January 2014

JANUARY 2014

O

ff

ic

i a l M a ga

zi

ne

Of

f

ic

ial Maga

zi

ne

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

The Business of Being a Doctor

NORCAL Mutual is owned and directed by its physician-

policyholders, therefore we promise to treat your individual

needs as our own. You can expect caring and personal

service, as you are our first priority. Contact your broker or

call 877-453-4486 today. Visit norcalmutual.com/start

for a premium estimate.

A N o r c A l G r o u p c o m pA N y

N o r c A l m u t u A l .c o m

JANUARY 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 1

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.

JAN

UA

RY 2014 | TAB

LE OF C

ON

TENTS

10

cOVeR STORY

16 The buSineSS Of being a dOcTOR

Industry experts and physicians offer their tips on how doctors in private of-fices can implement a team approach and social media marketing and use technologies such as electronic medi-cal records and apps in order to con-tinue to run a successful business.

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

10 balance | lifeSTYle & WellneSSNews, studies, tips and opportunities to help physicians maintain a balanced lifestyle

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

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

24 uniTed We STand | aT WORK fOR YOuLACMA and CMA membership at work for you

fROM yOuR assOciaTiOn4 PReSidenT’S leTTeR | MaRShall MORgan, Md

26 ceO’s leTTeR | ROcKY delgadillO

27 lacMa neWS | aSSOciaTiOn haPPeningS

16

22

22 cal MedicOnnecT: Rebalancing

califORnia’S lOng TeRM SuPPORT and SeRViceSPhysicians and healthcare profes-sionals who treat dual-eligibles (patients receiving Medicare and Medi-Cal) can expect big chang-es when California, as part of the Affordable Care Act.

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.

EdiTOR

diSpLAY Ad SALES / diRECTOR OF SALESSALES EXECUTiVE

CLASSiFiEd Ad SALESEdiTORiAL AdViSORY BOARd

pRESidENT pRESidENT-ELECT

TREASURER SECRETARY

immEdiATE pAST pRESidENT

CmA TRUSTEECOUNCiLOR - diSTRiCT 9COUNCiLOR - diSTRiCT 2

mEd STUdENT COUNCiLOR/USC kECkCOUNCiLOR-AT-LARgE

YOUNg phYSiCiAN COUNCiLORCmA TRUSTEE

COUNCiLOR - diSTRiCT 5EThNiC phYSiCiANS COmmiTEE REpRESENTATiVE

COUNCiLOR - diSTRiCT 1COUNCiLOR - diSTRiCT 17COUNCiLOR - diSTRiCT 14

COUNCiLOR - diSTRiCT 7ChAiR OF LACmA dELEgATiON

COUNCiLOR-AT-LARgE COUNCiLOR - diSTRiCT 6

COUNCiLOR - SSgpFCOUNCiLOR-AT-LARgE

COUNCiLOR - diSTRiCT 3COUNCiLOR - diSTRiCT 10

COUNCiLOR - SCpmgALTERNATE mEd STUdENT COUNCiLOR/UCLA

RESidENT/FELLOW COUNCiLORCmA TRUSTEE

ALTERNATE RESidENT/OFFiCER COUNCiLORCOUNCiLOR-AT-LARgECOUNCiLOR-AT-LARgE

CmA TRUSTEE (RESidENT)

Sheri carr 559.250.5942 | [email protected]

ADVErtiSinG SALES

christina correia 213.226.0325 | [email protected] bennett 925.272.0857 | [email protected] Pebdani 858.231.1231 | [email protected] h. aizuss, Md Troy elander, Md Thomas horowitz, dO Robert J. Rogers, Md

HEADquArtErS

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-

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, Executive Assistant, at [email protected] or 213-226-0304.

TrueBeam was designed to treat your

patient’s cancer with unparalleled

ease, precision, speed and specificity:

• Delivers advanced treatment techniques including IMRT, IGRT, SBR and SRS with game-changing flexibility.

• Expands treatment options for even the most challenging cancers, including prostate, head/neck, lung, breast, brain and abdomen.

• Sophisticated motion managmement synchronizes beam delivery with respiration.

• Generates high-quality, 3-D, cone-beam CT images 60% faster* using 25% less x-ray dose.

For Physicians For Patients Advanced Radiation Centers is proud to be

among the few providers in the Los Angeles

area offering TrueBeam. We enhance this

cutting-edge therapy with unparalleled

comfort and service, including an inviting,

easy-access facility; bright, spacious

treatment rooms; and a dedicated Cancer

Navigator to guide each patient through the

treatment process.

8929 Wilshire Boulevard, Suite 100Beverly Hills, California 90211

424.249.7500arcbeverlyhills.com

TrueBeam was designed to ensure the

most comfortable treatment tailored to

your type of cancer:

• Fast, precise treatments take just minutes a day.

• Advanced communications systems keep you in close contact with the technologist.

• Music feature creates a soothing treatment environment.

*Compared to earlier generations of Varian imaging technology.

The TrueBeam™ radiotherapy system unlocks treatment opportunities...

...for even the most complex cancer cases.

Advanced Radiation Center of Beverly Hills is a multi-lingual facility.

Rosalyn Morrell, MDRadiation Oncologist

ARC_BH_Ad_PhyMag_0913_FINAL_Rev2.indd1 10/16/20133:04:40PM

4 p h ys i c i a n m aG a Z i n e | JANUARY 2014

daMned if YOu dOn’T, Then daMned if YOu dOAs recently as the late 90’s, opiates were used almost

exclusively for post-operative pain, cancer, and end of life care. They were seldom prescribed for chronic non-cancer pain because clinicians believed that they were dangerous medications, potentially lethal in overdose, and potentially addictive when given over long periods.

Over the past 15 years that situation changed. The NIH reported that 100 million persons in the United States suffered from chronic pain. There was a consensus that most patients with chronic, non-cancer pain were not re-ceiving adequate analgesia. Influential pain specialists ar-gued that prevalent beliefs (that treatment of non-cancer

chronic pain with opioid drugs was unsafe and ineffective) were erroneous, that concerns about opiods were overstated, and that these patients could benefit from chronic opioid therapy.

These advocates for better pain treatment, aided by support from the manufacturers of opioid medications, found ready allies among regulators and lawmak-ers. In 2000, the VA and the Joint Commission for the Accredita-tion of Hospitals issued stan-dards for pain assessment and control, identifying pain intensity as the “5th Vital Sign”.

In 2001, a civil lawsuit, brought under California’s “Elder Abuse” statute resulted in a $1.5 million dollar judgment against a physician for failure to adequate-ly treat a patient’s pain.

Also in 2001, the California legislature adopted legisla-tion that required every California physician (radiologists and pathologists excepted) to endure a mandatory 12 hour course on pain management and end-of-life care. Those of you who took those courses during the 2000’s will re-call the strong emphasis on the physician’s responsibility to alleviate pain, and the contention that opioids were useful and appropriate therapy for non-malignant chronic pain.

In 2004, the Federation of State Medical Boards ad-opted a Model Policy for the Use of Controlled Substances for the Treatment of Pain. That policy recognized the wide-spread “inadequate treatment of pain” and emphasized the obligation of government to “ensure the availability of controlled substances” for legitimate medical purposes. The policy specifically stated that the under-treatment of pain was a departure from an acceptable standard of care.

Predictably in this environment, there was a major in-crease in opioid prescriptions, fueled by the development of new more potent and longer acting products accompa-nied by intensive advertising by drug companies. (Accord-ing to the New York Times the dollar volume of opoid sales increased 110% between 2001 and 2012.)

The first indication that there was a problem with this

well-intended change in practice came in a paper pub-lished in 2005 in the American Journal of Industrial Medi-cine which examined opiate prescribing patterns and deaths attributable to opioid use in the Washington State workers compensation system. That study documented markedly increased daily doses of opioids for work-related injuries in the years 1995-2002 and 32 deaths attributed to opioid overdose. This finding triggered closer tracking by authorities of rates of opioid prescription and adverse events including addiction, overdose and overdose-relat-ed deaths.

According to the CDC, prescription drug overdoses tri-pled between 1990 and 2008, and now account for more deaths than motor vehicle accidents. The great majority of drug related deaths are caused by opioids.

The adverse effects of increased opioid prescribing, and the widespread public and professional awareness of those effects has had consequences. Guidelines designed to limit the opioid use are being developed. Some have been created by professional associations and ad hoc groups of physicians (my specialty, Emergency Medicine, has been particularly active in this regard). At least one large multispecialty group has created mandatory pre-scribing guidelines; physicians who will not follow them have been fired. One state government has mandated consultation with pain specialists in certain patients on high doses of opioids.

The message from the medical literature, physician opinion leaders, governmental regulators and courts to practicing doctors has changed: we are no longer being told: “It is your duty to treat and control pain, with opioids if necessary, and you may be punished severely if you don’t”. We now hear: “It is your duty to closely control and decrease the use of opioids, and you may be punished se-verely if you don’t.”

