incur significantly higher taxes. Make the Most of Losses As most taxpayers know, the IRS lets you use long-term capital losses to offset long-term gains. In any given year, you can minimize your capital gains tax by timing your losses to correspond with gains. What’s more, you can carry forward unused losses to future years, and use them to offset future gains, subject to certain limitations. You can also offset up to $3,000 of unused capital losses per year against ordinary income. So before taking a long-term capital loss, consider the timing of gains as well as ordinary income.

Get a Professional’s Perspective Keeping an eye on

taxes is a prudent way to try to enhance your investment returns over time. However, tax laws are complex, subject to change and may have implications you haven’t considered.

Footnotes/Disclaimers 1 Example assumes monthly pre-tax contributions of $400 over a 20-year period, a 5% annual rate of return, compounded monthly, and a marginal tax rate of 25%. Example is hypothetical. Your results will differ. 2 Does not take into consideration Medicare tax on certain unearned net investment income or state or local taxes, which will vary. If you would like to learn more, please contact Marlene Dietrich & Emilia Pirro. Branch Name: Morgan Stanley 9665 Wilshire Blvd., Suite 600, Beverly Hills, CA 90212; Phone Number: 310 285-6544 & 310 285-2691 ; Web Address: Marlene.Dietrich@MorganStanley.com Emilia.Pirro@morganstanley.com Article by Wealth Management Systems, Inc. and provided courtesy of Morgan Stanley Financial Advisor. The author(s) are not employees of Morgan Stanley Smith Barney LLC (“Morgan Stanley”). The opinions expressed by the authors are solely their own and do not necessarily reflect those of Morgan Stanley. The information and data in the article or publication has been obtained from sources outside of Morgan Stanley and Morgan Stanley makes no representations or guarantees as to the accuracy or completeness of information or data from sources outside of Morgan Stanley. Neither the information provided nor any opinion expressed constitutes a solicitation by Morgan Stanley with respect to the purchase or sale of any security, investment, strategy or product that may be mentioned. Tax laws are complex and subject to change. Morgan Stanley Smith Barney LLC (“Morgan Stanley”), its affiliates and Morgan Stanley Financial Advisors and Private Wealth Advisors do not provide tax or legal advice and are not “fiduciaries” (under the Internal Revenue Code or otherwise) with respect to the services or activities described herein except as otherwise agreed to in writing by Morgan Stanley. This material was not intended or written to be used for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Individuals are encouraged to consult their tax and legal advisors regarding any potential tax and related consequences of any investments made under such account. Morgan Stanley Financial Advisor(s) engaged Wealth Management Systems Inc. to feature this article. Emilia Pirro & Marlene Dietrich may only transact business in states where they are registered or excluded or exempted from registration or FINRA Broker Check http://brokercheck.finra.org/Search/Search.aspx]. Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Emilia Pirro & Marlene Dietrich are not registered or excluded or exempt from registration. © 2014 Morgan Stanley Smith Barney LLC. Member SIPC. CRC 942158 6/14

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retiring abroad? here’s what you need to know BY BILL HUNTER, DIRECTOR OF PERSONAL RETIREMENT SOLUTIONS, BANK OF AMERICA MERRILL LYNCH

There’s something undeniably appealing about the idea of living an expatriate adventure in retirement. Striking out for foreign shores can seem both pragmatic and poetic. But relocating to another country isn’t easy. You’ll need to consider a range of factors, from your destination country’s political stability to the logistics of managing your assets from afar. Retirees need to plan carefully and consider the following questions. Is your family on board? Moving across the globe can change family dynamics. Understand the impact your move will have on your relationships. Make sure your spouse is as invested in the idea as you are that way, when unexpected issues arise, you won’t have the added complications of resentment and blame. How will you handle health care needs? Access to quality health care is

paramount in retirement, so be sure to understand the relative cost and quality of care in the country where you hope to retire. Research local physicians and facilities and plan accordingly. Make sure quality remains on par with what’s available in the U.S. If it doesn’t, budget for the possibility that you may need to return home for certain medical procedures. Given that Medicare doesn’t cover health services outside the U.S., you may want to look into private health insurance or seek out a country that allows those holding permanent residence visas to join its national health plan. Keep in mind that if you return home later in retirement and sign up for Medicare, your premium will be 10% higher for each year you could have been enrolled but were not.

