june 2015 | physician magazine

JUNE 2015

O

FF

IC

I A L M A GA

ZI

NE

OF

F

IC

IAL MAGA

ZI

NE

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

SOLVING THE

PRACTICE MANAGEMENTPUZZLE

Financing for your practice — and so much more

Apply for a Wells Fargo Practice Finance loan between 04/16/2015 and 06/30/2015 and, upon approval, get $250 off the documentation fee. The loan must commence funding by 07/31/2015. All financing is subject to credit approval. Business refinance program is for practice-related debt only. Existing Wells Fargo Practice Finance debt and revolving credit are not eligible for consolidation. © 2015 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. SBS60-0244 (1243048_14516)

With more than 20 years of healthcare financing experience, Wells Fargo Practice Finance understands the business of running a practice and is here to help you achieve your goals.

Get up to 100% financing for a variety of business purposes:• Practice start-up and acquisition• Equipment purchases or upgrades• Office expansion, remodel, and relocation• Practice debt refinancing• Working capital

To talk to us about our other small business appreciation offers, call 1-800-359-3557, go online to wellsfargo.com/appointments to set up a convenient time to meet with a banker near you, or contact your local banker today:

Enjoy limited-time offers designed to celebrate businesses like yours

Apply by June 30, 2015, and receive $250 off the documentation fee

1243048_14516

8.375x10.875

4C

1243048_14516 8.375x10.875 4C.indd 1 3/19/15 10:30 AM

JUNE 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 1

Volume 146 Issue 6

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.

JUN

E 2015 | TAB

LE OF C

ON

TENTS

COVER STORY

6 SOLVING THE PRACTICE MANAGEMENT PUZZLE

Successfully putting together the pieces of the practice management puzzle can be filled with challenges, especially in this rapidly changing healthcare environment. In this ar-ticle, you’ll find vital information on a variety of key issues, including an eye-opening Stanford University study illuminating the key features of high-performing primary care practices, must-know facts about new payment models, reimbursement tips, streamlining your prac-tice, mitigating liability risk, trends in market-ing your practice and much, much more.

FROM YOUR ASSOCIATION

4 President’s Letter | Pedram Salimpour, MD

20 Refer-A-Colleague Program

16 CEO’s Letter | Rocky Delgadillo

24 The LACMA Career Center

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.

EDITOR

DISPLAY AD SALES / DIRECTOR OF SALESCLASSIFIED AD SALES

EDITORIAL ADVISORY BOARD

PRESIDENT PRESIDENT-ELECT

TREASURER SECRETARY

IMMEDIATE PAST PRESIDENT

CMA TRUSTEEALTERNATE RESIDENT/FELLOW COUNCILOR

COUNCILOR – SSGPF COUNCILOR – DISTRICT 9

CMA TRUSTEE CMA TRUSTEECOUNCILOR – DISTRICT 5

COUNCILOR – DISTRICT 2COUNCILOR-AT-LARGE

ETHNIC PHYSICIANS COMMITTEE REPCOUNCILOR – DISTRICT 1

COUNCILOR – DISTRICT 17COUNCILOR – DISTRICT 14

COUNCILOR – USCCOUNCILOR – DISTRICT 7 COUNCILOR – DISTRICT 6

COUNCILOR-AT-LARGE COUNCILOR – ALLIED PHYSICIANS

COUNCILOR-AT-LARGECOUNCILOR – DISTRICT 3

COUNCILOR – DISTRICT 10MEDICAL STUDENT COUNCILOR/UCLA

COUNCILOR – SCPMG RESIDENT/FELLOW COUNCILORYOUNG PHYSICIAN COUNCILOR

COUNCILOR-AT-LARGECOUNCILOR – SSGPF

ALT. MEDICAL STUDENT COUNCILOR/UCLACOUNCILOR-AT-LARGE

CHAIR OF LACMA DELEGATION

Sheri Carr 858.226.7647 | [email protected]

ADVERTISING SALES

Christina Correia 213.226.0325 | [email protected] Pebdani 858.231.1231 | [email protected] H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD

HEADQUARTERS

Physicians News NetworkLos Angeles County Medical Association707 Wilshire Boulevard, Suite 3800Los Angeles, CA 90017Tel 213.683.9900 | Fax 213.226.0350www.physiciansnewsnetwork.com

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

No matter where you are in life, LACMA Group Level Term Life Insurance benefits can be an affordable solution to help meet your family’s financial protection needs.

Mercer and LACMA leveraged the buying power of your fellow members to secure dependable and affordable life insurance benefits at competitive premiums from ReliaStar Life Insurance Company, a member of the Voya® family of companies.

With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan.

It features:

• Benefits up to $1,000,000

• Rates that are designed to remain level for 10 or 20 full years*

• Benefit amounts that never change during the level term period provided premiums are paid when due

A financial safety net for you— AND THE ONES YOU LOVE

10- AND 20-YEAR LEVEL TERM LIFE

See For Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

Sponsored by:

Underwritten by:ReliaStar Life Insurance Company,

a member of the Voya® family of companies

71393 (6/15) Copyright 2015 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 S. Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • [email protected] • www.CountyCMAMemberInsurance.com

* The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days’ advance written notice.

