January 2015 | Physician Magazine

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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 State of Healthcare in California

T H E B U S I N E S S O F H E A L T H C A R E I N 2 0 1 5

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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.

JANUARY 2015 | 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 146 Issue 1

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COVER STORY

10 THE STATE OF HEALTHCARE IN CALIFORNIA

An in-depth look at the hottest issues affect-ing California physicians and tips on how you can prepare for anticipated changes, challenges and opportunities ahead.

THE BUSINESS OF HEALTHCARE IN 2015

8 Congress Passes Healthcare Provisions in Current Budget

16 Avoiding CMS Penalties for Noncompliance

20 Verifying Your Patients’ Eligibility and Benefits in 2015 Could Save Your Practice Thousands of Dollars

DEPARTMENTS FRONT OFFICE | PRACTICE MANAGEMENT

6 Diagnostic Error: The Most Common Allegation in Malpractice Lawsuits

ASSOCIATION HAPPENINGS | LACMA NEWS

22 Discovery Cube Los Angeles Opens Pedram Salimpour, MD, Wendy Greuel, Tim

McCallion and Melanie Coto Will Lead Board

16148

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. Statement of Ownership, Management, and Circulation: Publication Title: Southern California Physician. Publication Number: 1533-9254. Filing Date: 11/19/12. Issue Frequency: Monthly. Number of Issues Published Annually: 12. Annual Subscription Price: $39. Complete Mailing address of Known Office of Publication: 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Complete Mailing Address of Headquarters or General Business Office of Publisher: 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor - Publisher: Sheri Carr, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Editor: Tom York, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Managing Editor: 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017; Owner: LACMA Services, Inc. 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or more of Total Amount of Bonds, Mortgages, or Other Securities: None. Tax Status: Has Not Changed Dur-ing Preceding 12 Months. Publication Title: Southern California Physician. Issue Date for Circulation Data Below: September 2012. Extent and Nature of Circulation - 15a. Total Number of Copies: 5335 (avg)/5205 (actual); 15b1. 4712 (avg)/4774 (actual); 15b2. 0 (avg)/0(actual); 15b3. 0 (avg)/0(actual); 15b4. 0 (avg)/0(actual); 15c. 4712 (avg)/4774 (actual); 15d1. 0 (avg)/0(actual); 15d2. 0 (avg)/0(actual); 15d3. 0 (avg)/0 (actual); 15b4. 623 (avg)/431(actual); 15e. 623 (avg)/431(actual); 15f. 5335 (avg)/5205 (actual). 15g. 0(avg)/0 (actual). 15h.5335 (avg)/5205 (actual). 15i. 88.3 (avg)/89.6 (actual). 16a: Requested and Paid Electronic Copies: 6161 (avg)/7842 (actual); 16b. Total Requested and Paid Print Copes + Requested/Paid Elctronic Copies: 10,893 (avg)/12,616(actual); Percent Paid and/or Rueqested Cirulation (both print and electronic copies); 100 (avg)/100 (actual). Publication of Ownership: If the publication is a general publication, publication of this statement is required. Will be printed in the January 2015 issue of the Publication. Signature and Title of Editor, Publisher, Business Manager or Owner. , Publisher. 11/19/14.

69929 CMA/Los Angeles LTD (1/15)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

69929, 69953 Copyright 2015 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:

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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!

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.

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.

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 | JANUARY 2015

HOW TO CAPITALIZE ON OUR VICTORY

As a child I recall hearing the story of a Persian man who claimed to speak Arabic. He was asked what the word was for cow. He happened to know and responded appro-priately. Then, he was asked what the word was for calf. He did not know but cleverly responded by saying that the Arabs were very patient people; they did not have a word

for calf. “They wait instead,” he said. “They wait for the calf to grow up. And then they call it ‘cow.’” As Americans, we are extraordinarily tolerant; we cringe at the word “enemy.” Instead, often in patience we wait for our adversaries to grow up. And then, we call them “friends.”

So it remains to be seen whether such is the state of the medical profession in California. We just finished the toughest fight in a generation. Doctors worked hard to de-feat Proposition 46. Tens of millions of dollars and count-less thousands of speeches and meetings later, we did de-feat Proposition 46 and with it, those who brought the fight to us.

But there may be a victory yet within the more obvious one. It is possible that in our waiting we will find a friend with whom we can work toward the delivery of better healthcare for all of us. The alliances we built to wage our confrontation do not have to be transitory. We can build

further on them. And now they can include even those on the other side. Maybe we have similar interests now. Stronger in resolve, bigger in numbers, and together with those who have become friends, and again on behalf of our patients and our profession, we can more easily rise up and defeat the next adversary.

Today, over three decades after hearing that story, I hold even more dearly that which I believed in my heart of hearts as a child: that Americans, as a nation and as individuals, are the greatest peacemakers that history has ever known. Americans are the reconcil-ers of the world.

Just beneath reconciliation, there is alliance. And this is the season for both of those.

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Twenty-five percent of these claims (1,877 claims) were diagnosis-related. The analysis then focused on the variance between these medical specialties in the incidence of alleged diagnosis-related error and the specific diagnoses involved.

Overall, 34% of nonsurgical specialty claims were diagnosis-related (the number one allegation in these claims). For surgical specialties, 14% were diagnosis-related (the third most common allegation in these claims).