How does the cost of living compare? A beachfront home in Mexico may cost less than its U.S. counterpart, but you need to consider your entire budget. For example, relocation costs may be higher than if you moved somewhere domestically. And the costs of groceries, electricity, and transportation may equal what you’re currently spending. Will you be able to work? Many of today’s retirees hope to work during their retirement but living in a foreign country may complicate employment. Consider the job prospects for people with your experience in that country and whether you’ll be allowed to work as a U.S. citizen abroad. How will you manage your assets? As finances can

be comfortably managed from afar, expat retirees can keep most assets in the U.S., where the economy and political situation are relatively stable. A local account will prevent currency exchange fees and ATM withdrawal charges. You may want to explore proactively addressing cash flow issues — like having your account automatically frozen when you repeatedly access your credit card from a remote location. Talk to your financial advisor about how to hedge against exchange-rate fluctuations by setting up a local account and making regular transfers from your U.S. account to cover everyday expenses. It’s a good idea to know whether these transfers might incur their own fees, and to ensure that legal documents will be enforceable in your destination country. When moving assets abroad or acquiring new investments in another country, consult a lawyer to determine whether those assets will be subject to local estate tax rules.

tential destination before making a permanent move. How will you connect with family and friends? Email and video services make it easy to stay in touch with family and friends back home, but if you want to see them regularly, choose a destination that will enable you and your loved ones to travel easily and affordably. Starting a brand-new life is appealing, but retiring abroad adds a layer of complexity to many aspects of retirement planning. So do your homework, and make the decision with your eyes wide open. Any information presented about tax considerations affecting client financial transactions or arrangements is not intended as tax advice and should not be relied upon for the purpose of avoiding any tax penalties. Neither Bank of America, Merrill Lynch nor its Financial Advisors provide tax, accounting or legal advice. Clients should review any planned financial transactions or arrangements that may have tax, accounting or legal implications with their personal professional advisors. Bank of America Merrill Lynch is a marketing name for the Retirement Services business of Bank of America Corporation (“BAC”). Banking, trust and fiduciary services are performed by wholly owned banking affiliates of BAC, including Bank of America, N.A., member FDIC. Brokerage services are performed by wholly owned brokerage affiliates of BAC, including Merrill Lynch, Pierce, Fenner & Smith Incorporated (“MLPF&S”), a registered broker-dealer and member SIPC. For more information, contact Tanya Stratton, Personal Wealth Advisor, in the Fresno, CA office at 559-436-3309, Tanya.stratton@ml.com or http://fa.ml.com/tms. Merrill Lynch makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of Bank of America Corporation. Investment products: Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value MLPF&S is a registered broker-dealer, Member SIPC and a wholly owned subsidiary of Bank of America Corporation. © 2014 Bank of America Corporation. All rights reserved.

Can you adjust? After the fantasy of liv-

ing abroad becomes reality, some expats find themselves feeling isolated. Consider living somewhere with a vibrant expatriate community. Keep in mind that the amount of English spoken in countries may vary between regions. Spend a few months in a poD E C E M B 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 9

F INANC IAL P LANNING & RET IREM EN T | F EAT U RE

Are you looking for a tax advantage? The IRS taxes U.S. citizens on income no matter where they live. Even if you relinquish your citizenship, you’ll owe income tax as a nonresident alien. The U.S. also has laws to collect income tax from retirees who move their assets to a foreign country; however, many countries have tax treaties with the U.S. that prevent double taxation.

LACMA Honors Outstanding Contributions to Community Health

Pictured (left to right): Pedram Salimpour, MD, Troy Elander, MD, Richard J. Riordan, Rocky Delgadillo.

