December 2015 | Physician Magazine by Los Angeles County Medical Association

2016 TAX LAW CONSIDERATIONS & MAXIMIZING REDUCTIONS

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

PLUS:

The Business of Being a Doctor

2015 L.A. HEALTHCARE AWARDS

Healthcare Champion of the Year

L I A

MITCHELL H. KATZ, MD

M A G

DECEMBER 2015

L I A

M A G

Wells Fargo Practice Finance

Financing for your practice — and so much more

With more than 25 years of healthcare financing experience, Wells Fargo Practice Finance understands the business of running a practice and is here to help you achieve your practice goals. Get up to 100% financing for a variety of business purposes: • Practice start-up and acquisition • Equipment purchases or upgrades • Office expansion, remodel, and relocation • Practice debt refinancing • Working capital Thinking about starting, acquiring, or expanding your practice? Let’s talk: 1-800-377-7340 or wellsfargo.com/physicians

All financing is subject to credit approval. Business refinance program is for practice-related debt only. Existing Wells Fargo Practice Finance debt and revolving credit are not eligible for consolidation. © 2015 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. ECG-1436101 SBS60-0244

D ECEM B ER 2015 | TA B LE OF CONT ENT S

Volume 146 Issue 12

1 60

10 FEATURE | The Business of Being a Doctor 14 Taxes 2016: Law Considerations & Reductions

COVER STORY

L.A. Healthcare Awards

The L.A. Healthcare Awards, held on Nov. 19 recognized individuals and institutions for their exemplary contributions to improving access to quality healthcare in Los Angeles and benefited the Patient Care Foundation of Los Angeles County Medical Student Scholarship Program to help cultivate the next generation of physicians practicing in Los Angeles County.

FROM YOUR ASSOCIATION 4 President’s Letter | Peter Richman, 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 801 S. Grand Avenue, Suite 425, 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,801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request. Statement of Ownership, Management, and Circulation: Publication Title: Southern California Physician. Publication Number: 1533-9254. Filing Date: 10/27/15. Issue Frequency: Monthly. Number of Issues Published Annually: 12. Annual Subscription Price: $39. Complete Mailing address of Known Office of Publication: 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Complete Mailing Address of Headquarters or General Business Office of Publisher: 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor - Publisher: Sheri Carr, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Editor: Sheri Carr, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Managing Editor: Sheri Carr, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017; Owner: LACMA Services, Inc. 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or more of Total Amount of Bonds, Mortgages, or Other Securities: None. Tax Status: Has Not Changed During Preceding 12 Months. Publication Title: Physician Magazine. Issue Date for Circulation Data Below: November 2015. Extent and Nature of Circulation - 15a. Total Number of Copies: 6213 (avg)/6494 (actual); 15b1. 5839 (avg)/6184 (actual); 15b2. 0 (avg)/0(actual); 15b3. 0 (avg)/0(actual); 15b4. 0 (avg)/0(actual); 15c. 5839 (avg)/6184 (actual); 15d1. 0 (avg)/0(actual); 15d2. 0 (avg)/0(actual); 15d3. 0 (avg)/0 (actual); 15b4. 374 (avg)/310(actual); 15e. 374 (avg)/310(actual); 15f. 6213 (avg)/6494 (actual). 15g. 0(avg)/0 (actual). 15h.6213 (avg)/6494 (actual). 15i. 94 (avg)/95 (actual). 16a: Requested and Paid Electronic Copies: 8022 (avg)/7894 (actual); 16b. Total Requested and Paid Print Copes + Requested/Paid Elctronic Copies: 13,861 (avg)/14,078(actual); Percent Paid and/or Rueqested Cirulation (both print and electronic copies); 97.4 (avg)/97.8 (actual). Publication of Ownership: If the publication is a general publication, publication of this statement is required. Will be printed in the December 2015 issue of the Publication. Signature and Title of Editor, Publisher, Business Manager or Owner. , Publisher. 11/19/14.

D E C E M B ER 2015 | 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 858.226.7647 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

DISPLAY AD SALES / DIRECTOR OF SALES CLASSIFIED AD SALES

EDITORIAL ADVISORY BOARD

HEADQUARTERS

The Los Angeles County Medi-

Physicians News Network Los Angeles County Medical Association 801 S. Grand Avenue, Suite 425 Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.physiciansnewsnetwork.com

cal Association is a professional association representing physicians from every medical

