September 2013

SEPTEMBER 2013

A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

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R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y

The New Official PublicaTiON Of The lOs aNgeles cOuNT y Medical assOciaTiON

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Volume 144 Issue 09

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 90017. Advertising rates and information sent upon request.

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14 WHaT’S neXT fOR HealTHcaRe iT

Doctors are bombarded with talk of EHR implementation, mobile IT, remote device monitoring and cloud-based computing—but what does all these data and all these new technologies mean and how can they benefit your practice?

dePaRTMeNTs 6 fROnT Office | PRacTice ManageMenTTips, hints, advice and resources

8 Balance | lifeSTyle & WellneSSNews, studies, tips and opportunities to help physicians maintain a balanced lifestyle

10 TRanSiTiOnS | caReeR ManageMenTA look at the questions and challenges associated with various stages of your medical career

12 Pnn | neWS in ReVieWThe latest headlines impacting the economics of healthcare delivery in Southern California

22 UniTed We STand | aT WORK fOR yOULACMA and CMA membership at work for you

fROM yOuR assOciaTiON

4 PReSidenT’S leTTeR | MaRSHall MORgan, Md

27 lacMa neWS | aSSOciaTiOn HaPPeningS

26 ceO’s leTTeR | ROcKy delgadillO

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27 HOWaRd R. KRaUSS aPPOinTed TO

califORnia Medical BOaRd Governor Edmund G. Brown Jr. recently announced the appoint-ment of LACMA Councilor How-ard R. Krauss to the California Medical Board.

SubScriptionSMembers 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.

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Physicians news networklos angeles county Medical association707 Wilshire Boulevard, Suite 3800los angeles, ca 90017Tel 213-683-9900 | fax 213-226-0350www.physiciansnewsnetwork.com

LAcMA officErS Marshall Morgan, MdPedram Salimpour, MdPeter Richman, MdVito imbasciani, MdSamuel i. fink, Md

LAcMA boArD of DirEctorS

david aizuss, MdWilliam averill, Md Boris Bagdasarian, dOerik BergStephanie Booth, MdSteven chen, MdJack chou, MdTroy elander, Md Hector flores, Mdcarlotta freeman, MdSidney gold, Md William Hale, Md david Hopp, Md Paul Kirz, Mdlawrence KneisleyKambiz Kozari, Md Howard Krauss, Md Maria lymberis, Mdcarlos e. Martinez, Md nassim Moradi, Md ashish Parekh, Md Jennifer Phan Heidi Reich, MdPeter Richman, MdSion Roy, MdMichael Sanchez, Md nhat Tran, Mderin Wilkes, Md

the Los Angeles County medi-

cal Association is a profes-

sional association representing

physicians from every medical

specialty and practice setting

as well as medical students,

interns and residents. For more

than 100 years, LACmA has

been at the forefront of cur-

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members are represented in the

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lenges of managing a practice.LACmA’s board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. they always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, executive Assistant, at [email protected] or 213-226-0304.

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4 p h ys i c i a n m aG a Z i n e | september 2013

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On THe day I began writing this month’s Letter, the lead article in the Los Angeles Times featured the Harbor-UCLA Medical Center’s experience with gun-shot wound victims, concentrating on the care of one young man who surely would have died but for the skill of his surgeon, and noting that in the three sum-mer months of last year, the hospital treated 107 gun-shot victims. Today, as I finish this, the Times’ lead ar-ticle details an epidemic of gunshot deaths in Pomona, where there have been 19 murders so far this year; all of those killed died of gunshot wounds.

Firearm-related injury and death is a major unad-dressed public health problem in the United States. There are on av-erage more than 30,000 firearm-related deaths and twice as many nonfa-tal injuries in the United States each year. The cost of medical care for these injuries is enormous, as is the cost of lost productiv-ity and social services for those disabled by them. The abiding psychologi-cal, emotional and social consequences suffered by surviving victims and their families are incalculable.

The sheer number of firearms circulating in our society and, more impor-tant, their ready availability to persons with criminal records and relevant psy-chiatric problems create

an environment in which essentially no one is safe (al-though some are less safe than others). In my own re-cent experience, three incidents have come to strongly illustrate this fact: The son of an attorney I know, an ambitious young man, came home after working a late shift to his apartment in Pomona. Gangsters were ly-ing in wait to kill rivals (which they did) but also shot and killed him. My sister, a physical therapist who does home calls, went to visit a patient in East Oakland and found herself in the line of fire of an attempted assas-sination in broad daylight. Fortunately she was not injured. A few days later, I was called in to the UCLA Emergency Department to help with the victims of the shooter at the Santa Monica College Campus. Two of those persons died of their wounds.

Compared with other high-income developed countries, the failure of the United States to deal ef-fectively with this epidemic is a national disgrace. The

majority of European countries, for example, have firearm-related mortality rates less than 1/10th of ours, and none has rates half as great.

I understand that many responsible people wish to keep firearms for self-defense or for sport, such as hunting. In my opinion, the rights of such persons are not infringed upon by sensible regulations designed to prevent the misuse of firearms and reduce the num-ber of deaths and injuries caused by them. I am proud that established California Medical Association poli-cies support the ability of California cities to regulate commerce in firearms (e.g., gun shows), support a re-quirement for completion of a firearms safety course before purchasing, owning or using firearms, and support a ban on private ownership of semiautomatic weapons with large magazines. CMA lobbyists have taken “support” positions on bills in the Legislature that, when passed, implement these policy positions. CMA policy also holds that physicians, in appropriate circumstances, should educate patients about the risks of guns in the home.

In addition to using “commonsense” measures to address this public health problem, it is also important to employ a scientific public health approach in which studies of the epidemiology of firearms injuries, and trials of interventions based on the results of such stud-ies will be undertaken.

Unfortunately no such studies have been done in the past several years because the United States Con-gress has essentially forbidden federal granting agen-cies to fund them. However, there appears to be, at long last, a change coming. In January 2013, President Obama issued 23 executive orders directing federal agencies to improve knowledge of the causes of fire-arm violence, the interventions that might prevent it, and strategies to minimize its public health burden. In response, the Centers for Disease Control asked the Institute of Medicine and the National Research Coun-cil to develop a research agenda to focus on the public health aspects of firearm-related violence. That report was released on June 5. We can hope that over the next several years research-based, effective interven-tions to reduce firearm-related violence will be discov-ered and implemented.

In the meantime, we physicians will continue to treat victims of gun violence, counsel our patients about the dangers posed by firearms and advise those who own guns to store both guns and ammunition under lock and key, preferably in separate locked re-ceptacles, particularly if there are children in the home, and advocate for commonsense measures to minimize firearm injuries.

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.

This is how Dr. Eubanks got paid for Meaningful Use.

A fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an

effective way to begin earning up to $44,000 in Medicare incentive payments.

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One of the most frequently used and vital tools in most practices that physicians and their office staff need to master is the electronic medical records (emr) system. there are certain facts you should know prior to implementing a system in your medical office.

select a system that works best with your techno-logical talents and limitations.