HEALTHCARE CHAMPION OF THE YEAR Former Los Angeles Mayor, Richard J. Riordan Hospital Physician Leadership Award Ronald W. Busuttil, MD, UCLA Liver Transplant Program Independent Physician Leadership Award Ken Sim, MD, Allied Physicians of California Innovation Award — Community Service South Central Scholars, James London, MD, & Patricia London Innovation Award — Public Education Castulo de la Rocha, CEO, AltaMed Health Services Innovation Award — Facilities Robert Stone, CEO, City of Hope Accepting on behalf of City of Hope was Mark Wakabayashi, MD, President, Medical Staff Innovation Award — Physician Leadership in Medical Education Stephanie Hall, MD, Keck Medical Center of USC Shine the Light Media Award David Pryor, MD, BlackWomensHealth.com

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

The Los Angeles County Medical Association held its annual L.A. Healthcare Awards on Thursday, Nov. 13, at the California Club in Downtown Los Angeles. Attending were approximately 250 LACMA member physicians and their supporters. Rocky Delgadillo, LACMA CEO, served as master of ceremonies for an evening-long celebration recognizing the outstanding contributions of physicians, medical students, healthcare professionals and elected officials to the overall health of the Greater Los Angeles community. LACMA president, Pedram Salimpour, MD, set the tone for the evening with his opening remarks in which he praised the efforts of LACMA members in the defeat of Propositions 45 and 46 in the recent November election. He noted that “in the past month, we have fought and decisively defeated two major legislative initiatives that would have significantly and irreversibly eroded the practice of medicine for doctors and our patients.” Dr. Salimpour also noted that LACMA has experienced “the most robust growth in membership at any time in the past decade and a half.” According to him, LACMA membership now stands at 6,500 members in Los Angeles County. He also reminded members of the importance of LACMA’s ongoing support of medical students through scholarships. LACMA member Troy Elander, MD, who serves as chairman of the board of the Patient Care Foundation of Los Angeles, provided an overview of the activities of the foundation, reporting a successful year of patient advocacy. Medical student Ezinne Ihenachor, a student at the David Geffen School of Medicine, provided a student perspective on medical education and her passion for improving healthcare for the underserved. Ihenachor was one of nine 2014 LACMA scholarship recipients. Drs. Salimpour and Elander joined Rocky Delgadillo in presenting the awards, including the Healthcare Champion of the Year Award presented to former Los Angeles Mayor Richard J. Riordan. All Healthcare Awards attendees received a copy of Riordan’s recently published book, The Mayor. The event was underwritten by presenting sponsor Wells Fargo; platinum sponsors PIPA Allied Pacific and Network Medical Management; gold sponsor AltaMed and Keck Medical Center of USC; silver sponsors Dignity Health, Cedars-Sinai, Cooperative of American Physicians, Hunt Enterprises, LACMA districts 1, 3, 6, 9, 10, 14 and 17, Moore-White Medical Foundation, UCLA Health and White Memorial Medical Center; and table sponsor City of Hope.

D..

PICTURED: A) Rocky Delgadillo, Pedram Salimpour, MD, Patricia London, James London, MD, and Troy Elander, MD B) Pedram Salimpour, MD, Mark Wakabayashi, MD, and Troy Elander, MD F.

C) Medical Student Ezinne Ihenachor D) More than 250 LACMA members and supporters attended the event

E) Rocky Delgadillo, Pedram Salimpour, MD, and Kenneth T. Sim, MD F) Rocky Delgadillo, Pedram Salimpour, MD, Stephanie Hall, MD, and Troy Elander, MD G) Rocky Delgadillo, Pedram Salimpour, MD, Castulo de la Rocha and Troy Elander, MD

