december 2014 | physician magazine
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Physician Magazine is published by Physicians News Network and is the official publication of the Los Angeles County Medical AssociationTRANSCRIPT
DECEMBER 2014
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A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com
R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y
E X P E R T A D V I C E O N F I N A N C I A L P L A N N I N G & R E T I R E M E N T
2014 L.A. HEALTHCARE AWARDSHealthcare Champion of the Year
RICHARD J. RIORDAN
A N o r c A l G r o u p co m pA N y
NORCAL Mutual is owned and directed by its
physician-policyholders, therefore we promise
to treat your individual needs as our own. You
can expect caring and personal service, as you
are our first priority. Visit norcalmutual.com, call
877-453-4486, or contact your broker.
DECEMBER 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 1
Volume 145 Issue 12
Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Advertising rates and information sent upon request.
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COVER STORY
10 L.A. HEALTHCARE AWARDSThe Los Angeles County Medical
Association held its annual L.A. Healthcare Awards last month, recognizing several out-standing contributions to community health. The top honor, Healthcare Champion of the Year, was presented to former Los Angeles Mayor Richard Riordan.
FINANCIAL PLANNING & RETIREMENT
6 Your Annual Review Checklist
7 Strategies for Tax-efficient Investing
8 Retiring Abroad? What You Need to Know
DEPARTMENTS FRONT OFFICE | PRACTICE MANAGEMENT
12 What a Physician Needs to Know about Medi-Medi Patients and Cal MediConnect
UNITED WE STAND | AT WORK FOR YOU
14 VICTORY: California Voters Speak Loudly
15 CMA Welcomes New President
FROM YOUR ASSOCIATION
4 President’s Letter | Pedram Salimpour, MD
16 CEO’s Letter | Rocky Delgadillo
1686
A N o r c A l G r o u p co m pA N y
NORCAL Mutual is owned and directed by its
physician-policyholders, therefore we promise
to treat your individual needs as our own. You
can expect caring and personal service, as you
are our first priority. Visit norcalmutual.com, call
877-453-4486, or contact your broker.
SUBSCRIPTIONSMembers of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.
The Los Angeles County Medi-
cal Association is a profes-
sional association representing
physicians from every medical
specialty and practice setting
as well as medical students,
interns and residents. For more
than 100 years, LACMA has
been at the forefront of cur-
rent medicine, ensuring that its
members are represented in the
areas of public policy, govern-
ment relations and community
relations. Through its advocacy
efforts in both Los Angeles
County and with the statewide
California Medical Association,
your physician leaders and staff
strive toward a common goal–
that you might spend more time
treating your patients and less
time worrying about the chal-
lenges of managing a practice.
LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at [email protected] or 213-226-0304.
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LACMA OFFICERS Pedram Salimpour, MDPeter Richman, MDVito Imbasciani, MDWilliam Averill, MDMarshall Morgan, MD
LACMA BOARD OF DIRECTORS
David Aizuss, MDErik Berg, MDRobert Bitonte, MDStephanie Booth, MDJack Chou, MDTroy Elander, MDHilary Fausett, MDSamuel Fink, MDHector Flores, MDC. Freeman, MDSidney Gold, MDWilliam Hale, MDStephanie Hall, MDDavid Hopp, MDKambiz Kosari, MDYoung-Jik Lee, MDPaul Liu, MDMaria Lymberis, MDCarlos Martinez, MDNassim Moradi, MDTJ NguyenAshish Parekh, MDHeidi Reich, MDSion Roy, MDMichael Sanchez, MDHeather Silverman, MDAndrew SumarsonoNhat Tran, MDFred Ziel, MD
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4 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
PAINSTAKING WAR ON SCIENCE: The Attack on Women’s Sexual Health (The Sham Drug Idea of the Year: ‘Pink Viagra’)
There are two kinds of people in this world: those who look down on other people, and those who don’t look down on other people. And those two groups of people look down on each other. Such is the state of the groups who advocate for and against medical management or prevention of certain illnesses. We have entered a time when even illness and medicine are politicized as aggressively as ideology. And this
is unfortunate because un-like ideology, diseases and their therapeutic options are not simple matters of opinion. Pathophysiology of disease is, in fact, a rigor-ously studied state of bio-logical being. And clinical interventions are, like the diseases they work against, subjects of equally rigor-ous investigation to which our best and brightest minds devote their careers, and lives.
It is of course under-standable that the slick, highly produced, and ab-solutely relentless televi-sion advertising for all things medical can make
us weary. But for those who suffer from diabetes, dry eyes, depression or whatever illness the medication is hoping to treat, these drugs and their competitors of-fer options that allow our patients to work, play and function more effectively and efficiently alongside ev-eryone else.
Still, as a clinician it’s difficult not to encounter abrupt diversions from scientific issues critical to our health. Childhood immunizations, treatments for ge-netic disorders, and others have fallen into a malaise of ideological distraction. But arguments based on ideology often discount legitimate health needs and objective clinical evaluations of whether a treatment is safe and effective.
We have read in recent months about the refusal of some families, based entirely on this pseudosci-ence, to vaccinate their children. Sadly, that ideology is creeping into other areas of medicine too, and soon politicized medicine may involve something you need. But for now, let’s add to the mix of crusades the dubi-ous campaign against women’s sexual health.
My involvement in the study of male and female sexual dysfunction spans two decades. In the late 1990s, I worked in Dr. Irwin Goldstein’s laboratory at Boston University School of Medicine on various sex-
ual dysfunction projects. Some projects included ba-sic science research on animal cells and tissue others were studies on individuals or populations. All were ethically sound and scientifically robust. So much so that Dr. Goldstein was selected as first author of the New England Journal of Medicine paper on sildenefil citrate, the scientific article that introduced Viagra to the world. For the next few years, I had the opportunity to travel around the world, presenting results of our findings on the burgeoning new science of male and female sexual dysfunction.
