January 2013

JANUARY 2013

INTRODUCING

THE NEW LACMA

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

A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

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

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

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Volume 144 Issue 01

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.

FEATURES

16 ThE nEw lAcmAThe many challenges surround-

ing healthcare reform and physicians ad-vocating for patients’ rights, while looking for their own representation and support, will require strong leadership and doctors who stand united.

10 Overprescribing: how to Avoid Discipline

Important insight into to taking appropri-ate steps to protect yourself from mis-takes that can lead to overprescribing en-forcement actions by the Medical Board.

dePaRTMeNTs 6 FROnT OFFicE | PRAcTicE mAnAgEmEnTNews, tips, advice and resources

9 BAlAncE | liFESTylE & wEllnESSTips, hints, advice and resources to make your practice run more smoothly.

12 TRAnSiTiOnS | cAREER mAnAgEmEnTQuestions and challenges associated with various phases of your medical career.

14 Pnn | nEwS in REViEwThe latest headlines impacting the economics of healthcare delivery in Southern California

20 UniTED wE STAnD | AT wORK FOR yOUYour LACMA and CMA membership at work for you.

fROM yOuR assOciaTiON

4 PRESiDEnT’S lETTER | SAmUEl FinK, mD

24 cEOS lETTER | ROcKy DElgADillO

25 lAcmA nEwS | ASSOciATiOn hAPPEningS

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SubScriptionSMembers of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. SCP is not responsible for unsolicited manuscripts.

editor

display ad sales / director of sales

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editorial advosory board

ceo

president

president-elect

treasurer

secretary

immediate past president

cma trustee

councilor

med student councilor/usc keck

councilor-at-large

young physician counsilor

cma trustee

ethnic physicians commitee representative

councilor

councilor

med student councilor/ucla david geffen

councilor

chair of lacma delegation

councilor-at-large

councilor

councilor

councilor

councilor

councilor

councilor-at-large

resident/felloW councilor

councilor

resident/felloW councilor

councilor

councilor-at-large

cma trustee (resident)

Sheri Carr 559-250-5942 | [email protected]

ADVErtiSinG SALES

Christina Correia 213-226-0325 | [email protected] Pebdani 858-231-1231 | [email protected] H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD

HEADquArtErS

Physicians News NLos Angeles County Medical Association707 Wilshire Boulevard, Suite 3800Los Angeles, CA 90017Tel 213-683-9900 | Fax 213-226-0350www.physiciansnewsnetwork.com

LAcMA officErS Rocky DelgadilloSamuel I. Fink, MDMarshall Morgan, MDPedram Salimpour, MDPeter Richman, MDTroy Elander, MD

LAcMA boArD of DirEctorS

David Aizuss, MDWilliam Averill, MDErik BergStephanie Booth, MDSteven Chen, MDJack Chou, MDHector Flores, MDSidney Gold, MDWilliam Hale, MDShelley HanVito Imbasciani, MD Paul Kirz, MDLawrence KneisleyHoward Krauss, MDGideon Lowe, MDCarlos E. Martinez, MDNassim Moradi, MDAshish Parekh, MDJeffrey Penso, MDHeidi Reich, MDBob Rogers, MDSion Roy, MDPejman Salimpour, MDRobert Bitonte, 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.


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

I HOPE THAT, all of you had exactly the kind of holiday you were hoping for...I asked Santa for the eradication of the SGR, and the elimination of the In-dependent Payment Advisory Board. He just laughed Ho, Ho, Ho, and handed me a twenty page govern-

ment form to fill out, driving away in a low-emission hybrid sleigh. As have many of you, I just received notice from Medi-care that I had to “reapply” to continue seeing patients within the Medicare program. And yes, this is a complete “from scratch” new application. They requested all original IRS pa-perwork from when I formed my corporation fourteen years ago, which, of course, necessitated several conversations with the IRS, since the original paper-work is buried deep some-where within a long-forgotten box. I personally had to get on the phone with Medicare to initiate the application...when I told them (despite the fact that they already have this infor-mation) that I was born in Los Angeles, California I was asked what country that was in. I re-

plied that I thought it was on Mars, and was told that was not the information they had on file for me. To this point, my biller and I have spent five hours of unneces-sary time, and have only progressed to where, hopeful-ly, we will be mailed an internet link at which point we can begin to fill out the actual online “reapplication.” I was under the impression that the eighth amendment to the Constitution prohibits cruel and unusual punish-ment...obviously that doesn’t apply to physicians.

The issue that appears to be most critical to doc-tors in Los Angeles right now is the potential for the forced enrollment of the dual-eligible population (Me-di-Medi) into managed care plans as of June, 2013, unless these patients opt-out with a form that has yet to be distributed, or even created! Here is where we stand: As of right now, there is no contract between the State of California and L.A. Care to provide for the care of these dual-eligible patients, as reimbursement rates have not been agreed upon. In the absence of these rates, no provider network can be formed. I have seen applications being sent to physicians around the county for the formation of new IPAs, ostensibly to care

for this group of patients...but such formation is pre-mature, and purely speculative. I would advise all of you to be very careful before committing your dollars or time to such ventures. Also, remember that LACMA is strongly advocating for the preservation of the cur-rent physician-patient relationships that so many of our members have established. It is possible that all or part of Los Angeles County will be excluded from this pilot program! Stay tuned, and we will try to keep you up to date with our weekly Physicians News Network, which all of you should be receiving via email...if you are not receiving this new member benefit please let us know, and we will get you on our list!

LACMA has also been hard at work forming Phy-sicians Advisory Committees, to better represent our members...one month ago the Latino Physicians Ad-visory Committee met for the first time, chaired by Dr. Hector Flores. Dr. Flores has been a member of LACMA for a long time, and has always been a strong advocate for Latino physicians. I was very impressed by the passion and energy displayed at this meet-ing. Dr. Flores and his committee will be working on several initiatives, including the effort to recruit more Latino medical students, as well as Latino physicians that wish to practice in underserved areas of Los An-geles County. I am also happy to welcome Dr. Flores as the newest member of the LACMA Board of Direc-tors! The Women’s Physicians Advisory Committee, an African-American Physicians Advisory Committee, and an Asian Physicians Advisory Committee are all in the planning stages, and we welcome your participation, as well as suggestions for other advisory groups that we should consider forming.

In my last column, I discussed our plan to revitalize the LACMA Districts, and I am happy to welcome Mar-garet Vieira to the LACMA team, where she will serve in the capacity of our new District Manager. Margaret just moved to Los Angeles from Washington, D.C., and she will be working hard on ensuring that every LAC-MA district has an elected president and board. We are actively recruiting for our district boards, and this would be an excellent way for you to become involved in the New LACMA! Please contact Margaret immedi-ately at 213-226-0393 if you’d like to be involved in the leadership of our dynamic organization!

I will update you soon on the status of my Medicare reapplication, and was glad that I could assist our gov-ernment office with the knowledge that Los Angeles, California is in the United States! Until next month....

Samuel Fink, MD, is an internist in private practice in Tarzana. He is

the 141st president of the Los Angeles County Medical Association.