I activated an existing office emr in 2011, and this was quite painless as the system was set up by the ven-dor and the It support was well-known and responsive to the office. In fact, this vendor was proactive in the medicare incentive programs, including meaning-ful Use, and was interface-ready with other systems. I chose a gradual transition, which allowed minimal interruption to patient flow and billing.

Know the system and any restrictions, and learn a work-around: electing a gradational transition had its pros and cons. this approach allowed the staff at my practice to address and fix “electronic issues” as they

arose, without seriously affecting productivity. but, we also discovered that this emr software and the other vendors that were evaluated had a challenging flaw that we needed to address. We had to master an issue regarding the ability to allow multitasking in real time.

train your office staff to be the best geeks:every office event requires electronic availability.

therefore, training your office staff to contact the emr vendor’s It department to explore the system’s capa-bilities and troubleshoot problems will allow you and your practice to function more efficiently.

educate your office staff to know the cyber risks and how to avoid them:

the benefits of emrs are well publicized, but physicians must also be well informed of the mul-tiple risks and how to avoid them. excellent medi-cal documentation has always been a major part of a physician’s work, but with the advent of emrs come new challenges. A new liability emerges with the in-troduction of emr involving computer inexperience, misunderstood sign-lock functions, metadata that is never lost, and countless other pitfalls all occurring at cyber speed. And, physicians must be hyperaware of protecting patient data against the barrage of unfore-seen events ranging from lost passwords to stolen mo-bile devices, unencrypted laptops, and collaboration with outside entities’ cyber issues. physicians must take the time to educate and inform themselves as well as their staff about these electronic issues that come with the benefits of emrs.

the bottom line is know thyself, thy practice and thy medical office staff when selecting and implement-ing one’s emr. It is a brave new technologically savvy world, but with the right knowledge and determina-tion, your practice will thrive.

Lisa Thomsen, MD, FAAFP, a Cooperative of American Physicians, Inc. (CAP) member since 2003, and CAP board member since 2011.

Implementing EMR in Your Practiceby LisA thOmseN, md

aS a SOlO family physician in California, I have always believed that if you practice good medicine,

the patients will come, and you will be successful in your endeavors. With all the technological

advances in medicine, one must be a stellar physician as well as a bit of a technology geek. Today,

physicians and their staff must learn to embrace and master the technological tools that are essen-

tial to modern medicine and crucial to the survival of their practice.

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surgeons whose domestic partners were physi-cians tended to be younger, newer to practice, were more likely to delay having children and:

• Weremorelikelytobelievethatchildrearinghadslowed their career advancement.

• Were less likely tobelieve that theyhadenoughtime for their personal and family life compared with their colleagues who had non-working or non-physician domestic partners.

• More often experienced a recent career conflictwith their domestic partner and a work/home con-flict than surgeons whose domestic partners either didn’t work outside the home or were employed, but not as physicians.

All relationships take work and commitment—so do medical careers. Ultimately, it’s how individual physicians balance and prioritize their work and life challenges that ultimately dictates their satisfaction with their lives and careers, regardless of whether or not their partners or spouses are also physicians or other healthcare providers.

Healing a Fractured Relationship: PRactical SolutionS FoR PHySicianS

If you’re in a relationship damaged by the demands of your career or your spouse’s or partner’s inability to

accept the demands of your career, chances are you won’t repair it overnight—but you can get the process started today.

stArt tALKIng: Ask for what you need and ask your spouse or partner what he or she needs to make the relationship healthier and happier.

mAKe LIFe bALAnCe A prIOrItY: put improving your relationship on your agenda. Don’t expect it to “happen naturally”—make time for it, and give it the effort and attention it deserves.

ACt AFFeCtIOnAteLY: A good exercise is for you and your spouse or partner to resolve to remember three things you like about each other and find a quick way of showing it each day—a compliment at break-fast, a text message from work, a chocolate from the gift shop to take home.

get HeALtHY: If you’re constantly tired and cranky, chances are it’s not your partner’s fault. take the same advice you give your patients about eating and sleep-ing well, getting daily exercise and reducing stress. support your spouse or partner in their stress manage-ment efforts whenever possible.

sHAre YOUr FrUstrAtIOns: start telling each other about your days. respect your partner’s frustrations and stresses as you would have your spouse respect yours. It’s not a competition to see who had the worst day.

LOWer expeCtAtIOns: the phrase “that doesn’t work for me” is underutilized by medical profession-als. A physician’s spouse or partner has no control over the physician’s agenda, but the physician does. Unless someone’s life is literally on the line, the phy-sician has a right and responsibility to carve out time for self-care and family life.

DIsCOnneCt AnD reCOnneCt: Unless you’re on call, turn off your phone and computer and have at least an hour a day where work can’t reach you and you can either relax alone or in the company of your loved ones.

trY COUpLes COUnseLIng: When resentments have built up over years, it can be very difficult to initi-ate constructive conversations without first establish-ing some ground rules. An objective counselor can make the process less stressful.

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Go from residency to a residenceExplore an exciting home financing opportunity for new doctors

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The Medical Marriageby Liz FerrON, msW, LiCsW, seNiOr CONsuLtANt ANd mANAger OF CLiNiCAL serviCes, physiCiAN WeLLNess serviCes

accORding TO a 2010 survey by the American College of Surgeons, surgeons with other phy-

sicians as their domestic partners experience greater challenges balancing personal and profes-

sional life than surgeons whose domestic partner is working outside medicine or stays at home.

Surgeons with non-working domestic partners tended to be older and appeared most satisfied

with their careers.

Go from residency to a residenceExplore an exciting home financing opportunity for new doctors

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

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1 0 p h ys i c i a n m aG a Z i n e | september 2013


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most practices, with new tech-nologies in place, will reap the results of bet-ter marketing communication, higher efficiencies and more accurate record keeping.

1. Build youR oFFice team

to successfully integrate new technologies into the doctor’s office requires that all staff members fully understand why the technology is being integrated, how the process will unfold, what challenges to expect and what their roles will be.

the experts recommend using a formal problem-solving approach such as a plan Do Check Act to ensure its success.

2. Plan FoR integRating tHe tecHnology

the plan should include collecting baseline data for the measures of success that it has identified, such as how the technology will increase productivity and patient safety.

the American medical Association said it would do so, but the experts recommend that each site should go beyond the research reports and measure its own success in implementation. physicians should also measure patient and customer satisfaction and how electronic health records affect both.

3. PRovide an enviRonment tHat accommodateS tRial and eRRoR For some physicians, especially those who have practiced for a long time and aren’t technology savvy, adapting to the new environment will be challenging. experts foresee that it will take a lot of work and dedication to integrate technologies into a daily routine. by offering doctors room to grow and fostering career opportunities, medical practices can attract and retain loyal, productive and innova-tive physicians.

4. PRovide SuPPoRt SeRviceS and tRaining

physicians should provide training for their staff and provide a comfortable environment where staff members can get used to the new environment, adapt to the workload and work on a preferred schedule.

With two out of three physicians foreseeing that the integration of eHr will be challenging, accord-ing to national statistics, having a game plan will help ease some of the growing pains.

experts expect that in time most practices, with new technologies in place, will reap the results of better marketing communication, higher efficiencies and more accurate record keeping.

