June 2014
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“PHYSICIANS UNITED FOR A HEALTHY SAN DIEGO” OFFICIAL PUBLICATION OF SDCMS JUNE 2014 $12,500 / Year* Returned to Every Doctor’s Practice By the Member Physicians of SDCMS-CMA *ON AVERAGE
description
Our June 2014 issue of San Diego Physician focuses on federal (SGR, ICD-10, GPCI) and state (MICRA, CMA governance) — with a special, in-depth look at the GPCI win so important to San Diego's physicians.
Transcript of June 2014
“Physicians United for a healthy san diego”
official publication of SDcMS june 2014
$12,500 / Year*
Returned toEvery Doctor’s
Practice
By the Member Physicians
of SDCMS-CMA*on average
B SAN DIEGO PHYSICIAN.OrG OctOber 2011
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Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and informa-tion sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or ser-vices advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to [email protected]. All advertising inquiries can be sent to [email protected]. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [email protected]. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]
volUme 101, nUmber 6ContentsJUne
departments4 Briefly Noted: Calendar • All- Physician Social • Featured Members • And More … 8Rediscovering Our Wanting: Balancing Interests Inside and Outside of MedicineBY HeLAne FROneK, MD, FACP,
FACPH
10Planning a Vacation? Include Risk Management So You Can RelaxBY THe DOCTORS COMPAnY
26Physician Marketplace: Classifieds
28ColleaguesBY DAnIeL j. BReSSLeR, MD, FACP
MANAGING EDITOR: Kyle LewisEDITORIAL BOARD: Theodore M. Mazer, MD, James Santiago Grisolía, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Van C. Johnson, MD, Roderick C. Rapier, MDMARKETING & PRODUCTION MANAGER: Jennifer RohrSALES DIRECTOR: Dari PebdaniART DIRECTOR: Lisa WilliamsCOPY EDITOR: Adam Elder
SDCMS BOARD OF DIRECTORS
OFFICERSPRESIDENT: J. Steven Poceta, MDPRESIDENT-ELECT: William T-C Tseng, MD, MPH (CMA Trustee)TREASURER: Mihir Y. Parikh, MDSECRETARY: Mark W. Sornson, MDIMMEDIATE PAST PRESIDENT: Robert E. Peters, PhD, MD
GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORSEAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD, Alt: Susan Kaweski, MD (CALPAC Treasurer)HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD, Alt: Thomas J. Savides, MDKEARNY MESA: Sergio R. Flores, MD, John G. Lane, MD, Alt: Anthony E. Magit, MD, Alt: Eileen R. Quintela, MDLA JOLLA: Geva E. Mannor, MD, Marc M. Sedwitz, MD, Alt: Lawrence D. Goldberg, MDNORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Alt: Anthony H. Sacks, MDSOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD, Alt: Elizabeth Lozada-Pastorio, MD
AT-LARGE DIRECTORSLawrence S. Friedman, MD, Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD
AT-LARGE ALTERNATE DIRECTORSKarl E. Steinberg, MD, Jeffrey O. Leach, MD, Toluwalase A. Ajayi, MD, Phil Kumar, MD, Wayne C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella M. Wilson, MD
OTHER VOTING MEMBERSCOMMUNICATIONS CHAIR: Sherry L. Franklin, MD (CMA Trustee)YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MDRESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MDRETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MDMEDICAL STUDENT DIRECTOR: Spencer D. Fuller
OTHER NONVOTING MEMBERSYOUNG PHYSICIAN ALTERNATE DIRECTOR: Daniel D. Klaristenfeld, MDRESIDENT PHYSICIAN ALTERNATE DIRECTOR: Diana C. Gomez, MDRETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MDSDCMS FOUNDATION PRESIDENT: Albert Ray, MD (CMA Trustee, AMA Delegate)CMA SPEAKER: Theodore M. Mazer, MDCMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MDCMA TRUSTEES: Robert E. Wailes, MD, Erin L. Whitaker, MDCMA SSGPF DELEGATE: James W. Ochi, MDCMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Mehta, MDAMA ALTERNATE DELEGATE: Lisa S. Miller, MD
8
2 j u n e 2014
22
features12 $12,500 / Year Returned to Every Doctor’s Practice by the Member Physicians of SDCMS-CMABY THeODORe M. MAZeR, MD
14 Increased Costs. Losing Trusted Doctors. Threatened Privacy. That’s What Happens When Lawyers Play DoctorBY RICHARD THORP, MD
18 Federal Update: SGR • ICD-10 • GPCIBY eLIZABeTH MCneIL
22 Governance Reform: CMA Envisions a New Future for Organized Medicine BY STeVen e. LARSOn, MD, MPH
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4 j u n e 2014
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SDCMS Seminars & Webinars SDCMS.orgfor further information or to register for any of the follow-ing SDcMS seminars, webinars, workshops, and courses, email [email protected].
OSHA update (seminar/webinar)Jul 10: 11:30am–1:00pm
Consent and Abuse Reporting: Your Duties and Responsibilities (seminar/webinar)Jul 17: 11:30am–1:00pm
Advocacy Training (workshop)Jul 19: 8:00am–12:00pm
HIPAA update (seminar/webinar)auG 14: 11:30am–1:00pm
CMa WebinarsCMAnet.org/events
The Power of the Pen: The Physician’s Responsibility in Prescribing and Referring for Medi-Cal PatientsJun 18: 12:15pm–1:15pm
Recipe for Financial Success: Key Steps to Increasing Your net IncomeJul 16: 12:15pm–1:15pm
What to expect From a Medi-Cal AuditJul 30: 12:15pm–1:15pm
HIPAA Breach notification and California RequirementsJul 31: 12:15pm–1:15pm
Calendar
briefly noted
Workers’ Compensation Advanced Part 1: Tips and Tricks for Workers’ Compensation BillingauG 5: 12:15pm–12:45pm
Workers’ Compensation Advanced Part 2: Second Bill Review Plus Managing Third-party BillersauG 12: 12:15pm–12:45pm
Workers’ Compensation Advanced Part 3: Requests for Authorization, Dispensed Pharmaceutical and DMePOS Billing for Workers’ CompensationauG 19: 12:15pm–12:45pm
Community Healthcare Calendarto submit a community healthcare event for possible publication, email [email protected]. Events should be physician-focused and should take place in or near San Diego county.
San Diego Academy of Family Physicians Symposium, Family Medicine update: 2014Jun 27–29 (www.sandiegoafp.org)
RCMA’s 10th Annual “Cruisin’ Thru CMe”Jul 9–22 (www.rcmanet.org/portals/17/04Events/flyer/2014cruise.pdf)
Summer Medical AcademyJul 14–25 (facesforthefuture.org/san-diego/san-diego.html)
31st Annual Primary Care Summer ConferenceauG 1–3 (www.scripps.org/sparkle-assets/documents/primary_care_summer_2014.pdf)
“ ”a great secret of success is to go through life as a man who never gets used up.
— Albert Schweitzer, German/French Theologian, Organist, Philosopher, Physician, and Medical Missionary (1875–1965)
All San Diego County Physicians: Join SDcMS for a networking opportunity and mixer on thursday, July 10, from 5 to 8 p.m.! all physicians are welcome and encouraged to attend. come mingle, socialize, and network with your fellow San Diego county physicians! complimentary hors d’oeuvres and drinks will be served! our July 10 social will take place in East county near Grossmont Hospital. to RSVp, email your name and telephone number to Jen at [email protected]. Questions? call Jen at (858) 300-2781.
*JUly 10 PHySiCian SoCial
featUred MeMber
SDCMS-CMA member Arthur “Tony” A. Blain IV, MD, FAAFP, MBA, finished his first ultramarathon (100 miles) in May, running in the seventh annual KEYS100, a point-to-point event beginning in Key Largo and ending in Key West. Congratulations, Dr. Blain!
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////PUbliC HealtH CHaMPionS
tHe CoUnty of San diego held its 13th Annual Live Well San Diego! Public Health Champion Awards Ceremony on April 11, 2014, recognizing achievements in public health services that protect and promote the health of San Diego County residents.This year’s theme — “Public Health: Start Today! Today’s Public Health Professionals Are Helping Individuals and Com-munities Navigate the Changing World of Public Health” — celebrated the principles of Live Well San Diego!, the County’s 10-year vision to build healthy, safe, and thriving communities.
Both the San Diego County Medical Society (SDCMS) and the SDCMS Foundation were honored this year, the Foundation in particular for the work of its Project Access San Diego initiative, which has since 2008:
• improved the health of 2,400 patients• saved 20 lives• reduced emergency department visits by 80%• reduced workdays missed by 75%• performed 682 surgeries and GI procedures• facilitated 7,463 specialty healthcare appointments• and received $8 million in donated care by physicians, hospitals, surgery centers, and
ancillary healthcare providers.Thank you to Wilma J. Wooten, MD, MPH, SDCMS-CMA member since 2006, the County
of San Diego’s public health officer, and Nick Macchione, the director of the County of San Diego’s Health and Human Services Agency, for bestowing this honor on SDCMS and the SDCMS Foundation, and for their untiring efforts to protect and promote the health of San Diegans!
