www.socalphysician.net
October 2012
PLUS
FIGHT BACK LACMA DOCTORS
The Underserved In L.A. County
NEW LAWSUIT FILED AGAINST HEALTH NET
Samuel Fink, MD, President of the Los Angeles County Medical Association.
OF f ic
ial
zin e m aga of the
le s g eical d e Loosu nAtn M y io n C
Assoc
iat
The Supreme Court’s Decision Doesn’t Change One Thing You still need to make important decisions now about rising health insurance premiums. So what can you do? • Enroll in a qualified High-Deductible Health Plan and open a Health Savings Account. This provides significant premium savings that can help fund your HSA account. With individual-only coverage, you are eligible to contribute up to $3,100 to your account or $6,250 with family coverage, on a tax-deductible* basis (members age 55–64 are eligible to contribute another $1,000). • Investigate RAF Sales Health plans offer incentives through discounts off their risk adjustment factors (RAFs) for you to change health plans. Instead of your
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Volume 143 Issue 10 October 2012
14 FEATURES
every issue
From Your Association
14 LACMA FIGHTS BACK Insurance giant Health Net routinely and illegally denies patients’ claims to important, and medical treatments, according to a new lawsuit filed by the Los Angeles County Medical Association.
6 Front Office Tips, hints, advice and resources to make your practice run more smoothly.
4 President’s Letter This month’s musings from Samuel Fink, MD.
16 Minority Health An examination of the challenges of treating the underserved in L.A. County now and in the future.
32 Just the Facts Health insurance by the numbers.
10 CMA The latest update on regulations.
2 CEO’s Letter An update on how your association works for you from Rocky Delgadillo. 24 Member Benefits Check out these pages to find out how your membership is working for you! 28 Association Happenings
20 State-of-the-art Healthcare Kaiser Permanente’s latest facilities serve patients while reducing carbon footprint and incorporating clean energy and sustainable design.
Southern California Physician (ISSN 1533-9254) is published monthly by Research Group of Companies, LLC in affiliation with 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. 10 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 Southern California Physician, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.
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Ceo’ s l e t t e r | Rock y d e lgad i llo
Doctors, Not Businessmen, Must Make Treatment Decisions for Their Patients
O
n S E P T E M B E R 1 3 , the Los Angeles County Medical Association filed legal action in the local Superior Court charging that insurer Health Net illegally denies patients’ claims to important, and sometimes lifesaving, medical treatments on a routine basis. Two patients who have been caught up in Health Net’s denial of treatment business practices — practices that we believe present a continuing threat to the public’s health, safety and welfare — joined us in the lawsuit. Our filing follows another lawsuit filed against Aetna on July 3 charging that the insurer often refuses to reimburse policyholders who go out of their networks when medically necessary, even though they have purchased policies that allow them to do so. We took legal action because we believe that the practices of Aetna and Health Net demonstrate unfair and unlawful business practices that must be stopped. Our two lawsuits send a clear signal to the world of health care that LACMA is no longer going to stand on the sidelines in the world of policy, and, in fact, we have decided to step into the ring on behalf of doctors and their patients. The issue of medical necessity is the next big frontier in the fight on behalf of our members. We believe that many insurers define the term “medical necessity” in their own words in their contracts, and then refuse to grant reimbursement when policyholders must seek potentially lifesaving treatment by going out of network. This has become an issue for not only our members, but for all doctors in California, and it’s one of the reasons why we have been joined in our suit against Aetna by the California Medical Association and the Santa Clara County Medical Association. We hope that the lawsuits will inspire other doctors and their patients to come forward and tell us their stories. When they come forward, we’ll review them, and they could end up in legal action. By deciding what treatments are necessary and which ones it will arbitrarily cover, Health Net is dictating medical care from the boardroom. As I noted at the news conference in mid-September when we announced the filing against Health Net, patient care must be decided by doctors, not business suits.
PHYS
SO U T H E R N
P U B L I C AT I O N s M A N A G E R
Sheri Carr
559-250-5942 | sheri@physiciansnewsnetwork.com E D I tor
Tom York
tom.york@gmail.com
C ontributing W riters
Russell A. Jackson, David Reynolds
advertising SALEs
D isplay A d sales / D irector o f sales
Christina Correia
213-226-0325 | christinac@lacmanet.org C lassi f ied / D isplay A d S ale S
Dari Pebdani
858-231-1231 | dpebdani@gmail.com
Editorial Advisory Board David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD
Los Angeles County Medical Association Officers CEO
Rocky Delgadillo P resident
Samuel I. Fink, MD P resident- elect
Marshall Morgan, MD T reasurer
Pedram Salimpour, MD S ecretar y
Peter Richman, MD I mmediate P ast P resident
Troy Elander, MD
Headquarters Southern California Physician Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 Tel 213-683-9900 | Fax 213-226-0350 www.socalphysician.net
Rocky Delgadillo
Chief Executive Officer
2 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
Subscriptions Members of the Los Angeles County Medical Association: Southern California Physician 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 Southern California Physician, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213683-9900. Acceptance of advertising in Southern California Physician 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 Southern California Physician, LACMA Services Inc. or the Los Angeles County Medical Association. Southern California Physician reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. SCP is not responsible for unsolicited manuscripts.
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pr e si d e n t ’ s l e t t e r | sam u e l fi n k , M D
I
H O P E T H AT A L L O F YO U have had a
good September! I want to thank you for your calls and letters...it’s always good to know that someone other than my wife is reading my column! As you now know, LACMA filed a lawsuit on September 13th against Health Net of California for its refusal to pay claims for medically necessary and life-saving procedures. We were joined in this lawsuit by two brave patients who have been harmed by Health Net’s tactics. This company has a long history of overruling treatments that have been prescribed by doctors, and denying care that patients need. The suit seeks to require Health Net and other health carriers in California to abide by California law, and to stop using their own definition of medical necessity to deny legitimate claims for health care. LACMA represents thousands of doctors who are fed up with insurance companies interfering with patient care. We’re asking the court to establish a clear definition of medical necessity that will stop these ongoing abuses. Please contact our office (www.lacmanet.org) and share any similar experiences that you have had with us! I’d like to update you on the status of our Aetna lawsuit as well...as you know, Aetna has been illegally denying patients access to out-of-network benefits that they have paid for, and has been terminating the contracts of physicians that referred patients to out-of-network facilities. Since this lawsuit was filed in July, Aetna has declared that it will no longer negotiate contracts with California Medical Association and LACMA members, and has, in our view, been more aggressive in terminating the contracts of our physicians. Please call Carol Chaker in our downtown office at 213-226-0313 and let her know if this has happened to you. Retaliating against physicians is illegal, and
we’d like to be able to get you the help you need! Whenever I’m speaking about the benefits of LACMA membership, I always mention the money that each of you has saved on medical malpractice insurance, because of MICRA, the Medical Injury Compensation Reform Act. Despite the importance of MICRA to all California physicians, I’m often tuned out at this point, because, after all, MICRA was passed almost 40 years ago, in 1975! But, just a few weeks ago, the California Trial Lawyers attempted to overturn MICRA virtually overnight, with a “gut and amend” bill that would have allowed plaintiff attorneys to sue based upon the retail price of the medical services provided, rather than upon the amount actually paid by the injured party. We are vigilant 24 hours a day against any attempt to overturn MICRA...never underestimate the hard work that your medical association does to make sure that you are protected! In just one month we will all vote on the direction that our country will take for the next four years. I have never seen our country so divided between two competing visions. The hostility and anger are palpable...and that will not serve our country well no matter what the out-
4 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
come of the election is. However, two weeks ago, I had the honor to meet two physicians that are running for office. One is Dr. Raul Ruiz, an emergency physician running for the House of Representatives from California’s 36th Congressional District (www.drraulruiz. com). The other is Dr. Matthew Lin, an Orthopedic Surgeon running for the California legislature in the 49th Assembly District (www.votedrlin.com/ home). Now, Dr. Ruiz is a Democrat, and Dr. Lin is a Republican. But, when I sat at the same table with them, I could detect no difference between their positions on the issues that we physicians care about. Both are committed to tort reform, are strong MICRA advocates, and would like to see MICRA expanded nationally. Both understand that Medicare--and in fact all patient care--has to be properly and fairly funded. Both understand that the planned 30% cut in physician Medicare reimbursement scheduled for January 1, 2013 will essentially destroy the program. Having access to an insurance card is not the same thing as having access to a doctor that will see you, spend time with you, and provide the care that you need. Both understand as well that it is physicians that are ultimately responsible for patient care, and that there are no shortcuts to competency. I want to commend both candidates for having the courage to take time away from their busy practices and run for public office. We can all learn from their example! What should LACMA be doing, and what would you like more information about? As always, drop me a line at president@lacmanet.org. Until next month... Samuel Fink, MD, is an internist in private practice in Tarzana. He is the 141st president of the Los Angeles County Medical Association.
