When we ask Los Angeles County Medical Association members and non-
members what they consider to be the most important activities that LACMA should engage in, we are consistently told that economic and legislative advocacy are the two highest priorities.

On Leap Day, the South Los Angeles Collaborative for Specialty Care Access met for the first time, deciding how to proceed in using a recently awarded $150,000 grant from Kaiser Permanente.

Although Governor Schwarzenegger's healthcare proposal failed to pass the state legislature, both the CMA and LACMA are on record in support of some form of healthcare reform. As physicians, we are painfully aware of the control that insurance companies exercise over the care we provide for our patients. We find ourselves frequently at odds over requirements for prior authorization for medications, procedures, imaging studies and even necessary laboratory tests with insurance company medical directors who may not be aware of the latest advances in a given specialty.

California Assemblyman Curren Price came out to the Los Angeles County Medical Association for a Jan. 21 reception that introduced him to politically active doctors and some of their concerns. Price, whose district includes Inglewood, Hawthorne, Gardena, Lawndale, and Compton, is considered to be an ally to doctors on many medical issues, including defense of the Medical Injury Compensation Reform Act.

The Los Angeles County Medical Association co-sponsored a mock trial put on by the USC Keck School of Medicine and the USC Gould School of Law as part of a curriculum intended to impress upon medical students the importance and application of ethics and the law in medical practice.

The Los Angeles County Medical Association is getting set for a dynamic 2008 by bringing in new executive leadership and organizing vital political advocacy programs.

The Certified Medical Coder preparatory course can train a trusted office staffer to be a high-caliber coder with a mastery of terms and coding conventions.

The Los Angeles County Medical Association sponsored two Obesity Prevention Champion Training Sessions held by the California Medical Association Foundation on Nov. 1 at LACMA's downtown headquarters and Nov. 3 at Glendale Memorial Hospital and Health Center in Glendale.

Doctors at nine private hospitals affected by the closure of Martin Luther King Jr.-Harbor Hospital can take advantage of a new reimbursement program from the Los Angeles County Department of Health Services, according to Carol Meyer, the agency's director of governmental affairs.

The Los Angeles County Medical Association delegation to the California Medical Association House of Delegates had an amazingly successful and productive meeting this year. LACMA's advocacy on behalf of our members resulted in the passage of a number of policy statements by the CMA.

On Nov. 5, Luis Ayala became the Los Angeles County Medical Association's new director of government relations, filling the position left vacant when David Pruitt accepted a job as executive director of the California Medical Association Political Action Committee. In his new LACMA post, Ayala will be at the forefront of the association's advocacy efforts.

In October, KCET Channel 28 interviewed me about medical tourism. While many physicians who hear the term medical tourism may think of continuing medical education programs held in vacation locales, that is not the type of medical tourism I was asked to discuss. Rather, there is a growing trend of patients seeking medical care overseas to avoid the higher cost of healthcare in the United States.

To keep physician employers within the law, Stacy Rochelle, California Employer Association Southern California regional director, explained upcoming labor law changes and offered hiring tips at a Sept. 25 seminar at the Los Angeles County Medical Association headquarters.

After three years as the vice president of government relations at the Los Angeles County Medical Association, David Pruitt has taken over as the executive director of the California Medical Association Political Action Committee, where he will directly influence the CMA's interactions with the state Legislature.

Physicians are under constant pressure to alter their prescribing habits--and new developments are adding to the force.

Seven resolutions adopted at an Aug. 22 meeting will guide the Los Angeles County Medical Association delegates attending this month's California Medical Association House of Delegates meeting, which will set the statewide organization's agenda for 2008.

The Los Angeles County Medical Association and an evolving list of about 10 partner groups are working to find alternative primary- and specialty-care options for South Los Angeles residents, whose limited access to healthcare was further stressed by the August closure of Martin Luther King Jr.-Harbor Hospital.

Physicians wanting to speak directly to a Blue Cross of California medical director are welcome to call a dedicated phone number--818/234-5072--newly set up for the purpose, says Jeff Kamil, MD, the company's vice president and senior medical director.

Where does the patient's personal responsibility end and physician babysitting begin? When do patients and families take responsibility and when do we stop blaming physicians for everything that goes awry in healthcare?

Aiming to influence how members of the U.S. Congress will vote on legislation affecting Medicare payments to physicians, Los Angeles County Medical Association members met with a congressman and staff members from three other legislators' offices as part of an effort led by the California Medical Association.

In July, the Los Angeles County Medical Association joined a new project designed to raise high school graduation rates by making education more relevant and more interesting to students. Led by ConnectEd: The California Center for College and Career, the initiative has participation from the Los Angeles Area Chamber of Commerce, the Alliance for a Better Community, Apple Inc. and 10 other groups.