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Subscribers can sign up to receive monthly digest bulletins and/or as-it-happens “news flashes” for critical or time-sensitive issues. You can tailor your subscription to receive only information on subject matters of interest to you and your practice including: billing, pay-ment and policy rule changes.The California Medical Association has advocated for a service like this for a long time and we are pleased to see it coming about. It will allow physicians to have news delivered directly to their inboxes, rather than having to visit the Medi-Cal website to track down the latest information.Subscriptions are free. To sign up, go to the Medi-Cal Subscription Services Subscriber Form on the Medi-Cal website (http://files.medi-cal.ca.gov/pubsdoco/mcss/mcss.asp#1) and click the subject matter areas of interest and fill in your email and zip code.

the california department of healthcare services launches a neW

Medi-Cal Email News Service

The QRURs will give physicians a preview of how data will be used to adjust Medicare pay for some physicians under a value-based modifier that will take effect in 2015 for some physicians.The Physician Resource Use Measurement and Re-

porting Program was originally created in 2008 by the Medicare Improvements for Patients and Providers Act. This was extended and enhanced by the Affordable Care Act of 2010. The program is now called the Physician Feedback Program.QRUR feedback provides comparative information so that physicians can view examples of the clinical care their Medicare patients receive in relation to the aver-age care and costs of other Medicare patients. The report data is based on claim submission data. QRURs help CMS share comparative indicators of quality and cost performance with physicians and to receive input prior to making changes in Medicare payment based on the value-based payment modifier.The value-based payment modifier will be implemented in 2015 for physicians in groups of 100 or more. It is not an actual modifier but rather a methodology of modify-ing payments, and will be based on 2013 claims submis-sion data.Solo physicians and those in groups of 99 or fewer phy-sicians will not be affected by the value-based modifier until 2017 when all physicians will be affected. In 2017 it will be based on 2015 claims data.For more information about the value-based payment modifier program and the Physician Feedback Reports, visit the CMS website www.cms.gov.

CMS to Release Quality Reports to Physician Groups By CMA StAff

THE CEnTErs fOr Medicare & Medicaid Services (CMS) are making available Medicare Quality and Resource Use Reports (QRUR) to California physician groups of 25 or more. These reports will allow physicians to measure the quality and costs of their care compared with other doctors treating Medicare patients.


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Risk Tip

a long-time staple of the magazine, the Front Office section is your

resource for tips, strategies and

trends for effective and efficient prac-tice management.

for your offiCe plAn:• A checklist of to-do items in case of an emergency.

These steps should enable you to preserve your assets as well as communicate with your staff and patients. The list should be ordered by priority and can be de-signed to match up with specific weather-related infor-mation, such as in a hurricane.

• Adisasterrecoverychecklistwithstepstofollowuponyour return from an evacuation.

• A full-circle calling tree that provides directions onwho will contact whom in the event of a disaster.

• Instructionsonsettingupinstantmessaginggroupstoenable your staff to communicate when cell phones may not work.

• Regularly revisit your office plan and review itwithyour staff.

• Verify that home health agencies that are caring foryour patients have plans to provide adequate services in case of a disaster.

for your hoSpitAl’S plAn:• Askhospitals todefineor redefineyour roleand re-

sponsibilities as a medical staff member during an emergency.

• Understandyourhospital’sincident/disastercommandstructure and participate in drills and exercises.

for your CoMMunity’S plAn:• Participateinthedevelopmentofacommunitydisas-

ter plan.• ProvideinputtolocalentitiessuchasEmergencyMan-

agement authorities, hospitals that are accredited by The joint Commission, and volunteer organizations such as the red Cross and Salvation army.

• Workinconcertwiththeleadorganizationcoordinat-ing disaster relief when volunteering to assist during or after a disaster.

Hurricane Sandy underscores the need forPhysicianstoBePreparedforaDisasterCATAsTrOPHEs suCH As the recent Hurricane “Superstorm” Sandy, the japan earthquake, and Hurricane

Katrinaunderscoretheimportanceofproperplanningfordisastersbybothphysiciansandhealthcaresystems.Pre-

paredness is a continuous cycle of planning, organizing, training, equipping, rehearsing, and evaluating.

Physiciansshouldbeinvolvedindisasterpreparednesstoensurethatthebestcareisdeliveredtopatientsand

criticalservicesarenotinterrupted,especiallyforat-riskindividualswhomayhavespecialmedicalneeds.Physi-

cians also should be aware of the potential threat of medical malpractice liability when serving as a volunteer health

professional during a natural disaster or other declared state of emergency.

HErE ArE A fEw TIPs TO HElP PHysICIAns wITH dIsAsTEr PrEPArEdnEss:

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

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I loved your ad on PNN!

I clicked on your ad on PhysiciansNewsNetwork.com!

I’m a LACMA Member!

Thanks for supporting physicians interests!

This exciting new department deliv-ers news, studies, tips and opportu-nities that encour-age physicians to maintain the healthy, balanced lifestyle that is essential to ca-reer success and longevity.

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We Encourage Our Valued Readers to Patronizie Our Advertisers - and When You Do, Tell Them We Sent You!

- Physician Magazine, & PNN (physiciansnewsnetwork.com)

I clicked on your ad on PhysiciansNewsNetwork.com!

I saw your ad in Physician Magazine!

Start The New Year With Your Own Prescription of ExerciseBy MArion weB

With more doctors recommending exercise to their patients to help combat medical problems, in-cluding obesity, diabetes and heart disease, exercise may just be their own best-kept secret to relieve stress, fatigue and achieve a healthier lifestyle for themselves.

To gain health and wellness benefits, accord-ing to the U.S. Department of Health and Human Services exercise guidelines, healthy adults need to engage in 2½ hours of weekly moderate-intensity exercise, such as brisk walking or gardening.

For more physically fit adults, 75 minutes of vig-orous physical activity, such as swimming laps, hik-ing uphill or racewalking can offer similar benefits in half the time.

A great option for exercise, as well as the envi-ronment, is to start cycling for pleasure or commut-ing to work.

But even 10-minute bouts of heart-pumping ac-tivity are better than none at all. To regain lost mus-cle mass and strengthen weakening bones, which is part of the typical aging process, the experts also recommend that adults lift weights twice a week.

Considering that two-thirds of American adults are overweight and obese, exercising combined with a healthy diet can be a lifesaver given the

clear link between ex-cessive weight gain and a heightened risk for se-rious chronic diseases, including heart disease, diabetes, cancer and high blood pressure.

For the first time, Americans are raising children who may grow up even less healthy than their parents, because many are even more inac-tive than adults, preferring playing videogames and online social networking over exercise.

Yet, scientific evidence has shown that regular physical activity can do much more than cut feel-ings of fatigue and bolster overall well-being.

An expert panel gathered by the U.S. Depart-ment of Health and Human Services found that regular physical activity can cut risk of heart attacks and stroke by at least 20% and reduce the chance of early death.

With only about 26% of U.S. adults engaging in vigorous leisure-time physical activity three or more times a week, there is no better time to make a posi-tive change toward a more active lifestyle than now.

Exercise is great medicine and a great way to start spending time with your loved ones and friends.

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

California has a state database for drug pre-scribing known as Controlled Substance Utiliza-tion Review and Evaluation System, commonly called CURES. There are over 100 million entries on the CURES database.