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front office | practice tips
Risk Tip
Are Your Prescribing Practices Secure? Prescription theft and abuse is a real and growing problem, making it imperative for physicians to protect themselves and their practices. In addition, a recent court ruling spotlights potential obligations to third parties when prescribing medications to patients. Together, these developments signal the need for vigilance and security in your prescribing practices. The Prescription Regulatory Environment
Physicians who continue to use paper pre-
Court Rules Physicians
scriptions should implement protocols with
Liable for Patient’s Actions
The Drug Enforcement Administration
local pharmacies to manage prescription
In February, the Utah Supreme Court
(DEA) has developed federal and state reg-
theft, forgery, and alteration. Physicians
ruled that third parties may sue doctors
ulations to safeguard prescribing practices.
may also consider terminating the physi-
for injuries caused by a patient whose ac-
The Centers for Medicare and
tions are associated with alleged
Medicaid Services (CMS) also
medication mismanagement.
Consider these risk management tips:
requires that prescription pads have security features to prevent copying, modifying, and counterfeiting. Currently, 49 states have passed legislation to implement operational Prescription Monitoring Programs (PMPs), which seek to curtail prescription drug abuse and diversion through highly effective tools and strategies developed for use by government officials. Tips to Avoid Prescription Fraud and Abuse
sue a physician and his staff
• Request notifications from local pharmacies before prescriptions for controlled substances are dispensed. • Use the control batch number on each script to track the order of prescriptions. • Require patients to visit the office to obtain prescriptions for controlled medications. • Note actual amounts prescribed, and give matching numerals to discourage prescription alterations (e.g., thirty/#30)
electronic prescribing, or eprescriptions, into their practice to protect themselves against diversion. Electronic prescribing promotes efficiency and reduces medical liability—two objectives of the HITECH Act. It eliminates the timeintensive process involved with tracking paper prescriptions, voids opportunity for alterations, and provides a direct connection to pharmacists to ensure accurate
after a patient killed his wife. According to the American Medical Association, “The court ruled that when potential risks might outweigh potential benefits for a given activity, doctors must consider the potential effects their actions could have on third parties.” While state laws differ, courts in several other states have issued similar rulings. As a result, health professionals in Utah
Physicians can incorporate
prescriptions.
The ruling allowed relatives to
and other jurisdictions may be cian/patient relationship with a patient who
found to have a legal responsibility to
is involved in prescription abuse, theft, or
third parties when prescribing medicine
diversion. If prescription fraud occurs, phy-
to patients—which will likely impact the
sicians should investigate and notify local
way medicine is practiced.
law enforcement, the local DEA office, and the necessary state licensing and medical boards. Physicians should also contact their malpractice insurer to discuss other reporting requirements and further safeguards for preventing diversion.
6 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com.
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front office | practice tips
Tips for Getting Paid According to “UCR” By John a. mills, esq.
THERE ARE A VARIETY OF REASONS why physicians decide not to contract, or renew their contract, with health plans. For many, a reason to give up the benefit of patient “steerage” that comes with participating in a plan’s network is that the contractual rates for reimbursement are unfeasibly low. However, when physicians begin treating the plan’s members as an “out-of-network” provider, they often find that the plan’s reimbursement amount is not much higher, and may be even lower, than the plan’s contract rates. If you are seeing that trend in your practice, then it’s possible you are overlooking a few key steps that may help you get paid the amount you’re owed.
1
3
2
4
Understand UCR. It’s important to keep in mind that the amount you’re owed is not necessarily the amount you actually charge. As an out-of-network physician in California, you should be getting paid, at a minimum, the “usual, customary and reasonable” amount for your professional services, commonly referred to as the “UCR” amount. UCR essentially means the fee that a physician usually charges for a service that is within the range of usual fees charged for that service by other physicians in the same or similar geographic area, and which is justifiable in light of the particular case in question. There are a number of resources to help with determining fee schedules, including FAIR Health (www.fairhealth.org). Conduct a thorough verification of your patient’s health insurance benefits. Except in the case of emergency care (where the service must be provided irrespective of the patient’s ability to pay), the patient’s insurance benefits should always be verified in advance of rendering your services. This is your opportunity to get a breakdown of the patient’s insurance coverage. The patient’s plan should be asked to provide detailed information about the patient’s out-ofnetwork benefits coverage, including such things as confirmation of the effective dates of coverage; the amount of the patient’s coinsurance, deductibles, co-pays, out-of-pocket maximums, as well as the amounts met for each; and whether the plan requires prior authorizations. It is extremely important to find out whether the plan pays out-of-network benefits according to a UCR rate. Do not assume that it does. The plan’s representative will often say that the plan covers a particular percent (e.g., “70%”), but it is necessary to ask “70% of what?” If the response is “70% of the plan’s allowable charge,” then it’s important to verify that the so-called “allowable charge” correlates to UCR. Because not all plans are required to pay out-of-network benefits according to UCR, some may define “allowable charge” as being the equivalent of Medicare rates or in-network rates, which can translate into awfully low reimbursement. Finally, it is absolutely imperative that your verification of benefits be carefully documented, as it often proves to be crucial evidence when disputes later arise.
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Make sure you have a comprehensive assignment of benefits form. Taking an “assignment of benefits” from the patient means that you are acquiring the right to receive the patient’s benefits from the health plan. (Note that some health plans refuse to honor assignment of benefits, and insist on sending benefits checks only to the patient. This is a hotly-debated topic which is outside the scope of this article.) In the event you have a reimbursement dispute with the patient’s plan, it’s important that your assignment of benefits form is broadly worded. You do not want to just have the right to receive the benefits money; you also want to have all the other rights the patient has under the plan, including the right to directly appeal an adverse benefit determination. Aggressively appeal adverse benefit determinations. Claims that are denied or underpaid should be timely appealed to every level of appeal that the plan offers. As part of your appeals, be sure to request the documentation which the plan used for reaching its decision. Some plans are subject to penalties if they refuse to provide you with the documents. Also ask for an explanation of how it calculated the reimbursement for your services. If you can do so, enlist your patient’s assistance in the appeal process.
5
Be cautious about waiving co-pays and giving discounts. Some out-of-network providers seek to attract patients by agreeing to waive co-pays and deductibles. Health insurers are increasingly refusing to reimburse practices that do this, on the grounds that “fee-forgiving” is contrary to the patient’s insurance contract and, in some cases, is fraudulent. An experienced health care attorney can help you ensure that your efforts to minimize your patient’s financial burden will not jeopardize your practice.