There was extraordinary excitement around the field. But at times, when I ran into people whom I con-sidered colleagues, I encountered astonishing resis-tance. On an occasion I’ll never forget, I was asked to speak to an undergraduate psychology class on sexu-al dysfunction. The professor refused the offer of pizza for the students, saying she didn’t want the class to be swayed by the medical perspective.
But the medical and scientific perspectives point to something that cannot be ignored: Sexual dysfunction in women, like that of erectile dysfunction in men, is real and ought to be studied and eventually treated. Almost two decades after I started work in Boston, there are no FDA-approved treatments for women.
That, despite the fact that today, for the first time, we have a far better scientific understanding (differ-ent from just “knowing”) about the critical role that the human brain plays in regulating a woman’s sexual drive. We finally understand the scientific basis for per-sistent and recurrent low sexual desire, the root cause of which appears, based on advanced brain imaging, to stem from an imbalance of neurotransmitters in the brain. Yet there are no solutions that address this re-markable biology.
All of us deserve to benefit from the advancement of science, including women and men who suffer from something the rest of us may think is funny. The stig-ma was overcome for men with the unprecedented clinical success of Viagra, which was followed by com-mercial success (not the other way around). Women still have a little way to go.
The advancement of science and medicine coex-ists in a societal context formulated by everyday points of view, but we all must balance the hyperbole with the facts. Steve Jobs lost his life because he chose to ignore the scientific evidence in favor of the clinical options for his cancer. Too late to turn back, according to his biographer, he regretted his decision. The pseu-doscience that has grown up in the Western world is dangerous not because it advocates against the ap-plication of science to women’s health. It’s dangerous because it advocates against science.
It is human nature to judge. In medicine, we strive to overcome that human temptation through the ap-plication of rigorous science to understanding disease and its treatment options. And we don’t judge.
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6 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
Preparing for an annual financial review may be easier with a checklist to help you focus on important matters. With that in mind, here is a list of key considerations that you may want to discuss with your financial advisor.
• Do I need to rebalance my asset allocation? Depending on the performance of your investments so far this year, you may want to examine whether your mix of stocks, bonds, cash, and other assets is close to your target. If not, it may be time to rebalance to a mix that more closely resembles your de-sired exposure to risk and potential return.1 Rebalancing can be accomplished in two ways: You can sell existing assets and use the proceeds to bring your portfolio closer to your desired mix. Or you can leave your portfolio as is and allocate new investments to the areas that you want to increase. Rebalancing may involve tax consequences, especially for non-tax-deferred accounts.
• Am I on track to fund my retirement? Making sure you are on track to amass the assets you will need for your later years should be one of your key concerns. If you participate in an employer-sponsored retirement plan, consider investing as much as you can afford. If you do not have access to an employer-sponsored plan, or if you do and can afford to contribute even more, consider fund-ing an IRA.
• What were my yearly capital gains and losses? If your year-end planning entails selling certain assets, be aware of rules regarding capital gains and losses. Gains on investments held less than one year, known as short-term capital gains, are taxed as ordinary income. Gains on investments held for one year or longer, considered long-term capital gains, are taxed at a maximum rate of 20% for fed-eral income tax purposes. State tax rules may differ. On the federal level, capital losses offset capital gains and are netted against each other. If net capital losses still remain, up to $3,000 may be used to offset ordinary income. Capital losses not used in a given year can be carried forward to future years. Note that different rules apply for gains on the sale of collectibles, or qualified small-business stock.
your annual review checklistARTICLE BY WEALTH MANAGEMENT SYSTEMS, INC. AND PROVIDED COURTESY OF MARLENE DIETRICH & EMILIA PIRRO
financial planning & retirementexpert advice
DECEMBER 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 7
One area of investing that is easy to over-look is the effect of taxes on a portfolio. Yet most investors can improve a portfolio’s bot-tom line by employing a few simple tax-effi-cient investment strategies. With higher top tax rates now in effect, it may be time to ask yourself: Are you doing everything possible to improve your portfolio’s bottom line through tax-efficient investing? Here are five tried-and-true strategies to help lower your tax bill while improving your net return.
Take Advantage of Tax-Sheltered Accounts To encourage Americans to save for retirement, Uncle Sam offers tax incentives in the form of IRAs, 401(k)s, 403(b)s and other qualified re-tirement savings plans. These accounts provide the opportunity to defer paying tax on contri-butions and earnings or to avoid paying taxes altogether on earnings, depending on the type of vehicle you choose.
By contributing as much as possible to these accounts, you can realize significant savings over time. For instance, contributing $400 per month to a traditional IRA (assuming deductibility rules apply) will save you nearly $22,000 in taxes over 20 years, assuming a 5% annual return and 25% tax rate.1 (Taxes, how-ever, will be due on distributions at the time you make withdrawals.)
For 2014, you can contribute up to $5,500 to a traditional or Roth IRA. And if you’re over
50, you can contribute an extra $1,000. For employer-sponsored retirement savings vehi-cles such as 401(k) or 403(b) plans, you can contribute up to $17,500 in 2014 and an ad-ditional $5,500 if you’re over 50.
But keep in mind that most withdrawals pri-or to age 59½ from a qualified retirement plan or IRA may be subject to a 10% federal penalty in addition to any taxes owed on contributions and accumulated earnings.
Turn to Municipal Bonds for After-Tax Yield In today’s low-rate environment, finding yield can be a challenge. Rates on high-quality cor-porate bonds have hovered at historical lows, and the yield on US Treasuries has not topped 4% since 2008. While municipal bonds, or “munis,” are no exception, they carry one significant advantage: Interest paid by muni bonds is generally exempt from federal and, in some cases, state and local taxes.
