Saturday, August 18, 2018

OCMA Blog

Avoiding Medical Board Discipline when Prescribing Opiates


There are a host of new, ever changing, and conflicting guidelines from a multitude of regulators and academic societies.  This evolving and uncertain landscape is making the life of a practicing pain physician in the midst of today’s nationwide opiate epidemic…painful.  

Here are 10 Tips to help you avoid Medical Board discipline when prescribing opiates:

1.  Don't Prescribe Opiates Unless . . . 

  • The patient has exhausted all reasonable alternatives.
  • There is medical indication

o   Recently documented objective evidence of/consistent with Patient's Pain Complaints

  • You have conducted a comprehensive history, initial exam, imaging, UDT's, CURES, ORT's, have a signed Pain Contract, and have provided Informed Consent.

2.  Treat the 2014 MBC Guidelines as Dictating the Standard of Care (i.e., rules you must follow) - Deviations from these Guidelines must be justified and documented.

Click here to read the remaining tips.  


Distracting Devices in Healthcare: Malpractice Implications

By:  Shelley Rizzo, MSN, CPHRM, Patient Safety Risk Manager II, The Doctors Company

Digital distraction in healthcare is emerging as a great threat to patient safety and physician well-being.1 This phenomenon involves the habitual use of personal electronic devices by healthcare providers for nonclinical purposes during appointments and procedures.2 Some call it “distracted doctoring.”

But the threat might more aptly be called “distracted practice,” as it impacts all healthcare workers and staff. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients. And the consequences can be devastating.

Distraction can be both a symptom of and a contributor to healthcare provider stress and burnout. As a symptom of burnout, digital distraction is a way to escape a stressful environment. As a contributor to burnout, digital distraction impedes human interaction because of the sheer volume of data demanding our attention.

For most healthcare providers, distractions and interruptions are considered part of the job; it is the nature of their work. If we consider healthcare distraction on a continuum, on one end are distractions related to clinical care (e.g., answering team member questions or responding to surgical equipment alarms). On the other end of the continuum are distractions unrelated to clinical care (e.g., making personal phone calls, sending personal text messages, checking social media sites, playing games, or searching airline flights).

From a litigation perspective, the distinction between distractions related to clinical care and those unrelated to clinical care is important. In a medical malpractice claim where there is an allegation that an adverse event was caused by distracted practice, a distraction caused by a clinical-care-related activity may be found to be within the standard of care and is, therefore, often defensible. But where it can be shown that the distraction was caused by non-patient matters, the plaintiff’s attorney will certainly use that against the defendant. In these situations, the defendant’s medical care may not even enter the equation, because during eDiscovery the metadata (i.e., cell phone records, scouring findings from hard drives) serves as the “expert witness.” Even if the defendant’s clinical care was within the standard, the fact that there are cell phone records indicating that the healthcare provider was surfing the Internet or checking personal e-mail may imply distraction and could potentially supersede all other evidence.

Two new CME courses from The Doctors Company, How Healthcare Leaders Can Reduce Risks of Distracted Practice in Their Organization and The Risks of Distracted Practice in the Perioperative Area, address addiction to personal electronic devices and provide strategies that individuals and organizations can use to minimize the patient safety risks associated with distractions from these devices.

Find these courses and explore our extensive catalog of complimentary CME and CE activities at http://www.thedoctors.com/patient-safety/education-and-cme/ondemand/.

  1. Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age

https://www.amazon.com/Distracted-Doctoring-Returning-Patient-Centered-Digital/dp/331948706X

  1. Treat, Don’t Tweet: The Dangerous Rise of Social Media in the Operating Room

https://psmag.com/social-justice/treat-dont-tweet-dangerous-rise-social-media-operating-room-79061

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

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

 

 



Welcome to CMA's Next Generation

Earlier this week, CMA launched its new branding initiative along with its updated website. The initiative called, “Next Generation of CMA,” has been in the planning process for over a year.  You can check out information on it by clicking here.

OCMA was one of the early adopters at the county level and we released our new logo at the same time.  

As you can see, the logo is consistent with CMA other than its color, and the new logo design will soon be adopted by all the county medical societies in California.  Each will have its own color.  Over the next few months, OCMA will be upgrading its website making it easier for our member physicians to navigate and get the information they need.  Stay tuned. 