H) Rocky Delgadillo, Pedram Salimpour, MD, and Ronald W. Busuttil, MD

D E C E M B 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 11

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

WHAT A PHYSICIAN NEEDS TO KNOW ABOUT

Medi-Medi Patients and Cal MediConnect BY JENNIFER DAVIS

T H E CO O R D I N AT E D C A R E Initiative (CCI) is an

effort by California and the federal government to integrate the delivery of medical, behavioral and long-term services and support for persons eligible for both Medicare and Medi-Cal (i.e., dual eligibles, or “Medi-Medi” patients). California has approximately 1.1 million Medi-Medi beneficiaries. Of these beneficiaries, about 456,000 are estimated to be eligible for enrollment into the Cal MediConnect program, with a 200,000 enrollment cap in Los Angeles. Many California physicians are curious about the implications if their patients enroll in Cal MediConnect. CCI consists of Cal MediConnect and Managed Long Term Services and Supports. Cal MediConnect is a new plan that will administer both Medicare and Medi-Cal benefits. Participation in Cal MediConnect will occur for patients by default, meaning if the patient does not decline to participate (“opt-out”), the patient will be automatically enrolled in Cal MediConnect. This automatic enrollment would occur on the first day of his/her birth month, but the patient can decide to actively disenroll at any time. 1 2 P H Y S I C I A N M A G A Z I N E | D E C E M B ER 2014

Patient Enrollment and Provider Impact | If a physician’s patient enrolls in Cal MediConnect, the physician has options that are dependent upon the physician’s status as an in-network or out-of-network provider. If the physician is in the plan’s network, the patient can request to continue to see this physician. If the physician is out-of-network, the physician will have the right to temporarily (up to six months) continue seeing the patient. A physician may be able to see an existing patient for a longer period of time if the health plan approves such request. This time frame is separate from the general ability to request completion of covered services for acute or serious conditions.1 Cal MediConnect enrollees will eventually be required to receive all covered services from in-network providers. If a physician is out-of-network and wants to join the network, the physician must contact the specific Cal MediConnect plan in the physician’s county. In Los Angeles, for example, the health plans include Care1st, CareMore, Health Net, L.A. Care and Molina Dual Options. Continuity of Care | There are several conditions that must be met in order for a Cal MediConnect patient to receive temporary care from an out-of-network physician. Actions must be taken by either the patient or the existing out-of-network physician. • The enrollee or the physician may request for “continuity of care” from the specific Cal MediConnect plan by calling the health plan member services. • A pre-existing relationship must exist between physician and patient, which is established by the plan from a review of Medicare claims data. o For a primary care physician, this means that the patient saw the physician at least once in the 12 months preceding enrollment. o For a specialist, this means that the patient saw the specialist at least twice in the 12 months preceding enrollment. • The out-of-network physician must be willing to accept the Cal MediConnect plan rate or the applicable Medicare or Medi-Cal rate, whichever is higher, and agree to receive payment from the plan. The plan rate is typically 80% of the Medicare fee schedule. • The physician must enter an agreement with the health plan and not be disqualified from the network due to quality-of-care issues. The agreement will allow care to be provided for six months and can be extended at the option of Cal MediConnect.

Retroactive Continuity of Care | Physicians can be

reimbursed for services provided to a patient before the Cal MediConnect-enrolled patient has received approval from the health plan for continuity of care. The reimbursement is contingent upon the continuity of care requirements being met (discussed above). The request for continuity of care must also be made within 30 calendar days of the first service provided to the patient after the patient enrolls in Cal MediConnect.

Providers Not Impacted | For the time being, skilled nursing home facilities will not be impacted by the enrollment of current residents into Cal MediConnect even if the nursing home is not in the health plan’s network. Newly enrolled Cal MediConnect residents will not have to change facilities. Providers of either In-Home Supportive Services, Community-Based Adult Services or Multipurpose Senior Service Programs will not be immediately impacted by the enrollment of current patients into Cal MediConnect. Similar to skilled nursing home residents, program beneficiaries will not have to change providers based on network arrangements. In the long term, however, providers who do not contract with health plans may experience declining referrals, as plans encourage referral to contracted providers.

claim for the 20% co-pay to the patient’s Medi-Cal plan, or in some cases, Medicare will send these claims automatically to the Medi-Cal plan. Physicians do not need to be a part of the MediCal plan’s network to have these claims processed and paid.