Consider this: A municipal bond yield-ing 4% translates to a tax-equivalent yield of 5.33%, assuming a 25% tax rate. In other words, you would need to earn 5.33% on a taxable bond to receive the same after-tax yield as a 4% municipal bond.
Remember, however, that any capital gains arising from the sale of municipal bonds are still taxable (at capital gains rates), and that income from some municipal bonds may be taxable under alternative minimum tax rules.
strategies for tax-efficient investingARTICLE BY WEALTH MANAGEMENT SYSTEMS, INC. AND PROVIDED COURTESY OF MARLENE DIETRICH & EMILIA PIRRO
FOR MORE INFORMATION CONTACT
Emilia Pirro 310.285.2691
&Marlene Dietrich
MORGAN STANLEY 9665 Wilshire Blvd., Suite 600,
Beverly Hills, CA 90212
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• Am I taking full advantage of tax-advantaged accounts? Remember that certain types of investments receive favorable tax treatment. Employee contributions to traditional 401(k)s, for example, are deducted from your paycheck before taxes are assessed, which lessens taxable income during the year the contribution is made. Contributions may potentially grow free of federal income taxes until qualified withdrawals are made during retirement. If you are age 59 1/2 or older and have maintained the account for a minimum of five years, qualified withdraw-als from a Roth IRA are tax free.2 (To contribute to a Roth IRA, investors must meet income thresholds established by the IRS. Learn more at www.irs.gov.)
You may have additional concerns unique to your situation, but this checklist may help you keep your investment portfolio in order.1Asset allocation and rebalancing do not assure a profit or protect against loss in a declining market. There may be a potential tax implication with a rebalancing strategy. Please consult your tax advisor before implementing such a strategy.2For nonqualified withdrawals, restrictions, penalties, and taxes may apply.Article by Wealth Management Systems, Inc. and provided courtesy of Marlene Dietrich & Emilia PirroMorgan Stanley and its Financial Advisors do not provide tax or legal advice, are not “fiduciaries”( under ERISA, the Internal Revenue Code or other-wise) with respect to the services or activities described herein, and this material was not intended or written to be used for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Individuals are urged to consult their tax or legal advisor before establishing a retirement plan or to understand the tax, ERISA and related consequences of any investments made under such plan.The authors are not employees of Morgan Stanley Smith Barney LLC (“Morgan Stanley”). The opinions expressed by the authors are solely their own and do not necessarily reflect those of Morgan Stanley. The information and data in the article or publication has been obtained from sources outside of Morgan Stanley and Morgan Stanley makes no representations or guarantees as to the accuracy or completeness of information or data from sources outside of Morgan Stanley. Neither the information provided nor any opinion expressed constitutes a solicitation by Morgan Stanley with respect to the purchase or sale of any security, investment, strategy or product that may be mentioned.Morgan Stanley Financial Advisors, Marlene Dietrich & Emilia Pirro engaged Wealth Management Systems, Inc. to feature this article.Marlene Dietrich & Emilia Pirro] may only transact business in states where they are registered or excluded or exempted from registration FINRA Broker Check http://brokercheck.finra.org/Search/Search.aspx]. Transacting business, follow-up and individualized responses involving either effect-ing or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Marlene Dietrich & Emilia Pirro are not registered or excluded or exempt from registration.© 2014 Morgan Stanley Smith Barney LLC. Member SIPC.CRC 914101 05/14
8 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
BY BILL HUNTER, DIRECTOR OF PERSONAL RETIREMENT SOLUTIONS, BANK OF AMERICA MERRILL LYNCH
There’s something undeniably appealing about the idea of living an expa-triate adventure in retirement. Striking out for foreign shores can seem both pragmatic and poetic.
But relocating to another country isn’t easy. You’ll need to consider a range of factors, from your destination country’s political stability to the logistics of managing your assets from afar. Retirees need to plan carefully and consider the following questions.
Is your family on board? Moving across the globe can change family dy-namics. Understand the impact your move will have on your relationships. Make sure your spouse is as invested in the idea as you are that way, when unexpected issues arise, you won’t have the added complications of resent-ment and blame.
How will you handle health care needs? Access to quality health care is paramount in retirement, so be sure to understand the relative cost and qual-ity of care in the country where you hope to retire. Research local physicians and facilities and plan accordingly. Make sure quality remains on par with what’s available in the U.S. If it doesn’t, budget for the possibility that you may need to return home for certain medical procedures.
Given that Medicare doesn’t cover health services outside the U.S., you may want to look into private health insurance or seek out a country that allows those holding permanent residence visas to join its national health plan. Keep in mind that if you return home later in retirement and sign up for Medicare, your premium will be 10% higher for each year you could have been enrolled but were not.
Avoid Short-Term Gains Before you sell an invest-ment, check to see when you purchased it. If it was less than one year ago, any profit will be considered a short-term gain. If it was more than one year ago, the profit will be considered a long-term gain. That’s important because long-term capital gains are taxed at significantly lower rates than short-term capital gains, especially if you’re in a high tax bracket.
• Short-term capital gains are taxed at ordinary in-come rates which can be as high as 39.6%.
• Long-term capital gains are taxed at a maximum rate of 20% in 2014.2
Considering those different rates, it can pay to look at the calendar before you sell a profitable in-vestment. Selling just a day or two early could mean that you’ll incur significantly higher taxes.
Make the Most of Losses As most taxpayers know, the IRS lets you use long-term capital losses to offset long-term gains. In any given year, you can mini-mize your capital gains tax by timing your losses to correspond with gains. What’s more, you can carry forward unused losses to future years, and use them to offset future gains, subject to certain limitations.
You can also offset up to $3,000 of unused capital losses per year against ordinary income. So before taking a long-term capital loss, consider the timing of gains as well as ordinary income.
