July 2010

July 2010 SAN DIEGO PHYSICIAN.OrG A

✖ SDCMS CelebrateS ItS 140th annIverSary In 2010 ✖

“Physicians United For a healthy san diego”

j U ly 2 0 1 0 official publication of the san diego county medical society

Reaching 8,500 Physicians Every Month

HeAltH InformAtIon tecHnology

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B SAN DIEGO PHYSICIAN.OrG July 2010

We fight frivolous claims. We smash shady litigants. We over-prepare, and our lawyers do, too. We defend your good name. We face every claim like it’s the heavyweight championship. We don’t give up. We are not just your insurer. We are your legal defense army. We are The Doctors Company.

The Doctors Company built its reputation on the aggressive defense of our member physicians’ good names and

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More than a fighting chance, for starters. The San Diego County Medical Society has exclusively endorsed our

medical professional liability program since 2005. To learn more about our benefits for SDCMS members, call

(800) 328-8831, extension 4390, or visit us at www.thedoctors.com/sdcms.

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July 2010 SAN DIEGO PHYSICIAN.OrG 1 (619) 683-2005 | www.ucprx.com | 1875 3rd Avenue, San Diego, CA 92101

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2 SAN DIEGO PHYSICIAN.OrG July 2010

thismonthVolume 97, Number 7

featureshealth inForMation technology 18 FEDErAl EHr CErtIFICAtION rulE by the California Medical Association

20 HEAltH INFOrMAtION EXCHANGES: CONSIDErAtIONS FOr YOur PrACtICE by Mark Branning

24 FrOM IMPACt-ED tO HEAltH INFOrMAtION EXCHANGE: A PrOtOtYPE FOr INFOrMAtION SHArING by Ted Chan, MD

25 BEACON COMMuNItY COllABOrAtIVE by Josh lee, MD, and Ed Babakanian

26 ElECtrONIC MEDICAl rECOrD DEPlOYMENt: tHE MErCY PHYSICIANS MEDICAl GrOuP EXPErIENCE by Michael Couris, MD

30 MEANINGFul uSE: PrACtICE CONSIDErAtIONS FOr PHYSICIANS by David A. Ginsberg

32 SECurItY AND CONFIDENtIAlItY WItH EMrS AND PHrS by The Doctors Company

34 lOCAl EXtENSION CENtEr: WHAt IS It? by Kitty Bailey

36 tElEMEDICINE: ClOSING IN ON DIStANCE MEDICINE by Brett C. Meyer, MD, and larry S. Friedman, MD

departments 4 CONtrIButOrS This Issue’s Contributing Writers

5 ArE YOu tAKING ADVANtAGE OF your SDCMS-CMA Member Benefits?

6 SDCMS SEMINArS, WEBINArS, AND EVENtS

8 COMMuNItY HEAltHCArE CAlENDAr

10 BrIEFlY NOtED SDCMS Medical Office Manager Bulletin Board, and More …

16 ACCESS tO CArE How you Can Help Make a Healthier San Diego

42 PHYSICIAN MArKEtPlACE Classifieds

44 MESSAGE FrOM tHE PrESIDENt “Individually, We Are One Drop, but Together We Are an Ocean.”

18

44

16

July 2010 SAN DIEGO PHYSICIAN.OrG 3


MANAGING EDItOr Kyle lewisEDItOrIAl BOArD Van l. cheng, md, adam f. dorin, md, Kimberly m. lovett, md, theodore m. mazer, md, Robert e. peters, md, phd, david m. priver, md, Roderick c. Rapier, mdMArKEtING & PrODuCtION MANAGEr Jennifer RohrSAlES DIrECtOr dari pebdaniPrOjECt DESIGNEr lisa WilliamsCOPY EDItOr adam elder

sdcMs Board oF directorsoFFicersPrESIDENt susan Kaweski, mdPASt PrESIDENt (AMA Alternate Delegate) lisa s. miller, mdPrESIDENt-ElECt (CMA District 1 trustee) Robert e. Wailes, mdtrEASurEr sherry l. franklin, mdSECrEtArY (SDCMS At-large Director) Robert e. peters, md, phd

geograPhic and geograPhic alternate directorsEASt COuNtY William t. tseng, md, heywood “Woody” Zeidman, md (A: Venu prabaker, md)HIllCrESt niren angle, md, steven a. ornish, md (A: eric c. yu, md)KEArNY MESA John g. lane, md (A: Jason p. lujan, md)lA jOllA J. steven poceta, md, Wynnshang “Wayne” sun, md (A: matt h. hom, md)NOrtH COuNtY James h. schultz, md, doug fenton, md, arthur “tony” blain, md (A: steven a. green, md)SOutH BAY Vimal i. nanavati, md, mike h. Verdolin, md (A: andres smith, md)

at-large directors and at-large alternate directorsJeffrey o. leach, md, bing s. pao, md, Kosala samarasinghe, md, david e.J. bazzo, md, mark W. sornson, md, John W. allen, md, mihir y. parikh, md (A: carol l. young, md (SDCMS FOuNDAtION

PrESIDENt), thomas V. mcafee, md, ben medina, md, James e. bush, md, edward l. singer, md, alan a. schoengold, md, Jerome a. Robinson, md)

other Board MeMBers COMMuNICAtIONS CHAIr theodore m. mazer, mdYOuNG PHYSICIAN DIrECtOr Van l. cheng, mdAltErNAtE YOuNG PHYSICIAN DIrECtOr Kimberly m. lovett, mdrESIDENt PHYSICIAN DIrECtOr Katherine m. Whipple, mdAltErNAtE rESIDENt PHYSICIAN DIrECtOr steve h. Koh, mdrEtIrED PHYSICIAN DIrECtOr Rosemarie m. Johnson, mdAltErNAtE rEtIrED PHYSICIAN DIrECtOr mitsuo tomita, mdMEDICAl StuDENt DIrECtOr adi J. priceCMA SPEAKEr OF tHE HOuSE James t. hay, md

ex-oFFicio, nonvoting Board MeMBers CMA PASt PrESIDENtS Robert e. hertzka, md, Ralph R. ocampo, mdCMA DIStrICt I truStEES theodore m. mazer, md, albert Ray, md, Robert e. Wailes, mdCMA truStEE (OtHEr) catherine d. moore, md, CMA SOlO AND SMAll-GrOuP PrACtICE FOruM DElEGAtES michael t. couris, md, James W. ochi, mdAltErNAtE CMA SOlO AND SMAll-GrOuP PrACtICE

FOruM DElEGAtE dan i. giurgiu, mdAMA DElEGAtES James t. hay, md, Robert e. hertzka, mdAltErNAtE AMA DElEGAtES lisa s. miller, md, albert Ray, md

contributors

OpiniOns expressed by authors are their own and not necessar-ily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unso-licited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to [email protected]. All advertising inquiries can be sent to [email protected]. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For sub-scriptions, email [email protected]. [san DiegO COunty MeDiCal sOCiety (sDCMs) printeD in the u.s.a.]

Kitty BaileyMs. Bailey is the executive director of the San Diego County Medical Society Founda-tion.

MarK BranningMr. Branning has spent 30 years in the healthcare information systems industry and is a consultant specializing in health information exchange, interoperability, product positioning, and personal health records.

caliFornia Medical associationThe California Medical Association (CMA) represents 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

ted chan, MdDr. Chan, SDCMS-CMA member since 2005, is medical director of the UC San Diego emergency department.

Michael coUris, MdDr. Couris, SDCMS-CMA member since 2001, is a solo ophthalmologist who has de-ployed NextGen EMR and EPM in his office. Dr. Couris served on an EMR selection com-mittee for Mercy Physicians Medical Group and is an advocate for widespread EMR adoption and interoperability to improve patient care and to provide timely, full, and accurate reimbursement to the practicing physician.

larry s. FriedMan, MdDr. Friedman, SDCMS-CMA member since 2005, is UC San Diego’s medical director of ambulatory quality and safety, and co-direc-tor of the Southern California Telemedicine Learning Center.

toM gehringMr. Gehring is executive director and CEO of the San Diego County Medical Society (SDCMS).

sonia gonzalesMs. Gonzales is your SDCMS director of medical office manager support and your SDCMS office manager advocate. She can be reached at (858) 300-2782 or at [email protected].

Brett c. Meyer, MdDr. Meyer, SDCMS-CMA member since 2005, is associate professor of clinical neu-rosciences at the UC San Diego School of Medicine, co-director of the UC San Diego Stroke Center, and medical director of the UC San Diego Department of Telemedicine.

jenniFer M. tUteUr, MdDr. Tuteur, SDCMS-CMS member since 2006, is board-certified in family medicine. From 1997 to 2009, Dr. Tuteur worked at Community Health Centers in San Diego County. Since then, she has been the medi-cal director of the County of San Diego’s County Medical Services.

Send your letters to the editor to [email protected]››

SDCMS Tweets!Follow SDCMS on Twitter.com to keep abreast of H1N1 updates, the latest healthcare reform developments, SDCMS seminars, and more!


˛ Are you getting your reimbursement issues resolved?˛ Does your office manager have an ally she can turn to?˛ Do you have a tough HR question you need answered?˛ Are you protecting your assets?˛ Is your bank working as hard as you?˛ Are you saving on your professional liability insurance?˛ Are you writing off bad debt unnecessarily?˛ Is your prescription pad reorder rut costing you money?˛ Are you squeezing all you can out of your health plan

contracts?˛ Is outsourcing your billing the solution?˛ Have you done enough to prevent an IT meltdown?˛ Is the right person doing your accounting?˛ Are you unsure about a code and need it verified?˛ Are your waiting-room magazines increasing your

malpractice risk?˛ Are you letting deadlines critical to your bottom line pass?˛ Are you meeting your staff’s training needs?˛ Are you getting stopped unnecessarily on your way to an

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Contact SDCMS at (858) 565-8888 or at [email protected] today!