The County Medical Associations & Societies receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

71393 LACMA TL Ad (6/15)Full Size: 8.5” x 11” Bleed: Yes= 8.75” x 11.25” Live: 7.5” x 10”Folds to: N/A Perf: N/AColors: 4C=(CMYK)Stock: N/A Postage: N/A Misc: N/A

MERCER

4 P H YS I C I A N M AG A Z I N E | JUNE 2015

In the past year, LACMA has grown into the largest medical association in California, likely the largest non-state medical association in the country. Without a doubt, we are all intensely proud. But it is what we do now with this re-

invigoration and strength that will define us as an organiza-tion, and as a profession.

For me, medicine has al-ways been something of a love affair. As with any such relation-ship, you can’t but emerge with some scars, and I have mine. But all in all, this has been the best year of my life. I can honestly say that since medi-cal school I haven’t worked as hard, or been rewarded with such incredible challenges. I was thrilled to witness every day the dedication of our staff and executive board. And to-day, we are an organization more than any in recent mem-ory that can have an impact because we have the strength of numbers, the economic in-frastructure and resources, and

the organizational discipline to make an impact. My 4-year-old patients tell me they want to be

doctors when they grow up. And I have 24-year- old young men and women whom I interview for medical school tell me why they want to be doctors. In the 24-year-old, I look for the twinkle in the eye of the 4-year-old. Medicine is and al-ways will be the most honorable profession in the world, in every culture in the world. But here, there are forces at play that compel us to have to put ourselves in a position to fight for what seems to us to be the obvious.

I am certain that as the scientific, moral and social engines of medicine, doctors will contin-ue to lead. The market forces that are driving patients to look for more efficient options will, with the right clinical leadership, lead patients right to their doctors. So all this talk about a consumer-centric model, this search for a value proposition, these changing models of reim-bursement, they all have the potential to cre-ate a healthcare marketplace where doctors do

what they do best. But it is so much more complicated than that.

For doctors to do well for themselves and for their patients in this new milieu of retail minute clinics, high-deductible health plans, and pri-vate equity’s requisite focus on ROI, we can’t just do what we do best. We also have to do what we don’t do best. If we want to survive as a profession in the fashion that is best for our pa-tients, we have to take on leadership positions in the emerging businesses of healthcare and in government.

To do that, we have to become better at as-sembling and managing teams of teams and ourselves, emerging as market realities instead of reacting to them. Doctors have to lead, but we will likely lead organizations that are far flat-ter in their structures. That means we have to be more communicative, with each other, with our patients, and with our organizations. Adoption of emerging technologies is key in this reality. And we have to be quicker at recognizing and reacting to market forces. We know with undue emphasis that we are not immune from these.

I have come to believe that all of this will be far more within reach if doctors fight for and are granted anti-trust relief. I have seen doctors struggle with implementation of onerous EMR systems that take them into a world of govern-ment compliance and away from their patient’s eyes. I have seen doctors powerless in their ne-gotiations with insurance companies with more economic resources than most countries. And I have seen economic denials of care lead to clinical devastation. LACMA is now a force that together with other national physician organiza-tions can move us in the direction of anti-trust relief.

All the seemingly limitless possibilities of our youth led us to this profession. If we want to see things change for us and our patients, we have to lead this gargantuan sector of the economy to where we want it to go. It is time for us to eliminate the possible in favor of the actual.

Serving as President of the Los Angeles Coun-ty Medical Association has been the highlight of my career. Thank you for affording me this in-credible honor. With you, I look forward to the capable leadership of Dr. Peter Richman, whom I have known and admired for many years.

PR

ES

IDE

NT

’S L

ET

TE

R |

PE

DR

AM

SA

LIM

PO

UR

, M

D

LESSONS LEARNED“In the life of every person there comes a point when he realizes that out of all the seemingly limitless possibilities of his youth he has in fact become one actuality.”

-H. KISSINGER, 1949 (OPENING SENTENCE TO UNDERGRADUATE THESIS AT HARVARD)


Success.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE!

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

It’s what California’s finest physicians strive for. . .and what CAP can help you achieve.

On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action

Guide for Medical Practices has the answers you need to successfully make the transition.

Request your free electronic or hard copy today!

800-356-5672 CAPphysicians.com/icd10now


Successfully putting together the pieces of the practice man-agement puzzle can be filled with challenges, especially in this rapidly changing healthcare environment. In this issue we’ve collected tips from experts in their respective fields to help you keep abreast of your responsibilities and stay ahead in this high-ly competitive environment. You’ll find vital information on a va-riety of key issues, starting with an eye-opening Stanford Univer-sity study illuminating the 10 key features of high-performing primary care practices, must-know facts about new payment models such as “bundled pay,” and reimbursement tips and strategies on how to streamline your practice, from electronic health records and billing to dealing with fluctuating patient vol-ume and government audits. Learn how to mitigate your liability risk in your medical practice as well as when dealing with elec-tronic health records. With doctors having to rethink their prac-tice model as serving consumers rather than patients, you’ll find the latest trends in marketing your practice successfully to health professionals, insurance companies and consumers.

SOLVING THEPRACTICE

MANAGEMENTPUZZLE

SOLVING THEPRACTICE

MANAGEMENTPUZZLE

Creating High-Performing Primary Care PracticesWhile some people believe that replicating the efforts of very large health systems is the key to delivering excep-tional performance, even for small practices, a study of 11 primary care practices — located in large and small communities — suggests that small practices can deliver high-quality care at much lower-than-average total costs to a commercially insured population. In a first-of-its-kind analysis of commercial insurance data, the Peterson Center on Healthcare and Stanford University’s Clinical Excellence Research Center (CERC) identified the follow-ing 10 key features that high-performance primary care sites have in common.