Undertreated pain is a significant problem for millions of Americans, which must be addressed. Although there is still disagreement about the best way to do so, it’s clear that the pre-1990 clinicians who did not prescribe opioids for chronic pain had a point: these are dangerous drugs, potentially lethal in overdose and potentially addictive with prolonged use. In an attempt to alleviate chronic pain, we appear to have made prescription drug abuse, which is ar-guably an iatrogenic disease, very much worse.

The point of all this? There are several: Prevailing medi-cal standards, even pathophysiological “facts” change, and often enough turn out to be wrong… “Caveat emptor”.

Opioid drugs are dangerous and if used to treat chron-ic pain should be prescribed with great care.

There has been a collision between the effort to alle-viate the problem of undertreated chronic pain and the subsequent lethal epidemic of prescription drug abuse; the development of appropriate medical and social policy to deal with these issues is a work in progress. We should monitor developments and work toward rational policies which protect both doctors and patients.

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.

pRES

idEN

T’S

LETT

ER |

mA

RSh

ALL

mO

RgA

N, m

d


pRA

CTi

CE

mA

NA

gEm

ENT

| FRO

NT

OFF

iCE

Are You a Photocopier Away From a $1 Million Fine?NEW hipAA RULE gOES iNTO EFFECTCmA STAFF

The U.S. Department of Health and Human Ser-vices (HHS) recently released new regulations that made important changes to the privacy and security requirements under HIPAA. These new regulations, known as the HIPAA Omnibus Rule, implement many of the provisions of the Health Information Technol-ogy for Economic and Clinical Health (HITECH) Act. The new rules took effect in March and physicians had until Sept. 23, 2013, to update practice policies and procedures to comply with the new regulations. Are your policies and procedures up to date?

While the copier infraction is not new, it does il-lustrate how physicians and medical office staff must think about potential risks to protected patient health information and identify and improve privacy and se-curity vulnerabilities in office business practices.

In this instance, a New York health insurer called Affinity Health Plan really got a shock when it was informed by CBS Evening News that, as part of an investigatory report, it had purchased a photocopi-er previously leased by Affinity that still contained protected health information (PHI) for more than 300,000 patients.

In August 2013, the federal Office for Civil Rights (OCR), which is charged with enforcing the HIPAA privacy laws, settled with the plan for $1 million. The investigation revealed that Affinity failed to incor-porate the electronic PHI stored on the photocopier hard drives in its analysis of risks and vulnerabilities as required by the HIPAA security rule and failed to implement policies and procedures for securing or deleting that data when returning the photocopiers to its leasing agent.

If you think that you are too small a practice to run afoul of HIPAA, think again. Small practices are not exempt from the HIPAA requirements, and any phy-sician practice that uses electronic means to engage in designated transactions — including health claims, remittance or payment advice, claim status inquiries, eligibility inquiries, enrollment and disenrollment, re-ferral certification and authorization, and coordination

of benefits or health plan premium payments — is a covered entity and must comply with HIPAA or be sub-ject to enforcement actions.

But Will OCR COme AfteR the little Guys?OCR has initiated enforcement actions on prac-

tices big and small. Last year, a small cardiac surgery practice in Arizona agreed to pay a $100,000 settle-ment fine after it was found to have been sending PHI through an unsecured, web-based email program. In addition to using unsecured email to send PHI, the practice was also posting patient appointments on an Internet-based calendar, which was publicly acces-sible. With a careful assessment of their business prac-tices and risks, physicians should be able to implement HIPAA compliance plans in their practices to protect patient information and reduce their risks of violating HIPAA and state privacy and security laws.

WhAt’s NeW?Some of the key changes made by the HIPAA Om-

nibus Rule include, but are not limited to, an updated definition of a business associate, new rules surround-ing certain permitted uses and disclosures of PHI, such as the sale of PHI and the use of PHI for fund-raising and marketing, and rules controlling how patients can obtain medical records that are kept by a physician electronically. It also made significant changes to the PHI breach notification rule.

Physician offices will, at a minimum, need to re-view and update their business associate agreements, office privacy and security policies, and notice of pri-vacy practices in order to bring their offices into com-pliance with the new rule.

In the end, your practice doesn’t have to be locked down like Fort Knox, but you must be able to demon-strate that your practice has taken “reasonable” mea-sures to protect the privacy and security of PHI. Each practice will differ in some detail. As doctors and staff learn more about HIPAA, your staff should be able to determine what you need to do if you have not already

dO YOu OR your staff scan patient health records on a leased copy machine? You might be violat-

ing the Health Insurance Portability and Accountability Act (HIPAA), putting private patient data at

risk and opening yourself up to massive fines and other penalties. Many of these copy machines

have an internal memory that, unless proper safeguards are in place, may allow unauthorized peo-

ple to access patient data.

pRAC

TiCE m

AN

Ag

EmEN

T | FRO

NT O

FFiCE


pRA

CTi

CE

mA

NA

gEm

ENT

| FRO

NT

OFF

iCE

implemented your safeguards.This means using appropriate and reasonable ad-

ministrative, technical, and physical safeguards for all health information. Every staff member has an obliga-tion to protect this information. This includes keeping doors properly locked, keeping computer passwords secret, securely transporting and using portable and mobile computers and devices that access PHI, and speaking softly when discussing medical information in publicly accessible areas. The law also requires ev-ery practice to designate a Privacy and Security Offi-cial, whether it is the physician, an associate, or staff member, to oversee the practice’s HIPAA compliance

plan. This person will be key to developing and im-plementing policies and procedures, receiving com-plaints, and knowing where documentation of your processes are kept; he or she will be responsible for thinking ahead about compliance, and can help or lead your office through an audit. This person needs to understand computers, but does not have to be a “te-chie.” They will, however, require some education and some support. Information technology (IT) is involved, but this is NOT an IT project. Keeping your practice in compliance with HIPAA will ultimately require the whole organization’s cooperation and support.

If you think that you are too small a practice to run

afoul of HIPAA, think again. Small practices are not exempt from the

HIPAA require-ments, and any

physician practice that uses electronic

means to engage in designated

transactions is a covered entity

WheRe CAN We Get help?The California Medical Association (CMA) has a number of resources that are useful in under-

standing and for getting medical practices up to par on the HIPAA rules. These and other resources are available at www.cmanet.org/hipaa.

• Sample Documents: For more information and for an updated sample notice of privacy practices and business associate agreement, see the California Medical Association’s (CMA) ON-CALL documents #4101, “HIPAA ACT SMART: Introduction to the HIPAA Privacy Rule,” and #4103, “Business Associates.” These documents are available free to members. Nonmembers can pur-chase documents for $2 per page.

• On-demand Webinar: CMA recently hosted a webinar, “HIPAA Compliance: The Final HITECH Rule,” available for on-demand playback at your convenience.

• Frequently Asked Questions: CMA has produced a brief resource document, “HIPAA Omnibus Rule Compliance Frequently Asked Questions,” which answers common questions about the new HIPAA regulations.

• HIPAA Compliance Toolkit: The CMA/ PrivaPlan HIPAA Toolkit is a comprehensive online re-source to assist physicians in complying with the HIPAA privacy and security rules and Cali-fornia law. It contains detailed sample forms, policies, procedures for compliance tailored for California physicians, training materials, and resources to help physicians with implementation and planning. LACMA-CMA members can purchase the toolkit from PrivaPlan by calling (877) 218-7707 or visiting PrivaPlan’s website at www.privaplan.com. The cost is $325 per practice for members or $495 for nonmembers. Annual updates to this program cost $75 for LACMA-CMA members. A coupon code is required to access this discount. Visit www.cmanet.org/benefits or call CMA’s member service center at (800) 786-4262 to obtain the code.

• HIPAA Training Tool: PrivaPlan also offers an online HIPAA Training Tool that is an easy and affordable way to train staff. This comprehensive course can be taken online at any time, any-where. It features videos and online quizzes to help just about anyone understand HIPAA and what policies and procedures must be put into place. LACMA-CMA members can purchase the HIPAA Training Tool for $129 for LACMA-CMA members or $169 for nonmembers.

For more information and resources, visit www.cmanet.org/hipaa.

The California Medical Association (CMA) represents more than 38,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

And don’t forget that under the ACA, patients receiving premium assistance through federal tax subsidies are given a 90-day grace period in which to pay their portion of the premium. During the first 30 days of the grace period, the plans must pay for services incurred. However, during days 31-90 of the grace period, plans are allowed to suspend the patient’s coverage. If the patient doesn’t true-up by day 90, the plan can terminate the policy, potentially leaving 60 days worth of unpaid claims. While physicians can pursue the patient for the balance incurred during days 31-90 of the grace period, it seems unlikely a patient would be able to pay a doc-tor’s bill if unable to pay for the plan premium.