The Los Angeles County Medical Association's summer election has given the group a new secretary, George Ma, MD. Dr. Ma is clear about his aims: easing the financial strain on primary care physicians and increasing membership among minority and younger doctors.

Due to the antitrust restrictions on the freedom with which physicians can negotiate with insurance companies and the discussions that we can have with each other, LACMA cannot and will not urge physicians to take any concerted action as a group with respect to the latest Blue Cross fee schedule alterations. However, every physician must be cognizant of his practice overhead and margin to ensure practice survival while making a reasonable income given the long years of training, steep education loans, and return on investment of time and energy.

Jonathan Fielding, MD, director of the Los Angeles County Department of Public Health, met with members of LACMA District 1 at the association's headquarters on June 21 to call for more joint activities.

To officially commence the presidency of David Aizuss, MD, the Los Angeles County Medical Association held a June 20 installation banquet at the Millennium Biltmore Hotel in downtown Los Angeles attended by about 50 association members and their families.

In order to spur the widest possible member involvement, LACMA has re-established a number of dormant committees and created a variety of new ones. A few officers and board members cannot do this alone, and I encourage you to participate either through a committee or in your local LACMA district.

Responding to the multiple dueling reform plans facing the California Legislature, the Los Angeles County Medical Association convened a task force to spell out what the association considers the most important elements of any reform.

Kevin de Leon, a first-term Democratic assemblyman from Los Angeles, had a chance to hear physicians' concerns at an April 26 fundraiser at the Los Angeles County Medical Association's downtown headquarters.

Meeting for the third time in 10 years, the Women's Health Policy Summit assembled fresh approaches to 10 areas of health disparity among women that will help guide policy at the local, county and state levels.

California Assemblyman Mike Eng (D-Monterey Park) visited the Los Angeles County Medical Association's headquarters for a May 16 fundraiser held in his honor by the political action committees of LACMA, the California Medical Association and seven other physician organizations.

The global marketplace of today will be the only marketplace of tomorrow. In 2010, the medical ecolo-nomic influence of globalization rose to a political force sufficient to reshape the course of healthcare delivery within the U.S. Globalization, therefore, is and was the fifth watershed in the great American medical ecolo-nomic evolution.

The Los Angeles County Medical Association's annual Legislative Reception had a strong showing this year, drawing about 100 attendees to eat, drink and talk politics at the Sacramento Sheraton Grand Hotel.

Held on April 23, the day before the California Medical Association's Legislative Leadership Day, the reception created an informal, convivial setting for seasoned physician-lobbyists and first-timers alike, who compared notes and got acquainted with Los Angeles County lawmakers.

The crowd welcomed at least five state legislators, including Assemblyman Mike Eng (D-Monterey Park), Assemblyman Anthony Portantino (D-Pasadena), Assemblyman Kevin de Leon (D-Los Angeles), Sen. Gilbert Cedillo (D-Los Angeles) and Sen. Alex Padilla (D-San Fernando Valley).

In an effort to reach out to California community organizations, the Pharmaceutical Research and Manufacturers of America hosted an April 18 reception at the Los Angeles County Medical Association's headquarters. The event featured Billy Tauzin, the former U.S. representative from Louisiana who serves as president and CEO of the Washington, D.C.-based organization.

The fourth watershed event to change the direction of healthcare delivery was government cost-cutting and rationing legislation that produced diagnosis-related groups in 1985.

The Los Angeles County Medical Association and the California Medical Association will host two workshops in mid-July for physician members and office staffers who want guidance in dealing with third-party payer contracts and in improving billing and collections procedures.

With an eye toward bolstering physicians' influence in state healthcare policy, the Los Angeles County Medical Association's Public Policy Education Fund hosted an April 11 legislative workshop to prepare county medical students for this year's Legislative Leadership Day. Approximately 27 students were expected to attend the event in Sacramento, at which they will lobby California legislators on hot issues, such as healthcare access and scope of practice.

There is nonpartisan momentum in the media today for universal financing of healthcare. Is this health reform momentum proceeding in a purposeful fashion toward a defined program or is it just a lot of talk buzzing about in heat-accelerated but random Brownian motion?

On March 7, the Los Angeles County Board of Supervisors voted unanimously to adopt a resolution that will provide $33.3 million in additional revenue for trauma and emergency services through January 2009. Physicians who treat uninsured patients in the ER will benefit, as will all hospitals that deliver unfunded care.