LACMA OFFICERS

specialty and practice setting PRESIDENT

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

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

PRESIDENT-ELECT

TREASURER SECRETARY

IMMEDIATE PAST PRESIDENT

Peter Richman, MD Vito Imbasciani, MD William Averill, MD Richard Baker, MD Pedram Salimpour, MD

than 100 years, LACMA has LACMA BOARD OF DIRECTORS

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

CMA TRUSTEE

ALTERNATE RESIDENT/FELLOW COUNCILOR

COUNCILOR – SSGPF

COUNCILOR – DISTRICT 9 CMA TRUSTEE COUNCILOR

areas of public policy, govern-

COUNCILOR – DISTRICT 2

ment relations and community

ETHNIC PHYSICIANS COMMITTEE REP

relations. Through its advocacy

COUNCILOR – DISTRICT 17

COUNCILOR-AT-LARGE

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

COUNCILOR – DISTRICT 1

COUNCILOR – DISTRICT 14 COUNCILOR – USC

COUNCILOR – DISTRICT 7 COUNCILOR – DISTRICT 6 COUNCILOR-AT-LARGE

COUNCILOR – ALLIED PHYSICIANS COUNCILOR-AT-LARGE

COUNCILOR – DISTRICT 3

COUNCILOR – DISTRICT 10

MEDICAL STUDENT COUNCILOR/USC

COUNCILOR – SCPMG

RESIDENT/FELLOW COUNCILOR

YOUNG PHYSICIAN COUNCILOR

COUNCILOR-AT-LARGE

COUNCILOR – SSGPF

ALT. MEDICAL STUDENT COUNCILOR/UCLA

time worrying about the chal-

COUNCILOR-AT-LARGE

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 Jinha Park, MD Stephanie Hall, MD David Hopp, MD Kambiz Kosari, MD Sion Roy, MD Paul Liu, MD Maria Lymberis, MD Philip Hill, MD Nassim Moradi, MD Vamsi Aribindi Ashish Parekh, MD Jerry Abraham, MD Po-Yin Samuel Huang, MD Michael Sanchez, MD Heather Silverman, MD Annie Wang Nhat Tran, MD Fred Ziel, MD

lenges of managing a practice. LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

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, 801 S. Grand Avenue, Suite 425, 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.

The CMA/LACMA’s exclusive new Workers’ Compensation program can help your practice save money! Savings

CMA members qualify for an additional 5% discount* on top of Preferred Insurance’s already competitive rates. Preferred’s rates are set for long term consistency, and are managed by focusing on safety and injury prevention, fraud prevention and the control of medical costs for your practice by getting employees back to work as soon as practical.

Service Mercer’s team of insurance advisors is knowledgeable about the needs of physicians and is available to walk you through the application process. Preferred’s claims examiners are experts in helping members with an employee injury or illness claim. Plus Preferred’s payroll management and flexible payment plans help you manage your premiums in the way that works best for you and your practice’s cash-flow needs.

Safety In addition to mandatory CalOSHA information and videos on workplace safety, Preferred’s team of Risk Advisors are available for consultations when you need them. They also have a strong fraud prevention policy and as a California-based carrier, they know exactly what it takes to do business successfully in this State.

Stability Preferred Insurance prides itself on its stability, which includes maintaining some of the best and most consistent pricing available for CMA members. And because of its Medical Provider Network of credentialed medical professionals, claim costs can be closely monitored and managed while providing quality care to injured employees.

Call Mercer today at 800-842-3761 for a premium indication. CMACounty.Insurance.service@mercer.com or www.CountyCMAMemberInsurance.com.

See how CMA/LACMA’s Workers’ Compensation team can help you save! Sponsored by:

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*Most practices will qualify for group pricing and receive the 5% discount; however some practices will need to be underwritten separately when they do not qualify for the special program terms and conditions. A minimum premium applies to very small payrolls.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 • Copyright 2015 Mercer LLC. All rights reserved. • 71367 (12/15) 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com

P RES IDEN T â&#x20AC;&#x2122;S LET T ER | P ET ER RIC H M AN, M D

T H E M E D I C A L S C H O O L C U R R I C U LU M has evolved to prepare the medical

