August 2013

AUGUST 2013

A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

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R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y

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

PLUS: Understanding The California Heathcare Exchange

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

Volume 144 Issue 08

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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14 TRends & OppORTUniTies

A look at payment reform, con-sumer engagement and political advocacy and what these trends could mean for your practice and what you can do to be prepared.

dePaRTMeNTs 6 fROnT Office | pRacTice ManageMenTTips, hints, advice and resources

10 Balance | lifesTyle & WellnessNews, studies, tips and opportunities to help physicians maintain a balanced lifestyle

12 pnn | neWs in ReVieWThe latest headlines impacting the economics of healthcare delivery in Southern California

22 UniTed We sTand | aT WORK fOR yOULACMA and CMA membership at work for you

fROM yOuR assOciaTiON

4 pResidenT’s leTTeR | MaRshall MORgan, Md

24 lacMa neWs | assOciaTiOn happenings

26 ceO’s leTTeR | ROcKy delgadillO

14

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20 UndeRsTanding The exchange

There are many uncertainties remaining regarding the actual implementation of the California Health Care Exchange and the im-pact it will have on doctors’ prac-tices. We offer an overview of the exchange and some of the critical issues remaining.

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.

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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 Marshall Morgan, Mdpedram salimpour, Mdpeter Richman, MdVito imbasciani, Mdsamuel i. fink, Md

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The Los Angeles County Medi-

cal Association is a profes-

sional association representing

physicians from every medical

specialty and practice setting

as well as medical students,

interns and residents. For more

than 100 years, LACMA has

been at the forefront of cur-

rent medicine, ensuring that its

members are represented in the

areas of public policy, govern-

ment relations and community

relations. Through its advocacy

efforts in both Los Angeles

County and with the statewide

California Medical Association,

your physician leaders and staff

strive toward a common goal–

that you might spend more time

treating your patients and less

time worrying about the chal-

lenges of managing a practice.LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Executive Assistant, at [email protected] or 213-226-0304.

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

We MUsT pROTecT MicRa

It is a great privilege to be a physician. We have the opportunity to alleviate suffer-ing and improve the lives of our patients. We are held in high regard by the great ma-jority of our fellow citizens, and we earn a comfortable living. However, with privilege come challenges, and we face several: non-physicians want to practice medicine; the governor wants to reduce Medi-Cal reimbursement; insurance companies refuse to pay for appropriate care. The list goes on. Your medical association fights against all of them, with considerable success!

The newest and most dangerous challenge we face at this mo-ment is a well-organized, well-funded and very serious attempt to undo the protections that the Medical Injury Compensation Re-form Act of 1975 (MICRA) provides to physicians and hospitals by setting reasonable limits on awards for non-economic damages (pain and suffering) in medical malpractice cases.

The trial lawyers and their allies have mounted a multi-pronged, very sophisticated attack. They have placed an enormous number of articles in prominent newspapers on opioid abuse and misuse that portrays physicians in a very unfavorable light.

They have hired a prominent and extremely competent con-sulting firm to run their campaign. They promise if they fail to win in the Legislature to propose and qualify for a ballot initiative.

Should they succeed in destroying MICRA, California will re-turn to an era of multimillion-dollar awards for non-economic damages, sky-high malpractice insurance premiums, closure of practices and decreased access to care. This is a fight we cannot afford to lose.

The cost of winning this battle will be enormous. What can you do to help? You can educate your friends, your colleagues, your patients, your legislators, if you know them. Above all, you can raise money. You can (and should) participate in the effort to raise

money from hospital medical staffs. The total amount of money raised by this ef-fort will be more than doubled by the California Hospital Association. If you wish to participate in this effort (and again, you should!), please contact Luis Ayala (email: [email protected]; phone (213) 407-6224 to coordinate your efforts with LACMA and CMA staff.

You can contribute directly to LACPAC or CALPAC, which can support legislators who agree with our stance on this critical issue.

You can urge your colleagues who are not LACMA members to join the medical association. There is strength in numbers. If the trial lawyers win, doctors who are not members will suffer along with the rest of us.

Marshall Morgan, MD, is a professor and chief of emergency medicine at the Ronald Reagan UCLA Medical Center and director of the emergency medicine center at the David Geffen School of Medicine at UCLA. He is the 142nd president of the Los Angeles County Medical Association.

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An individual can be excluded from participation for a variety of reasons, including patient abuse or vio-lation of Medicare and Medicaid billing rules. Exclu-sions are mandatory based on certain events (e.g., con-viction of healthcare fraud) and discretionary in other cases. In addition to exclusion by the OIG, state Medi-Cal authorities have the power to exclude individuals irrespective of federal authorities.

The effect of exclusion on an individual is serious: no payment will be made by any federal healthcare program for services furnished, ordered or prescribed by an excluded individual. The Medicare Program may demand repayment of amounts paid while an ex-cluded individual was employed.

Perhaps the most common errors regarding ex-clusion relate to indirect services. The OIG does not limit the prohibition to provision of patient care by excluded individuals, but instead takes an extremely broad view of services that are in the “causal chain”

leading to the making of healthcare claims. This broad interpretation makes it extremely difficult, if not impossible, for an excluded person to obtain work with a healthcare provider.

Healthcare providers that bill Medicare or Medic-aid should be careful not to hire an excluded individu-al if the person’s job involves patient care activities and if any of the revenue supporting the wages of the ex-cluded individual comes from federal healthcare pro-grams. The OIG has stated in multiple Advisory Opin-ions that employers of excluded individuals or entities face civil monetary penalties for submitting claims to federal and state healthcare programs for services pro-vided by excluded individuals or entities. With this in mind, healthcare providers should always refer to the OIG’s exclusions list, as well as California’s Medi-Cal exclusions list, prior to hiring any employee or con-tracting with an individual or entity. Further, providers should conduct checks on all potential contractors, manufacturers and medical equipment suppliers that are used in the care or treatment of patients and are reimbursed by a federal healthcare program.

For healthcare providers in the unfortunate position of already having hired an excluded individual, acting expeditiously is the best option. Terminating the rela-tionship and stopping all billing of government payers is crucial. Developing a corrective action plan, includ-ing voluntary disclosure under the Provider Self-Dis-closure Protocol, is also necessary and important step in this scenario. Failure to act quickly can carry serious consequences, including civil monetary penalties, the repayment of significant government payments, costs associated with government investigations, and civil or administrative litigation. Farooq Mir is an associate at the law firm of Fenton Nelson LLP and advises healthcare providers in civil and administrative litigation matters, and has experience in representing clients in healthcare regulatory and transactional matters.Sources https://oig.hhs.gov/exclusions/effects_of_exclusion.asp; https://oig.hhs.gov/faqs/exclusions-faq.asp

Should You Hire an Excluded Individual or Entity in Your Practice?FArOOq mir, ASSOCiATE, FENTON NELSON, LLp

UndeR secTiOns 1128 and 1156 of the Social Security Act, the Office of Inspector General (OIG)

has the authority to exclude individuals from participation in federal healthcare programs, including

Medicare and Medicaid. The purpose of exclusion, according to the OIG, is to protect the integrity

of the healthcare system as well as protect the public from individuals and entities engaging in fraud

and abuse. Healthcare providers thinking of employing an individual excluded by the OIG should

think twice before doing so because of the potentially significant consequences.