SDCMS and SDCMS Foundation Honored as 2014 Live Well, San Diego! 2014 Public Health Champions
SA n D I eGO P H YSI C I A n .O rG 5
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l–R: nick Macchione, San Diego county HHSa director, Dr. Steve poceta, SDcMS president for 2014–15, tom Gehring, SDcMS executive director, Dr. Wilma Wooten, San Diego county public health officer, Dr. al Ray, SDcMS foundation president, barbara Mandel, SDcMS foundation executive director, Dr. Rosemarie Johnson, SDcMS foundation medical community liaison, Dr. carol Young, SDcMS foundation board member, county Supervisor Dianne Jacob, and Dr. nick Yphantides, county of San Diego HHSa cMo.
featUred MeMber
President Obama announced the appointment of Dr. Horacio Rodiles, SDCMS-CMA member since 1973, to the United States Section of the United States-Mexico Border Health Commission, a binational presidential commission co-chaired by the secretaries of health of the United States and Mexico. Dr. Rodiles is joining a diverse group of public health leaders committed to enhancing the health and wellbeing of border residents. Dr. Horacio Rodiles, who is a physician at the Balboa Nephrology Medical Group, a position he has held since 2006, was sworn in by Peter C. Lewis, U.S.
Magistrate Judge, on May 6, 2014. Congratulations, Dr. Rodiles!
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6 j u n e 2014
SdCMS-CMa MeMberSHiP
Allan V. Hansen, MDEmergency Medicinela Jolla(760) 739-3000
Nasra S. Haroun, MDchild and adolescent psychiatrySan Diego(619) 421-6900
James M. Huot, MDfamily Medicineborrego Springs(760) 767-5051
Beth A. Judge, MDforensic psychiatrySan Diego(858) 694-3900
David I. Kaufer, MDinternal MedicineEl cajon(619) 401-0404
H. Susan Kower, MDpsychiatrySan Diego(760) 967-4475
Michael S. Krelstein, MDforensic psychiatrySan Diego(858) 694-3900
Karim I. Mohamed, MDpediatricsDesert Hot Springs(760) 676-5240
Kathleen S. Moser, MDpublic Health and General preventive MedicineSan Diego(858) 694-3900
David Naimark, MDforensic psychiatrySan Diego(619) 531-3047
Anthony T. Nasser, MDfamily MedicineSan Diego(858) 694-3900
Armando Olivera, MDfamily MedicineEl cajon(619) 401-0404
Welcome New and Rejoining SDCMS-CMa Members!
Nathan A. Perrizo, DOpain MedicineEncinitas(760) 941-7336
Ran Regev, MDEmergency Medicinechula Vista(619) 502-5800
John A. Siefert, MDEmergency Medicinecoronado(619) 532-7427
Soheyla Talebimarandi, MDpsychiatrySan Diego(858) 694-3900
Myres W. Tilghman, MDinfectious DiseaseSan Diego(619) 515-2300
Katherine Trintchouk, MDinternal MedicineSan Diego(858) 694-3900
Gary Tsai, MDpsychiatrySan Diego(858) 694-3900
Laura A. Vleugels, MDchild and adolescent psychiatrySan Diego(858) 694-3900
Blake A. Wylie, DOfamily MedicineJulian(760) 765-1223
RejOInIng MeMBeRS
Timothy D. Bilash, MDobstetrics and Gynecologyla Jolla(858) 997-0212
Melissa E. Heart Deer, MDpsychiatrySan Diego(619) 234-2158
Samuel O.T. Etchie, MDpsychiatryla Mesa(619) 303-8363
Rebecca L. Ferrini, MDGeneral preventive MedicineSantee(619) 596-6351
Frank B. Hamlett, MDDiagnostic RadiologySan Diego(619) 234-3918
Amanda J.L. Holden, MDEmergency MedicineValley center(760) 739-3000
Sepi Mahooti, MDanatomic pathologySan Diego(858) 552-8585
Violeta C. Martel, MDinternal MedicineSantee(619) 596-6351
neW MeMBeRS
Edward G. Arevalo, MDchild and adolescent psychiatrySan Diego(858) 694-3900
Scott P. Bunner, MDpsychiatrySan Diego(619) 692-8750
Yi-Ning Cheng, MDpediatricsSan Diego(619) 692-8600
Vijay K.N.C. Jayaprakash, MDpsychiatryEl cajon(858) 694-3900
Puja Chitkara, MDRheumatologySan Diego(619) 289-9145
Ernest V. De Guzman, MDpsychiatrySan Diego(858) 694-3900
Brenda L.F. Rodriguez, MDpediatricsEl cajon(619) 401-0404
Joan E. Friedson, MDpsychiatryla Jolla(858) 551-8171
Dauod M. Ghafari, MDfamily MedicineEl cajon(619) 401-0404
Bruce L. Gillingham, MD, FAAOSorthopedic Surgerycoronado(619) 532-6411
Bret E. Ginther, MDEmergency Medicinefallbrook(760) 739-3000
Thomas J. Murphy, MDobstetrics and Gynecologyla Mesa(619) 463-0600
Paul A. Pyka, DOobstetrics and Gynecologyla Mesa(619) 463-9195
Alfredo Ratniewski, MDinternal MedicineEscondido(760) 871-0606
Robert E. Scott, MDphysical Medicine and RehabilitationSan Diego(858) 277-7123
Dean E. Sidelinger, MDpediatricsSan Diego(619) 685-2539
Bernard Wosk, MDpediatricscarlsbad(619) 401-0404
Nicholas J. Yphantides, MDGeneral practiceSan Diego(760) 737-2000
SDCMS Member Question: We often have patients ask us to fill out forms on their behalf. these forms can be lengthy, and they can take up a lot of time. is there any way we can charge them for this?
Answer: So long as the activity is not prohibited by law or a physi-cian’s contract with a third-party payer, whether and how much a physician charges for filling out forms on behalf of a patient should be an individualized decision made by the physician. While many physicians charge their patients for this activity, some do not, and some charge only if they have to be completed prior to a visit. Some charge only for complex forms, whereas others charge for all forms regardless of complexity.
for more relevant facts to consider, please see cMa on-call document #7656, “charging for form completion.” SDcMS-cMa members can contact your SDcMS physician advocate, Marisol Gonzalez, at [email protected] to obtain this document.
aSk yoUr PHySiCian advoCate
SA n D I eGO P H YSI C I A n .O rG 7
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board of direCtorS
Congratulations to the Following Physicians for Being Elected to SDCMS’s Board of Directors!
President-elect: William t-c tseng, MD
Treasurer: Mihir Y. parikh, MD
Secretary: Mark W. Sornson, MD
At-large Director #1: lawrence S. friedman, MD
At-large Director #5: Stephen R. Hayden, MD
At-large Director #6: peter o. Raudaskoski, MD
At-large Director #8: Holly b. Yang, MD
At-large Alternate Director #2: Jeffrey o. leach, MD
At-large Alternate Director #5: Wayne c. Sun, MD
At-large Alternate Director #7: carl a. powell, Do
At-large Alternate Director #8: Marcella M. Wilson, MD
Young Physician Director: Edwin chen, MD
Young Physician Alternate Director: Daniel Klaristenfeld, MD
Resident Physician Director: Jane bugea, MD
Resident Physician Alternate Director: Diana Gomez, MD
east County geographic Director #3: Jay p. Mongiardo, MD
Hillcrest geographic Alternate Director #1: thomas J. Savides, MD
Kearny Mesa geographic Director #1: Sergio R. flores, MD
Kearny Mesa geographic Director #2: John G. lane, MD
La jolla geographic Director #2: Marc M. Sedwitz, MD
La jolla geographic Alternate Director #1: lawrence E. Goldberg, MD
8 j u n e 2014
early in oUr training when we were trying to get to know each other, a medical school classmate asked, “What do you like to do?” My answer was telling: “I used to like to read, I used to like to play music, I used to like to run ….” In the medical profession, studying and working had to come before playing if we wanted to become the profes-sional we dreamed of becoming. For many years it didn’t matter what we wanted, and acknowledging what we desired was more painful and frus-trating than going along with what
we thought we had to do.When coaching clients who feel
stuck and confused, I’ll often ask, “What do you want?” Almost every time, they respond, “That’s a great question!” My reply is always the same: It’s THE question.
That part of us that knows what we want has been buried for so long that we can feel disconnected from knowing what would make us happy or fulfilled. In Fierce Conversations, Susan Scott warns that we may eventually realize “that you have no discernible identity. … It’s not that
rediscovering our Wantingbalancing interests inside and outside of Medicineby Helane Fronek, MD, FACP, FACPh
pERSonal & pRofESSional DEVElopMEnt
your credit card or Social Secu-rity number was stolen. It’s that an internal voice is whispering, ‘This isn’t you.’ Parts of you are failing to show up.” This makes it crucial for each of us to spend some time asking ourselves, “What do I really want?”
Journaling is one way of opening the conversation with ourselves. In The Artist’s Way, Julia Cameron suggests we write three pages each morning before our day begins. Dreams from the night before, thoughts filtered through our un-conscious during the night, leftover concerns and ideas from the days before have an opportunity to rise to the page and be acknowledged. As busy professionals, we may not have time for three pages, but perhaps we do have time for one. A regular prac-tice of writing can help us discover many of our wantings.
During a recent presentation on balancing your interests inside and outside of medicine, I asked the medical student attendees to imagine their perfect life. The room became quiet as they closed their eyes and visualized themselves 15 years in the future. There were many surprises as some students real-ized they valued a traditional, stable family life and others were excited by a career filled with cutting-edge research. What fills your own vision of your perfect life, in five, 10, or 15 years?
We work hard to improve our patients’ lives. Shouldn’t we also dedicate time to our own? To make sure we are living a life filled with activities we enjoy, relation-ships that nurture us, work that is meaningful and fulfilling? Each of us deserves to live the life we want, but creating it doesn’t happen without intention and action. As the wise Yogi Berra once said, “If you don’t know where you are going, you might wind up someplace else.” The first step is to ask one question: “What do I really want?” And then listen for the answer.
Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical pro-fessor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helane-fronekmd.wordpress.com.
What fills your own
vision of your
perfect life, in 5, 10, or 15 years?