Get a Professional’s Perspective Keeping an eye on taxes is a prudent way to try to enhance your invest-ment returns over time. However, tax laws are com-plex, subject to change and may have implications you haven’t considered. Footnotes/Disclaimers1Example assumes monthly pre-tax contributions of $400 over a 20-year pe-riod, a 5% annual rate of return, compounded monthly, and a marginal tax rate of 25%. Example is hypothetical. Your results will differ. 2Does not take into consideration Medicare tax on certain unearned net invest-ment income or state or local taxes, which will vary. If you would like to learn more, please contact Marlene Dietrich & Emilia Pirro. Branch Name: Morgan Stanley 9665 Wilshire Blvd., Suite 600, Beverly Hills, CA 90212; Phone Number: 310 285-6544 & 310 285-2691 ; Web Address: [email protected] [email protected] by Wealth Management Systems, Inc. and provided courtesy of Morgan Stanley Financial Advisor.The author(s) are not employees of Morgan Stanley Smith Barney LLC (“Mor-gan Stanley”). The opinions expressed by the authors are solely their own and do not necessarily reflect those of Morgan Stanley. The information and data in the article or publication has been obtained from sources outside of Mor-gan Stanley and Morgan Stanley makes no representations or guarantees as to the accuracy or completeness of information or data from sources outside of Morgan Stanley. Neither the information provided nor any opinion expressed constitutes a solicitation by Morgan Stanley with respect to the purchase or sale of any security, investment, strategy or product that may be mentioned.Tax laws are complex and subject to change. Morgan Stanley Smith Barney LLC (“Morgan Stanley”), its affiliates and Morgan Stanley Financial Advisors and Private Wealth Advisors do not provide tax or legal advice and are not “fiduciaries” (under the Internal Revenue Code or otherwise) with respect to the services or activities described herein except as otherwise agreed to in writing by Morgan Stanley. This material was not intended or written to be used for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Individuals are encouraged to consult their tax and legal advisors regarding any potential tax and related consequences of any investments made under such account.Morgan Stanley Financial Advisor(s) engaged Wealth Management Systems Inc. to feature this article.Emilia Pirro & Marlene Dietrich may only transact business in states where they are registered or excluded or exempted from registration or FINRA Broker Check http://brokercheck.finra.org/Search/Search.aspx]. Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Emilia Pirro & Marlene Dietrich are not registered or excluded or exempt from registration.© 2014 Morgan Stanley Smith Barney LLC. Member SIPC. CRC 942158 6/14
retiring abroad?here’s what you need to know
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here’s what you need to know
Are you looking for a tax advantage? The IRS taxes U.S. citizens on income no matter where they live. Even if you relinquish your citizenship, you’ll owe in-come tax as a nonresident alien. The U.S. also has laws to collect income tax from retirees who move their as-sets to a foreign country; however, many countries have tax treaties with the U.S. that prevent double taxation.
How does the cost of living compare? A beachfront home in Mexico may cost less than its U.S. counter-part, but you need to consider your entire budget. For example, relocation costs may be higher than if you moved somewhere domestically. And the costs of gro-ceries, electricity, and transportation may equal what you’re currently spending.
Will you be able to work? Many of today’s retirees hope to work during their retirement but living in a for-eign country may complicate employment. Consider the job prospects for people with your experience in that country and whether you’ll be allowed to work as a U.S. citizen abroad.
How will you manage your assets? As finances can be comfortably managed from afar, expat retirees can keep most assets in the U.S., where the economy and political situation are relatively stable. A local account will prevent currency exchange fees and ATM withdrawal charges.
You may want to explore proactively ad-dressing cash flow issues — like having your account automatically frozen when you re-peatedly access your credit card from a re-mote location.
Talk to your financial advisor about how to hedge against exchange-rate fluctuations by setting up a local account and making regular transfers from your U.S. account to cover everyday expenses. It’s a good idea to know whether these transfers might in-cur their own fees, and to ensure that legal documents will be enforceable in your des-tination country.
When moving assets abroad or acquiring new investments in another country, consult a lawyer to determine whether those assets will be subject to local estate tax rules.
Can you adjust? After the fantasy of liv-ing abroad becomes reality, some expats find themselves feeling isolated. Consider living somewhere with a vibrant expatriate community. Keep in mind that the amount of English spoken in countries may vary be-tween regions. Spend a few months in a po-
tential destination before making a permanent move.
How will you connect with family and friends? E-mail and video services make it easy to stay in touch with family and friends back home, but if you want to see them regularly, choose a destination that will en-able you and your loved ones to travel easily and af-fordably. Starting a brand-new life is appealing, but retiring abroad adds a layer of complexity to many as-pects of retirement planning. So do your homework, and make the decision with your eyes wide open.
Any information presented about tax considerations affecting client financial trans-actions or arrangements is not intended as tax advice and should not be relied upon for the purpose of avoiding any tax penalties. Neither Bank of America, Mer-rill Lynch nor its Financial Advisors provide tax, accounting or legal advice. Clients should review any planned financial transactions or arrangements that may have tax, accounting or legal implications with their personal professional advisors.Bank of America Merrill Lynch is a marketing name for the Retirement Services business of Bank of America Corporation (“BAC”). Banking, trust and fiduciary ser-vices are performed by wholly owned banking affiliates of BAC, including Bank of America, N.A., member FDIC. Brokerage services are performed by wholly owned brokerage affiliates of BAC, including Merrill Lynch, Pierce, Fenner & Smith Incorpo-rated (“MLPF&S”), a registered broker-dealer and member SIPC. For more information, contact Tanya Stratton, Personal Wealth Advisor, in the Fres-no, CA office at 559-436-3309, [email protected] or http://fa.ml.com/tms.Merrill Lynch makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of Bank of America Corporation.Investment products:Are Not FDIC Insured Are Not Bank Guaranteed May Lose ValueMLPF&S is a registered broker-dealer, Member SIPC and a wholly owned subsidiary of Bank of America Corporation.© 2014 Bank of America Corporation. All rights reserved.