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As a physician, you now face a dilemma. What is your responsibility for the information provided by a patient whom you have not seen? Whether or not you review this information, you face a risk if the pa-tient believes that a physician-patient relationship has been established. And if the patient has indicated a serious medical condition and you don’t take action consistent with the community standard of care, then you are potentially liable.

To avoid this risk, place a disclaimer on any data-collecting instrument. The following are recommen-dations for disclaimers for both electronic and paper forms:

ElEctronic Form DisclaimEr

Please be advised that by using this form to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our web-site, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours. This form of communication is not intended for acute, emergency, or life-threatening health conditions. If you believe you are having a health emergency, contact 911 or go to your nearest emergency department.

PaPEr Form DisclaimEr

Please be advised that completing preliminary health and insurance questionnaires does not estab-lish a physician-patient relationship with this practice. Dr. <X> will review your health history and conduct an initial evaluation to determine whether you are a suitable candidate and whether the practice will ac-cept you as a patient.

Protecting the confidentiality of all patients—whether they are established clients or no-shows—is important to minimize the risk of a malpractice suit. Another way to minimize your practice liability is to do a loss prevention checkup. The Doctors Company offers a “Patient Safety Interactive Guide for Office Practices,” which includes a checklist to ensure you and your office staff are protecting the confidentiality of all patients under the Health Insurance Portability and Accountability Act (HIPAA).

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

No-Show New Patients May Leave Physicians at Riskphysicians face ceRTain risks and responsibilities when collecting patient information prior to

the patient arriving for his or her appointment. A new patient may complete an online intake form

but not show up for the appointment. Or a new patient may complete a paper record with an intake

history but then leave before being seen. The data that is collected, either electronically or on paper,

is in the hands of your office practice.

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Risk Tip

Medline’s Generation Pink® latex-free exam gloves are made with an innovative

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Pink Glove Dance

Medline’s Generation Pink® latex-free exam gloves are made with an innovative

polymer formulation which provides outstanding sensitivity, softness and comfort.

Plus, for each case of Generation Pink gloves that you purchase, we will donate $1

to the National Breast Cancer Foundation to help fund free mammograms for those

who could not otherwise afford them.

Help increase breast cancer awareness in your office with pink gloves.Call Physician Office Customer Service at 1-855-294-9618 or visit medline.com today.

Great Gloves. Critical Cause.Helping You Improve the Health of Your Practice.™

© 2013 Medline Industries Inc. Medline and Generation Pink are registered trademarks of Medline Industries, Inc. Helping you improve the health of your practice is a trademark of Medline Industries, Inc.

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Pink Glove Dance

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

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Many other or-ganizations and individuals who would be affected by the dissolution of the Diversion Program joined, including specialty and county medical societies, liability carriers, well-being committee mem-

bers, and individual physician service providers. That effort led in 2009 to the creation of the new, inde-pendent 501(c)(3) organization, California Public Protection and Physician Health, Inc. (CPPPH), to ad-dress public protection and appropriate responses to physicians who experience medical, psychological, emotional, behavioral or substance use issues in the absence of a Medical Board-run program. Now in its fourth year, CPPPH is the only physician health orga-nization in California that coordinates the large net-work of individuals, groups and resources that serve and promote health and wellness among physicians throughout the state.

With funding from many of the founding organiza-tions and individuals, CPPPH has provided education and linkages to resources for the different physician well-being committees throughout the state while its parent organizations have pursued legislation to es-tablish and fund a state-sanctioned program. CPPPH seeks to respond to the American Medical Association (AMA) Resolution that all states should provide access to programs that address physician health so that col-leagues will know how to intervene appropriately.

cPPPH activitiEs incluDEGuidelines: At the request of CPPPH and with

CPPPH staff support, California Society of Addiction Medicine has established a Clinical Advisory Task Force to develop guidelines relevant to physician

health. CPPPH approved, published and distributes Guidelines for Selecting Physician Health Services, http://cppph.org/resources/#guidelines, and a guide-line on Evaluation of Health Care Professionals is in its final stages of review.

Publications: E-Newsletter – featuring informa-tion and resources on one or more of the following topic areas: aging, burnout/stress, caase finding and early identification, committee policies and proce-dures, disruptive behavior,family issues, guidelines, mental illness, physical illness, resources, specialty-specific issues, substance use/abuse, wellness. You can review current and archived issues at cppph.org

Regional Networks and Workshops: CPPPH of-fers free Saturday morning workshops for members of committees in hospital medical staffs and medical groups every four months in each of four areas of the state: San Francisco Bay Area, Sierra Sacramento Val-ley, Los Angeles, and San Diego. For dates and all specifics, see http://cppph.org/regional-networks/. Medical school committee members are also invited to twice-a year-workshops. The workshops cover one topic in depth with ample time for questions and dis-cussion. The workshops:

Deliver practical information, education and

training for committees and persons currently do-ing physician health work in California.

Provide the structure for ongoing communication and statewide information sharing .

Identify and share information about the resources that the committees currently use.

Identify needs that CPPPH will address as it de-velops plans for a statewide program and that will allow CPPPH to serve as the voice for physician health in California. For information about CPPPH and a wealth of oth-

er physician health information and resources, visit the CPPPH Website at www.CPPPH.org.

California Public Protection and Physician Health, Inc.By GAiL JArA, ExECUTivE dirECTOr Cppph

When The Medical Board of California voted to end the 27-year-old California Diversion Program

in June of 2007, California became one of the few states in the US without a statewide, state-sanc-

tioned physician health program. The California Medical Association quickly convened a coalition

of stakeholders, including California Society of Addiction Medicine (CSAM), California Psychiatric

Association (CPA), the Permanente Medical Group (TPMG), California Hospital Association (CHA),

and the California Society of Anesthesiologists (CSA) to assess the situation.

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A Service of the Physicians News Network andThe LOS ANGeLeS COuNTy MediCAL ASSOCiATiON

PNN | LOCAL • TIMELY • RELEVANT

REpORTINg ON ThE ECONOMICs Of hEALThCARE dELIVERY

REAd fuLL sTORIEs ANd subsCRIbE TO ThE pNN ENEws buLLETINs AT www.phYsICIANsNEwsNETwORk.COM

READ THE fULL SToRy on PAgE 23 trial attorneys want micra cap Lifted

NBC4 in Los Angeles recently aired a series of interviews addressing the subject of the MICRA cap, a subject that is of endur-ing interest to physicians.