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Cma | qu i ck list
Easing of Student Loan Debt for Physicians Working in Poor Neighborhoods T H E B oard of superv isors has decided to help ease the burden of student loan debt for Los Angeles County health care professionals, especially those practicing in underserved areas. On Aug. 26, the five board members approved a motion sponsored by Supervisor Mark Ridley-Thomas that permits county employees to apply for relief under the Steven M. Thompson Physician Corps Loan Repayment Program. The program provides up to $105,000 in loan assistance to physicians who commit to working full time for three years in an area with a shortage of health professionals. In addition, the employees may apply for other repayment programs that do not require county financial contributions, according to the motion passed by the board. The motion passed by the board
Governor Signs Workers’ Comp Reform Bill into Law
O
on september 1 9 Governor Jerry Brown signed a Workers’ Compensation bill that overhauls the state’s financially troubled, $17-billion workers’ compensation system. State senators Kevin de León (D-Los Angeles) and Jose Solorio (D-Anaheim) introduced the legislation during the last days of the Legislature, and the Los Angeles County Medical Association, as well as the California Medical Association, were involved behind the scenes with other groups in the working out of key sections of the important reform effort and giving support to the bill. The new legislation changes the formula used to calculate benefits for injured workers, increasing their compensation 29 percent on average. But the overall savings is expected to reach $740 million a year. It also ends payments for certain health conditions that often are subject to lawsuits, such as psychiatric problems, sexual dysfunction and sleep loss. The State Compensation Insurance Fund said employers likely will pay less for workers’ compensation insurance under the law. According to de León, any savings generated by the law will help raise benefits for permanently disabled workers. After signing the bill, Brown issued a statement which said: “These significant reforms save hundreds of millions of dollars for California’s employers while preventing an imminent crisis of skyrocketing rates that would have hurt both injured workers and businesses.” James T. Hay, president of the California Medical Association, said his group joins “a long list of coalition partners and legislators from both sides of the aisle in supporting SB 863 because the bill will ensure that physicians can continue to treat our patients.” “After many hours of meetings with stakeholders, we believe SB 863 represents sound policy. We look forward to working with the Division of Workers’ Compensation in providing physician input throughout the development of implementing regulations,” he added. CMA said it was able to obtain a number of crucial amendments and ended up taking a support position on the bill. Among the amendments as detailed at the CMA website:
also directs the county staff to create a master plan on how to address physician shortage challenges in medically underserved areas using federal, state and philanthropic funds. “By assisting physicians, who typically carry hefty loads of student loan debt, we hope to give them every incentive to go into public service,” said Ridley-Thomas. “At the same time, the public benefits; we’ll be expanding access to health care throughout Los Angeles County, particularly in our urban, rural and traditionally underserved communities.”
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• Silent PPO protections: A CMA-written amendment will shine a light on “silent PPO” activity by medical provider networks (MPN). A silent PPO is created when a payor sells its reduced provider rates to other insurers, third party administrators and employers. Physicians will now be notified every time an MPN that they participate in is sold. • MPN contracting: CMA has long been concerned that physicians are unknowingly placed into MPNs when signing commercial health plan contracts. Language in SB 863 will, for the first time, require that a physician sign a stand-alone acknowledgment before being included in an MPN. • Changes to the Fee Schedule: At CMA’s insistence, amendments were added to the bill to ensure that workers’ compensation is not subject to the volatility of the Medicare fee schedule. The amended bill also provides additional funding for services that Medicare does not cover, such as consultations and interpreters. The fee schedule will also add new coverage for evaluation and management services provided during global surgery periods.
qu i ck list | cma
Aetna Retaliating Against CMA Physicians in Response to LACMA Lawsuit
A
TTORNEYS for LACMA and the CMA are charging that Aetna Inc. is
engaged in retaliatory practices against physicians in the wake of a lawsuit filed against the insurer in July. In the lawsuit, the 35,000-member CMA, including three county medical societies, 60 individual physicians and four ambulatory surgical centers, said Aetna improperly restricts PPO and POS patients to out-of-network benefits. Since that lawsuit was filed, the two organizations say Hartford, Connecticut-based Aetna has been refusing to negotiate or contract with physicians who are members of the CMA or county medical societies participating in the lawsuit. “They are effectively limiting some 35,000 physicians from participating in their network, which impacts access to care for patients that rely on Aetna for insurance coverage,” said LACMA President Dr. Samuel I. Fink, M.D. “It appears Aetna is increasing the voracity with which they terminate provider contracts for referring patients out of network -- the subject of the original lawsuit. Physicians who have only occasionally made out-of-network referrals are getting their contracts terminated, which leads us to believe that the uptick is tied to the lawsuit.” LACMA CEO Rocky Delgadillo said state Department of Insurance regulations require that insurers cannot take retaliatory action against physicians for advocating for the care of their patients. “By law, physicians are allowed to advocate for the best care for their patients, which is exactly what the lawsuit is about,” said Delgadillo. Aetna told an L.A. Times reporter that it disagreed with claims that it is engaged in retaliatory practices and said that it was “fighting on behalf of patients against ‘egregious and improper billing practices’ that drive up costs for consumers.” Source: Physicians News Network at physiciansnewsnetwork.com.
Last Minute Move by Trial Lawyers to Scuttle MICRA Is Thwarted I n the last days of the 2012 legislative session, a shell bill (SB 1528) was gutted and amended in an attempt by trial lawyers to undermine California’s Medical Injury Compensation Reform Act (MICRA). The California Medical Association (CMA) was able to thwart this move and the bill is dead for this legislative season. The bill would have artificially inflated medical expense damages by valuing them on the basis of the retail price of medical services provided, not the actual expense to the injured party. Simply put, this would allow trial lawyers to value medical expenses at rates much higher than what the physician who provided the service is actually paid. The legislation would have scrapped longstanding principles of law that allow an injured person to recover as economic medical expense damages only amounts actually paid or incurred for medical care and services. SB 1528 would have artificially inflated economic medical expense damage awards and undermined MICRA’s intent to prevent double recovery of these damages. This, in turn, would have increased medical malpractice premiums for physicians, many of whom would be forced to close shop thereby further limiting access to care for all Californians. Had this bill passed, it would have undermined the state’s landmark MICRA law, which comprises a number of different statutory provisions all designed to contain costs in medical professional negligence cases while ensuring adequate compensation for injured persons. MICRA was signed by Gov. Brown in 1975 during his first term as governor. The next legislative year CMA expects another challenge from the same lawyers and we will fight to the end to preserve the MICRA laws.
O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 1 1
Cma | qu i ck list
CMA Urges Congress to Stop $11 Billion in Medicare Sequestration Cuts
T
he automatic budget cuts required under a deficit-reduction law would slash Medicare spending by $11.1 billion next year, according to a report issued recently by the White House Office of Management and Budget. This comes just days after the California Medical Association (CMA), the American Medical Association and 99 other state and specialty societies submitted a letter to Congress urging the passage of legislation nullifying the 2 percent cut payments called for under the sequestration act. The 2 percent Medicare “sequestration” cuts are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year’s debt-ceiling crisis. Under the act, across-the-board cuts will be
triggered if Congress fails to come to an agreement on how to reduce the federal deficit. These cuts would come on top of the 27 percent Medicare physician payment cuts triggered by the flawed sustainable growth rate (SGR) formula. The letter to Congress argues that “the combination of a sequestration cut and looming Medicare sustainable growth rate payment cut would not only impede improvements to our health care system, it could lead to serious access to care issues for Medicare patients as well as employment reductions in medical practices, we strongly urge Congress to work diligently during the fall to reach a bipartisan agreement to pass legislation nullifying the Medicare physician payment cuts.” CMA and the other cosigners also
expressed a commitment to work with Congress on the shared goal of delivery and payment reform in the Medicare program. Because “To reach this goal, adequate and stable investments are necessary so that physicians can modernize their practices to support the coordinated care that will improve health and prevent costly complications and enable the participation in new payment and delivery models,” the letter said. The sequestration cuts will take effect on January 2, 2013, if Congress fails to either reach a deficit reduction agreement or takes additional legislative action to stop the cuts. Congressional Republicans remain deadlocked with the Obama Administration over sharp differences in their preferred approaches to reduce future deficits.
Governor Brown Signs Bill to Create Medical School Scholarships G OV E R N O R B R OW N signed AB 589 (Perea), which will create a medical school scholarship program for students, helping to increase the physician workforce throughout California. AB 589 establishes within the Health Professions Education Foundation, the Steven M. Thompson Medical School Scholarship Program (STMSSP). This program would provide up to $105,000 in scholarships to selected participants who agree to serve a minimum of 3 years in an eligible setting upon attaining full licensure. Eligible settings are either federally designated “medically underserved areas” or areas of the state where unmet priority needs for physicians exist as determined by the California Healthcare Workforce Policy Commission. “On behalf of all future physicians, CMA thanks Assemblymember Perea, the bill’s author, and Governor Brown for signing this important legislation into law,” said James T. Hay, M.D., CMA president. “California will soon have millions of newly insured patients with the
implementation of health reform, and ensuring that there are enough physicians working where those patients are is crucial to those patients getting treated.” Of California’s 58 counties, 42 are below the federal standard for primary care physician supply, and 48 have at least one region designated as a Health Professional Shortage Area. In addition, there are over 200 distinct areas in California federally designated as medically underserved. AB 589 addresses this growing concern by recruiting medical students to work in these areas at the completion of their training, giving preference to students pursuing careers in primary care. “AB 589 will provide the impetus for more students to attend medical school, and increase the number of available physicians practicing in the most underserved areas. Medical education debt can be a daunting deterrent for students,” added Dr. Hay. “This bill makes it possible for many more young adults interested in pursuing medicine to do so.”