1. They offer patients same-day ap-pointments, accommodate walk-ins and are otherwise “always” available to patients.

2. They have a care team that not only ensures patients receive evidence-based care and proactively identi-fies tests and treatments but also conserves resources by tailoring care to the needs of patients.

3. They value feedback from patients and take complaints seriously.

4. Primary care teams do as much as they can rather than referring pa-tients out and can arrange for spe-cialist supervision to take on addi-tional low-complexity services.

5. When patients need to be referred out, they stay connected to assure the treatment plan respects their patients’ preferences and needs.

6. Their care team follows up to en-sure that patients are seen quickly after they are discharged from the hospital.

7. They maximize the ability of their staff, nurses, physician assistants and medical assistants, etc., so they are free to attend to the pa-tients who need the most direct physician contact.

8. The care team works closely to-gether and has continuous com-munication among both clinical and non-clinical staff, learning through close collaboration with clinicians without regard to hierar-chy.

9. Physicians are paid based on qual-ity of care, patient experience, re-source utilization and contribution to practice-wide improvement activities, rather than solely on the basis of productivity.

10. They invest in people, not space and equipment. They rent modest offices to save money and invest in lab, imaging and other equipment if it allows them to provide care most cost-effectively in-house.

New Payment Models A year from now, physicians who treat Medicare beneficiaries may have vastly expanded resources to help them prepare for a new payment structure de-fined by quality and efficiency measures, according to Frank Irving, editor of Medical Practice Insider. That is because the Medicare Data Sharing Program, enacted in 2010 as part of the Affordable Care Act, could be significantly en-larged under the Medicare Access and CHIP Reauthorization Act (MACRA), signed into law on April 16, which repealed the outdated sustainable growth rate formula. According to Irving’s May 7 article, “SGR Repeal Opens Doors to Big Data,” MACRA’s Section 105 is intended to put more claims data into the hands of analytical experts who can help practices figure out performance metrics to help them be more efficient and effective in the new payment land-scape by adjusting treatment timelines and other outcomes. That said, some experts expect that half of all Medicare payments will be bundled by 2018, which means that especially physician-owned practices need to learn how to manage and respond to the quality of metrics of new payment models. Here are five must-know facts when it comes to “bundled payments” as cited in the Medical Practice Insider’s article “How to prepare for bundled payments” on April 16:

1. In a physician group, bundled pay has a direct impact on personal com-pensation, which means that doctors need to know the difference between bundled pay and fee-for-service, and negotiate.

2. Look at the infrastructure to see what upgrades need to be made, or make arrangements with practices or consultants about resources.

3. Look at patient protocols and practice guidelines to improve efficiencies and team-based care. Schedule certain procedures like mammograms, check lab work and monitor for chronic conditions.

4. Evaluate the practice’s clinical, financial and management systems and find ways to lower direct costs.

5. With alternative payments increasing the importance of intermediary orga-nizations between the health plan and doctor, it’s key that physicians pay close attention to the details in their contracts.


PR

AC

TIC

E M

AN

AG

EM

EN

T | F

EA

TU

RE

Reimbursement TipsPhysicians find themselves under constant pressure to successfully receive reimbursement for the work they do, and these challenges aren’t expected to go away this year. To avoid some pitfalls when filing claims and dealing with insurance and find new ways to maximize revenues, follow these seven tips:

1. With insurance companies denying submission of claims based on even small data entry errors, it’s key that physician practices file “clean” claims, according to the experts quoted in Modern Medicine’s article “Top 15 challenges facing physicians in 2015” from Dec. 1, 2014.

2. Physicians who opted out of accepting insurance altogether may need to evaluate that decision care-fully to avoid loss of income.

3. Physicians need to stay abreast of the ongoing de-bate surrounding the American Board of Internal Medicine’s (ABIM’s) Maintenance of Certification (MOC). For family doctors, the application fee can range from $1,300 to $1,500, but ABIM and MOC proponents argue that the program is necessary to ensure doctors maintain their medical know-how.

4. Doctors need to address healthcare costs with patients early so they don’t miss out on collecting co-pays and deductibles when caring for patients enrolled in state exchanges or the federal marketplace site.

5. With mounting paperwork — which The Practice Profitability Index said rose from 58% in 2013 to 70% in 2014 — physicians need to take steps to avoid burnout, which often can drive doctors to sell their practices.

6. With rising overhead costs, doctors need to imple-ment ways to increase revenues by maximizing per-sonnel, growing revenues through extended hours or choosing technology to help them become more efficient.

7. To stay successful, independent practices should revamp their billing practices, ensure collection, re-examine fee schedules and look for high-impact savings as well as consider joining independent phy-sician associations to align with other physicians.

Keeping Up with Patient DemandWith many smaller practices lacking access to critical tools and resources to achieve economies of scale, it’s especially critical to right-size core staff and contingency resources to accommodate fluc-tuating patient volume. Here are five tips to help you right-size your practice.

1. The first step is to capture data to right-size your core staff with a minimal need to pick up over-time or have shifts cancelled.

2. Capturing data will also allow practices to identify certain trends such as when patient volume spikes or is down. Practices can then use that information to anticipate staffing needs and plan ahead. For instance, if Thursdays are lighter days than Mondays, the schedule should reflect that, wrote Jenny Korth, director of Project Management & Support at Avantas in an article in Medical Practice Insider titled “Can’t keep pace with patient demand? Balance core, contingency staff,” published on May 8.