Conclusion | Many physicians and provid-

ers will be impacted by patients enrolling in Cal MediConnect. In particular, physicians who decline (or are unable) to contract with a Cal MediConnect plan are likely to see their patients reassigned to in-network physicians, with the significant prospect of losing the patient relationships altogether. While existing physicians and providers can continue to see existing patients for a temporary period of time if they meet the continuity of care requirements, it is imperative for physicians to consider long-term options with respect to Cal MediConnect plans and dual eligibles. Physicians can receive additional information by contacting Cal MediConnect plans in their county or visiting www.calduals.org.

physicians who decline to contract with a Cal MediConnect plan are likely to see their patients reassigned to in-network physicians

Providers Impacted | Suppliers of transportation, durable medical

equipment and medical supplies must be in-network providers for Cal MediConnect enrollees. Home health and physical therapy providers must also be in-network providers for Cal MediConnect enrollees, and therefore out-of-network providers would lose patients upon Cal MediConnect enrollment. Providers prescribing medication covered by Medicare Part D can continue such prescribing under the provisions of continuity of care, which includes a 30-day supply of any existing Medicare Part D prescription. After this time frame, enrollees must switch to medication on the plan’s formulary. Financial and Billing Implications | If a patient actively declines Cal MediConnect, the patient can keep Medicare as it is but must choose a Medi-Cal plan to receive Medi-Cal benefits. For a physician, if your patient decides not to join a Cal MediConnect plan, the patient can continue to see you as a Medicare Fee-for-Service (FFS) physician. Even if your patient joins a Medi-Cal plan, the patient can continue to see you as the current Medicare provider. Medicare physicians do not need to be contracted with Medi-Cal to see dual eligibles. As stated earlier, the rate provided to the Medicare physician is generally 80% of the Medicare fee schedule. If a dual eligible patient declines to enroll in Cal MediConnect, the Medicare physician should bill for Medicare services as is the regular billing practice of the physician. If the patient is enrolled in a Medi-Cal managed care plan, the physician should continue to bill for Medicare services as is the regular billing practice of the physician. There is also no change to the process of handling “crossover claims,” or the amount not covered by Medicare, which is typically 80%. Providers need to send the crossover

In addition, physicians or providers can contact Nelson Hardiman, LLP for more information. 1 CA Health & Safety Code, Sec. 1373.96 Jennifer Davis is a law clerk with Nelson Hardiman, pending her forthcoming admission to the California State Bar. Working with and under the supervision of Nelson Hardiman attorneys, Jennifer’s practice focuses on transactional and regulatory matters for the firm’s healthcare clients. Jennifer has extensive experience with hospital administration, having served as Business Director for City of Hope prior to receiving her JD from UCLA. As Director, Jennifer managed the Departments of Anesthesiology and Surgery which included the divisions of Urologic Oncology, Surgical Oncology, Gynecologic Oncology, Neurosurgery, Orthopedic Surgery, Plastic Surgery, Thoracic Surgery, and Head and Neck Surgery. As Director of the Surgery Department, Jennifer managed the largest robotic-assisted surgical program worldwide. At City of Hope, Jennifer also managed the prostate, breast, brain tumor and gastrointestinal cancer programs. Jennifer also completed her MBA from UCLA. While completing this advanced degree, Jennifer created her own consulting company, which focused on fundraising and business plan development for local and national nonprofits.

D E C E M B 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 3

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

CAL MEDICONNECT AND SPECIFIC PROVIDER TYPES

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

O N E L E C T I O N DAY, the California Medical

Association (CMA) made history by resoundingly defeating the trial attorneys’ attempt to overturn California’s Medical Injury Compensation Reform Act (MICRA) protections. This was one of the most contentious and high-stakes ballot fights in California history. The voters sent a clear message: Californians simply don’t want to increase healthcare costs and reduce health access so trial attorneys can file more lawsuits. But the Election Night celebration was not limited to Prop. 46: CMA’s priority candidates also performed exceedingly well. CMA participated in “independent expenditure” campaigns for six candidates. Sacramento pediatrician and Assemblyman, Richard Pan, M.D., was at the top of the list. Dr. Pan faced off against fellow Democrat Roger Dickinson in California Senate District 6 in one of the most hotly-contested races of the election. Conventional wisdom gave Dr. Pan very little chance to defeat Dickinson, who has spent more 1 4 P H Y S I C I A N M A G A Z I N E | D E C E M B ER 2014