Sexual Harassment Allegations in Healthcare: Rising Risks


By:  Richard Cahill, JD, vice president and associate general counsel, The Doctors Company 

Healthcare providers are not immune from the growing number of reported incidents of alleged sexual harassment in the workplace. Accusers may be employees, patients, third-party vendors or visitors. Individuals alleged to have acted inappropriately may include co-workers, both supervisors and subordinates, professional staff—and even patients. 


Repercussions of Harassment Claims 

After complaints are filed, costly and potentially embarrassing investigations are often conducted by law enforcement, human resources departments, and administrative agencies. Depending on the nature and scope of the findings, serious adverse consequences and often irreparable harm to a person’s reputation may follow.

Adopt and Enforce Zero Tolerance

Healthcare practitioners and facilities are strongly encouraged to develop and consistently enforce a zero-tolerance policy. Protocols must be written, periodically reviewed, and updated as necessary, detailing:

The types of conduct that will not be tolerated, regardless of the identity of the alleged perpetrator.
A clear methodology for reporting claimed instances of wrongdoing.
The process to be followed in investigating complaints, and rules that should be observed to help insure that confidentiality and due process are appropriately protected. 
Documentation to be completed and maintained.
The range of sanctions, up to and including termination, for both employees and patients, should the allegations ultimately be determined to be true.

Staff should receive proper training as part of the on-boarding process and on a regular basis thereafter. Offices should develop and retain attendance sign-in sheets of such training in the regular course of business to demonstrate, in the event of a subsequent problem, the good faith and due diligence as continuing efforts of the clinic, provider or facility to comply with federal and state requirements.

Be Sure You’re Covered

Healthcare providers are also strongly encouraged to consult with their personal or corporate attorney to understand the potential financial risks of claims involving allegations of sexual harassment or misconduct. They should then confer with their insurance agent or broker to determine pro-actively what coverages might be available in their respective states to protect the provider in the event of such a claim.

Most practitioners carry professional liability coverage in the event of a claim for medical malpractice. Not uncommonly, however, medical professional liability policies specifically exclude coverage for acts of sexual misconduct committed by a physician against a patient. 

It’s also prudent to consult with insurance brokers and agents about the availability of Employment Practices Liability Insurance (EPLI). EPLI may provide coverage for certain types of workplace harassment, which may include sexual misconduct involving the policy holder and an employee.

And finally, claims of inappropriate sexual behavior against a physician or other licensed healthcare practitioner may result in administrative proceedings by a state medical board, or the privileges committee of a hospital or other facility regulated by The Joint Commission. Endorsements are widely available as part of medical professional liability policies to pay legal defense costs in the event of an investigation or subsequent disciplinary hearing.


OCMA partners with Carr Healthcare Realty to encourage Orange County Physicians to capitalize on their highest negotiable expense - real estate.

FOR IMMEDIATE RELEASE                                                       Contact: Katie Tomarchio, OCMA

25 June 2018                                                                                Phone: 949-398-8100

                                                                                                      Email: ktomarchio@ocma.org

 

OCMA partners with Carr Healthcare Realty to encourage Orange County Physicians to capitalize on their highest negotiable expense - real estate

[Newport Beach, CA] - OCMA has officially approved Carr Healthcare Realty as business partner.  To level the playing field between landlords and sellers, Carr Healthcare Realty is committed to only representing the interests of physicians with their leasing or purchasing needs.   They are the nation’s leading provider of commercial real estate services for those in the healthcare industry, and only represent tenants and buyers. By not listing properties or representing landlords they assure their clients that their interests are always protected, resulting in the most favorable terms possible. 

“Our only goal at CARR Healthcare Realty is to protect the interest of our doctor clients in their real estate endeavors.  We are excited that the OCMA has recognized that our core value aligns with their mission.  This is a great partnership that will provide another benefit to OCMA members with unparalleled results.”  – Tricia McCarroll, Orange County Agent

Real estate is the second highest expense for most healthcare practices.  The difference between a properly or poorly negotiated transaction can benefit or cost a practice hundreds of thousands of dollars.  With this much at stake, maximizing every opportunity is paramount to increasing profitability.  Achieving the most favorable terms goes far beyond just lease rates or purchase price; there are many substantial concessions available when a doctor is properly represented.

“The services Carr provides are critical to our members as they take major steps with their practices.  We’re excited to work with Carr’s professional and dedicated Orange County team to better the experience of our Members.” – Katie Tomarchio, Director of Public Affairs & Strategic Partnerships, OCMA. 

