April 2014

APRIL 2014

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T h e O f f i c i a l P u b l i c a T i O n O f T h e l O s a n g e l e s c O u n T y M e d i c a l a s s O c i a T i O n

A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

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

RISK TIP: Don’t Be Defective in Dealing with Device Alerts and Recalls

DATA PRIVACY AND THE

LAW

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APRIL 2014 | w w w. p h ys i c i a n s n e w s n e t wo r k .com 1

Volume 145 Issue 4

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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10 daTa pRiVacY and The law

If your medical practice has not up-dated your data compliance forms, it is time to engage in data protec-tion compliance efforts. However, HIPAA is not the sole concern. There is a growing pool of regula-tions connected to data privacy.

dePaRTMenTs 6 fROnT Office | pRacTice ManageMenTTips, hints, advice and resources

8 pnn | newS in ReViewThe latest headlines impacting the economics of healthcare delivery in Southern California

16 UniTed we STand | aT wORK fOR YOULACMA and CMA membership at work for you

fROM yOuR assOciaTiOn

4 pReSidenT’S leTTeR | MaRShall MORgan, Md

14 ceO’s leTTeR | ROcKY delgadillO

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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

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david aizuss, Mdwilliam averill, Md Boris Bagdasarian, dOerik BergStephanie Booth, MdSteven chen, MdJack chou, MdTroy elander, Md hector flores, Mdc. freeman, MdSidney gold, Md william hale, Md david hopp, Md fred ziel, Mdlawrence KneisleyKambiz Kosari, 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, MdSion Roy, 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-

rent medicine, ensuring that its

members are represented in the

areas of public policy, govern-

ment relations and community

relations. Through its advocacy

efforts in both Los Angeles

County and with the statewide

California Medical Association,

your physician leaders and staff

strive toward a common goal–

that you might spend more time

treating your patients and less

time worrying about the chal-

lenges of managing a practice.

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at [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 | APRIL 2014

fOR neaRlY 30 years, the Medical Board of California operated a Physician Diversion Pro-gram to protect patients while physicians suffer-ing from drug and alcohol misuse were undergo-ing monitored rehabilitation.

In 2008, the Board discontinued the Diver-sion Program and abandoned all efforts at re-

habilitation. It now attempts to protect the public only by punitive actions against the licenses of physicians. This change positioned California as one of only a few states without access to an inte-grated, accessible system of services and resources for im-paired physicians.

This is a serious problem: Many, if not most, hospital Physician Well-being Com-mittees, and nearly all me-dium and small physician groups, do not have access to the expertise and resources required to support physician health while assuring quality care to patients.

There is indirect but per-suasive evidence that a large

number of California physicians who need such services are not receiving them.

In 2009, the California Medical Associa-tion, the California Hospital Association and a number of defense-oriented malpractice firms pooled resources to create California Public Protection and Physician Health Inc. (CPPPH), an independent 501(c)(3) organization with fund-ing sufficient for two to three years. Their goal was to write and pass legislation to establish, within state government but independent of the Medical Board, an entity that would replace the function previously served by the Diversion Program but with responsibility to address phy-sician health not limited to drug and alcohol abuse but also medical and psychiatric issues. That could not be accomplished because of op-position from powerful individuals in the state

government who opposed it.In the absence of legislative action, leaders,

members and staff of CPPPH saw a profound need for a substantive, coherent, statewide mechanism to address physician health. They have done so. They created four regional net-works and sponsor a recurrent series of regional conferences to train and mentor the people who actually do the work of supporting the wellness and well-being of doctors: members of the Phy-sician Well-being Committee of hospital medi-cal staffs and those who do equivalent work for medical groups. The CPPPH can and does provide those committees with the resources and expertise needed to safely and effectively identify, counsel and monitor physicians with substance abuse issues or disabilities related to medical and psychiatric illnesses, aging and disruptive behavior.

CPPPH is our best hope for an appropriate, ef-fective, statewide physician health process. The initial funding provided in 2011 was intended as a bridge to legislation that could not be accom-plished. It is crucial that CPPPH continue the work it is doing for physicians and patients. They have created a two-year plan to develop sources of in-come, e.g., consulting services, identification of qualified service providers, conferences, grants and corporate sponsorships, which will allow the organization to become self-supporting. In the meantime, CPPPH must now engage in a sec-ond and final round of fund-raising, this time as a bridge to self-sufficiency. Part of the bridge has been constructed in the form of contributions from corporations and physician organizations, including LACMA, but more is needed.

I strongly suggest that you visit the CPPPH website at CPPPH.org. After you explore the site, and see what they are doing, you may, like me, be moved to hit the “donate now” button at the bottom left of the webpage and make a gener-ous contribution to this extraordinarily worth-while organization.

Marshall Morgan, MD, is a professor and chief of emergency medicine at the Ronald Reagan UCLA Medical Center and director of emergency medicine center at the David Geffen School of Medicine at UCLA. He is the 142nd president of the Los Angeles County Medical Association.

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risk tip

The FDA classifies recalls into three categories:• Class I recalls are themost serious.They involve

a health hazard with a reasonable probability that the use of the product will cause serious adverse health consequences or death.

• Class II recallspresentaremotepossibilityofad-verse health consequences from the use of the product.

