T h e N e w O f f i c i a l P u b l i c at i on o f t h e Lo s An g e l e s Co u nt y M e d i c a l A s s o c i at i on
REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY
A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com
PLUS: Understanding The California Heathcare Exchange
AUGUST 2013
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NORCAL Mutual is owned and directed by its physicianpolicyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Contact your broker or call 877-453-4486 today. Visit norcalmutual.com/start for a premium estimate.
A N o r c A l G r o u p c o m pA N y
N o r c A l m u t u A l .c o m
AUGUST 2013 | TA B LE OF CONT ENT S
Volume 144 Issue 08
FEATURE
14
trends & opportunities
A look at payment reform, consumer engagement and political advocacy and what these trends could mean for your practice and what you can do to be prepared.
14 DEPARTMENTS 6 Front Office | Practice Management
Tips, hints, advice and resources 10 Balance | Lifestyle & Wellness
6
20
understanding the exchange
News, studies, tips and opportunities to help physicians maintain a balanced lifestyle 12 PNN | NEWS IN REVIEW
The latest headlines impacting the economics of healthcare delivery in Southern California 22 United We Stand | AT WORK FOR YOU
There are many uncertainties remaining regarding the actual implementation of the California Health Care Exchange and the impact it will have on doctors’ practices. We offer an overview of the exchange and some of the critical issues remaining.
LACMA and CMA membership at work for you
From Your Association 4
President’s Letter | marshall morgan, MD
24 LACMA News | Association Happenings 26 CEO’s Letter | Rocky Delgadillo
20 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.
AUG US T 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1
editor
Sheri Carr 559-250-5942 | sheri@physiciansnewsnetwork.com ADVERTISING SALES
display ad sales / director of sales CLASSIFIED ad sales editorial advIsory board
The Los Angeles County Medi-
Christina Correia 213-226-0325 | christinac@lacmanet.org Dari Pebdani 858-231-1231 | dpebdani@gmail.com David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD Headquarters
cal Association is a profes-
Physicians News Network Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 Tel 213-683-9900 | Fax 213-226-0350 www.physiciansnewsnetwork.com
sional association representing physicians from every medical specialty and practice setting
LACMA Officers
as well as medical students, interns and residents. For more than 100 years, LACMA has
President President-elect Treasurer Secretary Immediate Past President
been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, government relations and community relations. Through its advocacy
LACMA BOARD OF DIRECTORS CMA Trustee Councilor - District 9 Councilor - District 2 med student Councilor/usc keck Councilor-at-large young physician councilor cma trustee Councilor - District 5 ethnic physicians commitee representative Councilor - District 1 Councilor - District 17
efforts in both Los Angeles
Councilor - District 14
County and with the statewide
Chair of LACMA Delegation
California Medical Association,
Councilor - District 6
your physician leaders and staff
Councilor-at-large
strive toward a common goal–
Councilor - District 10
that you might spend more time
Alternate med student Councilor/ucla
Councilor - District 7 Councilor-at-large Councilor - SSGPF Councilor - District 3
treating your patients and less time worrying about the challenges of managing a practice.
Marshall Morgan, MD Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD Samuel I. Fink, MD
Councilor - SCPMG RESIDENT/FELLOW Councilor cma trustee alternate RESIDENT/officer Councilor Councilor-at-large Councilor-at-large cma trustee (resident)
David Aizuss, MD William Averill, MD Boris Bagdasarian, DO Erik Berg Stephanie Booth, MD Steven Chen, MD Jack Chou, MD Troy Elander, MD Hector Flores, MD Carlotta Freeman, MD Sidney Gold, MD William Hale, MD David Hopp, MD Paul Kirz, MD Lawrence Kneisley Kambiz Kozari, MD Howard Krauss, MD Maria Lymberis, MD Carlos E. Martinez, MD Nassim Moradi, MD Ashish Parekh, MD Jennifer Phan Heidi Reich, MD Peter Richman, MD Sion Roy, MD Michael Sanchez, MD Nhat Tran, MD Erin Wilkes, MD
LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Executive Assistant, at lisa@lacmanet.org or 213-226-0304.
Subscriptions Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.
You create a brighter future. We work to protect it.
Let us help find the right Long-Term Care insurance plan for you, so you can spend time on things that matter the most. People are living longer these days, but as life expectancies increase, so does the risk of serious health problems that could require long-term care. In fact, at retirement age, 70% of Americans will need long-term care and 40% will enter a nursing home.1 And with the average cost for nursing home care in a semiprivate room equating to more than $67,500 per year, that could literally
Long-Term Care Resources LACMA is pleased to announce that members now have access to an interactive and educational Long-Term Care evaluation tool to help you make the best decisions for your specific situation. To learn more, visit: www.myltcplan.com/lacma.
cost most or all of your life’s savings.2 Long-Term Care insurance may not be for everyone. But with soaring
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Call 800.616.8759 or visit www.myltcplan.com/lacma. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, October 2008, www.longtermcare.gov. Genworth 2010 Cost of Care Survey, April 2010, www.genworth.com/content/genworth/us/en/products/long_term_care/long_term_care/cost_of_care.html. The Long-Term Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in all states. 1 2
62464 (8/13) ©Seabury & Smith, Inc. 2013, 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance.com
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PR ES ID ENT ’S LET T ER | MA RS HA LL MORGA N, MD
W e mu s t prot e c t M ICR A
It is a great privilege to be a physician. We have the opportunity to alleviate suffering and improve the lives of our patients. We are held in high regard by the great majority of our fellow citizens, and we earn a comfortable living. However, with privilege come challenges, and we face several: non-physicians want to practice medicine; the governor wants to reduce Medi-Cal reimbursement; insurance companies refuse to pay for appropriate care. The list goes on. Your medical association fights against all of them, with considerable success! The newest and most dangerous challenge we face at this moment is a well-organized, well-funded and very serious attempt to undo the protections that the Medical Injury Compensation Reform Act of 1975 (MICRA) provides to physicians and hospitals by setting reasonable limits on awards for non-economic damages (pain and suffering) in medical malpractice cases. The trial lawyers and their allies have mounted a multi-pronged, very sophisticated attack. They have placed an enormous number of articles in prominent newspapers on opioid abuse and misuse that portrays physicians in a very unfavorable light. They have hired a prominent and extremely competent consulting firm to run their campaign. They promise if they fail to win in the Legislature to propose and qualify for a ballot initiative. Should they succeed in destroying MICRA, California will return to an era of multimillion-dollar awards for non-economic damages, sky-high malpractice insurance premiums, closure of practices and decreased access to care. This is a fight we cannot afford to lose. The cost of winning this battle will be enormous. What can you do to help? You can educate your friends, your colleagues, your patients, your legislators, if you know them. Above all, you can raise money. You can (and should) participate in the effort to raise money from hospital medical staffs. The total amount of money raised by this effort will be more than doubled by the California Hospital Association. If you wish to participate in this effort (and again, you should!), please contact Luis Ayala (email: luisa@lacmanet.org; phone (213) 407-6224 to coordinate your efforts with LACMA and CMA staff. You can contribute directly to LACPAC or CALPAC, which can support legislators who agree with our stance on this critical issue. You can urge your colleagues who are not LACMA members to join the medical association. There is strength in numbers. If the trial lawyers win, doctors who are not members will suffer along with the rest of us. Marshall Morgan, MD, is a professor and chief of emergency medicine at the Ronald Reagan UCLA Medical Center and director of the emergency medicine center at the David Geffen School of Medicine at UCLA. He is the 142nd president of the Los Angeles County Medical Association.