La children hospitals initiate team approach to Family-centered careChildren’s Hospital Los Angeles and Mattel Children’s Hospital UCLA are among a new breed of children’s hospitals nationwide focusing on providing family-centered care via a team-based approach. This is part of a wider trend by hos-pitals to deliver high-quality care using teams of health providers to streamline processes and improve efficiency, in part to avoid penalties under health reform. The team-based approach at the two children’s hospitals includes physicians in many disciplines, nurses, pediatric psychologists and Child Life specialists.

survey: most La Doctors want to keep indepen-dent practices

Los Angeles County doctors who own medical practices prefer to stay in-dependent, according to

two local healthcare realty experts. However, with health reform changes, many are keeping their options open by no longer choosing long-term lease options, giving themselves the flexibility to join other medical groups, coming up with creative ways to stay afloat, or selling.

The experts’ view agrees with a new survey of 2,094 physicians nationwide who own medical practices that found that 58% are not looking to sell, with solo practitioners being the most com-mitted to staying independent.

The survey, conducted by health information technology firms CareCloud and QuantiaMD, found that of the surveyed doctors, only 11% plan to sell while 10% have already sold their practices.

La physician praises supreme court’s Decision on arbitrationThe Supreme Court recently upheld the right of physicians to arbitrate their claims against Oxford Health Plans on a class-wide basis. Dr. Jeffrey Nor-della, a family physician from Los Angeles, who earlier this year won a lawsuit against Blue Cross for unlawful network exclusion, said this can have a phenomenal impact but only if doctors make a decision to fight back against the insurance companies.

La health it expert Declares old model of health information exchange Dead

The failure of the health information ex-change (HIE) in the past and its evolution under the Affordable Care Act was the topic at the Idea

Exchange Digital Healthcare Forum at UC Irvine last week.

Director of eConsult Program for Los Angeles and founder of HITEC-LA, keynote speaker Sajid Ahmed argued that HIE evolved from a technolo-gy-oriented effort that barely survived to an essen-tial part of a new type of patient care.

According to Ahmed, HIE projects failed in the past because there was a lack of value proposition - no one was willing to pay for an infrastructure that was unusable, did not fit into the existing workflow and had no value to physicians at that time. When grant money would run out the projects would die.

La clinics, hospital Join efforts to improve coordinated care

July marked the launch of a pilot project to im-prove coordinated care between St. Francis Medi-cal Center and primary care physicians working at eight federally qualified Southside Coalition of Community Health Centers. The goal is to cut hos-pital readmissions, length of hospital stay and cre-ate overall better efficiency to reduce cost.

“This is the first time that a cohort of clinics will try to create in a meaningful way a relationship with one hospital,” said Nina Vaccaro, executive direc-

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tor of the Southside Coalition. The hope is that, if successful, the program will become a model for other hospitals working with community clinics in Los Angeles County.

cma, Lacma step Up effortsto Fight overturn of micra

Dr. Paul Phinney, president of the California Medical Association, told PNN that CMA is talk-ing to everyone—from the governor’s office to health providers and their patients—about the im-portance of preserving the Medical Injury Com-pensation Reform Act (MICRA), as trial lawyers are stepping up their efforts to overturn the law.

LACMA and other local physician groups, along with CMA, have been fighting for years on behalf of physicians to ensure that MICRA caps do not get lifted.

“We are very concerned at CMA, and as a pe-diatrician I’m also speaking for all doctors across California, that the trial lawyer-sponsored chang-es would increase the number of meritless law-suits, increase healthcare costs and would hurt access to care for the most vulnerable patients,” Dr. Phinney said.

Unitedhealth announces outcomes Based payment plan for physicians

UnitedHealth Group Inc. recently announced it will increase its payments from $20 billion to $50 billion in the next five years to doctors tied to quality and cost efficiency.

The announcement on July 10 reflects the transformation of the U.S. medical system from a traditional fee-for-service payment model to pay-ment based on patient outcomes and efficient teamwork to keep patients healthy.

UcLa health system among magazine’s ‘most wired’ hospitals

Hospitals and Health Networks magazine re-cently named UCLA Health System and its hos-pitals among this year’s “most wired” hospitals, based on an annual survey measuring the use and implementation of information technology in healthcare delivery systems nationwide.

More hospitals nationwide are integrating technologies that doctors will use to enter pa-tient data, such as electronic medication orders, and administrators will use to identify and man-age gaps in care and analyze large amounts of data.

Hospitals and doctors in Los Angeles Coun-ty are becoming a part of this growing trend, prompted by the need, under health reform, to increase efficiencies and improve quality of care while keeping costs down.

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disruptions: Medicine That Monitors you

They look like normal pills, oblong and a little smaller than a daily vitamin. But if your doctor writes a prescription for these pills in the not-too-distant future, you might hear a new twist on an old cliché: “Take two

of these ingestible computers, and they will e-mail me in the morning.” Although these tiny devices are not yet mainstream, some people on the cutting edge are already swallowing them to monitor a range of health data and wirelessly share this information with a doctor.

hospitals Prescribe Big data to Track doctors at Work

Health systems across the U.S. increasingly are leveraging “big data” to better understand physician practicing patterns and drive performance improve-ment. Physicians are split on the big data effort. At MemorialCare Health System in California, executives have begun tracking how doctors employed at the hos-pital or affiliated medical groups perform on a series of measures, including immunizations, mammograms and blood glucose control in diabetic patients.

Medical Training Goes holographic

Advances in technology mean you can now turn to the virtual human and pull the heart out in a 3-D, holo-graphic environment.

A system called zSpace uses a large screen, glasses and pointer — like a ball-

point pen — to interact with and manipulate 3-D im-ages. The technology allows users to look completely around the object, examine it from all angles, and zoom in and out. It’s also finding its way into uni-versities and will be used to train med students and future surgeons. One day, the doctor operating on a wounded soldier or diagnosing a veteran may have had his humble beginnings exploring a virtual body.

read Full stories and subscribe to the Pnn enews Bulletins at www.Physiciansnewsnetwork.com/iPnn

REpORTINg ON ThE TEChNOLOgY Of hEALThCARE dELIVERY


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Payment RefoRmChanges are needed in the way healthcare providers are paid if we are going to control the rapid growth in

healthcare costs and improve quality of care, but progress has been slow because there are many barriers to changing payment systems that have been in place for so long. According to a report by Accenture, only 36% of physicians in the United States will practice independently in 2013. Traditional fee-for-service still dominates the reimbursement structure in most practices, regardless of size. According to the Physicians Practice 2013 Staff Salary Survey, 87% of solo practices and 84% of two-to-five physician practices are still using the fee-for-service model. Of the remaining minority, 1 in 3 is expected to resort to subscription-based models, such as direct pay, concierge medicine or online consultations, to sustain profits, health experts predict. But trends are emerging and the potential to impact on your practice is certain.