3. While larger organizations often have contingency staff available to accommodate patient vol-ume, smaller groups might have to leverage part-time staff or semi-retired staff who like to pick up occasional hours.

4. Relying on high-quality staffing agencies, while often “erroneously labeled as a bad idea,” is es-pecially helpful for smaller clinics as long as they don’t over-use this service, according to Korth.

5. Finally, cross-training staff such as nurses to answer phones and schedule appointments or having a front-desk staff fill in as a medical aide or assist with billing could lead to greater efficiencies.

F

EA

TU

RE

|

PR

AC

TIC

E M

AN

AG

EM

EN

T


IT Investments — EHRs and BillingAccording to Derek Kosiorek, a principal at Denver-based

Medical Group Management Association, the two quintes-sential software packages to run a medical practice in this new era are electronic health records and billing. Here are five reasons why you need to consider these two essential IT investments and how to best implement both, if you haven’t done so already.

1. Government incentives and patient perceptions of whether the practice is advanced technology-wise will dictate that the practice needs to invest in billing and EHR software, Kosiorek said.

2. With software everywhere moving into the cloud, it only makes sense that healthcare providers, and small prac-tices, also follow this trend.

3. Consider having a picture archiving and communication system (PACS) available onsite to store images and other products.

4. It is critical to find the right vendor for cloud-based servic-es, which Kosiorek recommends over outright purchase.

5. Kosiorek believes that while small practices tend to in-vest a minimal amount in technology, maximizing the in-vestment, including planning for scalability, will pay off in the long-term.


PR

AC

TIC

E M

AN

AG

EM

EN

T | F

EA

TU

RE


LOS ANGELES HEALTH ALERT NETWORK

Join the

Do you want to be notifi ed of a local public health threat such as pandemic infl uenza or MERS?

Do you want to receive authoritative information about infectious diseases that may aff ect your patients?

JOIN LAHAN TO STAY INFORMED!The Los Angeles County Department of Public Health has launched the Los

Angeles Health Alert Network (LAHAN) to communicate important public health information to health care professionals in Los Angeles County.

All Los Angeles physicians are encouraged to join LAHAN to improve communication

during public health emergencies.

LAHAN sends health alerts, advisories, and updates on topics such as disease outbreaks, emerging infectious diseases, immunizations,

drug shortages and recalls. There are, on average, only 1-2 communications a month and the

urgency and target audience are clearly marked.

For more information and to see archived LAHAN communications, visit publichealth.lacounty.gov/lahan

Please join this important network. It is a valuable resource to help you serve your patients and to

protect the health of the Los Angeles community.

Sign up to become a member of LAHAN by visiting:

publichealth.lacounty.gov/lahanSign up takes less than 2 minutes. Your contact information will not be shared and you can unsubscribe at any time.

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

Marketing Your PracticeWhile many physicians may be wary of marketing, the chang-ing medical climate, with its new delivery models focused on “consumers,” means that more doctors must adopt new forms of communication and, with that, marketing. The good news is that marketing in this new era is less focused on selling and more on clearly communicating one’s products and services. Use the following seven expert tips to market your practice suc-cessfully today.

1. In this new era, physicians need to clearly communicate the value of a well-earned set of medical skills to entice consum-ers. One of the best ways to market your practice is via so-cial media. It also helps to use digital services such as online scheduling and bill-payment capabilities by providing pa-tients with a secure portal and other medical software, wrote Zach Watson in Medical Practice Insider.

2. According to a study by the Journal of the American Medical Association, 89% of patients rated insurance acceptance as the most important factor in choosing a primary care doctor, and referrals from other doctors received 34%. This means that marketing to healthcare professionals who can refer patients to your practice as well as making presentations to insurance providers to get involved with their managed care plans can yield big results.

3. Ensure that your website isn’t only live and functional but also shows up in Google search results so that patients can easily find your practice.

4. Delivering excellent care still is the best way to attract a great number of referrals from your existing patients as well as positive online reviews, which is another tactic that carries substantial weight.

5. Taking a closer look at your office to determine that it pro-vides friendly and fast service is as pertinent as focusing on extraordinary services that make you stand apart from other practices.

6. Also consider offering free services such as a monthly flu clinic or free vaccines to the first 10 patients, which is a great way to attract patients who may otherwise visit a pharmacy clinic.

7. Given the rise in retail clinics providing fast and convenient service, practices that create a fast track for patients to come in and get lab work done and emailing forms to patients be-fore they come in can be a great way to make your practice more attractive.

F

EA

TU

RE

|

PR

AC

TIC

E M

AN

AG

EM

EN

T

1. Don’t alter records, a vexatious problem for defense attorneys. Lost pages are also considered “record alteration.”

2. Keep good records. Every mistake is not actionable, and the standard of care is not perfection. It is merely living up to the quality of practice represented by other competent physicians. Keeping excellent records can be the difference maker.

3. When a complication occurs, recognize possible errors in-stead of continuing in a routine way.

4. Do not give inexperienced nurses an isolated post, such as a graveyard shift, for obvious reasons.

5. Establish a rigid protocol for processing laboratory results.6. Look at the record of a previous visit to avoid false diagnosis

and potentially disastrous outcomes.

7. Don’t hesitate to refer a difficult case to a specialist in a timely manner.

8. Offer staff such as interns and first-year residents proper super-vision. An adverse treatment outcome is almost certain to be blamed on the failure of supervision if a jury is convinced that an unsupervised trainee has exceeded the scope of his skills.