Are You Taking Advantage of Your SDCMS-CMA

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For further information, visit SDCMS.org/event

or contact SDCMS at (858) 565-8888 or at

[email protected].

free to member Physicians and their office Staff!don’t see What you need? let Us Know!

sdcmsseminars/webinars/events

SDcmS SemInArS / WeBInArS / eventSDate Time PresenterTopic S* W* E* Day

x

x

x

x

x

x

x

x

x

x

Jul 20

Jul 21

Jul 22

aug 7

aug 18

aug 25

sep 11

sep 15

sep 16

sep 18

oct 1–29

oct 7

oct 27

noV 4

noV 12

noV 17

noV 18

noV 20

6:30pm – 7:30pm

11:30am – 12:30pm

6:30pm – 9:00pm

8:30am – 12:00pm

11:30am – 1:00pm

11:30am – 1:00pm

4:00pm – 7:00pm

11:30am – 12:30pm

11:30am – 1:00pm

9:00am – 12:00pm

8:00am – 4:00pm

11:30am – 1:00 pm

11:30am – 1:00pm

11:30am – 1:00pm

6:00pm – 9:00pm

6:30pm – 7:30pm

11:30am – 12:30pm

8:00am – 4:00pm

“the employee’s Role in decreasing liability Risks in the physician office” (Risk management)

“the employee’s Role in decreasing liability Risks in the physician office” (Risk management)

membership social

“ms outlook for busy docs” (practice management)

osha updates

hipaa updates

young physician summer social

e-townhall (t)

palmetto / medicare

media training

certified medical coder course

economic survival

“scope / allied health professionals” (legal issues)

“expert Witness, medical board interactions” (legal issues)

membership social (t)

“emerging patient safety issues impacting office practices” (Risk management)

“emerging patient safety issues impacting office practices” (Risk management)

“preparing to practice” Workshop

the doctors company

the doctors company

sdcms (Rock bottom brewery-la Jolla)

tom gehring, sdcms

tom gehring, sdcms

david ginsberg, privaplan

sdcms

tom gehring, sdcms

michele Kelly, california medical association

tom gehring, sdcms

practice management institute

aKt cpas

california medical association

alexander & alexander, attorneys at law

sdcms (location tbd)

the doctors company

the doctors company

multiple presenters, sdcms

Wed

thu

thu

sat

Wed

Wed

sat

Wed

thu

sat

5 fRidays

thu

Wed

thu

fRi

Wed

thu

sat

* "S" = Seminar • "W" = Webinar • "E" = Event

x

x

x

x

x

x

x

x

x

x

x

x

x

x


SDCMS Endorsed Partner Benefits

Total Potential Value to SDCMS Members:

$11,000–$18,000


communityhealthcarecalendar

To submit a community healthcare event for possible publication, email [email protected]. All events should be physician-focused

and should take place in San Diego County.

Diabetes Day for Primary Care PhysiciansJUL 17 • Presented by the American Association of Clinical Endocrinologists • Hyatt Regency La Jolla • Contact (904) 353-7878

Critical Care Summer Session 2010JUL 22–24 • Catamaran Hotel, San Diego • cme.ucsd.edu/criticalcare

Learn How to Become a POLST Trainer (Physicians Orders for Life-Sustaining Treatment)AUG 19 • 8:30am–5:00pm • SDCMS Meeting Room • CME/CEU Provided • $25 • contact sdcms at (858) 565-8888, at [email protected], or visit capolst.org

12th National Kaiser Permanente Hospital Medicine ConferenceSEP 2–3 • Hotel del Coronado • meetingsbydesign.com

Infertility and Pregnancy Loss: Getting Your Patients the Emotional Help They NeedSEP 25 • Skaggs School of Pharmacy, La Jolla • 8:00am–5:00pm • regonline.com/IPLO

Southwest Regional Integrated Behavioral Health ConferenceSEP 8–9 • The Crowne Plaza Hotel in San Diego • $299 • mhsinc.org/calendar

5th Annual Frontiers of Clinical Investigation Symposium: Pain 2010 Bench to BedsideOCT 14–16 • Estancia La Jolla • cme.ucsd.edu/b2b2010

Challenges in the Perioperative Management of OSA PatientsOCT 15 • San Diego Location TBD • cme.ucsd.edu

American Society for Bioethics and Humanities 12th Annual MeetingOCT 21–24 • Hilton San Diego Bayfront Hotel • asbh.org

Cutting-edge Strategies in Diabetes Care: Making the ConnectionOCT 30 • San Diego Convention Center • cme.ucsd.edu

4th Annual UCSD Hands-on NOTES and Single Site Surgery SymposiumNOV 11–13 • Omni San Diego Hotel • cme.ucsd.edu/notes

West Coast Geriatric Psychiatry ConferenceFEB 16–19, 2011 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu

Topics and Advances in Internal MedicineMAR 7–13, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

Topics and Advances in Pulmonary and Critical Care MedicineMAR 13–14, 2011 • San Diego Marriott, La Jolla • cme.ucsd.edu

July 2010 SAN DIEGO PHYSICIAN.OrG 9 CHMB DELIVERS THE HIGHEST LEVEL OF SERVICE AND EXPERTISE TO ENSURE A SWIFT, SMOOTH AND SUCCESSFUL EHR COMPLETION.

CHMB – The Choice for EHR & Successful AdoptionImproved business performance starts with CHMB—ranked among the top providers in California for EHR Adoption & Implementation Services. Here’s why hundreds of physicians have selected CHMB for building and installing the Allscripts EHR application into their community practices:

NATIONAL AND LOCAL EXPERTISE

• Established footprint with 1,000 community physicians and clinics statewide

• Experts who know the full story– Hardware Selection & Procurement, Network Configuration, Application Support

TARGETED SOLUTIONS

• World Class Portfolio – Clinical and Business Solutions – Allscripts, Dell, Cox Business

• Flexible approach to drive efficiencies and meet diverse needs, from multi-specialty and specialty, to single provider, to multiple providers

• Innovative technology that delivers at the speed you need

PROVEN RESULTS

• Real Utilization – 95% of physicians are at Meaningful Use with CHMB EHR Services

• Superior Support – 98% client satisfaction on CHMB Clinical & IT Services during implementation & on-going support

• Outstanding ROI – 97% of physicians believe CHMB’s services met all expectations, including cost, training, implementation, and application optimization

As your business partner, let us navigate your entire EHR project and create the right solution to fit your practice. Count on us to train you to use the EHR at its optimal level. It’s time to trade up to EHR and discover Meaningful Use with CHMB.

San Diego County — 1121 East Washington Ave., Escondido, CA 92025Orange County — 7700 Irvine Center Drive, Ste 290, Irvine, CA 92618

760.520.1400 • 800.727.5662 • www.chmbsolutions.com

ARE YOU READY FOR EHR?

“ CHMB has been our trusted

business partner for more than

six years. It made perfect sense

that when we decided to move

forward with EHR in our practice,

we entrusted our implementation

of Allscripts to them as well. They

have been there for us every step

of the way!”

ELIZABETH SILVERMAN, MD

PartnerNorth County OB/GYN Medical Group

Call today for your FREE EHR Readiness Assessment!

Ron Anderson • 1.760.520.1340

Marianne Gregson • 1.760.520.1333

Geoff Doyle • 1.760.520.1343

SDCMS Medical Off ice Manager

brieflynoted

By Sonia Gonzales, Your Off ice Manager Advocate

Help Us Help you With your

Information technology

Please take a few moments to answer the following

questions:

1. YES Or NO : Do you know if you have the proper

security hardware and software?

2. YES Or NO : Do you understand your network

topology?

3. YES Or NO : Are you sure you have the proper backup

systems in place?

4. YES Or NO : Do you have adequate insurance

coverage for your IT network?

5. YES Or NO : Do you know how to choose hardware

with the future in mind?

If you answered “No” to any of these questions, or if you

simply want to learn more about information technology

for your office, SDCMS will be conducting an “IT Overview”

seminar/webinar on July 15 from 11:30 a.m. to 1:00 p.m. For

more information, see our list of upcoming seminars on page

6, visit SDCMS’ “Calendar of Events” at SDCMS.org/event, or

contact me at (858) 300-2782 or at [email protected].

SpECial FoCuS: Medical Board of california’s required notice to consumers by PhysiciansEmail your Questions to [email protected] physicians are now required to inform their patients that they are licensed by the Medical Board of California and to provide patients with the MBC’s contact information. The new regulations, which took effect June 27, 2010, require physicians to provide this notice by one of three methods:

By prominently posting a sign in an area of your office

•that is conspicuous to patients, in at least 48-point type in Arial font.By including the notice in a written statement, signed

•and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient un-derstands that the physician is licensed and regulated by MBC.By including the notice in a statement on letterhead,

•discharge instructions, or other document given to a patient or the patient’s representative; the notice must be placed immediately above the patient’s signature line in at least 14-point type.Regardless of which method you choose, the notice

must read as follows: “NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.ca.gov.”According to the MBC, physicians, not facilities, are

responsible for compliance with this regulation. In group settings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients. For more information on this new regulation and/or to view samples of notifications, visit SDCMS.org.

10 SAN DIEGO PHYSICIAN.OrG July 2010Sonia

access sdcMs’ recorded seMinars anytiMe at sdcMs.orgReminder: If you are unable to attend our seminars in person or our webinars live, you can log in with your SDCMS member office manager password to view them anytime at SDCMS.org. Please let me know if you need your password information by emailing me at [email protected].

[SAve tHe DAteS!]The Best Events and Seminars for

Medical Office Managers

✓ julY 15: INFOrMAtION tECHNOlOGY OVErVIEW

✓ AuGuSt 18: OSHA uPDAtES

✓ AuGuSt 25: HIPAA uPDAtES

✓ OCtOBEr 1–29: CErtIFIED MEDICAl CODEr COurSE (5 FrIDAYS)

✓ OCtOBEr 7: ECONOMIC SurVIVAl

aSk Your oFFiCE

ManagEr aDvoCatE!

Question: We recently received an EOB that states

it is an “Expedited Agreement” for an amount much

less than our contracted rate with the health plan. It

also states that the health plan has contracted with

them for the resolution of this claim. I am not sure

why there is a discount rate, and I do not know why

there is a third party involved. Do we need to sign it

to be paid?

Answer: In this case I would contact the health

plan directly because this sounds like it may be a

Silent Preferred Provider Organization (Silent PPO).

Silent PPOs result when contracting agents (such as

health plans, insurers, and PPOs) sell or rent their

directly contracted physician networks to third

parties, giving the third party the advantage of the

discounted reimbursement a managed care orga-

nization has negotiated with the physician. There

are many reasons why Silent PPOs are unfair and

potentially unlawful. The potential challenges differ

depending on whether or not the physician signed

an agreement that authorized the downstream con-

tracting of the physician’s discount, and, if so, the

terms of the contract. One of the red flags that silent

Be Sure to Look for Our August Office Manager Issue of

San Diego Physician!

PPO activity is occurring is your EOB since it does not specify the source of the discount claimed. You should scrutinize all EOBs with discounts to ensure that dis-counts are properly claimed.CMA is actively working on many fronts to eliminate unfair physician discounts and would appreciate cop-ies of EOBs or other correspondence that document improper silent PPO activity. Please send such docu-mentation to: CMA Legal Center, Attention: Silent PPOs, California Medical Association, FAX: (916) 551-2027. Please indicate all of the following: 1) Whether you believe the activity constitutes a violation of the law by the payer claiming the discount, the managed organization that “leased” your discount, or both; 2) All violations you believe the documentation demon-strates; and 3) All efforts you have made to redress the violation, including copies of all relevant correspon-dence.