Emerging Models As the sweeping transformation in healthcare takes hold, several models will be taking shape. Each has

its strengths and weaknesses, but also represent opportunities and risk. Here is a closer look at four models experts believe will be most relevant:

BUNDLED PAYMENT MoDELS - A middle ground between fee-for-service reimbursement and capitation, bundled payments can offer several benefits: Providers can benefit from cost savings from payers included in the program, derive enhanced volumes from private insurers and cash patients who are drawn by cost clarity and discounts and benefit from Medicare volume enhancement, as well as build stronger ties with hospitals through collaborations. To make this model work takes thorough bundle definition, accurate cost analysis, will-ing and committed partners and the infrastructure to manage the process.

ACCOUNTABLE CARE ORGANIzATIONS - While hardly proven, ACOs are a rising trend as a way to cut costs and provide better overall health. According to the Physicians Practice Staff Salary Survey of 1,200 respon-dents, only 12% of solo practitioners are members of ACOs. However, that number jumps to 41% with 20-plus physician groups. Benefits of doctors joining ACos include the opportunity to reap financial benefits and greater efficiency driven by quality and better management of risks through collaborations. Hospitals will try to forge enhanced relationships with doctors owning outpatient ancillary services, be more open to create joint ventures with physicians and foster more than a low-level interest in primary care, according to health experts.

CAPITATION - Capitation allows provider groups several benefits. Control over their own destiny and en-hanced business possibilities and centers around long-term health management rank among them. To make this model work requires a provider network with adequate breadth and depth, proper funding, a large mem-bership, sophisticated care coordination systems and providers that are vested in the success of the model, not unlike the ACO model.

CoNCIErgE MEDICINE - About 5,000 physicians nationwide practice concierge medicine, which offers pa-tients more personalized attention, such as next-day appointments, text messages and responses, and com-prehensive checkups. According to the 2013 survey, 2% of solo practitioners and two-to-five physician prac-tices are in concierge medicine; the majority of concierge doctors—5%—work in six-to-10 physician practices. Doctors charge patients an annual fee for the personalized attention and bill patients’ health insurance sepa-rately for providing medical services. The American Academy of Private Physicians (AAPP), which represents concierge doctors, offers detailed information.

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ONLINE VISITS - More doctors are also practicing online, providing consultations and education. There is an array of companies offering company-approved doctors concierge virtual visits with their patients and subscription-based edu-cation for consumers from doctors on such topics as heart health, diabetes, osteoporosis, dentistry and weight man-agement.

Whether these models represent your future or your competition, experts recommend keeping a close eye on such businesses to emulate their strengths and learn from their mistakes.

Physician ContractsWith more physicians moving away from independent

practice and gravitating toward employment with hospitals or other large organizations, doctors need to understand their rights and responsibilities before agreeing to an employment contract.

To help physicians come to the negotiation table without surprises, experts recommend the following tips: In most jurisdictions, an offer letter is a contract.

Since leveraging and negotiating change to the standard form of contract is limited by what’s said in the offer letter, it’s a good idea to talk to a lawyer (if needed) as soon as the offer letter arrives.

Furthermore, the experts recommend doctors ask for clarification before signing if a contract contains provisions that aren’t entirely clear.

Conflict of InterestUnder the final regulations of the Physician Payment Sunshine Act, makers of drugs, medical devices

and supplies covered by Medicare, Medicaid and CHIP require that transfers of money exceeding $10 to physicians and teaching hospitals will be reported to the Centers for Medicare and Medicaid Services as of this August.

With physicians and doctors increasingly interacting online, health experts caution physicians to figure out best ways to disclose potential conflicts of interest when using social media, which can be tricky.

Practice Efficiencyoptimizing patient flow is an on-going challenge for medical practices, but achieving cost-savings while

providing high-quality care can only be done when efficiencies are high.Health experts say one way to create higher efficiency is to create a document known as a value-stream

map to illustrate where your personnel is wasting time and energy. To make everyone’s day better and more productive, many medical groups organize “team huddles” to

give each member the opportunity to address issues and give thanks for a job well done.

Patients’ Financial Responsibility With 30% of practices’ revenue stream coming from patient responsibility—including copays, deduct-

ibles, co-insurance and self-pay for services, practices have a responsibility to their patients to collect all the revenue to which they are entitled.

By creating a culture in which balances are collected consistently, the practice has revenue to hire the best doctors, buy better equipment and deliver the best care.

ConsumeR engagementWith consumers becoming more vocal in how they want to spend their healthcare dollars and increas-

ingly turning online to do “comparison-shopping” for pricing of medical care, physicians who take the initia-tive in getting patients involved in their own health and well-being will have a competitive edge, experts say.

Here are six tips for getting your existing and future patients involved.

Team-based ApproachAlready a trend at hospitals nationwide, including Children’s Hospital and Mattel Children’s Hospital

UCLA, doctors that provide family-centered care via a team-based approach can deliver high-quality care while improving efficiencies.

Under this model, doctors of all disciplines involve families early on to help them and their patients with the difficult experience.

The same approach can be used in medical practices by involving the back office and front office in working more efficiently together to address patient inquiries from booking appointments and pricing of medical procedures to payment options.

Consumer Ratings Could Hit Your PocketbookWith more consumers turning to the Internet to find the doctor of their choice, reputation management

will become increasingly important for doctors.Just like searching for restaurant and movie reviews, consumers are expected to pick doctors based on

reviews while offering their own post-visit reviews.According to health experts, consumer reviews will generate penalties and bonuses based on outcomes.

Pay-for-performance measures could mean more than $3 billion in bonuses for insurers and penalties of $850 million for providers, according to PwC’s Health Research Institute (HRI).

Already, there are various health consulting and IT companies specializing in helping doctors improve and manage their online presence to retain existing patients and draw new ones as competition rises.

To help doctors increase and protect reviews posted online at places like Vitals and Yelp, LACMA is cur-rently looking for the best partner to bring these vital services to its members.

“As part of LACMA’s online marketplace, which offers LACMA doctors a listing of preferred vendors and programs at discounted rates, we are currently looking to identify the best partner to provide these reputation ser-vices, and more, at a discounted rate,” said Rosario Ortega, LACMA’s membership outreach representative.

Arm Consumers with Price ListsWith economists proposing that doctors, hospitals and

healthcare providers arm consumers with detailed price lists and quality reports to help them make informed decisions about their care, it is expected that doctors would then need to respond by offering cheaper, more competitive services.