One of the devices the Medical Board uses is a Patient Activity Report. The Patient Activity Report will contain an entire list of all Schedule II-IV prescription drugs that have been prescribed to an individual patient. The Patient Activity Report will include the name of the physician that pre-scribed the drug as well as the pharmacies where

the patient obtained the drugs. This generally comes into play after a com-

plaint has first been filed with the Medical Board. After receiving the complaint, the Medical Board will initiate an investigation into the validity of the complaint. During this process, Medical Board in-vestigators will review the Patient Activity Report and look for patterns that indicate overprescribing of narcotics. Some of the patterns that will get the Medical Board’s attention, include the quantity of drugs being prescribed to particular patient, the patient’s location as compared to the location of

Overprescribing and Medical Board Enforcement: How to Avoid DisciplineBy niCk Jurkowitz, fenton-nelSon

THE MEdICAl BOArd

takes the inappropri-ate overprescribing of controlled medication very seriously. For this reason, it is impor-tant to take appropriate steps to protect yourself from mistakes that can lead to overprescribing enforcement actions by the Medical Board. In addition, whereas many physicians may feel that it may be dif-ficult for the Medical Board to monitor pre-scriptions, it is actually not the case.

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PHYSICIANSNEWSNETWORK.COM EXPANDED COVERAGE


the physician (presumably, if a patient travels a great deal to see a physician, he or she may appear to be seeking il-licit drugs), how many past physicians the patient has seen and how many different pharmacies the patient used to fill out the prescription.

Many times, physicians are innocent parties and fall prey to a patient that is “doctor shopping” for pain medication. These kinds of patients may go from one doctor to an-other looking for a physician to prescribe pain medications. To the physician, the patient may seem qualified for a prescription, but in reality the pa-tient is simply trying to obtain illegal drugs. This is especially difficult for physicians because measuring pain in a patient is complicated and physicians reg-ularly have to rely on patient testimonials to assess pain. Nonetheless, even innocent physicians can be held responsible for negligent overprescribing.

It is not surprising, that many drug-related types of misconduct are forbidden by California law, and subsequently will serve as the basis for Medical Board enforcement. Any conviction for violating a federal or state statute regulating drugs, constitutes unprofessional conduct. A violation of one of these statutes, even without a conviction may serve as the basis for a finding of unprofes-sional conduct. Moreover, Business & Professions Code section 2241.5(d) states “a physician and sur-geon shall exercise reasonable care in determining whether a particular patient or condition, or the complexity of a patient’s treatment, including, but not limited to, a current or recent pattern of drug abuse, requires consultation with, or referral to, a more qualified specialist.”

So what can a physician do to avoid the over-prescribing traps? Registering for access to the CURES database will allow physicians to obtain reports on patients, which will provide statistical information about prior drug prescriptions with regard to a particular patient. Once registered, a

physician can look up a new patient who has raised certain red flags regarding pain medi-cation. Physicians should also perform complete examina-tions of patients and docu-ment meticulous notes in the patient’s charts. If a physician does attract the attention of the Medical Board, then he or

she will have to justify the prescription. Well main-tained and documented patient charts are essential for that, especially if memory may be an issue based on the amount of time that has elapsed from when the physician treated the patient. In maintaining proper documentation, the physician should keep a record of all drugs dispensed in the office and all prescriptions filled out, detailed descriptions of the tests or examination performed, and detailed descriptions of the pain or symptoms of the patient. Physicians should avoid prescribing pain medica-tions without first performing a physical exam, even if it is a recurring patient.

Physicians should also properly screen patients seeking prescription drugs. Likely red flags include, patients who have had numerous physicians in a short period of time, patients that refuse to try non-narcotic treatments, patients that request specific narcotics at the outset of treatment, and patients that appear to require refills too quickly. Physi-cians should use common sense and their trained medical instincts when screening patients for the first time.

Investigations and Medical Board trials are costly. Even if the physician ultimately prevails, thousands of dollars may have been spent to prove he or she was not negligent or did not engage in unprofessional conduct. For this reason, it is essen-tial that physicians take appropriate steps to ensure that pain medication prescriptions do not get the negative attention of the Medical Board.

Nicholas Jurkowitz is an associate at Fenton Nelson with a wide range of experience representing and advising healthcare providers on litigation related matters

Likely red flags include, pa-tients who have had numerous physicians in a short period of time, patients that refuse to try nonnarcotic treatments, patients that request specific narcotics at the outset of treat-ment, and patients that appear to require refills too quickly.

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ThisNEWsectionwill take a look at the questions and challenges associ-ated with various career phases of

Southern Califor-nia physicians,

from student loans and applying

for positions, to starting/buying/

selling a practice, switching careers and planning for

retirement.

Concern regarding cash flow often leads residents to utilize forbearance in order to postpone student loan payments and attain the liquidity necessary to pay for living expenses such as rent and groceries. While forbearance offers payment relief, it can be at a considerable cost, as interest continues to accrue and can substantially increase an already significant medical school debt burden.

This article provides an overview of the student loan repayment options and debt minimizing strate-gies that are available to medical school graduates.

Utilize Federal StUdent debt relieF ProgramSFederal student debt relief programs are available to

help recent graduates obtain payment relief and sav-ings on their federal student debt. The nuances of these programs must be fully understood in order to ensure eligibility and the maximization of potential benefits.

income-baSed rePaymentIncome-Based Repayment (IBR) is a viable

option for residents, as it was specifically designed for borrowers with high debt levels and low in-comes. IBR limits monthly loan payments to 15% of a borrower’s prior year discretionary income. Should the loans not be paid off within 25 years, the remaining balances will be forgiven. Addition-al benefits of IBR include no interest capitaliza-tion while enrolled in the program and, for up to three years, the government will pay any interest on subsidized loans not covered by the monthly payment.

It is extremely important to utilize the most ac-curate income documentation when applying for IBR in order to ensure the lowest possible monthly loan payment and the highest subsidy.

Considerations as You Navigate Medical School Debt

duE TO THE rIsIng

cost of higher educa-

tion, student loan debt

for medical school

graduates has more

than tripled in the last

15 years. The average

debt level now exceeds

$174,000.* Needless to

say, these debt levels, in

conjunction with low

starting salaries, can re-

sult in an undue finan-

cial hardship on resi-

dent physicians.


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icr-a (Pay aS yoU earn)Income Contingent Repayment (ICR-A), com-

monly known as “Pay as You Earn,” is a new repay-ment plan that will soon be available to help bor-rowers further reduce the cost of debt. While the repayment plan is not yet available, it will be very similar to IBR but with monthly loan payments re-duced to 10% of a borrower’s discretionary income. Additionally, the remaining balance on a borrower’s loans would be forgiven after 20 years instead of 25. Qualification requirements are still being finalized but borrowers must have no outstanding loans dis-bursed prior to October 2007 and at least one loan disbursed after October 2011.

PUblic Service loan ForgiveneSSPublic Service Loan Forgiveness (PSLF) allows

for tax-free loan forgiveness to federal loan borrow-ers who make 120 qualifying payments while work-ing for an eligible nonprofit entity. The majority of hospitals are classified as nonprofit and, therefore, many medical school graduates can begin working towards forgiveness during the first year of their resi-dency. The Department of Education also recently released the Employment Certification Form for PSLF to allow borrowers to easily track their prog-ress towards forgiveness.