For more information on silent PPOs, see CMA ON-CALL document #1907.



brieflynoted

officers:President: Susan Kaweski, MDImmediate Past President: Lisa S. Miller, MDPresident-elect: Robert E. Wailes, MDTreasurer: Sherry L. Franklin, MDSecretary: Robert E. Peters, MD, PhD

geographic Directors:East County: William T. Tseng, MDEast County: Heywood “Woody” Zeidman, MDHillcrest: Niren Angle, MDHillcrest: Steven A. Ornish, MDKearny Mesa: John G. Lane, MDLa Jolla: J. Steven Poceta, MDLa Jolla: Wynnshang “Wayne” Sun, MDNorth County: James H. Schultz, MDNorth County: Doug Fenton, MDNorth County: Arthur “Tony” Blain, MDSouth Bay: Vimal I. Nanavati, MDSouth Bay: Mike H. Verdolin, MD

geographic Alternate Directors:East County: Venu Prabaker, MDHillcrest: Eric C. Yu, MDKearny Mesa: Jason P. Lujan, MDLa Jolla: Matt H. Hom, MDNorth County: Steven A. Green, MDSouth Bay: Andres Smith, MD

At-large Directors:Jeffrey O. Leach, MDBing S. Pao, MDKosala Samarasinghe, MDDavid E.J. Bazzo, MDMark W. Sornson, MDJohn W. Allen, MDMihir Y. Parikh, MD

At-large Alternate Directors:Carol L. Young, MDThomas V. McAfee, MDBen Medina, MDJames E. Bush, MDEdward L. Singer, MDAlan A. Schoengold, MDJerome A. Robinson, MD

other Board members:Communications Chair: Theodore M. Mazer, MDYoung Physician Director: Van L. Cheng, MD Alternate Young Physician Director: Kimberly M. Lovett, MDResident Physician Director: Katherine M. Whipple, MDAlternate Resident Physician Director: Steve H. Koh, MDRetired Physician Director:

Rosemarie M. Johnson, MDAlternate Retired Physician Director: Mitsuo Tomita, MDMedical Student Director: Adi J. PriceCMA Speaker of the House: James T. Hay, MD

other nonvoting Board members:CMA Past President: Robert E. Hertzka, MDCMA Past President: Ralph R. Ocampo, MDCMA District I Trustee: Theodore M. Mazer, MDCMA District I Trustee: Albert Ray, MDCMA District I Trustee: Robert E. Wailes, MDCMA Trustee (Other): Catherine D. Moore, MDCMA Solo and Small-group Practice Forum Delegate: Michael T. Couris, MDCMA Solo and Small-group Practice Forum Delegates: James W. Ochi, MDCMA Solo and Small-group Practice Forum Alternate Delegate: Dan I. Giurgiu, MDAMA Delegate: James T. Hay, MDAMA Delegate: Robert E. Hertzka, MDAlternate AMA Delegate: Lisa S. Miller, MDAlternate AMA Delegate: Albert Ray, MD

SDCMS-endorsed Coastal Health-care Consulting Group, Inc., is a specialty consulting firm that assists clients with managed care contract-ing, contract negotiations, credentialing, revenue enhancement, and strategic planning. As a benefit of membership, SDCMS physicians receive free contracting analysis, discounts on hourly rates, and package prices on ser-vices for contract negotiations, including health plan contracts. Contact Kim Fenton at (949) 481-9066, at [email protected], or visit HealthcareConsultant.org.

get off Autopilot: Squeeze All you can out of your contracts!Save 10% of net revenue

SDcmS BoArD of DIrectorS for 2010–11


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brieflynoted

PHySIcIAnS get noticed!

physicians: let your legislators know that you’re paying attention and that you vote by wishing them a happy birthday! notE: Due to mail handling procedures for government office buildings, postal mail to Washington, DC offices may be delayed by several weeks or even months. please fax or email if possible.

Welcome our new members!

Kathy M. Clewell, MDinternal medicinePoway • (858) 592-7040

joseph F. Cutler, MDinternal medicinesan diego

Nancy A. Folks, MDfamily medicinela mesa

joanna l. Gunn, MDinternal medicinela mesa

Amy C. Kakimoto, MDfamily medicineEncinitas • (760) 942-0118

Mamata V. Kene, MDemergency medicineSan Diego • (619) 446-1646

Santosh Kesari, MDneurologyLa Jolla • (858) 822-7524

jennifer l. Khoe, MDsurgerySan Diego • (619) 516-6571

tom-Oliver Klein, MDinternal medicineSan Diego • (619) 446-1657

Geva E. Mannor, MDophthalmologyla Jolla

Glenn P. Murphy, MDgeriatric medicinebonita

rosa M. Navarro, MDpain medicineChula Vista • (619) 271-1683

Gregory I. Ostrow, MDpediatric ophthalmologySan Diego • (858) 764-3176

ramin raiszadeh, MDorthopedic surgerysan diego

Margaret riley-Hagan, MDpediatricsescondido

Devjani Saha, MDanesthesiologySan Diego • (858) 565-9666

Sergio D. Sanguesa, MDfamily medicineLa Mesa • (800) 290-5000

james Z. Zhou, MDfamily medicineSan Diego • (800) 290-5000

Welcome our rejoining members!

james E. Bates, MDsports medicineSan Diego • (619) 286-9480

A. Marcus Gerber, MDdiagnostic RadiologySan Diego • (619) 528-3143

Scott A. Hacker, MDorthopedic surgerySan Diego • (619) 286-9480

Eric r. Horton, MDorthopedic surgerySan Diego • (619) 286-9480

Mark D. jacobson, MDsurgery of the handSan Diego • (619) 286-9480

john A. Kafka, MDpediatricsLa Mesa • (858) 499-2701

ralph E. rynning, MDorthopedic surgerySan Diego • (619) 286-9480

thomas H. Shannon, MDpsychiatrySan Diego • (619) 920-6935

please Welcome our new and rejoining SDcmS-cmA members!

Wish Your legislators a Happy Birthday!

Birthday: sePteMBer 4Congressman Bob FilnerE: house.gov/filnerWashington, DC Office:united States Congress2428 Rayburn House Office BuildingWashington, DC 20515T: (202) 225-8045F: (202) 225-9073San Diego County Office:333 F Street, Suite AChula Vista, CA 91910T: (619) 422-5963F: (619) 422-7290Imperial County Office:1101 Airport Road, Suite DImperial, CA 92251T: (760) 355-8800F: (760) 355-8802


5946 Priestly Drive, Ste. 200Carlsbad, CA 92008

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sdcMs contact inForMation5575 Ruffin Road, suite 250 san diego, ca 92123t (858) 565-8888F (858) 569-1334E [email protected] SDCMS.org • SanDiegoPhysician.orgCEO/EXECutIVE DIrECtOr tom gehring at (858) 565-8597 or [email protected]/CFO James beaubeaux at (858) 300-2788 or [email protected] OF MEMBErSHIP DEVElOPMENt Janet lockett at (858) 300-2778 or at [email protected] OF MEMBErSHIP OPErAtIONS AND PHYSICIAN ADVOCAtE marisol gonzalez at (858) 300-2783 or [email protected] OF MEDICAl OFFICE MANAGEr SuPPOrt AND OFFICE MANAGEr ADVOCAtE sonia gonzales at (858) 300-2782 or [email protected] OF ENGAGEMENt Jennipher ohmstede at (858) 300-2781 or at [email protected] OF COMMuNICAtIONS AND MArKEtING Kyle lewis at (858) 300-2784 or at [email protected] BuSINESS MANAGEr nathalia aryani at (858) 300-2789 or [email protected] ASSIStANt betty matthews at (858) 565-8888 or at [email protected] tO tHE EDItOr [email protected] SuGGEStIONS [email protected]

sdcMsF contact inForMation5575 Ruffin Road, suite 250 san diego, ca 92123t (858) 565-8888F (858) 560-0179W sdcmsf.orgEXECutIVE DIrECtOr Kitty bailey at (858) 300-2780 or [email protected] CArE MANAGEr barbara Rodriguez at (858) 300-2785 or at [email protected] ACCESS PrOGrAM DIrECtOr brenda salcedo at (858) 565-8161 or at [email protected] DAY PrOGrAM MANAGEr alisha mann at (858) 565-8156 or at [email protected] ACCESS MANAGEr lauren Radano at (858) 565-7930 or at [email protected]

Your SDCMS and SDCMSF Support Teams Are Here to Help!

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accesstocare

By Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Vice President of Business and Member Development, American Academy of Professional Coders (AAPC)

How You Can Help Make a

HeAltHIer San DiEgo

and find some Job satisfaction too

By Jennifer M. Tuteur, MD


What Is county of San Diego cmS?The County of San Diego’s County Medical Services (CMS) Program is a medical assis-tance program available to San Diego Coun-ty-eligible adult residents with serious medi-cal conditions. The CMS Program assists medically indigent adult county residents who are not eligible for other government healthcare programs. CMS is not health in-surance.

Patients may qualify for CMS assistance if they meet medical severity threshold (see below) and are:

a U.S. citizen or legal resident•a permanent resident of San Diego County•21 through 64 years of age•not eligible for Medi-Cal•determined to meet CMS financial •requirements

CMS services may cover:medical visits for evaluation by primary care•primary clinic follow-up care•emergency care•emergency hospital care•prescription medications on the CMS •formulary

specialist visits*•surgical/diagnostic procedures*•emergency medical transportation•emergency dental care•limited rehabilitation, medical equip-•ment, and home health services*

medical severity threshold is defined as:

immediately life-threatening or significant-•ly disabling physical conditions, such as myocardial infarction or trauma from MVAacute illnesses that could ultimately lead •to disability or death, such as cholecystitis and gastric ulcerchronic illnesses, including diabetes and •hypertension

Why Help?The rewards of treating CMS patients are many, including the satisfaction of assist-ing a patient who may not have needed a physician in years and is now desperate for help. You could help a patient overcome an acute event and become healthy and strong enough to return to work. You might find satisfaction in working on a challenging case, and you will be sure to enjoy working with the CMS team of social workers and RN

case managers. Or you could enjoy helping patients and their families address chronic illnesses in a way that will stave off long-term sequelae for many years.

Physicians like the appreciation they get from the patients they see from CMS. “These patients are so grateful to us, and thank us every time,” says staff at Dr. Musinski’s office in Encinitas. A referral clerk says of one of our RN case managers, “She helps me to help the patients.”

How you can Help?You can help care for indigent adult patients with acute and chronic medical conditions. As a contracted specialty physician, you will have access to an online eligibility website. Contracted providers also have the use of a new electronic system for submitting and reviewing treatment authorization requests. Please consider joining hundreds of other San Diego County physicians in providing a medical safety net to indigent, ill, adult residents of San Diego. To become a CMS provider, contact Rebecca Velie, contract ad-ministrator/compliance manager, via email at [email protected] or by phone at (858) 495-1360.

How You Can Help Make a

HeAltHIer San DiEgo

Thirty-five-year-old A.N. worked in San Diego and supported himself. He wasn’t covered by medical insurance through his work but didn’t seem overly concerned about it since he was a healthy, productive member of society. However, last August his life changed in an instant. A.N. was involved in a serious motor vehicle accident and sustained severe trauma to his foot. Paramedics brought him to the ED, where both his medical and his financial needs were assessed. He qualified for medical care through the County of San Diego’s County Medical Services and underwent multiple surgeries, including amputation of his foot, during his month-long hospitalization.

He lost his job during the hospitalization. Without an income, he lost his housing as well. Hospital staff contacted the RN case managers at CMS when he became ready for discharge. While he continued with orthopedics, surgery, physi-cal therapy, and other outpatient specialty visits, A.N. qualified for room and board housing through CMS. He was visited weekly by a CMS social worker, who helped him navigate medical and social assistance programs. During this time, he received food, housing, support, and assistance with transportation to medical visits. In turn, he gave encouragement to other patients undergoing surgical and medical treatments living at the same room and board.