The top five diagnoses for each medical specialty’s diagnosis-related claims involved commonly encoun-tered conditions with differential diagnoses that were well-known to most physicians. Furthermore, 52% of the top diagnoses were found repeatedly in differ-ent specialties, e.g., acute myocardial infarction ap-peared in emergency medicine, internal medicine, family medicine, hospital medicine and cardiology. This suggests that knowledge deficiency was not the primary cause of diagnostic error and that other fac-tors played an important role.

The following are some of the factors that can lead to diagnostic errors. To reduce risks and enhance pa-tient safety, physicians should keep these factors in mind when making a diagnosis:

• First-impression or intuition-based diagnosis.• Narrowly focused diagnosis influenced by a

known chronic illness. • Failure to create a differential diagnosis.• Impaired synthesis of diagnostic data from various

sources, such as medical history, physical exami-nation, diagnostic tests or consultations.

• Failure to order appropriate diagnostic tests.• Context errors.• Failure to follow diagnostic protocols.• System-related errors, such as poor communica-

tion or electronic health record design flaws.• Human-factor errors, such as impaired judgment,

fatigue or distractions.

In an effort to better understand the causes of diagnosis-related error, the Institute of Medicine has appointed a Committee on Diagnostic Error in Health Care. The committee will examine a range of topics, such as the epidemiology of diagnostic error, the bur-den of harm and economic costs associated with di-agnostic error, and current efforts to address the prob-lem. The committee will propose solutions that may include definitions and boundaries, educational ap-proaches, behavioral/cognitive processes and cultural change and health information technology.

To achieve the desired goals, the committee will devise conclusions and recommendations that will propose action items for key stakeholders. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

DIAGNOSTIC ERROR: The Most Common Allegation in Malpractice Lawsuits PROBLEMS RELATED TO diagnostic error are the most common allegations in medical malpractice

claims, according to industry sources such as the PIAA’s (Physician Insurers Association of America)

Data Sharing Project. The Doctors Company reviewed 7,438 claims closed from 2007-2013. The

claims involved 10 medical specialties: pediatrics, emergency medicine, internal medicine, family

medicine, hospital medicine, cardiology, general surgery, gynecology, orthopedics and obstetrics.

34% of nonsurgical

specialty claims were diagnosis-re-lated. For surgical

specialties, 14% were diagnosis-

related.

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Congress Passes Healthcare Provisions in Current BudgetCMA STAFF

• Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted and ponderous administrative burdens placed on providers. It asks the Centers for Medicare and Medicaid Services (CMS) to reconsider that fee schedule provision.

• The budget includes $5.4 billion of emergency funding to prepare for and respond to the Ebola outbreak.

• The National Institutes of Health will receive $30.3 billion (an increase of $150 million), including $283 million for Ebola-related research.

• CMS receives no increase in funding over last year ($3.6 billion).

• The Centers for Disease Control and Prevention (CDC) will receive money to combat prescription drug abuse around the country. Twenty million dollars has been set for prevention of drug abuse and another $12 million has been included under the Substance Abuse and Mental Health Services Administration for the states to expand treatment services for drug addiction. This funding is also expected to support activities to establish or expand prescription drug monitoring databases of physicians writing prescrip-tions for opiates and pharmacists filling prescriptions.

• The bill looks at the Medicare Recovery Audit Contractors (RAC) and how audits may be reducing pa-tient access to care. The bill directs CMS to provide education to providers on error reduction. It also asks the agency to develop procedures to reduce backlogs of claims and hearings and asks CMS to provide education to RAC contractors to improve the accuracy of their audits.

• The bill urges the Office of the National Coordinator for Health Information Technology to decertify electronic health records products that block the sharing of information and to certify only those prod-ucts that meet current meaningful use program standards.

CONGRESS NARROWLY PASSED a $1.1 trillion federal budget that will fund most of the

federal government through September 2015. Below is a summary of key healthcare provi-

sions in the bill.

The bill directs CMS to provide

education to providers on error

reduction and asks the agency

to develop proce-dures to reduce

backlogs of claims and hearings

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These materials are based on information and content provided by others, which we believe are accurate. No guarantee, warranty or representation is made by Commercial Asset Group, Inc. or its personnel. All interested parties must independently verify accuracy and completeness. As well, any projections, assumptions, opinion, or estimates are used for example only and do not represent the current or future performance of the identified property. Your tax, financial, legal and toxic substance advisors should conduct a careful investigation of the property and its suitability for your needs, including land use limitations. The property is subject to prior lease, sale, change in price, or withdrawal from the market without notice.

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1 0 P H YS I C I A N M AG A Z I N E | JANUARY 2015

THE STATE OFCALIFORNIA HEALTHCARE

BY MARION WEBB


DEVELOPMENTS AFFECTING YOUR INCOMEThe new year will bring developments

that may be troubling to physicians and af-fect physicians’ income to various degrees. Here are some tips to plan ahead.

• High Deductibles: According to a study by the Kaiser Family Foundation, eight of 10 employees covered by health insurance now have a deduct-ible, and 18% have deductibles of at least $2,000. For many individuals and families, these high de-ductibles could become a major financial burden, putting your practice at risk for not getting paid. To ensure payment, ask for payment up front or put patients on a payment plan. Inform patients of costs up front. More on this subject will be cov-ered in the February issue.

• Malpractice Premiums: According to an annual premium survey released last October by Medi-cal Liability Monitor, malpractice premiums for three specialities—ob/gyns, internists and gen-eral surgeons—saw a 13% decline in premiums nationwide since 2008. California voters last No-vember struck down efforts by consumer groups to repeal the Medical Injury Compensation Re-form Act (MICRA), but the fight isn’t over. The Su-preme Court in December agreed to hear a case that challenges the constitutionality of MICRA and also looked at how noneconomic damages should be paid.