• Class III recalls involvea situationwhere theuseof the product is not likely to cause adverse health issues.

The FDA has mandated that manufacturers must in-clude a unique device identifier (UDI) on all devices, starting with implantable devices. Implementation of the UDI system is expected to begin in 2014. UDIs can be captured in the electronic health record and used for device-tracking over time.

Physicians can be at risk for a malpractice suit if they do not handle defective device alerts and recalls properly. Take steps prior to and after surgery to de-crease this risk and promote patient safety in case of an eventual device issue. Before a device is implanted, involve the patient in an informed consent discussion that encompasses the possible complications and side effects of device implantation. Once the device has been implanted, dictate in the postoperative report the

type of implanted device and its serial number or UDI, and copy the post-op report to the office record. Note the UDI number on the patient’s card in the office re-cord on the first post-op visit.

Assign a specific individual in your practice the re-sponsibility of receiving, assessing, and acting on de-vice recall information.

If you receive a recall notification, follow these tips:• ForClass I recalls,workwith the surgical facility

where the device was implanted to verify which patients have the device. Notify the patients im-mediately, and determine the appropriate course of action.

• ForClassIIorIIIrecalls,itisappropriatetoinformpatients of their options. Contact your patient safety risk manager to see if he or she can provide a sam-ple letter to send to patients.

• Document the date the noticewas received, thesource of the notice, the device or product name and model number, the names of patients in the practice who were notified, and actions taken. Monitor patient compliance with and response to the notification.

• Follow the established process for properly han-dling explanted devices.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

Don’t Be Defective in Dealing with Device Alerts and Recalls deVice ManUfacTUReRS OfTen contact physicians with issues regarding implantable devices.

Contact can range from an alert of issues with the device to a U.S. Food and Drug Administration

(FDA) recall.

athenahealth guarantees we will be ready for ICD-10 by the October 1, 2014 deadline or you don’t pay for our services until we are. Additionally, any new clients who experience significant interruption in cash flow may be eligible to receive a cash loan from us.†

If you participate in the Meaningful Use program—Stage 1 or Stage 2—athenahealth guarantees your Medicare incentive check. And our track record speaks for itself, with 96% of our participating providers attesting in 2012.††

ICD-10 Guarantee Meaningful Use

Two fast-approaching initiatives—the ICD-10 transition and Stage 2 of the Meaningful Use program—are hitting the calendar at the same time. And both can cause administrative chaos and financial strain for practices.

At athenahealth, we don’t believe government mandates—or any change—should take focus away from patients. So, as part of our continued dedication to caregivers, we guarantee your success as you face these programs.

It’s an assurance no traditional vendor could even attempt. But with our proven combination of cloud-based software, network intelligence and back-office services, we are uniquely poised to come through for our clients.

YOUR 2014 SUCCESS: GUARANTEEDIn a year of massive change, athenahealth wants to help your practice stay independent

† This Guarantee covers ICD-10-CM codes and does not cover the ICD-10-PCS code set. Eligibility for the cash advance is limited to independent practices that (i) are live on athenahealth’s athenaOne services, or on our athenaCollector, athenaCommunicator and athenaClinicals services, by June 30, 2014; (ii) have an overall average days in accounts receivable (DAR) of more than 60 days in regard to transactions occurring on or after October 1, 2014; (iii) have Client-responsible DAR of seven days or less for such month; and (iv) are not in breach of the athenahealth Master Services Agreement; provided, however, that the total aggregate amount of cash advances made by athenahealth to its clients will not exceed $50 million dollars in the aggregate and cash advances made to each practice will be capped based on the number of MDs and mid-level providers in such practice. Additional terms and conditions apply; please see your sales representative for more information. †† If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act reimbursement payments only. Additional terms, conditions, and limitations apply.

John Kulin, M.D.On the network since 2009

BETTER NOWWe guarantee ICD-10 and Meaningful Use. So patients can be guaranteed your undivided attention.

TO LEARN MORE VISIT: athenahealth.com/socaprint

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athenahealth guarantees we will be ready for ICD-10 by the October 1, 2014 deadline or you don’t pay for our services until we are. Additionally, any new clients who experience significant interruption in cash flow may be eligible to receive a cash loan from us.†

If you participate in the Meaningful Use program—Stage 1 or Stage 2—athenahealth guarantees your Medicare incentive check. And our track record speaks for itself, with 96% of our participating providers attesting in 2012.††

ICD-10 Guarantee Meaningful Use

Two fast-approaching initiatives—the ICD-10 transition and Stage 2 of the Meaningful Use program—are hitting the calendar at the same time. And both can cause administrative chaos and financial strain for practices.

At athenahealth, we don’t believe government mandates—or any change—should take focus away from patients. So, as part of our continued dedication to caregivers, we guarantee your success as you face these programs.

It’s an assurance no traditional vendor could even attempt. But with our proven combination of cloud-based software, network intelligence and back-office services, we are uniquely poised to come through for our clients.