He recovered from his surgeries and received a prosthesis. After several PT sessions, he learned how to walk again and now does so without a discernable limp. After receiving medical clearance from his surgeons, A.N. found a job and returned to work full-time. Six months later, he is completely self-sufficient and, again, a productive member of society.

*These services must be approved in advance by the AmeriChoice Medical Management Services Department.

A.n.’S Story


federal eHr certification ruleBy the California Medical Association

HealtH InformatIon tecHnology

foR moRe infoRmation, Visit healthit.hhs.goV/tempceRt


federal eHr certification rule

BackgroundIn order to receive electronic health record (EHR) incentive payments under the Ameri-can Recovery and Reinvestment Act (“ARRA” or the “Stimulus Bill”), physicians will have to demonstrate “meaningful use” of a “certi-fied” EHR system.

Currently, the Office of the National Co-ordinator for Health IT (ONCHIT) is involved in two separate rulemaking processes to de-fine the process by which physicians will qualify for those incentive payments. The first proposed rule sets up a definition for “meaningful use.” The comment period for that regulation closed on March 15, with the final rule expected to be released sometime this summer.

The second proposed federal rulemaking, which is the focus of this summary, lays out the process by which ONCHIT will certify EHR systems. On June 24, the Federal Health and Human Services Agency (HHS) pub-lished a final rule in the Federal Register, lay-ing out the process by which they will select organizations who will certify EHR systems.

The previous version of this EHR certifica-tion rule was published in March of this year, and the comment period closed in April. CMA filed comments based on a review of the proposed rule by CMA’s Council on In-formation Technology.

It is important for physicians to note that they must use a certified EHR system to qualify for federal provider incentives. Now that this rule is final, it is expected that lists of certified EHR products will be available in early-to-mid fall. This will give physicians a starting point for selecting appropriate EHRs for their practices.

temporary ProcessIn the previous version of this rule, HHS had proposed a two-step process. In order to ex-pedite the EHR certification process, HHS proposed a Temporary Certification Program that would begin this summer and con-tinue until December 31, 2011. The entities named to perform certification during this temporary program would be called ONC-Approved Testing and Certification Bodies (ONC-ATCBs).

The final rule released on June 24 only

covers the Temporary Certification Program. The rules governing the permanent program will be published in a subsequent federal rulemaking next year.

While this temporary program is in place, the federal government will be establishing the rules and regulations for a permanent certification program. The permanent pro-gram will be more comprehensive and would begin in January 2012.

onc-atcB approval ProcessOrganizations that are interested in becom-ing an ONC-ATCB can request an application from ONCHIT in writing. Interested organi-zations must be able to test EHR systems in real-world situations, such as in a simulation lab. Organizations can either apply to certify complete EHR systems or to only certify one “module” (such as e-prescribing software). ONCHIT will have 30 days to review and respond to organizations interested in be-coming a temporary certification body. It is anticipated these temporary bodies, or ONC-ATCBs, will be named early this fall.

In the earlier version of this rule, HHS stated that they believed only one or two or-ganizations would be capable of becoming ONC-ATCBs. Based on the level of interest around this proposed rule, they now believe that there will be multiple entities capable of meeting the requirements. This is a posi-tive change for physicians since more ONC-ATCBs will spread out the work, and prod-ucts can be certified faster. It will also lessen the chances of one organization controlling the market for certified EHRs.

certificationOnce they begin their work, ONC-ATCBs will only be assessing whether or not EHR sys-tems will enable physicians to demonstrate meaningful use. While they can, at their own discretion, assess EHRs based on other crite-ria, those other criteria will not affect federal certification.

ONCHIT will develop one website that will list all of the certified products, as well as a standard certification label that vendors can use to identify certified products. ONC-ATCBs will be required to report to ONCHIT no less than weekly regarding new products

that have been certified.Once an EHR is certified, it will not need

to be recertified if the vendor makes minor upgrades to it. It will need to be recertified, however, when the transition to the perma-nent program occurs in 2012.

In a few rare cases, providers have self-de-veloped EHRs. In these cases, a provider may have assembled an electronic medical record, an e-prescribing system, and other software into a custom bundle. In these cases, a pro-vider will be allowed to request certification of the self-developed EHR.

certification and meaningful UseBy the draft definition, meaningful use will come in three stages: stage 1, which will be fi-nalized this summer, stage 2, which will take effect in 2013, and stage 3, which will take effect in 2015. Because they will only be in effect until the end of 2011, ONC-ATCBs will only be able to certify EHR systems to allow physicians to achieve stage 1 of meaningful use. Certifying EHR systems for stages 2 and 3 of meaningful use will be done in the per-manent certification process, which may be different than the temporary process.

timelines and next StepsDue to the urgency of naming ONC-ATCBs as soon as possible, HHS has waived the normal 30-day period for final regulations to take effect. Therefore, this rule became ef-fective immediately upon publication (June 24). There is no further opportunity for pub-lic comment.

ONCHIT will now move to begin the ap-plication process for organizations interested in becoming ONC-ATCBs. Their stated goal is to begin naming ONC-ATCBs as soon as possible, in order to begin certification of products as early as this fall.

For physicians, now is a good time to pre-pare for the transition to EHR. Until the first list of certified EHR systems is published, physicians can spend time assessing practice EHR needs, mapping office workflow, and re-searching potential vendors. This will allow practices to move quickly once vendors are certified.


Health Information exchangesBy Mark Branning


IE (Health Informa-tion Exchange) activity can enhance virtually any clinical function by providing a broader set of data to enhance

clinical decision-making. Although there are many ben-

efits of HIE, key benefits for practitioners are to support:

care coordination — the ability to view •more comprehensive patient informationpatient engagement•reporting of quality measures, immuniza-•tions, and syndromic surveillance

HIE is a powerful tool. HIE is, or will soon be, a part of your workflow. The need to ex-change information is being driven by a desire to improve care coordination, recent legislation, a more involved consumer, as well as additional quality and public report-ing requirements.

The goals of this article are to both inform and assist your planning around workflows and implementation or upgrades of EMR (electronic medical record) software. The ar-ticle will discuss electronic HIE. Electronic HIE can replace the inefficient paper processes of requesting paper records from other provid-ers and patients carrying their information from one provider to the next.

What Is HIe?The following summary is from HIMSS (Healthcare Information and Management Systems Society): “In its most conservative definition, HIE (the verb) is the activity of securing health data exchange between two authorized and consenting trading partners. Data exchange occurs between any two trad-ing parties — a data supplier and a data re-ceiver. To add complexity, a third party could also be storing data from and on behalf of the data supplier and be transmitting data on behalf of the data supplier ….” Figure 1 is a simple diagram to illustrate the most com-mon structure for HIE.

HIE models include: central, where the data is stored at the HIE entity; federated, where the data is stored at each provider;

consideRations foR youR pRactice


and hybrid, which has some data stored centrally and some federated. Most success-ful HIE implementations have incorporated a hybrid model using an HIE entity, who is a third party.

HIE can take place in one of two basic ways: push or pull. Push means the data ar-rives unsolicited, i.e., the user did not have to do anything to get the data other than be associated with the patient. Pull means the data exchange is a result of a query/request by the user.

What can HIe Do for you?Key examples are summarized below. Con-nections to the stimulus’ HITECH mean-ingful use legislation criteria will be made as appropriate. Meaningful use (MU) is covered on page 30.

care coordination: labsThe most common HIE is sharing lab results with all providers associated with a patient. The performing lab sends the results back to the ordering physician through the HIE en-tity. The results are sent — pushed — to the other providers via email, fax, or directly to an EMR.

care coordination: Beyond labsThe same method used for labs can be used for encounter summaries, radiology results, and other data where there are sharing agree-ments.

care coordination: comprehensive ViewLet’s take a new-patient visit as an example and assume the patient has lived in the San Diego area for 10 years. Let’s also assume for the moment that San Diego has already im-plemented a community HIE solution.

The patient verbally provides his or her history, current medications, perhaps some recent lab results, and a paper encounter summary from a visit to another physician. All of this information is being recorded by you and your staff in your EMR.

Because the patient has lived in the area, you are fairly sure that there is data from previous providers. While in your EMR, you have a button on the screen that is labeled “HIE.” You select “HIE,” and a summary of clinical information is displayed. The in-formation has been pulled and aggregated from a central HIE database, other provid-ers, labs, pharmacy benefits management

sites, and other sources. You may even have information displayed from a patient’s PHR (personal health record). The source of each piece of data is clearly identified. You are able to drill down on any items of interest to you. You are also able to select items in the display and have them instantly downloaded into your EMR. It’s important to emphasize that to minimize information overload, the data is in a summary format when displayed.

You now have a much more comprehen-sive view of the patient. Even before you are up and running on an EMR, you may still be able to do this query.

A similar scenario occurs during an ED or urgent care encounter.

Related MU Stage 1 requirements are: pro-viding an electronic summary care record for each transition of care and referrals; and ex-changing clinical information electronically with other providers and patient-authorized entities.

Patient engagementPatient portals, PHRs, wellness sites, and re-cent legislation have accelerated patients’ ability to actively participate in their health-care. Stage 1 MU criteria require that patients be provided with an electronic copy of their information upon request, and that patients have timely electronic access to their infor-mation. When a patient requests a copy of his or her record, there’s a button that says “print to paper” and/or “print to a CD, mem-ory stick, or some other electronic media.” At the end of each visit, selecting the “encoun-ter summary button” produces an electronic version of the encounter.

Patient access to information is achieved through patient portals that are being of-fered now by practically all of the major EMR and HIE vendors. Many healthcare delivery systems have developed their own portals. The portal can be a view into a single EMR or a display of EMR data from several EMRs.

Although PHR exchange is not explicit in Stage 1, it is anticipated that Stage 2 require-ments and demands by consumers will result in copies of patient information being sent to PHRs. Several EMR and HIE vendors are al-ready outputting data and sending it to PHRs.

HIE supporting patient engagement will

FigUre 1: siMPle hie diagraM


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result in better informed and more engaged patients.

reporting requirementsMost EMR vendors know that they must have the ability to send data to CMS, states, im-munization registries, and public agencies for Stage 1 compliance. There will be, for example, an “output to public health agency button” providing an electronic file that can be sent to the agency in de-identified formats.

With the increase in reporting require-ments, electronic production and transmis-sion of these reports will reduce your office’s workload.

new methods for HIe are emergingNHIN Direct is a new model of exchange that does not use an HIE entity but instead relies on two parties directly sharing information. In the past year, this model has gained consid-

erable traction.Health record banks use PHRs as the coordi-

nation tool. Providers would only need agree-ments between themselves and the bank, and not with every other provider. The State of Washington is implementing this model.

How close are We to this care coordination Vision in San Diego?To answer, we need to separate HIE into two categories: enterprise HIE and community HIE. All the major healthcare systems in San Diego have and/or have efforts under way to ensure that EMRs in their system are sharing information both within the system and with affiliated providers, i.e., information that is exchanged across the enterprise.