• ICD-10: There have been many delays in imple-menting the International Classification of Diseas-es (ICD-10), but many people believe the dead-line of Oct. 1, 2015, will stick. More on this hot topic in the February issue.

Healthcare reform has brought sweeping changes for physicians. In this issue we will provide ex-pert opinions commenting on the state of the healthcare industry for 2015. We’ll take an in-depth look at the hottest issues affecting Cali-fornia physicians and provide tips on how you can prepare for an-ticipated changes, challenges and opportunities ahead. Learn about critical developments—from pri-vate healthcare insurers and mal-practice insurance to ACOs and Medicare and Medi-Cal—and how they could affect your income this year. How secure is your website? Read on to learn how you can miti-gate your security risk for a data breach and how to keep your electronic information protected whether you’re logging in from a healthcare site or from home. We’ll also look at legislative is-sues, including Gov. Jerry Brown’s administration’s consideration to expand Medi-Cal to undocument-ed immigrants in California, and what they could potentially mean for your practice. Learn about the market forces that are going to im-pact healthcare and what health-care jobs are hot in the New Year.

18% of employees covered by

health insurance have deductibles of at least $2,000


More than 257,000

U.S. doctors will see their

Medicare pay cut by

1% this year, because they

didn’t meet goals for us-

ing electronic medical records

1%

MEDICARE DEVELOPMENTS For 2015, there will also be key Medicare developments that

could impact doctors both negatively and positively. Here are three key issues:

• More than 257,000 U.S. doctors will see their Medicare pay cut by 1% this

year, because they didn’t meet goals for using electronic medical records, and 28,000 providers will be docked another 1% of Medicare pay for not prescrib-ing medications electronically, the Wall Street Journal reported on Dec. 18, 2014. Others will lose 1% of their Medicare pay this year for missing the dead-line for EMR use. Those who did not comply with the program as of Dec. 29, 2014, will be notified by CMS and subjected to pay cuts imposed by law.

• This year, physicians also need to deal with two new websites, or “Open Pay-ments site,” which report pay by Medicare and makers of drugs and medical devices. Dr. Ted Mazer, past president of the San Diego County Medical Soci-ety, told Medscape.com that he tried unsuccessfully to review his information online and warned doctors that wrong reporting could have serious conse-quences for doctors. Other doctors also reported issues in trying to review their information online.

• On the upside, CMS’s new chronic care management, starting this year, will pay doctors for managing Medicare patients with two or more chronic con-ditions, even when contact is made by phone or email, not in person, which could be a significant source of income for family practitioners.

These and other telemedicine trends will be covered in the March issue of Physician Magazine.

• Although the number of ACOs keeps rising—from 27 in 2012 to 337 in 2014—the number of Pioneer ACOs has dropped—from 32 in 2012 to 19 in 2014—accord-ing to Medscape.com. This is key because shared-savings ACOs are supposed to look like Pioneer ACOs and are vulnerable to penalties, ex-perts said. Many ACOs have threatened to leave the pro-gram if penalties become mandatory this year.

• Last month, the CMS re-leased the long-awaited No-tice of Proposed Rulemak-ing (NPRM) for the Medicare Shared Savings Program

(MSSP), which, when final-ized, will impact ACOs enter-ing the program in January 2016 and those renewing their agreements for another three years.

• Among the proposed chang-es: MSSP participants in Track 1, which involves only upside risk, can remain in Track 1 for three more years but also can expect less savings (max sav-ings would fall to 10% from 40% or 50%), Healthcare Fi-nance News reported. As of last December, MSSP partici-pants were required to tran-sition into Track 2 in subse-quent performance periods, which was a major concern

for doctors. The proposed changes are seen as a way to retain current participants while encouraging others to apply. CMS also proposed that ACOs move more groups to the two-sided risk mod-els and proposed creating a Track 3 model that would increase both rewards and risks. Experts say the com-ment period will be critical for the future of ACOs.

• Some ACOs, like Los An-geles-based National ACO (NACO), have seen tremen-dous growth—from 21 PCP participants to more than 50 PCPs in 2014.

ACOS—CRITICAL DEVELOPMENTSMedicare accountable care organizations will mark their anniversary this year, which

is a key juncture because the program’s three-year shared-savings contract, which shielded ACOs from losing money, will run out. ACOs that stay in the program will start taking a “downside risk” and face the possibility of penalties. If you participate in an ACO or are deciding whether to join, consider the following:


MEDI-CAL TRENDS More than 3 million Californians

now reportedly have Medi-Cal cov-erage, cutting California’s number of uninsured in half.

• Gov. Jerry Brown’s consideration, an-nounced last month, to expand state-funded Medi-Cal coverage to undocu-mented immigrants could benefit more than a million immigrants in California, but also comes at a cost. We will con-tinue to follow this issue.

• A new California law requires the state Department of Health Care Services to establish standards to provide technical assistance to Medi-Cal managed plans to offer hospice care to patients who are seriously ill. To put the law into practice, however, will be challenging due to the shortage of doctors and other health-care providers, as the delivery of hos-pice is supposed to be cost-neutral.

• The current state budget continues its 10% cut in reimbursement to health-care providers, a lingering sore spot for lawmakers, doctors and others. Califor-nia doctors have among the lowest re-imbursement for treating underserved patients nationwide. Access to care, a shortage of providers and reimburse-ment remain major issues.