Only Direct Loans are eligible for PSLF, so many borrowers interested in pursuing PSLF will need to transfer federal loans issued through the Family Edu-cational Loan Program (FELP) to the Direct Loan Program via the Federal Direct Loan Consolidation program.

combine ibr and PSlFIn order to make a qualifying payment in pur-

suit of PSLF, one must be enrolled in IBR or an-other qualified repayment option. Assuming qualify-ing employment, once a borrower makes 10 years of IBR or other repayment option payments while working at a nonprofit facility, they will have their remaining federal debt forgiven. Keep in mind these payments need not be consecutive, and can be made while working at different nonprofit entities.

Federal direct loan conSolidation ProgramAs referenced above, federal consolidation with

the Direct Loan program may be necessary to posi-tion loans for Public Service Loan Forgiveness. Con-

solidation can take months to complete, so timing is an important consideration. Additionally, structuring consolidations by grouping like interest rate loans together will preserve the ability to target higher rate debt if necessary in the future.

Additional Items to Consider Outside of Debt Relief Programs:

reFinancing oPPortUnitieSDue to improvements in the private loan mar-

ketplace, certain borrowers may be able to refinance their higher rate student loans. Lowering private loan interest rates can result in thousands of dollars of savings since none of this debt can be forgiven. Careful analysis must be performed when evaluating the potential savings and costs associated with any refinancing decision.

Financial allocation managementWith high student debt levels and relatively low

starting salaries, residents face a unique challenge in balancing the repayment of their student loans with living expenses, insurance coverage, saving for future purchases like a home and investing. When deter-mining the appropriate allocation, one must con-sider liquidity needs, tax implications, risk tolerance and rate of return.

UnderStanding yoUr oPtionSStudent loans and related federal programs can

be overwhelming. Taking full advantage of available benefits requires an in-depth understanding of each program’s details. To begin formulating your optimal repayment strategy, CMA members can sign up for a free personalized student debt assessment from GL Advisor. GL Advisor offers a unique service designed to help medical professionals lower the cost of their debt, obtain payment relief as needed and save time so they can focus on their careers. After receiving a free assessment, CMA members can retain GL Ad-visor’s service at a discounted fee for their first 12 months of service.

*Based on data collected by the AAMC, AMA and GL internal student database.

White paper was prepared for the California Medical Association by Todd Balsley of GL Advisor. GL Advisor is a financial advisory firm that specializes in helping physicians effectively manage their medical school debt and other financial matters. To learn more or sign up for an as-sessment, visit www.glAdvisor.com/CMA or call (877) 552-9907.GL Advisor is a division of Graduate Leverage, LLC. GL Advisor does not offer all services to residents of North Dakota at this time.


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PNNbringsread-ers a look at the latest local and state headlines impacting the economics of

healthcare deliv-ery in Southern

California. Local, timely and rele-

vant.InthisNEWsection you will

find a summary of the latest head-

linesfromPNN’smost recent week-

ly eBulletins.

A Service of the Physicians News Network andThe LOS ANGeLeS COuNTy MediCAL ASSOCiATiONPNN | LOCAL • TIMELY • RELEVANT

reporting on the economics of healthcare delivery

Read Full StoRieS and SubScRibe to the Pnn WeeklY eneWS bulletin at WWW.PhYSicianSneWSnetWoRk.com

la Officials scramble to comply with affordable care act

With California being an early adopter of health insurance exchanges, Los Angeles County officials are scrambling to overhaul the county’s outdated health-care system to comply with the Affordable Care Act and compete against private health insurers by Jan. 1, 2014.

huntington hospital exec explains Physician collaboration via Technology

Rebecca Armato, executive director of physician and interoperability services at Huntington Memo-rial Hospital, recently addressed the annual World Healthcare Innovation and Technology Congress to outline plans on how to use technology systems to improve quality of care while cutting costs.

apollo Medical holdings inks Pact for Physicians with california hospital Medical center

Apollo Medical Holdings Inc. recently signed an agreement with California Hospital Medical Center in Los Angeles to provide hospitalist services.

Under the terms of the contract, published on Nov. 21, Apollo will provide two daytime and one nighttime doctor at the hospital to respond to rapid response, emergency calls and provide internal medi-cine consultations on trauma patients.

Keck school Online Program draws interestThe Keck School of Medicine at the University of

Southern California is drawing interest from health professionals, including physicians, for its newly cre-ated online public health graduate program, accord-ing to the program director.

The program, which combines online coursework and a practicum, recently started accepting applica-tions for the spring of 2013.

st. John health center shakes up leadershipSaint John’s Health Center in Santa Monica

abruptly has ousted its top two executives and most of its governing board, as the hospital grapples with financial losses and rising competition, according to the Los Angeles Times.

New Triage system cuts eR waiting TimesTorrance Memorial’s new triage system has led to

improved patients’ waiting times in the emergency room and streamlined the process for providing pa-tient care, according to news reports.

Last June, a team of physicians, nurses and other staff joined forces to improve operations in the ER by using the “Lean Operating System,” Toyota’s model for process improvement.

la salle Medical Physicians get New Paperwork guidelines

Associated physicians with San Bernardino-based independent practice association, La Salle Medical Associates, Inc., now are required to submit claims and other paperwork electronically to a new managed care services organization, Network Medical Manage-ment, Inc.

anthem blue cross Rate hike Plan draws scrutinyNews reports that California’s largest for-profit

health insurer, Anthem Blue Cross, is seeking to raise rates an average of 18% for more than 630,000 indi-vidual policyholders, is drawing scrutiny from regula-tors and the ire of consumers and doctors here and elsewhere.

low-income children to be Transitioned to Medi-cal

On January 1st, the Department of Healthcare Services (DHCS) will start transitioning about 409,000 low-income children, including those living in Los An-geles County, from the Healthy Families program to Medi-Cal.This will be the first of four phases in the plan, which calls for transitioning more than 860,000 low-income children from the Healthy Families pro-gram to Medi-Cal, according to news reports.

New la Program Provides workforce health Risk assessments

Dr. Max Lebow, medical director at the Reliant Im-mediate Care Medical Group, Inc., located at the LAX International Airport, recently rolled out Healthy@Work, a program to provide employer workforces with health risk assessments, preventive health screenings, and health and lifestyle information.

www.Physiciansnewsnetwork.com


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lacMa chair is eager to work with santa Monica Mayor

LACMA’s chair of the political action committee, Dr. Tom Horowitz, said he is looking forward to work-ing with Santa Monica Mayor Richard Bloom, who de-clared himself the winner in a tight Westside Assembly race recently.

On Nov. 28, Bloom declared victory in an email thanking supporters, after his lead over Assembly-woman Betsy Butler grew to 1,246 votes, according to news reports.

anthem blue cross announces acO Network expansion in la county

This month, Anthem Blue Cross announced the ex-pansion of its Accountable Care Organization (ACO) network with a program focusing on managing pa-tients with chronic disease at Cedars-Sinai Medical Care Foundation and Torrance Memorial Medical Cen-ter/Torrance Memorial Integrated Physicians.