9. Record telephone conversations. Once a lawsuit is filed, the patient’s memory can become highly selective. Even a brief notation on what the patient said and doctor advised can be of great help to the defense. When the doctor expands on this note, telling the jury in detail what was said on the phone, his testimony becomes much more believable compared to a recollection unsupported by any note.

10. Carry adequate malpractice insurance.

Legal TipsCOURTESY OF FENTON LAW GROUP LLP

1. You should perform HIPAA training for your employees on an annual basis. This will reduce the chances of a breach and provide greater protection in the event of any breach.

2. If you are contacted by an investigator from the Medi-cal Board, DEA, the police or any other state or federal agency, you have the right to, and you should, decline to discuss any matter pertaining to your medical prac-tice, and you should contact an attorney who special-izes in representing physicians.

3. You should not turn over medical records without written patient authorization to anyone, including the California Medical Board, in the absence of a search warrant, with the single exception that the California Department of Healthcare Services may come to your office to inspect MediCal patient charts, and if you de-cline to permit such inspection, you may be suspended from MediCal.

4. It`s wise, although not necessarily required by the stan-dard of care, when examining a patient of the oppo-site sex, to have a chaperone present to guard against baseless patient claims of inappropriate conduct or touching.

5. If you utilize physician assistants in your practice, you should be certain to document your review of the medi-cal records prepared by the physician assistants with your signature. You should ensure that your treatment protocols are up to date to avoid the potential of charg-es by the Medical Board of inadequate supervision.

6. You should not rely only on office administrators to fill out medical staff appointments and reappointments or other credentialing documents. You should be certain to carefully review such documents because any errors will be attributed to you as captain of the ship and could po-tentially result in denial on the basis of dishonesty.

7. Always bill patients for co-pays and deductibles. The failure to charge for these services may raise an issue for insurance companies and government payors about whether what was charged to the payor was truthful and accurate. Ultimately, if the patient is unable to pay, you may write off the fees, but they must first be billed.

Medical Risk ManagementFinally, when it comes to medical malpractice, the majority of cases reflect fact situations that are repetitive, David Rubsamen, MD, LLB, wrote in an article titled “The 10 Commandments of Medical Risk Management” published by Practice Management Daily on April 8. To help you avoid some of these common errors, follow these suggestions:


How to Prepare for Government-mandated Audits When it comes to government-mandated audits, Medicare Advantage health plans are at risk of po-tentially losing millions of dollars, according to Pam Klugman, co-founder and chief product officer of Clear Vision Information Systems. To prepare for an audit she offered the following four suggestions. Here is what doctors need to know:

1. A review of the Centers for Medicare and Med-icaid Services’ requirements should be done an-nually.

2. Doctors should learn about proper and accurate documentation.

3. Having the proper systems and discipline in place can make a major difference in how health plans perform in the audits.

4. Assigning a project manager and creating cross-functional teams that include risk adjustment, clinical, coders, medical directors and compli-ance are key.

Managing Malpractice Risk for Electronic Health RecordsWhen it comes to potential liability risks, the Doctors Company finds that new technologies such as EHRs can pose unanticipated consequences. A supporter of EHRs, the Doctors Company offers the following tips to help doctors minimize their liability risk:

1. Doctors are responsible for e-health information they can access from outside the practice, from their practice EHR or Web site, or through a health information exchange, and if the patient gets injured as a result of a failure to access such information or make use of it, the physician may be held liable.

2. E-prescribing is rapidly being adopted and offers many benefits but can also expose practices to community medication histories. For instance, if a doctor sees that a drug prescribed by another doctor could interact with a drug he wants to prescribe to the same patient, it is his responsibility to contact the other doctor to “negotiate” which drug will be discontinued or changed. If the doctor doesn’t take action, he or she may be liable.

3. Doctors need to take all drug-drug interaction alerts into careful consid-eration and follow up.

4. Doctors need to pay close attention to the quality of notes and docu-mentation. By substituting a word processor, for instance, for the physi-cian’s thoughtful review and analysis, the narrative documentation of daily events and patient’s progress may be lost, compromising the pa-tient’s records.

5. The computer creates a barrier between doctors and patients, diverting attention from the patient, limiting interactive conversation and restrict-ing creative thinking. Also, its location within the office is an important ergonomic consideration.

6. Many EHRs autopopulate fields in the H&P (history and physical) and in procedure notes. Overdocumentation may facilitate billing, but entering erroneous or outdated information can increase liability.

7. Providers are responsible for the information and materi-als provided through patient portals to the EHRs, which can create risk. Some EHRs have patient questionnaires that use an algorithm to interview the patient through these portals. Lack of or incomplete follow-up to health issues that come up through the questionnaire can create potential liability.

8. Vendor contracts may try to shift liability resulting from faulty software design or CDS (clinical decision support) data onto the doctor, which makes it critical for physicians to pay close attention to their vendor contracts.

9. Attorneys may request printed copies of EHRs and copies in native form to show how the data was used and when. All physician interaction with the EHR, as well as email and smartphone records, is time-tracked and discoverable.

10. Beware that erroneous information once entered into the system may be perpetuated elsewhere in the EHR.

11. Clinicians should know the source of medication and CDS information on EHRs, because it may be in conflict with the clinical standards of care or practice guidelines for their specialty and with the information in Food and Drug Ad-ministration-approved drug labels or drug alerts.

12. Computer-assisted documentation can contain redundant information that makes it easy to overlook significant clini-cal information, posing a risk.

13. Document why a prompt related to medication and chronic disease management and preventive care was overridden.

Assisting physicians with legal issues for over three decades.