4 PHYSICIAN MA G A Z INE | AUG US T 2013
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PR ACT I CE M A NAGEMENT | FRONT OFFICE
Should You Hire an Excluded Individual or Entity in Your Practice? Farooq Mir, Associate, fenton nelson, LLP
Un d e r S e c ti o n s 1128 and 1156 of the Social Security Act, the Office of Inspector General (OIG)
has the authority to exclude individuals from participation in federal healthcare programs, including Medicare and Medicaid. The purpose of exclusion, according to the OIG, is to protect the integrity of the healthcare system as well as protect the public from individuals and entities engaging in fraud and abuse. Healthcare providers thinking of employing an individual excluded by the OIG should think twice before doing so because of the potentially significant consequences.
An individual can be excluded from participation for a variety of reasons, including patient abuse or violation of Medicare and Medicaid billing rules. Exclusions are mandatory based on certain events (e.g., conviction of healthcare fraud) and discretionary in other cases. In addition to exclusion by the OIG, state MediCal authorities have the power to exclude individuals irrespective of federal authorities. The effect of exclusion on an individual is serious: no payment will be made by any federal healthcare program for services furnished, ordered or prescribed by an excluded individual. The Medicare Program may demand repayment of amounts paid while an excluded individual was employed. Perhaps the most common errors regarding exclusion relate to indirect services. The OIG does not limit the prohibition to provision of patient care by excluded individuals, but instead takes an extremely broad view of services that are in the “causal chain” 6 PHYSICIAN MA G A Z INE | AUG US T 2013
leading to the making of healthcare claims. This broad interpretation makes it extremely difficult, if not impossible, for an excluded person to obtain work with a healthcare provider. Healthcare providers that bill Medicare or Medicaid should be careful not to hire an excluded individual if the person’s job involves patient care activities and if any of the revenue supporting the wages of the excluded individual comes from federal healthcare programs. The OIG has stated in multiple Advisory Opinions that employers of excluded individuals or entities face civil monetary penalties for submitting claims to federal and state healthcare programs for services provided by excluded individuals or entities. With this in mind, healthcare providers should always refer to the OIG’s exclusions list, as well as California’s Medi-Cal exclusions list, prior to hiring any employee or contracting with an individual or entity. Further, providers should conduct checks on all potential contractors, manufacturers and medical equipment suppliers that are used in the care or treatment of patients and are reimbursed by a federal healthcare program. For healthcare providers in the unfortunate position of already having hired an excluded individual, acting expeditiously is the best option. Terminating the relationship and stopping all billing of government payers is crucial. Developing a corrective action plan, including voluntary disclosure under the Provider Self-Disclosure Protocol, is also necessary and important step in this scenario. Failure to act quickly can carry serious consequences, including civil monetary penalties, the repayment of significant government payments, costs associated with government investigations, and civil or administrative litigation. Farooq Mir is an associate at the law firm of Fenton Nelson LLP and advises healthcare providers in civil and administrative litigation matters, and has experience in representing clients in healthcare regulatory and transactional matters. Sources https://oig.hhs.gov/exclusions/effects_of_exclusion.asp; https://oig.hhs. gov/faqs/exclusions-faq.asp
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PR ACT I CE M A NAGEMENT | FRONT OFFICE
Risk Tip
No-Show New Patients May Leave Physicians at Risk Phys i cia n s fac e c e rtain risks and responsibilities when collecting patient information prior to
the patient arriving for his or her appointment. A new patient may complete an online intake form but not show up for the appointment. Or a new patient may complete a paper record with an intake history but then leave before being seen. The data that is collected, either electronically or on paper, is in the hands of your office practice. Electronic Form Disclaimer
Please be advised that by using this form to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours. This form of communication is not intended for acute, emergency, or life-threatening health conditions. If you believe you are having a health emergency, contact 911 or go to your nearest emergency department. Paper Form Disclaimer
As a physician, you now face a dilemma. What is your responsibility for the information provided by a patient whom you have not seen? Whether or not you review this information, you face a risk if the patient believes that a physician-patient relationship has been established. And if the patient has indicated a serious medical condition and you don’t take action consistent with the community standard of care, then you are potentially liable. To avoid this risk, place a disclaimer on any datacollecting instrument. The following are recommendations for disclaimers for both electronic and paper forms:
8 PHYSICIAN MA G A Z INE | AUG US T 2013
Please be advised that completing preliminary health and insurance questionnaires does not establish a physician-patient relationship with this practice. Dr. <X> will review your health history and conduct an initial evaluation to determine whether you are a suitable candidate and whether the practice will accept you as a patient. Protecting the confidentiality of all patients— whether they are established clients or no-shows—is important to minimize the risk of a malpractice suit. Another way to minimize your practice liability is to do a loss prevention checkup. The Doctors Company offers a “Patient Safety Interactive Guide for Office Practices,” which includes a checklist to ensure you and your office staff are protecting the confidentiality of all patients under the Health Insurance Portability and Accountability Act (HIPAA). Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
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Medline’s Generation Pink® latex-free exam gloves are made with an innovative polymer formulation which provides outstanding sensitivity, softness and comfort. Plus, for each case of Generation Pink gloves that you purchase, we will donate $1 to the National Breast Cancer Foundation to help fund free mammograms for those who could not otherwise afford them. Help increase breast cancer awareness in your office with pink gloves. Call Physician Office Customer Service at 1-855-294-9618 or visit medline.com today. © 2013 Medline Industries Inc. Medline and Generation Pink are registered trademarks of Medline Industries, Inc. Helping you improve the health of your practice is a trademark of Medline Industries, Inc.