THe TecHnOlOgy TaKe-OVeR has begun and physicians are slowly acclimating to the

new rapidly evolving healthcare environment where using electronic health systems, e-pre-

scriptions and their smartphones will become the norm. To help doctors adapt to this new

environment, the experts recommend taking the following key steps.

ADAPTING TO NEW TECHNOLOGIESby mAriON Webb


A SERVICE OF The LOS ANGeLeS COuNTy MediCAL ASSOCiATiONPNN | LOCAL • TIMELY • RELEVANT

RePoRting on tHe economicS oF HealtHcaRe deliveRy

Read Full StoRieS and SuBScRiBe to tHe Pnn enewS BulletinS at www.PHySicianSnewSnetwoRk.com

moSt read Lacma, cma Disagree with capG and aarp; praise Defeat of controversial Bill

On Aug. 6, the California Medical Association, LACMA and other physician groups nationwide won a victory when California lawmakers defeated a bill that sought to increase the scope of practice for nurse practitioners.

Backers of the bill, however, such as the Califor-nia Association of Physician Groups (CAPG), AARP and the California Primary Care Association, are hopeful that the bill will be reconsidered.

La company offers Virtual cmo opportunities The Institute for Medi-cal Leadership, based in LA County, recently launched a nationwide program that places vir-tual chief medical officers into smaller hospitals and

accepts applications from local doctors who are interested in becoming virtual CMOs.

Dr. Susan Reynolds, president and CEO of Pacific Palisades-based Institute for Medical Leadership, a company that specializes in consult-ing services for health providers, said that unlike larger hospitals, smaller ones often don’t have the resources to hire a full-time physician executive.

editor’S Pickcms outlines plans to resolve overpayments for incarcerated Beneficiaries

The Centers for Medicare and Medicaid Ser-vices (CMS) recently outlined in an email to PNN how it plans to address improper recoupment of payments for claims of services provided to incar-cerated beneficiaries. CMS said that the resolution of claims that were filed by doctors who provided medical services to incarcerated beneficiaries will “require a series of complex actions, including the restoration of the original data on the Medicare Enrollment Data Base, the identification of the overpayments that will need to be abated and re-funded, and the creation of claims processing sys-tem utilities to effectuate the necessary changes.”

cma Files amicus Brief on Behalf of centinela physicians

The California Medical Association announced on July 15 it filed an amicus brief in the California Court of Appeal in Centinela Freeman Emergency Medical Association vs. Health Net on behalf of nu-merous healthcare providers that weren’t paid af-ter La Vida Independent Practice Association (IPA) went bankrupt.

‘herculean effort’ moves sGr reform Legislation Forward

The U.S. House Energy and Commerce Com-mittee recently approved legislation to appeal and replace the Medicare Sustainable Growth Rate (SGR) physician payment formula, a move the Cali-fornia Medical Association called a “herculean ef-fort.” The approval is also the first hurdle cleared to achieve locality reform.

“CMA is pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment loyalties,” CMA said in a press release. At the same time, CMA cautions doctors that they still have a long way to go to achieve per-manent reform.

aha summit introduces new perspective

“Constant change is the new norm” was the message from every pre-senter at the American Hospitals Association (AHA) Summit in San Di-ego recently, giving physi-cians an idea of things to

come as the Affordable Care Act rolls out. Donald Crane, CEO of the California Association of Physi-cian Groups (CAPG), who attended the summit, told PNN that he was amazed at the content presented this year. “If you look at the titles of the sessions: ‘In-novations in Managing the Health of Populations,’ ‘Succeeding in the Business of Accountable Care,’ ‘Transition from Volume to Value,’ ‘Physician Co-management’—all are tracks about managed care,” said Crane. “They are all part of the same business model. It is all about managed care.”

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ruling may prompt insurers to Ban arbitration option

The U.S. Supreme Court’s ruling that doc-tors’ payment disputes can be arbitrated as a group for cases in which contracts are silent on

this issue may be welcome news for doctors who want to challenge underpayments by insurers, as PNN reported in a story last month. But some legal experts and health leaders believe the deci-sion could prompt insurers to limit dispute reso-lution options, such as class arbitration, during contract negotiations with physicians.

pharmaceutical content in ehrs will Benefit outcomes, costs

The top official at healthcare company Mito-chon Systems Inc., which recently exited its free electronic health record system business and switched focus to providing pharmaceutical-driven content for EHR vendors, told PNN its aggregated content can help doctors improve outcomes and reduce costs. Chris Riley, presi-dent and CEO of Laguna Niguel-based Mitochon Systems, said the rising numbers of free EHR so-lutions has created pressure on EHR vendors to introduce services doctors can use to run their own practices more efficiently while sharing in-formation with patients, a requirement under meaningful use.

independents eye UcLa’s plans for clinically integrated option

After years of strategic planning to prepare for health reform changes, the University of Cali-fornia, Los Angeles Health System is now in the planning stages of developing a clinically inte-grated provider network option. Dr. Patricia Ka-pur, executive VP of UCLA Health System and CEO of UCLA Faculty Practice Group, said that in-dependent doctors in Los Angeles County have expressed interest in affiliating with UCLA with-out having to give up their own practices, and she expects that such a clinical integration will be happening soon.

La employers saying no to pricey research hospitals and insurance plans

A new study shows that more Los Angeles employers, in an effort to trim costs, are avoiding high-priced academic and research institutions to provide health coverage for their employees.

Read Full StoRieS at PHySicianSnewSnetwoRk.com

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ePGL Medical invents Self-Powered Contact Lenses

Irvine-based epgL medi-cal announced that its en-gineers have invented the world’s first self-powered, self-contained, power source for contact lenses.

“Using cutting-edge technology, epgL has invented a self-perpetuating power source for lenses which does not require exter-nal energy such as rF,” said David markus, phD.

LA County Team is mhealth X Challenge Finalist

A Los Angeles County-based company is among 12 finalists of the nokia sens-ing x Challenge who will be moving on to the final round of a competition focusing on breakthrough mobile health technologies that are poised to change the way doctors practice medicine.

On Aug. 6, a panel of experts announced the names of the finalists including Los Angeles-based Holomic, which creates photonics-based technologies for mobile health applications

iPhone device detects heart Rhythm Problem

special iphone case and app can be used to quickly and cheaply detect heart rhythm problems and pre-vent strokes, according to University of sydney re-search.

the research found the AliveCor Heart monitor for iphone (ieCg) was a high-ly-effective, accurate and cost-effective way to screen patients to identify previously undiagnosed atrial fibril-lation (AF) and hence help prevent strokes.

Read Full Stories and Subscribe to the Pnn enews Bulletins at www.Physiciansnewsnetwork.com/iPnn

RePoRting on tHe tecHnology oF HealtHcaRe deliveRy


These days, doctors are bombarded with talk about EHR implementation, mobile IT, remote device monitoring and cloud-based computing.

But many doctors may be asking themselves what all these data and all these new technologies will mean and how can they benefit their own practices.