Fenton Law Group, LLP1990 South Bundy DriveSuite 777Los Angeles, CA 90025 310.444.5244

www.fentonlawgroup.com

M E D I C A L B O A R D H O S P I T A L S T A F F F R A U D / A B U S E M E D I - C A L / M E D I C A R EMEDICAL PRACTICE PURCHASES, SALES AND MERGERS

The brand physicians trust

PR

AC

TIC

E M

AN

AG

EM

EN

T | F

EA

TU

RE


F

EA

TU

RE

|

PR

AC

TIC

E M

AN

AG

EM

EN

T

When social media is left unmonitored, medical offices face the very real risk of violating federal pri-vacy laws by breaching patient confidentiality, which in addition to substantial fines, can permanently dam-age one’s professional reputation. While the content of the social media is of paramount concern, another cause for headaches is the excessive time employees waste accessing social media websites during work hours. Creating a social media policy to clarify the

standards for permissible and prohibited content for both personal and profes-sional social media is one way to protect your patients, your productivity, and your business reputation.

A social media policy should communicate em-ployer expectations regard-ing the use of personal electronic devices and prohibited social media content. There are numer-ous examples of healthcare social media policies avail-able online that can serve as a template for your office

policy—so there’s no need to reinvent the wheel. In your research, consider reviewing social media poli-cies from major medical centers. Next, consider your specific office needs and how you might tailor one of these policies for your office. Be certain to address the following in your policy:

1. Define social media and include examples of popular social media sites (e.g., Twitter, Facebook, Yelp, etc.) as well as the type of information the policy will cover.

2. Determine who can access social media from the office as well as any restrictions on the use of of-fice equipment.

3. Emphasize that patient privacy is paramount. Explain the HIPAA privacy rules and the serious consequences for violations (fines of up to $1.5

million) and provide examples of content that constitutes breach.

4. Describe what information employees are al-lowed to post online and what is off limits. Explain that if employees ever have questions about the appropriateness of content, they should first ask their employer or chief privacy officer.

5. Reinforce that employees are responsible for maintaining a professional image of the business, the physicians, their coworkers, and themselves.

5. Identify the consequences of noncompliance with the social media policy. Be clear that employees are held responsible for their actions and that vio-lators will be subject to disciplinary action includ-ing a written reprimand or termination of employ-ment.

After this policy has been created, it is imperative that employees are educated so they understand of-fice expectations. When educating office employees, discuss the importance of maintaining professional boundaries with patients and remind them that they should not “friend” patients on Facebook. Addition-ally, inform them that posting photos of patients, for any reason, is strictly prohibited. While labor laws allow an employee to discuss their work conditions, employees should never post any details of their work day that relates to patients, even if the informa-tion seems generic. When employees post on social media, not only do they represent themselves, they represent the employer, the office, and all healthcare professionals.

Inappropriate communications with patients on-line, online violations of patient privacy, and unpro-fessional comments directed at patients or coworkers are some of the issues that can be prevented with a good office social media policy. One of the best tips continues to be to always pause before hitting the send key. If something does not look right, makes you question the rules, or think twice—get approval.

Kimberly Danebrock, RN, JD, is a professional risk management and patient safety executive with 30 years of combined experience in nursing, medical-legal, and risk management and patient safety. Ms. Danebrock develops and conducts risk management and patient safe-ty educational presentations for physicians, residents, and office staff.

“Does Your Medical Office Need a Social Media Policy?”BY KIMBERLY DANEBROCK, RN, JD, RISK MANAGEMENT & PATIENT SAFETY SPECIALIST | COOPERATIVE OF AMERICAN PHYSICIANS, INC.

Yes. In fact, every office should have one! Even if the business doesn’t participate in social media, odds are that the majority of the office employees use social media in their personal lives. And sometimes, in using social media, employees inadvertently breach the boundar-ies between the personal and professional, thereby creating an unprofessional “social media presence” for the medical office—without their employer’s knowledge or approval. And it’s not just the office’s reputation that’s on the line and in jeopardy.

When educating office employ-ees, discuss the importance of maintaining professional

boundaries with patients and re-mind them that they should not

“friend” patients on Facebook. Additionally, inform them that posting photos of patients, for

any reason, is strictly prohibited.



RPM’s Physician’s Mortgage Program is designed to meet your unique

financial needs by offering you low down payment options, flexible

qualification guidelines and no monthly mortgage insurance.

Contact me for more informationabout this exclusive program

You are committed to your practice

I am committed to finding you the right home loan

Michelle MolluraBranch Manager

[email protected]/mmolluraNMLS # 320542445 Silver Spur RoadRolling Hills Estates, CA 90274

RPM Mortgage, Inc. – NMLS# 9472 – Licensed by the Department of Business Oversight under the Residential Mortgage Lending Act. Equal Housing Opportunity. 2243

Specializing in the field of specialties

When you’re responsible for hiring healthcare professionals, you need the expertise of the Los Angeles County Medical Association Career Center. As a member of the National Healthcare Career Network, the LACMA Career Center gives you access to the best source of local and national candidates—its more than 250 member associations and professional societies. Save time and money by reaching the right people faster when your job is posted throughout a nationwide network that reaches over two million professionals dedicated to careers in healthcare. When you want the best, go where the best are: the LACMA Career Center

Visit careers.lacmanet.org to get started


On July 28, 2014, the Centers for Dis-ease Control and Pre-vention (CDC) issued the first official health advisory to emergen-cy communication partners about the potential for travel-

associated spread of Ebola Virus Disease and urged healthcare providers in the U.S. to be vigilant for potential cases. On the same day, all of the members of the Los Angeles Health Alert Network (LAHAN) received this important communication. As the global drama unfolded over the next several months, LAHAN members received timely, authoritative, and tailored communications from local and national sources about Ebola preparedness and response including detailed practical guid-ance and tools for managing potential Ebola cases in inpatient and outpatient settings in Los Angeles County.