• A study by the California HealthCare Foundation said the number of Califor-nia primary care doctors participating in Medi-Cal fell short of federal guide-lines—35 to 49 per 100,000 enrollees instead of the recommended 60 to 80.

• Reversing the 10% cut would have cost the state less than $300 million, accord-ing to the Los Angeles Times. Assembly Speaker Tony Atkins (D-San Diego) told the newspaper in August she would keep pushing for reform.

the percentage of California primary care doctors participating in Medi-Cal fell short of federal guidelines—35 to 49 per 100,000 enrollees instead of the recom-mended 60 to 80.

35-49 per 100,000


JOB OUTLOOKThe HHS says the demand for

primary healthcare services will see a dramatic rise this decade, largely driven by the growing ag-ing population and expansion of healthcare under the Affordable Care Act.

Indeed, the gradual increase in the number of insured Califor-nians, the Gary Anderson Center for Economic Research at Chap-man University said in its recently published annual economic fore-cast for California, will lead to a 3.6% rise in the number of jobs in the healthcare services and social assistance sector over the 2013-2020 period, or an added 498,000 jobs. Here are some of the hottest and fastest-growing jobs:

• Pharmaceutical and medical device manufacturing jobs will rise 2.1% over the next six years, according to Chap-man University’s forecast.

• Topping the list of Moneywatch’s leading health care jobs for 2015 are audiologists (34% projected growth by 2022); pharmacists (14% growth by 2022); physiologists (19%); and podiatrists (23%).

• Other healthcare jobs in high de-mand include dental hygienists, dietitians, medical lab technicians, medical technologists, opticians and physical therapists.

CYBER SECURITYElectronic medical records and the explosion of

healthcare information outside the doctor’s prac-tice and health systems, including fitness-related wearable devices, make sensitive health data vul-nerable to hackers.

• Auditors found weaknesses in the U.S. Department of Health and Human Services’ financial management of IT systems, including $65 billion in improper pay in fiscal 2013, mostly from Medicare. With the conversion to elec-tronic medical records, HHS will need to closely monitor incentives to providers. Medicare and Medicaid incentives totaled $25.4 billion as of September 2014, according to Healthcare Finance.

• HHS has made huge strides in fighting waste and fraud, but experts suggest that providers continue to give feed-back about the rollout of EHRs.

• With more hackers targeting doctors’ practices, even small physicians’ offices are well served in implementing IT se-curity tools, such as encryption technologies, that they can afford to protect themselves and patient data.

• Cyber-liability insurance protection can help cover the costs incurred after a data breach.

As we enter the new year, we will continue to follow up on some of the projected key trends identified by leading experts in the healthcare industry and dive even deeper into the issues. We wish all of our valued readers a happy and successful 2015.

$25.4 billion

Medicare and Med-icaid incentives to-taled $25.4 billion as of September

2014, according to Healthcare Finance.

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Avoiding CMS Penalties for NoncomplianceBY MATT KINLEY, ESQ., PARTNER, TREDWAY LUMSDAINE & DOYLE LLP

PRIM ARY CARE PHYSICIANS (PCPs), already financially affected by years of

stagnant reimbursements and rising costs, will soon face a new challenge to

their bottom lines. Beginning in 2015, government financial incentives aimed

at encouraging physicians to use electronic health records (EHRs) and report

quality metrics will turn into costly penalties. As the Centers for Medicare and

Medicaid Services (CMS) continues its efforts to align regulations with poli-

cies expressed by the Accountable Care Act (ACA), physicians should prepare

for value-based healthcare reform and begin to phase out traditional fee-for-

service payment methods. Following the action items listed below could save

your practice money and, in some cases, help increase profits in 2015.


Avoiding CMS Penalties for NoncomplianceBY MATT KINLEY, ESQ., PARTNER, TREDWAY LUMSDAINE & DOYLE LLP

The Dark Side of Meaningful Use

Medicare’s meaningful use program promotes the utilization of EHRs. In the past, physicians could ap-ply for bonuses from CMS for reaching milestones in adopting EHRs and demonstrating appropriate usage in the office.

EHRs are a digital version of a patient’s paper chart. They are real-time, patient-centered records that make information available instantly and secure-ly to authorized users.

Federal agencies have wanted to support EHRs for years, especially for federal healthcare. As previously stated by the CMS, “When fully functional and ex-changeable, the benefits of EHRs offer far more than a paper record can.” EHRs serve to provide:

• Improved quality and convenience of pa-tient care

• Increased patient participation in care• Improved accuracy of diagnoses and

health outcomes• Improved care coordination• Increased practice efficiencies and cost

savings

Not all physicians agree, however. A sizable group claims that technology dehumanizes health-care by decreasing face time with patients, and a small percentage of doctors are actually opting out of Medicare.

Starting in 2015, physicians’ offices that are not supported by EHRs will be penalized. The penalties start at 1% of Medicare, and eligible professionals (EPs) who have not demonstrated meaningful use of EHRs will face a 1% penalty in Medicare reimburse-ments in 2015. These penalties will increase by 1% annually until 2019, when they plateau at 5%.

For EPs who are not participating in Medicare’s electronic prescribing program, the penalties start at 2% in 2015 and will climax at 5% in 2019. In addi-tion, all EPs must continue to demonstrate meaningful use every year through 2019 to avoid penalties.