YOUR 2014 SUCCESS: GUARANTEEDIn a year of massive change, athenahealth wants to help your practice stay independent

† This Guarantee covers ICD-10-CM codes and does not cover the ICD-10-PCS code set. Eligibility for the cash advance is limited to independent practices that (i) are live on athenahealth’s athenaOne services, or on our athenaCollector, athenaCommunicator and athenaClinicals services, by June 30, 2014; (ii) have an overall average days in accounts receivable (DAR) of more than 60 days in regard to transactions occurring on or after October 1, 2014; (iii) have Client-responsible DAR of seven days or less for such month; and (iv) are not in breach of the athenahealth Master Services Agreement; provided, however, that the total aggregate amount of cash advances made by athenahealth to its clients will not exceed $50 million dollars in the aggregate and cash advances made to each practice will be capped based on the number of MDs and mid-level providers in such practice. Additional terms and conditions apply; please see your sales representative for more information. †† If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act reimbursement payments only. Additional terms, conditions, and limitations apply.

John Kulin, M.D.On the network since 2009

BETTER NOWWe guarantee ICD-10 and Meaningful Use. So patients can be guaranteed your undivided attention.

TO LEARN MORE VISIT: athenahealth.com/socaprint


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REAd fuLL sTORIEs ANd subsCRIbE TO ThE pNN ENEws buLLETINs AT www.phYsICIANsNEwsNETwORk.COM

health plans Liable for negligently Delegating risk

Los Angeles physicians who initially lost their bid to recoup money from a health plan when a Los Angeles County Superior Court judge dismissed the case have been allowed to

proceed with their claim.In a precedent-setting opinion in Centinela

Freeman Emergency Medical Assocs. v. Health Net et al, a California appellate court is allowing Cen-tinela emergency care providers to move forward with their demands against the health plans that delegated risk to La Vida Independent Practice Association (IPA) knowing the association was in financial trouble.

The ruling means California health plans can be held liable when they negligently delegate risk to an IPA that subsequently fails to reimburse providers.

most readLocal company seeking La Doctors for Virtual office Visits

Dr. Quang Dinh Vo is trying to recruit LA County doctors to use his new company, Qwikvisit, to visit with their patients using telemedicine.

“I work in hospitals in Orange County and Los Angeles, and my goal is to get colleagues to cre-ate their profile on Qwikvisit and their patients to participate,” Dr. Vo told PNN. He expects to be up and running by April.

By using telemedicine, doctors can bill for each visit using a modified billing code and can reduce overhead costs because no staff is needed to sign patients in and out.

Lacma ceo: Duals confusion continues with Dhcs official’s retirement

Jane Ogle, deputy director of the Department of Health Care Services, recently wrote an email to LACMA’s leaders informing them of her retirement effective as of Feb. 28.

Ogle’s retirement comes at a time of great uncer-tainty and confusion over the planned implementa-tion of the dual eligible program for Medicare and

Medi-Cal patients called Cal MediConnect.On Jan. 28, leaders of LACMA and the Los

Angeles County Podiatric Medical Society sent a letter to Ogle reiterating concerns that the pro-posed project would threaten the medical care of 200,000 mostly elderly, low-income and disabled patients in LA County and expressed their disap-proval of the department’s failure to provide opt-out forms to patients.

“Jane Ogle opted out on finishing the job with Cal MediConnect, and the confusion continues,” said Rocky Delgadillo, LACMA’s CEO.

survey: what’s the average wait time to see La Doctor?

A recent survey from Merritt Hawkins found it takes on average 12 days to schedule an appoint-ment with a physician in Los Angeles.

On average, in Los Angeles it took 12 days to see a cardiologist; 14 days to see a dermatologist; 8 days to see an OB/GYN; 7 days to see an ortho-pedic surgeon; and 20 days to see a family doctor.

Los Angeles wait times went down from 24 days in 2009 and 22 days in 2004 to 12 days in 2013. The average wait time to see a family practi-tioner fell from 59 days in 2009 to 20 days in 2013, the survey reported.

The researchers attributed the improvement to practices employing more midlevel providers like nurse practitioners, better healthcare IT to help with scheduling and an increase in the number of urgent care centers—a rising trend in Los Angeles County and elsewhere.

cedars sinai researchers study patient satisfaction, postsurgical pain

A new study recently presented by a researcher and physician at the Cedars Sinai Medical Center in Los Angeles found that a patient’s perception of postsurgical pain is one of the most influential fac-tors in evaluating physicians and hospitals.

As patient satisfaction becomes more closely linked to reimbursement, physicians have to take these findings into account; however, pain man-agement drugs have been getting bad publicity lately due to overprescription and cases of drug overdose.

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As heard on KFI

REpORTINg ON ThE TEChNOLOgY Of hEALThCARE dELIVERY

Fitbit to Recall Force Wristband Fitbit, a wearable tech maker, says it’s issu-

ing a recall of its Force wristband after users reported issues with skin irritation.

CEO and co-founder James Park posted a letter on Fitbit’s website stating that the com-pany will no longer sell the Force and plans to issue full refunds.

“While only 1.7% of Force users have re-ported any type of skin irritation, we care about every one of our cus-tomers,” says Park. “On behalf of the entire Fitbit team, I want to apolo-gize to anyone affected.”

The recently launched Fitbit Force is a wristband that lets you track activity and sleep and allows you to sync your results and review them through your computer or smartphone.

BevMd introduces Beverage to end Pre-op Fasting

BevMD, a medical beverage company focused on optimizing patients’ pre-surgical experience, announced its first patented bev-erage.