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The Los Angeles County Medical Association held its annual L.A. Healthcare Awards on Thursday, Nov. 13, at the California Club in Downtown Los Angeles. Attending were approximately 250 LACMA member physicians and their supporters.
Rocky Delgadillo, LACMA CEO, served as master of cer-emonies for an evening-long celebration recognizing the out-standing contributions of physicians, medical students, health-care professionals and elected officials to the overall health of the Greater Los Angeles community.
LACMA president, Pedram Salimpour, MD, set the tone for the evening with his opening remarks in which he praised the efforts of LACMA members in the defeat of Propositions 45 and 46 in the recent November election. He noted that “in the past month, we have fought and decisively defeated two major leg-islative initiatives that would have significantly and irreversibly eroded the practice of medicine for doctors and our patients.”
Dr. Salimpour also noted that LACMA has experienced “the most robust growth in membership at any time in the past de-cade and a half.” According to him, LACMA membership now stands at 6,500 members in Los Angeles County. He also re-minded members of the importance of LACMA’s ongoing sup-port of medical students through scholarships.
LACMA member Troy Elander, MD, who serves as chairman of the board of the Patient Care Foundation of Los Angeles, pro-vided an overview of the activities of the foundation, reporting a successful year of patient advocacy.
Medical student Ezinne Ihenachor, a student at the David Geffen School of Medicine, provided a student perspective on medical education and her passion for improving healthcare for the underserved. Ihenachor was one of nine 2014 LACMA scholarship recipients.
Drs. Salimpour and Elander joined Rocky Delgadillo in pre-senting the awards, including the Healthcare Champion of the Year Award presented to former Los Angeles Mayor Richard J. Riordan. All Healthcare Awards attendees received a copy of Riordan’s recently published book, The Mayor.
The event was underwritten by presenting sponsor Wells Far-go; platinum sponsors PIPA Allied Pacific and Network Medical Management; gold sponsor AltaMed and Keck Medical Center of USC; silver sponsors Dignity Health, Cedars-Sinai, Coopera-tive of American Physicians, Hunt Enterprises, LACMA districts 1, 3, 6, 9, 10, 14 and 17, Moore-White Medical Foundation, UCLA Health and White Memorial Medical Center; and table sponsor City of Hope.
LACMA Honors Outstanding Contributions to Community Health
HEALTHCARE CHAMPION OF THE YEARFormer Los Angeles Mayor, Richard J. Riordan
Hospital Physician Leadership AwardRonald W. Busuttil, MD, UCLA Liver Transplant Program
Independent Physician Leadership AwardKen Sim, MD, Allied Physicians of California
Innovation Award — Community ServiceSouth Central Scholars, James London, MD, & Patricia London
Innovation Award — Public EducationCastulo de la Rocha, CEO, AltaMed Health Services
Innovation Award — FacilitiesRobert Stone, CEO, City of Hope
Accepting on behalf of City of Hope was Mark Wakabayashi, MD, President, Medical Staff
Innovation Award — Physician Leadership in Medical Education
Stephanie Hall, MD, Keck Medical Center of USC
Shine the Light Media AwardDavid Pryor, MD, BlackWomensHealth.com
Pictured (left to right): Pedram Salimpour, MD, Troy Elander, MD, Richard J. Riordan, Rocky Delgadillo.
DECEMBER 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 11
PICTURED: A) Rocky Delgadillo, Pedram Salimpour, MD, Patricia London, James London, MD, and Troy Elander, MD
B) Pedram Salimpour, MD, Mark Wakabayashi, MD, and Troy Elander, MD
C) Medical Student Ezinne Ihenachor
D) More than 250 LACMA members and supporters attended the event
E) Rocky Delgadillo, Pedram Salimpour, MD, and Kenneth T. Sim, MD
F) Rocky Delgadillo, Pedram Salimpour, MD, Stephanie Hall, MD, and Troy Elander, MD
G) Rocky Delgadillo, Pedram Salimpour, MD, Castulo de la Rocha and Troy Elander, MD
H) Rocky Delgadillo, Pedram Salimpour, MD, and Ronald W. Busuttil, MD
A. B.
C. D..
E.
F.
H.G.
12 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
THE COORDINATED CARE Initiative (CCI) is an
effort by California and the federal government
to integrate the delivery of medical, behavioral
and long-term services and support for persons
eligible for both Medicare and Medi-Cal (i.e., dual
eligibles, or “Medi-Medi” patients). California
has approximately 1.1 million Medi-Medi benefi-
ciaries. Of these beneficiaries, about 456,000 are
estimated to be eligible for enrollment into the
Cal MediConnect program, with a 200,000 enroll-
ment cap in Los Angeles. Many California physi-
cians are curious about the implications if their
patients enroll in Cal MediConnect.
CCI consists of Cal MediConnect and Managed Long Term Services and Supports. Cal MediConnect is a new plan that will administer both Medicare and Medi-Cal benefits. Participation in Cal MediConnect will occur for patients by default, meaning if the patient does not decline to participate (“opt-out”), the patient will be automatically enrolled in Cal MediConnect. This automatic enrollment would occur on the first day of his/her birth month, but the patient can decide to actively disenroll at any time.
Patient Enrollment and Provider Impact | If a physi-cian’s patient enrolls in Cal MediConnect, the physician has options that are dependent upon the physician’s sta-tus as an in-network or out-of-network provider. If the physician is in the plan’s network, the patient can re-quest to continue to see this physician. If the physician is out-of-network, the physician will have the right to tem-porarily (up to six months) continue seeing the patient. A physician may be able to see an existing patient for a longer period of time if the health plan approves such re-quest. This time frame is separate from the general abil-ity to request completion of covered services for acute or serious conditions.1 Cal MediConnect enrollees will eventually be required to receive all covered services from in-network providers.