ACTION ITEMS Should you opt-out of Medicare? If a physician choos-es to opt out of Medicare, specific actions must be

taken by the physician. Even so, some physicians ar-gue that it is far easier to opt out of Medicare than it is to stay in the program. Broadly stated, the procedure to opt out of Medicare involves the following:

1. Notify patients you are opting out of Medicare. 2. File an affidavit with “each carrier that has juris-

diction over the claims that the physician or prac-titioner would otherwise file with Medicare” no later than 10 days after entering into your first pri-vate contract.

3. Enter into a private contract prior to rendering any covered services to a Medicare Part B beneficiary.

4. Make sure your office never files a Medi-care claim and never provides information to a patient that en-ables filing a Medi-care claim. (There are two exceptions: for emergency or urgent care and for covered services that Medi-care would deem un-necessary.)

Keep in mind, a new “opt out” affidavit must be filed every two years to maintain your status.

The final date for all Medicare participants to register and attest to 2014 meaningful use is Feb. 28, 2015.

More Penalties: Physician Quality Reporting System

The Physician Quality Reporting System (PQRS) seeks to improve the quality of healthcare through technological reporting. When it reaches full imple-mentation it seeks to further the trend of quality over quantity by using a combination of incentive pay-ments and payment adjustments to promote reporting of quality information.

Up until 2014, this was a voluntary program. Phy-sicians provided data on whether or not they were

Starting in 2015, physicians’ offices that are not supported by EHRs will be penalized. The penalties start at 1% of Medi-care, and eligible professionals (EPs) who have not demonstrat-ed meaningful use of EHRs will face a 1% penalty in Medicare reimbursements in 2015.

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meeting selected quality measures, and special-ists participating in the reporting protocols received a .5% increase in their Medicare reimbursements

through maintaining the certification program. This program for special-ists ended in 2014.

In order to comply, EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries.

Very few practices are ready for this pro-gram. However, starting in 2015, a penalty for not reporting PQRS data

starts at 1.5% and will rise to a 2% penalty in 2016. The penalties are based on the previous year’s data and are ironically called, “Negative Payment Adjust-ments.”

ACTION ITEMS PQRS penalties are difficult to figure out, and the best way to get up to speed with what is required is to visit the CMS website at www.cms.gov and search “how to get started.” This site will tell you if your practice is eligible for penalties or payments under this program.

Chronic Care Changes to CPT Code

On the minus side, CMS will scrutinize the most widely utilized and abused Current Procedural Ter-minology (CPT) codes, Modifier 59. The CPT Manual defines Modifier 59 as follows:

“Distinct Procedural Service: Under certain cir-cumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/ser-vices, other than E/M services, that are not normally

reported together, but are appropriate under the cir-cumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than Modifier 59. Only if no more descriptive modifier is available, and the use of Modifier 59 best explains the circumstances, should Modifier 59 be used.”

Consistent with amendments to the Affordable Care Act, CMS has been engaged in a vigorous ef-fort over the past several years to identify and review potentially overused codes, and to make adjustments where appropriate. The codes under attack are those that have been used for catch-all services that cannot be adequately defined. In place of the Modifier 59 in the Healthcare Common Coding System, physicians’ offices will be using four new subset modifiers.

ACTION ITEMS New coding requirements related to Healthcare Com-mon Procedure Coding System (HCPCS) Modifier 59 could impact your reimbursement. Change Request (CR) 8863 notifies MACs and providers that the Cen-ters for Medicare and Medicaid Services is establish-ing four new HCPCS modifiers to define subsets of the Modifier 59, a modifier used to define a “Distinct Pro-cedural Service.” Review the CMS website at www.cms.gov, which gives specific examples of modifiers for different specialties.

Primary Care and Chronic Care Management (CCM)

CMS established a new policy to make separate payment for non-face-to-face—phone or electronic means—chronic care management services for Medi-care beneficiaries who have multiple (two or more) significant chronic conditions.

Payment for Chronic Care Management is only one part of a multifaceted CMS initiative to improve Medicare beneficiaries’ access to primary care. This

2% For EPs who are not par-ticipating in Medicare’s

electronic prescribing program, the penalties

start at 2% in 2015

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is a novel program in order to promote care for chronic patients by utilizing tech-nology. Models being tested through the Innovation Cen-ter will continue to explore other primary care innova-tions. CCM services include regular development and revision of a plan of care, communication with other treating health professionals and medication manage-ment. This program supports the concept of value-based payment, allowing signifi-cant payments for support-ing and managing chronic pain patients. The final rules for this program became public at the end of October and will likely result in an increase in physician reimbursement. To qualify, the physi-cian must have EHR systems, and they must be able to share information with caregivers. Since the physician’s office must be available to the patient 24 hours a day, it will probably require the use of mid-level professionals such as nurse practitioners. This rule specifically provides for greater flexibility in such staff.

ACTION ITEMS Physicians must work with their patients to identify which population may be able to take advantage of these payments. An expert in pre-dictive modeling may be utilized to determine the appropriate population. More traditional utilizations may be through the new diagnosis of chronic disease, or multiple hospitalizations.

ConclusionIn this vastly shifting legal landscape, for a

physician practice to succeed, medical profes-sionals will have to be diligent when approach-ing the implementation of these new laws. If you follow the action items noted above, you could

be well on your way to cementing a lasting, and profitable, practice.