The good news is that these technologies will transform the way doctors practice and communicate with patients and other healthcare providers. They are also expected to provide benefits ranging from payers’ incentives and shared savings to helping doctors run a more efficient practice.

Healthcare ITEHRs • mHealth • The Cloud

WHaT’s NExTBy MaRIon WEBB


EHRs By 2015, all doctors are required to use electronic health records (EHRs) or face pen-alties. Health experts have long said that the patient data generated by EHRs used

by insurance companies, researchers and large health systems will provide better managed care for patients, increase efficiencies and cut waste.

How to Make EHRs Work for YouMost providers are still focused on implementing EHRs with some doctors who already have a

system in place, collecting and reporting certain data to meet requirements of the meaningful use incentive program.

In this article you’ll find expert advice on how to use EHRs to identify improvements on the busi-ness side and how you may be able to seize opportunities to participate in new payment models.

To identify what data to use and to analyze it is a three-step process: you want to identify goals, measure accomplishments and change operations, said Bill o’Byrne said in recent published re-ports. o’Byrne is executive director of the new Jersey Health Information Technology Extension Center, the state’s regional center, a frontrunner in helping practices understand patient data.

Identify Goals Identifying goals is critical. “Even small practices need medical records that are readable, acces-

sible and up-to-date,” said Laura Jacobs, executive VP of the Camden Group, a Los angeles-based healthcare consulting group.

EHRs can help doctors track whether patients have received preventive care or need it, identify patients who are at risk for diseases, and identify which patients need to come in for follow-up visits.

as physicians start to manage their practices in a data-driven world, preventive care and chronic care management are good places to start, the experts said.

“The first use of EHRs is the ability to do some population health management using registry of patients where doctors can reach out to patients and provide care and use the data to help pa-tients,” said Sajid ahmed, Chief Information and Innovation officer at Martin Luther King Jr. Hospital. “now you know how many patients need a flu shot or a mammogram and so forth.”

To get this process started, o’Byrne advised creating a full practice profile. The profile could include lists of patients with certain chronic conditions and a count of how

many patients are being treated for the condition or need intervention and lists of patients within certain age and gender demographics to see how many of them have received preventive services.

When the profile is done, doctors and their staff can hone in on specific diseases or patient populations and try to identify measurements that need improvement.

Physicians can also use the meaningful use program as a guide. While Stage 2 of the meaning-ful use program has 64 measures that physicians can track, the experts advise focusing on specific ones to create a baseline report as a starting point, and then set goals with specific targets.

one example would be to track diabetics who are struggling to keep a1c levels under control. If reducing a1c levels becomes a goal, then the practice may decide what percentage of patients they target and in what time frame they hope to achieve that goal.

Measure AccomplishmentsBefore EHRs, measuring progress was limited to data collected through claims data, the expert

noted. With EHRs doctors can get a snapshot of specific dates and times.Most experts believe that it will take doctors some time to learn how to analyze data and mea-

sure success. By creating checkpoints, they can see successes along the way.For instance, if a practice wants to increase the number of colorectal cancer screenings, they

could use the EHR to identify patients based on age who should have a colorectal cancer screening done but have not yet come into the office.

The office could then send a postcard to remind patients to get their screening done. Having data of patients who came in and actually had a polyps removed isn’t only potentially life-saving for patients, but could also translate into financial rewards for doctors from payers.

Much of the data can be used to measure not only productivity and rate of follow-up care, but also waste and redundant care, which will be key for doctors planning to participate in shared-savings models.

Change OperationsCertainly, uncovering the data and acting upon it is likely to change the way doctors are running

their daily practices. Some doctors already use EHR data to re-create the way they handle appointments. one option is to use a problem data list to assign a level of acuity to each patient with level 1

being assigned to healthy patients, who come in for general appointments, and thus, would rank low on the priority list of same-day appointments; level 2 patients could be those with chronic illnesses who are given priority when they call in with symptoms and complaints; and level 3 would be patients with severe illnesses who need the most attention.

The data could also be used to identify business opportunities or ad-ditional services, such as the need to hire a dietician. It can also lead physicians toward participation in aCos, o’Byrne said, adding that he notices that practices are discovering new ways to use data every day.

Challengesahmed, however, noted that many answers remain unclear.“I believe we won’t have real data until we enter into Stage 3

of the meaningful use requirement,” he said.Return of investment is also unclear. according to a recent

survey using data from 49 community practices in a large EHR pilot (the Massachusetts eHealth Collaborative) to project five-year returns on investment, the average physician would lose $43,743 over five years with 27% of practices achieving a posi-tive return on investment and 14% coming out ahead had they received $44,000 in federal meaningful-use incentives.

•MountainView,Calif.-based drchrono scored highest for iPad EHR apps (as determined bymorethan1,400practices nationwide)•MediTouchHealthFusion•Care360byQuest•MacPractice•GreenwayPrimeMobile•NextGenMobile•PracticeFusion•CernerPhysicianEx-press

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THE EHR mobiLE app vENdoRs RaTEd

HigHEsT iN CusTomER saTisfaCTioN:


mHealth With the implementation of EHRs, researchers predict that integrated mo-bile applications will also see tremendous demand by doctors, especially

smartphone users. Global market revenue for mobile health technology is predicted to reach $26 billion by 2017, according to a report from Berlin-based market research firm research2guidance.

according to the report, published March 8, the market for mobile health tools is growing in three phases: the initial trial phase, a commercialization phase (which is the current phase) and integration phase.

Many tools are already commercialized with 15% of mHealth applications on the market be-ing intended for use by healthcare professionals, including continuing medical education, remote monitoring and healthcare management applications, according to the report.

another survey published in May by the research firm Black Book Ratings also found that while 89% of primary care and internal medicine doctors currently use their smartphones to communicate with staff and 51% of clinicians use tablets to perform independent medical references and online research, less than 1% estimate they are maximizing their mobile clinical and business applications.

one of the big challenges remaining for vendors is how to better integrate mHealth applica-tions into EHRs.

The majority (95%) of doctors who used mHealth apps complained that the iPhone/android screen size was too small; 88% had trouble with the ease of movement within the chart; 83% said they were concerned about replicating their EHR system on a mobile device, preferring simplified versions; and 77% didn’t like the non-optimized touch screens.

“The vast majority of all survey respondents favored mobile applications that focus on the pa-tient data and core parts of medical practice most needed when a physician is away from the office setting,” said Doug Brown, managing partner of Black Box Research, in a company statement.

Doctors said they preferred EHR mobile apps that allowed for remotely reviewing and updating charts, assigning tasks and viewing scheduling and appointments, enabled them to send messages to their staff and the lab allowed for, eprescribing, patient encounter documentation and inputting of vital signs.

The Cloud While client-servers continue to dominate the market—in 2011, 55% of office-based physicians were using EHRs and 59% were using them

as stand-alone systems according to a July 2012 report from the Centers for Disease Control and Prevention—health experts predict that cloud-based products will also soon become more com-monplace in doctors’ offices.