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beCaUSe liability never takes a holiday, your vacation plans should include medical coverage arrangements for your practice, particularly when you use locum tenens. The following tips will help reduce risks in your practice and promote the safety of your patients as you plan your vacation:• Review managed care contracts for
relevant coverage requirements. Some managed care contracts contain very specific language on this topic and many contain indemnification clauses that could expose you to the liability of the covering physician (as well as breach of contract).
• Whenever possible, make second-ary coverage arrangements. Confirm coverage arrangements via email or fax
RiSK ManaGEMEnt
with the locum tenens who are covering your practice in order to avoid misun-derstandings, possible uncertainty of dates or timeframe, and exposure to abandonment.
• Ensure that the practice coverage arrangements include an understand-ing about patient billing practices in conjunction with any managed care contracts or plans.
• Choose covering physicians who share your medical specialty and have privi-leges at the same hospitals that you do.
• Determine if covering physicians carry professional liability coverage and the limits of such coverage. While asking these questions could be awkward, you may be required to ask under certain
Planning a vacation?include Risk Management So You can RelaxContributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
managed care plans, provider agree-ments, and hospital bylaws.
• Before leaving on vacation, prepare a list of patients who are hospitalized or are in the midst of diagnostic workup, or who have special medical problems or needs. Give this information to the covering physicians and document any specific advice you provide.
• Inform the attending physicians or hospitalists of any hospitalized patients you are following about your cover-age arrangements, and document the hospital chart to reflect these conversa-tions.
• Advise your patients of the coverage ar-rangements, and give them the covering physicians’ names.
• Make each hospital where you have on-call responsibilities aware of the dates of your unavailability and the identity and phone numbers of the covering physicians. Give similar notice to your answering service and office staff.
Upon returning from vacation, promptly confer with all covering physicians. Docu-ment what you were told by the covering physicians about any significant develop-ments in patients’ clinical course or treat-ment while you were away.
Consider implementing these funda-mental loss-prevention measures for even brief periods when you are unavailable, such as observance of religious holidays, attending medical conferences, personal illness, or a long weekend. Unfortunately, vulnerability to claims is not diminished on these occasions.
10 j u n e 2014
SA n D I eGO P H YSI C I A n .O rG 11
90%
90%
90%
90%
90%
12 j u n e 2014
$12,500 / Year* Returned to
Every Doctor’s Practice
by the Member physicians of SDcMS-cMa
BY THeODORe M. MAZeR, MD
GP
CI
* on average
areas resulted in some shifts in California, but by that time it was becoming apparent that the original payment locality group-ings, which were based on data that hadn’t been updated for several counties that had become urbanized since the original data sets were collected, was resulting in highly inaccurate payments in counties like San Diego, Santa Cruz, Monterey, and others — and the problem was repeating itself in other states.
By 2000, several doctors and staff members at CMA had identified the grow-ing problem, which was worsened by the gradual adoption of Medicare physician fee schedules by commercial payers, and even by IPAs and other medical groups. As Medicare payments grew more negatively out of line with increasing practice costs in the urban counties that had been placed in California payment locality 99, San Diego
An Inequity Is BornWhat began in 1992 with a new Medicare payment system based on the cost to render physician services, i.e., RBRVS, quickly became mired in formulas tied to government policies both to support rural access to care and to group like-cost areas into payment localities. In some cases, the formulas undervalued urban cost differ-ences in order to shift monies to support rural practices.
California was broken into multiple payment localities — using the initial formulas — to allow for accurate pay-ments to physicians that reflected their geographic cost differences, while paying at levels that would sustain access to care for Medicare beneficiaries, in accordance with statutes requiring payments to meet these conditions.
A 1997 readjustment of RBRVS payment
$12,500 / Year* Returned to
Every Doctor’s Practice
by the Member physicians of SDcMS-cMa
BY THeODORe M. MAZeR, MD
included, efforts began to have the Health Care Financing Administration (HCFA) — CMS’s precursor — correct the growing problem by removing the urbanized coun-ties from Area 99 and recalculating more accurate payments.
Unfortunately, in a tangle of Medicare rules and in a zero-sum game, any move to increase payments to these now under-paid counties would need to shift monies from other counties that would remain in Area 99. Thus began a protracted battle between CMA, Medicare, and the Depart-ment of Health and Human Services, and, eventually, Congress, and later lawyers in a class-action lawsuit.
The Long Battle BeginsI became involved in the battle sometime in 2000, as chairman of CMA’s Com-mittee on Medical Services, while at the same time a couple of doctors in Northern California — Drs. Ned Bentley and Larry DeGhetaldi — began working with their local legislators and CMA to try to get the problem corrected at their end of the state. Though we were only beginning to see the negative impact of the flawed Geographic Practice Cost Index (GPCI) payment formula in 2000, San Diego County would soon grow to be the most adversely impacted county not only in California but in the entire United States.
Unless San Diego and 13 other similarly situated and underpaid counties could be withdrawn from Area 99 (and Area 3 for Marin), the underpayments would continue. Other states, like Texas, had been granted changes to address similar concerns, but Medicare put California in the position of somehow having to solve Medicare’s own error by trying to find a solution wherein some counties would have to accept decreased payments in order to make other counties whole — a recipe for disaster.
In December 2001, while local ef-forts had begun in Santa Cruz County, I convened the first formal meeting on the GPCI inequities, and CMA gathered representatives from HCFA and Region IX Medicare, along with CMA staff and doctors from the affected counties. By the end of the meeting, we learned how the formula was made in error, what the im-pacts were, and, unfortunately, that there was no easy resolution to the problem.
Thus began a nearly 13-year campaign to obtain a ‘GPCI fix’ that would take all of us, primarily Drs. Bentley, DeGhetaldi, and myself, along with CMA staffer and lobbyist Elizabeth McNeil, on a journey of CMA resolutions, CMA Board of Trustee challenges, local and Washington, DC,
visits with legislators and legislative staff-ers, multiple House of Representative bills that died in December sessions year after year, broken promises by House Ways and Means leadership, and even a still ongoing lawsuit in which I — along with several counties and two other doctors — am a plaintiff against DHHS, seeking both prospective correction of and retrospec-tive relief from the GPCI underpayments. That lawsuit is still in process, since roughly 2007, and is now over $4 billion in retroactive underpayments.
Taking the Fight to the Legislature and the CourtsThe numbers guys, Drs. DeGhetaldi and Bentley, have already had incredibly im-portant impact over the years by finding other errors in CMS calculations of annual updates that even CMS agreed with and corrected, avoiding onerous cuts to Cali-fornia physician payments. They, along with Ms. McNeil, have made numerous trips to DC, holding educational sessions for congressional staff that not only helped lead to a few bills that eventually failed — we call it Lucy pulling the ball away just as Charlie Brown was about to kick us a field goal — but also to what finally became the GPCI fix of 2014.
For my part, as GPCI King from San Diego (a moniker given to me locally for my obsession with resolving this issue), I worked hard to ensure that any fix would be applied fairly to all counties impacted by the broken formula, which, unfor-tunately, led to my fighting to delay an earlier proposal that would have helped my friends in Northern California but that would have left San Diego out and hoping for future relief. I continued to press the issue through CMA and with federal legis-lators and Medicare administrators.
Many of you reading this probably got tired of hearing me talk about how close we kept coming to resolving this problem year after year, and thought, like me, that I was passing time tilting at a windmill that would never fall.
As the legislative impasse continued, I, along with my fel-low musketeers, decided that we needed to turn to the legal arena. We eventually worked to gather several California counties to become plaintiffs on behalf of their local doc-tors and patients, and filed a class-action lawsuit seeking correction of the problem going forward and compensation going back, under the statute of limitations, to the early 2000s. As the suit progressed, fought by DHHS and Medicare, repre-
Nonmembers: Thank Your SDCMS Member Colleagues! this win is not any one person’s victory, but resulted from the concerted efforts of organized medicine, backing those who choose to take an active role. for those readers who are already sdcms-cma members, your support and membership allows this kind of advocacy, often requiring persistence through the frustrating political and legal processes.
nonmembers should recognize that while they may benefit from this work, they owe a thank-you to those whose membership shouldered the burden on all doctors’ behalves … and should reconsider their own decision not to be a mem-ber of sdcms-cma.
the increased reimburse-ments that will ultimately result through both medicare and commercial rate changes will more than pay for most physi-cians’ memberships year after year for those who are not yet nearing retirement. and the gPci issue is but one of many that sdcms and cma advocate for year after year.
continued on page 16
SA n D I eGO P H YSI C I A n .O rG 13
INC
RE
AS
ED
C
oS
TS
. Lo
SIN
g
TR
uS
TE
D D
oC
To
RS
. T
hR
EA
TE
NE
D
PR
IvA
CY
.t
hat’s
What
Hap
pens
W
hen l
awyers
pla
y D
octo
r
BY
RIC
HA
RD
TH
OR
P,
MD
mIC
ra
Yo
u m
ay h
ave h
eard
that
the t
rial-
law
yer-
spo
nso
red
b
allo
t m
easu
re t
hat
aim
s to
und
erm
ine t
he
pro
tectio
ns
of
the M
ed
ical i
nju
ry c
om
pensa
tio
n
Refo
rm a
ct
(Mic
Ra
) has
offi
cia
lly q
ualifi
ed
fo
r th
e
nove
mb
er
ballo
t. ¶
in le
ss t
han s
ix m
onth
s, o
n n
ov.