student for a lifelong profession. Students are given a broad foundation on which residency training builds. They are taught the basic sciences with an introduction to clinical medicine. Medical students no longer just memorize disease symptoms, signs and medical treatments. Medical research has exploded over the past generation. Biochemical pathways have been elucidated with multiple genetic defects leading to defective enzymes altering these pathways and resulting in a myriad of disease states. Furthermore, there has been an exponential growth of medications targeting these disease states. Single diseases in the past now have multiple subcategories and multiple medical regimens that only the specialist can remember, and even specialists need computer assistance. There is not enough time to learn it all. In residency, trainees concentrate in a specialty, learning limited disease entities in greater specificity. After completing residency, the young physician is ready to tackle the world. However, there is a rude awakening. Medical students and residents are not taught the business side of medicine. What are the available options of practice? How does one set up a practice, or if joining an existing group, what employment contract issues need to be addressed? How does one obtain a Medicare provider number? How is insurance authorization obtained? What is meaningful use? The list goes on. Even for those joining a very large group, a working knowledge of medical business such as assessing budgets, planning capital purchases and strategic planning is immensely useful, especially for those involved in administrative duties. The ideal situation would be a course in medical school that addresses the basics. Medical schools have not felt it is in their purview to teach this subject, nor do they feel they have the time block, given the vast quantity of medical information that needs to be imparted. Furthermore, the utility of the information comes into play after residency, which is years away. Much of the information would be forgotten, just like organic chemistry or calculus. LACMA and CMA are developing curricula that address both business and political education. Short, free standing courses and mentoring programs are available to those interested students and residents who wish to partake at a time they feel would be beneficial. It is a service that organized medicine can provide. Those in practice have often learned the hard way and can instruct young physicians with knowledge and practical experience.

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 2015

For the difference you make. Get a discount on select Sprint monthly service because of where you work.

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*HCVRT_ZZZ* Please bring proof of employment with you to the store, such as a badge or a current paystub.

Activ. Fee: $36/line. Credit approval req. Early Termination Fee (sprint.com/etf): After 14 days, up to $350/line. SDP Discount: Avail. for eligible company employees, org. members or agency employees (ongoing verification). Discount subject to change according to the company’s, org.’s or agency’s agreement with Sprint and is avail. upon request for select monthly svc charges. Discount only applies to Talk 450 and primary line on Talk Share 700; and data service for Sprint Family Share Pack, Sprint $60 Unlimited Plan and Unlimited, My Way, Unlimited Plus Plan and Sprint Family Share Plus plans. Not avail. with no credit check offers or Mobile Hotspot add-on. Sprint Buyback: Offer ends 12/31/15. Limit of 5 returned devices per active mobile number during one 12 month period, 3 per transaction. Phone must be deactivated and all personal data deleted before recycling. Device will not be returned. Credit varies depending on phone condition and valuation. Credit applied to store purchase or account within 3 invoices. Also available at sprintbuyback.com. Other Terms: Offers and coverage not available everywhere or for all devices/networks. Restrictions apply. See store or sprint.com for details. © 2015 Sprint. All rights reserved. Sprint and the logo are trademarks of Sprint. Android, Google, the Google logo and Google Play are trademarks of Google Inc. Other marks are the property of their respective owners. N115880 MV1234567

R I SARM K T IP Y H | EM EALT P LOYIN H P ROF G ES ADVAN 2S0ION 1 5 CED L.A. S S C HPEALT OLARS RACTHICE CHARE IPP P ROVIDERS ROGRAM AWARDS

PCF President Troy Elander, MD, 2015 Healthcare Champion of the Year Mitchell H. Katz, MD, and LACMA President Peter Richman, MD.

Dr. Mitchell H. Katz has been the director of the Los Angeles County Department of Health Services, the second largest health system in the nation, for the last five years. Previously, he was the director of health for the City and County of San Francisco for 13 years. Prior to becoming the director in San Francisco, he served the department in a number of positions, including director of the AIDS Office and director of the Emergency Medical Services Agency. He is a member of the Institute of Medicine and a professor of clinical medicine at UCLA. He practices as an outpatient primary care doctor at Edward R. Roybal Comprehensive Health Center and sees inpatients at LAC+USC, Harbor-UCLA, and Olive View-UCLA Medical Centers.