To do that, providers would have to become more effi-cient at delivering care without jeopardizing quality.

Although no other state has required the healthcare in-dustry to publish its prices, 11 states have taken preliminary steps to shed light on the real costs of medical care. Colo-rado, Kansas, Maine, Maryland, Minnesota, New Hampshire, Oregon, Tennessee, Utah, Virginia and Vermont are in various

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stages of developing so-called “all payer claims databases” that collect and analyze the widely varying prices healthcare providers charge private insurers, Medicare, Medicaid, uninsured individuals and other payers.

In other states, these transactions are considered confidential business information and kept under wraps. However, increasingly, private companies that encourage people to become smarter consumers are publishing

pricing and price comparisons for medical procedures in different cities. New data from New Choice Health recently suggested that on average consumers pay less for medical

procedures in Los Angeles County than in Orange County.

Integrate Patient Portal Under meaningful use requirements, physicians must implement a patient portal where patients can access

their records and send secure messages to doctors. Most likely each patient will be hosted on the practice’s website, which lends itself to doctors implementing

mechanisms that allow patients to schedule appointments and get prescription refills. A survey of 2,311 Americans conducted in July 2012 by Harris Interactive found that online scheduling was

important or very important to 41% of patients, but only 11% had access to the service.

Social Media The experts advise doctors to write blogs to provide critical education to patients. The most effective blog

posts are written in layman’s terms, easy to digest and conversational in style. Doctors who use social media to draw new patients and serve existing patients will have a competitive edge.

Using Apps as PrescriptionWhile the idea of medically prescribed apps is still relatively new, some people believe that they may pro-

vide an answer to tracking chronically ill patients. This could help reduce doctor office visits while improving patient outcomes with doctors tracking patients without actually seeing them.

one of the pioneers in the prescription-app field is a company called WellDoc.Its DiabetesManager system, which patients use through a smartphone app, cell phone or desktop com-

puter, collects information about a patient’s diet, blood sugar levels and medication regimen. Patients can enter the data manually or link their devices wirelessly with glucose monitors and then also get

advice on best foods after recording glucose levels. The Food and Drug Administration cleared the device, and two insurance companies agreed to pay the bill

for patients whose doctors ask them to use the device, according to published reports.Issues regarding safety and privacy of use remain, but the proliferation of gadgets, apps and Web-based in-

formation has given clinicians—especially young ones—new ways to diagnose and treat disease and will change the doctor-patient relationship with patients becoming more involved in their own health in an effort to control healthcare costs.

advoCaCyFor years, doctors didn’t need to pay much attention to politics, but physicians are finding that as gov-

ernment becomes more involved in the process, they can either participate in the political process to affect medicine’s political environment or abstain and take the consequences. More and more the mind-set is that physician advocacy is now a core component of medical professionalism.

“We don’t go to medical school to learn how to advocate in the legislature,” said Dr. Andy Harris, a Maryland

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congressman who is also a practicing anesthesiologist. “But the leg-islature has gotten so involved, part of taking care of patients now is making our views heard in the legislature.”

This is an important trend, and if you are not one to sit idly by, here are some opportunities for you to participate in the political process and learn how you can get involved and why all doctors in Los Angeles County should stand united with LACMA.

Public Trusts Doctors to Do the Right Thing“Physicians today garner both respect and suspicion when in-

volved in political affairs,” said Dr. Kristina Maletz in a commentary in the Virtual Mentor.

A Gallop poll, during the height of the healthcare reform de-bate, however, showed that almost three-quarters of Americans expressed confidence in physicians in changing the healthcare delivery system; only half of them felt that way about congressional leaders, Dr. Maletz wrote.

As the CMA states, “Critical issues are being decided in the legislative arena at a fast and furious pace. Healthcare reform, medical liability and insurance regulations are just a few of the vital issues being debated and voted on by decision-makers in Sacramento. Hearing from a physician with experience from the frontlines of medicine can make all the difference for a legislator facing a complicated healthcare issue.” CMA offers many advocacy opportunities, including CMA’s Grassroots Action Center (http://www.cmanet.org/grassroots/).

Advocacy in Medical SchoolsLACMA has long recognized the importance of reaching out to medical students and residents and

welcomes their commitment and involvement. Physicians in training are beginning to have the opportunity to learn about advocacy from the very beginning of their career, with many medical schools now offering courses and certificates on advocacy.

LACMA and the Political Action CommitteeDr. Harris stressed in news reports the extreme importance of all doctors getting involved in politics by

joining specialty societies, finding opportunties and taking the time off to make their views known to the people whose policies have an effect on their practice.

rocky Delgadillo, LACMA’s CEo, finds that doctors spend a good part of their day talking to patients, which is a good place to start with advocacy.

“We think being a member of LACMA and the California Medical Association is a powerful way to reach the decision makers that will impact the doctor-patient relationship,” Delgadillo said. “The more doctors join, the more power LACMA has to achieve results on behalf of physicians.”

To support issues,doctors should elect candidates at the state and local level to improve access to care and treatment, support medical students, and join LACMA’s Political Action Committee (PAC).

The PACs are critical avenues for advocacy since about one-third of the California Legislature resides in Los Angeles County and Los Angeles County has one of the largest healthcare budgets in the nation.

The healthcare environment is clearly changing and though many questions remain, providers can take some proactive steps—from deciding which model makes sense for them, to getting consumers involved and being advocates for their profession—to stay ahead of the healthcare curve.


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NumbEr of uNIN-SURED - There are dif-ferent estimates of California’s uninsured, the Associated Press re-ported.

The California HealthCare Foundation estimated the state has about 7.1 million people without health insurance, or about one in five non-elderly Californians.

The foundation also reportedly projects that ratio to fall to 1 in 10 by 2016 because of the ACA.

The California Health Benefit Exchange, which goes by Covered California, estimates there are roughly 5.6 million people without health insurance, or 16% of the population under age 65. Of that popu-lation, 4.6 million people are eligible for coverage under the ACA and 1 million are not because of their immigration status.

Peter Lee, the exchange’s executive director, said a more realistic figure by 2017 is closer to 2.3 mil-lion people.

mEdICaId - An estimated 8 million Californians are served by Medicaid, or Medi-Cal, the AP reported.

Of those, about 1.4 million more Californians are expected to be covered under expanded Medicaid provisions, according to a joint report released in January by the University of California, Berkley Cen-ter for Labor Research and Education and the UCLA Center for Health Policy Research.

The Los Angeles Times reported that in Califor-nia, individuals earning less than about $16,000 will qualify for the Medi-Cal expansion. Above that threshold, individuals making less than $46,000 and families earning below $94,000 annually will qualify for federal subsidies.