San Diego is behind other communities in defining a community HIE solution. The com-munity solution will be the glue for exchange of information for all providers whether they

are part of a system, or a group, or a solo prac-titioner. There are several worthwhile proj-ects that are under way for coordinating care; however, an overall strategy has not been de-veloped.

With the market for HIE being driven by MU, consumerism, as well as a recent $15 mil-lion award to a consortium of the key San Di-ego healthcare delivery stakeholders, the op-portunity for the San Diego community HIE is promising.

SummaryElectronic HIE can provide care coordination, patient engagement, and reporting benefits. To achieve the benefits of HIE, changes to workflow and EMRs need to be implemented. As you implement or upgrade your system, keep the functionality/buttons in mind. If vendors cannot clearly show how they can achieve MU and that they have the right func-tionality, move on.

July 2010 SAN DIEGO PHYSICIAN.OrG 23 JuNE 2010 SAN DIEGO PHYSICIAN.OrG 23

San Diego County Medical Society (SDCMS) | 5575 Ruffin Road, Suite 250 San Diego | 858.565.8888 | SDCMS.org

SDCMS Is at the Table!By choosing to join the San Diego County Medical Society (SDCMS), over 3,000 practicing physicians,

resident physicians, and medical students in San Diego County have given voice to our patients and to our communities in the healthcare reform discussions and in every single healthcare

issue being debated locally, in Sacramento, and in Washington, DC.

Ask your colleagues: “Are You a Member of SDCMS?”

POLITICAL REALITY:

YOU’RE EITHER

AT THE TABLE

OR

YOU’RE ON THE MENU


from ImPAct-eD to Health Information exchangea pRototype foR infoRmation shaRingBy Ted Chan, MD


ealth information tech-nology (HIT) holds the potential to improve healthcare delivery and

enhance the patient experience. In a very specific population,

we are showing that HIT can help us solve the problem of emergency room overcrowd-ing, while demonstrating that when separate provider systems work together to share in-formation, patients and providers benefit.

Our project began in response to the two San Diego County safety net assessments that reported that many patients seen in the emergency department are there for non-emergent issues, contributing to the problem of ED overcrowding. Moreover, both reports noted that primary care capacity existed in the community clinics and recommended that systems be developed to refer patients from the ED to the clinics when they were in need of a medical home.

Recognizing that EDs are a costly setting for care that could be provided in the com-munity clinics, which receive federal fund-ing to help support their safety net role, we developed “IMPACT-ED” (Improving Medi-cal home and Primary care Access Through the Emergency Department) in partnership with the San Diego Family Care (SDFC) com-munity clinics. This project, funded by Alli-ance Healthcare Foundation, electronically links the UC San Diego Medical Center ED directly with an SDFC clinic using a secure, HIPAA-compliant internet connection avail-able on a 24/7 basis. The system allows UC San Diego ED physicians and staff to sched-ule follow-up appointments for patients, of-ten the next day, directly with a community clinic near the patient’s residence.

We conceived this project based on stud-ies showing a dramatic decrease in ED use by Medi-Cal and unfunded patients when they have access to more appropriate health and social services that address their needs. We theorized that by helping low-income pa-tients establish a relationship with a clinic as


their medical home for preventive, primary, specialty, and chronic care, they would cur-tail their reliance on more costly hospital emergency rooms as their primary health-care resource.

The project has been a success. Since IMPACT-ED was launched in 2007, we have referred more than 2,000 patients to a com-munity clinic provider. Our data indicate that patients who are scheduled for an appoint-ment with a clinic before they leave the ED are 24 times more likely to keep their appoint-ment than those who are simply given con-tact information and encouraged to call for an appointment and follow up on their own.

Recognizing the potential for this pro-gram as a way to rein in healthcare costs and relieve some of the stress on our EDs, United-Health Group/PacificCare provided a grant for UC San Diego Health System and clinic partners to expand the program. The Family Health Centers of San Diego (FHCSD) joined UC San Diego and SDFC to develop the San Diego Health Information Exchange (HIE). With this program, we are expanding our capabilities to include medical information transmittal so that in addition to setting up an appointment, we can immediately trans-

fer updated medical information about the patient to the clinic. Because FHCSD has an electronic medical record system, we can link directly to share patient information and schedule appointments. In the case of the SDFC clinics, access to the patient’s UC San Diego medical records will be possible through a secure, internet-based link.

We are also pleased to be participating in a regional expansion of this model through Safety Net Connect. This county-funded ini-tiative, which is being implemented through Community Health Improvement Partners (CHIP), aims to connect the region’s hospital emergency departments with community clinics throughout San Diego. The goal is to get even more patients into appropriate medical homes, to decrease the unnecessary use of EDs, while strengthening communica-tion among key players in the region’s health care safety net.

These projects demonstrate the value of creating electronically linked networks among separate systems and providers, re-sulting in more efficient and appropriate utilization of healthcare resources, while improving the care and service we provide to our patients.

Beacon community collaborativethe San Diego healthcare community was recently in the national spotlight when vice pres-ident Joe Biden and Health and Human Services Secretary kathleen Sebelius announced that our region was one of only 15 communities across the country selected to pilot the wide-scale use of health information technology (Hit) to improve quality, safety, efficiency, and cost effectiveness in the delivery of patient care.

the multimillion-dollar Beacon Community Collaborative grant awarded to uC San Diego on behalf of a wide collaboration of healthcare providers and the community is part of a $220 million american recovery and reinvestment act initiative to use Hit to advance mean-ingful, measurable improvements in healthcare. thanks to the joint efforts of San Diego’s healthcare providers, the strength of our healthcare stakeholder community, and the innova-tive application of Hit already taking place throughout San Diego, our region was the only California community to successfully compete for this grant.

to read the complete “Beacon Community Collaborative” article by Josh lee, MD, informa-tion services medical director at uC San Diego Health System, and Ed Babakanian, chief information officer at uC San Diego Health Sciences, visit SDCMS.org/publications.

When separate provider systems work together to share information, patients and providers benefit.


electronic medical record Deployment

By Michael Couris, MD


the meRcy physicians medical gRoup expeRience


ealth information technology (HIT) and specifically the electronic medical record is about to burst onto the scene in private practices throughout the nation. Buoyed

by passage of President Obama’s stimulus package, the HITECH Act, the ARRA, and the recent award of a $15 million Beacon Grant to UC San

Diego, San Diego practices need to start plan-ning their paths through the IT maze, which is peppered with potential pitfalls.

This article is written from the experience of deploying a combined, single database electronic medical record (EMR)/practice management system in 10 primary care of-fices of various sizes in Mercy Physicians Medical Group (MPMG), a multispecialty IPA in central and south San Diego County. The group is involved in capitated care for both Medicare Advantage and commercial patients. Many participating physicians also see fee-for-service Medicare and serve com-mercial patients. Perhaps some pearls can be gleaned from our physicians’ experience to ease the transition for our colleagues.

Selection of a specific EMR product was accomplished by committee. MPMG’s man-agement company, North American Medi-cal Management, convened representatives from multiple IPAs under its umbrella about two years ago. An initial product selection was a nonstarter and was fortunately tested in a different IPA. The secondary selection proved to be an excellent decision. More than 25 practitioners are now using this soft-ware during a one-year rollout period.

EMR deployment was a business decision for MPMG as costs continue to escalate and payers were putting pressure on the group to be more efficient. It was obvious to the MPMG board of directors and to the MPMG EMR Committee that few practices would move forward without significant financial


support up front. The lure of future govern-ment dollars did not figure into past or fu-ture IPA calculations, since requirements for government reimbursement are nebulous at this time and were not extant during the planning stages. Significant financial sup-port was afforded practices to relieve the bur-den of hardware and software costs, training, implementation, and data conversion. A temporary drop in revenue was also some-what ameliorated with the financial support given. The IPA’s goal was to encourage EMR adoption for more efficient, better patient management at lower cost.

taKe hoMe #1: Be sure to use all local re-sources before deciding which system to purchase or lease. Check with colleagues to see what works best in your type of practice and specialty. Use companies that have strong financials, good support, and that will be around in the next several years. Finally, see if your hospital or medi-cal group is sponsoring specific EMRs, is providing monetary support, or can light-en the burden for your practice in any way. Do not go it alone.

The MPMG board decided that any govern-ment funds that might materialize should be retained by the physicians who have adopted EMR as a reward for early adoption. This act also served as a statement that the board believed adoption is the right thing to do for countless reasons — the promise of gov-ernment funding not being of great import. At press time, the Centers for Medicare and Medicaid Services (CMS) has not released “meaningful use” guidelines. These guide-lines are to provide a list of EMR functions that must be met in order to receive govern-ment support. Many who follow this issue closely believe that one of the requirements for meaningful use will include the ability to share data with colleagues and other entities such as hospitals and laboratories.

There are many companies in the market-place guaranteeing that they will be able to meet all meaningful use requirements. The requirements have not been finalized, so this claim is specious at best today. One other caveat is that the expense to achieve mean-

ingful use with any one product may be cost-prohibitive. Many communities, including San Diego, are forming health information exchanges to facilitate data sharing among various healthcare entities. Be sure your EMR can participate in these collaborative ven-tures or else your practice may be electronic but unable to communicate with your col-leagues and affiliated hospitals.

taKe hoMe #2: The hurdles to obtain gov-ernment dollars might be very high. Cast a wary eye on any company that “guaran-tees” meaningful use, as the costs to meet the requirements may be onerous. Look to the community for a health information exchange (HIE), which will allow your EMR to interface with the greater health-care community at a reasonable cost, or one that lets you adopt electronic capabili-ties in a modular, affordable approach.

“Initial deployment in the office will be disruptive to you, your staff, and patients,” says Billie Green, MD, an adopter of MPMG’s EMR system. “I was pulling my hair out the first two weeks. Things have become much better. I’m already back to seeing the same number of patients that I saw before putting EMR in my office only after four weeks.” Dr. Green’s experience is typical of the physi-cians who deployed the MPMG-sponsored EMR. A four-month-lead time was required. Each office was shepherded by an EMR con-sultant who had experience in setting up more than 250 electronic offices, making the process less daunting for the physicians and office staff.

taKe hoMe #3: Your vendor should be able to provide a consultant to assist with planning. Expect a large lead-time from completing a contract to deployment of your chosen system. A well-thought-out plan is necessary to ensure a successful experience. Remember, there are a lim-ited number of healthcare IT specialists in a time when thousands of physicians are planning to go electronic. Plan accord-ingly.

Lucy Polak, MD, another adopter of MP-

the importance government and private payers

are placing on electronic

initiatives is very obvious

considering the large

amount of money committed. Where

this becomes especially

pertinent to the practicing

physician is the future

reduction in funding for

medical care.


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Project4:Layout 1 9/22/08 11:22 AM Page 1

MG’s EMR, has many observations about her deployment experience. “At first, our office could not see as many patients,” she says. “Our computer skills eventually improved. Patients are very impressed with electronic records and have been very supportive. It is much easier to evaluate a patient with all of the data in once place. I can also look at labo-ratory results, document my interpretation, and phone the patient very efficiently. In-ternal office communications are also much better as they are now more efficient and task assignment can be audited. I’m sorry to say we may not need as large an office staff going forward.”

taKe hoMe #4: If you are deploying an EMR in the office, be ready for major changes. Workflow changes will be enor-mous. Things will be difficult at first but will improve with time as long as there is commitment on the part of the staff and

physicians. No transition from paper to computer was easy or without challenges for MPMG physicians. With perseverance, all have made the transition and are now practicing with electronic offices.