4, 2
014
, th
ese
trial l
awyers
will
ask
vo
ters
to
weig
h in
on “
the t
roy
and
ala
na p
ack p
atient
Safe
ty a
ct,”
an in
itia
tive
that
was
care
less
ly t
hro
wn t
og
eth
er
witho
ut
any c
oncern
fo
r ta
xp
ayer
po
cke
tbo
oks,
privacy,
patients
, or
healthcare
. if
tria
l law
yers
g
et
their w
ay, o
ur
state
will
be s
ad
dle
d w
ith a
co
stly
thre
at
to
privacy t
hat
calif
orn
ia s
imp
ly c
anno
t aff
ord
.
no in
crea
sed
secu
rity
sta
ndar
ds to
pro
tect
you
r pe
rson
al p
resc
ript
ion
info
rmat
ion
from
hac
king
an
d th
eft.
Tho
ugh
the
data
base
alr
eady
exi
sts,
it
is
unde
rfun
ded,
und
erst
affed
, an
d te
chno
-lo
gica
lly in
capa
ble
of h
andl
ing
the
mas
sive
ly in
-cr
ease
d de
man
ds t
his
ballo
t m
easu
re w
ill p
lace
on
it. T
his
ballo
t mea
sure
wil
l for
ce t
he C
UR
ES
data
base
to re
spon
d to
tens
of m
illio
ns o
f inq
ui-
ries
eac
h ye
ar,
som
ethi
ng t
he d
atab
ase
sim
ply
cann
ot d
o in
its
curr
ent f
orm
or f
unct
iona
lity.
A
nonf
unct
ioni
ng d
atab
ase
syst
em w
ill p
ut p
hysi
-ci
ans
and
phar
mac
ists
in th
e un
tena
ble
posi
tion
of
hav
ing
to b
reak
the
law
to tr
eat t
heir
pat
ient
s,
or b
reak
the
ir o
ath
by r
efus
ing
need
ed m
edic
a-ti
ons t
o pa
tien
ts.
Mos
t co
ncer
ning
, th
e m
assi
ve r
amp-
up o
f th
is d
atab
ase
wil
l si
gnifi
cant
ly p
ut p
atie
nts’
pr
ivat
e m
edic
al i
nfor
mat
ion
at r
isk.
The
bal
lot
mea
sure
con
tain
s no
pro
visi
ons
and
no fu
ndin
g to
upg
rade
the
data
base
wit
h in
crea
sed
secu
rity
st
anda
rds
to p
rote
ct p
erso
nal
pres
crip
tion
in-
form
atio
n fr
om g
over
nmen
t int
rusi
on, h
acki
ng,
thef
t, o
r im
prop
er a
cces
s by
nonm
edic
al p
rofe
s-si
onal
s.T
he i
niti
ativ
e is
bad
for
pat
ient
s, t
axpa
yers
, an
d he
alth
care
as
a w
hole
, and
the
re h
as n
ever
be
en a
gre
ater
nee
d fo
r ph
ysic
ians
to
band
to-
geth
er a
nd fi
ght f
or o
ur p
atie
nts.
As
you
can
see,
thi
s in
itia
tive
is f
raug
ht w
ith
prob
lem
s an
d w
ould
pro
ve d
etri
men
tal t
o C
ali-
forn
ia’s
hea
lthc
are
syst
em.
I’m
ask
ing
each
of
you
to jo
in t
he e
ffor
t to
defe
at t
his
cost
ly t
hrea
t to
our
sta
te, a
nd, i
n do
ing
so, p
rote
ct a
cces
s to
ca
re a
nd p
reve
nt h
ighe
r co
sts
for
all C
alif
orni
a.
Tog
ethe
r, I’
m s
ure
we
wil
l be
vict
orio
us.
As
we
forg
e ah
ead
to E
lect
ion
Day
, it
is m
ore
impo
rtan
t tha
n ev
er to
mak
e su
re w
e ar
e sp
eak-
ing
as
a un
ified
, co
ordi
nate
d vo
ice.
If
yo
u ha
ven’
t do
ne s
o al
read
y, p
leas
e vi
sit
CM
A’s
w
ebsi
te a
t w
ww
.cm
anet
.org
/mic
ra f
or t
he l
at-
est
info
rmat
ion,
han
dout
s, a
nd t
o si
gn u
p as
a
cam
paig
n co
ordi
nato
r in
you
r ar
ea. P
leas
e al
so
visi
t th
e ca
mpa
ign
web
site
at
ww
w.s
toph
igh-
erhe
alth
care
cost
s.co
m t
o si
gn u
p to
bec
ome
an
offici
al o
ppon
ent
of t
his
badl
y fl
awed
mea
sure
. Fr
om th
e w
ebsi
te y
ou c
an:
•Si
gn u
p to
add
you
r nam
e to
the
grow
ing
list
of i
ndiv
idua
ls a
nd g
roup
s op
pose
d to
the
M
ICR
A b
allo
t mea
sure
.•
Get
impo
rtan
t fac
ts, d
ownl
oads
, and
info
r-m
atio
n th
at w
ill h
elp
you
spre
ad t
he w
ord
abou
t thi
s cos
tly
mea
sure
•B
e pa
rt o
f ou
r ou
trea
ch t
eam
. If
you
hav
e di
rect
pat
ient
con
tact
, bec
ome
part
of
our
outr
each
tea
m.
Vis
it C
MA
’s M
ICR
A r
e-so
urce
pag
e to
sig
n up
as
a ca
mpa
ign
coor
-di
nato
r her
e.•
Part
icip
ate
in
mes
sage
/med
ia
trai
ning
. T
he c
ampa
ign
is a
lso
look
ing
for p
hysi
cian
s in
tere
sted
in
taki
ng o
n a
mor
e pu
blic
rol
e sp
eaki
ng t
o co
mm
unit
y gr
oups
abo
ut w
hy
this
bal
lot
mea
sure
sho
uld
be d
efea
ted.
C
onta
ct M
olly
Wee
dn a
t m
wee
dn@
cma-
net.
org
for m
ore
info
rmat
ion.
Dr.
Tho
rp is
pre
side
nt o
f th
e C
alifo
rnia
Med
ical
A
ssoc
iati
on (C
MA
).
*Ple
as
e P
os
t in
Ph
ys
icia
n c
om
mo
n a
re
as
*
INC
RE
AS
ED
C
oS
TS
. Lo
SIN
g
TR
uS
TE
D D
oC
To
RS
. T
hR
EA
TE
NE
D
PR
IvA
CY
.t
hat’s
What
Hap
pens
W
hen l
awyers
pla
y D
octo
r
BY
RIC
HA
RD
TH
OR
P,
MD
Yo
u m
ay h
ave h
eard
that
the t
rial-
law
yer-
spo
nso
red
b
allo
t m
easu
re t
hat
aim
s to
und
erm
ine t
he
pro
tectio
ns
of
the M
ed
ical i
nju
ry c
om
pensa
tio
n
Refo
rm a
ct
(Mic
Ra
) has
offi
cia
lly q
ualifi
ed
fo
r th
e
nove
mb
er
ballo
t. ¶
in le
ss t
han s
ix m
onth
s, o
n n
ov.
4, 2
014
, th
ese
trial l
awyers
will
ask
vo
ters
to
weig
h in
on “
the t
roy
and
ala
na p
ack p
atient
Safe
ty a
ct,”
an in
itia
tive
that
was
care
less
ly t
hro
wn t
og
eth
er
witho
ut
any c
oncern
fo
r ta
xp
ayer
po
cke
tbo
oks,
privacy,
patients
, or
healthcare
. if
tria
l law
yers
g
et
their w
ay, o
ur
state
will
be s
ad
dle
d w
ith a
co
stly
thre
at
to
privacy t
hat
calif
orn
ia s
imp
ly c
anno
t aff
ord
.
but
espe
cial
ly i
n ru
ral
area
s an
d ar
eas
that
are
al
read
y un
ders
erve
d.
Com
mun
ity
heal
thca
re
clin
ics
like
Plan
ned
Pare
ntho
od a
nd t
he C
entr
al
Val
ley
Hea
lth
Net
wor
k ar
e al
read
y w
arni
ng t
hat
this
mea
sure
will
cau
se sp
ecia
lists
like
OB/
GY
Ns
to r
educ
e or
elim
inat
e se
rvic
es t
o th
eir
pati
ents
. T
his
mea
sure
cou
ld a
lso
caus
e do
ctor
s to
leav
e th
e st
ate,
mea
ning
tho
usan
ds o
f C
alif
orni
ans
coul
d lo
se a
cces
s to
thei
r tru
sted
doc
tors
.O
ver
the
next
few
mon
ths
you’
ll he
ar a
lot
of
rhet
oric
fro
m t
he p
ropo
nent
s of
the
mea
sure
—
but
real
ly,
this
is
anot
her
exam
ple
of s
peci
al-
inte
rest
pol
itic
s tr
ying
to
fool
the
vot
ers
into
th
inki
ng th
is is
som
ethi
ng th
at it
’s n
ot. A
utho
rs
purp
osel
y ad
ded
doct
or d
rug
test
ing
to d
isgu
ise
thei
r re
al i
nten
t be
hind
the
bal
lot
mea
sure
: to
in
crea
se la
wsu
its
agai
nst
heal
thca
re p
rovi
ders
, w
hich
wil
l inc
reas
e ou
r hea
lthc
are
cost
s an
d re
-du
ce a
cces
s to
qua
lity
heal
thca
re. A
ccor
ding
to
the
Los A
ngel
es T
imes
: “T
he d
rug
rule
s are
in th
e in
itia
tive
bec
ause
they
pol
l wel
l, an
d th
e ba
cker
s fig
ure
that
’s th
e w
ay to
get
the
publ
ic to
sup
port
th
e m
easu
re. ‘
It’s
the
ult
imat
e sw
eete
ner,’
say
s Ja
mie
Cou
rt, t
he h
ead
of C
onsu
mer
Wat
chdo
g”
(Dec
. 10,
201
3).