l i festy le & wellness | B A LA NCE
California Public Protection and Physician Health, Inc. by Gail Jara, Executive Director CPPPH
W h e n th e M e di c a l Board of California voted to end the 27-year-old California Diversion Program
in June of 2007, California became one of the few states in the US without a statewide, state-sanctioned physician health program. The California Medical Association quickly convened a coalition of stakeholders, including California Society of Addiction Medicine (CSAM), California Psychiatric Association (CPA), the Permanente Medical Group (TPMG), California Hospital Association (CHA), and the California Society of Anesthesiologists (CSA) to assess the situation. Many other organizations and individuals who would be affected by the dissolution of the Diversion Program joined, including specialty and county medical societies, liability carriers, well-being committee members, and individual physician service providers. That effort led in 2009 to the creation of the new, independent 501(c)(3) organization, California Public Protection and Physician Health, Inc. (CPPPH), to address public protection and appropriate responses to physicians who experience medical, psychological, emotional, behavioral or substance use issues in the absence of a Medical Board-run program. Now in its fourth year, CPPPH is the only physician health organization in California that coordinates the large network of individuals, groups and resources that serve and promote health and wellness among physicians throughout the state. With funding from many of the founding organizations and individuals, CPPPH has provided education and linkages to resources for the different physician well-being committees throughout the state while its parent organizations have pursued legislation to establish and fund a state-sanctioned program. CPPPH seeks to respond to the American Medical Association (AMA) Resolution that all states should provide access to programs that address physician health so that colleagues will know how to intervene appropriately.
health. CPPPH approved, published and distributes Guidelines for Selecting Physician Health Services, http://cppph.org/resources/#guidelines, and a guideline on Evaluation of Health Care Professionals is in its final stages of review. Publications: E-Newsletter â&#x20AC;&#x201C; featuring information and resources on one or more of the following topic areas: aging, burnout/stress, caase finding and early identification, committee policies and procedures, disruptive behavior,family issues, guidelines, mental illness, physical illness, resources, specialtyspecific issues, substance use/abuse, wellness. You can review current and archived issues at cppph.org Regional Networks and Workshops: CPPPH offers free Saturday morning workshops for members of committees in hospital medical staffs and medical groups every four months in each of four areas of the state: San Francisco Bay Area, Sierra Sacramento Valley, Los Angeles, and San Diego. For dates and all specifics, see http://cppph.org/regional-networks/. Medical school committee members are also invited to twice-a year-workshops. The workshops cover one topic in depth with ample time for questions and discussion. The workshops: Deliver practical information, education and training for committees and persons currently doing physician health work in California. Provide the structure for ongoing communication and statewide information sharing . Identify and share information about the resources that the committees currently use. Identify needs that CPPPH will address as it develops plans for a statewide program and that will allow CPPPH to serve as the voice for physician health in California.
CPPPH activities include
Guidelines: At the request of CPPPH and with CPPPH staff support, California Society of Addiction Medicine has established a Clinical Advisory Task Force to develop guidelines relevant to physician 1 0 PHYSICIAN MA G A Z INE | AUG US T 2013
For information about CPPPH and a wealth of other physician health information and resources, visit the CPPPH Website at www.CPPPH.org.
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Information is accurate as of date of printing and subject to change without notice. Wells Fargo Home Mortgage is a division of Wells Fargo Bank, N.A. © 2011 Wells Fargo Bank, N.A. All rights reserved. NMLSR ID 399801 AS989185 Expires 8/2013
phy s i c i ansnewsnetwo r k . co m | NEWS i n r ev i ew
Read Full Stories and Subscribe to the PNN eNews BulletinS at www.PhysiciansNewsNetwork.com
A Service of the Physicians News Network and
The LOS ANGELES County Medical Association
PNN | LOCAL • TIMELY • RELEVANT reporting on the economics of healthcare delivery READ the full story on page 23
Trial Attorneys Want MICRA Cap Lifted NBC4 in Los Angeles recently aired a series of interviews addressing the subject of the MICRA cap, a subject that is of enduring interest to physicians. LA Children Hospitals Initiate Team Approach to Family-Centered Care Children’s Hospital Los Angeles and Mattel Children’s Hospital UCLA are among a new breed of children’s hospitals nationwide focusing on providing family-centered care via a team-based approach. This is part of a wider trend by hospitals to deliver high-quality care using teams of health providers to streamline processes and improve efficiency, in part to avoid penalties under health reform. The team-based approach at the two children’s hospitals includes physicians in many disciplines, nurses, pediatric psychologists and Child Life specialists. Survey: Most LA Doctors Want to Keep Independent Practices Los Angeles County doctors who own medical practices prefer to stay independent, according to two local healthcare realty experts. However, with health reform changes, many are keeping their options open by no longer choosing long-term lease options, giving themselves the flexibility to join other medical groups, coming up with creative ways to stay afloat, or selling. The experts’ view agrees with a new survey of 2,094 physicians nationwide who own medical practices that found that 58% are not looking to sell, with solo practitioners being the most committed to staying independent. The survey, conducted by health information technology firms CareCloud and QuantiaMD, found that of the surveyed doctors, only 11% plan to sell while 10% have already sold their practices.
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LA Physician Praises Supreme Court’s Decision on Arbitration The Supreme Court recently upheld the right of physicians to arbitrate their claims against Oxford Health Plans on a class-wide basis. Dr. Jeffrey Nordella, a family physician from Los Angeles, who earlier this year won a lawsuit against Blue Cross for unlawful network exclusion, said this can have a phenomenal impact but only if doctors make a decision to fight back against the insurance companies. LA Health IT Expert Declares Old Model of Health Information Exchange Dead The failure of the health information exchange (HIE) in the past and its evolution under the Affordable Care Act was the topic at the Idea Exchange Digital Healthcare Forum at UC Irvine last week. Director of eConsult Program for Los Angeles and founder of HITEC-LA, keynote speaker Sajid Ahmed argued that HIE evolved from a technology-oriented effort that barely survived to an essential part of a new type of patient care. According to Ahmed, HIE projects failed in the past because there was a lack of value proposition - no one was willing to pay for an infrastructure that was unusable, did not fit into the existing workflow and had no value to physicians at that time. When grant money would run out the projects would die. LA Clinics, Hospital Join Efforts to Improve Coordinated Care July marked the launch of a pilot project to improve coordinated care between St. Francis Medical Center and primary care physicians working at eight federally qualified Southside Coalition of Community Health Centers. The goal is to cut hospital readmissions, length of hospital stay and create overall better efficiency to reduce cost. “This is the first time that a cohort of clinics will try to create in a meaningful way a relationship with one hospital,” said Nina Vaccaro, executive direc-
CMA, LACMA Step Up Efforts to Fight Overturn of MICRA Dr. Paul Phinney, president of the California Medical Association, told PNN that CMA is talking to everyone—from the governor’s office to health providers and their patients—about the importance of preserving the Medical Injury Compensation Reform Act (MICRA), as trial lawyers are stepping up their efforts to overturn the law. LACMA and other local physician groups, along with CMA, have been fighting for years on behalf of physicians to ensure that MICRA caps do not get lifted. “We are very concerned at CMA, and as a pediatrician I’m also speaking for all doctors across California, that the trial lawyer-sponsored changes would increase the number of meritless lawsuits, increase healthcare costs and would hurt access to care for the most vulnerable patients,” Dr. Phinney said. UnitedHealth Announces Outcomes Based Payment Plan for Physicians UnitedHealth Group Inc. recently announced it will increase its payments from $20 billion to $50 billion in the next five years to doctors tied to quality and cost efficiency. The announcement on July 10 reflects the transformation of the U.S. medical system from a traditional fee-for-service payment model to payment based on patient outcomes and efficient teamwork to keep patients healthy. UCLA Health System Among Magazine’s ‘Most Wired’ Hospitals Hospitals and Health Networks magazine recently named UCLA Health System and its hospitals among this year’s “most wired” hospitals, based on an annual survey measuring the use and implementation of information technology in healthcare delivery systems nationwide. More hospitals nationwide are integrating technologies that doctors will use to enter patient data, such as electronic medication orders, and administrators will use to identify and manage gaps in care and analyze large amounts of data. Hospitals and doctors in Los Angeles County are becoming a part of this growing trend, prompted by the need, under health reform, to increase efficiencies and improve quality of care while keeping costs down.