“The big trend for this year is the cloud,” said Mary Pat Whaley, owner of Manage MyPractice, a healthcare consulting firm, in recent news reports. “That’s a real game changer, either for physicians going into practice or small practices getting ready to add an EHR.”

a recent study by the firm MarketsandMarkets also indicated that the healthcare cloud comput-ing market—currently only 4% of the industry—is expected to grow to nearly $5.4 billion by 2017.

While privacy concerns have kept some doctors from migrating to the cloud, some health ex-perts note that the cloud offers several major benefits, including:


• Security:Withonlinemedicalrecordsstoragebeingthemainreasonforusingcloudcomputing,doctors should know that cloud service providers are now as liable for HIPPa compliance as the healthcare entities they serve. all data must be encrypted, securely backed up, easily recovered and use permission-based data access.

• Scalability:Healthcareserviceprovidersgenerallymustkeeprecordsforatleastsixyears.Con-sidering the volume of patient data, cloud server or storage solutions are able to adapt to EHR load quickly and store terabytes of your patients’ data in secure, redundant cloud storage.

• Mobility:Withcloudsolutionsbeingreadilyavailable,doctorscanreviewmedicalrecords,testsor do research anywhere, anytime.

• Cost:Smallpracticesoftendon’thavethefinancialmeanstoinvestinon-sitehardwareinfra-structure and maintenance to securely store patient information. The cloud often makes a more sophisticated tool available to doctors who otherwise may not be able to afford it, noted Jacobs.

• Doctorswhousethecloudcansubmitprescriptionsandrefillselectronicallytopharmaciesandincrease the accuracy of reimbursement coding. according to a report in Healthcare Financial Management, saving benefits of EHRs can amount to upwards of $37 million over a five-year period.

• Sharing: Cloud computing solutions keepphysicians connectedwith patients and their col-leagues, including specialists who can access patient history from the referrals online and thus, avoid repeat diagnostic testing.

PrecautionsHowever, before jumping onto the cloud bandwagon, experts said, doctors should evaluate their

purchasing decisions closely, evaluating cost, functionality, convenience, security and applications. In addition, with cloud computing and infrastructure security continually evolving to meet

growing security requirements, legitimate cloud service providers have strict security protocols de-signed to comply with different regulatory mandates, including SEC, the Sarbanes-oxley act and HIPaa, according to Forbes magazine.

Under HIPPa, (Health Insurance Portability and accountability act), and the american Recovery and Reinvestment act, everyone in the healthcare industry is required to migrate patient records and other data to cloud computing.

Still, the experts advise that doctors should verify that their chosen cloud service provider is HIPaa compliant before signing up with the service.

Whether you’ve already implemented an EHR system or are in the process of evaluating systems, the experts said, one thing is for sure: the technology revolution is coming.

“The challenge and opportunity will be to take the data and with the help of analytics turn it into something actionable that doesn’t just describe a particular situation, but also provides infor-mation that can predict outcomes and trends,” noted Dr. Henry Johnson, VP and medical director of Midas + Solutions based in Tucson, ariz. in an recent article.


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HealtHcaRe ReFoRm:tHe BaSicS FoR individualS

beginning January 1, 2014, new regulations pro-vide most Americans access to affordable health in-surance that covers essential care. the regulations that facilitate this include:

• InDIvIDUAL mAnDAte – most individuals are required to have and maintain health insurance effective January 1, 2014. there are exceptions for certain individuals.

• penALtY – If you elect not to purchase coverage, you are required to pay a penalty:

o in 2014: the greater of $95/individual (3 per family), or 1% of income

o In 2015: the greater of $325/individual (3 per family), or 2% of income

o In 2016: the greater of $695/individual (3 per family), or 2.5% of income

• gUArAnteeD IssUe – Insurance companies must sell coverage to everyone, regardless of pre-existing conditions, and can’t charge more based on health or gender.

• HeALtH InsUrAnCe exCHAnge – Individuals without access to affordable, employer-sponsored plans that provide qualifying coverage can enroll in plans offered either through the individual in-surance market or through Covered California, the state-based exchange, with coverage beginning January 1, 2014. Open enrollment for Covered California commences on October 1, 2013. If in-dividuals don’t enroll with the exchange during the initial open-enrollment period, they will have to wait until next year’s open-enrollment period to obtain coverage.

• sUbsIDIes – Individuals and families may qualify for federal tax credits and benefit subsidies only through Covered California. tax credits are avail-able to those who meet certain income require-ments and do not have access to affordable health insurance that meets minimum coverage stan-dards offered through their employer or another government program.

eligibility for tax credits is based on family income and size. Individuals and families who make be-tween 138% and 400% of the federal poverty lev-el (FpL) may be subsidy eligible. benefit subsidies will also be available to provide assistance with co-pays and out-of-pocket amounts for individu-als who earn less than 250% of the FpL.

• premIUms – premiums can only vary by age,

THE AFFORDABLE CARE ACT: What You Need to Know by rOy s. LyONs, mANAgiNg direCtOr, mArsh

THeRe iS nO doubt that the ACA is the most transformational change in health insurance since

medicare. it’s survived a supreme Court challenge, presidential election and continuing congressio-

nal attempts at repeal, modification or defunding (40 attempts at last count). One thing is for certain:

while there may be delays in implementing certain parts of the law, it is not going away. you’ll need to

know the basics to evaluate how it influences your medical insurance buying decisions. The following

will help with your decision making-process that lies ahead.

september 2013 | w w w. p h ys i c i a n s n e w s n e t wo r k .com 2 1

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geography, and family composition in California. they may not vary by gender or health conditions.

• Annualorlifetimelimits:Notpermittedonessen-tial benefits.

• Out-of-pocketexpenses:Limitsout-of-pocketex-penses for co-pays, co-insurance, deductibles, etc., to $6,350 per individual to a maximum of $12,700/family annually.

oPtionS FoR coveRage the impact on individuals depends on a variety

of factors.

• nO COverAge In pLACe: Individuals must pur-chase and maintain qualifying health coverage or instead pay a penalty. If their income is between 138% – 400% of the federal poverty level and they have no other coverage available to them that is affordable and qualifying, they could be eligible for a tax credit in the exchange. In 2013, the range is between $15,860 – $45,960 for indi-viduals and for a family of four between $32,500 and $94,200.

Individual plans in and out of the ex-change will provide guaranteed issue coverage and include essential benefits and plan designs that meet the four metal levels: platinum, gold, silver and bronze. A silver plan is meant to cover 70% of an average person’s expenses with the insured expected to pay 30% for deductibles, co-pays, co-insurance, etc.

• exIstIng COverAge: If you currently have an individual policy in force, one of two things can occur.

o If the plan was in place prior to the ACA signing on march 23, 2010, and has not undergone any significant change since, it may be continued.

o If an individual’s plan is not grandfa-thered, and the plan of benefits does not meet one of the tiered metal levels, the benefits will be modified. this will likely have an impact on plan premiums as well.