The report also estimated that as many as 510,000

who are already eligible for Medicaid but not yet en-rolled are expected to join, because of federal law’s in-dividual mandate and a simplified enrollment process.

However, several entities, including the Los Ange-les County Department of Health Services, and doc-tors are concerned about the planned Medi-Cal ex-pansion, saying the realignment of funding from the state threatens the local health safety net.

Some doctors, including Dr. Lemmon McMillan, a trained obstetrician/gynecologist who runs man-aged care practices in Inglewood and Hawthorne, are concerned that traditional doctors won’t have a voice when their patients are being moved to Medi-Cal un-der health reform.

“All the resources are going toward federally qual-ified health centers, and not the traditional doctors,” said Dr. McMillan. He said that doctors like himself have been practicing in their communities for de-cades and know their patients well.

“My concern is that these patients won’t get the care they need and are being lost in the system,” Dr. McMillan noted. “The FQHC close at 5 p.m. whereas physician providers will be there until the last patient is seen, and the clinics have long waiting times and don’t know the patients like we do.”

Under Gov. Jerry Brown’s budget proposal, an es-timated 1.2 million people—30% of them in Los An-geles County—would qualify for the Medi-Cal expan-sion under the federal health law. The budget lays out two options—expanding coverage through the state or through the counties.

Dr. Mitch Katz, who heads the Los Angeles County Department of Health Services, said in news reports earlier this year that he expects millions of low-in-come people won’t qualify for Medi-Cal, even under the expansion.

The burden of their care traditionally has fallen on public hospitals, county health centers and com-munity clinics. If the state is taking back funding that counties have depended on to care for the uninsured, these institutions will be in financial jeopardy, the of-ficial said in news reports.

Small buSINESSES - Covered California estimated

Understanding the ExchangeBy mAriON WEBB

While TheRe aRe a lot of uncertainties remaining regarding the actual implementation of the

California Health Care Exchange and its impact on doctors’ practices, this article offers doctors an

overview of the exchange and some of the critical issues remaining. In 2010, Congress passed his-

toric sweeping healthcare legislation, the Patient Protection and Affordable Care Act (ACA), which

reformed the individual and small group health insurance markets, and starting in 2014, will cover the

nation’s uninsured.

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that 375,000 small businesses with 25 or fewer full-time employees with an in-come of less than $50,000 a year will be eligible to receive a 50% federal tax cred-it through the new program dubbed the Small Business Health Options Program.

The program aims to help small employers provide the type of health plans that have only been available to large employers, the AP reported.

ExCHAngE SET-UP - Covered California is an independent public entity within state government with a five-member board that is charged to create the insur-ance marketplace in which individuals and small businesses will be able to com-pare and enroll in health plans. CMA estimated that under the ACA, two-thirds of California’s uninsured may be covered by private insurance through the health exchange purchase pool. Two of the Covered California board members are ap-pointed by the governor, one by the Senate, and another one by the Assembly. The Secretary of the Health and Human Services Agency serves as an ex-officio voting member of the board. The members serve four-year terms. California was the first state to authorize a state-run health insurance exchange after passage of the ACA.

CalIforNIa’S ChoSEN ComPaNIES - The 13 chosen companies that will par-ticipate in the health insurance exchange for individual plans include a mix of large and small companies:

• Alameda Alliance for Health • Anthem Blue Cross of California• Blue Shield of California • Chinese Community Health Plan• Contra Costa Health Plan • Health Net• Kaiser Permanente • L.A. Care Health Plan• Molina Healthcare • Sharp Health Plan• Valley Health Plan • Ventura County Health Care Plan• Western Health Advantage

Most companies will offer four “metal” levels of plans: bronze, silver, gold and platinum. The platinum plans cover the largest share of expected medical costs, and they also cost the most, according to Covered California news reports.

Platinum plans are expected to cover about 90% of costs with the consumer’s share being 10%; the gold plan ratio is 80% to 20%; silver is 70% to 30%; and bronze is 60% to 40%.

gRAnTS To SET UP ExCHAngE - Since September 2010, Covered California has been allocated $910.5 million in federal planning grants from the U.S. Department of Health and Human Services for implementation of the ACA, the AP reported.

• A $1 million grant to establish the exchange board and recruit staff, analyze insurance markets, gather input and develop plans.

• A $39 million Level 1 Establishment grant supporting strategic, business and operational planning, such as information technology analysis and system design.

• A $196.5 million Level 1.2 Establishment grant to support a wide vari-ety of research, marketing, consultation, technology and management, and a customer service center.

In November 2012, Covered California reportedly submitted a Level 2 funding request to the federal government for $706 million to provide funding for 2013 and 2014. The government reportedly awarded $674 million of that request in January.

After 2014, the exchange must be self-supporting from fees paid by health plans and insurers participating in it.

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Early boarding will allow providers to connect to Noridian’s EDI Support Services gateway prior to the transition. Noridian will act as a clearinghouse, col-lecting claims, performing basic front-end editing and then sending the claims to Palmetto GBA for process-ing and payment.

Providers that use a vendor to submit claims do not need to take any action. Your vendor will be working with Noridian directly to connect. However, providers should check with vendors to ensure this is occurring and encourage them to make contact with Noridian if it is not.

If you bill directly, you can take the necessary steps to board early by reading an article published online by Noridian titled: Noridian Jurisdiction E (JE) Early Boarding Has Begun.

The Centers for Medicare and Medicaid Services also asks that physicians check to make sure that their

National Provider Identification (NPI) numbers are updated in the National Plan and Provider Enumera-tion System (NPPES) and are up to date and consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). According to No-ridian, the number one reason for problems during similar transitions is inaccurate NPI data in the NPPES system. Updates can be made on the NPPES website.

Noridian has also set up “Meet and Greet” work-shops throughout the state. The California Medical Association (CMA) encourages practices to take ad-vantage of this opportunity to meet Noridian staff and learn about the transition, including what will and will not change with the transition from Palmetto to Noridian.

To stay up to date on the latest news related to the Noridian transition, see CMA’s Medicare Transition webpage at www.cmanet.org/medicare-transition.

Prepare Your Practice For THE MEDICArE CLAIMS ADMINISTrATor TrANSITIoNCmA STAFF

The TRansiTiOn fROM Medicare claims contractor Palmetto GBA to Noridian takes place on

September 16, 2013 (Part B). During the transition, Noridian is encouraging providers that submit

electronic claims to take advantage of an “early boarding” opportunity.

UpdaTe yOUR npi infORMaTiOn - Ac-cording to a new report, 58% of the databas-es used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS).

The national revalidation effort by the Cen-ters for Medicare & Medicaid Services (CMS) is a big step in improving the accuracy of Medicare provider enrollment data. This effort has helped bring awareness to physicians of the impor-tance of updating their records in a timely man-ner when addresses, organizational structure, key contacts, phone numbers, etc., change. However, few physicians think to update their

NPI record to ensure it stays as current as their enrollment. Accurate data in NPPES could help expedite the revalidation process.