reporting on the technology of healthcare delivery
Read Full Stories and Subscribe to the PNN eNews Bulletins at www.PhysiciansNewsNetwork.com/iPNN
Disruptions: Medicine That Monitors You They look like normal pills, oblong and a little smaller than a daily vitamin. But if your doctor writes a prescription for these pills in the not-too-distant future, you might hear a new twist on an old cliché: “Take two of these ingestible computers, and they will e-mail me in the morning.” Although these tiny devices are not yet mainstream, some people on the cutting edge are already swallowing them to monitor a range of health data and wirelessly share this information with a doctor.
Hospitals Prescribe Big Data to Track Doctors at Work Health systems across the U.S. increasingly are leveraging “big data” to better understand physician practicing patterns and drive performance improvement. Physicians are split on the big data effort. At MemorialCare Health System in California, executives have begun tracking how doctors employed at the hospital or affiliated medical groups perform on a series of measures, including immunizations, mammograms and blood glucose control in diabetic patients. Medical Training Goes Holographic Advances in technology mean you can now turn to the virtual human and pull the heart out in a 3-D, holographic environment. A system called zSpace uses a large screen, glasses and pointer — like a ballpoint pen — to interact with and manipulate 3-D images. The technology allows users to look completely around the object, examine it from all angles, and zoom in and out. It’s also finding its way into universities and will be used to train med students and future surgeons. One day, the doctor operating on a wounded soldier or diagnosing a veteran may have had his humble beginnings exploring a virtual body.
AUG US T 2013 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 1 3
news i n r ev i ew | phy si c i ansnewsnetwo r k . co m
tor of the Southside Coalition. The hope is that, if successful, the program will become a model for other hospitals working with community clinics in Los Angeles County.
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H wi ealt cia ll b h e xp lik ns e al ely wi a w erts lig so o sp th ate ag tic hts pp ell new rsh ree e re ula thr ort sig tre d y tha f u r e n o po rm in e ni ifi n e t tre liti , tere tre ties can ds ar f nex an nd cal con st t nds . T t c ari or t ye p h d s c ad su o h s t wh o vo m ph hat is a an ing hys ar at uld ca er ysi wi rti ge th ica m cy en cia ll b cle , b at . n g n yo ean Lea ag s: P e o hig ut h f e u do for rn w me aym par to you ha nt en be r t t an t pr pra hes d ep ct e ar ice ed .
Changes are needed in the way healthcare providers are paid if we are going to control the rapid growth in healthcare costs and improve quality of care, but progress has been slow because there are many barriers to changing payment systems that have been in place for so long. According to a report by Accenture, only 36% of physicians in the United States will practice independently in 2013. Traditional fee-for-service still dominates the reimbursement structure in most practices, regardless of size. According to the Physicians Practice 2013 Staff Salary Survey, 87% of solo practices and 84% of two-to-five physician practices are still using the fee-forservice model. Of the remaining minority, 1 in 3 is expected to resort to subscription-based models, such as direct pay, concierge medicine or online consultations, to sustain profits, health experts predict. But trends are emerging and the potential to impact on your practice is certain. Emerging Models As the sweeping transformation in healthcare takes hold, several models will be taking shape. Each has its strengths and weaknesses, but also represent opportunities and risk. Here is a closer look at four models experts believe will be most relevant: Bundled Payment Models - A middle ground between fee-for-service reimbursement and capitation, bundled payments can offer several benefits: Providers can benefit from cost savings from payers included in the program, derive enhanced volumes from private insurers and cash patients who are drawn by cost clarity and discounts and benefit from Medicare volume enhancement, as well as build stronger ties with hospitals through collaborations. To make this model work takes thorough bundle definition, accurate cost analysis, willing and committed partners and the infrastructure to manage the process.
Accountable Care Organizations - While hardly proven, ACOs are a rising trend as a way to cut costs and provide better overall health. According to the Physicians Practice Staff Salary Survey of 1,200 respondents, only 12% of solo practitioners are members of ACOs. However, that number jumps to 41% with 20plus physician groups. Benefits of doctors joining ACOs include the opportunity to reap financial benefits and greater efficiency driven by quality and better management of risks through collaborations. Hospitals will try to forge enhanced relationships with doctors owning outpatient ancillary services, be more open to create joint ventures with physicians and foster more than a low-level interest in primary care, according to health experts. Capitation - Capitation allows provider groups several benefits. Control over their own destiny and enhanced business possibilities and centers around long-term health management rank among them. To make this model work requires a provider network with adequate breadth and depth, proper funding, a large membership, sophisticated care coordination systems and providers that are vested in the success of the model, not unlike the ACO model. Concierge Medicine - About 5,000 physicians nationwide practice concierge medicine, which offers patients more personalized attention, such as next-day appointments, text messages and responses, and comprehensive checkups. According to the 2013 survey, 2% of solo practitioners and two-to-five physician practices are in concierge medicine; the majority of concierge doctorsâ&#x20AC;&#x201D;5%â&#x20AC;&#x201D;work in six-to-10 physician practices. Doctors charge patients an annual fee for the personalized attention and bill patientsâ&#x20AC;&#x2122; health insurance separately for providing medical services. The American Academy of Private Physicians (AAPP), which represents concierge doctors, offers detailed information.