Individuals trapped in old, high-priced plans due to health conditions are now

eligible to move to a new plan at possibly lower costs without having to be concerned about un-derwriting considerations. the individual should look very carefully at the provider networks avail-able under each plan to ensure they are still able to seek care from their personal physician and hospital.

leaRn moReLet marsh be your partner on this new adven-

ture. For more healthcare reform communications, including information on marsh’s private healthcare exchange for members, please call marsh at 800-842-3761 or go to www.marshhealthoptions.com.

marsh and the association do not provide tax or legal advice. please consult with your own advisors to determine how the law’s changes and your deci-sions impact your personal situation.

d/b/a in CA Seabury & Smith Insurance Program Management • CA Ins. Lic. #0633005 • AR Ins. Lic. #245544 1-340 (8/13) ©Seabury & Smith, Inc. 2013 • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • [email protected] • www.CountyCMAMemberInsurance


Although every ef-fort has been made to

minimize the burden to practices and to ensure

that physicians con-tinue to receive their

medicare payments in a timely fashion after transition, physician

practices will have to make some changes in

their processes

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1. electronic claim submitters must change the Contractor ID (payor ID) on their transmis-sions. the new ID for northern California jurisdiction is 01112, and for the southern California jurisdiction it is 01182. please note, the change to the Contractor ID should not be made before september 12 for part b claims.

2. paper claim submitters will submit claims to a new address. these will be announced in upcoming articles and in CmA medicare transition guide.

3. there will be a new toll-free telephone number, (855) 609-9960, for all telephone inqui-ries to noridian (this number will not be activated until september 16, 2013).

practices are encouraged to review the resources available regarding the transition:

• CmA’s meDICAre trAnsItIOn WebpAge – CmA has created a dedicated medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the abil-ity to access updates and important information regarding the transition in one easy-to-access location. All resources related to the medicare transition will be accessible through this page.

• CmA’s meDICAre trAnsItIOn gUIDe: WHAt pHYsICIAns neeD tO KnOW – this guide, which members can download free from the CmA website, includes an FAQ that contains information on the transition dates, what will remain the same with the transi-tion and what will change, noridian’s online provider portal, what practices can do to prepare for the transition, and links to additional resources and ways to stay apprised of new information on the transition.

• nOrIDIAn’s trAnsItIOn WebsIte: the noridian transition website includes informa-tion on what’s new/changing and what will remain the same during and after the transition.

• CmA prACtICe resOUrCes – CmA practice resources (Cpr) is a free monthly newslet-ter from CmA’s practice management experts that focuses on critical payor and healthcare industry issues, including the medicare transition, and how these issues directly impact the business of a physician practice. to sign up, visit the CmA website or contact CmA member services at (800) 786-4262 or [email protected].

• COntent ALert UpDAtes – the CmA website allows registered users to create custom content alerts on the topics that are of interest to you. Once signed up, you will be notified anytime there is new content posted in one of your interested areas, including medicare issues. to sign up, users should visit their account dashboard on the CmA website and click on “my alerts,” then under “new Content Alerts,” click on the “Alert settings” tab, and select “Insurance reimbursement -> medicare.”

The Medicare TransitionCmA stAFF

IMPORTANT REMINDER

SePTeMBeR 16, 2013, is the cutover date for transition of the medicare part b fee-for-service contrac-

tor from palmetto gbA to Noridian. Although every effort has been made to minimize the burden

to practices and to ensure that physicians continue to receive their medicare payments in a timely

fashion after transition, physician practices will have to make some changes in their processes, includ-

ing but not limited to:


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How you present appeals to your carrier can make a difference between suc-cess and failure. Here are the top five tips to achieve success.

5. Be PRePaRed Anyone speaking with the carrier regarding an appeal – whether coder, biller, office manager or physician – should have the knowl-edge and specific information necessary to discuss that appeal in full. The caller should be able to review the operative note with the payer, to explain the rationale for the coding/billing and to demonstrate why the claim should have been treated differently.

4. wRite a PRoPeR aPPeal letteR Don’t just send an explanation of benefits (EOB) with a balance bill. The payer shouldn’t have to guess the problem. In-stead, you should spell out for the payer exactly what you wish them to review (such as fees, coding denials, etc.). You’ll have to spend a few extra minutes to put your request in writing, but it can make a big difference.

3. coRRect tHe claim BeFoRe you aPPeal If the original claim was incor-rect, appealing with the same claim will not change your results. Double-check the claim’s EOB, CPT® coding, diagnoses and documentation to be sure it is correct. Be absolutely certain you are applying modifiers appropriately. Add-ing modifiers (e.g., modifier 59 Distinct procedural service) to a claim does not guarantee payment, and may lead to accusations of fraud or abuse.When you’ve finished reviewing the claim, make the necessary changes and/or documentation addenda before resubmitting.

2. code only wHat documentation SuPPoRtS If you are billing a sur-gery, review the body of the operative note to be sure that all the procedures reported actually were performed. A common mistake is to code from the “list of procedures performed” at the beginning of the operative note. As payers and auditors know, these lists often do not accurately reflect what occurred in the operating room. A careful reading of the operative note might even reveal separately reportable procedures that would have been missed if relying only on the note summary.Similarly, coders shouldn’t rely on a physician’s recommended coding, but should instead review the documentation to be sure they are reporting the correct codes. If necessary, the physician should be prepared to amend the record to better reflect the nature of the service and/or the patient’s condition.

1. avoid oBviouS miStakeS Payers will tell you (and audits confirm) that a staggering number of denials are the result of obvious errors, such as missed timely filing deadlines; illegible claims; claims not properly filled out (e.g., in-correct patient identifier info); failure to obtain pre-authorization; and wrong, insufficient or non-existent documentation. These errors can be avoided easily by double-checking claims prior to submission. It’s worth the time: You’ll re-ceive payment quicker, and the payer does not have to process a denial EOB for an avoidable error. It’s a win/win.

For more coding tips, visit CMA’s resource library at www.cmanet.org/re-source-library and search “Coding Corner.”

“Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of healthcare.

The cOdiNg cORNeR:

The Top five essential Tips for successful appeals

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aeTna UnaBle TO lOcaTe cOnTRacTS fOR SOMe SOcal PROVideRS

CmA has learned that over the next year, Aet-na will be reaching out to 1,200 southern Cali-fornia physicians requesting verification of their executed ppO contracts. Aetna indicates that while its records show that these physicians are participating providers, the plan has been unable to locate a written contract. As a result, Aetna will be making initial outreach by phone to approxi-mately 100 physicians each month to request that physicians provide copies of their contracts with Aetna.

If a physician is unable to provide a copy of the contract, Aetna will mail a follow-up notifica-tion letter and current 2013 contract to the phy-sician. physicians will have 30 days to consider whether they wish to sign the new agreement.

physicians who choose to sign the new agree-ment should be aware that the contract includes participation in the Aetna ppO and medicare Advantage products. Aetna has advised that phy-sicians who wish to opt out of the medicare Ad-vantage product have the ability to do so.