than 30 years as a career politician. However, CMA built a coalition of labor and business allies to put together a full-fledged campaign that helped overcome a double-digit deficit in the primary to place Dr. Pan in the state Senate. In another tight race, two liberal Democrats, David Chiu and David Campos, squared off for San Francisco’s Assembly District 17. The candidates agreed on many issues, but David Chiu believes in and publicly advocates for the protection of MICRA. Chiu’s advocacy on the matter became a critical point of contention in the campaign, transforming this race into a proxy race for Proposition 46. Once again, the advocate for protecting access to care prevailed: CMA-endorsed David Chiu will be heading to Sacramento. CMA emerged from the election with a perfect score on the six independent expenditure campaigns for our endorsed candidates. In total, the 15 CMA-endorsed candidates for state Senate all won their election. In the state Assembly, 65 out of our 70 endorsed candidates triumphed. (Please note there are a few races that are too close to call.) Visit CMA.org to see the full roster of candidates CMA supported and the results of their races.

The California Medical Association (CMA) has installed Humboldt County physician Luther Cobb, MD, as its 147th president. He takes office on the heels of the momentous defeat of Proposition 46, a campaign in which doctors and healthcare providers across California rallied together to oppose the measure that ultimately failed 33-67 percent. “What a thrilling time to be assuming the role of CMA president,” said Dr. Cobb. “The healthcare community has stood tall in protecting our patients and their access to care, and as we look ahead to the year in front of us, I am confident that we will continue to do so.” After attending Stanford Medical School, Dr. Cobb went on to do his residency at Stanford as well, taking a two-year fellowship to study pancreatic islet transplantation for diabetes. He later joined the Stanford faculty and worked at the affiliated county hospital in Santa Clara County, Santa Clara Valley Medical Center. “Becoming a doctor was something I wanted to do because not only would it be an avenue to help

the greatest number of people I could, but it was and continues to be an evolving field with new discoveries around each corner,” he said. Dr. Cobb is a former chair of the CMA Council on Legislation and has served on the organization’s executive committee since 2006. He is also past president of the Humboldt-Del Norte County Medical Society. “Dr. Cobb brings the experi- “What a thrilling time to be ence, leadership and fortitude assuming the role of CMA president. The healthcare community to CMA’s presidency that will has stood tall in protecting our lead us into an incredible time patients and their access to care, in healthcare,” said CMA CEO Dustin Corcoran. “As we look and as we look ahead to the year in front of us, I am confident that ahead to the changes that lie in front of us, I have the utmost we will continue to do so.” faith in Dr. Cobb’s ability to lead the 40,000 plus members of CMA as we advocate for quality and for timely access to safe and affordable healthcare.” Dr. Cobb’s term as CMA president will run from November 2014 through October 2015.

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D E C E M B 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

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

CMA Welcomes New President

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

CEO’s LETTER

AF TER A LONG BAT TLE , we finally witness a victory of political power.

LACMA is thrilled that California voters have sided with their doctors to end the single largest assault on MICRA in 39 years. During the November election, Proposition 46 was defeated by a clear margin of 67.1% to 32.9%. The actual vote count was 3,415,996 “No” votes to 1,671,163 “Yes” votes, according to figures from the California Secretary of State. This demonstration of power marks a new day for physician leadership in the state of California. And the campaign’s two major supporters -- LACMA and the California Medical Association -- couldn’t be more pleased about the outcome. Dustin Corcoran, CEO of the CMA and chair of the opposition campaign, noted that “California voters spoke loudly and definitely: In this healthcare environment, undermining California’s long-standing malpractice cap is a political poison pill and a policy ‘third rail.’” He added that Californians voted against the measure because increasing the payouts in medical malpractice lawsuits would have led to higher healthcare costs and reduced access to care. The malpractice cap has been in place since 1975. Attempts to increase the state’s $250,000 limit on pain-and-suffering awards in malpractice lawsuits have been rejected 10 times in court, five times in the state Legislature, and now, by California voters. I’m very proud of all the physician leaders who put their reputation and their pocketbooks on the line in the interest of their patients. This said, I am hopeful that physicians across California will seize the moment and push through much-needed reforms in the legislative cycle. This December will mark our quarterly board meeting as well as the 143rd Annual House of Delegates in San Diego, where we will discuss various initiatives and actions to advocate for reform. On a lighter note, LACMA’s celebration at the third annual Healthcare Awards dinner to honor individuals and institutions that have made exemplary contributions to the community was a huge success. Our innovative leaders will inspire the next generation of physician leaders, and we are proud to be a part of that effort. During this holiday season, I would like to wish everyone a joyous and peaceful holiday and a healthy and happy New Year. A New Year … a New Challenge.