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Payment Reform
Online Visits - More doctors are also practicing online, providing consultations and education. There is an array of companies offering company-approved doctors concierge virtual visits with their patients and subscription-based education for consumers from doctors on such topics as heart health, diabetes, osteoporosis, dentistry and weight management. Whether these models represent your future or your competition, experts recommend keeping a close eye on such businesses to emulate their strengths and learn from their mistakes. Physician Contracts With more physicians moving away from independent practice and gravitating toward employment with hospitals or other large organizations, doctors need to understand their rights and responsibilities before agreeing to an employment contract. To help physicians come to the negotiation table without surprises, experts recommend the following tips: In most jurisdictions, an offer letter is a contract. Since leveraging and negotiating change to the standard form of contract is limited by what’s said in the offer letter, it’s a good idea to talk to a lawyer (if needed) as soon as the offer letter arrives. Furthermore, the experts recommend doctors ask for clarification before signing if a contract contains provisions that aren’t entirely clear. Conflict of Interest Under the final regulations of the Physician Payment Sunshine Act, makers of drugs, medical devices and supplies covered by Medicare, Medicaid and CHIP require that transfers of money exceeding $10 to physicians and teaching hospitals will be reported to the Centers for Medicare and Medicaid Services as of this August. With physicians and doctors increasingly interacting online, health experts caution physicians to figure out best ways to disclose potential conflicts of interest when using social media, which can be tricky. Practice Efficiency Optimizing patient flow is an on-going challenge for medical practices, but achieving cost-savings while providing high-quality care can only be done when efficiencies are high. Health experts say one way to create higher efficiency is to create a document known as a value-stream map to illustrate where your personnel is wasting time and energy. To make everyone’s day better and more productive, many medical groups organize “team huddles” to give each member the opportunity to address issues and give thanks for a job well done. Patients’ Financial Responsibility With 30% of practices’ revenue stream coming from patient responsibility—including copays, deductibles, co-insurance and self-pay for services, practices have a responsibility to their patients to collect all the revenue to which they are entitled. By creating a culture in which balances are collected consistently, the practice has revenue to hire the best doctors, buy better equipment and deliver the best care.
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With consumers becoming more vocal in how they want to spend their healthcare dollars and increasingly turning online to do “comparison-shopping” for pricing of medical care, physicians who take the initiative in getting patients involved in their own health and well-being will have a competitive edge, experts say. Here are six tips for getting your existing and future patients involved. Team-based Approach Already a trend at hospitals nationwide, including Children’s Hospital and Mattel Children’s Hospital UCLA, doctors that provide family-centered care via a team-based approach can deliver high-quality care while improving efficiencies. Under this model, doctors of all disciplines involve families early on to help them and their patients with the difficult experience. The same approach can be used in medical practices by involving the back office and front office in working more efficiently together to address patient inquiries from booking appointments and pricing of medical procedures to payment options.
Consumer Ratings Could Hit Your Pocketbook With more consumers turning to the Internet to find the doctor of their choice, reputation management will become increasingly important for doctors. Just like searching for restaurant and movie reviews, consumers are expected to pick doctors based on reviews while offering their own post-visit reviews. According to health experts, consumer reviews will generate penalties and bonuses based on outcomes. Pay-for-performance measures could mean more than $3 billion in bonuses for insurers and penalties of $850 million for providers, according to PwC’s Health Research Institute (HRI). Already, there are various health consulting and IT companies specializing in helping doctors improve and manage their online presence to retain existing patients and draw new ones as competition rises. To help doctors increase and protect reviews posted online at places like Vitals and Yelp, LACMA is currently looking for the best partner to bring these vital services to its members. “As part of LACMA’s online marketplace, which offers LACMA doctors a listing of preferred vendors and programs at discounted rates, we are currently looking to identify the best partner to provide these reputation services, and more, at a discounted rate,” said Rosario Ortega, LACMA’s membership outreach representative. Arm Consumers with Price Lists With economists proposing that doctors, hospitals and healthcare providers arm consumers with detailed price lists and quality reports to help them make informed decisions about their care, it is expected that doctors would then need to respond by offering cheaper, more competitive services. To do that, providers would have to become more efficient at delivering care without jeopardizing quality. Although no other state has required the healthcare industry to publish its prices, 11 states have taken preliminary steps to shed light on the real costs of medical care. Colorado, Kansas, Maine, Maryland, Minnesota, New Hampshire, Oregon, Tennessee, Utah, Virginia and Vermont are in various
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stages of developing so-called “all payer claims databases” that collect and analyze the widely varying prices healthcare providers charge private insurers, Medicare, Medicaid, uninsured individuals and other payers. In other states, these transactions are considered confidential business information and kept under wraps. However, increasingly, private companies that encourage people to become smarter consumers are publishing pricing and price comparisons for medical procedures in different cities. New data from New Choice Health recently suggested that on average consumers pay less for medical procedures in Los Angeles County than in Orange County. Integrate Patient Portal Under meaningful use requirements, physicians must implement a patient portal where patients can access their records and send secure messages to doctors. Most likely each patient will be hosted on the practice’s website, which lends itself to doctors implementing mechanisms that allow patients to schedule appointments and get prescription refills. A survey of 2,311 Americans conducted in July 2012 by Harris Interactive found that online scheduling was important or very important to 41% of patients, but only 11% had access to the service. Social Media The experts advise doctors to write blogs to provide critical education to patients. The most effective blog posts are written in layman’s terms, easy to digest and conversational in style. Doctors who use social media to draw new patients and serve existing patients will have a competitive edge. Using Apps as Prescription While the idea of medically prescribed apps is still relatively new, some people believe that they may provide an answer to tracking chronically ill patients. This could help reduce doctor office visits while improving patient outcomes with doctors tracking patients without actually seeing them. One of the pioneers in the prescription-app field is a company called WellDoc. Its DiabetesManager system, which patients use through a smartphone app, cell phone or desktop computer, collects information about a patient’s diet, blood sugar levels and medication regimen. Patients can enter the data manually or link their devices wirelessly with glucose monitors and then also get advice on best foods after recording glucose levels. The Food and Drug Administration cleared the device, and two insurance companies agreed to pay the bill for patients whose doctors ask them to use the device, according to published reports. Issues regarding safety and privacy of use remain, but the proliferation of gadgets, apps and Web-based information has given clinicians—especially young ones—new ways to diagnose and treat disease and will change the doctor-patient relationship with patients becoming more involved in their own health in an effort to control healthcare costs.
Advocacy
For years, doctors didn’t need to pay much attention to politics, but physicians are finding that as government becomes more involved in the process, they can either participate in the political process to affect medicine’s political environment or abstain and take the consequences. More and more the mind-set is that physician advocacy is now a core component of medical professionalism. “We don’t go to medical school to learn how to advocate in the legislature,” said Dr. Andy Harris, a Maryland
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congressman who is also a practicing anesthesiologist. “But the legislature has gotten so involved, part of taking care of patients now is making our views heard in the legislature.” This is an important trend, and if you are not one to sit idly by, here are some opportunities for you to participate in the political process and learn how you can get involved and why all doctors in Los Angeles County should stand united with LACMA. Public Trusts Doctors to Do the Right Thing “Physicians today garner both respect and suspicion when involved in political affairs,” said Dr. Kristina Maletz in a commentary in the Virtual Mentor. A Gallop poll, during the height of the healthcare reform debate, however, showed that almost three-quarters of Americans expressed confidence in physicians in changing the healthcare delivery system; only half of them felt that way about congressional leaders, Dr. Maletz wrote. As the CMA states, “Critical issues are being decided in the legislative arena at a fast and furious pace. Healthcare reform, medical liability and insurance regulations are just a few of the vital issues being debated and voted on by decision-makers in Sacramento. Hearing from a physician with experience from the frontlines of medicine can make all the difference for a legislator facing a complicated healthcare issue.” CMA offers many advocacy opportunities, including CMA’s Grassroots Action Center (http://www.cmanet.org/grassroots/). Advocacy in Medical Schools LACMA has long recognized the importance of reaching out to medical students and residents and welcomes their commitment and involvement. Physicians in training are beginning to have the opportunity to learn about advocacy from the very beginning of their career, with many medical schools now offering courses and certificates on advocacy.