Thi
s pr
opos
al a
lso
forc
es d
octo
rs a
nd p
har-
mac
ists
to
use
a m
assi
ve s
tate
wid
e da
taba
se
know
n as
the
Con
trol
led
Uti
lizat
ion
Rev
iew
and
Ev
alua
tion
Sys
tem
, or
CU
RES
, fille
d w
ith
Cal
i-fo
rnia
ns’
pers
onal
med
ical
pre
scri
ptio
n in
for-
mat
ion
— a
man
date
our
gov
ernm
ent
wil
l find
im
poss
ible
to
impl
emen
t, a
nd a
dat
abas
e w
ith
If t
his
mea
sure
is
appr
oved
by
vote
rs,
mal
-pr
acti
ce l
awsu
its
and
payo
uts
wil
l sk
yroc
ket,
ad
ding
“hu
ndre
ds o
f mil
lions
of d
olla
rs”
in n
ew
cost
s to
sta
te a
nd lo
cal g
over
nmen
ts, a
ccor
ding
to
an
impa
rtia
l ana
lysi
s con
duct
ed b
y th
e st
ate’
s L
egis
lati
ve A
naly
st. S
omeo
ne w
ill h
ave
to p
ay,
and
that
som
eone
is
prov
id-
ers,
tax
paye
rs,
and
cons
um-
ers. T
he C
alif
orni
a Med
ical
As-
soci
atio
n (C
MA
) has
join
ed a
ca
mpa
ign
coal
itio
n to
opp
ose
the
mea
sure
bec
ause
it
wil
l be
cos
tly
for
cons
umer
s an
d ta
xpay
ers,
end
ange
r pa
tien
t ac
cess
to
qual
ity
heal
thca
re,
and
jeop
ardi
ze t
he p
riva
cy o
f ou
r per
sona
l hea
lth
info
rma-
tion
. T
his
grou
p, “
Pati
ents
an
d P
rovi
ders
to
P
rote
ct
Acc
ess
and
Con
tain
Hea
lth
Cos
ts,”
is
a
dive
rse
and
grow
ing
coal
itio
n of
tru
sted
do
ctor
s,
com
mun
ity
heal
th
clin
ics,
hos
pita
ls,
fam
ily-p
lann
ing
orga
niza
-ti
ons,
loca
l lea
ders
, pub
lic s
afet
y offi
cial
s, b
usi-
ness
es, a
nd w
orki
ng m
en a
nd w
omen
form
ed to
op
pose
this
cos
tly,
dan
gero
us b
allo
t pro
posi
tion
th
at w
ould
mak
e it
eas
ier a
nd m
ore
profi
tabl
e fo
r la
wye
rs to
sue
doc
tors
and
hos
pita
ls.
Thi
s m
easu
re w
ould
als
o ha
ve d
evas
tati
ng e
f-fe
cts
on a
cces
s to
car
e fo
r pa
tien
ts e
very
whe
re,
no in
crea
sed
secu
rity
sta
ndar
ds to
pro
tect
you
r pe
rson
al p
resc
ript
ion
info
rmat
ion
from
hac
king
an
d th
eft.
Tho
ugh
the
data
base
alr
eady
exi
sts,
it
is
unde
rfun
ded,
und
erst
affed
, an
d te
chno
-lo
gica
lly in
capa
ble
of h
andl
ing
the
mas
sive
ly in
-cr
ease
d de
man
ds t
his
ballo
t m
easu
re w
ill p
lace
on
it. T
his
ballo
t mea
sure
wil
l for
ce t
he C
UR
ES
data
base
to re
spon
d to
tens
of m
illio
ns o
f inq
ui-
ries
eac
h ye
ar,
som
ethi
ng t
he d
atab
ase
sim
ply
cann
ot d
o in
its
curr
ent f
orm
or f
unct
iona
lity.
A
nonf
unct
ioni
ng d
atab
ase
syst
em w
ill p
ut p
hysi
-ci
ans
and
phar
mac
ists
in th
e un
tena
ble
posi
tion
of
hav
ing
to b
reak
the
law
to tr
eat t
heir
pat
ient
s,
or b
reak
the
ir o
ath
by r
efus
ing
need
ed m
edic
a-ti
ons t
o pa
tien
ts.
Mos
t co
ncer
ning
, th
e m
assi
ve r
amp-
up o
f th
is d
atab
ase
wil
l si
gnifi
cant
ly p
ut p
atie
nts’
pr
ivat
e m
edic
al i
nfor
mat
ion
at r
isk.
The
bal
lot
mea
sure
con
tain
s no
pro
visi
ons
and
no fu
ndin
g to
upg
rade
the
data
base
wit
h in
crea
sed
secu
rity
st
anda
rds
to p
rote
ct p
erso
nal
pres
crip
tion
in-
form
atio
n fr
om g
over
nmen
t int
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on, h
acki
ng,
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t, o
r im
prop
er a
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s by
nonm
edic
al p
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s-si
onal
s.T
he i
niti
ativ
e is
bad
for
pat
ient
s, t
axpa
yers
, an
d he
alth
care
as
a w
hole
, and
the
re h
as n
ever
be
en a
gre
ater
nee
d fo
r ph
ysic
ians
to
band
to-
geth
er a
nd fi
ght f
or o
ur p
atie
nts.
As
you
can
see,
thi
s in
itia
tive
is f
raug
ht w
ith
prob
lem
s an
d w
ould
pro
ve d
etri
men
tal t
o C
ali-
forn
ia’s
hea
lthc
are
syst
em.
I’m
ask
ing
each
of
you
to jo
in t
he e
ffor
t to
defe
at t
his
cost
ly t
hrea
t to
our
sta
te, a
nd, i
n do
ing
so, p
rote
ct a
cces
s to
ca
re a
nd p
reve
nt h
ighe
r co
sts
for
all C
alif
orni
a.
Tog
ethe
r, I’
m s
ure
we
wil
l be
vict
orio
us.
As
we
forg
e ah
ead
to E
lect
ion
Day
, it
is m
ore
impo
rtan
t tha
n ev
er to
mak
e su
re w
e ar
e sp
eak-
ing
as
a un
ified
, co
ordi
nate
d vo
ice.
If
yo
u ha
ven’
t do
ne s
o al
read
y, p
leas
e vi
sit
CM
A’s
w
ebsi
te a
t w
ww
.cm
anet
.org
/mic
ra f
or t
he l
at-
est
info
rmat
ion,
han
dout
s, a
nd t
o si
gn u
p as
a
cam
paig
n co
ordi
nato
r in
you
r ar
ea. P
leas
e al
so
visi
t th
e ca
mpa
ign
web
site
at
ww
w.s
toph
igh-
erhe
alth
care
cost
s.co
m t
o si
gn u
p to
bec
ome
an
offici
al o
ppon
ent
of t
his
badl
y fl
awed
mea
sure
. Fr
om th
e w
ebsi
te y
ou c
an:
•Si
gn u
p to
add
you
r nam
e to
the
grow
ing
list
of i
ndiv
idua
ls a
nd g
roup
s op
pose
d to
the
M
ICR
A b
allo
t mea
sure
.•
Get
impo
rtan
t fac
ts, d
ownl
oads
, and
info
r-m
atio
n th
at w
ill h
elp
you
spre
ad t
he w
ord
abou
t thi
s cos
tly
mea
sure
•B
e pa
rt o
f ou
r ou
trea
ch t
eam
. If
you
hav
e di
rect
pat
ient
con
tact
, bec
ome
part
of
our
outr
each
tea
m.
Vis
it C
MA
’s M
ICR
A r
e-so
urce
pag
e to
sig
n up
as
a ca
mpa
ign
coor
-di
nato
r her
e.•
Part
icip
ate
in
mes
sage
/med
ia
trai
ning
. T
he c
ampa
ign
is a
lso
look
ing
for p
hysi
cian
s in
tere
sted
in
taki
ng o
n a
mor
e pu
blic
rol
e sp
eaki
ng t
o co
mm
unit
y gr
oups
abo
ut w
hy
this
bal
lot
mea
sure
sho
uld
be d
efea
ted.
C
onta
ct M
olly
Wee
dn a
t m
wee
dn@
cma-
net.
org
for m
ore
info
rmat
ion.
Dr.
Tho
rp is
pre
side
nt o
f th
e C
alifo
rnia
Med
ical
A
ssoc
iati
on (C
MA
).
Mo
st
co
ncern
ing
, th
e m
ass
ive
ram
p-u
p o
f th
is
data
base
will
si
gnifi
cantly
put
patients
’ p
rivate
med
ical
info
rmatio
n
at
risk
.
16 j u n e 2014
sented by the U.S. Department of Justice, it became apparent that the plaintiffs list needed to include practicing physicians, and I became a named plaintiff. That resulted in a most memorable trip to CMS headquarters in Baltimore, perhaps the most intensely secure campus I have ever entered.
A gPCI Fix for California Secured … AlmostIn 2013, as bipartisan, bicameral legis-lation to eliminate the year-after-year “doc fixes” by repealing the SGR made its way through Congress, CMA was able, through the efforts noted above and through long-established relation-ships with our federal legislators, to insert language into the bill to fix GPCI for California (and eventually the rest of the nation) without negatively impacting other counties. CMA’s innovative method to fix the Medicare payment system, which has underpaid San Diego doctors by up to $30 million a year — compounded by similar underpayments by commercial payers following — alone was an incred-ible accomplishment.