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FIGHTING BACK LACMA lawsuit aims to protect patient and doctor’s rights to making medical decisions On September 13 the Los Angeles County Medical Association filed a lawsuit against insurance giant Health Net charging that the insurer routinely and illegally denies patient claims for critical medical care. Rocky Delgadillo, LACMA CEO, later held a news conference on the day the lawsuit was filed to explain the actions of his organization that represents the 6,500 physicians in the county. Delgadillo said that the multi-billion-dollar insurance provider systemically refuses legitimate patient claims
tion to protect patients from such illegal practices in the future.
Health Net, through its subsidiaries, provides and administers health
Delgadillo told the news conference
benefits to approximately 5.5 million
by employing its own definition and
that the practices present a continuing
individuals across the country, includ-
set of criteria for “medical necessity,”
threat to the public’s health, safety and
ing 2.3 million members in Califor-
violating well-established standards
welfare.
nia. Based in Woodland Hills, Calif.,
set forth by California law. Health Net is “the leader” in this
“Unless Health Net is permanently enjoined and restrained they will
Health Net reported $11.9 billion in revenues last year.
calculated corporate practice to avoid
continue to commit acts … to cause
paying claims, he said.
irreparable harm and injury to the
good faith and fair dealing, and breach
public,” he said.
of contract on behalf of Plaintiffs
The lawsuit was filed in Los Angeles County Superior Court. LACMA
The complaint alleges breach of
was joined by two patients who were
good faith and fair dealing, and breach
denied treatment by Health Net at a
of contract on behalf of the patients as
news conference the same day that the
well as LACMA.
lawsuit was filed. Los Angeles City Attorney Carmen
“This is a huge problem for thou-
The complaint alleges breach of
Robert Mendoza, Kalana and David Penner as well as LACMA. The suit seeks an end to the unlawful business practices by Health Net with an injunctive relief, and dam-
sands of policyholders who are
ages for Mendoza and the Penners
Trutanich and LACMA President Dr.
routinely refused coverage for neces-
for denial of their claims to medically
Samuel Fink, plus representatives of
sary medical procedures, like surgery,
necessary procedures.
the law firms filing the suit, as well
leaving patients holding the bag for
as patients who were recent victims
medical bills,” said William Shernoff,
behalf of another victim, Bonnie Scott,
of this unlawful practice also partici-
lead attorney on the lawsuit, and
against Health Net.
pated in the conference.
partner at Shernoff Bidart Echeverria
The plaintiffs are seeking an injunc-
Bentley, LLP.
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A separate lawsuit has been filed on
Degadillo said LACMA is part of the lawsuit because it is working to stop
Speaking at a the LACMA press conference are LACMA CEO Rocky Delgadillo, left and Bonnie Scott, patient and plaintiff, top right.
the wrongful conduct of all California
wake of its lawsuit against Aetna Inc.,
The coalition filed the suit July 3 in
health insurers, including Health Net,
which charges that the insurer rou-
Los Angeles County Superior Court,
because its member doctors are pre-
tinely denies policy-holders access to
and is seeking an end to the practices,
vented by the acts of these companies
out-of-network providers.
as well as compensation for patients
from providing medically neces-
and physicians, as well as puni-
sary care and treatment to their
tive damages.
patients. LACMA joined the complaint because it also believes physicians across the state also suffered and will continue to suffer from Health Net’s practices. “Organizations such as LACMA have had to devote significant time and resources in order to curtail these practices, rather than focusing on advocating
LACMA is part of the lawsuit because it is working to stop the wrongful conduct of all California health insurers, including Health Net, because its member doctors are prevented by the acts of these companies from providing medically necessary care and treatment to their patients.
The lawsuit charges Aetna sells policies that promise purchasers that they could go to doctors out of their networks if medically necessary, but routinely refuses to reimburse policy holders who do so, costing them tens of thousands of dollars in medical bills in some cases. The suit also alleges Aetna threatens to terminate the con-
quality health care for all pa-
tracts of doctors who refer their
tients,” said Fink.
patients to providers outside of
The lawsuit has generated much
The California Medical Association
their networks.
coverage in the local, as well as the
joined LACMA in the legal action
The coalition has also established a
national media.
along with the Santa Clara County
page on LACMA’s website for patients,
Medical Association and Ventura
physicians and employers to share
County Medical Association.
their experiences about Aetna.
Meanwhile, LACMA continues to receive support across the U.S. in the
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underS
The
1 6 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
underSERVED of Los Angeles County
For the past eight years, Dr. Christina M. McAlpin, an otolaryngologist in private practice in downtown Los Angeles, has seen a steady stream of so-called underserved patients seeking treatment for their ear, nose and throat conditions. Dr. McAlpin says treating each of these patients is a rewarding experience in spite of the challenges they bring to her practice and the emergency department at nearby California Hospital Medical Center, where she serves on the trauma team. She says 20 to 30 percent of her patients live in underserved communities, which include broad swatches of the city, such as East and South Central Los Angeles. Much larger numbers come to the emergency room. “My patients come with much more complex issues,” she says. “Most of them never go to the doctor, so they have so many problems. “And their conditions are all out of control,” she adds. “They really don’t have a handle on them because when they do get to see a physician, it’s for five seconds, so they don’t get a chance to answer all of the questions that they have.” She says many in this patient population suffer from high blood pressure, as well as other systemic issues, and they don’t always understand the severity of their illness. For example, her patients are not consistent in taking their blood pressure medicine, which can be vexing. “They tell me that some days they take it, and some days they don’t,” says McAl-
pin, “not understanding that not taking it can lead to so many other complications.” As a result, those patients don’t really receive the necessary instructions they need to deal with their condition, explains McAlpin, who graduated from Harvard University and went to medical school at the University of Southern California. Her patients don’t know how or where to get information, she says, because they don’t have access to such important tools as computers and the Web. “They just say, ‘The doctor says I have a condition, and that’s it,’” says McAlpin. “They have complex conditions, and often they are undertreated.” McAlpin is not alone in treating the poor in their health care needs. About 16 percent of Los Angeles County’s population lives below the poverty line, compared to 14 percent statewide, based on U.S. Census data. Interestingly, more than 56 percent of the county’s residents speak another language, which further exacerbates com-
munication between patient and doctor. The area is huge by any measure, and the numbers of dollars spent correspondingly large. For example, more than 800,000 of the county’s 10 million residents seek treatment at the county Department of Health Services’ four hospitals and 13 clinics, as well as other clinics and physician practices. The county agency spends more than $3.5 billion each year on treating the underserved, a number expected to swell when the Affordable Care Act takes effect in 2014. The county’s top health care officials expect the number of patients to jump to 2 million then, which will put a strain on a network that’s already under duress. All now come — or will come — from underserved communities. “That’s our mission,” says a spokesman for the massive department. “And that’s been our mission for more than 100 years. We are the safety net system.” O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 1 7
The county health department emis considered underserved, especially of newly insured patients under the Afploys 22,000, which includes thousands of in terms of qualifying for important fordable Care Act will further exacerbate frontline physicians and nurses. state and federal grants, so that a larger the shortage, he says. And the department has contracts with percentage of doctors can be put into “The limitations of the ACA and the dozens of private concerns also providing underserved areas. fact that many doctors are going to retire, frontline health care to patients, many “A lot of Los Angeles qualifies for fedplus the reality that doctors can’t make as part of the region’s mosaic of ethnic eral grants,” he says. much money as before, are going to have populations, which is in flux. Designation of shortage areas falls an impact on the number of new docA decade ago, the population was 7 under different definitions, such as Meditors in the future,” he says. “There aren’t percent African American, 11 percent cally Underserved Areas (MUAs), or Health enough programs out there to supply the Asian, 32 percent Latino and 47 percent Professional Shortage Areas (HPSAs), to doctors that will be needed to deal with white. help boost the chances of getting county the growing population of patients.” By the year 2050, Latinos will comassistance to help address shortages. He says the public health provider prise 52 percent of the population in the “The designations also help new stumodel will have to depend less on physicounty and Asians 13 percent, cians and more on other health while African Americans will professionals such as physician “ T he crisis in Los Angeles , assistants, registered nurses and decline to 5 percent and whites to 26 percent. practitioners. as well as the rest of Cali - nurse “With the arrival of new One of the biggest challenges is the number of doctors fornia , is that more than technologies, that should be available to treat the poor at all a lot easier to accomplish,” he stages of life. 3 0 percent of doctors are says. “Doctors are losing their Alberto Tovar, chief operating influence in health care because 60. T over the age of hat the new model is driving the officer of the Los Angeles Counchange.” ty Medical Association, notes means a lot have already that the number of licensed He says this model of using doctors available for frontline larger numbers of other providretired, or [are ] about to ers may or may not work, as it duty is deceiving, because many are retired or don’t practice but retire . T hat ’ s going to hasn’t been tested in practice. retain their licenses, skewing the “There are a lot of variables in actual count available to see play,” he says. create a huge shortage .” patients. One of those variables is the For example, of the 27,000 cost of doing business for a new doctors licensed in Los Angeles County, dents qualify for medical school scholdoctor. Tovar estimates only 22,000 physicians are arship programs or recently graduated “We have anecdotal information that actually practicing medicine. students for loan repayment programs,” new doctors are choosing to practice He bases his information on the statesays Tovar, including a new program that outside of Los Angeles County because of wide Grumbach Report, published by the LACMA is in the process of setting up that the higher cost of living here,” he explains. California Healthcare Foundation. The will help address the shortage. “Even though we have strong residents report found that the number of doctors The average young graduate has programs in the county, the cost of living practicing statewide is less than previously $149,000 in student loans. is so high that many graduates decide to thought. “The crisis in Los Angeles, as well as practice in other parts of Southern CaliAnd it’s a statistic that’s readily apparthe rest of California, is that more than fornia, such as Riverside, San Bernardino ent in his own membership. Of the 6,500 30 percent of doctors are over the age and Ventura counties, especially in the members of LACMA, for example, only of 60,” he says. “That means a lot have beginning when their incomes aren’t as high.” 2,500 — 38 percent — are practicing already retired, or [are] about to retire. medicine. That’s going to create a huge shortage.” He says they might come back, or they Tovar says that most of Los Angeles The addition of hundreds of thousands might not, once they’ve settled into their 1 8 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