With ACOs, hospitals and a network of doctors share responsibility for providing care to patients with the goal of saving costs by avoiding unneeded tests and procedures. Several hospitals, insurers and phy-sician practices are making plans to form ACOs for Medicare patients and those with private insurance.

lacMa Officials lobby to stop Medicare cutsLACMA’s top officials said a recent meeting with

Congresswoman Karen Bass (CA-33) to gain support for stopping proposed Medicare cuts as well as re-move Los Angeles County from the proposed dual-eligible reform, was highly successful.

Physicians earnings Remain flat; Other healthcare Professionals Taking on larger Roles

New research published in a letter in the Nov. 28 issue of the Journal of the American Medical Associa-tion suggests that although physicians remain impor-tant, other health professionals will take on greater roles as health benefits are expanded in the next 13 months, under the Affordable Care Act.

growing demand anticipated for los angeles county 211 helpline

With hundreds of thousands of uninsured people joining the healthcare system under the Affordable Care Act in 2014, the 211 Los Angeles County helpline will likely play a more prominent role connecting pa-tients with doctors and social service providers.

infrastructure and investment. la county-- Los Angeles area healthcare answer-

ing service Medical Practice Solutions, Inc. has been acquired by nationwide call center 1-800 We Answer, according to news reports.

“Supporting doctors through English and Spanish language call center support and live telephone answering services is central to our business,” said Rob Porter, CEO and president of 1-800 We Answer.

-- WellCare Health Plans, Inc. completed the acquisition of Easy Choice Health Plan, Inc., which serves about 36,000 Medicare Advantage plan members in Los Angeles, Orange, Riverside and San Bernardino coun-ties, according to news reports.

In addition, Easy Choice will increase its 2013 service area to 11 California counties, including the San Diego area, as well as five counties in Northern California.

-- Construction of a 190,000-square-foot medical office at Wilshire Blvd. and Witmer Street in City West, slated to be finished in the second quarter of 2014, will serve as home to Good Samaritan’s specialty medical clinics, including cardiology, orthopedics and primary care.

The $80 million project will create a fa-cility with a pharmacy, an outpatient surgical center and five levels of physician offices.

-- MemorialCare Health System in Long Beach and Orange County said on Nov. 27 it would buy specific assets of Universal Care and file an application for its newly formed Seaside Health Plan to become a California licensed health plan.

Seaside seeks to support managed Medi-Cal members and prepare for the California Children’s Services (CCS) demonstration project, addressing children with certain dis-eases and ongoing conditions.



WElCOME TO THE NEWNEW LACMA

By MArion weB

Advocacy—Protecting Doctors’ and Patients’ RightsWhen it came to stopping the proposed 26.5% Medicare (SGR)

physician cuts and 2% Medicare sequestration cuts, LACMA’s offi-

cials took swift action by asking doctors to call their congressional

leaders, urging them to stop the cuts.

Meanwhile, LACMA’s top officials took the initiative to meet with

political leaders, including Congresswoman Karen Bass (CA-33), to

advocate for their members.

Luis Ayala, LACMA’s director of government affairs, said that af-

ter hearing doctors’ concerns, Bass, a former physician’s assistant,

agreed to support them.

“She understands healthcare and understood the equation and

basically committed herself to work with us and to make sure our

voices are heard for the benefit of the patients,” Ayala said.

LACMA’s political action committee members have made it

a point to meet with all state legislators in Los Angeles County to

ensure physicians’ issues and voices are being heard, said Dr. Troy

Elander, past president of LACMA.

“We’ve been getting to know them and they know what issues

are important to us,” said Dr. Elander, who is also the assistant clini-

cal professor at Jules Stein Eye Institute in Westwood.

This type of political advocacy ultimately benefits not only LAC-

MA’s members, but all Los Angeles County physicians and the pa-

tients they serve.

TIMEs ArE CHAngIng. The many challenges surrounding healthcare reform and physicians advocating for patients’ rights, while looking for their own representation and support, will require strong leadership and doctors who stand united.

“As more doctors become employed physicians, more than ever do they need an association to support them,” said Dr. Samuel Fink, LACMA’s president and chairman of the board.

As we’re heading into the New Year, the NEW LACMA is ready to take on these challenges, advocate on behalf of doctors and pa-tients, and restore some fairness to the Los Angeles healthcare sys-tem, vowed Rockard (Rocky) Delgadillo, LACMA’s CEO.

LACMA has already laid much of the groundwork.


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“The political action committee had a great track re-

cord in terms of the candidates that were elected and we

talked to them about protecting our patients and other

issues that are important to doctors,” Dr. Elander said.

This effort will continue.

“The new political action committee will support

candidates that are beneficial and have the best interest

of doctors and patients in their hearts,” Dr. Fink said.

The great vigilance LACMA provides its members

isn’t always apparent. But Dr. Fink, who has been a LAC-

MA member for more than 30 years, wants physicians

to know that his organization has and always will ensure

that members are well protected—financially, politi-

cally, and legally.

One of the major benefits of

being a LACMA member, he

pointed out, is the money

members save on such

critical issues as medical

malpractice insurance.

Though The Medi-

cal Injury Compensation

Reform Act (MICRA)

was passed almost 40

years ago, California Trial

Lawyers tried to overturn it

virtually overnight with a bill

that would have allowed plaintiff

attorneys to sue based upon the re-

tail price of the medical services provided,

rather than upon the amount paid by the injured party.

“We are vigilant 24 hours a day against any at-

tempt to overturn MICRA,” Dr. Fink wrote in an article

informing members about MICRA. “Never underesti-

mate the hard work that your medical association does

to make sure that you are protected!”

not Afraid to Take legal Action Dr. Fink is passionate about LACMA. He and Delga-

dillo agree that The NEW LACMA requires even greater

strength in numbers given the challenges ahead.

“There are many competing agencies out there,

but we hardly see anyone who advocates for patients

and physicians (like LACMA does),” Dr. Fink said. “We

try to advocate for both groups, because we know the

doctor-patient relationship is critically important.”

Last year, LACMA broke barriers by entering the

courtrooms. This year, Delgadillo said, the NEW LAC-

MA also will not shy away from filing suits to fight for

patients’ and doctors’ rights.

Last July, LACMA made headlines, drawing the at-

tention of doctors and patients across the nation when

it filed a lawsuit against Aetna, charging that the insurer

often refuses to reimburse policyholders who go out of

their networks when medically necessary, even though

they have purchased policies that allow them to do so.

This was followed by another lawsuit on September

13, 2012 in the local Superior Court. At that time, LACMA

went up against Health Net for legally denying patients’

claims to important, even life-saving, medical treatments

on a routine basis.

“Our two lawsuits send a clear

signal to the world of healthcare

that LACMA is no longer go-

ing to stand on the sidelines

in the world of policy, and,

in fact, we have decided

to step up into the ring on

behalf of doctors and their

patients,” Delgadillo said.

greater Diversification Other LACMA physicians

regard Delgadillo’s arrival at

LACMA in 2012 as a major win for

the organization. Under his leader-

ship, the NEW LACMA is poised for even

more growth and ethnic diversification.