In my last visit to DC in March of this year, we quickly saw that what could have and should have been a bipartisan repeal of SGR, which would have included our GPCI fix, was about to fall apart due to an inability for House and Senate leadership to find an agreeable means to pay for the very policy legislation they all supported. Once again, we saw Lucy getting ready to pull the ball away from Charlie Brown just when we were going to score. We were even emboldened enough to pass out to key legislators pictures of our dear Peanuts friends, pleading with them not to block us from scoring once again. But the mood when we left DC was one of gloom, know-ing that the SGR repeal, with our GPCI fix, appeared doomed, and another bill to kick the can down the road on SGR was likely to arise, leaving our GPCI fix on the floor.
Last-minute Save!And indeed another short-term proposal did arise. But, thanks to our team in DC, and to some very important and long-term key legislators, a minor miracle oc-curred. With the assistance of Represen-tative Sam Farr, representing California’s central coast, and our very own Repre-sentative Darrell Issa, the language of the GPCI fix from the overall SGR repeal bill was inserted into the last-minute SGR doc fix bill with agreement by both House and Senate leadership, and was eventually passed by both houses of Congress.
The GPCI fix, albeit a slow implementa-
tion, is not a one-year kick of the can down the road, but rather a permanent solution for California, and will result in more accurate payments without negatively impacting the still-rural counties, while aligning payment adjustments for doctors with those for hospitals and serving as a model for eventual realignment of accurate payment for the nation.
President Obama quickly signed the SGR bill, locking in the GPCI fix, and, finally, after more than 14 years of work, resolving the issue on a prospective basis. Is it ideal? No. But resolving this going forward will correct a longstanding problem, leading for instance to a 5–9% payment increase for San Diego doctors for Medicare services, and likely for all medical services where fees are predicated on the Medicare fee schedule. It will also allow CMA and others to refocus the resources and time given to this issue for many years into other areas of advocacy, including permanent repeal of SGR and development of new payment models.
Success at Last — With Lots of helpIt has been a long and frustrating, though educational, journey. When I traveled last year to the La Mancha region of Spain, I felt at home looking for windmills to tilt at and feeling much like Don Quixote as I continued to fight the injustice of the GPCI impact on San Diego and other counties, and the injustice of delay after delay in resolving it. I hoped not to suffer the same fate of Don Quixote in the effort to tip the windmills over, despite Lucy’s showing up year after year. And here we are, finally having tilted at the GPCI suc-cessfully, with lots of help.
I may not be practicing long enough to fully benefit from what was finally accomplished, and the fate of the lawsuit seeking retroactive damages remains unknown. But as I said to Congressman Farr when presenting him a thank-you from SDCMS in May, I know the difficulty of fixing a problem in Medicare and I know that sometimes perseverance results in change. I also know that while I won’t be spending so much time being a GPCI King anymore, there are more windmills to tilt at, and I will be back working with these same persevering folks for the next battles. The goals of advocacy are not necessarily for immediate or even personal gains, but to meet long-term needs of both physicians and the patients they serve, thus helping to preserve the profession for the future.
Dr. Mazer, SDCMS-CMA member since 1989, is past president of SDCMS and cur-rent speaker of CMA’s House of Delegates.
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18 j u n e 2014
SGR • icD-10 • GpciBY eLIZABeTH MCneIL, VICe PReSIDenT OF
FeDeRAL gOVeRnMenT ReLATIOnS, CMA
Ca
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Federal update
prior years. The House and Senate jointly introduced a bicameral, bipartisan bill (HR 4015/S 2000) to repeal the SGR and establish a reasonable new payment sys-tem. It passed out of three powerful House and Senate committees unanimously. Nearly every physician organization in the country supported the bill. Politi-cal miracles were abundant. There was incredible momentum going into the final phase, where Congress would assign the funding sources.
And then the congressional leadership resorted to their partisan, dysfunctional, 3% approval rating behavior. The House and the Senate couldn’t agree to the Medicare slate of funding sources because it would force them to cut hospitals and pharma, and raise premiums on AARP seniors in an election year. So the House proposed to fund the SGR with a repeal of the ACA individual mandate. While it passed the House with Republican votes, it had no chance in the Senate. The Senate proposed to use unspent Afghanistan and Iraq military funding or not pay for it at all — equally unacceptable to the Republican leadership despite two Wall Street Journal editorials urging the House Republicans to “simply pass the bill and stop the pretense of fake-paying for it.” They were at a par-tisan impasse, got caught up in election-year politics, and lost their political will.
Over organized medicine’s opposition to another short-term patch, on March 31, 2014, the night before the SGR cut, the House and Senate voted on the 17th patch in a decade. With the president’s signa-ture, the bill took effect immediately and provides the following:• Stops the 24% Medicare physician pay-
ment cut for one year until April 2015.• Provides a 0.5% payment increase
through Dec. 31, 2014; 0% through April 1, 2015.
• Delays the burdensome ICD-10 coding system until October 2015.
• Permanently reforms the California physician payment localities. Over the next decade, it provides at least $400 million in payment increases to San Benito, Santa Cruz, Marin, Santa Barba-ra, San Diego, Monterey, Sonoma, Placer, El Dorado, Yolo, Sacramento, San Luis Obispo, Riverside, and San Bernardino. It permanently holds the rural county physicians harmless from cuts.While CMA opposed yet another
patch, the silver lining is that California
The Wall Street Journal editors have called the Medicare SGR a “Greek tragedy.” For a decade, organized medicine has been
working to repeal the flawed Medicare SGR fee-for-service payment formula and replace it with a new payment system. Year after year, for one reason or another, Congress fails to eliminate the SGR and enacts a short-term patch to stop the SGR cut. But this year was going to be different.
The Congressional Budget Office (CBO) announced that the cost to repeal the SGR was at an all-time low of $116 bil-lion compared to the $368 billion cost in
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physicians will receive a delay in the costly ICD-10 coding system and a substantial $50 million annual increase in geographic Medi-care payments.
CMA, AMA, and almost every national specialty society and state medical associa-tion called upon Congress to return to the negotiating table to achieve permanent Medicare physician payment reform. A de-cade of patches had cost the taxpayers $150 billion — almost as much as the long-term reform bill. There had never been a better opportunity with the bipartisan committee agreement on the new payment system and the low price tag.
CMA, AMA, and others worked aggres-sively all year long to develop an agreeable new payment system. The proposed system provided payment updates, incentives for physicians to improve quality, efficiency, and coordinate care. It provided resources to help small practices transition to the new systems. It allowed large upside bonuses for alternative payment models. And it gave physicians the data to effectively manage their practices. It also repealed the SGR. It met most of CMA’s goals for payment reform.
CMA physician leaders worked tire-lessly to improve the legislation and to bring
organized medicine to one unified posi-tion in support of the bicameral, bipartisan legislation, HR 4015 and S 2000, which unanimously passed the House and Senate committees in December 2013. The Energy Commerce Committee passed the first bipartisan version in July 2013. It was a truly Herculean effort, and, for the first time in a decade, Congress made real progress. But they failed to finish the job.
Whether it is the fate of a Greek tragedy, an evil spell cast upon physicians, or the difficult political and fiscal environments in the state capitol and Washington, DC, phy-sicians continue to be challenged by public programs, such as Medicare and Medi-Cal. Despite CMA’s most valiant attempts to raise Medi-Cal reimbursement rates since the early 1990s, California’s remain last in the nation. Despite CMA’s and AMA’s aggressive advocacy since 2002, Medicare rates (while increasing) fail to keep pace with the growing costs to practice medicine.
Physicians will not be the “Greek tragedy.” The fight this year is not over. We are too close. We have a bipartisan bill that we can carry forward. Physicians will regroup and broaden our coalition outside of medicine. We will immediately call upon
the committed members of Congress from both parties, in both the House and the Senate, who have worked so hard over the past year to reach bipartisan agreement, to continue to persevere through the funding debate to get the bill passed. We will push the leadership to enter a real negotiation over the financing. And we will hold the 113th Congress accountable for delivering perma-nent Medicare reform. We must break their habit of patching the SGR. It is essential that we stabilize the Medicare program for physicians and their patients.
Thanks to the CMA physician leaders and physicians all across the state who fought and continue to fight for reform.
While CMA opposed yet another patch, the silver lining is that California physicians will receive a delay in the costly ICD-10 coding system and a substantial $50 million annual increase in geographic Medicare payments.
SA n D I eGO P H YSI C I A n .O rG 21
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cMa Envisions a new future for organized Medicine
BY STeVen e. LARSOn, MD, MPH
22 j u n e 2014
Change is never easy, but oftentimes it is necessary, and even invigorating. The California Medical Association (CMA) is about to embark on a journey
of change that will position our association as a nimble, proactive organization ready to lead the practice of medicine into a brave new world. In 2013, the CMA House of Delegates (HOD) approved a plan to reform the way our association is governed. Will it be easy? No. Will it be worth it? There is not a doubt in my mind.
SA n D I eGO P H YSI C I A n .O rG 23
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In a nutshell, the reforms will make CMA more relevant and effective by focusing the association on, and bolstering its resources to address, the critical issues of universal importance to physicians. By doing so, CMA will be better able to protect the interests of its physician mem-bers and, even more importantly, guide the future of our profession, not only in California but nationwide.
150 Years of TraditionFor 150-plus years, CMA has been guided by the HOD, which meets once a year to set policies and direct resource allocation. This has led to a sometimes unwieldy 581-mem-ber HOD, a Board of Trustees numbering more than 50, a seven-member Execu-tive Committee, and hundreds of other members serving as alternate delegates and in various capacities on dozens of councils, committees, sections, and mode-of-prac-tice forums.
Over the years, there have been sev-eral task forces assigned to this subject. It wasn’t until this year, however, that the abstract discussions about “governance
reform” began to produce concrete results.These discussions resulted in big ques-
tions. Does the HOD foster a reactive culture rather than a proactive one? Does it inhibit CMA’s ability to take quick action in a rapidly evolving healthcare environment?