careers. He says a lot of other factors may come into play, so it’s hard to predict. Meanwhile, the rising tide of patients includes those coming from neighboring Riverside and San Bernardino counties because of the shortages of providers. The New York Times reported in July that Riverside County will face a shortage of 5,000 doctors in a decade, which could send more patients seeking treatment traveling west in search of providers. In Los Angeles, the Public Health Department estimates that it could be serving as many as 2 million patients in 2014 and beyond as all elements of the ACA fall into place, but it thinks it has a handle on what’s ahead for the agency. A spokesman says the agency has spent a number of years preparing for the changeover and points to the success of its Healthy Way LA program, which has enrolled 200,000 underserved residents over the past few years.
The program, funded with a combination of federal, state and local monies, is seen as a model for what to expect from the department as 2014 approaches. Enrollees are assigned a primary physician and get access to most health care, including treatment for mental health issues. “We think we’ll thrive under the new system,” says a spokesman for the health department. “But of course there are lots of uncertainties. We’re building a lot of infrastructure to accommodate these patients.” Dr. McAlpin says she’s positive about the Affordable Care Act when it comes to treating the underserved, because it will give patients improved access to care. “Actually, I think things will get better,” she says. “They’ll have access to medical care that they don’t have now, and it won’t be as limited; they won’t have to face such factors as pre-existing condi-
available all day McDonald’s
tions that have pushed many out of the system. “And it will be easier for doctors to see patients, because we won’t be getting killed in the emergency room trying to see all these patients who don’t have insurance.” Meanwhile, treating her patients, rich and poor, young and old, provides a great source of satisfaction. “I know I am making a difference. I could do anything, but I have chosen something that lets me go home and sleep well at night knowing that I am making a difference in people’s lives,” she says. She earns less than she did when she worked for a group medical practice before striking out on her own eight years ago, but she says the work with her patients is much more satisfying. “I work a lot and do a lot of good,” she says. “I go home happy every day.”
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FEATURE | K AISER PER M ANENTE
Kaiser Permanente’s New Facilities Designed for a Healthy Environment Deliver State-of-the-art healthcare services and improved patient care
Kaiser Permanente has had an aggressive capital building campaign. In the last five years, within Los Angeles County, it has built four new hospital facilities and two are currently under construction for Phase II additions. East of Los Angeles County, the Ontario Medical Center opened its doors in November 2011 and a major hospital replacement project is now under way in Fontana. The Kaiser Permanente Fontana Replacement Hospital is scheduled to open in Spring 2013 and promises to be a continued emblem of health for the City of Fontana and for residents throughout the Inland Empire. The new, stateof-the art seven-story hospital is valued at approximately $720 million. Once open, the Kaiser Permanente Fontana Replacement Hospital will have 314 private patient rooms and 2 0 s o u t h e r n c a l i f o r n i a p h ys i c i a n | OCTO B ER 2 0 1 2
provide numerous specialties including a cardiac center of excellence, a 51-bed emergency department (ED), pediatric and neonatal ICU, pediatrics, ICU, labor and delivery, cardiac lab and surgery to help serve a regional membership base of 430,000. Decades of design and construction best practices that improve the environment and patient care will come to life in the new 490,000-square-foot hospital that includes a new 50,000-square-foot medical office building and a 23,000-square-foot central utility plant. Environmental Best Practices Kaiser Permanente has been an advocate for environmental best practices in healthcare and the workplace for more than sixty years. At a time when government envi-
ronmental policies were not yet imposed and as early as the 1950s—Kaiser Permanente founder and industrialist—Henry J. Kaiser—made a $5 million investment to install air pollution control equipment at the Kaiser Steel Mill in Fontana. As a healthcare provider, “our goal is to create medical facilities that are sustainable and that contribute to the overall health of our members and visitors,” said Rick Ginley, Executive Director of National Facilities Communications & Public Policy. Kaiser Permanente has instituted policies and practices to reduce its carbon footprint and to incorporate clean energy and sustainable design in its medical facilities. “The initial investment to convert to greener healthcare design is typically more costly, however, over the lifetime of these sustainable measures we are able to provide a positive impact on the health of our members and the communities in which we serve,” added Ginley. Volumes of studies have shown that adverse environmental impacts have a direct relationship to health, e.g., air pollution is known to trigger Asthma, one of the leading causes of ED visits at Kaiser Permanente medical centers. By reducing its carbon footprint—Kaiser Permanente minimizes its carbon emissions—and in turn, helps curb the amount of air pollution in the environment that consequently improves air quality and minimizes the need for future medical care. Kaiser Permanente’s use of a template hospital design and construction process not only enables it to open hospitals sooner and more cost effectively, it improves patient care. “Kaiser Permanente developed The Total Health Environment Initiative to create a distinct and consistent environment across Kaiser Permanente buildings and to provide a setting for care that is consistent with its promise to ‘Total Health’,” said Theresa Ashby, PhD, Fontana Medical Center Transition Director. Kaiser Permanente lists numerous template design features that will enhance patient care at the Fontana Replacement Hospital such as larger patient rooms that help reduce trips and falls and encourage families and friends to engage in patient care; a triangular nurse station that provides optimal patient monitoring within close proximity of patients for quick patient access; private patient rooms that help reduce noise and provide another layer of infectious disease control; use of warm bold colors to create a vibrant and positive atmosphere; and ER break-away doors that allow for the quick addiO C TO B E R 20 1 2 | w w w. s oc a l p h ys i c i a n . n et 2 1
FEATURE | K AISER PER M ANENTE tion and removal of gurneys. Externally, tranquil outdoor courtyards are lined with water features, and large windows providing natural light line the main public corridors along with sitting benches for patients and visitors. Stairwells have been moved from the interior of the facility to the exterior with large windows to allow for natural light and to encourage patients and staff to use the stairs for exercise. “We also investigate the path of travel for every part of the hospital and incorporate it into the design. It’s important to ensure that the route from one unit to the next flows seamlessly and that it also provides the most comfortable passage for patients,” said Ashby. All units are strategically located on one floor in the diagnostic and treatment area to provide the ultimate patient care. The Fontana Replacement Hospital will have an enhanced ED unit that will create access to the imaging department enabling hospital staff to take patients from the ER to radiation or CT quickly and effortlessly. Kaiser Permanente’s facilities team and architects are not alone in creating design features that improve patient care. There are focus groups comprised of Kaiser Permanente members who are involved in the development of facilities and overall design standards to ensure high quality patient care and safety. “We also work with physicians, nurses, and technicians to obtain input to the design that will contribute to the operational flow of each department. Staff helps validate that the
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area will accommodate patients needs and help ensure that it has and can house the latest technology and equipment,” explains Ashby. If there’s a design feature or workflow that may be incorrect or needs to be optimized, it is corrected and incorporated into the final design, asserts Ashby. Sustainability Beyond Design Sustainability does not begin and end with design. Kaiser Permanente also promotes sustainable food choices, such as locally grown fresh fruits and vegetables and its new Sous Vide Precision Cooking method that decreases food waste due to increased patient satisfaction. This French-inspired cooking method is known to help retain the nutritional value, color, and taste of food and facilitates the conversion to a room-service model. Kaiser Permanente introduced this new cooking method at the Ontario Medical Center and earned its place as the third hospital in the country to use this approach. Kaiser Permanente’s long history of ecofriendly best practices and its commitment to continually improve its hospital design standards lead to better patient care and contribute to the health and wellbeing of the greater communities in which it operates and provides services. The Fontana Replacement Hospital was designed by HMC Architects, structural engineering firm Saiful Bouquet, MEP engineering firm Ted Jacobs Engineering Group, and is being built by McCarthy Building Companies.