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 2015

THE LOS ANGELES COUNTY MEDICAL ASSOCIATION hosted the L.A. Healthcare Awards on Nov. 19 at the California Club. The highly successful event recognized individuals and institutions for their exemplary contributions to improving access to quality healthcare in Los Angeles. Mitchell H. Katz, MD, Director, LA County Department of Health Services was honored as the 2015 Healthcare Champion of the Year. “LACMA is proud to recognize individuals and institutions whose leadership and commitment to the medical profession have resulted in the advancement and progression of the standards of healthcare,” said Peter Richman, MD, LACMA president. Proceeds from the event support the Patient Care Foundation of Los Angeles County Medical Student Scholarship Program to help cultivate the next generation of physicians practicing in Los Angeles County. “Tonight’s event benefits the Patient Care Foundation of Los Angeles, which provides a connection between LACMA physicians and our communities by looking to improve patient access, care and treatment, to advance health education, and to encourage physician involvement and service in communities,” said Troy Elander, MD, president of the Patient Care Foundation, in his opening statements. The Foundation, a charitable organization that serves as a link between physicians and the community, impacts the quality of life of all patients in Los Angeles County by expanding the pool of medical professionals who practice medicine in underserved communities. The Patient Care Foundation Scholarship Program provides financial assistance to deserving medical students on their journey toward becoming the next generation of Los Angeles physicians. “LACMA remains committed to equipping our physicians with the necessary tools they need to succeed in serving patients in all of Los Angeles County’s communities,” said Dr. Richman. “We remain steadfast in upholding our founders’ vision to strive to make impactful and positive strides in healthcare issues. In true LACMA tradition, we will work diligently to always be advocates for progress in the healthcare system.” Following dinner, Dr. Elander returned to the podium to announce the four Medical Student Scholarship Recipients. Howard Krauss, MD, and Jean Campbell-Morgan then took the stage to announce the establishment of the Marshall Morgan, MD, Scholarship Fund, named in honor of a LACMA leader and past president, and established to recognize an outstanding Emergency Medicine resident in Los Angeles County. “Candidate qualifications for this scholarship involve criteria that Dr. Marshall Morgan was very passionate about. The ideal candidate is highly engaged in community activism, a firm gun control advocate, and a contributor in medical innovation, all while exhibiting professionalism in all acts of service,” said Dr. Krauss. “The recipient embodies leadership through his or her contributions towards disaster relief efforts, administering to the underserved and most in-need areas. “Participation in Operation Mend, UCLA’s partnership among UCLA Health, the United States military and the Department of Veterans Affairs to help heal the wounds of war by providing advanced surgical and medical treatment and comprehensive psychologicalhealth support for post-9/11-era service members, veterans and their families is also an essential facet.“ Event sponsors include Exclusive Presenting Sponsor Wells Fargo; along with Gold Sponsors Providence Health & Services and USC Keck Medical Center; and Silver Sponsors AltaMed, Cedars-Sinai, City of Hope, Cooperative of American Physicians (CAP), Glendale Adventist Medical Center, Kaiser Permanente , L.A. Care, Los Angeles County Medical Association, Moore White, White Memorial and UCLA Geffen School of Medicine.

2 0 1 5 L.A. H EALT H C ARE AWARDS

PHOTOS Top left: Peter RIchman, MD, Honoree Dr. Alexandra Levine, MD, and LACMA Board Member William Averill, MD. Top right: Honorees Vicken Sepilian, MD, and John Raffoul, with colleagues. Middle left: LACMA Immediate Past President Pedram Salimpour, MD with Mr. Ryan Belkin and PCF President Troy Elander, MD. Middle right: Dr. Richman with Honoree John Raffoul and Dr. Troy Elander. Bottom left: Honoree Vicken Sepilian, MD, center and colleagues. Bottom right: Honoree Anne L. Coleman, MD, PhD, with Dr. Elander.

HEALTHCARE CHAMPION OF THE YEAR | Mitchell H. Katz, MD, Director, LA County Department of Health Services HOSPITAL PHYSICIAN LEADERSHIP AWARD | Alexandra Levine, MD, MACP, Chief Medical Officer, City of Hope National Medical Center INDEPENDENT PHYSICIAN LEADERSHIP AWARD | Vicken Sepilian, MD, Past President, Armenian American Medical Society

INNOVATION AWARD — COMMUNITY SERVICE | Anne L. Coleman, MD, PhD, Director, UCLA Mobile Eye Clinic – Jules Stein Eye Institute INNOVATION AWARD — PUBLIC EDUCATION | John G. Raffoul, President and CEO, Tu Mundo Hoy, White Memorial Medical Center

INNOVATION AWARD — HEALTHCARE FACILITIES | William Shrank, MD, Senior VP, Chief Scientific Officer, Chief Medical Officer of Provider Innovation, CVS Health SHINE THE LIGHT MEDIA AWARD | Ryan McGarry, MD, Director and Writer, CODE BLACK Documentary