For those physicians who choose not to sign the new agreement, the notice will serve as a 90-day notice of termination from the Aetna net-work.

physicians with questions are urged to con-tact Aetna network management at (818) 932-6270 or [email protected] for assistance.

anTHeM BlUe cROSS nOTifieS neaRly 1,000 PRacTiceS Of inTenT TO TeRMinaTe Medi-caRe adVanTage PPO cOnTRacTS

On July 25, Anthem Blue Cross notified 973 practices advising of its intent to terminate the prac-tices’ Medicare Advantage PPO contract.

According to the notice, Blue Cross has decided to narrow this network of providers and is exercising its right to terminate the agreement without cause, per the terms of the contract.

Two different notices were issued to practices. The first went to 881 practices who, according to Blue Cross, had a low volume of claims billed to Blue Cross. The other went to 92 practices who, Blue Cross reports, had a higher cost of care relative to other network providers.

The termination becomes effective on January 31, 2014. Physicians whose contracts are terminated can, however, continue to see Blue Cross Medicare Advantage patients on an out-of-network basis and be reimbursed by Blue Cross at Medicare rates. Phy-sicians are reminded that out-of-network services typically result in higher out-of-pocket costs for pa-tients. Practices are encouraged to discuss their net-work status with patients in advance.

Practices who wish to appeal the termination may do so by sending written notice and support-ing documentation to:

Anthem Blue Cross, P.O. Box 292187, Nashville, TN 37229.

Questions can be directed to Blue Cross Net-work Relations at (855) 238-0095 or [email protected].

In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimburse-ment policies and claims editing software called ClaimsX-ten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a differ-ence in how certain codes and code pairs are adjudicated.

Along with the notice, Anthem provided a comprehen-sive grid outlining all new, revised and existing reimburse-ment policies and claims editing rules as well as copies of Anthem’s reimbursement policies.

Changes include: denial of 3D rendering CPT codes 76376 and 76377; assistant surgeon and co-surgeon codes eligible for payment; qualitative drug screen codes eligible for payment; frequency edits on certain codes; denials on invalid match of diagnosis and procedure code; several

changes pertaining to durable medical equipment frequen-cy and rental; and denials of attended sleep studies billed with place of service of 21 (home), among others.

Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies and reimbursement rates to understand how the changes will affect their individual practices.

Physicians can also access the information in the mailer via the Blue Cross website. (Select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section.)

Questions about any of the claims editing rules or pay-ment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.

anTHeM BlUe cROSS annOUnceS cHangeS TO ReiMBURSeMenT POlicieS and claiMS SOfTWaRe

PAYeR UPDATeS

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PAYeR UPDATeS

BlUe SHield: Blue Shield announced updates to its drug formulary effective June 20, 2013, to include the addition of Brilinta, Effient and Lialda. Being removed is Asacol HD. For more information visit the Blue Shield website. Blue Shield also announced changes to some medication coverage policies for office-based drugs cov-ered in the medical benefit. Changes are effective June 20, 2013, and include policy changes to Avastin, Cimzia, Humira and Rituxan, among others.

UniTed: United Healthcare Military & Veterans (UMVS) will be hosting a series of educational webcasts about TRICARE topics for the provider community through the month of October. Each webcast will include an in-troduction to TRICARE as well as information regarding referrals and authorizations, claims, provider resources and important contact information. Each session will last approximately 90 minutes. Practices wishing to register should visit www.unitedhealthcareonline.com or contact their United Healthcare Physician Advocate.

anTHeM BlUe cROSS: Blue Cross has announced that effective October 1, 2013, the following clinical guide-lines and medical policies will require prior authorization/precertification review for the following services:• MicroprocessorControlledLowerLimbProsthesis(NewcodeaddedtotheexistingMedicalPolicy–L5859)

• WheeledMobilityDevicesWheelchairs-PoweredMotorized,WithorWithoutPowerSeatingSystemsandpower Operated vehicles (pOvs) (new code added to the existing Clinical guideline – K0013)

For more information, see the July 2013 professional network Update on the blue Cross website at www.anthem.com/ca.

Physicians have different needs, that’s why we’re offering special mortgage financing.Our special home financing program is designed specifically to meet your needs as a busy physician for the purchase of your primary residence or refinancing your existing home.

• Financing available with low 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.• 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 how you can take advantage of this special home financing program from BBVA Compass, give us a call today.

Alex BergerMortgage Banking OfficerNMLS# [email protected]://www.bbvacompass.com/mortgages/aberger

All loans subject to approval, including credit approval. Elligible 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.

1-800-COMPASS • bbvacompass.combanking built for you.®

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WiTH THe iMPleMenTaTiOn of the Affordable Care Act getting closer, LACMA will keep a very close eye on new developments and continue to fight for doctors’ and patients’ rights.

The implementation of the hastily and ill-conceived Cal MediConnect Demonstration Proj-ect in Los Angeles County raises fundamental concerns.

LACMA and its new partner, the Los Angeles County Podiatric Medical Society, recently cre-ated a task force dedicated to persuading federal and health officials to cancel the ill-founded

pilot program. In a recent letter to Ms. Jane Ogle, the Deputy Director of Health Care Delivery

Systems at the Department of Health Care Services, we outlined the most pressing issues below.

Nine months is simply not enough time to implement a pilot program compris-ing 200,000 patients in one county. We also proposed downsizing the project to a specific zip code in Los Angeles County, and monitoring and assessing the results, rather than trying to encompass the entire LA County of 4,084 square miles.

We also noted a quality issue. To date, there exists no proof that either LA Care or HealthNet—which have been chosen to manage the two private health plans for dual eligible enrollees—has the necessary expertise, staff and financial resources to properly provide an education campaign.

We have asked for a response to these concerns, which we will share with LAC-MA members as soon as they become available.

Next month will be critical as it marks the initial open-enrollment period for the new exchanges.

While it’s too soon to predict how its design will impact doctors and medical care, many doctors are anticipating more crowded waiting rooms.

Doctors in Los Angeles County are nervous for good reason. With an expected 500,000 to 700,000 newly insured in Los Angeles County and

the longstanding physician shortage, this is a sure recipe for difficult times ahead. The exchange implementation is also uncertain. We believe that more resources are needed to promote community outreach and to better

communicate to our physician providers and patients how the exchange implementation will affect them.

Finally, LACMA will continue its fight to preserve MICRA. As California’s trial lawyers are working on gathering the required 500,000 signatures to

place the measure to repeal MICRA before voters in November 2014, we will continue our ef-forts to defeat them by uniting physicians across the state.

Summer may be coming to an end, but for LACMA doctors, many critical issues will be heating up. We will be sure to follow all developments closely and keep members informed.

Rocky Delgadillo

Rocky DelgadilloChief Executive Officer


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Loans for:

Call me now to discuss your needs!