LACMA and the Political Action Committee Dr. Harris stressed in news reports the extreme importance of all doctors getting involved in politics by joining specialty societies, finding opportunties and taking the time off to make their views known to the people whose policies have an effect on their practice. Rocky Delgadillo, LACMA’s CEO, finds that doctors spend a good part of their day talking to patients, which is a good place to start with advocacy. “We think being a member of LACMA and the California Medical Association is a powerful way to reach the decision makers that will impact the doctor-patient relationship,” Delgadillo said. “The more doctors join, the more power LACMA has to achieve results on behalf of physicians.” To support issues,doctors should elect candidates at the state and local level to improve access to care and treatment, support medical students, and join LACMA’s Political Action Committee (PAC). The PACs are critical avenues for advocacy since about one-third of the California Legislature resides in Los Angeles County and Los Angeles County has one of the largest healthcare budgets in the nation. The healthcare environment is clearly changing and though many questions remain, providers can take some proactive steps—from deciding which model makes sense for them, to getting consumers involved and being advocates for their profession—to stay ahead of the healthcare curve.
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Un d e r stand i ng t he Exchange | FEAT UR E
Understanding the Exchange by marion webb
W hile th e r e a r e a lot of uncertainties remaining regarding the actual implementation of the
California Health Care Exchange and its impact on doctors’ practices, this article offers doctors an overview of the exchange and some of the critical issues remaining. In 2010, Congress passed historic sweeping healthcare legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets, and starting in 2014, will cover the nation’s uninsured. Number of Uninsured - There are dif-
ferent estimates of California’s uninsured, the Associated Press reported. The California HealthCare Foundation estimated the state has about 7.1 million people without health insurance, or about one in five nonelderly Californians. The foundation also reportedly projects that ratio to fall to 1 in 10 by 2016 because of the ACA. The California Health Benefit Exchange, which goes by Covered California, estimates there are roughly 5.6 million people without health insurance, or 16% of the population under age 65. Of that population, 4.6 million people are eligible for coverage under the ACA and 1 million are not because of their immigration status. Peter Lee, the exchange’s executive director, said a more realistic figure by 2017 is closer to 2.3 million people. Medicaid - An estimated 8 million Californians are
served by Medicaid, or Medi-Cal, the AP reported. Of those, about 1.4 million more Californians are expected to be covered under expanded Medicaid provisions, according to a joint report released in January by the University of California, Berkley Center for Labor Research and Education and the UCLA Center for Health Policy Research. The Los Angeles Times reported that in California, individuals earning less than about $16,000 will qualify for the Medi-Cal expansion. Above that threshold, individuals making less than $46,000 and families earning below $94,000 annually will qualify for federal subsidies. The report also estimated that as many as 510,000
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who are already eligible for Medicaid but not yet enrolled are expected to join, because of federal law’s individual mandate and a simplified enrollment process. However, several entities, including the Los Angeles County Department of Health Services, and doctors are concerned about the planned Medi-Cal expansion, saying the realignment of funding from the state threatens the local health safety net. Some doctors, including Dr. Lemmon McMillan, a trained obstetrician/gynecologist who runs managed care practices in Inglewood and Hawthorne, are concerned that traditional doctors won’t have a voice when their patients are being moved to Medi-Cal under health reform. “All the resources are going toward federally qualified health centers, and not the traditional doctors,” said Dr. McMillan. He said that doctors like himself have been practicing in their communities for decades and know their patients well. “My concern is that these patients won’t get the care they need and are being lost in the system,” Dr. McMillan noted. “The FQHC close at 5 p.m. whereas physician providers will be there until the last patient is seen, and the clinics have long waiting times and don’t know the patients like we do.” Under Gov. Jerry Brown’s budget proposal, an estimated 1.2 million people—30% of them in Los Angeles County—would qualify for the Medi-Cal expansion under the federal health law. The budget lays out two options—expanding coverage through the state or through the counties. Dr. Mitch Katz, who heads the Los Angeles County Department of Health Services, said in news reports earlier this year that he expects millions of low-income people won’t qualify for Medi-Cal, even under the expansion. The burden of their care traditionally has fallen on public hospitals, county health centers and community clinics. If the state is taking back funding that counties have depended on to care for the uninsured, these institutions will be in financial jeopardy, the official said in news reports. Small Businesses - Covered California estimated
that 375,000 small businesses with 25 or fewer full-time employees with an income of less than $50,000 a year will be eligible to receive a 50% federal tax credit through the new program dubbed the Small Business Health Options Program. The program aims to help small employers provide the type of health plans that have only been available to large employers, the AP reported.
Exchange Set-Up - Covered California is an independent public entity within
state government with a five-member board that is charged to create the insurance marketplace in which individuals and small businesses will be able to compare and enroll in health plans. CMA estimated that under the ACA, two-thirds of California’s uninsured may be covered by private insurance through the health exchange purchase pool. Two of the Covered California board members are appointed by the governor, one by the Senate, and another one by the Assembly. The Secretary of the Health and Human Services Agency serves as an ex-officio voting member of the board. The members serve four-year terms. California was the first state to authorize a state-run health insurance exchange after passage of the ACA. California’s Chosen Companies - The 13 chosen companies that will par-
ticipate in the health insurance exchange for individual plans include a mix of large and small companies: • • • • • • •
Alameda Alliance for Health Blue Shield of California Contra Costa Health Plan Kaiser Permanente Molina Healthcare Valley Health Plan Western Health Advantage
• • • • • •
Anthem Blue Cross of California Chinese Community Health Plan Health Net L.A. Care Health Plan Sharp Health Plan Ventura County Health Care Plan
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Most companies will offer four “metal” levels of plans: bronze, silver, gold and platinum. The platinum plans cover the largest share of expected medical costs, and they also cost the most, according to Covered California news reports. Platinum plans are expected to cover about 90% of costs with the consumer’s share being 10%; the gold plan ratio is 80% to 20%; silver is 70% to 30%; and bronze is 60% to 40%. Grants To Set Up Exchange - Since September 2010, Covered California has been allocated $910.5 million in federal planning grants from the U.S. Department of Health and Human Services for implementation of the ACA, the AP reported.