“With the arrival of Rocky last year, we outlined

what we think would be the survival and growth of

LACMA to represent our physicians and the patients

they serve,” said Dr. Robert Bitonte, past president of

LACMA and chair of the legal affairs committee.

Dr. Elander described Rocky as instrumental in tak-

ing on the fight against the big insurance companies.

He’ll also open the doors wide to a more unified

and diversified LACMA.

Under Delgadillo’s watch, LACMA will represent

the same ethnic diversity of the community it serves,

starting with the creation of the first ever Latino Physi-

cians Advisory Committee.

The Latino Physicians Advisory Committee, formed

last November, will be the first of a new planned series

of advisory committees to be launched by the NEW

“There are many competing agencies

out there, but we hardly see anyone who advocates for

patients and physi-cians (like LACMA

does). We try to advocate for both

groups, because we know the doctor-pa-tient relationship is

critically important.”


LACMA in an effort to expand the reach to physicians

and their patients.

To reach an even more diverse population in Los

Angeles County, the NEW LACMA also will create a

Women’s Physicians Advisory Committee, an African-

American Physicians Advisory Committee, and an

Asian Physicians Advisory Committee.

According to reported estimates, African-American

and Latino physicians in Los Angeles County represent

just over 6% of the county’s 26,940 physicians, despite

representing 48% of the population.

“When I first came on board, we had very little

representation of Latino physicians at LACMA, which

made it a priority for me to reach out to the Latino

community,” Delgadillo said.

Under the leadership of Dr. Hector Flores, the Latino

Physicians Advisory Committee will work hard this year

to increase the number of Latinos enrolling into medical

school while attracting Latino physicians from all over

the world to practice in Los Angeles County, he added.

With an estimated 34 million more Americans

gaining access to health insurance under the Afford-

able Care Act, along with a rising aging population,

researchers estimate a need for 52,000 more primary

care doctors within the U.S. by the year 2025.

Addressing the Physician ShortageLACMA already has begun to address the doctor

shortage by reaching out to medical students, residents

and fellows, providing scholarships, career guidance

and networking opportunities.

In October, the California Medical Association House

of Delegates passed a resolution to eliminate dues for

interns, residents and fellows who join the LA County

Medical Association and CMA in the hope of attracting

up-and-coming doctors.

During that time, LACMA also invited physicians to

its annual LA Healthcare Awards dinner to help raise

funds for a loan repayment and scholarship program

to encourage newly graduated physicians to practice in

underserved areas in the county.

“The foundation has been raising funds to provide

medical school scholarships and we’ve been targeting

those in disadvantaged neighborhoods,” Delgadillo said.

Dr. Bitonte believes that the lack of fair compensa-

tion is partly to blame for the shortage of doctors in un-

derserved communities.

“If you try to deliver care in underserved areas, it

is key to pay physicians a higher differential in those

underserved areas,” he said. Dr. Bitonte said he would

like to address the issue of better compensation or

debt forgiveness this coming year as an incentive, but

commented that “these are not easily solvable issues.”

He also said that allowing physicians to have au-

tonomy to make the best decisions for their patients

will be a cornerstone issue for the NEW LACMA. Fair

compensation for all doctors, regardless of where they

practice, also will be on the table.

LACMA BENEfiTs

new Purchasing group In its continued effort to provide even more ben-

efits to its members, the NEW LACMA will also form a

new purchasing group where doctors will save on key

purchases from malpractice insurance, surgical gloves

and other medical supplies to computers.

“We will also offer educational opportunities to in-

crease the business acumen for doctors who run their

own businesses,” Delgadillo said.

This should provide members with significant savings.

“Our goal is to save members money that is at least

equivalent to the cost of their membership,” Dr. Fink said.

Physicians news networkThe weekly Physicians News Network is an entirely new

concept to keep members abreast of key developments

in the industry, provide breaking news focusing directly on

Los Angeles County and to keep members involved. “Ev-

ery week we are communicating with our members,” Dr.

Elander noted. “You can get 1,000 emails, but not one will

have local medical news—PNN does just that.”

PNN is the only source that provides every doctor

serving in Los Angeles County with the weekly custom-

ized news they need to stay informed and abreast of

what matters to them.

“We believe that every doctor in Los Angeles

should be a member of LACMA,” said Dr. Fink.

Why? The answer is clear.

“Being a part of LACMA gives you prestige in the

physician community and business community and the

political arena and a presence,” Delgadillo said. “What

LACMA can do is connect the dots—to influential people

in Los Angeles County and for upward mobility.”

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“Being a part of LACMA gives you prestige in the physician com-munity and business community and the political arena and a presence. What LACMA can do is connect the dots—to influential people in Los Angeles County and for upward mobility”


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UnitedWeStanddelivers the latest

California Medical association news

and insight into CMa-supported

and opposed leg-islation, as well as information on the

results of health-care-related bills to keep member phy-sicians up-to-date on the latest from the policy makers

in Sacramento.

MeDI-Cal pRIMaRy CaRe RaTe hIkes DelayeD

Medi-cal primary care physicians will have to wait to receive the higher reimbursement rates that were set to go into effect on Jan. 1 under the Affordable Care Act (ACA). The delay has been caused by a state health plan amendment that must receive federal approval. It is not yet known when the federal approval process will be completed, but the California Department of Healthcare Services (DHCS) has said the earli-est it would be able to implement the increase is summer 2013. DHCS has been unable to provide any detailed information regarding the reason for the lengthy delay.

This 100% federally-funded increase was in-tended to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. With the in-crease, primary care physicians should see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to the Centers for Medicare and Medicaid Services (CMS), states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contract-ing with Medi-Cal managed care plans see the higher rates.

California is not alone in this delay; several other states are in the same boat as well. The final federal regulations governing the two-year primary care physician rate hike were released on November 1, which did not give state much time to write and submit the necessary plan amend-ments.

DHCS has indicated that regardless of when it is implemented, the increase will be retroactive to January 1, 2013. However, they have been un-able to tell us exactly when we can expect the rate increase and exactly how retroactive pay-ment will function, apart from saying that physi-cians will not be required to resubmit claims.

The California Medical Association will pro-vide members with additional information as it becomes available.

wITH 2012 COMIng to a close and 2013 looming ahead, as the new President of the Califor-nia Medical Association (CMA), I want to take this opportunity to outline what we may see unfold over the course of the next year.

When I assumed the role of president in Octo-ber, I identified three imperatives critical to both our short and long-term success as an association:

First – The importance of membership in orga-nized medicine NOW, when healthcare delivery is rapidly changing, and how it is ON US to “connect the dots” and find linkages between the needs of po-tential members and the value CMA can provide.

Second – The vital role of physicians in leading change, moving toward a healthcare delivery system that is patient centric, physician-driven, high value, high quality, evidence-based and universally acces-sible. Without doctors leading the way toward that end, we will inevitably see a less desirable result.

Third – Mentorship. It is important that we pro-vide guidance and experience to our medical stu-dents, residents and young physicians as they enter the workforce and grow in their practices, in order to help them succeed as they take the medical, social and political reins from our hands.

From almost the first years of practice, my profes-sional life was a mix of clinical and non-clinical ac-tivity. At some point, it became clear to me that even a large integrated group cannot insulate itself from accelerating change in the economic, technological and political context for medicine. It was clear to me that joining an organization like CMA was the natural thing to do.