ABOUT THE AUTHOR: Matt Kinley is a partner at Tredway Lumsdaine & Doyle LLP, a long-standing Southern California-based law firm providing a full range of legal services to pri-vately held companies and indi-viduals. With more than 25 years of experience, Kinley is chair of the firm’s healthcare law practice and regularly advises physicians to help them maintain a suc-cessful practice in a changing environment. His focus includes matters related to federal and state regulatory compliance, li-censing and certificates, Medical Board representation, Medicare and Medicaid law and audit representation, managed care contracting and disputes, fraud

and abuse issues, referral disputes, unique healthcare employment issues, HIPAA compliance, creations and mergers and acquisition of healthcare practices. Contact Kinley at [email protected] or call (877) 923-0971.

Starting in 2015, a penalty for not reporting PQRS data starts at 1.5% and will rise to a 2% penalty in 2016. The penalties are based on the previous year’s data and are ironically called, “Negative Payment Adjustments.”

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The new year also brings a host of other challeng-es that could affect your ability to be paid:

• Medicare patients can modify their enrollment choices from October 15 through December 7, al-lowing them to switch between Medicare fee-for-service and Medicare Advantage, or switch from one Advantage plan to another.

• The Covered California open enrollment period is November 15, 2014, through February 15, 2015. Existing exchange/mirror patients have the option

to select a different plan, and Covered California expects an additional 500,000 individuals will enroll in an exchange plan during 2015 open en-rollment.

Additionally, there will be some changes to ex-change/mirror product names in 2015. Covered Cali-fornia notified all exchange plans that the product names must be the same for exchange and mirror products and that plans must also utilize a standard naming convention for all individual exchange/mirror

Verifying Your Patients’ Eligibility and Benefits in 2015 Could SAVE YOUR PRACTICE THOUSANDS OF DOLLARSCMA STAFF

WITH THE NEW year soon upon us, physicians are urged to be diligent in verifying patients’

eligibility and benefits to ensure that you will be paid for services rendered. The beginning of a

new year means calendar year deductibles, and visit frequency limitations start over. With open

enrollment there may also be changes to patients’ benefit plans, or they may even be insured

through a new payor.

JANUARY 2015 | 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

products.California moved the remaining 25,000 seniors

and persons with disabilities (SPDs) from fee-for ser-vice to managed care on December 1, 2014, in the following counties: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plu-mas, San Benito, Sierra, Sut-ter, Tehama, Tuolumne and Yuba.

Additionally, 30,000 patients who are dually eligible for Medicare and Medi-Cal in Los Angeles and Santa Clara counties began the transition from fee-for-service Medicare and Medi-Cal into man-aged care on January 1, 2015. Dual eligible enroll-ees will transition in these two counties over the next 12 months based on month of birth. Duals will also continue to transition based on month of birth in San Bernardino, Riverside and San Diego counties. The duals transition for Orange County is scheduled to begin in July. For more information on Duals, see CMA’s toolkit, “Cal MediConnect Physician FAQ – What you need to know about keeping your patients and billing for the dual eligi-ble population,”available at www.cmanet.org/duals.

Don’t get stuck with unnecessary deni-als or an upset patient. Do your homework before the patient arrives by obtaining up-dated insurance information at the time of scheduling, if possible, and making cop-ies of the insurance card at the time of the visit.

And don’t forget that deductibles are typically based on the calendar year and have reset on January 1. Many of the ex-change/mirror plans have high deductibles (e.g., $5,000 deductible on the Bronze plan), as do some employer-based plans. This reinforces the importance of verify-ing patient eligibility – particularly for ex-change patients – each time they are seen. Best practice is to communicate with pa-tients upon scheduling to remind them that their plan has a deductible that may have reset on January 1 and, if that is the case,

payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice. as your ability to collect can decrease significantly after

the patient leaves the office.Taking these proactive steps to protect your prac-

tice by preventing denials, delays in payment and dis-gruntled patients goes a long way toward ultimately saving time and money.

The 2015 Covered California QHP naming convention is as follows:[carrier name] + [metal tier name] + [Actual Value] + [product type (e.g., EPO, HMO, PPO)]

Example: Blue Shield Bronze 60 PPO

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Wendy Greuel, former LA city controller, was was voted vice-chairwoman and Tim McCallion, presi-dent of the Western Region of Verizon, became the treasurer. Melanie Coto, president of the Coto Foun-dation, will serve as secretary.

Dr. Salimpour, practicing physician, scientist and researcher specializing in pediatric medicine and child development, said he is honored to be part of an organization that helps kids in Los Angeles. “Since much of my career has been dedicated to kids, I am delighted to help expand DCLA’s mission to inspire and educate young minds through science-based pro-grams and exhibits–both in the Valley and beyond.

“Research has proven that DCLA’s highly interac-tive approach is helping children learn in and out of the classroom, and it’s an honor to be able to bring a new level of hands-on discovery to more families throughout Southern California.”

Dr. Salimpour received his Master of Public Health degree at the UCLA School of Public Health, and earned his medical degree at Boston University School of Medicine. The first-ever two-time recipi-ent of the American College of Physicians’ Research Award, he completed his residency at L.A. County-USC Medical Center/Keck School of Medicine.

From 2001 to 2005, prior to the launch of CareNex Health Services, Dr. Salimpour served as co-founder and executive vice president of NexCare Collab-

orative, a not-for-profit organization that served the healthcare needs of more than 100,000 underserved children and families in Southern California.

Associated with the DCLA project from the begin-ning, Greuel previously served on the Los Angeles City Council and as Los Angeles city controller for five years.