• A $1 million grant to establish the exchange board and recruit staff, analyze insurance markets, gather input and develop plans. • A $39 million Level 1 Establishment grant supporting strategic, business and operational planning, such as information technology analysis and system design. • A $196.5 million Level 1.2 Establishment grant to support a wide variety of research, marketing, consultation, technology and management, and a customer service center.
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In November 2012, Covered California reportedly submitted a Level 2 funding request to the federal government for $706 million to provide funding for 2013 and 2014. The government reportedly awarded $674 million of that request in January. After 2014, the exchange must be self-supporting from fees paid by health plans and insurers participating in it.
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Prepare Your Practice for the Medicare claims administrator transition cma staff
Th e tr a n s iti o n from Medicare claims contractor Palmetto GBA to Noridian takes place on
September 16, 2013 (Part B). During the transition, Noridian is encouraging providers that submit electronic claims to take advantage of an “early boarding” opportunity. Early boarding will allow providers to connect to Noridian’s EDI Support Services gateway prior to the transition. Noridian will act as a clearinghouse, collecting claims, performing basic front-end editing and then sending the claims to Palmetto GBA for processing and payment. Providers that use a vendor to submit claims do not need to take any action. Your vendor will be working with Noridian directly to connect. However, providers should check with vendors to ensure this is occurring and encourage them to make contact with Noridian if it is not. If you bill directly, you can take the necessary steps to board early by reading an article published online by Noridian titled: Noridian Jurisdiction E (JE) Early Boarding Has Begun. The Centers for Medicare and Medicaid Services also asks that physicians check to make sure that their
Protect yourself from the possibility of delays, or potential occurrences of fraud, by ensuring your information is current.
U pdat e Your NPI In f orm ati o n - According to a new report, 58% of the databases used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS).
The national revalidation effort by the Centers for Medicare & Medicaid Services (CMS) is a big step in improving the accuracy of Medicare provider enrollment data. This effort has helped bring awareness to physicians of the importance of updating their records in a timely manner when addresses, organizational structure, key contacts, phone numbers, etc., change. However, few physicians think to update their
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National Provider Identification (NPI) numbers are updated in the National Plan and Provider Enumeration System (NPPES) and are up to date and consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). According to Noridian, the number one reason for problems during similar transitions is inaccurate NPI data in the NPPES system. Updates can be made on the NPPES website. Noridian has also set up “Meet and Greet” workshops throughout the state. The California Medical Association (CMA) encourages practices to take advantage of this opportunity to meet Noridian staff and learn about the transition, including what will and will not change with the transition from Palmetto to Noridian. To stay up to date on the latest news related to the Noridian transition, see CMA’s Medicare Transition webpage at www.cmanet.org/medicare-transition.
NPI record to ensure it stays as current as their enrollment. Accurate data in NPPES could help expedite the revalidation process. Accurate information in NPPES is also important for proper claims administration. When CMS implements edits for ordering/referring physician information, the NPPES database maintains the search tool that rendering providers will use to find the NPI necessary for claim payment in the event they cannot reach the ordering physician. A key to finding the correct physician is accurate information in that database. Protect yourself from the possibility of delays, or potential occurrences of fraud, by ensuring your information is current. Add the updating of NPPES to your list of items to check each time you make a change, or at least annually.
Trial Attorneys Want the $250,000 MICRA Cap Lifted A r e c e nt N B C 4 , Los Angeles series of interviews addressed the subject of the MICRA cap, a sub-
ject that is of enduring interest to physicians. MICRA, enacted in 1975, put in place the $250,000 cap on non-economic damages in cases brought against the physicians. MICRA has no limits on the economic damages that can be recovered by injured patients (medical costs and lost wages). Injured patients also can sue for unlimited punitive damages. In addition, MICRA includes a sliding pay scale, which ensures that more money goes to patients, not lawyers. According to CMA, “the trial lawyers and their front group, Consumer Watchdog, are taking the MICRA battle up another notch.” Los Angeles County Medical Association (LACMA) and other local physician groups, along with the California Medical Association (CMA), have been fighting for years on behalf of physicians to ensure that MICRA caps do not get lifted. Brian Kabateck, president of the Consumer Attorneys of California, said in an interview with NBC, it is time to lift the cap on how much money can be collected for pain and suffering in order to protect the public against callous physicians. According to Kabateck, doctors are getting away with cases of malpractice because at a $250,000 cap no attorney would take on a case. Kabateck also said that “there is about 12-15% of the doctors, just like in a regular society, who abuse alcohol and drugs, but we have also seen studies where about 60% of medical negligence may have a connection to either abusing drugs or abusing alcohol.” He said the Medical Board is not doing enough to prevent it. According to him, a threat of a lawsuit would be a better deterrent and would help protect the public more effectively. He advocates for mandatory random drug testing for doctors who have hospital privileges. According to CMA, MICRA is an effective way of limiting meritless lawsuits and keeping healthcare costs lower, but it
has been targeted by the trial lawyers because it restricts the amount of money they can collect in damage awards. Increasing MICRA’s cap on speculative noneconomic damages, according to CMA, will have a dramatic, costly and negative impact on the cost of healthcare in California, including medical liability rates.
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Exercise the Power of Your Voice
Get involved: Submit a resolution to the 2013 House of Delegates If you have concerns or issues about the future of healthcare, now is the time to exercise your membership privileges and translate your opinions into organized medicine policy. The most direct way for members to get involved in current healthcare related issues is to submit resolutions to the House of Delegates (HOD). As the California Medical Association’s legislative body, the HOD meets once a year to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health. With 450 delegates representing 11 geographic districts, 30 medical specialties, and all modes of practice, the delegates embody the diversity of California’s physicians. Any LACMA member may author a resolution. All issues and resolutions will be presented to LACMA’s Delegation for review and submission to the California Medical Association. This year, the House of Delegates will meet in October to formulate California Medical Association policy on healthcare. If you have something to say, now more than ever is the time to be heard! Your opinion is valued and it is important to your peers in the medical community.
We want to hear from you! Resolutions can be submitted directly to CMA no later than August 12. For additional information and to submit your resolution, please contact Lisa Le at lisa@lacmanet.org or 213-226-0304.