I had, at last, begun to understand the connection between organized medicine and what I wanted for my practice, my patients and the health of my com-munity, as well as what I wanted to contribute to the profession.

Many physicians – overloaded with exploding regulation of their practices, decreasing reimburse-

CMA PReSident’S MeSSAGe:

shaping the Future of healthcare in californiapAul r. phinney, MD, preSiDent, CMA

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

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ment rates and an overwhelming flow of informa-tion and expectation – may make that same con-nection.

It is up to US – the members of CMA – to help find that connection for physicians who haven’t yet done so. It will not happen by itself. At a time when legal, regulatory and legislative agendas are continu-ally shaping the way medicine is practiced in Cali-fornia, this is more important than ever.

With implementation of the Affordable Care Act just around the corner and with California lead-ing the way in many respects, it is imperative that physicians proactively take a lead role in shaping the changes ahead.

Only physicians know how to balance medical care wisely as we figure out how to realign incen-tives toward a sustainable health system and stable fiscal future.

If we resign ourselves to a future in which econ-omists and business executives lay out the rules for change, we are likely to end up with a system in which quality is measured in dollars, value is avail-able only to those who can pay for it and physicians are controlled by payors and regulators.

But it doesn’t have to be that way. With proactive involvement and dedicated advo-cacy, physicians can be the ones leading the change, helping to invent a better future for our patients.

Each physician will approach that effort in his or her unique way. But the aggregate effort by CMA as a whole will be both po-tent and determinative.

Each of us in the profession has arrived where we are with the guidance and men-torship of someone who believed in us. It is this critical assist that is the third imperative as physicians of CMA.

Medical students, residents and young physicians whom WE mentor today – here and in our offices – will not only provide our medical care, but will be the leading ad-vocates in the social and political arenas that will affect the science and art of medicine, the care and well-being of patients, the pro-tection of public health, and the betterment of the medical profession – the mission of our association.

Mentorship deserves our attention, and

it will be an area of my focus over the next year. It is something each one of us can and should do. A healthy future requires up-front investment.

As the New Year begins, I hope each of you will join me in bringing new energy to these three im-peratives: membership, mentorship and the steward-ship not just of our profession, but of the evolving system we use to provide care to our patients.

We live in turbulent and uncertain times that very likely will produce the most rapid change in the delivery of healthcare in decades. It is an incredible time to be part of the profes-sion. As we navigate the waters and obstacles ahead, I encourage each of you to consider what an important role you play in creat-ing a future we can delight in, and be proud of. The default – what will happen absent our effort – sim-ply is not good enough for us – or for our patients.

look for ongoing coverage of this topic in the PNN eNews bulletin and on phy-siciansnewsnetwork.com, your resource for what’s to come in 2013: The year of uncertainty, The year of Opportunity


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aS we’re heading into the New Year, the Los Angeles County Medical Association is pleased to offer existing and new members many more opportunities and benefits.At the same time, such key issues as healthcare reform and advocacy for physicians’ and patients’ rights in our communities and courtrooms will continue to take a center stage role at LACMA. Today, we are far more poised than ever to take on these challenges. We will look into building our political capabilities to advocate on behalf of physicians and restore some sense of fairness to the healthcare system in Los Angeles County.

Our new political action committee will connect even more dots with elected offi-cials—not just in Los Angeles County, but in the state of California and across the na-tion—to deal with these issues and ensure that physicians’ voices are being heard. We will continue to demonstrate our courage for physicians and stand up for their pro-fession—whether it will be in the courts, legislature or at City Hall. As we set out from the beginning, doctors need to be united. The more we can get doctors to unite around issues and continue to do outreach to get them to unite with LACMA, the better we are equipped to take on these challenges. We will provide ongoing training for physicians to help them accomplish their goals and continue our series of networking events with elected officials and others to make the presence of physicians tactile in the community. This year, LACMA will offer media training and create op-eds by physicians to let our voices be heard. Networking events, speaking engagements at hospitals and other events will also be a part of this equation to connect more physicians. We will provide members new benefits. LACMA’s new purchasing group, for one, will allow physicians to buy insurance, medi-cal supplies and equipment like computers at discounted rates. These savings should offset LACMA’s annual membership alone. With the enhanced communication we have put into place via the Physicians News Network (PNN) newsletter, physicians receive weekly news that isn’t only informative, but relevant to them.

We can get more doctors involved in the leadership of organized medicine through our various advisory communities, including the first Latino Physicians Advisory Committee, which we kicked off late last year.It will be an exciting year and we hope that existing members and the entire Los Angeles County com-munity will rally behind LACMA and get involved.

Rocky DelgadilloChief Executive Officer

as always the Los angeles County

Medical association will share social and

event highlights, as well as news and developments as

they continue their work to advocate

quality healthcare for all patients and

serve the profes-sional needs of its

members.

ceo’s letter


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lacma’S toP oFFicialS said a recent meet-ing with Congresswoman Karen Bass (CA-33) to gain support for stopping proposed Medicare cuts as well as remove Los Angeles County from the proposed dual-eligible reform, was highly successful.LACMA’s representatives, Rocky Delgadillo, Dr. Tom Horowitz, Dr. Marshall Morgan, and Luis Ayala, met with Bass last Monday.Ayala, LACMA’s director of government affairs, said the one-hour meeting focused on preventing the sched-uled 26.5% Medicare SGR physician cuts and the 2% Medicare sequestration cuts.The officials also addressed concerns surrounding the planned dual-eligible project, which would put poor seniors who are eligible for both Medicare, the single-payer system for retirees, and Medicaid, the program for low-income Americans, under the managed care of private insurers.Ayala noted that 50% of Medi-Cal patients—low-in-come Californians—have a tough time finding a doc-tor. About 75% of doctors stopped taking qualified patients, because the reimbursements do not meet the cost of overhead and supplies to treat them.Reform for dual eligibles is a hot-button issue for LA

doctors. “We advocated for LA County to be removed from the dual-eligible project,” Ayala said, citing concerns that LA County simply does not have enough doctors to meet the rising demand for healthcare services. That is discounting the challenges patients would face under the proposed reform.Dr. Samuel Fink, LACMA’s president and chairman of the board, echoed Ayala’s sentiments.Forcing dual eligibles into managed care plans, he said, would be disruptive and provide a disservice to patients.“Dual eligibles would be forced into managed care plans and away from the doctors they have been with for many years,” Fink said. “Patients should be given every opportunity to stay with their doctors.”After meeting with LACMA’s officials, Congresswom-an Bass, a former physician’s assistant, is expected to be supportive of LACMA.“She understands healthcare and understood the equa-tion and basically committed herself to work with us and to make sure our voices are heard for the benefit of the patients,” Ayala noted.

LACMA Officials Lobby to Stop Medicare Cuts

L ACM A hAS An n Ou n CE d the formation of its first-ever Latino Physicians Advisory Com-mittee with Dr. Hector Flores chairing the group.Flores is chairman of the Family Practice De-partment at the White Memorial Medical Center and co-director of the hospital’s Fam-ily Practice Residency Program. He received his undergraduate degree from Stanford Uni-versity and his medical degree from the Uni-versity of California at Davis.An advocate in cultural competency in healthcare, Dr. Flores is a frequent panelist and speaker on such topics as developing high-performing healthcare systems, pay-ment innovation, family medicine, the need for culturally relevant care, and the effect of diversity on healthcare quality.