This reinforces the importance of verifying patient eligibility—particularly for exchange pa-tients—each time they are seen. If the exchange patient’s eligibility verification states coverage is suspended, the practice can treat the situa-tion as it would any other patient who has had a

lapse in coverage. For non-emergency services, patients would have the option to either pay cash to see the physician or not be seen. The grace period issue applies only to exchange en-rollees receiving federal tax subsidies; however, information on whether or not they are receiv-ing subsidies will not be noted on their ID cards. (More information on the grace period issue can be found in CMA’s exchange toolkit, “CMA’s Got You Covered,” available free to members at www.cmanet.org/exchange.)

Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possi-ble, and making copies of the insurance card at the time of the visit.

Taking proactive steps to protect your prac-tice by preventing denials, delays in payment and disgruntled patients goes a long way to-ward ultimately saving time and money.

VErIFYING YOUr PATIENTS’ ELIGIBILITY AND BENEFITS IN 2014 MAY Save Your Practice Thousands of DollarsCmA STAFF

The beginning Of a new year means calendar year deductibles and visit frequency limitations

start over. Remember, with open enrollment there may be changes to patients’ benefit plans, or they

may even be insured through a new payer. Physicians are urged at this time of the year to be diligent

in verifying patients’ eligibility and benefits to ensure that you will be paid for services rendered.

2014 alSO bRingS a hOST Of OTheR challengeS ThaT cOuld affecT YOuR abiliTY TO be Paid:

• Medicare patients can modify their enrollment choices from October 15 through Decem-ber 7, allowing them to switch between Medicare fee-for-service and Medicare Advantage (MA), or switch from one MA plan to another.

• Under the Affordable Care Act (ACA), California opted to expand Medi-Cal eligibility to childless adults ages 19-64 with incomes up to 138% of federal poverty level, effective January 1, 2014. The state estimates an additional 1.6 million individuals may become eligible for Medi-Cal/Medi-Cal managed care under the ACA expansion.

• In 2013, over 900,000 children transitioned out of the Healthy Families program into Medi-Cal managed care, while another 274,000 transitioned from fee-for-service Medi-Cal into Medi-Cal managed care through the rural expansion project. Many of these enrollees tran-sitioned toward the end of 2013.

• With the ACA requirements on minimum benefit levels that must be offered by plans, ap-proximately 900,000 individuals have received policy cancellation notices from their cur-rent health plans. Many of those patients will have different plans and/or benefits effective January 1, 2014.

• Approximately 600,000 patients previously insured through the Low Income Health Pro-gram will be transitioned into Medi-Cal managed care plans on January 1, 2014.

• It is estimated that anywhere from 150,000 to 450,000 individuals will enroll in an ex-change plan through Covered California in 2014.

pRAC

TiCE m

AN

Ag

EmEN

T | FRO

NT O

FFiCE

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

BA

LAN

CE

| LiF

ESTY

LE &

WEL

LNES

S

What’s changed since then? Almost everything. Healthcare reform, EMR, ACOs, medical homes—and at the same time a major shift away from private practices.

Physicians are drawn to hospital or HMO employ-ment by reduced administrative responsibilities and overhead, more predictable hours or call schedules, and state-of-the-art diagnostic tools and medical re-sources. In gaining those advantages, many physi-cians have lost the autonomy and self-regulation they formerly had. However, while they may have committed to this new way of practicing medicine, it doesn’t necessarily mean they like it or that they’re

not experiencing worry and stress as a result.

uNpleAsANt side effeCts Of ChANGePhysicians who showed almost super-hu-

man capabilities to perform under stress dur-ing medical school are often surprised when stress takes a toll later in their careers. Doc-tors are not immune to change-related reac-tions, such as:

Resistance to change: Did you seize the last place on the sign-up list for Electronic Medical Record training?

health concerns: Does a level of stress that didn’t affect you as a medical student now cause symptoms ranging from headaches and digestive disorders to short temper and depres-sion?

decreased tolerance: Have your colleagues suddenly become idiots, your patients non-compliant and staff completely incompetent?

Self-protection and distrust: When asked to pitch in, have you become more apt to say, “What’s in it for me?” than “How can I help?”

There are many ways of responding to change—some healthier than others. Fighting the system is almost always a losing battle. The momentum for change in the medical workplace will continue. Some physicians are opting for flight—by retiring ear-ly or looking at non-medical or non-clinical careers. Yet, the vast majority are soldiering on.

Most physicians remain committed to the prac-tice of medicine—even though 87% reported being moderately to severely stressed or burned out on an

THE CHANGING FACE OF MEDICINE: How Is Change Affecting You?Liz FERRON, mSW, LiCSW

ManY PhYSicianS TOdaY feel that an implicit contract they made with society has been broken.

In a 2004 article published in the American Medical Association Journal of Ethics, the terms of that

contract were described: “Society granted physicians status, respect, autonomy in practice, the

privilege of self-regulation, and financial rewards on the expectation that physicians would be com-

petent, altruistic, moral, and would address the healthcare needs of individual patients and society.”1


average day in a representative survey conducted by Physician Wellness Services and Cejka Search in 2011.

ChANGiNG the WAy yOu ReACt tO ChANGe Change is inevitable but stress and worry aren’t. How do you manage a

situation or fact that can’t be changed? Start by challenging the assumption that there’s no way to modify or limit the extent of the change before you begin adjusting to it.

Healthcare administrators aren’t infallible. They may not be aware of potential downsides that seem evident to you—and may be open to sug-gested improvements in their plan. In our work with physicians, we advise them to:

• Beyourownadvocate• askforwhatyouwantandneed• suggestideasforworkingtogethermoreeffectively

The second phase of adapting to change begins as you explore what the future will look like with this change, accept the inevitability that change will occur, search for solutions that meet your needs and commit to making those changes.

• A study3 published in the Archives of Internal Medicine suggests that doctors who really believe in the core mission of their profession—a calling to help others—are more likely to be satisfied with their jobs. Remind yourself why you chose medicine, reflecting on the ways these elements are still a part of your daily work experience.

• Accept the fact that there is not going to be a perfect way to practice medicine right now. Many of the decisions you make related to your practice will have a positive side and a potential negative side. Make sure the scale is tipping toward your needs and interests being met.

• Join—or start—a provider support group or find a mentor or peer coach who can help you find and focus on the best approach for you.

Liz Ferron, MSW, LICSW, Senior Consultant and Manager of Clinical Services, Physician Wellness Services

1 Cruess, Sylvia R. MD, and Cruess, Richard L. MD Professionalism and Medicine’s Social Contract with Society, American Medical Association Journal of Medical Ethics/Virtual Mentor, April 2004, Volume 6, Number 4

3 Rasinski, Kenneth A. PhD; Lawrence, Ryan E. MD, MDiv; Yoon John D., MD; Curlin, Farr A. MD A Sense of Calling and Primary Care Physicians’ Satisfaction in Treating Smoking, Alcoholism, and Obesity, Archives of Internal Medicine. 2012; ():1-2. doi:10.1001/archinternmed.2012.3269

BA

LAN

CE

| LiFESTYLE & W

ELLNESS

WE TREAT

DOCTORS RIGHT!

Summit Lending is a direct lender, which specializes in assisting physicians with all their mortgage needs. Our programs are very aggressive. Following are features of some different programs:

1. Purchases with minimal to No Down Payment

2. Offering Lowest Interest Rates in the Market

3. More Lenient on Credit 4. As a direct lender, we close

loans fast and efficiently

The Best Always Deliver!!!

You may visit our website at www.gowithsummit.com or call us at the number below

TEL: (888) 762‐0220

NMLS: 339255 CA. DRE: 01864758

As heard on KFI


recycling Physicians to Meet the Future ShortageREBECCA OSTRANdER

all acROSS The United States, healthcare facilities are in need of doctors. Many of these are

community health centers with very diverse needs but without the ability to support a staff of spe-

cialists. In many cases, their needs would be met by the availability of full-time or even part-time

physicians with a broad range of medical skills. Unfortunately, this is just the kind of doctor that is

hardest to find, and it’s especially difficult for smaller medical centers without deep pockets and

fancy facilities to attract people from the limited pool of general practitioners available.

There is a current shortage of more than 33,000 pri-mary care physicians, a number that is likely to double in the next 10 years or so. If you want more alarming details, check out the statistics from the Centers for Dis-ease Control and Prevention (CDC). As of 2009-2010, specialty physicians outnumbered generalists, yet de-mand for the latter resulted in them working longer hours, including evenings and weekends, more than twice as often as specialists. However, according to the Association of American Medical Colleges (AAMC) Center for Workforce Studies, supply is falling well short of demand. Although annual medical school en-rollments are increasing, according to AAMC, first-year enrollments in 2013 were just under 20,000 (compare with the current PCP shortage alone), and more than half of those who graduate are likely to go into spe-cialties. Some of the PCP shortage has been met by foreign-educated physicians, physician assistants, and nurse practitioners, but the gap between supply and demand is still large and still growing.