“The Discovery Cube Los Angeles Board of Di-rectors has an extraordinary opportunity to impact LA’s next generation of practitioners and leaders in science, technology, engineering and mathematics,” said DCLA Executive Director Kafi D. Blumenfield. “We are pleased to add the talent of these respected leaders to our Board. Our four new officers have the local experience, wisdom and connections necessary to help turn our long-term vision for Southern Califor-nia into reality.”

Discovery Cube Los Angeles is a sister campus of the popular Discovery Cube Orange County in Santa Ana. It offers a world-class collection of technically advanced exhibits, displays, programs and learning spaces unique to Los Angeles.

Highlights of the two-story building in the Lake View Terrace neighborhood range from a simulated helicopter flyover of California’s natural resources to a planetary research station, interactive park science exhibits and immersive grocery story experience.

Discovery Cube Los Angeles OpensPedram Salimpour, MD, Wendy Greuel, Tim McCallion and Melanie Coto Will Lead Board

PEDR A M SALIMPOUR , MD, MPH, president of the Los Angeles County Medical Association

(LACMA), was elected board chairman of the Discovery Cube Los Angeles (DCLA) hands-on

science museum that opened in November 2014. The officers of the board will lead the 2.5-

acre campus at the Hansen Dam Recreation Area in the San Fernando Valley.

Cal MediConnect:Making It WorkChange can be difficult. But sometimes change can lead to a better outcome. Cal MediConnect is an example of just that. The Cal MediConnect program was designed to improve care coordination for dual eligible beneficiaries -- those who qualify for both Medi-Cal and Medicare. Members are provided with medical and behavioral health, long-term institutional and home-and community-based services all through one organized delivery system. The program even helps members live independently by receiving appropriate care in their homes and communities rather than in institutions. As a physician, we know you’re concerned about how this change will affect your patients, your practice and your processes. We understand your concerns because physician-owned clinics are part of our business too. That’s why we’ve made it easier for you…

We’re in This Together • We developed integrated care teams. These teams coordinate effective communication among members, their doctors, family and other caregivers. Together, the team determines the right approach to care in the right setting at the right time.

• We conduct a health risk assessment with each member, which identifies appropriate resources (social services, behavioral health, transportation, etc.) needed to manage each member’s care. The assessment is then shared with our contracted physicians to work toward shared goals for their patient.

• For physicians who are wary of a varied payment structure under Cal MediConnect, it’s important to know that the overwhelming majority of physicians will get paid at least their current fee-for-service rate.

• Our Community Connector program is well received by both members and providers. These community based individuals are available to assist physicians with their patients who need additional help with non-medical issues.

• By signing up on Molina Healthcare’s provider web portal, you have quicker access to authorizations.

• We have contracted with a vendor to offer our providers the op-tion to receive electronic fund transfers. This means you get paid faster and you receive copies of 835 files.

• We continue to hold group meetings with all our contracted pro-viders to share the latest information about Cal MediConnect and seek feedback and ideas to better our processes.

Working in PartnershipChange doesn’t come easily or alone. Neither physicians nor health plans nor community agencies can take care of the sickest and neediest members in our community alone. We may disagree about how we got here. We may still want to lobby for change. And we may have differ-ing opinions when it comes to providing care. But we can all agree that better care coordination will improve health outcomes and drive down the high costs of medical care. As the Cal MediConnect program has already begun, now is the time to work together to help patients benefit from the change.

Call us at (562) 435-3666 extension 127223and let us know what keeps you up at night about theCal MediConnect Program.

Let’s work together to care for our patients.


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CEO’s LETTER

AS WE’RE HEADING INTO THE NEW YEAR, I’m proud of the many great successes LACMA achieved in recent times. The year 2014 brought a lot of groundbreaking accomplishments for doc-tors and the patients they serve. I want to thank everyone for their hard work and hope that you will seize the moment to build upon our many successes to reach even greater heights.

Last year, LACMA proved again that we are getting stronger as an organization and will rise to the challenge to do what is right for our doctors, patients and the community as a whole.

Among the highlights of 2014 was the resounding defeat of the most contentious and high-stakes ballot initiative in California.

The victory of California’s No vote on Proposition 46, the ill-founded attempt to overturn Cali-fornia’s Medical Injury Compensation Reform Act, sent a clear message that patients don’t want to increase payouts in medical malpractice lawsuits that would have lead to higher healthcare costs and

reduced access to care.LACMA has become the “go-to” source for the voice of physicians and

patients in the media and will continue to be their voice in 2015. We have ramped up our efforts to remind the public that physicians are

the primary line of defense and of their importance in providing key services. President Salimpour continues to dedicate significant time and energy to the LACMA mission.

Most recently, Dr. Salimpour took the charge to discuss the preparedness of our LA County healthcare system to handle the possibility of an Ebola out-break. He will continue to work tirelessly to elevate LACMA’s mission and vision and empower all physicians along the way.

This year, LACMA’s committees remain instrumental in representing the interests of every practicing physician in Los Angeles County and our future physicians.

LACMA members can also look forward to an even greater number of events to promote and enhance opportunities for them, such as the vendor fair, which is sponsored by the Ambulatory Surgery Center Committee at LACMA.

For this coming year, we expect our committees to become even stronger in numbers so we can address key issues and provide education, mentorship and support to LA doctors. We can achieve these goals with your help.

Our 2014 HealthCare Awards and physician honorees elevate LACMA’s profile in LA County and cultivate the next generation of physicians who will

practice medicine in our community. That said, we will continue to face significant challenges ahead, and the affront to physicians’ abil-

ity to provide quality healthcare will not cease. We have already heard rumblings from our members about the unauthorized use of their reputa-

tions in the marketing of health plans by insurance companies. Rest assured, LACMA will not simply stand by and watch as our physicians are being misrepresented and have their good reputations tarnished.