If a physician is out-of-network and wants to join the network, the physician must contact the specific Cal MediConnect plan in the physician’s county. In Los Angeles, for example, the health plans include Care1st, CareMore, Health Net, L.A. Care and Molina Dual Options. Continuity of Care | There are several conditions that must be met in order for a Cal MediConnect patient to receive temporary care from an out-of-network physi-cian. Actions must be taken by either the patient or the existing out-of-network physician.
• The enrollee or the physician may request for “con-tinuity of care” from the specific Cal MediConnect plan by calling the health plan member services.
• A pre-existing relationship must exist between phy-sician and patient, which is established by the plan from a review of Medicare claims data. o For a primary care physician, this means that the
patient saw the physician at least once in the 12 months preceding enrollment.
o For a specialist, this means that the patient saw the specialist at least twice in the 12 months preceding enrollment.
• The out-of-network physician must be willing to accept the Cal MediConnect plan rate or the ap-plicable Medicare or Medi-Cal rate, whichever is higher, and agree to receive payment from the plan. The plan rate is typically 80% of the Medicare fee schedule.
• The physician must enter an agreement with the health plan and not be disqualified from the net-work due to quality-of-care issues. The agreement will allow care to be provided for six months and can be extended at the option of Cal MediConnect.
Retroactive Continuity of Care | Physicians can be reimbursed for services provided to a patient before the Cal MediConnect-enrolled patient has received approval from the health plan for continuity of care. The reimbursement is contingent upon the continuity of care requirements being met (discussed above). The request for continuity of care must also be made within 30 calendar days of the first service provided to the patient after the patient enrolls in Cal MediConnect.
WHAT A PHYSICIAN NEEDS TO KNOW ABOUT
Medi-Medi Patients and Cal MediConnect
BY JENNIFER DAVIS
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CAL MEDICONNECT AND SPECIFIC PROVIDER TYPES
Providers Not Impacted | For the time being, skilled nursing home facilities will not be impacted by the enrollment of current residents into Cal MediConnect even if the nursing home is not in the health plan’s network. Newly enrolled Cal MediConnect residents will not have to change facilities. Providers of either In-Home Supportive Ser-vices, Community-Based Adult Services or Multipurpose Senior Service Programs will not be immediately impacted by the enroll-ment of current patients into Cal MediCon-nect. Similar to skilled nursing home resi-dents, program beneficiaries will not have to change providers based on network arrange-ments. In the long term, however, providers who do not contract with health plans may experience declining referrals, as plans en-courage referral to contracted providers.
Providers Impacted | Suppliers of transportation, durable medical equipment and medical supplies must be in-network providers for Cal MediConnect enrollees. Home health and physical therapy pro-viders must also be in-network providers for Cal MediConnect en-rollees, and therefore out-of-network providers would lose patients upon Cal MediConnect enrollment. Providers prescribing medica-tion covered by Medicare Part D can continue such prescribing un-der the provisions of continuity of care, which includes a 30-day supply of any existing Medicare Part D prescription. After this time frame, enrollees must switch to medication on the plan’s formulary. Financial and Billing Implications | If a patient actively declines Cal MediConnect, the patient can keep Medicare as it is but must choose a Medi-Cal plan to receive Me-di-Cal benefits. For a physician, if your pa-tient decides not to join a Cal MediConnect plan, the patient can continue to see you as a Medicare Fee-for-Service (FFS) physician. Even if your patient joins a Medi-Cal plan, the patient can continue to see you as the current Medicare provider. Medicare phy-sicians do not need to be contracted with Medi-Cal to see dual eligibles. As stated ear-lier, the rate provided to the Medicare physi-cian is generally 80% of the Medicare fee schedule.
If a dual eligible patient declines to en-roll in Cal MediConnect, the Medicare phy-sician should bill for Medicare services as is the regular billing practice of the physi-cian. If the patient is enrolled in a Medi-Cal managed care plan, the physician should continue to bill for Medicare services as is the regular billing practice of the physician. There is also no change to the process of handling “crossover claims,” or the amount not covered by Medicare, which is typically 80%. Providers need to send the crossover
claim for the 20% co-pay to the patient’s Medi-Cal plan, or in some cases, Medicare will send these claims automatically to the Medi-Cal plan. Physicians do not need to be a part of the Medi-Cal plan’s network to have these claims processed and paid.
Conclusion | Many physicians and provid-ers will be impacted by patients enrolling in Cal MediConnect. In particular, physicians who decline (or are unable) to contract with a Cal MediConnect plan are likely to see their patients reassigned to in-network physicians, with the significant prospect of losing the patient relationships altogether. While existing physicians and providers can continue to see existing patients for a tem-porary period of time if they meet the con-tinuity of care requirements, it is imperative for physicians to consider long-term options with respect to Cal MediConnect plans and dual eligibles. Physicians can receive addi-
tional information by contacting Cal MediConnect plans in their county or visiting www.calduals.org.