Into this gap steps Physician Retraining and Reen-

try, Inc., or “PRR.” Founder Leonard W. Glass, MD, and his associates envisioned the ever-growing short-age of primary care physicians escalating with the ap-proach of the Affordable Care Act and its offspring, as well as the growing number of Americans eligible for Medicare. They also envisioned a solution: Get retired physicians to return to the medical workforce—even if only part time. But doing so means that they will need some retraining to learn about the most up-to-date drugs, equipment, and techniques, allowing them to strengthen their knowledge acquired years earlier. In the case of former specialists, they will need more generalized knowledge than they may have had since medical school. So now there’s a new need: re-edu-cation.

The founders brought in partners and consultants experienced in medical business management to help them get off to the right start. Both economically and in terms of geographic distribution of potential students, the obvious vehicle was the Internet. They collaborat-ed with the University of California, San Diego, and especially with two practicing faculty members Wil-liam Norcross, MD, and David Bazzo, MD, to develop a curriculum. Others at UCSD joined in to develop PRR’s educational materials, exams, and a compe-tence assessment required for graduation. The result is the only online educational retraining program de-signed to transform any doctor, regardless of specialty or field of practice, into an adult outpatient general practice physician.

Why would a specialist want to transform himself or herself into a general practitioner? There are any number of reasons—such as the surgeon whose auto accident left him with less-than-optimum manual dex-terity or the oncologist whose chain of terminally ill patients left her burned out and frustrated. But the larg-est pool of potential students are among the thousands of physicians who retired at a relatively young age, often because they wanted to take advantage of their retirement nest egg while healthy and active enough to enjoy it. Now, for one reason or another, they would like to re-enter the medical workforce without the

TRA

NSi

TiO

NS

| CA

REER

mA

NA

gEm

ENT


overwhelming demands of their own private practice. Some found out that their nest egg wasn’t going to last as long as they were. Others got bored. But many just found themselves missing interaction with patients and the fulfillment they found from helping those in need of their services. But their “time off” has left them somewhat out of touch, and they just don’t know how to make the leap back into the healthcare workforce.

PRR’s online educational module makes it possi-ble for such doctors to make the transition affordably and in a reasonably short time. Because the program is self-paced, it can accommodate individual personal demands and limitations, so the time frame depends on the student, but a determined person can com-plete the course in less than four months, with a full year as a maximum. Although the course is Internet-based, faculty are available for direct assistance via email. Students must pass an exam for each class and at the end for the entire course (including a one-day, on-campus practical exam), leading to a certificate of completion and around 100 hours of CME cred-its from the UCSD School of Medicine. Any program graduate wishing to polish his or her newly acquired

skills in a medical environment prior to re-entering practice can take advantage of a shadowing program offered as a supplement to the PRR coursework. And when all that is done, PRR’s job placement service can assist them with interviews for part-time or full-time adult outpatient general practice jobs virtually anywhere in the United States, from federally and pri-vately funded community clinics to medical schools, VA facilities, and retail providers. Learn more about PRR from their website, prrprogram.com.

Although the anticipated main audience for PRR is retired physicians, it is certainly not the only one. Any medical practitioner who wants more exposure to the field of outpatient general practice will benefit from PRR’s program. The ultimate goal is to reduce the shortage of general practitioners looming in the future of U.S. medical services. This promises to be one step in that direction.

Rebecca Ostrander, Marketing, Physician Retraining & Reentry, [email protected] References “Ambulatory Care Use and Physician Visits” FastStats web page, Centers for Disease Control and Prevention: http://www.cdc.gov/nchs/fastats/docvisit.htm; “Workforce Data and Reports” web page, Center for Workforce Studies, Association of American Medical Colleges: https://www.aamc.org/data/workforce/reports; Physician Retraining & Reentry website: http://prrprogram.com/

TRAN

SiTiON

S | C

AREER m

AN

Ag

EmEN

T

We train all specialties on-line for adult outpatient general practice.

BACK TO WORK1 OR MORE DAYS/WEEK ?

In collaboration with UNIVERSITY OF CALIFORNIA

@ SAN DIEGO SCHOOL OF MEDICINE

www.prrprogram.com

(858) 240-4647


phYS

iCiA

NSN

EWSN

ETW

ORk

.CO

m |

NEW

S iN

REV

iEW

A SERVICE OF The LOS ANGeLeS COuNTY MeDiCAL ASSOCiATiONPNN | local•timely•relevant

reportingontheeconomicsofhealthcaredelivery

readfullstoriesandsuBscriBetothepnnenewsBulletinsatwww.physiciansnewsnetwork.com

READ thE full stoRy on pAgE 28Questions remain about Dual-eligibles project

Los Angeles County Medical Association (LACMA) and Los Angeles County Podiatric Medical Society (LACPMS) held a meeting recently to bring

physicians up to date on the issues regarding the status of the Cal MediConnect demonstration proj-ect in Los Angeles County that affects the dual-eli-gible population.

Legislation aimed at repealing the medicare sGr approved

December 12, the Senate Finance Committee and the House Ways and Means Committee un-veiled revised legislative proposals to repeal the Medicare sustainable growth rate (SGr) and estab-lish a new payment system.

According to CMA, this is good news for Cali-fornia physicians, who have been working with both committees to revise the initial draft of the legislation since it was introduced in October.

Local Doctors explore alternative practice model

Dozens of Los Angeles County physicians re-cently attended an event to learn more about con-cierge medicine, an alternative practice model that is being discussed more broadly in light of health reform.

In concierge medicine, patients pay a month-ly or annual fee for enhanced services, including same-day appointments, 24/7 access to their doc-tor, email consultations and longer appointment times. To make more time for patients, concierge doctors typically carry smaller patient loads.

A survey conducted by Merritt Hawkins of 13,575 physicians nationwide showed that 6.8% of doctors are considering switching to concierge medicine.

cedars-sinai strikes Deals with UcLa, sports medicine Groups

Longtime rivals Cedars-Sinai Medical Center and UCLA Health System recently announced an unprecedented partnership to open a 138-bed rehabilitation facility in Century City, according to news reports.

Cedars-Sinai also announced they have signed a letter of intent to form a new partnership with two sports medicine groups.

Both deals are a sign of the times where big in-stitutions, faced by the pressures of health reform, are pooling their efforts to provide patient care to cut costs.

competition for patient safety award open to residents and young physicians

The Doctors Company Foundation in partnership with the Lucian Leape Insti-tute at the National Patient Safety Foundation (NPSF)

is accepting entries from medical students and resi-dents for its 2014 Young Physicians Patient Safety Award.

Entrants must submit a 500- to 1,000-word essay describing an instructional patient safety event they experienced during a clinical rotation that resulted in a personal transformation. Essays are due by 5 p.m. (ET) Feb. 3, 2014. More information and online entry forms are available at http://bit.ly/PtSafetyAward

A total of six $5,000 awards will be given and the winners will also receive travel to the Association of American Medical College’s Integrating Quality meeting June 12-13, 2014, in Chicago, where, where the awards will be presented.

The contest is sponsored by The Doctors Compa-ny Foundation in partnership with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF). Entries will be judged by a panel selected by the NPSF.

NEWS NETWORK

NEW

S iN REViEW

| phYSiC

iAN

SNEW

SNETW

ORk.C

Om

Low Latino exchange enrollment concerns Lacma, other health Leaders

The currently low enrollment numbers of Spanish speakers into the California health ex-change has Latino lawmakers and health lead-ers, including LACMA’s chairman of the Latino advisory committee, voicing concerns over cur-rent tactics being used to reach the Spanish-speaking community in Los Angeles County.

According to news reports, fewer than 1,000 Spanish speakers signed up in the health law’s first month.

Advocates have identified the following problems, which they believe contribute to Cal-ifornia’s lagging Latino enrollment: There are no paper applications in Spanish for a popula-tion that doesn’t have access to computers or isn’t using them. There are not enough bilin-gual phone operators to help Spanish speak-ers. There aren’t enough counselors to explain the process in person in clinics and community settings to a population that often doesn’t trust people with their personal information.

Usc’s keck medicine outpatient clinic has new Location

Keck Medicine of USC recently opened its relocated 7 , 0 0 0 - s q u a re - f o o t downtown outpatient clinic on Flower Street,

which will offer thousands of newly insured and existing patients in Los Angeles convenient ac-cess to a range of medical services.

The clinic, located on 830 S. Flower St., will focus on primary care but also offer patients orthopedic surgery, imaging and digital mam-mography, cardiac stress testing and a pharma-cy, according to news reports.

The clinic, which for the past nine years was located at 333 Hope St., will have a staff of mul-tiple doctors, one registered nurse, two licensed vocational nurses and two front office staff mem-bers who are expected to serve some 15,000 people in 2014, according to reports. That is up from 1,800 patients a year at its old location.

The clinic will have nine exam rooms and rooms for X-rays, mammograms and cardiac testing.