Services Provided:

  • Start-ups
  • Lease Renewals
  • Additional offices
  • Expansions
  • Purchases
  • Relocations
  • Practice Acquisitions

These services are always free to clients. In both residential and commercial real estate, the industry standard is for landlords and sellers to pay commissions to both their agent as well as the buyer’s or tenant’s agent. Commissions are being paid out regardless, so it is in the best interest of the doctor to put that money to good use and have their own representation. 

 

###


Thank Goodness for a Good TPA


Michael I. Gorelick, APR
President
Accredited Pension Representative

Have you ever used these words?  If you have, you know the value that a good TPA brings to your practice.

I received a call from a CPA friend a few months ago.  He was telling me about a medical practice that had 5 Doctors and 20 employees.  Each Doctor had set up their own SEP IRA or 401(k) or Profit Sharing Plan, many years ago.  They merged their individual practices into one group, but the employees were never included in any of the doctor’s plans and a plan was never established for the employees. No one had asked the question, “What should we do for our employees or Do we have to do anything for our employees”?  

They wanted to do things right but no one was giving them advice. Finally, their CPA advised them to get a TPA involved. Thank goodness they called me before the government stepped in.

I explained the government’s rules that require employers to cover their employees if the owners have plans for themselves.  They quickly figured out that they had a liability and what was at stake and proceeded to add a new 401(K)/ Profit Sharing Plan for their employees.  Additionally, each Doctor was able to keep their own plan in-tact and some of the doctors were able to increase their savings. 

It is not unusual for employers to overlook the myriad of governmental rules if their advisors do not bring issues or the rules to their attention. Most 401k/profit sharing record-keepers do not see it as their job to probe into how employers run their businesses’. This means either running afoul of the rules or missing out on law changes that can benefit them.

If you haven’t reviewed the operational and design aspects of your retirement plan, you may be violating rules or missing out on increased contributions for yourself or reductions in the overall cost to cover your employees. 

Benefit Equity is a premier local Third Party Administrator who has proudly participated in the Business Partnership program with the OCMA for the past 6 years.  Contact us for a no-cost plan review today!

Michael Gorelick, Accredited Pension Representative (APR)
President
Benefit Equity, Inc

mgorelick@nenefitequity.com
(714) 480-1364 x220



California’s Physicians Proudly Endorse Gavin Newsom for Governor

Today, the California Medical Association (CMA) formally endorsed Lieutenant Governor Gavin Newsom’s 2018 bid to become California’s next governor. 

“California’s physicians are proud to support Gavin Newsom for Governor,” said CMA President Theodore M. Mazer, M.D. “Gavin is a lifelong champion for health care in California, and we know he will continue to fight for pragmatic solutions to our most crucial health care challenges, including working to achieve universal access and tackling our state’s physician shortage.”

As Mayor of the City and County of San Francisco, Newsom worked with health care providers to bring the nation’s first universal access health system to all residents, regardless of income or immigration status. He fought alongside CMA to restore hundreds of millions of dollars in harmful statewide cuts to Medi-Cal services and vowed to protect access to care for all Californians. Newsom was also the first statewide official to support Proposition 56 and its full state budget allocation to health care delivery.

More recently, he has reaffirmed his support for a comprehensive legislative approach that creates a pathway to universal health access, renewed investment in prevention and wellness, and bold reforms that bend the cost curve without exacerbating the provider gap. Newsom has long advocated that any strong and successful universal access plan must address California’s critical physician shortages and expand medical residency programs so patients can access timely and affordable health care, as well as standardize and reduce administrative burdens so physicians can spend more time on patient care than paperwork.

He will also continue working to protect Medicare and raise Medi-Cal reimbursement rates – currently among the nation’s lowest –  to help increase access for the nearly 14 million Californians, including half of the state’s children, currently covered by the program.

“After more than a decade of partnership working side-by-side with California’s physicians to expand health access and improve health outcomes for every Californian, it is a high and humbling honor to receive their endorsement for Governor,” said Newsom. “The promise of universal health is within our grasp, and we need everyone at the policy table working in common cause to achieve it, especially the physicians Californians depend on day in and day out to deliver high-quality patient care.”  

For more information on Gavin Newsom’s candidacy, please visit https://gavinnewsom.com/




10 things you could buy with the money your practice is leaving on the table.