This drink can be safely consumed about two hours prior to surgery. It hydrates, nour-ishes, and assists in the recovery process and

can improve post-operative outcomes.Clearfast, a carbohydrate-rich beverage designed and patented by

anesthesiologist M. Lou Marsh, MD of BevMD, is the first product avail-able in the United States that is specifically formulated for consump-tion by pre-operative patients.

“More than 80 million surgical and diagnostic procedures requir-ing some form of anesthesia or sedation are performed annually in the U.S. alone,” said Dr. Marsh. “Though the risk of death or disability from the aspiration of stomach contents is extremely low, a majority of patients are still subjected to traditional, rigorous pre-operative fast-ing protocols. Patient noncompliance with fasting rules can lead to costly surgery delays, cancellations or, when undetected, can result in devastating regurgitation and aspiration. BevMD is leading the way to changing how millions of patients will be prepared for surgery every day across the country.”

Clearfast was granted the American Society of Anesthesiologists’ seal of compliance with all of its fasting guidelines.

Read Full Stories and Subscribe to the PNN eNews Bulletins at www.PhysiciansNewsNetwork.com/iPNN

1 0 p h ys i c i a n m aG a Z i n e | APRIL 2014

NeWS FLASh: dATA PRivACy iS A BiG deAL. The Federal Trade Commission (FTC) recently re-

leased a 2013 report again ranking identity theft as the top U.S. consumer complaint (nearly 300,000 complaints). U.S. Attorney General Eric Holder renewed the call for a U.S. national data breach notification law in response to ongoing concerns with identity theft plus the recent Target cyber-attack that accessed 40 million Americans’ credit card information. The Target event triggered consumer class actions, and now banks are suing Target for in-creased administrative costs (refunding transactions, opening new accounts, freezing accounts or block-ing transactions). Attorney General Holder correctly observes that data breaches are common.

The European Union (EU) recently called for strengthening EU data protection laws. Among re-quested improvements were a “general omnibus U.S. privacy law” and improved trust in EU-U.S. personal data transfers. This makes sense given evi-dence that the National Security Agency secretly eavesdropped on German Prime Minister Angela Merkel’s mobile phone calls. The German Federal Minister of Justice and Consumer Protection an-nounced this month that consumer rights organi-zations will soon be able to sue businesses directly for breaches of German data protection law.

Recently, the Financial Times reported that French Prime Minister Nicholas Sarkozy was taped during what were believed to be confidential inter-nal government discussions (although not by the NSA). Waves of regulations are playing catch-up to rapidly escalating data breach events.

Understanding how to navigate these regula-tions can avoid disaster. Why are there so many data privacy events and regulations?

NAviGATiNG The eLeCTRONiC OCeANCommunications and commerce evolved into

the cloud, a digitized sea of data connecting ev-ery country and government. Maritime commerce once triggered the need to understand and manage international laws (and pirates and security con-cerns). Today we navigate an electronic ocean that must be rendered as secure as possible for com-merce.

This is a complex and global process. But look no further than California. In February 2014 the Torrance office of Sutherland Healthcare Solutions, a medical billing company, suffered a break-in with computer and hard-drive theft causing health data loss for up to 168,500 patients.

DATA PRIVACY AND THE

LAWBy JamES EiSChEN, parTNEr, higgS FlETChEr & maCk, aNd aUSTiN rUThErFOrd, iNTErN


The California Attorney General’s Office recent-ly sued Kaiser Permanente for delayed consumer notification of a non-health record data breach under California’s data breach notification statute.

Forty-six states plus Washington, D.C., have data breach notification laws, along with New Mexico developing them. The California Attorney General has created both an eCrime Unit and a Privacy Enforcement and Protection Unit to pursue charges of violating the state and federal laws out-lined in this article. You simply cannot ignore data privacy compliance!

iS yOuR PRACTiCe ReALLy ReAdy?Medical practices are accustomed to HIPAA

regulatory compliance concerns. The HIPAA Final or Omnibus Rule, enacted in 2013, rendered vir-tually every person or entity holding decipherable electronic health information a “covered entity” subject to HIPAA regulation.

In a sense, medical practices have an advantage: They are already familiar with steering through the dangerous waters of HIPAA Privacy and Security Rules (that is, keeping electronic medical information private and enacting docu-mented efforts to maintain that privacy in scale to the business unit’s resources and technological platforms). But medical prac-tices (and frankly any business with elec-tronic health data) must realize that with data privacy a global issue, HIPAA compli-ance will become the subject of increased audits and regulatory action.

In 2013, the Health and Human Ser-vices (HHS) Office for Civil Rights (OCR) fined a Massachusetts dermatologist $150,000 after an unencrypted thumb drive containing ePHI of 2,200 individuals was stolen from an employee’s car. The vi-olations of HIPAA included an impermis-sible disclosure of ePHI (Privacy Rule vio-lation), a failure to conduct an adequate risk analysis (Security Rule violation), and a failure to train workforce members (Se-curity Rule violation).

Other enforcement actions include Puerto Rico fining a plan subcontractor $7 million for mailings addressed to pa-tients with identifiable health information in plain view. Last year the OCR fined an Arizona cardiologist $150,000 for failing to use a sufficiently secure online calen-daring system.