While these questions were being asked, the HOD was spending most of its time on a growing number of resolutions that struggled to be assigned or implemented because of resource limitations.
The CMA Board of Trustees, real-izing that a floundering governing style prevented the organization from quickly acting on issues of universal import to the membership and their patients, created a committee — the Governance Technical Advisory Committee (GTAC) — to look at this issue.
The GTAC confirmed what the executive committee had feared: The association was unable to quickly address universal issues that arose faster than the once-a-year HOD meetings could handle, and there were other inefficiencies in CMA’s governing bodies and processes.
And there was the cost. An independent governance Reform
The governance TAC Reportthe full report of the cma governance technical advisory committee, as amended by the house of delegates at its octo-ber 2013 meeting in anaheim, is available for download on the california medical association website. to access the report, available to members only, visit www.cmanet.org/hod and click on the “documents” tab. the report begins on page 12 of the “actions of the 2013 house of delegates” document.
24 j u n e 2014
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study commissioned by CMA (an activity-based costing, or “ABC” study) found that CMA governance is far more resource-intensive than previously thought, account-ing for almost one-third of CMA’s operating budget — an allocation that commensurately reduces resources available for advocacy and other member services.
The GTAC began its discussion of how to bring relevance, democracy, and cost-effectiveness to governing the association. It became clear to us that the rank and file members want more advocacy, while the delegates and trustees are heavily invested in leadership.
Tackling the Big IssuesA proposal to reform CMA’s governing structure, put before the 2013 CMA HOD by the GTAC this past October, proposed that instead of a diffuse focus on many issues, the HOD take on a limited number of big issues — the most important, most pressing matters facing physicians and the practice of medicine.
CMA’s longstanding traditions of democratic participation and representative governance would continue; the difference, as envisioned by the GTAC, is that specific
issues that are of concern to a narrow spec-trum of the membership would no longer command HOD’s limited time. Rather, the democratically elected Board of Trustees would act on those issues, as it already does on the increasing number of matters referred to the Board for action by a House that is aware of its policymaking constraints.
The HOD would continue to set policy on major issues, and its decisions would be informed through a year-round process not constrained by 15-minute limits on debate of recommendations developed in a rushed, overnight exercise, as is currently the case. More focused expertise would be brought to bear in a more careful development of recommendations for action. Policy on other issues would realize the same benefits of a more careful and expert deliberative process throughout the year.
We would like to improve the discussion at the House of Delegates to deal with the big issues of the day and to utilize the valuable resources of our delegates for the collective development and direction of important policy matters. We believe this proposal has real potential for a robust discussion around issues that will impact all physicians.
The reforms would also open the discus-
sion to individual members who could con-tinue to bring forth their ideas and proposals through a year-round resolution process provided for in the CMA bylaws. Such pro-posals would be studied, with recommenda-tions acted on by the Board.
A year-round dialogue about timely issues should result in well-thought-out policy pieces that could be brought to the floor dur-ing HOD.
Charting a Course for the Next 150 YearsThis year’s discussion and debate at HOD on governance reform has set the stage for the GTAC to make proposals to modify the bylaws to begin the changes needed to set CMA’s course for the next 150 years.
I am optimistic that this will result in an improvement for our entire organization. It will make CMA more effective in reaching the average member and give him or her a direct voice in policy, bringing broader input into our more difficult decisions.
Dr. Larson, a Riverside physician, has served as chairman of CMA’s Board of Trustees since 2011. He is also the chair of CMA’s Gover-nance Technical Advisory Committee.
SA n D I eGO P H YSI C I A n .O rG 25
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FULL-TIME OR PART-TIME URGENT CARE PHYSI-CIAN: Busy practice in El Cajon, established in 1982, seeks a full-time and/or part-time physician. Good hours
PRACTICE ANNOUNCEMENTS
DR. TANIA RIVERA, RHEUMATOLOGIST, RE-CENTLY RELOCATED TO SAN DIEGO: Dr. Rivera has opened two practices in La Jolla and Bankers Hill. She also provides consultation services at Scripps Memorial La Jolla and Scripps Mercy Hospital. Dr. Rivera has been practicing medicine for about 12 years. She performed rheumatology fellowship at New York University Medi-cal Center, and thereafter practiced rheumatology in Princeton, New Jersey. While she treats the full range of rheumatologic diseases, her special interests include lupus nephritis, lupus and pregnancy, fibromyalgia, os-teoporosis, and osteoarthritis. Dr. Rivera provides intra-articular injections and biologic treatments in the office, including denosumab. Telephone (858)-336-2810 or visit http://www.rheumsd.com. [232]
PHYSICIAN POSITIONS WANTED
LOOKING FOR PART-TIME POSITION IN PEDI-ATRICS: My name is Rafael Garcia, and I have been a board-certified pediatrician since 1996. I am looking for a part-time, outpatient position in pediatrics. I can work Tuesdays from 1pm to 11:00pm, and I can also work evenings from 5pm to 11:00pm (Monday–Wednesday). I have been in practice for 20 years, recertified in pediat-rics in April 2013. My phone number is (619) 990-6218 (I can be reached after 5pm), and my email is [email protected]. [246]
PHYSICIAN POSITIONS AVAILABLE
LOOKING FOR FULL-TIME FAMILY PRACTICE PHY-SICIAN: Neighborhood Healthcare is an award-winning organization that is known for excelling at its mission. The mission has remained the same over the years: to provide quality healthcare and promote wellness to everyone in our communities. We are looking for a full-time family practice physician to provide comprehen-sive medical services for members of the community, regardless of age or sex, on a continuing basis at our busy healthcare clinic in Temecula. Great benefits. Re-quirements: CA license, DEA license, CPR certification, obtain and maintain board certification. To apply please send your resume to [email protected]. [247]
PHYSICIAN WANTED, BEAUTIFUL NORTH SAN DIEGO COUNTY: Ambitious and attention to detail general family medicine / geriatrics / long-term care physicians to join our team of professionals that make “housecalls.” We serve chronically ill patients in their homes. No hospital call, M–F, 8–5, independent contrac-tor, occasional on-call pager, 10–12 patients per day. We are a very relaxed, professional practice environment. We very much look forward to your call at (760) 591-9975. [242]
SEEKING PER-DIEM, BOARD-CERTIFIED FAM-ILY MEDICINE PHYSICIAN: The Sycuan Band of the Kumeyaay Nation, located in east El Cajon, is seeking a per-diem family medicine physician for our medical clin-ic. Must have current, unrestricted CA and DEA licenses, at least three years of experience working as a medi-cal physician, and CPR certification. Bilingual English / Spanish preferred. Salary commensurate with experi-ence, malpractice coverage provided. Please email CV to Teresa Mogielnicki, MD, at [email protected] or fax to (619) 445-0988. [243]
LOOKING FOR A DERMATOLOGIST: Medical spa lo-cated in East County looking for a dermatologist who would like to buy into a very lucrative practice or willing to be a medical director. For more information, please call Dr. Shirin Dorin at (619) 456-4555. [238]
LOOKING FOR A RETIRED PHYSICIAN: Medical spa located in East County looking for a retired physician for a part-time position as a medical director. For more
(mostly 9:00am–5:30pm weekday shifts with some weekends from 9:00am–4:00pm and closed on major holidays) plus good pay. Please send CV to [email protected] or fax to (619) 442-2245. [161]
PRIMARY CARE JOB OPPORTUNITY: Home Physi-cians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to [email protected]. Visit www.thehousecalldocs.com. [037]
PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private non-profit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per-diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Span-ish preferred. Forward resume to [email protected] or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EEO Employer/Vet/Disabled/AA [912]
SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive sup-port allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night. Benefits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at [email protected]. Sal-ary $ 102–108,000 annually (equal to $130–135,000 full-time). [778]
OFFICE SPACE WANTED
3998 VISTA WAY, IN OCEANSIDE: Four medical of-fice spaces approximately 1,300–2,800 square feet available for lease. Close proximity to Tri-City Hos-pital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allowance to cus-tomize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at [email protected]. [234]
HAND SURGEON LOOKING FOR PART-TIME OF-FICE LOCATION: Looking for space to share in La Jolla to Del Mar areas. Limited space and time needs. One-half to one day per week. We have flexibility to accom-modate your schedule and staffing. Please contact me at [email protected]. [231]
LOOKING FOR SUBLEASE: Subspecialist looking for space to sublease in the following locations: Encinitas / Carlsbad or Carmel Valley / Sorrento Valley / La Jolla / UTC. Would be able to move in May or later. Please con-tact [email protected] with space loca-tion, availability, and type of arrangement (full or partial sublease, rooms / days available, etc.). [230]
OFFICE SPACE AVAILABLE
SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOL-LA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the cam-pus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/UTC area. Reception and staff may be available. Complete ultra-sound lab on site for scans or studies. Full-day or half-day timeslots. For more information, call Irene at (619) 840-2400. [154]
SA n D I eGO P H YSI C I A n .O rG 27
NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2100 square feet, at the 477-D Bldg. Occupied by Vascular & General Sur-geons. Excellent and central location at this large medi-cal center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day. Will consider subleasing the en-tire suite, totally furnished, if there is a larger group in-terest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153]
CLAIREMONT OFFICE SUITE AVAILABLE NOW FOR LEASE: 1,450ft2 office suite in medical office building centrally located in Clairemont. Second story suite in a new medical building, network wiring, with elevator access. Three exam rooms and a spacious con-sultation room. Current businesses on site include fam-ily practice, general dentist, and optometrist. Available month-to-month or long-term lease only $1.50ft2 gross lease. Call (619) 300-5139. [245]
LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127]
NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free park-ing for patients and staff, conference room in building. Several minutes from Sharp Memorial and Children’s Hospitals. Convenient freeway access to 163 and 805. Multiple half-day clinics available. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more informa-tion. [235]
LA JOLLA OFFICE SPACE: Share reception, waiting area, and exam/consultation rooms with neurosurgeon and orthopedic surgeon in new office. Five exam rooms. On-site X-rays with radiograph tech available. Office is close to Scripps Memorial Hospital. In Golden Triangle between 805 and 5 freeways. Terms negotiable. Please contact Kathy Koppinger at (858) 678-0455. [223]
BANKERS HILL PRIMARY CARE AND RESEARCH OFFICE SPACE TO SUBLEASE: 50-year established primary care practice and clinical research office with currently two internists has space to sublease to anoth-er primary care MD (internal medicine or subspecialties / family practice) to help curb overhead and see acute overflow patients. Also can provide opportunity to get involved with clinical research. Flexible terms / space. Free parking, close to hospital, easy access to freeways. Contact Cindy at [email protected]. [146]
POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage thera-pist. Low rates. Email inquiries to [email protected]. [173]
WOMEN’S HEALTH / WELLNESS OFFICE HAS SPACE AVAILABLE FOR SUBLEASE: Exam room, of-fice, and/or shared staff optional. Fully furnished exam rooms available and ready for use. Location features onsite billing, reception, medical assistants, potential use of in-office procedure room, and a rooftop lounge. If you are interested, please reply with the heading “Space for Sublease” outlining the details of space and/or staff use desired, with your contact information, and we will contact you to set up a showing. Reply to Mrs. Kim at [email protected]. [217]
MEDICAL OFFICE SPACE AVAILABLE FOR SUB-LEASE IN LA JOLLA: 9834 Genesee Avenue, Suite 400 (Poole Building). Steps away from Scripps Memo-rial Hospital, La Jolla. Please contact Seth D. Bulow, MD, at (858) 622-9076 if you are interested. [215]
SCRIPPS ENCINITAS CONSULTATION ROOM/EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703]
POWAY / RANCHO BERNARDO — OFFICE FOR SUB-LEASE: Spacious, beautiful, newly renovated, 1,467 sq-ft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and ra-diology onsite. Ideal sublease / satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at [email protected]. [873]
BUILD TO SUIT: Up to 1,900ft2 office space on Univer-sity Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radi-ology, or ancillary services. Comes with 12 assigned, gat-ed parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact [email protected] or (619) 504-5830. [835]
SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in build-ing. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email [email protected] for more information. [867]
NONPHYSICIAN POSITIONS AVAILABLE / WANTED
BEHAVIORAL HEALTH CONSULTANT: The behav-ioral health consultant, as part of the primary care treatment team, identifies, triages, and manages pri-mary care patients with medical and behavioral health problems. In addition, the BHC will provide skill training through psycho-education and patient education strat-egies and develop specific behavioral change plans for patients. The BHC assists primary healthcare provid-ers in recognizing and treating mental disorders and psychosocial problems, assists in detection of “at-risk” patients, and assesses the clinical status of patients referred by the PCP. Education / Certification: PsyD/PhD in psychology or LCSW; CPR certification (includ-ing BLS). Contact Araceli Mercado at [email protected] or at fax (760) 736-870. [244]
SUPERVISORY RN — MISSION MESA PEDIATRICS: Under the direction of the health center director / prac-tice manager, and in collaboration with the nursing ser-vices director, supervise the delivery of quality medical care with optimal efficiency and patient satisfaction. Job Skills: Ability to relate to and work with people of all ages, social and ethnic backgrounds, and maintain pa-tient confidentiality. Ability to work independently and as part of a team. Knowledge and Education: Current California state registered nurse license, current CPR certificate required. Bilingual (English / Spanish), bacca-laureate level of conceptual thinking. Experience: Four or more year’s general nursing experience in ambula-tory care, including one year supervisory experience. Please apply at https://rew31.ultipro.com/NOR1021/JobBoard/ListJobs.aspx. [241]
LOOKING FOR PRACTICE MANAGER POSITION: Ex-tensive healthcare management experience, motivated and highly driven to succeed. Documented ability to ex-pand medical practices, establish rapport at all levels of an organization, and build trust with professionals and staff of varied backgrounds. Excellent communication, time management, and education skills. Successful implementation of EMR systems, training staff and phy-sicians. Contact Kathy Fischer at (231) 740-2286 or at [email protected]. [240]
BOARD-CERTIFIED PHYSICIANS, PHYSICIAN AS-SISTANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical li-
cense and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229b]
PHYSICIAN ASSISTANT OPENING: Well-established orthopaedic practice in San Diego County has an open-ing for an experienced, licensed orthopaedic physician assistant. Responsibilities include patient evaluation, diagnosis and treatment, in-office injections. This is a clinic-based position. We are considering both part-time and full-time candidates. Interested parties, email your CV with a cover letter including part-/full-time prefer-ence and salary range / requirements to [email protected] (Word or PDF format only please). Thank you for your interest. [226]
SEEKING PHYSICIAN ASSISTANT: Physician assis-tant needed on per-diem basis for busy urgent care in the San Diego North County area. Hours are evening and/or weekends. Please email CV to [email protected] or fax to (760) 630-2558. [221]
SEEKING PA / NP AND RN: Medical spa in the Del Mar / Solana Beach area is seeking PA / NP and RN. Should have experience with laser hair removal, IPL, CO2 laser, Botox and fillers, and sales. Positive attitude, ability to multitask, perform patient treatment, sales, consulta-tions, effective communicator, work in a team environ-ment, focused on client care, knowledge of lasers and laser theory, quick learner, self motivated. PA/NP will perform consultations and good faith examinations. Minimum requirements: PA, NP, RN California license. This is a part-time position, 1–2 days a week. Please email résumé / cover letter to [email protected] or fax to (858) 259-0864. [219]
PART-TIME OB-GYN NURSE PRACTITIONER: Busy established OB-GYN office in La Jolla seeking a part-time OB-GYN nurse practitioner. Please email resume to [email protected]. [214]
SEEKING NURSE PRACTITIONER: Independent pe-diatrics private practices in Poway and La Mesa seeking nurse practitioner (preferably pediatrics experienced) for maternity coverage in April and July for 10–12 weeks or more. Poway is for 2–3 days per week; La Mesa is for 1–2 days per week. Appointment may be extended depending upon each situation, i.e., if original provider returning to full-time, part-time care or not at all. Please contact Venk Adigopula at (619) 504-5830 with que-ries about the two positions or email resume and inter-est letter to [email protected] (La Mesa) or [email protected] (Poway). [211]
NURSE PRACTITIONERS AND PHYSICIAN’S AS-SISTANTS: Established, busy pain management prac-tice in San Diego Mission Valley is looking for a nurse practitioner and physician’s assistant, preferably expe-rienced in pain management or family practice. Knowl-edge of controlled substance prescriptions and regula-tions is required. Interpretation of diagnostic tests and the ability to apply skills involved in interdisciplinary pain management is necessary. We offer a competitive salary and benefits package that provides malpractice coverage, CME allowance, as well as excellent profes-sional growth potential. Please email your curriculum vitae/résumé to [email protected]. [210]
PHYSICIAN ASSISTANT WANTED FOR SPORTS, SPINE, AND ARTHRITIS REGENERATIVE MEDI-CINE PRACTICE (ENCINITAS): Please reply with resume, letter of interest, and salary requirements to [email protected]. [199]
NURSE PRACTITIONER: Needed for house-call phy-sician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email [email protected]. Visit www.thehouse-calldocs.com. [152]
PHYSICIAN ASSISTANT OR NURSE PRACTITIO-NER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [038]
poEtRY anD MEDicinE
CoMPariSonS are inevitable. We learn new facts in the compara-tive context of old ones. If you meet someone named Donna, she will call to mind, consciously or not, the Donna you know from a book, a movie, a television show, or from “real life.” A short, bald man with a Central European accent will inevi-tably remind you of someone you’ve met in real or fictional encounters.
As doctors we belong to a group that has been widely represented in fiction. Some little bit of House’s brilliance, Quinn’s dependability and Lecter’s sadism all adhere to our mantle in the public imagina-tion. However we fight prejudgment in all its forms, some amount of it is inevitable. “You doctors … ” is a phrase I’ve heard from patients many times in my career. I’m sure it ricochets around in all of their (and our) minds more often still. Try to not finish a sentence that begins,
Colleagues by Daniel J. Bressler, MD, FACP
“You lawyers” or “You Swiss” or “You golfers.” We all do it. We draw inferences based on a few examples. Our better nature (and our scientific medical training) prevents us from inappropriately drawing broad con-clusions from limited sample sizes (the N=1 experiment being the most prominent), but cultural associa-tions often fly below the radars of our better nature and our statistical reality checks.
Just know this: Whenever we meet a patient, he has met us before, or so he imagines. So be prepared. Perhaps you can find in the club of your fictional colleagues some tools and traits that help you to connect, to persuade, and to heal.
Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and longtime contributing writer to San Diego Physician.
Whenever we meet a patient,
he has met us before,
or so he imagines.
ColleaguesMarcus Welbys, Doogie HowsersCrisp white coats and khaki trousers
Dr Quinn, Dr ZhivagoElsewhere’s Boston, Hope’s Chicago
Dr Jekyll, Dr WhoDr Me and Dr You
Dr Lecter, not benignPaging Doctor Frankenstein
Beverly Crusher, Bones McCoyJames Kildare, that Golden Boy
Medicine Women, Chanting ShamansSpecialized in chasing demons
ER’s hustle and House’s sneerMake medical mysteries disappear
Whatever doctor you might beThey’ve seen on Grey’s Anatomy
Though called “initial office visit”You’ve met before (just not explicit)
28 j u n e 2014
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