K AISE R PE R M ANENTE | F E ATU R E
Kaiser Sustainability Features Energy Conservation Features: • Energy-efficient air conditioning system • An automated mechanical control system is used to adjust temperature throughout the day based on actual hospital occupancy • Automatic light shut-off switches and fluorescent light fixtures to decrease the total energy usage • The hospital tower has a white-colored roof to absorb less heat and to help reduce interior cooling needs • Dual-pane glazing on all the exterior windows provides for better energy efficiency with less need for heating or cooling • Occupancy sensors are used for lighting • A 100% outside air ventilation system is used with a heat recovery system • A thermal fluid steam generator is used for less energy consumption versus a boiler • Individual temperature controls for each patient room reduce energy consumption and give more patient control over their own room temperature • Heat exchangers with heat recovery are used for domestic hot water, requiring less energy Toxin Reduction Measures: • Fluorescent lighting is used to help reduce dioxins
• Non-PVC backed carpet and rubber flooring are used which also includes recycled materials • Hospital includes furnishings and fixtures with fewer toxic chemicals • Use of low Volatile Organic Compounds (VOC’s) adhesives and paints Sustainability Practices: • Use of sustainable growth lumber comprised of 100 percent recycled content • Unrecyclable construction waste was minimized • Variable primary flow chilled water distribution system • A construction waste management program was deployed to recycle construction materials. To streamline the construction approval process and to reduce the amount of paper used on the project, 95 percent of all construction approvals were completed electronically, and in turn, saved more than 130 trees Water Conservation: • Use of native plants require less water • Pervious paving in parking areas and throughout campus filter storm water and divert water from storm drains • FDA approved water treatment systems are deployed for steam generators
No down payment for home mortgages up to $1 million Our special home financing is designed to meet your needs as a physician for the purchase of your primary residence. • Financing available with no down payment – up to $1,000,000. Expansion of loan-to-value ratios for loan amounts up to $1,750,000. • Private mortgage insurance is not required – save thousands over the life of the loan
• Single family homes, townhomes, lofts, and condominiums are eligible • Student loans that are deferred for 12 months are not counted in qualifying ratios. Refinances with high loan-to-values are also available.
For information on this special home financing program from BBVA Compass, give us a call today. Bryan Yaninek, Mortgage Banking Officer 719-329-3256 • bryan.yaninek@bbvacompass.com apply online at: www.bbvacompass.com/mortgages/byaninek
All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC. O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 2 3
m e mb e r b e n e fits | At Wo rk fo r yo u
2013 Will Be a Pivotal Year for LACMA
Be Sure to Renew Your Membership! All LACMA Members have received their 2013 dues
cal treatment and sued Aetna for denying patients the right
statements. 2013 dues are due by December 31, 2012. Please
to see out of network physicians and terminating contracts
be sure to renew your membership to ensure continuation
with their physicians.
of your benefits. Dues can be renewed conveniently online at www.lacmanet.org.
Under a strong network of physician leadership, we have been hard at work transforming LACMA into an organization
There are many benefits that physicians gain through
that truly advocates for the doctor-patient relationship. In
membership with LACMA, but none more important than
addition to taking on the insurance companies, LACMA is
providing a unified voice to fight important issues affecting
launching a new website that will include practice man-
LA County physicians. LACMA recently hired Rocky Delga-
agement resources to help grow your practice including a
dillo, former Los Angeles City Attorney, as our CEO. As he
member only money saving online marketplace, toolkits,
and our physician leaders take on insurance giants like Aetna
office manager networks, and more. Members can also look
and Health Net to protect physicians and their patients, we
forward to the roll out of the new Insurance Brokerage &
need the support of all LA County doctors to increase the
Administration Services and Medical Professional Liability
resources we apply to these issues. This year alone, LACMA
Insurance Services. Thank you for supporting your profession
filed a lawsuit against Health Net for denying critical medi-
and your patients by supporting organized medicine!
Meet Your Board!
L AC M A’ 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. officers Samuel Fink, MD
Marshall Morgan, MD
Pedram Salimpour, MD
Peter Richman, MD
Troy Elander, MD
President
President-Elect
Treasurer
Secretary
Immediate Past President
board of directors David Aizuss, MD
Sidney Gold, MD
Lawrence Kneisley, MD
Nassim Moradi, MD
Bob Rogers, MD
CMA Trustee
Councilor
Councilor-at-Large
Councilor
Councilor
William Averill, MD
William Hale, MD
Howard Krauss, MD
Ashish Parekh, MD
Sion Roy, MD
Councilor
Councilor
Councilor
Councilor
Resident/Fellow Councilor (Alternate)
Erik Berg
Shelley Han
Gideon Lowe, MD
Jeffrey Penso, MD
Medical Student Councilor / USC Keck
Medical Student Councilor / UCLA David Geffen
Councilor
Councilor-at-Large
Stephanie Booth, MD
Vito Imbasciani, MD
Jonathan Macy, MD
Heidi Reich, MD
Councilor-at-Large
Resident/Fellow Councilor
Councilor-at-Large
Councilor
Carlos E. Martinez, MD
Susan Reynolds, MD
Councilor
Councilor
Jack Chou, MD
Paul Kirz, MD
CMA Trustee
Chair of LACMA Delegation
2 4 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
Pejman Salimpour, MD Councilor
Shuo Steven Wang, MD Councilor-at-Large
Erin Wilkes, MD CMA Trustee (Resident)
at wo rk fo r yo u | m e mb e r b e n e fits
LACMA Opposing Efforts to Add New Taxes on Beverly Hills Surgery Centers L AC M A I S O P P O S I N G an effort by the city of Beverly Hills to increase taxes on two
gery centers. In a letter, LACMA President Dr.
surgery centers under an additional, more
Samuel I. Fink, M.D. encouraged associa-
costly classification.
tion members to write objections to the
If the city is successful, officials could expand the new taxes to more than 70 other surgery centers located in Beverly Hills,
new taxation efforts to the Beverly Hills City Council. Fink said the city has arbitrarily decided
thus requiring them to pay significant
that 75 percent of each center’s revenue is
additional taxes each year, said LACMA
subject to the rental services Class F tax.
officials. Traditionally, the surgery centers and
This tax rate of $23.50 per $1,000 of revenue will have a significant impact on
the physicians who work there paid city
physicians’ ability to serve patients, said
taxes under Class C, which is based on the
Fink.
number of payroll hours. Now the city is seeking to increase taxes on physicians and surgery centers under an additional Class F classification, the
For example, if a center generates $1 million of revenue, the annual rental tax would be an additional $17,625, he said. At $5 million of net revenue, the tax
same classification real estate leasing
would be another $88,125 each year, he
agents pay for their space.
said.