The U.S. Office of Inspector General (OIG) has called for increased HIPAA audits and increased OCR HIPAA oversight. Those audits will happen. Will HIPAA-regulated medical practices, and busi-nesses that may not realize they are HIPAA regu-lated, be ready?

With sufficient effort toward HIPAA compli-ance, the answer should be “yes.” But neither med-ical practices nor businesses with decipherable electronic health information should assume that borrowed forms, Internet browsing for templates, or crossed fingers suffice.

MORe ChANGeSThis year, HIPAA was the subject of yet an-

other adjustment, a 2014 rule entitling patients to directly secure electronic laboratory results from labs. Without question, medical providers must more persistently watch and regularly update their HIPAA compliance forms (notice of privacy prac-tices, business associate agreements with non-employee contractors receiving ePHI, and internal risk assessment memo to reflect reasonable evalua-

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Genetic Information Nondiscrimination Act (GINA): Federal law prohibiting health plans from requesting or requiring an individual to take a genetic test, and from charging an individual higher premiums based solely on genetic predispositions. GINA also amends HIPAA Privacy Rule to clarify that genetic information is protected health information which cannot be used or disclosed for underwriting purposes.

Children’s Online Privacy Protection Act (aCOPPA): Federal law requiring any operator of a website that collects and maintains personal information from children under 13 years old to post a privacy policy, pro-vide parental notice, and obtain verifiable consent to collect the children’s information.

Gramm Leach Bliley Act: Federal law requiring covered financial institutions to develop an information security program that is comprehensive, obtainable in written form, and appropriate to the size, complexity, and the nature of its activities.

California Online Privacy Protection Act (CalOPPA): California state law requiring website operators do-ing business with California residents to create and maintain specific privacy policies. Most recently, and the first of its kind, CalOPPA requires the operator to explain its policies and procedures toward Do Not Track signals.

California Shine the Light Act: California law requiring businesses collecting personal information from California consumers to give the consumer a choice to share the information, and provide a means for the consumer to know to whom and what categories of their information have been shared.

California AB 1950: California law requiring a covered business to use “reasonable security” measures to protect personal information. These security measures can be customized by the business appropriate to the nature of the information. A business that discloses personal information about a California resident must require, by contract, the third party to implement equally reasonable security procedures and practices.

California Breach Notification Law: California law requiring California businesses, or businesses that own or license computerized data that includes personal information of California residents, to disclose the dis-covery, or reasonable belief, of a breach of personal information. As Kaiser discovered, the state is willing to litigate to help stimulate improved compliance with this law.

California “Social Eraser” Law: California state law requiring all operators of websites directed to minors (California residents under 18), or with actual knowledge that minors use the website, to provide the option for minors to erase content upon request.

California Attorney General Recommendations to Mobile App Developers (January. 2013) outlines the California AG’s recommendations on minimizing data leak surprises for state citizens from unexpected privacy disclosure practices. App developers should: (1) create a checklist of data the app uses or accesses, (2) limit data collection to that necessary for basic functionality, (3) develop a clear, simple, and conspicuous privacy policy, and (4) use enhanced measures to draw user’s attention to data privacy practices. And Cali-fornia is not alone in this effort; other state attorneys general are acting to demand or stimulate improved privacy compliance.

California Confidentiality of Medical Information Act (CMIA): California state law seeking to protect an individual’s medical information, in either electronic or paper format, from unauthorized disclosures to third parties by requiring patient authorization for disclosure. While some California physicians may still think they avoid HIPAA by remaining “all paper,” they may underestimate how frequently paper records are digitized, and may also fail to understand that California’s version of HIPAA is not avoided with paper records.

California Patient Access to Health Records Act (PAHRA): California law giving patients the right to see and copy their medical records (with some exceptions) that are maintained by healthcare providers. Patients may also request changes to records they believe are inaccurate or incomplete. Federally, HIPAA/HITECH mandates patient access to electronic healthcare records.

HERE ARE bRIEf SummARIES of fEDERAl AND STATE lAwS To CoNSIDER:


HIPAA VIolATIoNS AND ENfoRCEmENT Failure to comply with HIPAA can result in civil and criminal penalties including:

CiviL PeNALTieS The Secretary of the Department of Health and Human Ser-vices (HHS) has discretion in determining the amount of the penalty based on the nature and extent of the violation and the nature and extent of the harm resulting from the violation. The Secretary is still prohibited from imposing civil penalties (except in cases of willful neglect) if the violation is corrected within 30 days (this time period may be extended).

CRiMiNAL PeNALTieS Covered entities and specified individuals who “know-ingly” obtain or disclose individually identifiable health information in violation of the Administrative Simplification Regulations face a fine of up to $50,000, as well as imprisonment up to one year. Offenses committed under false pretenses allow penalties to be increased to a $100,000 fine, with up to five years in prison. Finally, offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or mali-cious harm permit fines of $250,000, and imprisonment for up to ten years.

COveRed eNTiTy ANd SPeCiFied iNdividuALS The Department of Justice con-cluded that the criminal penalties for a violation of HIPAA are directly applicable to covered entities—including health plans, healthcare clearinghouses, healthcare providers who transmit claims in electronic form, and Medicare prescription drug card sponsors. Individuals such as directors, employees, or officers of the covered entity, where the covered entity is not an individual, may also be directly criminally liable under HIPAA in accordance with principles of “corporate criminal liability.” Where an individual of a covered entity is not directly liable under HIPAA, they can still be charged with conspiracy or aiding and abetting.