Accurate information in NPPES is also important for proper claims administration. When CMS implements edits for ordering/re-ferring physician information, the NPPES data-base maintains the search tool that rendering providers will use to find the NPI necessary for claim payment in the event they cannot reach the ordering physician. A key to finding the correct physician is accurate information in that database.

Protect yourself from the possibility of delays, or potential occurrences of fraud, by ensuring your information is current. Add the updating of NPPES to your list of items to check each time you make a change, or at least annually.

Protect yourself from the possi-bility of delays,

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In addition, MICRA includes a sliding pay scale, which ensures that more money goes to patients, not lawyers.

According to CMA, “the trial lawyers and their front group, Consumer Watchdog, are taking the MICRA battle up another notch.”

Los Angeles County Medical Association (LACMA) and other local physician groups, along with the California Medical Association (CMA), have been fighting for years on behalf of physicians to ensure that MI-CRA caps do not get lifted.

Brian Kabateck, president of the Con-sumer Attorneys of California, said in an in-terview with NBC, it is time to lift the cap on how much money can be collected for pain and suffering in order to protect the public against callous physicians. According to Ka-bateck, doctors are getting away with cases of malpractice because at a $250,000 cap no attorney would take on a case.

Kabateck also said that “there is about 12-15% of the doctors, just like in a regular society, who abuse alcohol and drugs, but we have also seen studies where about 60% of medical negligence may have a connec-tion to either abusing drugs or abusing alcohol.” He said the Medical Board is not doing enough to prevent it. According to him, a threat of a lawsuit would be a bet-ter deterrent and would help protect the public more effectively. He advocates for mandatory random drug testing for doc-tors who have hospital privileges.

According to CMA, MICRA is an ef-fective way of limiting meritless lawsuits and keeping healthcare costs lower, but it

has been targeted by the trial lawyers because it restricts the amount of money they can collect in damage awards.

Increasing MICRA’s cap on speculative non-economic damages, according to CMA, will have a dramatic, costly and negative impact on the cost of healthcare in California, including medical li-ability rates.

Trial Attorneys Want the $250,000 MICRA Cap Lifted

PHYSICIANSNEWSNETWORK.COM EXPANDED COVERAGE

a RecenT nBc4 , Los Angeles series of interviews addressed the subject of the MICRA cap, a sub-

ject that is of enduring interest to physicians. MICRA, enacted in 1975, put in place the $250,000

cap on non-economic damages in cases brought against the physicians. MICRA has no limits on

the economic damages that can be recovered by injured patients (medical costs and lost wages).

Injured patients also can sue for unlimited punitive damages.

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LACMA NOW GUARANTEES SAVINGS Preferred Partner Program

The Preferred Partner program marks LACMA’s first-ever initiative designed to provide exclusive discounts on products and services that physicians in private practice rely on to run a successful and

sustainable business.

Insurance Services As the world leader in delivering risk and insurance services and solutions to its clients, Marsh designs, develops, and implements insurance plans available only to members – with discounted pricing, enhanced coverage or both. Marsh assists members and their office managers by providing information, programs, and guidance to assist with insurance buying decisions.

Secure Texting for Healthcare TigerText is the leader in secure real-time messaging for healthcare. TigerText allows healthcare providers to create a private and secure mobile messaging network with their own smartphone. This controlled platform is HIPAA compliant and replaces the unsecured SMS text message that leaves protected health information and other confidential data at risk.

Members receive a free subscription to the TigerText application on their mobile device.

Clinic Supply Program Medline manufactures and distributes more than 350,000 medical and surgical products to health care institutions and retail markets. Medline’s market advantage ranks #1 across healthcare categories, including exam gloves, OR kits, and textiles.

Members are guaranteed a minimum savings of 10%, and up to 47% on clinical supplies.

Shipping UPS is the world's largest package delivery company and a leading global provider of specialized transportation and logistics services.

Members can save up to 37% on shipping through UPS.

Prescription Savings For Patients GoodRx works to save your patients up to 80% on their prescriptions. Every time your patient uses GoodRx, they donate a portion of the revenue to LACMA’s Medical School scholarships & loan debt relief program to increase the number of physicians serving patients in Los Angeles.

The Preferred Partner Program consists of carefully vetted, industry leading vendors who share LACMA’s goal to advocate quality health care for all patients and serve the professional needs of its members.

TO ACCESS THESE SERVICES, PLEASE VISIT WWW.LACMANET.ORG


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Loans for:

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aTTENTIoN laCma mEmbErSExErCISE THE PoWEr oF YoUr VoICE

Get involved: Submit a resolution to the 2013 house of delegatesIf you have concerns or issues about the future of healthcare, now is the time to exercise your membership

privileges and translate your opinions into organized medicine policy. The most direct way for members to get involved in current healthcare related issues is to submit resolutions to the House of Delegates (HoD).

As the California Medical Association’s legislative body, the HoD meets once a year to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health. With 450 delegates representing 11

geographic districts, 30 medical specialties, and all modes of practice, the delegates embody the diversity of California’s physicians.

Any LACMA member may author a resolution. All issues and resolutions will be presented toLACMA’s Delegation for review and submission to the California Medical Association.

This year, the House of Delegates will meet in october to formulate California Medical Association policy on healthcare. if you have something to say, now more than ever is the time to be heard!

Your opinion is valued and it is important to your peers in the medical community.

WE WANT To HEAr FroM YoU! Resolutions can be submitted directly to CMA no later than August 12.

for additional information and to submit your resolution, please contact lisa le at [email protected] or 213-226-0304.


ceo’s letter

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iT’s sUMMeRTiMe. Temperatures are rising around Los Angeles County, and many hot botton issues remain.

With the heightened efforts by the Consumer Attorneys of California group to overturn MI-CRA, LACMA and the California Medical Association are encouraging all physicians to rally behind our organizations.

Your help is critical to our success.California’s Medical Injury Compensation Reform Act (MICRA) was enacted in 1975 in re-

sponse to skyrocketing judgments, dramatic increases in malpractice insurance premiums, and diminishing access to healthcare.

At the time MICRA was enacted, California’s malpractice insurance rates were among the highest in the nation; today, California rates are among the lowest.

But trial attorneys have recently stepped up their efforts to overturn MICRA, and at a time when are we all thinking about ways to cut healthcare costs.

Increasing MICRA’s cap on speculative non-economic damages will have a dra-matic and costly impact on the cost of healthcare in California, including medical liability rates.

We need to protect the $250,000 cap on all damages in malpractice cases, which trial lawyers are hoping to raise, and stop their campaign to put this initiative on the November 2014 ballot.