However, city officials decided that sur-
“We are seeking your support in ad-
gery centers should pay two taxes because
vocating that the City of Beverly Hills’
centers offer two distinct business services:
imposition of a rental tax to surgery
patient care, which is subject to the Class C
centers is not applicable and will hurt
payroll tax; and rental services to patients
physicians’ ability to effectively care for
and physicians, which would be subject to
patients,” wrote Fink. “Additionally, this
the Class F tax.
newly imposed tax obligation will have an
Many of the centers rent out unused
exponential impact on other businesses
space to other doctors, and the city has put
that serve our patients. If the City is suc-
that practice on its radar screen.
cessful, your surgery center could face a
Luis Ayala, LACMA’s director of government affairs, said many of the doctors
large tax liability.” An attorney representing the two cen-
renting space are actually partners and in-
ters told the Los Angeles Business Journal,
vestors in the centers, and thus paying rent
“We’re not in the business of renting com-
to their partnerships. He said the centers
mercial property, so the city is trying to
should not be taxed additionally for rent-
twist the municipal code for its own ends,
ing space to their own investors.
to get more revenue.”
“We don’t think this is fair,” said Ayala. He noted that the effort comes after vot-
Sourced from the Physicians News Network
ers defeated a ballot initiative in 2009
at www.physiciansnewsnetwork.com.
Japan Medical Council seeking
2 West Coast Doctors to Participate in Radiation Training in Hiroshima
Susan Reynolds, president and CEO of the Los Angeles-based Institute for Medical Leadership, is looking for two doctors in Southern California willing to participate in the 2012 HICARE Training Program in Hiroshima, Japan. Japanese medical authorities established HICARE, or the Hiroshima International Council for Health Care of the Radiation-Exposed, in 1991 to make good use of the experience and knowledge of physicians and researchers for all radiationexposed people in the world. The participants shall be those who engage or will engage in treatment of the radiation exposed individuals, though they can be doctors who work in ICUs or ERs, she added. “What they are really trying to do is reach out around the world to come to Japan to get a better understanding of radiation exposure and its impact on human health,” she said. Reynolds said the West Coast is one of the few places where there are survivors of the two atomic bombs dropped in Japan at the end of World War II, so it would be fitting to find doctors in the region who would like the additional training. “Like Japan, we also have nuclear power and earth quake faults, and they feel they have this expert knowledge and training that will really help in the event of an emergency,” said Reynolds. The first is a one week program starting Jan. 20. The second is a one month program starting Feb. 1 and ending March 4. HICARE pays for the international airfare to Hiroshima, plus accommodations and per diem living allowance. For more details about the program, contact Reynolds at 800-361-5321, or email at sreynolds@medleadership.com.
that would have raised taxes on the surO C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 2 5
m e mb e r b e n e fits | At Wo rk fo r yo u
CMA
2012 Education Series
Oct. 3: Protect Your Practice From Payor Abuse Mark Lane • 12:15 – 1:15 p.m. CMA sponsored legislation (AB 1455 - The Health Care Provider Bill of Rights) includes many protections against unfair payment practices by health plans and insurers. Mark Lane from CMA’s Center for Economic Resources will discuss important California laws that protect physicians and their practices from payor abuse.
Oct. 10: Impact of ICD-10 AAPC • 7:30 – 9 a.m. or 12:15 – 1:45 p.m. ICD-10 will bring about some massive changes in healthcare. No matter what the implementation date, you need to understand how you will be impacted and what you should be doing now to prepare.
Oct. 17: Establishing Expectations for High Performance from Medical Staff Debra Phairas • 12:15 – 1:15 p.m. Superstar staff members are made, not born. Staff usually rise to the owner or manager’s level of expectations. This webinar 2 6 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
will teach physicians/managers how to set high expectations for performance, create monitoring tools to evaluate and reward staff who achieve stellar performance.
Oct. 18: Essentials for ICD-10-CM: Part 1 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued on Oct. 25 and Nov. 1 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
Oct. 25: Essentials for ICD-10-CM: Part 2 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued from Oct. 18 and ends Nov. 1 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
at wo rk fo r yo u | m e mb e r b e n e fits
Nov. 1: Essentials for ICD-10-CM: Part 3
Dec. 6: Essentials for ICD-10-CM: Part 2
AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued from Oct. 18 and 25 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued from Nov. 29 and ends Dec. 13 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
Nov. 7: Understanding ARC and CARC Revenue Codes
Dec. 13: Essentials for ICD-10-CM: Part 3
David Ginsberg • 12:15 – 1:15 p.m. The use of remark codes and claims adjustment reason codes became standardized under HIPAA. The recent introduction of the 5010 standards further emphasizes use of these codes on remittance advices and payments made to medical offices by health insurers. Understanding the codes can assist medical practices in more effective payment posting and follow up on denials or payment reductions.
AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued from Nov. 29 and Dec. 6 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
Nov. 14: State Disability Insurance Online for Your Patients and You Laurel Waters • 12:15 – 1:15 p.m. SDI is a California state mandated, employee funded benefit which provides partial wage replacement with two benefit plans: Disability Insurance (DI) and Paid Family Leave (PFL). SDI is transitioning to a system with online capability for your patients and you. This webinar will show you how to create an SDI Online physician’s account, authorize representatives to assist in completing the Doctor’s Certificates, and how to complete the new online Doctor’s Certificate.
Nov. 29: Essentials for ICD-10-CM: Part 1 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m. Continued on Dec. 6 and 13 Available in either classroom or online webinar, this 3-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice. Series of three.
Dec. 5: Impact of ICD-10 AAPC • 7:30 – 9 a.m. or 12:15 – 1:45 p.m. ICD-10 will bring about some massive changes in healthcare. No matter what the implementation date, you need to understand how you will be impacted and what you should be doing now to prepare. O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 2 7
asso ciati o n happe n i n gs | N e ws & e ve n ts
District 7 Sixth Annual
Resident Mixer
B A C K BY P O P U L A R D E M A N D , LACMA District 7 Beverly Hills held its 6th annual Resident Mixer at the Capital Grille in Beverly Hills. Approximately, 100 interns, residents, and fellows gathered for an evening of social networking. Jonathan Macy, MD, President, LACMA District 7 welcomed guests and introduced Rocky Delgadillo, LACMA CEO, who addressed important issues affecting the medical community and discussed how abusive behaviors of Insurance Companies and Health Plans hurt patients and doctors. Rocky emphasized the importance of organized medicine as these are the issues young physicians will face during the course of their medical careers.
2 8 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
N e ws & e ve n ts | associati o n happe n i n gs
September 18-September 20
Medi-Medi Tours LACMA welcomed guests from the California Medical Association and the Centers for Medicare and Medicaid and the California Department of Healthcare Services for a three day long, four hospital tour to address the pending dual eligible pilot program in LA County. Centinela Hospital in Inglewood, Glendale Memorial Hospital and Health Center, St. Francis Medical Center in Lynwood, and St. Mary in Long Beach were among the hospitals in the tour. Approximately 60 physicians attended each program and had the opportunity to engage in discussions to address questions and confusion surrounding the pending coordinated care initiative. In April, the Department of Health Care Services (DHCS) announced their initial plan for these pilot projects. Eight counties – Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara – have been selected as the pilot counties. While this was approved by the state legislature as a state budget proposal, it is actually a major policy change that will have far-reaching effects on the health care of vulnerable patients. As part of the Medi-Cal 1115 Waiver approved in late 2010, the legislature gave the Department of Health Care Services (DHCS) authority to undertake pilot projects to redesign care for Medicare/Medi-Cal dual eligibles. These pilot projects are part of a national effort being led by the Center for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation. The dual eligibles project is still being negotiated and changed. Most importantly, patients will have the right to opt out of the pilot projects, and remain in fee-for-service Medicare. But they must make an affirmative choice to do so. While we are educating our members about this transition, physicians will, in turn, need to educate their patients about their right to opt out. Details about the plan, along with facts about the counties involved can be found at www.calduals.org.