NO PRivATe CAuSe OF ACTiON While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 FR 82566). State law, however, may provide other theories of liability.

tions of security measures as new technology solu-tions are adopted).

If your medical practice has not updated your data compliance forms, or you are a business that holds decipherable health data without realizing HIPAA regulates you: It is time to engage in data protection compliance efforts. Do not let your ship sink under the weight of avoidable data leak regu-lations and litigation.

Do not assume HIPAA is the sole concern. As referenced above, there is a growing pool of regu-lations connected to data privacy. And privacy reg-ulation is by no means limited to the healthcare in-dustry. It has become a basic component of doing business in corporate America, and internationally. STAy ACTive ANd uPdATed

Regulations can trigger frustration, and they can protect important fundamental rights. Piracy can seem romantic or entertaining from a distance, until you are a victim. Then it becomes very real, imme-diate and dangerous. The rapidly increased global interest in data privacy compliance means that your HIPAA compliance cannot be passive or presumed. It must be active and updated. Electronic events oc-cur with rapidity unthinkable in prior times. That means your ability to be seaworthy in the digital ocean will be tested by regulators, and criminals. You may have very little time to steer clear of haz-ards. More than ever, your passengers expect you to run a tight ship. We all know how that movie ends about the beautiful unsinkable ship without suffi-cient lifeboats that could not turn quickly enough to avoid an iceberg in icy water.

A partner with Higgs Fletcher & Mack, LLP, James J. Eischen Jr. is a Cali-fornia attorney with over 27 years of experience. A graduate from the University of California at Davis law school, his expertise includes representing medical groups/physicians, software developers, Internet platforms, telemedicine solutions, and device manufacturing companies regarding all aspects of reimbursement and data protection compliance. Over the last four years, Mr. Eischen became a national expert in structur-ing consumer- and patient-funded models for delivering innovative healthcare solutions. He provides healthcare compliance presentations at American Association of Private Physicians (AAPP) and World Link physician conferences throughout the country. His practice includes general corporate business planning and real estate law for a wide variety of U.S. and international commercial interests.

An intern at Higgs Fletcher & Mack, LLP, Austin Rutherford is a second-year

law student at the University of San Diego School of Law. He is interested in focusing his future career on business transactions and emerging companies. He graduated with a cum laude degree in philosophy and political science from Santa Clara University in 2012.______________________________

http://www.ftc.gov/news-events/press-releases/2014/02/ftc-announces-top-nation-al-consumer-complaints-2013 Cal Civ. Code §§ 1798.29, 1798.82http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/genetic/ 15 U.S.C. §§ 6501–6506; see also Federal Trade Commission, 6-Step COPPA Compliance Plan for Business, http://business.ftc.gov/documents/bus84-childrens-online-privacy-protection-rule-six-step-compliance-plan-your-business Amended various provisions of titles 12 and 15 of the United States Code.Cal. Bus. & Prof. Code §§ 22575–22579.Cal. Bus. & Prof. Code § 22575(b)(5).Cal. Civ. Code § 1798.83.Cal. Civ. Code 1798.81.5.Cal Civ. Code §§ 1798.29, 1798.82.Cal. Bus. & Prof. Code §§ 22580–22582.Kamala Harris, Privacy on the Go: Recommendations for the Mobile Ecosystem, http://oag.ca.gov/system/files/attachments/press_releases/privacy_on_the_go.pdf? Cal. Civ. Code §§ 56.05–56.37.Cal. Health & Safety Code §§ 123100-123149.1.Cal. Health & Safety Code § 123111.


ceo’s letter

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ThiS SpRing SeaSOn, LACMA is looking forward to seeing many blossoming opportunities.For one, we are pleased that a number of potentially very large and influential health groups

and organizations plan to join our growing organization.LACMA is also steadily gaining stature in the LA community and far beyond as seen by the ris-

ing interest of members of the media calling on LACMA’s physician members for their expertise.With all the news surrounding healthcare changes, LACMA is becoming the “go to” source’

for physicians and advocacy. Most recently, we have seen Robert Bitonte, MD, provide his valuable in-

sights for an article in the Los Angeles Times focusing on medical necessity. In another recent LA Times story focusing on the rate of early elective

deliveries of babies in hospitals, Parissa Moradi, MD, also provided key com-mentary.

We look forward to a rising crop of LACMA members lending their ex-pertise to all the critical issues being discussed in the media and the wider community.

But even during this time of awakening, challenges remain.Among the major issues is the deeply flawed dual-eligible demonstra-

tion program, Cal MediConnect, which continues to give rise to much confu-sion among patients.

After expressing our concerns that opt-out forms would not be provided to patients (after reassurances that patients would have a choice), LACMA received the following email from Jane Ogle, deputy director of the Depart-ment of Health Care Services.

“I have enjoyed working at the DHCS and I sincerely appreciate having had the chance to work with all of you on the Coordinated Care Initiative,” Ogle said in the email, referring to her unexpected retirement.

Ogle opted out on finishing the job with Cal MediConnect; patients and physicians are trying to sort through the confusing issues remaining.

In this age when thousands of newly insured are entering LA County’s health system, the challenges of how to address the shortage of primary care physicians is also a huge burden on our health system.