 

Patient bills. Sitting in your AR.  Dollars left on the table.

It’s one of the top problems we hear about from our members at OCMA, and one that we can help you fix through our Business Partner Universal Financial Systems.

Most docs are leaving $150,000 on average on the table PER YEAR…what could you do with your extra cash?  Well, we took it upon ourselves to find out!

1.       A Jet Pack - $100,000

By Seg9585 [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

This is Orange County, you can get some real use from a water jet pack!  Wouldn’t the 10-year-old version of you be furious to know you have the ability to purchase a jet pack and haven’t yet flown through the sky?

 

2.      Duffy Boats - $52,000/each

  

See page for author  [Public domain], via Wikimedia Commons

You and 36 of your friends could be out on the water brunching and cruising every weekend!  Call UFS now and get out there this summer! 

 

3.        The Permits, Guides, and Gear for THREE Everest Climbs ($40-80,000/person)

By Mount_Everest_as_seen_from_Drukair2.jpg: shrimpo1967derivative work: Papa Lima Whiskey 2 [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

Even if Everest isn’t on your bucket list, imagine what bucket list items your savings could help you cross off!

 

4.           A litter of California’s most expensive dogs ($50,000/each)

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By danny O. (Flickr) [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Common

French bulldogs are some of the most expensive dogs on the planet, especially when they come from a top breeder – why not ensure you get the best?

 

5.      Team up with another doc and you could control the Bellagio Fountains ($250,000)

By Adam Jones from Kelowna, BC, Canada (Bellagio Fountain - Las Vegas, CA - USA - 02) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons


If it’s money you were leaving on the table, why not do something fun with it?  You’ve been living without it for years!  Seriously, stop leaving money on the table and reach out to our trusted partner UFS today!

 

6.      Tickets to Game 7 of the NBA Finals ($50,000/each)

 

By Eric Kilby (originally posted to Flickr as Tangle Underneath) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

NBA Finals Game 7 tickets have gone for up to $90,000/ticket.  With the money your practice leaves on the table, you could be sitting court-side every year…

 

7.      Live at the Versace Mansion for 2 Months ($1600/night)

By Daniel Di Palma [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

OC can get taxing, why not take a break living in luxury at one of the most infamous mansions in South Beach?  What’s $100k for two months of high fashion luxury?!


8.      Hire an up and coming celeb for a party ($100K)

By glenjamn [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

Sorry, an act like Elton John will set you back millions, but if your son of daughter wants to hire a new artist like Fetty Wap (ask them who he is), your $100K savings from hiring UFS could come in handy…

 

9.      You could eat nearly 30 pounds of European White Truffles ($3600/pound)

By Mortazavifar [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

You’ll never have to go out to dinner again if you can freshly shave white truffle on every meal!  Once you start, you won’t be able to stop…and you won’t have to with that new $100K truffle budget…

 

10.      And for the practical folks, a one-bedroom Condo in Sacramento ($104,000)


OCMA encourages our members to be vocal about the rights of physicians and patients, with your very own condo in Sacramento you can be in on the action at your home away from home in Sac Town!

Ready to get started?  Call UFS today!

OCMA members receive a complimentary Insurance & Patient Collection Performance Analysis ($300 value), as well as bundled pricing for billing and collection services. 

Contact: George Christidis, 310-502-3580, georgec@ufsworks.com

 


 

 

 


Survey: How would the AB 3087 price fixing proposal affect your practice?

Assemblymember Ash Kalra (D-San Jose) last week announced a radical physician rate setting proposal (AB 3087) that would increase patient out-of-pocket costs, create state-sanctioned rationing of health care for all Californians and force physicians out of state or into early retirement.

The California Medical Association is asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey is anonymous and the results will help in our legislative efforts to fight this dangerous and irresponsible legislation.

Take the survey now at: www.surveymonkey.com/r/ab3087

And, if you are among California's physicians that will be forced into early retirement or out of state if AB 3087 passes, we want to tell your story. Drop us a line at communications@cmanet.org.


Long-time OCMA Member Nick Anas, M.D. Has Passed Away

In Memoriam

Nick G. Anas, M.D.

June 14, 1950 - April 3, 2018

It is with great sadness that we announce the passing of Nick G. Anas, M.D., long-time member of OCMA.  Dr. Anas passed away peacefully on April 3, 2018.

To read the entire tribute, please click here.  


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