Together we can win this fight. I’m pleased to announce that LACMA is making tremendous progress on other

battles as well. Together, LACMA and the California Medical Association’s power in taking a

stand for what’s right for physicians and their patients turned victorious this May when the Department of Healthcare Services announced yet another delay of the dual-eligible demonstration project, or Cal MediConnect.

But the fight is far from over. We will raise our efforts to hold this program at bay and continue our dialogue

with the state to protect the most vulnerable population from the negative conse-quences of this program.

The implementation of Cal MediConnect as currently structured would put a tremendous burden on our safety net clinics and drive patients away from doctors and medical providers they know and trust.

Ensuring the safety of the Los Angeles County population is critical on other fronts as well. This month, LACMA’s newly elected president, Dr. Marshall Morgan, and other staff members

plan to meet with the Los Angeles County Health Department to discuss gun violence. Emergency doctors like Dr. Morgan see firsthand the aftermath of gun violence and hope to

work with local officials on solutions that can help save lives.Finally, we will keep a close eye on new developments regarding health reform and its impact

on our physicians. In this August issue of the magazine, you’ll read about critical trends regarding payment re-

form, consumer involvement and advocacy. This fall, we will continue our forward-looking trend, so stay tuned.

rocky Delgadillo

rocky DelgadilloChief Executive officer

The Los Angeles County Medical Association (LACMA) today issued a call for nominations for its annual Healthcare Awards, which honor leadership, innova-tion, education, community service and healthcare facilities in Los Angeles.

The awards will be announced at the 2nd Annual Healthcare Awards dinner to be held on October 17, 2013, at the California Club in Downtown Los Angeles. Proceeds will help support the Patient Care Foundation’s Medical Student Scholar-ship Program, which helps cultivate the next generation of physicians who will practice medicine in Los Angeles County.

The awards recognize individuals and institutions for their exemplary contribu-tions to improving access to quality healthcare in Los Angeles. Last year’s Health-care Champion of the Year, Los Angeles County Supervisor Mark Ridley-Thomas, and the other 2012 awardees will be inducted into the New Healthcare Hall of Fame.

“LACMA takes great pride in recognizing outstanding individuals and organi-zations who impact healthcare in our community, and particularly in improving care for the most underserved,” said Dr. Troy Elander, President of the Patient Care Foundation of Los Angeles County.

Award Categories include:• Healthcare Champion of the Year• Independent Physician Leadership Award• Hospital Physician Leadership Award• Innovation Award for Public Education• Innovation Award for Community Service• Innovation Award for Facilities• Innovation Award for Technology• Shine the Light Media Award

This year’s awards will feature a new category, the Shine the Light Media Award. The media award serves to recognize and honor branches of the media for their outstanding representations of the physician and healthcare provider com-munity. In addition to film and television, the award also considers achievements and other branches of the media and arts including theater, music, books, print media, Digital media and advertising, as well as Spanish language media.

LACMA is a professional medical association representing over 6,000 dedi-cated physicians. For more than 100 years, LACMA has been at the forefront of providing leadership and innovation in healthcare and fosters optimal collabora-tions among physicians, patients and the community through the Patient Care Foundation of Los Angeles County.

The Patient Care Foundation is a charitable organization that serves as a link between physicians and the community. Its mission is to impact the quality of life of all patients in Los Angeles County by expanding the pool of medical profession-als who practice medicine in underserved communities.

For additional event information, sponsorship opportunities and registration, visit www.lahealthcareawards.org.

LACMA ANNOUNCES

Call for Nominations for 2nd Annual Healthcare Awards

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Fun in the Sun!DISTrICT 5 HoLDS ITS ANNUAL BEACH PArTY

On Saturday, July 13, Los Angeles County Med-ical Association Bay District 5 hosted its fourth an-nual beach party at the Bel-Air Bay Club. About 130 member physicians and their families attend-ed the fun event. As usual, the gorgeous, sunny day was perfect for mingling with colleagues, spending time with the family and, of course, eat-ing barbecue fare under shady canopies.

The popular event was free for members and their families and included a full menu of ham-burgers, hot dogs and chicken, along with a va-riety of beverages including iced tea, sodas, mar-garitas, beer and wine. There’s sure to be a fifth annual beach party next summer!

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to pLace a cLassiFieD aD visit www.physiciansnewsnetwork.com OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

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CITY Of HOPE’S 6TH ANNUAL HOW THE ExPERTS TREAT HEMATOLOGIC MALIGNANCIES

September 18 to 20, 2013Casa Del Mar Hotel, Santa Monica, CA

JOIN US for this two-and-a-half-day conference for the opportunity to learn about the most recent advances in the treatment of multiple myeloma, lymphoma and leukemia. Updates on improved curative and palliative treatments, evolving molecular and immunologically-based systemic therapies and clinical trials, will be pro-filed and discussed.

To learn more and to register, visit www.cityofhope.org/hematologicconference2013

to pLace a cLassiFieD aD visit www.physiciansnewsnetwork.com OR CONTACT DARI PEBDANI AT [email protected] OR 858-231-1231.

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CITY Of HOPE’S 13TH ANNUAL WOMEN’S CANCER CONfERENCE: PROGRESS IN WOMEN’S CANCERS

fROM TREATMENT TO SURvIvORSHIPNovember 8 to 10, 2013

The Venetian/Palazzo Resort Hotel, Las Vegas, NVREGISTER NOW for this exciting conference featuring prominent oncology experts who will address clinical and translational research, prevention, practical issues, current standards of care, controversies and evolving new treatment recommendations for women’s cancers. Attendees will learn new tools to optimize decision mak-ing to help improve patient outcomes.

To learn more and to register, visitwww.cityofhope.org/womensconference2013

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PhysiciaNs News Network iNtroduces

REpORTIng On ThE TEChnOlOgY Of hEAlThCARE DElIvERY


12% of solo practitioners are members of acos. However, that number jumps to 41% with 20-plus physician groups

30%

30% of practices’ revenue stream come from patient responsibility—including copays, deductibles, co-insurance and self-pay for services.

online schedul-ing was impor-tant or very im-portant to 41% of patients

41%

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consumer reviews will generate penalties and bonuses based on outcomes. Pay-for-perfor-mance measures could mean more than $3 billion in bonuses for insurers and penalties of $850 million for providers.

benefits of doctors joining acos include the opportunity to reap financial benefits and greater efficiency driven by quality and better management of risks through collaborations.

PatientEngagement

Paymentreform

only 36% of physi-cians in the united states will practice independently in 2013.

36%as the sweeping transformation in healthcare takes hold, several models will be taking shape. Each has its strengths and weaknesses, but also represent op-portunities and risk.

By the numBeRs

What about your plan?

group healthpremiums

In 2013, California

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August 2013

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