There could be a shortage of up to 45,000 primary care doctors in the U.S. by 2020, according to the Association of American Medical Colleges.

But there is no solution to the crisis.Finally, the fight to preserve MICRA continues to take center stage.With certain groups pushing a measure that would raise the cap on pain and suffering dam-

ages from the current $250,000 to $1.1 million—as well as require doctors to be drug tested and to check a statewide database when prescribing certain medications to clamp down on prescrip-tion drug abuse—we need to fight for providers’ accessibility to MICRA and for patients’ rights to get the medical care they deserve.

We will do our part and continue our efforts to solicit financial support to make sure that MI-CRA is preserved.

This is the time for all physicians to get involved so we can tackle these critical issues together. Let’s strive to improve our yields during this time of change.

Rocky DelgadilloChief Executive Officer

The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s Trial Lawyers have launched an attack to

undermine MICRA and its protections and we need your help. Membership has never been so valuable!

savings of over $84,000

* Medical Liability Monitor - Annual Rate Survey Issue, Vol. 37, No. 10, October 2012. Annual rates with limits of $1 million/$3 million.

WAYS LACMA/CMA IS WORKING FOR YOU!

Are you a LACMA/CMA member?Los Angeles physicians are saving an average of $84,770 this year.

2012 LOS ANGELES COUNTY MEDICAL ASSOCIATION MICRA SAVINGS CHART

Los Angeles County Medical Association707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017Phone: (213) 683-9900 Fax: (213) 226-0353

General Surgery Internal Medicine OB/GYN Average (Non-Invasive)

Los Angeles County $41,775 $10,343 $49,804 $33,974 Miami & Dade Counties, FL $190,088 $46,372 $201,808 $146,089 Nassau & Su¥ olk Counties, NY $127,233 $34,032 $204,684 $121,983 Wayne County, MI $121,321 $35,139 $108,020 $88,160 FL-NY-MI Average $146,214 $38,514 $171,504 $118,744

MICRA Savings $104,439 $28,171 $121,700 $84,770

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medicare ICd-10 Front-end testing Week extendedCma STaFF

due to the success of the first week of ICd-10 testing, Noridian has partnered with Centers for Medicare & Medicaid services (CMs) to con-tinue acceptance testing for EdI submitters and vendors for an indefinite period.

The purpose of acceptance testing is to ensure that base system func-tionality and front end editing have been updated for ICd-10 and are functioning correctly. Acceptance testing will help ensure you are ready for the October 2014 implementation of ICd-10.

The California Medical Association (CMA) encourages all direct EdI submitters and vendors to test with Noridian. Those who wish to take ad-vantage of this opportunity must register. Additional information is avail-able at the Noridian EdIss ICd-10 Resource Center.

billing experts advise physicians to start preparing for the ICd-10 tran-sition now if they haven’t yet done so. steps to take include upgrading software systems, testing those updated systems, training staff and up-dating payer contracts and fee schedules. The American Medical Associa-tion (AMA) offers free educational resources that can help physicians get started. CMA has also partnered with AApC to provide various ICd-10 training courses to members at a discounted rate. for more information, visit www.cmanet.org/aapc.

White Coat BuzzBy halaiNE rOSE, laCma alliaNCE diSTriCT 2 prESidENT aNd Cma alliaNCE BOard mEmBEr

One hundred medical students from across California joined physicians at the Califor-nia Democratic Party Convention on March 7 and 8 at the LA Convention Center.

Their white coat presence along with their energy and enthusiasmwas powerful as they handed out information about the Nov. 4 anti-MICRA ballot proposition, emphasizing de-creased access to care and increased costs, the inevitable consequences of the proposition.

The students and physicians of numerous specialties talked about the adverse impact on patients—children, seniors, veterans, Latino groups, women’s organizations, health clinics.

LACMA president, Marshall Morgan, MD, CMA president Richard Thorpe, MD, along with LACMA members David Aizuss, MD, Hector Flores, MD, Susan Reynolds, MD, and Holt Rose, MD, were seen among the doctors participating with medical students from UC Davis, UC San Francisco, UCLA, USC, UC San Diego, UC Irivine, Western, Touro and Stanford.

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Three major managed care payors offering coverage through Covered California have provided additional in-formation to their contracted providers on their exchange/mirror products. Together, these three payors – Health Net, Anthem Blue Cross and Blue Shield of California – account for approximately 75% of enrollment in Covered California products to date.

The notices, sent to physicians within the past few weeks, were cobranded with Covered California and contain additional information to help providers navigate the exchange.

The Health Net notice, sent on March 7, includes in-formation such as the exchange/mirror products in which the physician is listed as participating, the product types that are offered in different regions and what information is on patient ID cards.

Blue Shield sent two notices, one for its EPO and one for its PPO. The notices, sent on March 14, were very comprehensive, containing clarification on “mirror” products, a plan summary that includes copayment, co-insurance and deductible information, sample ID cards, answers to frequently asked questions, a map indicating

which product types are offered by county and additional useful tools.

Anthem Blue Cross’s notice, sent on March 17, in-cludes answers to frequently asked questions, clarifies that it is offering a narrowed network for its exchange/mirror product enrollees, a breakdown of products sold by county, reported provider network size and a helpful plan name guide to assist practices in identifying their exchange/mirror product patients.