READ full stoRiEs At physiciAnsnEwsnEtwoRk.com

uCi Med Center Testing Google Glass Apps

Kyle Samani, founder and CEO of Pristine, a start-up company that develops Google Glass apps for sur-geries, hopes that doctors and nurses at the University of California, Irvine, Medical Center who are currently test-

ing his devices in live surgeries will see it — literally — as the future of healthcare. UC Irvine surgeons are currently using Pristine’s EyeSight, which streams live audio and video to and from Google Glass devices, smartphones and tablets, for teaching and training and remote con-sults, Samani told PNN.

happtique Announces inaugural Class of Certified Health Apps

Happtique, a mobile health solutions company, an-nounced it has certified 19 health and medical apps through its Health App Certification Program (HACP). This inaugural class is the first group of apps in the coun-try to pass the rigorous HACP standards announced earlier this year. Each app that receives certification has passed both technical testing—the verification of priva-cy, security, and operability standards by global testing leader Intertek—and content testing, as completed by relevant, independent clinical experts.

Wellness Reinvented With Smart Socks

Heapsylon (the maker of Sensoria Fitness) is betting that in the near future most pieces of clothing will come with embedded microelectronics and sensors.

Heapsylon has taken this idea and developed a smart sock that works with an electronic anklet that snaps onto the cuff of the sock and transmits the info to a smart-phone app, providing real time guidance through audio cues during a workout.

The Sensoria Fitness app will be available for iPhone (iOS 6 and above), Android (OS 4.3) and Windows Phone 8.x and provide home dashboard used without a phone.

readfullstoriesandsubscribetothepnnenewsBulletinsatwww.physiciansnewsnetwork.com/ipnn

reportingonthetechnologyofhealthcaredelivery


FEAT

URE

| Th

E B

USi

NES

S O

F B

EiN

g A

dO

CTO

R

The

businessof being a docTor

BY mARiON WEBB

Healthcare reform will bring sweeping changes

for physicians this year. While many uncertainties

remain, undoubtedly certain effects of the Afford-

able Care Act (ACA)—from doctors being rewarded

for providing quality care based on outcomes to the

rising influx of newly insured—will change the way

physicians run their medical practices. In this article,

industry experts and physicians offer their tips on

how doctors in private offices can implement a team

approach and social media marketing and use tech-

nologies such as electronic medical records and apps

in order to continue to run a successful business.


ElECtronIC MEdICAl rECordsThe Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the govern-

ment’s 2009 economic stimulus package, set the groundwork for healthcare reform. It provided $27 billion in Medicare and Medicaid incentive payments to go to doctors and hospitals that

adopted electronic medical records (EMR) under federally established guidelines, according to news reports.To receive payments, doctors and hospitals must show that their systems are being used to improve patient

care. Experts say that doctors who began participating in the program can receive as much as $44,000 from

Medicare and up to $63,750 from Medicaid. Furthermore, doctors who choose to participate in the Medicare program after 2015 can also receive pay-

ments, but at a reduced rate.As of December 2013, healthcare experts estimated that two-thirds of family doctors were using electronic

healthcare records.

William Averill, MD, LACMA’s District 9 president and a cardiologist in private practice in Torrance, consid-ers himself an early adopter of electronic medical records.

“I’m also on the IT committee for the Torrance Memorial Medical Center,” Averill said. “I can download all hospital records and do 95% of all prescriptions via e-prescribing, which is more accurate and more rapid (than writing them by hand).”

He said, to date, his patients don’t have access to the EMR portal at the practice. Under meaningful use requirements, physicians who implement a patient portal—for giving patients access

to their medical records, making appointments or getting prescription refills—have to consider privacy issues.Experts believe that patients will be hosted on the practice’s website, which would lend itself to doctors

implementing mechanisms for allowing patients to do things from scheduling appointments to sending secure emails.

One IT expert recommends that solo practitioners or small medical practitioners should outsource most of their technology needs altogether.

Kyle Samani, founder and CEO of Austin, Texas-based start-up Pristine, which develops Google Glass apps for surgeries that are currently being tested at the University of California, Irvine, Medical Center, said “small doctor practices spend too much time in trying to use EMRs and managing EMRs.”

“Athena Health (which provides cloud-based services for EMR, practice management and care coordina-

FEAT

URE

| Th

E B

USi

NES

S O

F B

EiN

g A

dO

CTO

R


tion) is among the biggest medical billing company in the country,” Samani said. “I think that kind of wholly managed model is the way to go for small medical practitioners.”

He feels that companies that specialize in all issues related to EMRs—from practice management to patient engagement—provide doctors’ offices a service that’s more cost-effective and efficient.

“This is all cumbersome overhead of doing business that can be outsourced,” Samani said. One doctor, however, noted that he still prefers keeping his own EMR system, because it allows him to have

more control over billing. Ultimately, he said, doctors are held responsible for inaccuracies in billing.

AppsWhile the idea of medically prescribed apps is still relatively new, some people believe that they may pro-

vide an answer to tracking especially chronically ill patients. This could help reduce doctor office visits while improving outcomes with doctors tracking patients without

actually seeing them.Among the pioneers in the prescription-app field is a company called WellDoc.Its DiabetesManager system, which patients use through their smartphone apps, cell phone or desktop

computer, collects information about a patient’s diet, blood sugar levels and medication regimen.Patients can enter the data manually or link their devices wirelessly with glucose monitors and then also get

advice on best foods after recording glucose levels. The U.S. Food and Drug Administration cleared the device, and two insurance companies agreed to pay the

bill for patients whose doctors ask them to use the device, according to published reports.However, issues regarding safety and privacy remain.Experts believe that apps and Web-based information have given physicians—especially younger ones

who gravitate toward technologies—new ways to diagnose and treat disease and communicate with patients. While there is no shortage of innovators creating apps, one company, MobileHealthMarketplace.com.,

recently created a directory of mobile health and medical apps focusing on solutions that connect patients and medical professionals with company health, wellness, workers’ compensation and safety programs.

A prescreened directory of apps is grouped into 33 categories. They focus on the treatment of chronic diseases, illnesses and injuries, including diabetes, cancer and heart

conditions; employer and individual health and wellness efforts; and new medical technology platforms.

ThE B

USiN

ESS OF B

EiNg

A d

OC

TOR

| FEATURE


For each app listed, MobileHealthMarketplace.com summarizes key information in a standard format, which makes it easy to compare different options.

One of the biggest challenges for doctors, Samani predicts, will be trying to find apps they’d actually want to recommend to their patients in the ever-growing sea of available medical apps.

His recommendation: “Try them on your own and use ratings to find good apps.”

tEAM-bAsEd ApproACHThe rising emphasis on a team-based approach where doctors work as part of a team to deliver high-quality

care while improving efficiencies is often part of the discussion in hospital settings. But experts believe that the same approach has a place in medical practices too.One way to put the model into practice is to get the back office and front office to work more efficiently

together to address patient inquiries, from booking appointments and pricing of medical procedures to payment options.

For others, a team-based approach could mean creating a multidis-ciplinary practice where doctors work side-by-side with other health professionals, such as registered dieticians who can counsel patients on their dietary needs, acupuncturists and chiropractors.

Dr. Emil Avanes, who opened his Glendale-based multidisciplinary practice, Harmony Health MD, last September, considers this chang-ing healthcare environment a good time for doctors to go it alone.

“The previous model is being changed and is asking every single doctor how we can best take care of our patients, and those who figure it out will be rewarded in the future,” he said.

The multispecialty group, Caduceus Medical Group, announced last month that it will open an all-nurse-practitioner women’s clinic in Yorba Linda.

The new clinic will be staffed by three female nurse practitioners who will assist patients with basic medical services, such as well-

women exams and physicals, which will be covered by insurers under the ACA.Gregg DeNicola, MD, CEO and chairman of Caduceus Medical Group, which operates sites in Yorba

Linda, Irvine and Laguna Beach, said the ACA with its focus on containing cost while providing quality care, reimbursement issues and the rising influx of newly insured women seeking preventive care all played a role in the decision to open up an all-nurse-practitioner clinic.

“When we tried to staff the women’s clinic with two full-time doctors, it was very difficult to recruit and make financial sense,” DeNicola said. “With government payers paying sub-optimally, private health plans cutting back and the exchanges in California paying just a little over Medi-Cal, we made the choice to recruit nurse practitioners.”

DeNicola said that nurses will refer patients who require the attention of a physician to the gynecologist and family doctor on staff.

He predicted that patient volume will rise starting this January when health reform kicks in and women, especially those who weren’t insured or were underinsured in the past, will be able to seek preventive care under their health plan.

MArkEtIng tHrougH soCIAl MEdIAExperts believe that doctors will need to become more business savvy to be successful and think of their

patients more as customers.

FEAT

URE

| Th

E B

USi

NES

S O

F B

EiN

g A

dO

CTO

R

“the previous model is being

changed and is asking every single

doctor how we can best take care of

our patients, and those who figure it

out will be rewarded in the future”

JANUARY 2014 | 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

With consumers becoming more vocal in how they want to spend their healthcare dollars and increasingly turning to the Internet to do “comparison shopping” for pricing of medical care, physicians who take the initia-tive in getting patients involved in their own health and well-being will have a competitive edge.