In addition, physicians or providers can contact Nelson Hardiman, LLP for more information.1CA Health & Safety Code, Sec. 1373.96Jennifer Davis is a law clerk with Nelson Hardiman, pending her forthcoming admission to the Cali-fornia State Bar. Working with and under the supervision of Nelson Hardiman attorneys, Jennifer’s practice focuses on transactional and regulatory matters for the firm’s healthcare clients. Jennifer has extensive experience with hospital administration, having served as Business Director for City of Hope prior to receiving her JD from UCLA. As Director, Jennifer managed the Departments of Anesthesiology and Surgery which included the divisions of Urologic Oncology, Surgical Oncol-ogy, Gynecologic Oncology, Neurosurgery, Orthopedic Surgery, Plastic Surgery, Thoracic Surgery, and Head and Neck Surgery. As Director of the Surgery Department, Jennifer managed the largest robotic-assisted surgical program worldwide. At City of Hope, Jennifer also managed the pros-tate, breast, brain tumor and gastrointestinal cancer programs. Jennifer also completed her MBA from UCLA. While completing this advanced degree, Jennifer created her own consulting company, which focused on fundraising and business plan development for local and national nonprofits.
physicians who decline to contract
with a Cal MediCon-nect plan are likely to see their patients
reassigned to in-network physicians
14 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
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ON ELECTION DAY, the California Medical
Association (CMA) made history by resound-
ingly defeating the trial attorneys’ attempt to
overturn California’s Medical Injury Compensa-
tion Reform Act (MICRA) protections. This was
one of the most contentious and high-stakes
ballot fights in California history. The voters sent
a clear message: Californians simply don’t want
to increase healthcare costs and reduce health
access so trial attorneys can file more lawsuits.
But the Election Night celebration was not lim-ited to Prop. 46: CMA’s priority candidates also performed exceedingly well. CMA participated in “independent expenditure” campaigns for six can-didates. Sacramento pediatrician and Assembly-man, Richard Pan, M.D., was at the top of the list.
Dr. Pan faced off against fellow Democrat Roger Dickinson in California Senate District 6 in one of the most hotly-contested races of the elec-tion. Conventional wisdom gave Dr. Pan very little chance to defeat Dickinson, who has spent more
than 30 years as a career politician. However, CMA built a coalition of labor and business allies to put together a full-fledged campaign that helped overcome a double-digit deficit in the primary to place Dr. Pan in the state Senate.
In another tight race, two liberal Democrats, David Chiu and David Campos, squared off for San Francisco’s Assembly District 17. The candidates agreed on many issues, but David Chiu believes in and publicly advocates for the protection of MICRA. Chiu’s advocacy on the matter became a critical point of contention in the campaign, trans-forming this race into a proxy race for Proposition 46. Once again, the advocate for protecting access to care prevailed: CMA-endorsed David Chiu will be heading to Sacramento.
CMA emerged from the election with a perfect score on the six independent expenditure cam-paigns for our endorsed candidates. In total, the 15 CMA-endorsed candidates for state Senate all won their election. In the state Assembly, 65 out of our 70 endorsed candidates triumphed. (Please note there are a few races that are too close to call.)
Visit CMA.org to see the full roster of candi-dates CMA supported and the results of their races.
DECEMBER 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 15
CMA Welcomes New President
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The California Medical Association (CMA) has installed Humboldt County physician Luther Cobb, MD, as its 147th president. He takes office on the heels of the momentous defeat of Proposition 46, a campaign in which doctors and healthcare provid-ers across California rallied together to oppose the measure that ultimately failed 33-67 percent.
“What a thrilling time to be assuming the role of CMA president,” said Dr. Cobb. “The healthcare community has stood tall in protecting our patients and their access to care, and as we look ahead to the year in front of us, I am confident that we will continue to do so.”
After attending Stanford Medical School, Dr. Cobb went on to do his residency at Stanford as well, taking a two-year fellowship to study pancreat-ic islet transplantation for diabetes. He later joined the Stanford faculty and worked at the affiliated county hospital in Santa Clara County, Santa Clara Valley Medical Center.
“Becoming a doctor was something I wanted to do because not only would it be an avenue to help
the greatest number of people I could, but it was and continues to be an evolving field with new dis-coveries around each corner,” he said.
Dr. Cobb is a former chair of the CMA Council on Legislation and has served on the organization’s executive committee since 2006. He is also past president of the Humboldt-Del Norte County Medical Society.
“Dr. Cobb brings the experi-ence, leadership and fortitude to CMA’s presidency that will lead us into an incredible time in healthcare,” said CMA CEO Dustin Corcoran. “As we look ahead to the changes that lie in front of us, I have the utmost faith in Dr. Cobb’s ability to lead the 40,000 plus members of CMA as we advocate for quality and for timely access to safe and afford-able healthcare.”
Dr. Cobb’s term as CMA president will run from November 2014 through October 2015.
“What a thrilling time to be assuming the role of CMA presi-dent. The healthcare community has stood tall in protecting our patients and their access to care, and as we look ahead to the year in front of us, I am confident that we will continue to do so.”
16 P H YS I C I A N M AG A Z I N E | DECEMBER 2014
CEO’s LETTER
AFTER A LONG BATTLE , we finally witness a victory of political power. LACMA is thrilled that California voters have sided with their doctors to end the single
largest assault on MICRA in 39 years. During the November election, Proposition 46 was defeated by a clear margin of
67.1% to 32.9%. The actual vote count was 3,415,996 “No” votes to 1,671,163 “Yes” votes, according to figures from the California Secretary of State.
This demonstration of power marks a new day for physician leadership in the state of California. And the campaign’s two major supporters -- LACMA and the California Medical Association -- couldn’t be more pleased about the outcome.
Dustin Corcoran, CEO of the CMA and chair of the opposition campaign, noted that “California voters spoke loudly and definitely: In this healthcare environment, undermining California’s long-standing malpractice cap is a political poison pill and a policy ‘third rail.’”
He added that Californians voted against the measure because increas-ing the payouts in medical malpractice lawsuits would have led to higher healthcare costs and reduced access to care.
The malpractice cap has been in place since 1975. Attempts to increase the state’s $250,000 limit on pain-and-suffering awards in malpractice law-suits have been rejected 10 times in court, five times in the state Legislature, and now, by California voters.