The electronic medical office has been slow in coming considering the rate of IT adoption across a range of industries over the past 20 years. The importance government and private payers are placing on electronic initiatives is very obvious considering the large amount of money committed. Where this becomes especially pertinent to the practicing physician is the future reduction in funding for medical care. Physicians hope-fully can harness IT effectively, provide more cost-effective care, and, maybe, just maybe, see reimbursements keep up with the costs of keeping their practices open. We at MPMG made a choice to proceed with EMR. We hope you’ll join us.

It was obvious to the mPmg board of directors and to the mPmg emr committee that few practices would move forward without significant financial support up front.


meaningful

USepRactical consideRations foR physiciansBy David A. Ginsberg


making Sense of a confusing SubjectFor almost a year physicians have been hear-ing about the meaningful use criteria that must be demonstrated (or at least attested to in the first year of incentive funding) to be eligible to receive CMS incentive funding. Of course, achieving meaningful use (hereafter referred to simply as “MU”) is only one com-ponent of qualifying for incentive funds. Physicians must also be “eligible providers” (certain hospital-based physician specialties are excluded from incentive funding on the principle that they use electronic health re-cords purchased by the hospital). Physicians as well must use an EHR from a certified vendor — subsequent federal rules and guid-ance have been issued on how vendors can become certified. Certification itself requires the vendor demonstrate they have the func-tionality and capability to meet each of the MU criteria. The MU criteria are designed to be met in three stages over a period from 2011 through 2015.

The complete set of MU criteria and measures to demonstrate they have been achieved was released in the “Medicare and Medicaid Programs: Electronic Health Re-cord Initiative Program A” Proposed Rule, released Dec. 30, 2009. This proposed rule generated hundreds of public comments, most of them challenging the MU criteria as too complicated, difficult, or inappropriate, as well as unlikely to be successfully reached by healthcare providers in the allotted time-frame. Timeframes for achieving MU are also tied to the incentive funding timeframe it-self. Incentive funding has a limited shelf life and, as proposed, decreases in amount and finally disappears. Thus physicians are faced with the challenge of not achieving MU in the prescribed timeframe and either losing incentive funding opportunities or receiving a reduced incentive.

The proposed MU criteria are organized into several categories that support a health outcomes policy priority, each with a specific goal. For the most part, these make sense and contribute to overall improved patient qual-ity and outcomes, practice efficiency, and even privacy and security of patient informa-tion. The categories are the following:


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Improving quality, safety, and ef-•ficiency, and reducing disparities. Some of the criteria in this category are the use of computerized order entry for diagnostic tests or medication prescrib-ing. This category is the largest, with 16 criteria.Engage patients and their families •in their healthcare, with criteria in-cluding the ability to provide patients with a clinical summary of their office-based visit or with timely electronic ac-cess to their health information, such as laboratory test results.Improve care coordination. • An ex-ample of the criteria in this category is performing medication reconciliation (prescription medications, home medi-cations, and so forth).Improve population and public •health. An example of the criteria in this category would be exchanging immuni-zation data with the San Diego County immunization registry program.Ensure adequate privacy and secu-•rity protections for personal health information. This category has only one criterion, which can be demonstrat-ed by showing that you have conducted or reviewed a security risk analysis as re-quired by the HIPAA security rule and have implemented security updates as necessary.

It remains to be seen how responsive CMS will be to the public comments and to what degree MU criteria will be modified. In the

meantime, there are a few practical tips that can be initiated for any medical practice. These are based on implementing those cri-teria today that make good sense from a prac-tice efficiency and compliance perspective.

Submit claims electronically.1. Using electronic claims submission generally results in faster reimbursement and bet-ter claims adjudication accuracy. Even if your practice management software can-not generate an electronic claim, there are clearinghouses that can help.Check insurance plan eligibility 2. and benefits electronically. The av-erage wait time for telephone eligibility verification nationally is still longer than 20 minutes! This is a terrible waste of of-fice personnel time and very inefficient. Even if you use a clearinghouse and must pay a small per-eligibility inquiry fee, the cost is usually well worth the time saved!Complete your HIPAA security com-3. pliance plan, including the risk analysis. Many medical practices have not completed the security rule compli-ance, even though it went into effect in 2005. Maintaining privacy safeguards and providing the forms (such as the no-tice of privacy practices) is not a complete compliance program! There are easy-to-use tools to help you achieve compliance and complete a risk analysis.

These three tasks are appropriate and, in the case of HIPAA, required now. They are also three of the proposed MU criteria your practice can achieve early.

the proposed mU criteria are organized into several categories that support a

health outcomes policy priority, each with a specific goal. for the most part, these

make sense and contribute to overall improved patient quality and outcomes,

practice efficiency, and even privacy and security of patient information.


Security and Confidentiality With emrs and PHrs

By The Doctors Company



Security and Confidentiality With emrs and PHrs

electronic Health recordsBreaches of electronic data are growing in frequency from small and large organiza-tions alike. More than 900 medical breaches were reported to the State of California in the first six months of 2009 alone. Many of these breaches were lost data sticks, lost or stolen laptops, and compromised electronic storage. Ensuring proper electronic medical record keeping that is in line with confidentiality and security laws is critical, as violating these laws may lead patients to take legal action or could result in the imposition of civil and/or criminal penalties. Consider the following issues with respect to protecting patients as well as managing the integrity and security of electronic medical records:

Medical offices need computer systems •with log-out and password protection. Computer systems and servers should be backed up and secure, and online com-munications should be limited to exist-ing patients. Remember that traditional email is not secure.Use a system with appropriate encryp-•tion against unauthorized third-party access. Laptops and remote devices need to be password-protected and securely transported. Be particularly cautious when remotely accessing an electronic records system from a home computer or a public computer that is used by others.Utilize an electronic system that main-•tains permanent audit records of all en-tries and changes. Develop a system for documenting corrections to computer-ized records, and make sure that no im-proper alterations are made.Develop a data recovery and/or disaster •plan to comply with the Red Flags Rule,

the compliance deadline for which has again been delayed by the Federal Trade Commission (FTC) until Dec. 31, 2010. This set of rules requires many businesses and organizations to implement a writ-ten Identity Theft Prevention Program designed to detect the warning signs — or “red flags” — of identity theft in their day-to-day operations. For more infor-mation, visit ftc.gov/redflagsrule.

Personal Health recordsDiffering from the physician-controlled EHR (electronic health record), the person-al health record (PHR) is an electronic file owned and controlled by patients. For physi-cians, it can be a way to quickly obtain basic patient health information, such as lists of medications, family history, allergies, vac-cinations and immunizations, past surgical procedures, and other information related to care provided by all physicians or hospi-tals. The PHRs can be paper-based, PC-based, hosted on the internet at a third-party site, held on a data stick or CD, and contained in storage on a mobile smart phone. While PHRs are being promoted by the govern-ment, health plans, employers, and patient advocacy groups, they do introduce special concerns to the patient’s provider:

The PHR is not a substitute for directly •communicating the patient’s medical in-formation to his or her physician in a tra-ditional format (in person, by telephone, etc.).It should be made clear to patients that •physicians are not responsible for know-ing the information contained within a PHR except when they have consulted it in association with a formal office visit or

online consultation.The PHR should not be considered a com-•plete record at any one point in time.Physicians should make it clear to pa-•tients that it is the patient’s responsibility to notify providers of any new informa-tion contained in the PHR.Entries into the PHR do not become part •of the medical record unless and until they are formally accepted for inclusion by the clinician.The data in the PHR may be exported •directly from an EHR, but do not assume that the information was entered, re-viewed, or recommended by a physician.The provider should make it clear that •the responsibility for the accuracy of the information in the PHR remains with the patient as the owner of the record.

for more risk management tips, articles, and information, visit thedoctors.com/knowledgecenter.

Protect yourself With cyberguardanticipating the growing risks of and mounting penalties for breaches of patient data and financial records, SDCMS-endorsed the Doctors Company has created and added Cyberguard for its members. the new, free coverage protects physicians against regulatory and liability claims arising from the theft, loss, or accidental transmission of confidential patient or financial information, as well as the cost of data recovery. For more information, visit thedoctors.com/cyberguard.


local extension centerWhat is it?By Kitty Bailey



The California Health In-formation Services and Partnership Organiza-tion (CalHIPSO) is a new

nonprofit organization funded by federal stimulus dollars that has been organized to help medical providers around the state successfully adopt electronic health records (EHRs) and to help eligible pro-

viders achieve federal meaningful use requirements and take advan-tage of “incentive payments” from either Medicare or Medi-Cal. Cal-

HIPSO will be working with Local Extension Centers (LECs) around the state of California to help Priority Primary Care Providers (PP-CPs) participate in this effort. The LECs will be selected by and will report to CalHIPSO (CalHIPSO.org).

The LEC will be a neutral, third party that will provide the following core services to PP-CPs supported by federal grant funds:

Outreach and Enrollment:• Build awareness and communicate the value of CalHIPSO and the LEC.Training and Education:• Provide on-going training and education about HIT, EHRs, and meaningful use.Readiness and Workflow Assess-•ment: Work with individual PPCPs to assess the current state of resources — hu-man, technical, and capital — that can be leverages for the upcoming EHR project.Assist With Vendor Selection: • Assist PPCPs with vendor selection while re-maining neutral.Project Planning:• Develop a high-level project schedule to prepare PPCPs for sequencing of events and managing expectations.Project Monitoring:• Coaching PPCPs through the phases of implementation and acting as an advocate with the EHR vendor.Meaningful Use Reporting:• Assist PPCPs with making progress toward meaningful use.

Depending on the level of services re-quired by the PPCP, some of these services will be offered to PPCPs at no cost to the pro-vider as a part of the federal grant. Additional services above and beyond those covered by

the funding will be available to PPCPs at pre-negotiated rates. The LEC will not pay for the cost of the EHR, nor will the LEC become a part of the contract between the PPCP and the EHR vendor. The LEC’s role is to provide education and support to PPCPs as they navigate through the purchase and imple-mentation of an EHR system and achieving meaningful use.

CalHIPSO will be supporting the opera-tions of the LECs through organizing a state-wide group purchasing effort and providing best practice tools and templates designed to reduce the complexity of installing and us-ing EHRs.

In San Diego and Imperial counties, the San Diego County Medical Society Founda-tion (SDCMSF) and the Community Clinics Health Network (CCHN) have jointly ap-plied to be an LEC. SDCMSF will provide ser-vices to private physicians, and CCHN will provide services to clinics. SDCMSF, which serves all physicians regardless of member-ship status in SDCMS, is SDCMS’ nonprofit, 501c3 arm. SDCMSF’s mission is to address unmet San Diego healthcare needs for all pa-tients and physicians through innovation, education, and service.