This also means that reputation management will become increasingly important.Experts predict that consumers will pick doctors based on reviews just like they would a restaurant or movie.There are various health consulting and IT companies specializing in helping doctors improve and manage

their online presence to retain existing patients and draw new ones as competition rises.With 30% of practices’ revenue stream coming from patient responsibility—including copays, deductibles,

co-insurance and self-pay for services, practices have a responsibility to their patients to collect all their rev-enue to which they are entitled.

At the same time, practices that offer more transparency upfront on pricing for different procedures and services could also have a competitive edge.

This is a principle that the Caduceus Medical Group has long believed in, according to Tina Franklin, Ca-duceus’ marketing director.

“Under the Affordable Care Act, a lot of services will be covered under preventive benefits,” Franklin said. “But we have always provided a cash price list on our website.”

On the website, the group said (as of December 17) that “cash prices offered require payment at the time of service, and are available to only those patients without health insurance coverage for the service.”

Among the services offered are a routine office visit, which costs $89, a well-woman exam for $150 and a removal of a wart, which costs $139.

With private companies increasingly publishing pricing and price comparisons for medical procedures in different cities, economists believe that more hospitals and doctors will provide patients with detailed price lists upfront.

To draw patients in the rapidly changing health environment, more doctors are also expected to use social networking to market their practices.

Indeed, experts say that doctors who write blogs providing critical education to patients can drive traffic to their website and ultimately patients into their practices.

Some people see Facebook as another great vehicle for doctors to announce promotions and news, and promote pages as well as provide free medical information.

Engaging patients will be key in the new healthcare environment, so will EMRs and other innovative tech-nologies.

But no technology can be a substitute for physicians, said Kourosh Parsapour, MD, who is the CEO of healthcare technology firm 5plustherapy.com.

“Telemedicine is like any other communication tool, like a telephone,” Parsapour said. “Telemedicine is neither designed nor meant to replace a healthcare provider—it relies on the presence of a trained individual.”

While DeNicola hopes his new all-nurse-practitioner group will pave the way to continued successes, he also relies on physicians to serve patients with more complex medical needs.

“The ledger, the documentation requirements with EMRs and the ad-ministrative demands make financial success with any privately owned group very challenging,” he said.

Still, Averill said in spite of all the changes ahead, he remains com-mitted to staying in private practice.

“I just signed another 10-year lease,” Averill said. “I love having my own practice and the interaction with patients and staff that private prac-tices offer.”

ThE B

USiN

ESS OF B

EiNg

A d

OC

TOR

| FEATURE


Cal MediConnect: rebalancing California’s Long-Term Support and Services BY JASON BLOOmE

PhYSicianS and healThcaRe professionals who treat dual-eligibles (patients

receiving Medicare and Medi-Cal) can expect big changes when California, as part

of the Affordable Care Act, implements Cal MediConnect (CMC) in 2014. CMC is

a three-year pilot program in eight counties (Los Angeles, Riverside, San Bernardi-

no, Orange, San Diego, Alameda, Santa Clara and Mateo) in which an estimated

456,000 dual-eligibles will be contracted with healthcare plans (HMOs) to manage

their care services.

Medi-Cal services (including long-term care and

In Home Supportive Services, etc.) for all dual-eligi-

bles will be managed by a CMC HMO. Medicare

services will be provided by a dual-eligible’s existing

Medicare provider or if he/she chooses, by the CMC

HMO as well.

CMC is expected to improve quality outcomes,

streamline healthcare delivery, and contain Medi-

care/Medi-Cal costs. CMC’s primary goals include

enhancing the ability of consumers to self-direct their

care and rebalancing California’s long term support

and services (LTSS), from skilled nursing facilities

(SNFs) to home and community base care settings,

such as Residential Care Facilities for the Elderly

(RCFEs).

Small RCFEs comprise a large part of California’s

care continuum. Of the estimated 7,500 RCFEs in

California, 80% are houses where two staff assist four

to six residents with 24-hour custodial care needs

(e.g., require help with dressing, bathing or incon-

tinence; are nonambulatory; have dementia or Al-

zheimer’s).

The CMC Memo of Understanding allows HMOs

to pay for care services provided in RCFEs (8 out of 10

dual-eligibles are 65+). Dual-eligibles migrating to

these settings will come from home (e.g., when their

care needs exceed the maximum allowable IHSS

hours: 283 hours/month or nine hours/day); from

hospitals (e.g., at the point of discharge, when they

require too much care to return home but do not need

skilled nursing care); and from SNFs (e.g., for patients

eligible for nursing home transition, also known as

Money Follows the Person - MFP).

California has a dismal record in regard to MFP

and has spent millions of dollars without producing

significant results. Since 2008, it has spent more than

$41 million in grants awarded the state by the Cen-

ters for Medicaid and Medicare Services and has only

transitioned 828 MFP patients (Kaiser Health News,

May 2012). In comparison, Texas, as of August 2012,

has transitioned more than 6,072 SNF patients back

into the community (Kaiser Foundation: Money Fol-

lows the Person Issue Paper, February 2013).

While not every eligible senior will want to partici-

pate with MFP, many, if given the choice, will choose

to receive their care in RCFEs. The 2008 California

Pathways/MFP study found in two of the participating

SNFs, a large percentage of patients (25% and 56%, re-

spectively) expressed a strong preference for transition.

The AARP/SCAN 2011 Long Term Care State Re-

port Card predicts, if California improved its perfor-

mance to the level of the highest performing state,

11,000 new users of Medi-Cal LTSS would benefit

from nursing home diversion and 9,800 current SNF

residents with low-level care needs would be eligible

for nursing home transition.

Paying for SNFs for patients who do not need to

be there will be an expensive proposition once CMC

HMOs, which are paid a capitated rate, are fiscally

responsible for a patient’s Medi-Cal expenses. Medi-

Cal currently reimburses SNFs $5,300/month. The

average cost for RCFEs is $2,200/month for a shared

room. Allowing current SNF residents or patients at

risk of institutionalization to use Medi-Cal dollars to

reside in RCFEs will save money and promote MFP

expansion in the future.

Community-based care funding will have other

positive outcomes as well. In 2013, the Centers for

Medicare and Medicaid Services (CMS) levied $227

million in Medicare fines against U.S. hospitals that

readmitted patients too soon after discharge (1 in 5

patients discharged from a hospital are readmitted

within one month). Low-income elderly patients who

bounce back to hospitals because they have insuffi-

cient care support at home would benefit from the

option of residing in RCFE settings.

Physicians and healthcare professionals often-

times have no choice but to recommend SNFs for

low-income patients who require 24-hour custodial

care but do not have skilled nursing needs (e.g., have

a G-tube, IV, ventilator, require rehabilitation). CMC

offers the bright promise of change in the future: a

chance for California to rebalance its long-term sup-

port and services, the ability of consumers to self-di-

rect where they would like to receive their care and,

for thousands of low-income seniors eligible for MFP,

pathways from institutions back into the community.

CMC passive enrollment begins in April 2014 and

will roll out over a 12-month period. More information

about CMC can be found at: www.calduals.org.

Jason Bloome is owner of Connections. More about us at 800-330-5993 or www.carehomefinders.com.

CMC offers the bright promise of change in the future: a chance for California to rebalance its long term support and services, the abil-ity of consumers to self-direct where they would like to receive their care and, for thousands of low-income seniors eligible for MFP, pathways from institutions back into the community.


UN

iTEd

WE

STA

Nd

| AT

WO

Rk F

OR

YOU

CMS Publishes 2014 Medicare Fee ScheduleOn nOVeMbeR 27, the Centers for Medicare and Medicaid Services (CMS) released the 1,369-

page 2014 Medicare Physician Fee Schedule final rule, which was published in the December 10

Federal Register. Most provisions take effect January 1, 2014, although a few issues are open for

public comment by January 27, 2014. The American Medical Association (AMA) has published a

summary of the final rule. Below are a few key points:

Although the final rule contains the 23.7% phy-

sician payment cut called for under the sustainable

growth rate (SGR) formula, Congress has also as part

of the federal budget negotiations agreed to a three-

month SGR patch that will stop the cut that would

otherwise take effect January 1, 2014—and replace

it with a 0.5 percent payment raise—which will give

lawmakers a little more time to finalize the long-term

Medicare payment reforms.

After strong opposition from organized medicine,

CMS will not be capping non-facility practice expens-

es for over 200 physician services at the lower rates

for ambulatory surgical centers or hospital outpatient

departments. The caps were below crucial supply

costs for some procedures.

CMS plans to pay for monthly chronic care man-

agement services beginning in 2015, at about $82

per month per beneficiary (using the 2013 conver-

sion factor).