2015 MEDICAL STUDENT SCHOLARSHIP RECIPIENTS

MARIA DE FATIMA REYES | Keck School of Medicine of USC Maria received her Bachelor of Arts degree at the University of California Los Angeles, completed her Post-Baccalaureate Pre-Health Program at the University of Pennsylvania and is a Doctor of Medicine Candidate at the Keck School of Medicine at the University of Southern California. She is a member of the Latino Medical Student Association and has served as secretary for the Student National Medical Association, Keck School of Medicine, and as treasurer for the Associated Students of the Keck School of Medicine. Her professional goal is to be an effective physician leader at LAC+USC Medical Center to work towards improving the health of her community. YVETTE OSEI-AKOSA | Keck School of Medicine of USC Yvette received her Bachelor of Arts degree from the University of Southern California, completed her Post-Baccalaureate Pre-Medical Program at Washington University in St. Louis and is now a MD, candidate at the Keck School of Medicine of USC. She is a member of the Student National Medical Association, Keck Chapter, the Association of Black Women Physicians, American Academy of Family Physicians and the American Medical Women’s Association. Raised in Mid-City Los Angeles, she gained experience volunteering as a mentor to inner-city youth and is interested in pursuing a medical career in pediatrics or family medicine. ELIZABETH PELAYO | David Geffen School of Medicine at UCLA Elizabeth received her Bachelor of Science degree from the University of California, Los Angeles and is currently attending medical chool at Charles Drew University of Medicine and Science/David Geffen School of Medicine at UCLA. She is a Lennox Supplies Coordinator and Interpreter for the Latino Medical Student Association, a participant in the Primary Care Continuity Program at the David Geffen School of Medicine and has served as a facilitator for the Drew/UCLA Pre-Matriculation Program. Raised in an underserved Latino community in the San Fernando Valley, Elizabeth says her professional goal is to become a pediatrician who works in the economically challenged, underserved neighborhoods in LA County. STACY SONGCO | David Geffen School of Medicine at UCLA Stacy Songco is a graduate of the University of California, Berkeley, where she received bachelor’s degrees in molecular and cell biology and sociology. She is currently attending the David Geffen School of Medicine at the University of California, Los Angeles. Stacy is on a mission to shape healthcare delivery to medically underserved communities in Los Angeles. She plans to become a primary care physician so she can serve a multicultural and diverse community similar to the one she grew up in. She has volunteered at the Obstetrics and Gynecology Department at Los Angeles County Harbor-UCLA Medical Center in Torrance, and interned at the Emergency Medicine Department at Alameda County Highland General hospital in Oakland, Kaiser Permanente Medical Center in San Francisco and Alameda County Health Pipeline Partnership in San Leandro. Describing herself as synergistic and knowing she can be a catalyst for positive change, Stacy says her medical career goal is to bring about positive health outcomes to those she serves, not just to heal but to also improve patients’ state of being and wellness. PHOTOS (top to bottom) Medical Student Scholarship Recipient Maria de Fatima Reyes and Yvette Osei-Akosa.

Champion of the Year Mitchell H. Katz, MD, with Medical Student Scholarship Recipient Stacy Songco and her Parents.

PCF Board Member Howard Krauss, MD, and Jean Campbell-Morgan announce the Marshall Morgan, MD, Scholarship Fund.

PCF President Dr. Troy Elander and Diane Elander with 2012 L.A. Healthcare Awards Healthcare Champion of the Year, LA County Supervisor Mark Ridley-Thomas.

8 P H Y S I C I A N M A G A Z I N E | D E C E M B ER 2015

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D E C E M B ER 2015 | 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

T H E B U S IN ES S OF B EIN G A DOC T OR | F EAT U RE

The

Business

of Being a Doctor

BY GAVIN SHEA

Even the most skilled business owners can find it challenging to manage the financial side of their business. As a physician, your primary focus is on what attracted you to starting a medical practice in the first place – your passion for helping patients or honing your medical expertise. Managing the financial affairs of your practice can seem like a timeconsuming and uncomfortable chore. The key is to get control of your practice finances from the very beginning, establishing reliable systems for monitoring, managing and growing your profitability and success. If you’re struggling to pull the financial side of your practice under control, use the following guidelines to get started. MANAGING THE FINANCIAL SIDE OF YOUR PRACTICE |

Hire an Experienced Team

Thankfully, managing your finances does not mean you have to personally crunch the numbers! A team of professionals can guide you towards the most appropriate financial decisions for your practice. Include both a Certified Public Accountant (CPA) and lender, ideally with previous medical practice experience. The services they should be able to provide include: ACCOUNTANT | An accountant or CPA monitors your income and expenditures to make sure your practice is financially sound. Your accountant should be able to develop tax projections, plans and estimates, and prepare and file tax documents for your practice. They should also be able to help establish collections and other financial procedures for the practice, and advise on tax and accounting implications of business and investment decisions. LENDER | Your lender provides the funds and resources for getting your practice started and developing its full potential. Understanding the distinction between different types of lenders is important. Collateral-based lenders typically use the value of your personal assets – such as your home, money market accounts and vehicles – as collateral when making credit decisions. Cash-

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 2015

flow lenders typically make credit decisions based on projected revenue and cash flow, using the practice itself as collateral, not personal assets. Cash-flow lenders tend to be specialty lenders focused on a particular business or industry.