This year, we will continue our efforts to address critical issues such as the ill-conceived Cal Medi-Connect demonstration project and MICRA’s preservation.

I’m pleased that LACMA’s membership continues to be on the rise—as it stands LACMA has 6,500 members in LA County. Our goal is to continue to add to these numbers thanks also to the prospects for additional physician groups. I’m hopeful that physicians across California will seize this opportu-nity and join LACMA to push through much-needed reforms in the legislative cycle.

If you’re not yet a member, this is the year to join and add your voice to the crescendo of power.

WISHING YOU A HAPPY, HEALTHY AND PROSPEROUS NEW YEAR!

Rocky DelgadilloChief Executive Officer

victoryOn nOvember 4, the vOters Of CalifOrnia spOke lOudly and definitively, sending the trial lawyers’ prOpOsitiOn 46 tO defeat by a vOte Of 67 tO

33. the message is Clear – CalifOrnians simply dOn’t want tO inCrease health Care COsts and reduCe health aCCess sO trial attOrneys Can file mOre lawsuits.

victoryAn increase in the Medical Injury Compensation Reform Act (MICRA) cap on non-economic damages has been rejected in California again and again: 10 times in court, 5 times in the Legislature and now overwhelmingly by voters. This idea now has its own dedicated spot in California’s political trash heap. But this time, we energized the membership of CMA as a whole to fight the fight together, as one unified voice of medicine, representing the patients we so deeply care about and the care that we have committed to provide them.

Despite the trial attorney proponents’ attempt to sweeten the deal by adding provisions that polled well– physician drug testing and mandatory checking of a prescription database – voters said NO on Election Night. As people throughout the state heard from physicians and No on 46 coalition members about the real intentions of the measure’s proponents, there was resounding opposition. One of the secret weapons of this effort was the size and diversity of our coalition. We helped amass one of the largest and most diverse campaigns in California history. The breadth of the coalition — which includes labor, business, local government, health providers, community clinics, Planned Parenthood, ACLU, NAACP, taxpayers, teachers, firefighters and more – underscores just how important affordable, accessible health care is to every Californian.

In addition to the groups on the ground talking to voters about the deception and trickery behind Prop. 46, every major editorial board in California opposed the initiative.

The Los Angeles Times said, “As worthwhile as [Proposition 46’s] goals may be, the methods the measure would use to achieve them are too flawed to be enacted into law.”

The San Francisco Chronicle decried Prop. 46 saying that the measure, “overreached in a decidedly cynical way.”

The Orange County Register, UT San Diego, San Jose Mercury News, Monterey County Herald, Sacramento Bee and dozens of other newspapers echoed these sentiments.

The efforts of the California Medical Association and the county medical associations across the state is a tremendous showing of what we can do for the future of health care, the quality of medicine and the dedication to patients everywhere. Working together to spread the truth about Prop. 46, building coalitions across communities and standing strong as one united voice is what helped carry us to victory.

This was one of the most contentious and high-stakes ballot fights in California history and we rose to the occasion. We must use this unity moving forward and showcase to our colleagues the value the California Medical Association brings to our great profession and stay united for whatever comes our way next.


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ADVERTISER INDEXArt Fries, Disability Claims Consultant .................................................................................... 19

City National Bank ................................................................................................................... 7

Commercial Asset Group ......................................................................................................... 9

Cooperative of American Physicians ......................................................................................... 5

Diamond Headache Clinic ..................................................................................................... 15

Fenton Law Group.................................................................................................................. 21

First Property Realty Corporation .............................................................................................. 3

Mercer ...................................................................................................................................C2

Molina Healthcare of California ............................................................................................. 23

Nelson Hardiman ................................................................................................................... 13

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

The Doctors Company............................................................................................................C4

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TOP10REASONSFOR 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.

LACMA/CMA IS THE VOICE OF PHYSICIANS

1Legislative AdvocacyLACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy to end abusive practices. In addition, LACMA has sued health care plans on behalf of members to stop intimidation tactics.

two FREE Reimbursement Assistance

Tired of fighting with payors? CMA’s Economic Services experts have recovered nearly $8 million for members since 2010!

3 FREE Jury Duty AssistanceLACMA can help you: • Reschedule your date • Relocate for your convenience • Reduce number of call-in days from 5 to 1!

27% in AVERAGE SAVINGSThrough an exclusive partnershipwith Medline, LACMA saves members a guaranteed minimum of 10% on their medical supplies and equipment. Find out how one member saved $31,000 for his practice!

4

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

five

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

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8FREE Networking & Referral Events• Socialize and network with members of the medical community• Find or create opportunities for your practice• Engage with legislators and policymakers

Unlimited Access to Legal ExpertsSave 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!

9 State-of-the-Art CommunicationInformation 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.

tenAccess to your Physician AdvocatesWhen you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need—be it help with a problematic payor, or details about your member discounts—just call the member helpline at (800) 786-4262 or visit www.lacmanet.org

LOS ANGELES COUNTY MEDICAL ASSOCIATION707 WILSHIRE BLVD, SUITE 3800

LOS ANGELES, CA 90017

PHONE: (213) 683-9900FAX: (213) 226-0353

For more information on member benefits and resources, visit www.lacmanet.org/Membership

RIGHT NOWis the best time to join LACMA and CMA

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

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January 2015 | Physician Magazine