LAHAN members were better prepared to recognize and respond to the first local measles cases thanks to an early ad-visory on January 8, 2015, warning that neighboring Southern California jurisdictions were reporting measles cases associ-ated with visits to Disneyland theme parks. Once the outbreak had spread to Los Angeles County, LAHAN members received more detailed resources for both providers and patients. This included an invitation to participate in the Los Angeles De-

partment of Public Health’s (LAC DPH) live and archived free CME webinar titled, “Measles Update—A Primer for Health Care Providers.”

LAC DPH created LAHAN to improve communication with local physicians regarding disease outbreaks, emerging infec-tious diseases, and other issues of public health importance such as new immunization recommendations. LAHAN shares important public health communications from the CDC and the California Department of Public Health as well as original local communications from LAC DPH.

Recognizing that physicians must triage and sort through a vast amount of information, LAHAN uses a tiered email com-munication system: alert, advisory, update, and informational to communicate different levels of urgency and action. On the LA-HAN webpage, the levels are also color-coded for quick scan-ning. Each message begins with the intended audience (usually by specialty or practice setting) as well as two to five short key messages. On average, there are only one to two LAHAN com-munications a month.

LAC DPH requests that all Los Angeles County physicians subscribe to LAHAN. The online sign-up is simple and takes less than two minutes. One can unsubscribe at any time with a simple click. LACMA members are encouraged to visit the LA-HAN webpage at publichealth.lacounty.gov/lahan to subscribe as well as to see all recent communications. LAC DPH believes that the more physicians are informed of public health threats, the safer the Los Angeles community will be.

AEMCEMBACEMBCC

Contact us today and apply for Fall 2015!Health Care Executive MBA [email protected] 949.824.0561

merage.uci.edu/go/HCEMBA

Lead the change in health care. Be a part of the solution.Advance your career with the Health Care Executive MBA program:

• Classes meet one weekend per month for just 21 months

• Week-long experiential residential on Federal Policy in Health Care in Washington D.C.

• Learn from the same world-renowned faculty who teach in our top-ranked Executive MBA program

• Up to 30 CME units may be earned

• Partial merit-based scholarships available for qualified candidates

Dr. Michael Miyamoto, HCEMBA ’12Cardiologist and CMO, uncleCare

Health Care Executive MBA

SPONSORED CONTENT

KEEPING PHYSICIANS INFORMED THROUGH THE Los Angeles Health Alert Network


AS

SO

CIA

TIO

N H

AP

PE

NIN

GS

| L

AC

MA

NE

WS

CEO’s LETTER

T H E S P R I N G S E A S O N kicked off with some sweeping changes, exciting news for LAC-MA’s membership numbers and key developments on the legislative front.

LACMA is excited to announce that some 100 physicians from the Molina Medical Group have entered into a three-year partnership with LACMA.

This marks yet another major milestone in LACMA’s growing membership numbers, speaking to our organization’s rising influence and importance in the local and larger medical community.

On the legislative side, all physicians received some long-awaited welcome news.“A milestone for physicians, and for the seniors and people with disabilities who

rely on Medicare for their healthcare needs,” as described in the words of President Obama, the Senate, in an overwhelming majority vote, repealed the arcane sustain-able growth rate bill, which has burdened physicians since its creation in 1997.

We are thrilled that doctors will finally see the fee increases they deserve and will reap the rewards for making patients healthier.

On the local front, the Los Angeles school board last month unanimously voted to support state legislation that eliminates parent choice when it comes to vaccinating their children.

The measure, SB 277, is critical to abolishing a “personal belief” exemption that currently allows parents of 13,500 kindergartners in Los Angeles to be excused from vaccinating their children.

The California Medical Association, American Academy of Pediatrics California, California Immunization Coalition, Vaccinate California and the Health Officers Asso-ciation rank among numerous organizations that support SB 277 with the creation of the I Heart Immunity Campaign.

LACMA is now calling on all physicians to contact their legislators and also make their voices heard in support of SB 277.

We all need to come together as one voice to say that vaccination is not an indi-vidual choice when it comes to protecting the health of all our children.

This month, I also urge LACMA physicians to make their voices heard within our own organiza-tion. LACMA’s 144th annual election is just around the corner. Among the vacancies on LACMA’s board of directors are the positions of Treasurer, Secretary, Councilor-At-Large, Young Physician Councilor, District 14 Councilor and Medical Student Councilor. Don’t miss this once-a-year op-portunity. Contact [email protected] to learn more about the candidates and the election process.

If you’ve always wanted to get an insider perspective on concierge medicine, learn more about the American College of Private Physicians, meet some of their doctors and learn about their pro-grams, you don’t want to miss the ACPP’s inaugural annual meeting at the Ritz Carlton in Laguna Niguel on June 13-14.

To keep abreast of key developments, including SB 277, in real time, don’t forget to sign up with Physicians News Network newsletters.

With summer being just around the corner, we’ll continue to work hard to keep you informed about all hot developments and hope you’ll also enjoy some family time at the beach.