I’m very proud of all the physician leaders who put their reputation and their pocketbooks on the line in the interest of their patients.
This said, I am hopeful that physicians across California will seize the mo-ment and push through much-needed reforms in the legislative cycle.
This December will mark our quarterly board meeting as well as the 143rd Annual House of Delegates in San Diego, where we will discuss various initiatives and actions to advocate for reform.
On a lighter note, LACMA’s celebration at the third annual Healthcare Awards dinner to honor individuals and institutions that have made exemplary contributions to the com-munity was a huge success.
Our innovative leaders will inspire the next generation of physician leaders, and we are proud to be a part of that effort.
During this holiday season, I would like to wish everyone a joyous and peaceful holiday and a healthy and happy New Year.
A New Year … a New Challenge.
Rocky DelgadilloChief Executive Officer
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DECEMBER 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 17
For a copy of your renewal invoice please email Carolina Velazquez, [email protected]
How to renew:
Call: Carolina Velazquez, 213-226-0361
Renew online at www.lacmanet.org/Renew Your Medical License number will act as your login
Mail your invoice and payment to:
707 Wilshire Blvd, Suite 3800; Los Angeles, CA 90017
By renewing your dues, you will continue to receive:
Legislative Advocacy—Continuous fight to protect the medical profession from current challenges such as Proposition 46, narrow networks in California, and CalMediConnect.
Access to documentation to help you navigate through today’s changing healthcare landscape.
Free Reimbursement Assistance—CMA has recovered nearly $8 million recovered since 2010 in unpaid claims for its members!
Free Jury Duty Assistance—Your time is valuable! Maximize your flexibility and increase your chances for reporting for the minimum period when scheduling jury duty service.
15-27% average annual savings through LACMA’s exclusive partnership with Medline, the medical supplies company.
Free and low cost access to events including CME events, mixers, training workshops, and webinars for you and your staff.
Renew your dues today!
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FREE DUES! Renew your 2015 membership by
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The defeat of Proposition 46 took center stage, but California voters also rejected Proposition 45, which would have given the state insurance commissioner new power over healthcare benefits, rates and co-pay-ments for individuals and small groups.
The California Medical Association (CMA) and oth-ers who were part of the broad coalition opposing the proposition felt strongly that the last thing doctors and patients needed was a politician having more power to interfere with what treatments are or are not covered.
A Proposition 45 campaign staffer told PNN that the contribution from local physicians and their active participation was vital to the effort. Physicians are the most trusted members of local communities, he said. Having local doctors participate by making themselves available to the media — whether writing commentar-ies or appearing on the local news or in commercials — was invaluable.
The Proposition 45 campaign coordinators wanted to recognize the following physicians who actively participated in the campaign:
Dr. Marshall Morgan (pictured), immediate past presi-dent of LACMA, and Dr. Amy Nguyen Howell, both of whom were filmed in the “Exam Room” commercial.
Dr. Samuel Fink, past president of LACMA, who was interviewed by multiple TV stations as well as by the Orange County Register for a story about Prop. 45.
Dr. Marty Gallegos of the Hospital Association of Southern California, who debated Consumer Watch-dog at a voter forum in LA.
Dr. Efrain Talamantes, who was interviewed by Fox News Latino.
Dr. Thais Aliabadi, who agreed to let the campaign use her office and appear in a campaign commercial (the campaign ended up filming the commercial in Sacra-mento instead).
Many appeared in a campaign mailer — Dr. Marshall Morgan, Dr. Amy Nguyen Howell, Dr. Richard Baker, Dr. Jorge Carreon, Dr. Efrain Talamantes and Dr. Car-los Martinez.
PROP. 45 DEFEAT: The Power of Participation
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TOP10REASONSFOR JOINING LACMA AND CMA
Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.
LACMA/CMA IS THE VOICE OF PHYSICIANS
1Legislative AdvocacyLACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy to end abusive practices. In addition, LACMA has sued health care plans on behalf of members to stop intimidation tactics.
two FREE Reimbursement Assistance
Tired of fighting with payors? CMA’s Economic Services experts have recovered nearly $8 million for members since 2010!
3 FREE Jury Duty AssistanceLACMA can help you: • Reschedule your date • Relocate for your convenience • Reduce number of call-in days from 5 to 1!
27% in AVERAGE SAVINGSThrough an exclusive partnershipwith Medline, LACMA saves members a guaranteed minimum of 10% on their medical supplies and equipment. Find out how one member saved $31,000 for his practice!
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Benefits & DiscountsAimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!
five
FREE CME & Educational ResourcesCMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with membership. In addition, LACMA provides access to important and local CME-accredited events.
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8FREE Networking & Referral Events• Socialize and network with members of the medical community• Find or create opportunities for your practice• Engage with legislators and policymakers
Unlimited Access to Legal ExpertsSave time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!
9 State-of-the-Art CommunicationInformation is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.
tenAccess to your Physician AdvocatesWhen you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need—be it help with a problematic payor, or details about your member discounts—just call the member helpline at (800) 786-4262 or visit www.lacmanet.org
LOS ANGELES COUNTY MEDICAL ASSOCIATION707 WILSHIRE BLVD, SUITE 3800
LOS ANGELES, CA 90017
PHONE: (213) 683-9900FAX: (213) 226-0353
For more information on member benefits and resources, visit www.lacmanet.org/Membership
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in refrigerated vaccine.Make sure you’re covered.
a malfunctioningthermostat ruined $51,000
In a Del Mar physician’s office,
For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.
n Medical Malpracticen Workers’ Compensationn Health and Disabilityn Property and General Liability
n Employment Practices Liabilityn Directors and Officers/Management Liabilityn Errors and Omissions Liabilityn Billing Errors and Omissions Liability
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www.thedoctors.com/TDCISCA License #0677182
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