For Physician Compare, CMS will begin reporting

in 2015 measures collected for groups that participate

in the 2014 Group Practice Reporting Option (GPRO)

of the Physician Quality Reporting System (PQRS).

CMS plans to correct errors identified during the pre-

view period, prior to publication.

2014 is the last year physicians can qualify for an

incentive payment of 0.5 percent under PQRS; start-

ing in 2015, there will only be penalties for failure

to achieve satisfactory reporting. Physicians will only

have to report on 50 (versus 80) percent of applicable

patients. Individual reporters must report on at least

nine measures to receive incentives, and must report

on more than one measure or measures group—and

cannot use the administrative claims option—to avoid

the PQRS penalty. Measures groups will only be re-

portable via registry. The GPRO will still be available

to practices of 25-99 eligible professionals.

Over strenuous objections from organized medi-

cine, CMS will expand the Value-Based Payment

Modifier to groups of 10 or more physicians and oth-

er health professionals in 2016. Based on how their

2014 costs and quality compared to national aver-

ages, physicians in these groups could see a yet-to-

be-determined increase or cuts of up to 2 percent in

their 2016 payments. CMS is required by law to apply

the Value Based Modifier to all physicians by 2017.


Duals Demonstration Project Delayed in Three Counties

The California Department of Health Care Ser-vices (DHCS) has delayed passive enrollment for three of the eight counties affected by the state’s “pilot project” to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three coun-ties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no ear-lier than July 1, 2014.

The project—known as Cal MediConnect—was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with dis-abilities. The program begins with a three-year demonstration project that would see a large por-tion of the state’s dual eligible beneficiaries transi-tion to managed care plans. The project will impact approximately 450,000 duals in eight counties – Al-ameda, Los Angeles, Orange, riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

Once the passive period begins, individuals in all counties except San Mateo will be automatically enrolled over a 12-month period based on birth month. (San Mateo will have a hard start date of January 1, 2014, rather than a 12-month rollout.)

Patients have the option to select a specific plan of their choosing or to opt out of the project by no-tifying the state of this choice.

For more information, visit www.cmanet.org/duals and www.calduals.org.

Unsuccessful Electronic Prescribers Face Payment Cuts in 2014Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013

Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule.

The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment.

If you believe this determination to be in error, CMS has implemented an informal review process through which reconsideration can be requested. Informal review requests will be accepted through February 28, 2014, and can be submitted via email only to [email protected]. CMS will make an informal review decision within 90 days of the original request. Please note that the informal review decision will be final, and there will be no further review or appeal.

For complete instructions on how to submit an informal review request, see CMS’s “2014 eRx Payment Adjustment Informal Review Made Simple.”

AT WO

Rk FOR YO

U | U

NiTEd

WE STA

Nd

Congress Approves A Three-monTh mediCAre pAymenT UpdATe UnTil sgr Fix is CompleTedCongress has adopted a 0.5 percent

update to Medicare payments for three

months, following a bipartisan vote

of 64 to 36 in the U.S. Senate. The

payment increase staves off a 24%

cut required by the failed sustainable

growth rate (SGR) formula and buys

three months for Congress to com-

plete its work on SGR repeal legisla-

tion without further disruption to the

Medicare program. The House Ways

and Means Committee and the Senate

Finance Committee recently passed

bills to eliminate the SGR, which has

plagued policymakers and physicians

for more than a decade, and replace

it with a stable payment system for

future generations of physicians and

the patients they serve.


ceo’s letter

ASS

OC

iATi

ON

hA

ppEN

iNg

S | L

AC

mA

NEW

S

The affORdable caRe acT dOMinaTed Much Of lacMa’S iniTiaTiVeS in 2013

As we’re heading into 2014—the start of the most significant change in American medicine in more than half a century—we will continue our efforts to unite doctors all over Los Angeles County.

We will continue to fight for physicians’ rights and protect the patients they serve. I’m proud of the tremendous successes our association achieved last year and want to thank you

for your hard work. Your support is pivotal to our success. While there are too many accomplishments to list in this letter alone, I would

like to take this opportunity to thank our physician advisory committee members for all of their hard work.

LACMA’s committees are instrumental in representing the diverse interests of every practicing physician in Los Angeles County as well as our up-and-coming physicians.

In 2013, LACMA’s Latino Physician Advisory Committee developed an action-oriented agenda of projects that will lay the groundwork for this year.

The Committee’s participation in Covered California forums was pivotal to protect the interests of Latino healthcare professionals against the perils of nar-rowing networks.

For this year, LACMA’s African-American Physician Advisory Committee al-ready announced its plans to meet with key legislators, which will ensure that our voice will be heard. Among physicians’ ongoing concern: the state’s plan to re-duce certain Medi-Cal payments by 10%.

LACMA’s Women Physician Advisory Committee plans to focus on education, events and elections this year.

Women physicians in leadership roles is crucial to a united medical profession. LACMA will continue its efforts to increase overall membership as well. We

hope that large groups will continue to join our mission to advocate for the pa-tients we serve.

Last November, 200 physicians from Keck Medicine of USC, the university’s medical enterprise, joined LACMA—the largest group to join LACMA in the last 15

years. LACMA is now 200 members stronger.We will continue to raise awareness in the community. Our 2013 HealthCare Awards and physician honorees elevated LACMA’s profile in Los Angeles

and helped us cultivate the next generation of physicians who will practice medicine in our dynamic community.

This year, LACMA will continue its fight to address critical issues such as MediConnect and the looming fight to protect MICrA.

To do so effectively and successfully, we need the support of all physicians in Los Angeles Coun-ty. We hope that our efforts will inspire all physicians to help make our organization even stronger.

Let’s continue to inspire change by standing strong behind the NEW LACMA.

rocky Delgadillo

rocky DelgadilloChief Executive Officer


LAC

mA

NEW

S | ASSO

CiATiO

N h

AppEN

iNg

S

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 Power

Economic Services

Medline & Enviromerica

Additional Discounts & Savings

Free Continuing Medical Education

Legal Assistance

Events

Jury Duty Assistance

Educational Resources

State-of-the-Art Communication

LACMA and CMA are distinguished by their successes. Dual membership provides for legislative, legal, and regulatory advocacy on behalf of the physicians of California.

CMA GETS YOU PAID! With over $7 Million recovered in unpaid claims since 2010, you can’t afford not to join CMA!

Through an exclusive partnership with these carefully selected vendors, LACMA saves you up

to 45% on your medical supplies, equipment, and medical waste with compliance.

LACMA offers you additional discounts and savings on Insurance, UPS services, Staples office supplies, Financial Planning, and more!

LACMA provides access to relevant and important online and local events that are CME-accredited. Topics include healthcare reform and issues facing physicians and their practices.

Up to date, relevant and easy to understand legal assistance that could save you thousands! Services include contract analysis, HIPAA Compliance, ACOs, buying and selling a practice, and much more!

Socialize and network with members of the medical community Find or create opportunities for your practice Engage with legislators and policymakers

CMA develops toolkits, guides, and resources on all things related to today’s changing healthcare landscape. These resources are at your fingertips and they are FREE with membership.

LACMA can help you: Reschedule your date

Relocate for your convenience Reduce number of call-in days from 5 to 1!

Access to exclusive information sources, including Southern California Physician Magazine, Physician News Network, Free TigerText subscription, and Find-a-Doc Phone App.

Los Angeles County Medical Association 707 Wilshire Blvd, Suite 3800 Los Angeles, CA 90017 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


District President Urges Membership for Stronger Voice

Dr. Nassim Moradi, chairwoman of LACMA’s Women Physician Committee and president of Dis-trict 10, which encompasses East/Southeast Los Angeles, hopes that more doctors will join LACMA to help support and address the many critical issues under health reform.

“The most important issue for us is to increase our membership so we can have a stronger and more unified voice,” Dr. Moradi told PNN. “We will have a better voice to approach MICRA and be ready for the Affordable Care Act.”

District 10, which includes cities such as Artesia, Bell, Bellflower, Montebello, La Mirada and Whit-tier, has a large underserved community that will become eligible for healthcare services under the Affordable Care Act.

Many of LACMA District 10 members work in hospital settings; others are in private practice.Dr. Moradi, who was born in Iran, is an anesthesiologist at Torrance Memorial Medical Center. She

earned her medical degree at Tehran University of Medical Sciences in 2000 and completed her post-graduate residency in surgery and anesthesiology at King/Drew Medical Center in Los Angeles and Harbor-UCLA Medical Center.

Dr. Moradi’s sister is also a physician in LA. Both women grew up with a physician father, an obste-trician/gynecologist and clinical professor at Tehran Medical School.

“He introduced me to the world of medicine,” Dr. Moradi said. “Through his experiences, I learned the joys and responsibilities of a physician and the difference that one can make in people’s lives, often the difference between life and death.”

Los Angeles County Medical Association (LAC-MA) and Los Angeles County Podiatric Medical So-ciety (LACPMS) held a meeting last week to bring physicians up to date on the issues regarding the status of the Cal MediConnect demonstration proj-ect in Los Angeles County that affects the dual-eli-gible population.