Regards,

Rocky DelgadilloChief Executive Officer

Thanks to Bisonbiz, we were able to reduce our tax liability by 80%. I also learned how to deduct Long Term Care Insurance from my taxes by adding a Flexible Spending Account. Thanks a lot, Walter!

- John Tyler, JMT Graphics

I have received excellent advice from Walter on tax strategies, and I highly recommend Bisonbiz to any-one who is tired of overpay-ing taxes!

- Marcus Beverly. BevTech & IT Consulting

Bison Business Solutions 20209 Nestor Ave. Carson, CA 90746 (310) 346-0850 [email protected] www.bisonbiz.com

Kasper & Associates 714 W. Olympic Blvd Ste. 450 Los Angeles, CA 90015 (213) 632-9697 [email protected] www.kasperlaw.com

The Bison Business Solutions team consists of several different business owners that have come together to leverage their expertise. Our goal is to provide the best services possible to our clients. Recently, we partnered with Travis Kasper of Kasper & Associates to provide our clients with POST-retirement options. While CPAs, CFPs, and RIAs may focus on pre-retirement taxation, and Estate Plan-ners may focus on post-retirement taxation, we are able to provide our clients with the best of both worlds. Our clients can expect to pay an average of 50% less than other high net worth individuals that rely on CPAs, RIAs, or Estate Planners only.

Walter Hines Travis Kasper, Esq.

Why us... Bison Business Solutions is the leading Tax Deduction Strategists for Healthcare Professionals and Small Business Owners in America. Unlike typical CPAs, RIAs, and Estate Planners, we provide our clients with strategies to reduce PRE-retirement taxation and POST-retirement taxation. The tax deduction strategies that we implement, along with proper estate planning, enables the heirs of our clients to build upon the legacy of their benefactors by reducing hefty federal and state taxation.

1 8 P H YS I C I A N M AG A Z I N E | JUNE 2015

JOB

BO

AR

D |

CL

AS

SIF

IED

S

TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

PhysiciansNewsNetwork.com

FAMILY MEDICAL AND INTERNAL MEDICINE IN VISTA AND RIVERSIDE

Located in Vista, California, Vista Community Clinic is a private, nonprofit outpatient community clinic located in North San Diego County serving people who expe-rience social, cultural or economic barriers to health care in a com-prehensive, high quality setting.

POSITION: Full-time, Part-time and Per Diem Family Medicine Physicians and Internal Medicine Physicians.

RESPONSIBILITIES: Provides outpatient care to clinic patients and ensures quality assurance. Malpractice coverage is provided by Clinic.

REQUIREMENTS: California li-cense, DEA license, CPR certifica-tion and board certified in fam-ily medicine. Bilingual English/Spanish preferred.

CONTACT US: Visit our website at www.vistacommunityclinic.org Forward resume to [email protected] or fax resume to 760 414 3702.EEO/AA/M/F/Vet/ Disabled

OPENINGS—PHYSICIANS

TRACY ZWEIG ASSOCIATES, INC.

• Physicians• Nurse Practitioners • Physician Assistants

LOCUM TENENSPERMANENT PLACEMENT

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

email: [email protected]

CONSULTING & SERVICES

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

Physicians Since 1983

CALL FOR A COURTESY CONSULTATION

818-693-7055

Shorr Healthcare Consulting

Consultants to Healthcare Providers

[email protected]

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

OPPORTUNITY WANTED

PRACTICE FOR SALE/LEASE

OB-GYNECOLOGY PRACTICE FOR SALE

at Los Angeles suburb. Please write to [email protected]

THOUSAND OAKS-BEAUTIFUL, MODERN OFFICE

aproximately 1200 square feet with lots of parking. Very reasonable rate. Call 661-266-0822 and ask for Perry.

OFFICE SPACE - LEASE/SHARE

ONLINE. IN PRINT.

ONE PRICE.

REACH THOUSANDS OF SOUTHERN CALIFORNIA PHYSICIANS

Place Your Ad Today!


CL

AS

SIF

IED

S | JO

B B

OA

RD

ADVERTISER INDEX

Bison Business Solutions ...................................................................................................17

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

County of Los Angeles Public Health ..................................................................................9

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

Fenton Law Group ............................................................................................................11

Mercer ................................................................................................................................3

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

RPM Mortgage ..................................................................................................................13

UC Irvine ..........................................................................................................................15

Wells Fargo ...................................................................................................................... C2

LOCUM TENENS AVAILABLE

TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

PM Marketplace

• Full or part-time positions

• Competitive Pay• Add revenue to your

current practice

• Flexible schedule, complete autonomy

• No Call

Surgeons Needed for Expanding Nationwide Surgical Practice

PLEASE CONTACT US FOR MORE INFORMATION:Phone: 1-877-878-3289 Fax: 1-877-817-3227

or email CV to: [email protected] www.AdvantageWoundCare.org

TRACY ZWEIG ASSOCIATES, INC.

• Physicians• Nurse Practitioners • Physician Assistants

LOCUM TENENSPERMANENT PLACEMENT

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

email: [email protected]

Refer-a-Colleague Program Every physician that joins LACMA & CMA strengthens our position at the negotiating table—help us continue to shape the future of healthcare.

Recruit 5 physician colleagues and receive

free membership dues in 2016

How it works:

Submit the names of five physicians and their contact information to [email protected]

You will be credited once your referrals have joined LACMA & CMA

www.lacmanet.org/Membership

june 2015 | physician magazine

Documents