If you are interested in learning more about the LEC or signing up, please contact Kitty Bailey at [email protected] or (858) 300-2780. local

extension center

a priority primary Care provider is defined as a licensed clinician with a primary care practice (internal medicine, family practice, oB/gYn, pediatrics, geriatrics) and prescriptive privileges (MD, Do, np, pa) who works in the following practice care settings:

private physician practice of 10 or fewer1. nonprofit primary care clinics, including community health centers and 2. rural health clinicsthe ambulatory care clinics associated with public, rural, and critical 3. access hospitals

if you are a primary care provider working in a practice with 10 or fewer providers, CalHipSo and the lEC can provide neutral, trusted information and assistance with implementation of EHr and meaningful use regardless of where you are in the process. to learn more, contact kitty Bailey, SDCMSF executive director, at [email protected] or at (858) 300-2780.

In San Diego and Imperial counties, the San Diego county medical Society foundation and the community clinics Health network have jointly applied to be an lec.



telemedicineclosing in on distance medicineBy Brett C. Meyer, MD, and Larry S. Friedman, MD


elemedicine has the potential to expedite and improve the delivery of high-quality, cost-effective care by extending the reach of practitioners beyond their local practice, using advanced information technologies.

The promise of telemedicine and the availability of funding in recent years have prompted many clinical prac-tices and hospitals to make up-front

investments in the hardware and software to connect providers and patients; even so, telemedicine has yet to become a standard approach to care delivery, and in many cases this technology is still sitting in a corner, un-used.

That’s not to say there isn’t substantial progress. Today there are an estimated 200 telemedicine networks operating in the United States (excluding radiology net-works), linking more than 2,500 institutions, and involving more than 50 subspecialties. Lawmakers and interested parties are as well working to streamline the credentialing and privileging process for physicians who pro-vide telemedicine services, one of the issues with remote practice relationships.

the Stroke Doc experienceAs the leader of a long-term National Insti-tutes of Health study called STRokE DOC (Stroke Team Remote Evaluation using a Digital Observation Camera), the UC San Diego Health System became an early advo-cate of telemedicine as a highly effective way to deliver specialty care to remote, medically underserved populations.

The STRokE DOC clinical trial used a hub-and-spoke model, linking UC San Diego Med-ical Center stroke specialists (the “hub”) from their desktop or laptop computer, to partner EDs at remote locations (the “spokes”). The system — developed in collaboration with the California Institute for Telecommunica-tions and Information Technology (Calit2), Qualcomm and BF-Technologies, Inc. — al-lowed us to respond to an emergency page from any location, even using wireless tech-nology. A mobile camera server with an intravenous-pole design placed at the foot of the patient’s bed at the remote site enabled

telemedicine


two-way communication. Highly sophisti-cated video, audio, and internet technology can transmit high-resolution images and real-time data. We can view physical signs of a possible stroke, the CT scan images of the patient’s brain, and other test results to assess the patient’s condition. The medical team, the patient, and family members can see, hear, and communicate directly with the stroke specialist, providing valuable infor-mation that can help establish an accurate diagnosis and determine the most effective intervention.

The results of our NIH-funded study, pub-lished in Lancet Neurology, showed that these telemedicine evaluations led to far better decision-making than telephone consulta-tions, with our stroke team consultation resulting in the correct decision regarding stroke treatment more than 98 percent of the time, compared to only 82 percent of the time with telephone consultation. For rural areas and other communities where stroke specialists are not available to provide an emergency evaluation in person, this solu-tion could have an immediate and profound impact on the treatment and recovery of stroke patients.

As our study and other successful telemed-icine initiatives show, the technology has ad-vanced to the point where today a provider can just as easily be examining a patient in the clinic or evaluating a patient at a distant site through a real-time, web-based connec-tion. Electronic medical record integration adds to a successful program, enabling a standardized, optimized, clinical computing experience.

the challengesWhile the promise of telemedicine is clear — from expediting the secure exchange of pa-tient information, including images and lab results, to providing specialty consultation in areas lacking the full spectrum of health-care resources — the challenges preventing widespread application are real. But, as the demand for efficient, cost-effective telemedi-cine services grows, with consumers, em-ployers, and payers recognizing the value of distance medicine, providers will need to be prepared to link into established telemedi-

cine networks or “grow their own.” Some of the components of a successful program are access to advanced technology and adequate training, a business plan with a sustainable financial model, a clinical infrastructure adapted to support a telemedicine practice, and patient acceptance.

To begin with, for any provider to opt into a telemedicine partnership, the program must be financially sustainable. Reimburse-ment models, especially those dependent upon third-party payers, are variable, but increasingly we are seeing public and pri-vate insurers covering telemedicine consults. Contracts and service agreements provide another model of reimbursement for certain types of programs. Many of us are working with lawmakers and industry representatives to influence payment methodologies for telemedicine services, and we are beginning to see expanded coverage for these types of services.

Access to advanced technology linked with integrated health information systems, and an efficient practice model with clear standards and guidelines, are also key ele-ments of a successful telemedicine program.

a Workable modelTo accelerate the adoption of telemedicine as a major element of clinical practice, the UC San Diego Health System has established a centralized, standardized telemedicine pro-gram called UCSD-AnyWhere, a “plug-and-play” model for UC San Diego practitioners who want to expand their expertise to com-munity partners in need by developing a tele-medicine partnership. As a first step, we have developed a comprehensive and detailed clinical infrastructure handbook outlining workflow, standards, and documentation requirements; technology specifications; a training plan, and guidelines for external contracting with telemedicine partners.

Using this model, we have established a successful tele-psychiatry partnership with an Indian health center in northern Cali-fornia. When we began, patients had a six-month wait to see a specialist. Today, we have been able to respond to urgent appointment requests within minutes. We have a novel interface with the electronic medical record

from well-established

radiology networks

that enable the viewing of

images across continents, to

the emerging field of

robotically assisted

tele-surgery, telemedicine is transforming

medical practice


and a feature that allows the remote clinic to immediately access clinic notes, enabling the patient’s personal physician to act quick-ly based on the specialist’s evaluation. We are bringing additional clinical subspecialties into this partnership, and we are in discus-sions with other external partners to develop similar agreements.

At UC San Diego, our focus is to develop systems and technologies that extend the de-livery of high-quality specialty care to distant partners, and also to provide training for our colleagues. “Tele-education” will be a focus of the new Medical Education and Telemedi-cine Building currently under construction on the School of Medicine campus, as part of

our role in the Southern California Telemedi-cine Learning Center.

From well-established radiology networks that enable the viewing of images across continents, to the emerging field of roboti-cally assisted tele-surgery, telemedicine is transforming medical practice. Future practi-tioners will not be constrained by geography. New generations of patients will not only be comfortable seeking medical consultations and interventions online and across distanc-es, they will demand it. Our mandate today is to create practice models that keep pace with the technology, while maintaining high quality and safety standards, and ensuring financial viability.

for rural areas and other communities where stroke specialists are not available to provide an emergency evaluation in person, this solution could have an immediate and profound impact on the treatment and recovery of stroke patients.


Sign up NOW at SDCMSF.orgWe need your volunteer commitment to help even one patient.

Our Medical Community Liaison, Rosemarie Marshall Johnson, MD, can answer your questions. Dr. Johnson can be paged at 619.290.5351. You may also contact Lauren Radano, Healthcare Access Manager, at 858.565.7930.

Join over 75 specialists as a project access volunteer! project access is actively

recruiting physicians, hospitals, and ancillary

service providers to participate in our program.

Together we can ensure that our vulnerable populations

have access to needed healthcare services.

your commitment to project access is needed for our success! please visit our

website at sDcmsF.org to learn more and to sign up.

San DiegoProject Access

VoluNtEEriSM MADE EASy

• physician Volunteer Flexibility: Physicians set their own volunteer commitment (ideal is one patient per month). Project Access patients are seen in the private office setting so you do not have to travel far to provide care for the medically underserved.

• enrolling patients Based on need: Patients are referred to us exclusively from the community clinics in the area and do not qualify for any type of public health insurance program. Specialty care is a significant challenge for the clinics, and many patients endure wait times of up to six months to see a volunteer specialist at their clinic.

• Making appropriate referrals: Project Access publishes referral guidelines for community clinic

use. our Chief Medical officer also reviews each case individually so that specialists see only the most appropriate referrals.

• providing enabling services: We provide services such as transportation and translation so that you don’t have to wonder if a patient is going to miss an appointment or if there will be a language barrier.

• providing Case Management services: We work with each patient one-on-one to coordinate follow-through on all medical needs.

• providing all needed services: through our partnerships, we ensure that a full scope of services is available to all of our patients, from hospital and ancillary services to a defined pharmacy benefit.

The heart of the program is to link low-income, uninsured adults in san Diego county with specialist volunteers who agree to see a limited number of patients per year in their office for free.


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to SubMIt a ClaSSIfIeD aD, email Kyle lewis at [email protected]. SDCMS members place classified ads free of charge (excepting “Services offered” ads). nonmembers pay $150 (100-word limit) per ad per month of insertion.

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sCripps enCinitas COnsultatiOn rOOM/eXaM rOOMs: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. located next to the Surgery Center. recep-tionist help provided if needed. Contact Stephanie at (760) 753-8413. [703]

neW COMMerCial BuilDing in la Mesa • spaCes FOr rent/pre-lease: Very close to Grossmont Hospital and highways 8 and 125. New building being constructed at 5980 Severin Dr., la Mesa. Near corner of Severin Dr. and Amaya, just north of the Brigantine restaurant. Beautiful and functional design. Spaces available from 1,000 to 5,500ft2. Pre-leasing/renting spaces. Call Nathan at (619) 787-3422 or email [email protected]. [823]

share OFFiCe spaCe in la Mesa — aVail-aBle iMMeDiately: la Mesa (Grossmont Hos-pital Campus) 1,400ft2 available to an additional doctor. Separate receptionist area, physician’s own private office, three exam rooms, and administra-tive area. ideal for a practice compatible with oB/GyN. Call (619) 463-7775 or fax letter of interest to la Mesa oB/GyN at (619) 463-4181. [648]

OFFiCe spaCe in la JOlla: Beautiful bright of-fice, with natural light, perfect for a plastic surgeon or other specialties. Ground level medical office complex (utC area) across from the Hyatt regency la Jolla at Aventine. Mult-specialty building. Several plastic sur-geons in building. two surgical centers on site. Ample free parking. From 1,100ft2 — 5,400ft2 / divisible. For further information, call Sidney H. levine, MD, at (858) 457-4040 or visit 8929 university Center, Suite 100/104, San Diego, CA 92122 ([email protected]) — ask for Helen. [819]

MeDiCal OFFiCe BuilDing With an On-site surgiCal Center: Prime spaces on the third and fourth floors in the heart of San Diego. Signage available on heavily traveled Kearny Villa road. Great location, close to freeways, i-805, and i-163. Nearby Sharp Hospital. immediate occupancy available. Free rent! Visit www.PromusCommercial.com for pictures and details, or email Scott Cook at

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MeDiCal OFFiCe spaCe aVailaBle part tiMe tO share in sOlana BeaCh: Excellent location off i-5 by coast. Space includes three fully equipped exam rooms, waiting room, lunchroom, two bathrooms. Available all day thursdays and other days half-day flexible schedule. Great oppor-tunity for a start-up practice that can’t fill a full-time schedule. Affordable rent and flexible arrangements. Call (858) 259-9708 or email [email protected] for more information. [811]