Jane Ogle, deputy director of the department of Healthcare Delivery Systems, answered ques-tions raised by physicians about the pilot project, such as passive enrollment strategy, losing pa-tients during the transition period, lack of provider education about the process, as well as reimburse-ment fees.

In terms of passive enrollment, Ogle empha-sized that patients have the option to choose the enrollment plan they want to be in (L.A. Care, Healthnet, or other participating plans) within the first 30 days; otherwise they will be passively en-rolled in a plan.

Dr. Anantjit Singh, who attended the meeting, brought up concerns about patients and physi-cians receiving information that seems to com-municate the message that patients will lose their health care if they do not enroll in Cal MediCon-nect. The phone calls are supposedly being made by the health plans.

Ogle said that no one should be receiving any-thing official from Cal MediConnect yet, so any communications of that nature cannot be coming from the department.

Alberto Tovar, COO of LACMA, encouraged physicians to contact LACMA when these cases occur so LACMA can advocate for physicians and their patients.

Another issue addressed by physicians during the meeting was the need to raise reimbursement fees when asked to see more patients and provide quality care. Ogle indicated that these questions should be brought up with the health plans that will be participating in Cal MediConnect.

While Ogle did attempt to ease some of the concerns, it was clear that more dialogue is need-ed.

LACMA and the health plans will continue their communication regarding this issue so that physi-cians know exactly how care will be handled for the patients who will be enrolled in Cal MediConnect.

Ogle also reviewed the history of Medi-Cal, and a process of expanding Medi-Cal managed care across the state. According to Ogle, “orga-nized care provides better care and services” and the purpose of the Cal MediConnect program is to integrate Medi-Cal and Medi-cal services.

Questions Remain about dual-eligibles Project

ASS

OC

iATi

ON

hA

ppEN

iNg

S | L

AC

mA

NEW

S


LAC

mA

NEW

S | ASSO

CiATiO

N h

AppEN

iNg

S

For a copy of your renewal invoice please email Margaret Vieira, [email protected]

How to renew:

Call: Margaret Vieira, 213-226-0393

Renew online at lacmanet.org/Membership/Renew Your medical license number will act as your login

Mail your invoice and payment to:

707 Wilshire Blvd, Suite 3800; Los Angeles, CA 90017

By renewing your dues, you will continue to receive:

Legislative Advocacy—Continuous fight to protect the medical profession from current challenges such as MICRA, Dual Eligibles, and the Health Benefits Exchange Access to documentation to help you be ready for changes in the healthcare landscape Free Reimbursement Assistance—Get your share of the over $7 million recovered since 2010 unpaid claims. Free Jury Duty Assistance—Your time is valuable! Maximize your flexibility and reduce your changes of reporting when scheduling jury duty service. Up to 30-40% savings through LACMA’s Group Purchasing Organization and Waste Manage-ment Company Free and low cost access to events including CME events, Mixers, Training Workshops, and Webinars for you and your staff

Renew your dues today!

Los Angeles Count y Medical Associa t ion

For our Valued Members

FREE DUES! Renew your 2014 dues by

December 31st, 2013 and be en-tered in a drawing to win FREE

dues for 2014!

S A N D I E G O

O R A N G E

L O S A N G E L E S

P A L O A L T O

S A C R A M E N T O

800-356-5672 www.CAPphysicians.com

Medical Professional

Liability Protection, and more!


to pLace a cLassifieD aD visit www.physiciansnewsnetwork.com OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

JOB

BO

ARd

| C

LASS

iFiE

d

118 cOnSulTing & SeRViceS

TRACY ZWEIG ASSOCIATES, INC.

• Physicians• Nurse Practitioners • Physician Assistants

LOCUM TENENSPERMANENT PLACEMENT

800-919-9141 • 805-641-9141FAX: 805-641-9143

email: [email protected]

135 legal SeRViceS

LEGAL REPRESENTATIONFOR PHYSICIANS

Former Deputy Attorney General, Law Professor & Administrative Law Judge specializing in Administrative & Medical Board matters.

Free initial consultationRONALD S. MARKS

A Professional Law Corporation2625 Townsgate Road, Suite 330,

Westlake Village, CA 91361

(818) [email protected]

205 Office fOR leaSe/ SubleaSe/ShaRe

520 OPeningS—PhYSicianS

Practice Appraisal & SalesPartnership Buy-In / Buy OutSupporting Southern California

Physicians Since 1983Call for a Courtesy Consultation

818-693-7055

Shorr Healthcare Consulting

Consultants to Healthcare Providers

[email protected]

ONLINE. IN PRINT. ONE PRICE.

PLaCE YOuR CLassIfIED aD TODaY!Visit the aLL NEW

PhYsICIaNsNEWsNETWORk.COm

single medical office building for lease in south gate

ample parking, available to move in, call 714-833-7573

medical condo for sale or lease

in torrance 90503. Renovated, ready for oc-cupancy, 287 SF on 1st floor with its own restroom. Agent David 310.933.5530 [email protected]


adVeRTiSeR index

Advanced Radiation Center ....................................................................................3

Cooperative of American Pbysicians .......................................................................29

Marsh ...................................................................................................................C4

NORCAL ...........................................................................................................C2

Office Ally .......................................................................................................... C3

Physician Retraining & Reentry ............................................................................13

Summit Lending ....................................................................................................11

CLA

SSiFiEd | JO

B B

OA

Rd

TRACY ZWEIG ASSOCIATES, INC.

• Physicians• Nurse Practitioners • Physician Assistants

LOCUM TENENSPERMANENT PLACEMENT

800-919-9141 • 805-641-9141FAX: 805-641-9143

email: [email protected]

to pLace a cLassifieD aD visit www.physiciansnewsnetwork.com OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

540 lOcuM TenenS aVailable

radiologistBoard certified. Have own malpractice insurance. Available for part-time posi-tion or film reading. Call 310-477-4257.

1/14

530 OPPORTuniTY WanTed

film readingCarl H. Boatright, MD, DABR, 30 years’ experience, rapid turn-around. We are now accepting Teleradiographs for General X-ray and General Ultrasound examinations. 866-723-2081.

PM Marketplace

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

current practice

• Flexible schedule, complete autonomy

• No Call

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


Sources: Deloitte 2013 Survey of U.S. Physicians; Physician adoption of health information technology:

31%

BY

ThE

NU

mB

ERS

| Th

E B

USi

NES

S O

F B

EiN

g A

dO

CTO

R

The HIT journey is expensive, and costs go beyond vendor contracts for hardware, software, and tech-nical support. The lion’s share of HIT costs is operational - in partic-ular, eliminating the major drivers of avoidable costs, such as redun-dant processes and paperwork, quickly and without disruption.

Physicians identify the trade-offs between larger (e.g., large medical groups, health systems, hospitals, and health insurance plans) versus solo practices: Larger practices are perceived to be better placed to secure superior third-party payer contracts and offer the greatest fi-nancial success potential, whereas solo practices are perceived to of-fer greater clinical autonomy.

By The NumBers

ehrs

runningaBusiness 1%

Only 1% physicians currently satisfied with practicing medi-cine find running a business the most satisfying factor about practicing medicine

HealthInformationTechnology

31% of solo practi-tioners have an EHr system that meets MU Stage 1 require-ments, compared to 62% of midsize practices, and 82% of larger practices.

73% of all physicians believe that HIT will improve the quality of care provided in the longer term – higher among physicians with 10 or less years in practice (81%) and those in larger practices (80%)

73%

$xx

65436 CMA/Los Angeles LTD (1/14)Full Size: 8.375” x 10.875" Bleed: 8.625” x 11.125” Live: 7.275” x 9.825"Folds to: NA Perf: NAColors: 4-Color Stock: NA Postage: NA Misc: NAM

ERCER

SponSored by:

65436 (1/14) Copyright 2014 Mercer LLC. All rights reserved.

Mercer Health & benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • [email protected] • www.CountyCMAMemberInsurance.com

UnderwrItten by:

New York Life Insurance CompanyNew York, NY 10010 on Policy Form GMR

Learn more about this valuable plan today!——————————————————

Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at:

800.842.3761——————————————————

OR SCAN TO LEARN MORE!

The pracTice was jusT beginning To Take off…

We work to protect you.

you work to protect your patients.

as a physician, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

that’s why the LACMA/CMA sponsors a Group Long-term disability program underwritten by new york Life Insurance Company:

• benefits not tied to a practice, giving you more flexibility with potential career changes

• benefit payments that are 100% tAX-Free — when you pay premiums yourself

• High monthly benefits up to $10,000

• protection in your medical specialty for the first 10 years of disability

with this critical protection, you’ll have one less thing to worry about until your return.

the Association Services division of Marsh has moved to Mercer, both part of Marsh & McLennan Companies.

65436 Los Angeles CMA Jan LTD Ad.indd 1 12/10/13 10:21 AM