Develop a Plan for Financial Success

Financially successful business owners understand how to recognize and solve problems as they arise, and take advantage of opportunities that present themselves. They create a plan for their future, modifying the plan as circumstances require. Following are general guidelines for developing a strategy for long-term financial success for your practice. For a complete financial plan, meet with your CPA or financial advisor. • Do not take on more debt than you can comfortably handle. Work with your CPA to determine the appropriate amount of debt for your situation. • Create business and marketing plans that specify how you will achieve annual growth in number of patients and level of production. • Create a regular schedule for reinvesting in

• Work with your tax advisor or accountant to take full advantage of tax benefits for small business owners, such as the Section 179 deduction for equipment purchases. • Create a realistic plan for retirement that does not rely exclusively on the sale of your practice, but includes other investments as well.

Know How to Implement Your Financial Strategy

So how do you go about putting your financial strategy into action? The secret is to establish reliable internal systems designed to inform you of the status of your finances and help you grow your income as needed. The following business systems can help you implement your strategy:

1. MONITOR PRACTICE PERFORMANCE | Exam-

ining your practice statistics regularly is a critical tool for maintaining the health of your medical practice. Profit and loss numbers help you diagnose and treat problems, much like a lab panel helps you diagnose and treat medical disorders. In order to understand the strengths and weaknesses of your practice and systems, you need to start with baseline measurements for everything from production to operating expenses. One way to do this is with Wells Fargo Practice Finance’s Milestones program, which was developed to help new practice owners establish and work with a sound business foundation. .

these efforts yourself, it’s helpful to create a consistent marketing program that builds awareness and recognition of your practice. One of the easiest, least expensive and often most effective marketing strategies is already within your practice: referrals from your current patients. Make a habit of requesting referrals or reviews from your best, most engaged patients. Speaking of reviews, don’t overlook social media. A Facebook page, for example, can be a great tool for creating an online community, giving your patients a place to comment and refer others. You can also send personal letters to members of the community to introduce yourself and directly ask for their business. As your budget allows, explore Internet ads, newspapers, billboards, or even radio and television. 4. IMPROVE YOUR COMMUNICATION SKILLS |

Understanding how to build trust and confront difficult situations is one of the keys to solid leadership in your practice. Effective commu-

MEDICAL BOARD HOSPITAL STAFF F R A U D / A B U S E MEDI-CAL/M E D I C A R E

MEDICAL PRACTICE PURCHASES, SALES AND MERGERS

2. MANAGE YOUR CASH FLOW | Any

business, large or small, finds itself with cash flow shortages at times. Make a plan to manage your cash flow by setting daily and monthly production goals, paying down outstanding debt, and saving 10% of income after expenses are paid. This will help ensure you have cash on hand in case of a bad month or an unanticipated expense.

3. BEEF UP YOUR MARKETING

Whether you choose to utilize an agency or consultant, or handle

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F EAT U RE | T H E B U S INES S OF B EIN G A DOC T OR

your practice to keep it current and competitive, for example, with equipment and technology upgrades.

T H E B U S IN ES S OF B EIN G A DOC T OR | F EAT U RE

nication allows for productive work environments. Healthy communication will increase morale and commitment from your team. 5. KNOW YOUR STRENGTHS AND BUILD ON THEM | Surround yourself with specialists and

staff who complement your skills. While you work to improve your weaknesses, let your strengths take the lead in guiding the tone and style of your practice. You’ll be happier in your work as you succeed while being yourself.

are aware of the advanced processes and services you now offer. Your equipment supplier can help assure you have the appropriate selection and integration of equipment and technology for your particular practice.

Financing Your Technology Upgrade

If you have been in your practice for a period of time, a practice equity loan may be ideal for financing ongoing technology purchases. By Create a Technology tapping into the equity you’ve already built into Investment Plan your practice, you can secure ongoing access to a An effective technology investment plan outsignificant amount of funding for technology purlines what new equipment you plan to acquire, chases that will help advance your practice. Also and when. For maximum value, incorporate new consider an equipment loan with fixed rates and a technology advancements on a planned, timely predictable payment plan. basis. Don’t rush to add This type of loan can help every new product evoluyou manage your cash tion as soon as it’s availflow to ensure repayment able – this will likely place Don’t rush to add every of your equipment investyou in needless debt and new product evolution ments before your exit at overwhelm your staff with retirement. as soon as it’s availexcessive training. Nor No matter which type should you hang onto your able – this will likely of financing you choose, equipment for decades to place you in needless the ready availability of wring every last dollar out loan funds can make it easdebt and overwhelm of its use. ier to time your upgrades your staff with excesRather, use the followaccording to what works ing guidelines to create a sive training. best for your practice, rathrealistic plan that meets er than the amount of your specific goals: personal savings or cash on hand. - Keep abreast of new By carefully planning your practice success, developments in medical technology through monitoring your cash flow, strategizing business regular trade show attendance and periodic growth, and working with an experienced team, meetings with your equipment supplier to you will one day find that the financial side of identify future technology needs. your practice seems to be managing itself. And - Categorize and prioritize the technologies you that’s because you will have successfully laid the wish to incorporate over the next three to five groundwork for your business, and finances, to years, including software and hardware sys- run smoothly and efficiently. tems, digital equipment and tools, utility systems that power your practice, and systems for Gavin Shea is the Senior Director of Sales and Marketing for Wells Fargo Practice Finance. With more than 17 years infection control. of banking experience with an emphasis in practice lend- Set aside funds every month – for example, 5% of net profits – for future technology purchases. That way, you will always be ready to take advantage of new advancements that can benefit your patients and practice. - Create a plan to actively market your new technology investments to your patients so they