OFFiCe spaCe in hillCrest: office space avail-able for a physician with an established primary care practice in Hillcrest, located near Scripps Mercy and uCSD. turnkey opportunity with excellent staff, state-of-the-art office and equipment. Please send letter of interest to [email protected]. [810]

OFFiCe spaCe tO share: Currently occupied by orthopaedic surgeon. Great location close to Scripps/Mercy and uCSD Hospital. looking to share with part-time or full time physician. Fully furnished, fully equipped with fluoro machine and 4 exam rooms and staff. (NEGotiABlE) Please contact ro-wena at (619) 299-3950. [804]

Multi-speCialty MeDiCal OFFiCe spaCe aVailaBle in BanKer’s hill area: large office with view of San Diego harbor, eight fully equipped exam rooms, lab on site, and underground parking. Please contact Chris Bobritchi at (619) 233-4044 or at [email protected]. [767]

1,200Ft2–1,600Ft2 OF OFFiCe spaCe in east san DiegO/la Mesa aVailaBle FOr lease: ideal as a satellite clinic or administrative office, on university Ave. near 70th St. Very visible tower sig-nage provides outstanding visibility and exposure to cars and pedestrians on university Ave. Adjacent to a pediatrics office, and with easy access from High-ways 8, 94, 125, and 15, Alvarado and Grossmont College, la Mesa, El Cajon, Spring Valley, lemon Grove, points south and north. Plenty of parking and directly across from the Joan Kroc recreation Center (over 3,000 families visit each week). Fixed rent for three years $1.95/ft2 per month, includes lighted tower signage, and No additional charges for common areas or services. Please contact Venk at (619) 504-5830 or by email at [email protected]. [777]

physiCian pOsitiOns aVailaBle

physiCians WanteD: Founded in 1972 in North San Diego County, California, Vista Community Clin-ic is a private, nonprofit medical, dental, and social services center, including advocacy and education programs. We serve people who experience social, cultural, or economic barriers to healthcare in a comprehensive, high-quality setting. We provide the highest quality services in five different locations throughout Vista and oceanside. We currently have openings for part-time and per-diem physicians in the following specialties: family medicine, oB/GyN medicine, and pediatric medicine. All candidates must hold a current Calif. license and DEA license.

Malpractice coverage is provided by the clinic. Bi-lingual English/Spanish preferred. Forward resume to [email protected] or fax to (760) 414 3702. Visit our website at www.vistacommunityclin-ic.org. EoE/M/F/D/V [821]

MeDiCal DireCtOr: licensed physician for busy outpatient substance abuse program. treatment for opiate addiction — Methadone and Suboxone — MAt format. thirty-two hours a week. San Diego and El Cajon locations. Contact [email protected] or (619) 718-9895. [820]

urOlOgist neeDeD in Chula Vista nOW: Huge potential for association with very busy urolo-gist in practice in Chula Vista since 1977. Next to Scripps Mercy Chula Vista. Full time or locum ten-ens or part time. Could be just busy office practice and/or very active urological surgical practice. We have more urology work than we can handle. No Medi-Cal or Medi-Cal HMos. little managed care. 30% cash practice with potential to expand cash business. Contact Bayside urology at (619) 420-0201, fax (619) 425-7795, or email [email protected]. talk with Dr. Dan. Shareholder status or just employee. [815]

part-tiMe anD Full-tiMe Openings FOr priMary Care physiCians: Board-certified family practice or internal medicine physicians wanted to join our prominent East County private medical group. one year or more experience pre-ferred. located on the Grossmont Hospital campus, our primary care group practices full-spectrum fam-ily medicine, including hospital care. Sharp Commu-nity Medical Group providers. ownership opportuni-ties available. interested applicants please send CV to [email protected]. For further information, visit us at www.gfmg.net. [808]

great Fp OppOrtunity in raMOna: imme-diate opening for CA-licensed physician in thriving family practice with small-town, rural atmosphere. We are flexible and friendly with excellent working conditions, loyal staff, and wonderful patients. No hospital work, easy call, attractive compensation package. Email [email protected]. [807]

uniQue, part-tiMe internal MeDiCine Op-pOrtunity in nOrth san DiegO COunty: tired of working too much? Want more flexibility? then this may just what you’re looking for. Well-established internal medicine practice in North County seeking part-time, board-certified internist on a long-term basis. this is a rare chance to enjoy the rewards of private practice in a well-respected, single-specialty group setting and still have plenty of free time for other work or family commitments. if interested, call (619) 248-2324. [806]

urgent Care physiCian neeDeD On a lOCuM tenens Basis FOr 4–5 shiFts per MOnth: the location of the urgent care is in the north county coastal area of San Diego County. Please visit our website at www.cassidymg.com for information on the group and hours of the ur-gent care. if interested, please send CV to [email protected] or fax to (760) 630-2558, attention: Judy Krueger, Executive Director. [803]

neW MeDiCal BuilDing alOng i-15: pinnacle medical plaza is a new 80,000 sF building recently completed off scripps poway parkway. The location is per-fect for serving patients along the i-15 from mira mesa to rancho bernardo and reaches west with easy access to highway 56. suites are available from 1,000—11,000 sF and will be improved to meet exact requirements. Free renT incenTives and a generous improvement allowance is provided.

For information, contact ed muna at 619-702-5655, [email protected]

www.pinnaclemedicalplaza.com


seeKing BOarD-CertiFieD peDiatriCian FOr perManent 3.5 Days per WeeK pO-sitiOn (tO start): Private practice in la Mesa seeks pediatrician 3.5 days per week (to start) on a PArtNErSHiP track. Practice pediatrics in a mod-ern office setting with a reputation for outstanding patient satisfaction for 14 years. Dedicated triage-pharmacy-referrals and education nurse takes rou-tine calls off your hands, leaving you to focus on direct, quality patient care. Nine office staff provide experienced, attentive support. Clinic care is three patients per hour, 1-in-3 call is minimal, rounding at Sharp Grossmont on newborns, no high-risk deliv-ery attendance (AlS nurse team present), all make for a very tolerable practice profile. Benefits include paid tail coverage included professional liability in-surance, paid holidays/vacation/sick time off, paid practice expenses, professional dues, health and dental insurance, uniforms, CME, disability and life insurance. Please contact Venk at (619) 504-5830 or by email at [email protected] for a July–September placement. [778]

praCtiCe FOr sale

Del Mar-area general praCtiCe: Prime location, huge potential for practice expansion in fast growing Carmel Valley community. Established in 1990; terms available. inquiries call (858) 755-0510. [185]

nOnphysiCian pOsitiOns aVailaBle

seeKing MeDiCal teChnOlOgist: We are seeking a highly motivated and skilled medical tech-nologist to join our team. We are a busy, five-physi-cian internal medicine practice with an in-house lab, and we are looking for a candidate with five years of experience performing basic chemistries and he-matologies, as well as other job functions pertinent to this position. We offer competitive pay and ben-efits. if interested, please email your resume with salary history to lydia Gormish (office manager) at [email protected] and Kathy Fisher (administra-tive assistant) at [email protected]. [812]

nurse praCtitiOner: We are looking for a nurse practitioner with at least two years experi-ence in oB/GyN mandatory. Please call Valerie at (858) 618-1156, ext. 105 or email [email protected]. [805]

MeDiCal eQuipMent

BOne DensitOMeter: Hologic. Full size hip and spine. Slightly used. $12,000. Call (760) 703-0691. [755]

OlyMpus elF p3 FiBerOptiC nasOphar-yngOsCOpe great COnDitiOn: lightly used. Halogen light source, clear lucite wall stand, car-rying case, and all accessories included. online comparable cost is $3450. Asking $2,750, oBo. Call (858) 277-8600, ext. 4. [817]

BiOMeriDian Msas Vantage eleCtrO-DerMal instruMent paCKage: includes the instrument, the Epic Probe, hand mass, stylus, and the slim external hard drive. installed programs in

the computer are Microsoft Windows XP, Symptom Survey Maestro, and MSAS 2007. included litera-ture: MSAS Vantage operator’s Manual, BioMerid-ian Basic training Manual, Epic Addendum, Protocol Addendum and the Virtual library Addendum for Metagenics and HEEl products. this system is in excellent condition and is being sold because it is just underutilized in the practice. the asking price is $4,000. A mobile stand and printer for the instru-ment is included. Monitor is not but is typically at 99-120. Call (858) 277-8600, ext. 4. [818]

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inquiries call stacey @ 619-994-3233 or via email [email protected].


messagefromthepresidentBy Susan Kaweski, MD

Note: This speech was delivered by Dr. Kaweski at her installation as SDCMS presi-dent for 2010–2011 at our inaugural “White Coat Gala” on Saturday, June 5, 2010.

I am truly and humbly honored to represent the physicians of San Di-ego County as your president. To-night is our White Coat Gala. White

coats remind me of the excitement of our medical school days, of the privilege of serv-ing others through being a physician, of the value of being kind, caring, and compassion-ate, and of the importance of professional growth and reflection.

Sometimes my white coat feels tattered, its fabric torn by the death of a loved pa-tient. Some days it’s wrinkled, exhausted by long hours and emotional drain. Sometimes it’s my energy source that keeps me going. Sometimes it’s my protective shield from dis-ease. And sometimes it’s a comforter warmed by the generous hugs of my patients.

Our white coat is viewed as the “cloak of compassion,” and a symbol of the caring and hope that patients expect to receive from us, their physicians. Even when we are not wearing it, our patients see it on us. It is our badge of honor and pride, and unites us as a profession.

And united we must be, especially in these tumultuous times. We will only prevail in our efforts to expand access to healthcare, stop the incursion of insurance companies into the doctor-patient relationship, and improve the public health if we are unified. Integrated advocacy is critical to our suc-cess. We must work together to a common good. Contributing to our PAC is important

because it represents the model of what we must do to meet our objectives.

This inaugural marks our 140th year as the San Diego County Medical Society. It all be-gan on July 19, 1870, with 10 members who elected Dr. David Bennett Hoffman, a gradu-ate of Toland Medical College in San Fran-cisco, as their president.

In order to qualify for membership, a phy-sician had to have a good primary education, a diploma from a medical school of good repute, and good professional and moral standing in the community. Not much has changed!

Today the San Diego County Medical So-ciety touts 2,444 members and represents 30 specialty societies. We are only 76 members behind Los Angeles County in member-ship because we have demonstrated the first-rate value of our membership. Our organization makes sure our doctors have information, opportunities, ed-ucational resources, and discounts.

Advocacy skills are provided to help our legislative, legal, member-ship, and communications agendas. But physicians have to participate in order for it to work. Remember, “Individually, we are one drop, but together we are an ocean.”

So wear your white coat with dis-tinction and professionalism, and be proud to be a member of our organi-zation.

“individually, We are one Drop, but together We are an ocean.”

united We Must Be, Especially in these tumultuous times

July 2010 SAN DIEGO PHYSICIAN.OrG 45 JuNE 2010 SAN DIEGO PHYSICIAN.OrG 45

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