Rocky Delgadillo Chief Executive Officer

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

The Power of Participation

The defeat of Proposition 46 took center stage, but California voters also rejected Proposition 45, which would have given the state insurance commissioner new power over healthcare benefits, rates and co-payments for individuals and small groups. The California Medical Association (CMA) and others who were part of the broad coalition opposing the proposition felt strongly that the last thing doctors and patients needed was a politician having more power to interfere with what treatments are or are not covered. A Proposition 45 campaign staffer told PNN that the contribution from local physicians and their active participation was vital to the effort. Physicians are the most trusted members of local communities, he said. Having local doctors participate by making themselves available to the media — whether writing commentaries or appearing on the local news or in commercials — was invaluable. The Proposition 45 campaign coordinators wanted to recognize the following physicians who actively participated in the campaign:

Renew your dues today! 

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Legislative Advocacy—Continuous fight to protect the medical profession from current challenges such as Proposition 46, narrow networks in California, and CalMediConnect. Access to documentation to help you navigate through today’s changing healthcare landscape. Free Reimbursement Assistance—CMA has recovered nearly $8 million recovered since 2010 in unpaid claims for its members! Free Jury Duty Assistance—Your time is valuable! Maximize your flexibility and increase your chances for reporting for the minimum period when scheduling jury duty service. 15-27% average annual savings through LACMA’s exclusive partnership with Medline, the medical supplies company. Free and low cost access to events including CME events, mixers, training workshops, and webinars for you and your staff. For our Valued Members

Dr. Marshall Morgan (pictured), immediate past president of LACMA, and Dr. Amy Nguyen Howell, both of whom were filmed in the “Exam Room” commercial. Dr. Samuel Fink, past president of LACMA, who was interviewed by multiple TV stations as well as by the Orange County Register for a story about Prop. 45. Dr. Marty Gallegos of the Hospital Association of Southern California, who debated Consumer Watchdog at a voter forum in LA. Dr. Efrain Talamantes, who was interviewed by Fox News Latino. Dr. Thais Aliabadi, who agreed to let the campaign use her office and appear in a campaign commercial (the campaign ended up filming the commercial in Sacramento instead). Many appeared in a campaign mailer — Dr. Marshall Morgan, Dr. Amy Nguyen Howell, Dr. Richard Baker, Dr. Jorge Carreon, Dr. Efrain Talamantes and Dr. Carlos Martinez.

FREE DUES! Renew your 2015 membership by December 31st, 2014 and be entered in a drawing to win FREE dues for 2015!

How to renew: Call: Carolina Velazquez, 213-226-0361 Renew online at www.lacmanet.org/Renew Your Medical License number will act as your login

Mail your invoice and payment to: 707 Wilshire Blvd, Suite 3800; Los Angeles, CA 90017 For a copy of your renewal invoice please email Carolina Velazquez, carolina@lacmanet.org

D E C E M B 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

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

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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.

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.

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When you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need—be it help with a problematic payor, or details about your member discounts—just call the member helpline at (800) 786-4262 or visit www.lacmanet.org

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is the best time to join LACMA and CMA For more information on member benefits and resources, visit www.lacmanet.org/Membership LOS ANGELES COUNTY MEDICAL ASSOCIATION 707 WILSHIRE BLVD, SUITE 3800 LOS ANGELES, CA 90017 PHONE: (213) 683-9900 FAX: (213) 226-0353

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