While the notices were sent only to contracting physi-cians, the information may also be helpful to non-con-tracting physicians.

To help practices navigate the exchange, CMA has also published several “Surviving Covered California” tip sheets, which are available free to members in CMA’s exchange resource center at www.cmanet.org/exchange. There you will also find many other exchange resources, including a comprehensive exchange toolkit, “CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange.”

Contact: CMA’s reimbursement helpline, (888) 401-5911 or [email protected].

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Three Major exchange Plans Provide Guidance for PhysiciansCma STaFF

1 8 p h ys i c i a n m aG a Z i n e | APRIL 2014

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Located in Vista, California, Vista Community Clinic is a private, non-profit outpatient community clinic located in North San Diego County serving people who experience so-cial, cultural or economic barriers to health care in a comprehensive, high quality setting.

PositionPart-time Psychiatry MD or DO or part-time or full-time Family Medi-cine/Psychiatry MD or DO.

ResPonsibilitiesProvide consultation-liaison servic-es for patients suffering from both psychiatric and medical disorders by focusing on the evaluation and treatment of patients serving ado-lescents, adult, seniors and their families. Preferably able to serve children as well, but not required.

RequiRements· Graduation from a recognized

school of medicine· Valid California medical license

as MD or DO; Board certified or eligible

· Authorized to practice psychiatry in California

· Certified as a diplomat in the American Board of Psychiatry and Neurology in psychiatry

· Completion of a psychiatric resi-dency or family medicine/psy-chiatry residency in an ACGME approved residency program

· Psychiatrist with Medicare and California Medicaid numbers prior to start of employment

· Valid DEA certificate· 2 years experience working full-

time as psychiatrists and MD or DO in child and adult psychiatry

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Position: Full-time, Part-time and Per Diem Family Medicine Physi-cians.

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RequiRements: California li-cense, DEA license, CPR certifica-tion and board certified in family medicine. Bilingual English/Spanish preferred.

ContaCt us: Visit our website at www.vistacommunityclinic.org For-ward resume to [email protected] or fax resume to 760 414 3702.EEO/AA/M/F/Vet/ Disabled


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For Joining LACMA and CMA Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.

Legislative Advocacy

FREE Reimbursement Assistance

FREE Jury Duty Assistance

Medline

Savings & Discounts

Educational Resources & Free CME

Free Legal Assistance

State-of-the-Art Communication

Networking & Referral Events

Access to your Physician Advocate

LACMA and CMA are distinguished by their successes. Dual membership provides for un-paralleled legislative advocacy at the local, state, and federal level on behalf of our members.

Tired of fighting with payors? CMA’s Economic Services experts recovered over 7.8 million dollars for members since 2010.

Aimed at meeting both your professional and personal needs, LACMA offers you additional dis-counts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!

CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with member-ship. In addition, LACMA provides access to important and local CME-accredited events.

Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!

Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.

If you come across a challenge and you are not sure what to do, call LACMA to support your practice and professional needs.

Los Angeles County Medical Association o 707 Wilshire Blvd, Suite 3800 o Los Angeles, CA o 90017 o FAX: (213) 226-0353

For more information on member benefits and resources, visit lacmanet.org/Membership or call (213) 226-0356

is the best time to join LACMA and CMA

LACMA can help you:

Reschedule your date

Relocate for your convenience

Reduce number of call-in days from 5 to 1!

Through an exclusive partnership with the medical supply manufacturing and distribution company, LACMA saves members a minimum of 10% on your medical supplies, equipment, and medical waste with compliance.

Socialize and network with members of the medical community

Find or create opportunities for your practice

Engage with legislators and policymakers

$xx

For Joining LACMA and CMA Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.

Legislative Advocacy

FREE Reimbursement Assistance

FREE Jury Duty Assistance

Medline

Savings & Discounts

Educational Resources & Free CME

Free Legal Assistance

State-of-the-Art Communication

Networking & Referral Events

Access to your Physician Advocate

LACMA and CMA are distinguished by their successes. Dual membership provides for un-paralleled legislative advocacy at the local, state, and federal level on behalf of our members.

Tired of fighting with payors? CMA’s Economic Services experts recovered over 7.8 million dollars for members since 2010.

Aimed at meeting both your professional and personal needs, LACMA offers you additional dis-counts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!

CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with member-ship. In addition, LACMA provides access to important and local CME-accredited events.

Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!

Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.

If you come across a challenge and you are not sure what to do, call LACMA to support your practice and professional needs.

Los Angeles County Medical Association o 707 Wilshire Blvd, Suite 3800 o Los Angeles, CA o 90017 o FAX: (213) 226-0353

For more information on member benefits and resources, visit lacmanet.org/Membership or call (213) 226-0356

is the best time to join LACMA and CMA

LACMA can help you:

Reschedule your date

Relocate for your convenience

Reduce number of call-in days from 5 to 1!

Through an exclusive partnership with the medical supply manufacturing and distribution company, LACMA saves members a minimum of 10% on your medical supplies, equipment, and medical waste with compliance.

Socialize and network with members of the medical community

Find or create opportunities for your practice

Engage with legislators and policymakers

sure you’re prepared.

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Physicians have

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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*Source: U.S. Department of Health and Human Services

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April 2014