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 2015

ing, he leads sales and marketing strategy development and implementation throughout the national footprint. His industry background offers practitioners a unique perspective as they approach some of the most important decisions in their professional lives. With more than 25 years of healthcare experience, Wells Fargo Practice Finance specializes in helping healthcare professionals acquire, start and expand their practices with various financing options and a signature Practice Success Program. Contact: Gavin.m.shea@wellsfargo.com | 844-626-4317.

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TAXES 2016 BY MARION WEBB

WITH THE START OF A NEW YEAR JUST AROUND THE CORNER, THIS IS A CRITICAL TIME FOR PHYSICIANS TO WRAP UP THEIR YEAR-END

TAX,

LEGAL

AND FINANCIAL OBLIGATIONS. TO HELP YOU DURING THIS ACTIVE TIME, HERE IS A LIST OF SOME BASIC

DUE

5 ITEMS TO HELP MAXIMIZE TAX REDUCTIONS

1 2

DILIGENCE

ITEMS TO CONSIDER FOR YOURSELF AND TO DIS-

3 4

CUSS WITH YOUR FINANCIAL AND TAX EXPERTS. 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 2015

Maximizing the tax benefits of your retirement plan, including 401(k)s, profit-sharing plans, money purchase plans, defined benefit plans or even SEP or SIMPLE IRAs, to reduce your deductions for 2015 is a good way to reduce taxes on April 15, 2016. A captive insurance company (CIC) can be beneficial for practice owners to insure all types of risks, from business risks such as declining revenues or the destruction of electronic records to litigation such as malpractice or employment issues. CIC also offers coverage for surgery centers and real estate. If created and maintained properly, the CIC can bring significant tax benefits, according to Modern Medicine. In some cases, working with a financial advisor to prepay some of the following year’s expenses in the present year, as long as the economic benefit from the prepayment lasts 12 months, can also bring substantial tax reductions. Beginning in 2013, the tax law imposed a 3.8% surtax on certain passive investment income of individuals, trusts and estates. For individuals, the amount subject to the tax is the lesser of net investment income or the excess of a taxpayer’s modified, adjusted gross income over an applicable threshold amount. Consulting a tax advisor about strategies might save large amounts of surtax. Charitable gifts can also bring significant tax benefits for your business and family, especially during a year of high income.

5 TAX LAW CONSIDERATIONS

When it comes to doctors, their human capital is likely their most valuable asset, an expert wrote in Modern Medicine. A common mistake many doctors reportedly make is to deduct the premium of their disability insurance, which gives a small deduction now, but can mean potentially significant taxes in the future. Ideally, disability insurance is paid with after-tax dollars.

Under the Patient Protection and Affordable Care Act, physicians earning more than $200,000 a year ($250,000 for joint filers) started paying higher Medicare hospital insurance taxes in 2013. The new tax is 2.35%, a 0.9% rise of applicable wages above those thresholds. Doctors who are sole proprietors will pay the additional 0.9% on their year-end tax return.

3 4

Also in 2013, high-income taxpayers became subject to a new Medicare tax on investment income such as capital gains, dividends, interests and rental income. For details, consulting a tax advisor can help.