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LACMA NEWS | A S S OCIAT I ON H A PP ENI NGS
ATTENTION LACMA MEMBERS
associ at i on ha ppen i ngs | lacm a news
ceo’s letter
It’ s summ e rti m e . Temperatures are rising around Los Angeles County, and many hot botton issues remain. With the heightened efforts by the Consumer Attorneys of California group to overturn MICRA, LACMA and the California Medical Association are encouraging all physicians to rally behind our organizations. Your help is critical to our success. California’s Medical Injury Compensation Reform Act (MICRA) was enacted in 1975 in response to skyrocketing judgments, dramatic increases in malpractice insurance premiums, and diminishing access to healthcare. At the time MICRA was enacted, California’s malpractice insurance rates were among the highest in the nation; today, California rates are among the lowest. But trial attorneys have recently stepped up their efforts to overturn MICRA, and at a time when are we all thinking about ways to cut healthcare costs. Increasing MICRA’s cap on speculative non-economic damages will have a dramatic and costly impact on the cost of healthcare in California, including medical liability rates. We need to protect the $250,000 cap on all damages in malpractice cases, which trial lawyers are hoping to raise, and stop their campaign to put this initiative on the November 2014 ballot. Together we can win this fight. I’m pleased to announce that LACMA is making tremendous progress on other battles as well. Together, LACMA and the California Medical Association’s power in taking a stand for what’s right for physicians and their patients turned victorious this May when the Department of Healthcare Services announced yet another delay of the dual-eligible demonstration project, or Cal MediConnect. But the fight is far from over. We will raise our efforts to hold this program at bay and continue our dialogue with the state to protect the most vulnerable population from the negative consequences of this program. The implementation of Cal MediConnect as currently structured would put a tremendous burden on our safety net clinics and drive patients away from doctors and medical providers they know and trust. Ensuring the safety of the Los Angeles County population is critical on other fronts as well. This month, LACMA’s newly elected president, Dr. Marshall Morgan, and other staff members plan to meet with the Los Angeles County Health Department to discuss gun violence. Emergency doctors like Dr. Morgan see firsthand the aftermath of gun violence and hope to work with local officials on solutions that can help save lives. Finally, we will keep a close eye on new developments regarding health reform and its impact on our physicians. In this August issue of the magazine, you’ll read about critical trends regarding payment reform, consumer involvement and advocacy. This fall, we will continue our forward-looking trend, so stay tuned.
Rocky Delgadillo
Rocky Delgadillo Chief Executive Officer
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LACMA NEWS | A S S OCIAT I ON H A PP ENI NGS
LACMA Announces
Call for Nominations for 2nd Annual Healthcare Awards The Los Angeles County Medical Association (LACMA) today issued a call for nominations for its annual Healthcare Awards, which honor leadership, innovation, education, community service and healthcare facilities in Los Angeles. The awards will be announced at the 2nd Annual Healthcare Awards dinner to be held on October 17, 2013, at the California Club in Downtown Los Angeles. Proceeds will help support the Patient Care Foundation’s Medical Student Scholarship Program, which helps cultivate the next generation of physicians who will practice medicine in Los Angeles County. The awards recognize individuals and institutions for their exemplary contributions to improving access to quality healthcare in Los Angeles. Last year’s Healthcare Champion of the Year, Los Angeles County Supervisor Mark Ridley-Thomas, and the other 2012 awardees will be inducted into the New Healthcare Hall of Fame. “LACMA takes great pride in recognizing outstanding individuals and organizations who impact healthcare in our community, and particularly in improving care for the most underserved,” said Dr. Troy Elander, President of the Patient Care Foundation of Los Angeles County. Award Categories include: • Healthcare Champion of the Year • Independent Physician Leadership Award • Hospital Physician Leadership Award • Innovation Award for Public Education • Innovation Award for Community Service • Innovation Award for Facilities • Innovation Award for Technology • Shine the Light Media Award This year’s awards will feature a new category, the Shine the Light Media Award. The media award serves to recognize and honor branches of the media for their outstanding representations of the physician and healthcare provider community. In addition to film and television, the award also considers achievements and other branches of the media and arts including theater, music, books, print media, Digital media and advertising, as well as Spanish language media. LACMA is a professional medical association representing over 6,000 dedicated physicians. For more than 100 years, LACMA has been at the forefront of providing leadership and innovation in healthcare and fosters optimal collaborations among physicians, patients and the community through the Patient Care Foundation of Los Angeles County. The Patient Care Foundation is a charitable organization that serves as a link between physicians and the community. Its mission is to impact the quality of life of all patients in Los Angeles County by expanding the pool of medical professionals who practice medicine in underserved communities. For additional event information, sponsorship opportunities and registration, visit www.lahealthcareawards.org.
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associ at i on ha ppen i ngs | lacm a news
Fun in the Sun!
District 5 holds its annual BEACH PARTY On Saturday, July 13, Los Angeles County Medical Association Bay District 5 hosted its fourth annual beach party at the Bel-Air Bay Club. About 130 member physicians and their families attended the fun event. As usual, the gorgeous, sunny day was perfect for mingling with colleagues, spending time with the family and, of course, eating barbecue fare under shady canopies. The popular event was free for members and their families and included a full menu of hamburgers, hot dogs and chicken, along with a variety of beverages including iced tea, sodas, margaritas, beer and wine. Thereâ&#x20AC;&#x2122;s sure to be a fifth annual beach party next summer!
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or contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.
CME City of Hope’s 6th Annual How the Experts Treat Hematologic Malignancies
PM Marketplace Surgeons Needed for Expanding Nationwide Surgical Practice
September 18 to 20, 2013 Casa Del Mar Hotel, Santa Monica, CA JOIN US for this two-and-a-half-day conference for the opportunity to learn about the most recent advances in the treatment of multiple myeloma, lymphoma and leukemia. Updates on improved curative and palliative treatments, evolving molecular and immunologicallybased systemic therapies and clinical trials, will be profiled and discussed. To learn more and to register, visit www.cityofhope.org/hematologicconference2013
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CME
Physicians News Network introduces
City of Hope’s 13th Annual Women’s Cancer Conference: Progress in Women’s Cancers from Treatment to Survivorship November 8 to 10, 2013 The Venetian/Palazzo Resort Hotel, Las Vegas, NV
REGISTER NOW for this exciting conference featuring prominent oncology experts who will address clinical and translational research, prevention, practical issues, current standards of care, controversies and evolving new treatment recommendations for women’s cancers. Attendees will learn new tools to optimize decision making to help improve patient outcomes.
If you are currently receiving the PNN eNews Bulletin, look for iPNN to be delivered to your inbox every week, If not
To learn more and to register, visit www.cityofhope.org/womensconference2013
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b y t he nu m be r s | healthca r e tr end s
By The Numbers As the sweeping transformation in healthcare takes hold, several models will be taking shape. Each has its strengths and weaknesses, but also represent opportunities and risk.
12%
Payment Reform
36% Only 36% of physicians in the United States will practice independently in 2013.
12% of solo practitioners are members of ACOs. However, that number jumps to 41% with 20plus physician groups
Benefits of doctors joining ACOs include the opportunity to reap financial benefits and greater efficiency driven by quality and better management of risks through collaborations.
30% of practicesâ&#x20AC;&#x2122; revenue stream come from patient responsibilityâ&#x20AC;&#x201D; including copays, deductibles, coinsurance and self-pay for services.
Patient Engagement
Online scheduling was important or very important to 41% of patients
41%
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30%
Consumer reviews will generate penalties and bonuses based on outcomes. Pay-for-performance measures could mean more than $3 billion in bonuses for insurers and penalties of $850 million for providers.
California group health premiums will cost up to 10% more. What about your plan?
In 2013,
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