(310) 963-0749Mark Magna | [email protected]

• Office Remodels• Practice Acquisition• Partner Buyout• Purchase of Existing Practice• Office Expansion

Business & Medical Practice Loans

Governor Edmund G. Brown Jr. has announced the appoint-ment of LACMA board member Howard R. Krauss, MD, to the California Medical Board. Krauss has been director of neu-rosurgical ophthalmology at Saint John’s Brain Tumor Cen-ter since 2007, director of ophthalmology for Pacific Eye and Ear since 2002 and an ophthalmologist in private practice and clinical professor of ophthalmology and neurosurgery at the University of California, Los Angeles David Geffen School of Medicine, since 1984. He was an assistant professor at the Uni-versity of Texas from 1982 to 1984 and a systems engineer at Hughes Aircraft Company from 1972 to 1974. Krauss is an American Board of Ophthalmology diplomat and founding member of the North American Skull Base Society. He earned a Doctor of Medicine degree from New York Medical College and a Master of Science degree in aeronautics and astronautics from the Massachusetts Institute of Technology. This position requires Senate confirmation. Congratulations, Dr. Krauss!

LACMA’s Howard Krauss, MD, Appointed to California Medical Board


LACMA NOW GUARANTEES SAVINGS Preferred Partner Program

The Preferred Partner program marks LACMA’s first-ever initiative designed to provide exclusive discounts on products and services that physicians in private practice rely on to run a successful and

sustainable business.

Insurance Services As the world leader in delivering risk and insurance services and solutions to its clients, Marsh designs, develops, and implements insurance plans available only to members – with discounted pricing, enhanced coverage or both. Marsh assists members and their office managers by providing information, programs, and guidance to assist with insurance buying decisions.

Secure Texting for Healthcare TigerText is the leader in secure real-time messaging for healthcare. TigerText allows healthcare providers to create a private and secure mobile messaging network with their own smartphone. This controlled platform is HIPAA compliant and replaces the unsecured SMS text message that leaves protected health information and other confidential data at risk.

Members receive a free subscription to the TigerText application on their mobile device.

Clinic Supply Program Medline manufactures and distributes more than 350,000 medical and surgical products to health care institutions and retail markets. Medline’s market advantage ranks #1 across healthcare categories, including exam gloves, OR kits, and textiles.

Members are guaranteed a minimum savings of 10%, and up to 47% on clinical supplies.

Shipping UPS is the world's largest package delivery company and a leading global provider of specialized transportation and logistics services.

Members can save up to 37% on shipping through UPS.

Prescription Savings For Patients GoodRx works to save your patients up to 80% on their prescriptions. Every time your patient uses GoodRx, they donate a portion of the revenue to LACMA’s Medical School scholarships & loan debt relief program to increase the number of physicians serving patients in Los Angeles.

The Preferred Partner Program consists of carefully vetted, industry leading vendors who share LACMA’s goal to advocate quality health care for all patients and serve the professional needs of its members.

TO ACCESS THESE SERVICES, PLEASE VISIT WWW.LACMANET.ORG



























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MICRA PROTECTIONmicra SaVeS La coUNtY PHYSiciaNS aN aVeraGe oF

$87,000 aNNUaLLY Trial Lawyers have begun their assault on MICRA, a statute enacted by the California Legislature in 1975 intended to lower medical mal-practice liability insurance premiums for healthcare providers by de-creasing their potential tort liability. If they are successful, malpractice insurance rates will quadruple.

your membership ensures our victory against the self-serving trial lawyers trying to generate more in legal fees.

PRACTICE MANAGEMENT SERVICESLacma aNd cma StaFF memBerS HeLPed memBer PHYSiciaNS

recoUP oVer $7 miLLioN iN UNPaid/UNderPaid cLaimS SiNce 2010How much could you be saving? Receive access to free Reimburse-ment Assistance, Jury Duty Assistance, Medical-Legal Resources, and E.H.R./H.I.T. support for your practice.

SAVINGS AND DISCOUNTSreaLiZe $1,000s iN SaViNGS WitH

Lacma’S NeW PreFerred PartNer ProGramOffering you a guaranteed 10% and up to 30% to 40% savings on key purchases from surgical gloves and medical supplies to insurance and prescriptions.

IN 2013, LACMA ALSO- Challenged the State’s Dual Eligible Demonstration

Project and was victorious in delaying its implementation

- Filed major lawsuits against Aetna and Healthnet for abusive business practices against physicians and patients

- Launched its first-ever dedicated resource center for solo and small group practice physicians and surgery centers

OUR WORK IS NOT DONE.Only through your continued support will LACMA and CMA

be able to serve members first and foremost through our ad-vocacy efforts and services that will help

serve patients and improve your bottom line.


to pLace a cLassiFieD aD Visit www.physiciansnewsnetwork.com Or COntACt DArI pebDAnI At [email protected] Or 858-231-1231.

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LEGAL REPRESENTATIONFOR PHYSICIANS

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CITY Of HOPE’S 6TH ANNUAL HOW THE ExPERTS TREAT HEMATOLOGIC MALIGNANCIES

September 18 to 20, 2013Casa 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 immunologically-based systemic therapies and clinical trials, will be pro-filed and discussed.

To learn more and to register, visit www.cityofhope.org/hematologicconference2013

to pLace a cLassiFieD aD Visit www.physiciansnewsnetwork.com Or COntACt DArI pebDAnI At [email protected] Or 858-231-1231.

cMe

CITY Of HOPE’S 13TH ANNUAL WOMEN’S CANCER CONfERENCE: PROGRESS IN WOMEN’S CANCERS

fROM TREATMENT TO SURVIVORSHIPNovember 8 to 10, 2013

The Venetian/Palazzo Resort Hotel, Las Vegas, NVREGISTER 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 mak-ing to help improve patient outcomes.

To learn more and to register, visitwww.cityofhope.org/womensconference2013

PM Marketplace

• Full or part-time positions• Competitive Pay• Add revenue to your

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PLeASe CONTACT uS FOR MORe iNFORMATiON:Phone: 1-877-878-3289 Fax: 1-877-817-3227

or email CV to: [email protected] www.AdvantageWoundCare.org

Surgeons Needed for Expanding NationwideSurgical Practice

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

SUBSCRIBE TODAYwww.PhysiciansNewsNetwork.com

PhysiciaNs News Network iNtroduces

REpORTIng On ThE TEChnOlOgY Of hEAlThCARE DElIvERY


24% of surveyed patients say they would be happi-er receiving prescriptions for an mHealth applica-tion rather than a pill.

$5.4

the overall cloud computing market in healthcare will grow to $5.4 Bil-lion by 2017

it is projected that only 27% of practices will achieve a positive return on their eHR investment over 5 years

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the largest difference be-tween practices with a posi-tive return on their eHR in-vestment and those with a negative return was the ex-tent to which they used their eHRs to increase revenue, primarily by seeing more patients per day or by im-proved billing that resulted in fewer rejected claims and more accurate coding.

90% of patients were willing to accept a prescription for an mHealth app, compared to the 66% of patients who wanted a traditional doctor’s order for their respective medications.

eHRs

mHealth

80% of doctors use mobile de-vices; 40-50% are using tablets

80%many tools are already commercialized with 15% of mHealth applications on the market being intended for use by healthcare pro-fessionals, including con-tinuing medical education, remote monitoring and healthcare management applications.

By The NumBers

sure you’re prepared.

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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.

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Call (800) 852-8872 today for a quote or a complimentary insurance assessment.

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*Source: Health Information Privacy/Security Alert

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September 2013

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