As of Aug. 1, 2013, pharmaceutical companies, life science firms and other groups started collecting information on the financial relationship with doctors and are required to report this information to the Centers for Medicare & Medicaid Services (CMS). Under the new law, companies must annually report to the CMS any direct or indirect pay or other transfers of value they make to physicians and teaching hospitals and ownership and investment interests held by physicians. CMS will make the reports publicly available. Doctors who have sold a practice or consider selling a practice to a hospital and are now hospital employees will likely encounter tax-related changes in expense reimbursement and their retirement savings plan. Here are some general tax considerations related to the sale of a practice and hospital employment transactions, according to Physicians Practice. If the group entity pays taxes under subchapter C of the IRS Code, the asset sale creates the risk of double taxation of the sale proceeds. That same transaction for a group entity that files as a partnership (an LLC or an “S Corp”) will generate significantly less total tax, because only the physician owners, not the group entity, will be taxed, according to the article. Recognizing which party is selling an asset can help avoid double taxation of the proceeds of that sale. Physicians also need to consider the probable net economic effect of accepting hospital employment, in particular, employment-related expenses typically subject to an annual cap and including properly documented dues and fees. These deductible expenses tend to be less than physicians may have been used to working for themselves. Also, physician practices retirement savings are usually more beneficial than those available to hospital employees, often because the private practice plans have higher annual contribution limits. Because of IRS/plan rules, the difference can particularly adversely affect doctors who are over age 50.

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

CEO’s LETTER

A S 2 0 1 5 I C O M I N G T O A N E N D and LACMA members are enjoying the holiday season, we can look back at a year of tremendous successes and accomplishments. This year, in particular, LACMA’s continued efforts to find new and creative ways to grow its membership base and retain existing members have made significant strides. We have never stopped growing. In 2015, LACMA increased its active membership numbers to 2,696 from 2,662 in 2014 with an 88.5% overall retention rate, exceeding our expectations to retain 80% of non-group (self-paying) members. According to CMA, LACMA’s recruitment rate this past year was almost twice that of the rest of the state, or 13.3% vs. 7% respectively. Overall, LACMA’s total member retention rate of 88.5% for groups and self-paying member is significantly higher than seen in previous years. We attribute much of this success to our 90-page strategic marketing plan, which guides our recruitment and retention efforts (lacmanet.org/marketing.aspx), but also to our new programs. LACMA’s new Career Center, Job Board and Leadership Development Program has led to a substantial increase in traffic to our website and has also drawn non-dues revenue from job postings. We expect that the new Career Center, launched this summer, will continue to bolster revenue during the next 12 months. In addition, LACMA is also working with critical partners such as the new websitebased Resource Centers for members and office staff, including the Resource Center on Taxes, Mortgages, and Home Buying, the Financial Planning Resource Center and EHR Resource Center, which offer our physician members critical information and benefits. LACMA is also proud that so many physician leaders have been placed on prominent boards, commissions and committees, including the California Medical Board and the Police and Fire Pension Board in the City of Los Angeles, LACMA has also broadened its commitment to being the “voice of medicine” through its Advisory Committees. As healthcare is ever evolving, LACMA is particularly proud to recognize those individuals and institutions whose leadership and commitment to the medical profession result in advancement and the progression of the standards of healthcare. During the recent Los Angeles Healthcare Awards, which took place on Nov. 19 at the California Club, LACMA honored this year’s awardees and raised record funds to benefit the Patient Care Foundation, which provides scholarships to the next generation of physicians, as well as the Marshall Morgan, MD, Scholarship Fund, named in honor of a LACMA leader and past president, which recognizes outstanding Emergency Medicine residents in Los Angeles County. As we move into the new year, LACMA will continue its efforts to find new and creative ways to unite the physicians of Los Angeles County and make our community stronger. Our new office, located on 801 S. Grand, is just three blocks from our previous location, on 707 Wilshire. With a new year also come new opportunities and change. I have had the great privilege to serve as LACMA’s CEO for the last four years. During this time, we have changed the game for physicians in the County of Los Angeles. I am extremely honored to have led this game change and proud to have worked with all of the great physician leaders in Los Angeles. I leave the position of CEO with the faith that LACMA will continue to grow and thrive as never before. Regards,

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 2015

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D E C E M B ER 2015 | 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

CALIFORNIA MEDICAL ASSOCIATION

CMA ON-CALL ONLINE HEALTH LAW LIBRARY With new laws and regulations passed every year, running a medical practice can be complicated. While the California Medical Association (CMA) works hard every

day to lighten unnecessary burdens and streamline information, we are also your best source of knowledge to effectively answer difficult questions about practicing medicine in California. CMA’s online health law library contains nearly 5,000 pages of CMA On-Call documents and valuable information for physicians and their staff. Access to the library is free to members.

Have you ever asked… What is the process for terminating the physician-patient relationship?

I’m having issues with a member of my staff—what are the legal steps required to terminate employment?

What restrictions apply to electronic prescribing of controlled substances?

What can I do regarding a negative online review about my practice?

How long do I have to retain medical records?

How can I challenge my quality rating in a pay-for-performance program?

I’m looking to grow my practice—are there laws that govern physician advertising?

www.cmanet.org/cma-on-call Access to CMA’s health law experts is a FREE, members-only benefit. Need help? Call (800) 786-4262 or visit cmanet.org.

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