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classi fi e ds / jo b boar d To place a classifieds ad, contact Dari Pebdani at dpebdani@gmail .com or 858 -231-1231. 118
consulting
LANCASTER MODERN MEDICAL BUILDING Great for all multi-specialties. X-ray available. Location for Lease, Rent or Share. Plenty of free parking. Call 661-305-1539.
520
openings—Physicians
• Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com
MEDICAL SUITE AVAILABLE Inside Brookdale Medical Center. Good for specialist (Orthopedic, ENT, Cosmetic/Plastic Surgery, etc.) Referrals available. Please contact jbarkodar@yahoo.com.
135
legal services
LEGAL REPRESENTATION FOR PHYSICIANS
Former Deputy Attorney General, Law Professor & Administrative Law Judge specializing in Administrative & Medical Board matters. Free initial consultation RONALD S. MARKS A Professional Law Corporation 21900 Burbank Blvd., Suite 300 Woodland Hills, CA 91367
(818) 347-8112
RonMarks@prodigy.net ww.ronmarks-law.com
205
office for lease/ sublease/share
REDONDO BEACH ARTESIA CORRIDOR 144-2,382 sq. ft. Professional and medical offices, some views, near freeways, restaurants and shops. Parking + ADA elevator at 2512 Artesia Blvd. 310-5690384 Email: maryannejankovic@ hotmail.com or visit: http://pike. nsicorp.net. REDONDO BEACH RIVIERA VILLAGE 145 – 2,017 sq. ft. Some views, balconies, impressively near restaurants, shops and beach! Medical parking + ADA elevator, at 1611 S. Catalina Ave. 310-5690384 Email: maryannejankovic@ hotmail.com or visit us at www. plazariviera.nsicorp.net. Los Angeles Office Office available to share in downtown LA. Reception, MD office, 3 exam rooms, with x-ray available. Across from California Medical Center. Contact: Steve Fleming 805-497-2801.
Medical Offices for Lease Pacifica Medical Plaza, Huntington Beach, CA. Suite 106 – 814 sf; Suite 205 – 1,080 sf; Suite 102 – 1,351 sf; Suite 105 – 1,840 sf. For more info, contact: Todd LaPlante, CCIM; Five Points Commercial. 714-317-1090; todd@fivepointscommercial.com; DRE ID 01014322. 240
medical building for sale/lease
Medical/mixed-use property Opportunity for owner occupant/ Medical/Dental Office investor. 1409 Sq. ft., walking distance to Centinela Hospital. Retain existing clients, has examination and records rooms, waiting area, ample parking. Call (310) 9891941, angie@guaranteedrealty.net. Gardena Medical 7400 s.f. free standing medical building Western Ave frontage, corner lot, signage. Other medical spaces from 800-4200 s.f. (in Torrance, Gardena, Montebello, Hawthorne, Long Beach). Contact Tom Torabi 310-768-8800 or ttorabi@lee-associates.com. classified ad
testimonial “Advertising in Southern California Physician magazine has had a positive impact on my Medical Professional focused practice. The readership is a great match with my client base and the services I provide.” Josh Nyholt, CPA www.nyholtcpa.com
3 0 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
TRACY ZWEIG ASSOCIATES
www.AdvantageWoundCare.org To Place a job board Ad
Contact DARI
or
DPEBDANI@GMAIL.COM
858-231-1231
DOCTOR FOR LAKE TAHOE PRACTICE All specialties considered. Excellent compensation and full benefits. No call. No weekends. Start at 3 days per week & will grow if desired. Flexible hours. Incentive bonus plan. Paid relocation expenses to winter & summer paradise. No hospital rounds or meetings. Resume: southshoretahoe@ aol.com / Ms. Forster, PO Box 5910, Stateline, NV 89449
SEEKING BC/BE FAMILY PRACTICE/ INTERNAL MEDICINE
Primary Care center in Hawthorne, CA, since 1985. Guaranteed plus bonus. Buy in opportunity. NP and PA Welcome. CONTACT: Dolly Pham (310) 200-5767, doly2k@aol.com,
www.stpaulmedicalctr.com
530
opportunity wanted
RADIOLOGIST Board certified. Have own malpractice insurance. Available for part-time position or film reading. Call 310-477-4257. FILM READING Carl H. Boatright, MD, DABR, 30 years’ experience, rapid turnaround. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.
cm e / mark e t place / ad i n d e x To place a CME listing, contact Dari Pebdani at dpebdani@gmail .com or 858 -231-1231. 535
opportunity offered
MEDICAL DIRECTOR URGENT CARE Entrepreneurial MD wanted for single location, expanding to multiple locales possible. Supervise clinical and management. Los Angeles area. BC/BE Fam Practice or ER. Email CV to jeff@coraltreecap.com 540 locum tenens available
TRACY ZWEIG ASSOCIATES
• Physicians • Nurse Practitioners • Physician Assistants LOCUM TENENS PERMANENT PLACEMENT 800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com
to place an ad
Contact DARI DPEBDANI@GMAIL.COM
or
858-231-1231
Classified • Job Board CME • Marketplace
610
medical practice for sale
MEDICAL OFFICE FOR SALE In Sunny California, just North of LA, a medical office is available for sale, all ready for the doctor to move in. Current tenant, retiring Board Certified General Surgeon will help with transition. The office is walking distance of main hospital and surrounded by multiple medical offices. May accommodate easily 2 MD’s. Current personnel will stay. It may be sold alone or together with the building it is in. Interested, please call 661942-6565.
CME 12th Annual City of Hope Conference on Women’s Cancers October 25 to 27, 2012 Four Seasons 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. To learn more and to register, visit www.cityofhope.org/ womensconference2012
Advertiser Index Athena Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 BBVA Compass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Cooperative of American Physicians . . . . . . . . . . . . . . C3 The Doctors Company . . . . . . . . . . . . . . . . . . . . . . . . . C4 Fenton Nelson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Eli Lilly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Los Angeles Center for Women’s Health . . . . . . . . . . . 13 Los Angeles County Sheriff’s Department . . . . . . . . . . . 9 Marsh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 NorCal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 McDonald’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 The Telephone Connection . . . . . . . . . . . . . . . . . . . . . . 27
SCP
Marketplace
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YOU
E! R HE d RA
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To place a marketplace ad, contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231 O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 3 1
J ust t h e fac ts | health insurance
1
Number of the uninsured, in California and the US, that have family incomes of $50,000 or more.
California now has the largest number of people without health insurance of any state in the nation.
Percent of adults reporting fair or poor health (age-adjusted.) National benchmark: 10%
9.4% 30%
22%
Number of Californians without health insurance.
6.9 million
#
one third
48,600,000
The number of Americans without Health Insurance
32 s o u t h e r n cal i f o r n i a p h ys i c i a n | O C TO B E R 2 0 1 2
Percent of U.S. children under the age of 18 without health insurance.
Percent of adults in Los Angeles County 18-64 without insurance
We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.
800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo
For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.
Superior Physicians. Superior Protection. O C TO B E R 20 1 2 | w w w. s o cal p h ys i c i a n . n e t 3 3
physician’s office, a malfunctioning thermostat ruined $51,000 in refrigerated vaccine. Make sure you’re covered.
In a Del Mar
For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner. Call (800) 852-8872 today for a quote or a complimentary insurance assessment. n n n n
Medical Malpractice Workers’ Compensation Health and Disability Property and General Liability
License#: 0677182
3465_SoCalPhysician_Jun2012.indd 1
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