With the Affordable Care Act, an estimated additional 500,000 Los Angeles County resi-dents, mostly Latinos, will qualify for medical insurance by the year 2014. This expansion, compounded with a shortage of physicians, will strain the capacity of the Los Angeles County healthcare system. One of the main goals of the new committee will be to in-crease the number of Latino physicians in Los Angeles County.“I look forward to leading LACMA’s Latino Physicians Advisory Committee,” Flores said. “We will be a committee action-focused on addressing the needs of patients and im-proving the healthcare system to better serve disadvantaged communities.”

LACMA Forms Latino Physicians Advisory Committee

seen on www.Physiciansnewsnetwork.com


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PhySicianS oF nUmeroUS special-ties shared camaraderie, fine food, and a delightful evening in a beautiful garden, thanks to the work of District 2 Alliance spouses. Seventy turned out to enjoy the 2012 version of a vaunted tradition, a re-spite from the rigors of modern medicine. Surgeon David Dahl and attorney wife Annabelle provided the olive and oak-framed setting. Excellent live music was contributed by orthopedic surgeon Steve Riffenburgh. Drs. Glenn Ehresmann and Robert Henderson, Chief of Staff of all 5 USC hospitals, took the microphone to applaud Halaine Rose for enthusiastically bringing us together against the odds! Halaine thanked her team--Marilyn Hen-

derson, Jan Moritz, Joan Dietrick, Joyce Getzen, Dr. Holt Rose--and heaven for holding off rain.

The 2012 party participants included some new and poten-tial members along with stalwarts. All Residents at Hun-

tington Hospital were invited (at no cost, thanks to generosity of several docs). Mrs. Rose challenged all present to conjure ways to gain young physician involvement and send ideas to Dr. Amy Caton (D2 member; resident at UCLA). Halaine noted the im-portance of legislative advocacy and drew attention to impressive photo display boards depicting D2 work and fun at local, national, state CMAA, and western states levels.

Neurosurgeon Bill Caton (D2 Board; then pres-ident of D2 and his specialty society) challenged wife Cathy, Halaine, and Jan Moritz to recreate a fall tradition. Their success in October 2006 was the catalyst for revitalizing our District 2 Alliance. Leading and continuing today, D2 is the largest and most active LACMA Alliance. We are in synch with LACMA President Sam Fink’s key goal of district revitalization.

Dr. Bill Caton and Cathy, Dr. Amy Caton and Lance Polverini.

Halaine Rose (right) with Dr. Steve Riffenburgh.

District 2 Harvest Moon Tradition Revival

a delightful evening of camaraderie, fine food, in a beautiful garden, thanks to the work of district 2 alliance spouses. seventy turned out to enjoy the 2012 version of a vaunted tradition, a respite from the rigors of modern medicine.

Halaine Rose , Janet Kadin, with officers Hollis Kim Bowles and Gloria DeOlarte,MD (LACMA & Alliance D2)

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

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By now, all LACMA and CMA Members have received their 2013 dues statements.

dues were due by december 31, 2012. Please be sure to renew your membership to ensure continuation of your benefits.

dues can be renewed conveniently online at www.lacmanet.org

ThANk you foR SuPPoRTINg youR PRofeSSIoN ANd youR PATIeNTS By SuPPoRTINg oRgANIzed MedICINe!

attention lacMa/cMa MeMbers

RENEW TODAY

new Online Marketplace Offers discounts on Products and Services For Your Practice! LACMA is pleased to designate a “best-in-class” designation for any vendor who meets the crite-ria outlined in our vendor vetting process so they may become a partner in our exclusive online marketplace. The online marketplace is a new and growing program designed to help your practice grow! Please call 213-226-0313 to access the discounts and learn more! FeAtuRed VendORS inClude:

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Members-only portals Physician community networks Office manager online forums Physician directories New online marketplace show-casing vendors offering exclu-sive money-saving discounts on products and services geared towards efficient prac-tice management operations.

LACMALAUNCHESCAMPAIGNTOURGELEGISLATORSTOHELPREMOVELOSANGELESCOUNTYFROMTHECOORDINATEDCAREINITIATIVE:DUALELIGIBLESDEMONSTRATIONPROJECT two yearS ago, the Legislature gave Medi-Cal the authority to do four “pilot projects” to redesign care for Medicare/Medi-Cal dual eligibles. The centerpiece of these pilot projects is requiring dual eligibles to enroll into Medi-Cal managed care plans.LACMA is opposing this proposal.

taKe action immediately

Urge the DHCS to withdraw this ambitious proposal to the Federal Government!

PleaSe viSit the Site belowto SUbmit a letter to yoUr legiSlator

http://www.lacmanet.org/advocacy/Takeaction.aspx

Legislators need to hear from LA County Physicians to know the true impact these cuts would have in their districts.


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and Pediatrician Garfield Health Center (GHC), op-erating as a Federally Qualified Health Center Look-Alike, is located in Monterey Park, California. GHC’s mission is to provide comprehen-sive, culturally competent, quality primary health care to medically un-derserved and vulnerable individu-als and families, including the Asian immigrant community, in the San Gabriel Valley. We are seeking full-time California licensed Family Practice Physician and Pediatrician to join our clinic.

Job requirements:• Board Certification in Family Prac-tice and Pediatrics• California Medical License• Bilingual – English/Chinese Man-darin or Cantonese highly preferred• Ability to be flexible

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Passive income opportunity $24k/year. Fallbrook Medical Center is seeking an offsite medical director board certified Family Practice/ Internal Medicine to serve as supervising physician. Malprac-tice covered by group. Contact 951-751-5593 [email protected]. 866-723-2081.

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www.Physiciansnewsnetwork.com


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Sources: The Future of Healthcare: A National Survey of Physicians. www.thedoctors.comA Survey of America’s Physicians: Practice Patterns and Perspectives http://www.physiciansfoundation.org

of doctors believe that healthcare reform

will

negatively impact their

relationship with patients.

51%

doctors believe that healthcare reform will negatively impact patient care.

Nin

e in

Ten

seventy-six% of California Doctors are concerned healthcare reform is eroding their

earning power physicians are unwilling to recommend healthcare as a profession

6 in 10

$25,000 the amount 62% of physicians estimate they provide in uncompen-sated care each year.

66.5%

of physi-cians w

ould choose the sam

e career if they had it to do over again

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forty% of physi-cians feel that liability/defensive medi-cine are the least satisfying about medical practice

65%of doctors do not think that healthcare reform will reduce defensive medicine.


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

800-252-7706 www.CAPphysicians.com

Superior Physicians. Superior Protection.

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.

We Celebrate Excellence

– James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

CAP_1361_SCP.indd 1 3/19/12 1:58 PM

Donald J. Palmisano, MD, JD, FACSBoard of Governors, The Doctors CompanyFormer President, American Medical Association

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts

with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of

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www.thedoctors.com

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