In response to Gov. Arnold Schwarzenegger's health reform proposal, the Los Angeles County Medical Association launched a Health Insurance Task Force to join the debate regarding expanded healthcare access in California.

The third medical ecolo-nomic watershed event was the passage of Medicare and Medicaid entitlements in 1965. Federal Medicare and Medicaid (Medi-Cal in California) programs soon blossomed, and the federal government immediately appointed itself as an organizer of healthcare delivery.

Joe Dunn, the CEO of the California Medical Association, and Dustin Corcoran, vice president of government relations, attended a LACMA board meeting in January to discuss the CMA's response to Gov. Arnold Schwarzenegger's health reform proposal.

Board members of the Los Angeles County Medical Association hosted a luncheon for new Lt. Gov. John Garamendi on Jan. 26. The focus of the conversation was Gov. Arnold Schwarzengger's health reform proposal.

The second medical ecolo-nomic watershed event was employment-based health insurance. This type of insurance changed the evolutionary course of healthcare delivery in the United States.

More than 100 residents at Los Angeles County facilities have benefited from a new program funded by retired physicians.

This first detailed and authenticated medical education quality study, "The Flexner Report," became a watershed event for healthcare delivery. With ample financial and political backing, the report gained wide acceptance and drove future economic considerations in healthcare.

Los Angeles County Medical Association Districts 6 and 17 hosted an Economic Advocacy Seminar on Nov. 29 at Maggiano's Little Italy Restaurant in Woodland Hills. More than 30 doctors and office managers attended for a lively discussion on how to handle unfair insurance company payment practices and how to obtain better PPO contracts.

The Los Angeles County Medical Association held a fundraiser for new Assemblywoman Julia Brownley (D-Santa Monica) on Nov. 20 at the Santa Monica home of Howard Krauss, MD.

Read a personal message from a budding physician of the future in this special "Holographic Internet Transmission" to Ralph Di Libero, MD.

The Los Angeles County Medical Association's Beverly Hills District 7 hosted a membership recruitment event on Oct. 25 at the Le Meridien Hotel in Los Angeles. Irving Posalski, MD, president of District 7, welcomed plenty of prospective members such as Michio Abe, MD, a Los Angeles internist, and Marion Johnson, MD, immediate past president of the Association of Black Women Physicians in Marina Del Rey. Dr. Posalski invited local physicians to join organized medicine and briefly outlined the association's benefits.

"When we ask physicians to join, many object by saying they don't have time or ask 'What will LACMA do for me?'" Dr. Posalski says. "LACMA fights for physicians and their patients on the state and national level. But we can't do it alone. We need you to join and fight with us."

To congratulate Los Angeles County's new delegation to the Legislature, the Los Angeles County Medical Association and the California Medical Association hosted an evening reception for local state senators and assemblymembers. The LACMA Political Action Committee played an integral role in getting 75 percent of LA County's local legislators into office, including Assemblyman Cameron Smyth (R-Santa Clarita), Assemblyman Mike Davis (D-Los Angeles) and State Sen. Alex Padilla (D-San Fernando Valley). More than 100 people attended the October reception.

"One of my goals in office is to fight for universal healthcare in LA County so consumers won't have to worry about insurance," says Assemblyman Davis. "My relationship with LACMA will show me how to go about doing that."

The woeful state of physician reimbursement deserves careful study. Just how did we get here and how can we fix it?

Arthur E. Auer brings more than 30 years of medical association management experience to the organization.

LACMA and CMA sponsor a Medicare Town Hall Meeting to air concerns about continued claims denials for alleged fraud.

Nearly 150 Los Angeles County providers who serve low-income communities received free e-prescribing technology in August thanks to a new $300,000 pilot program by L.A. Care Health Plan.

Amid all the "motherhood and apple pie" concepts in Proposition 86 is an exemption for hospitals from antitrust laws-hospitals would be given the ability to set and regulate doctor fees and doctor duties. Backed by the California Hospital Association, Proposition 86 would give hospitals monopoly power.

The association teams up with Bridgeport Financial, which takes a positive public-relations approach to medical debt collections.

The decision to restrain physician billing for services rendered in emergency care is a barrier to free trade in an open market economy. The governor's ban is definitely illegal and contrary to the opinion of the California judicial system.

A top official from the new Los Angeles County Department of Public Health tells District 1 physicians how to prepare.

There's an important drama playing out in the emergency room behind the scenes and beyond the trauma cases. It's about balance billing. An out-of-plan insured patient meets a doctor for the first time in the ER. The patient doesn't really want to be there, but chances are the doctor is going to get stiffed with the bill.

This month, meet the new LACMA district presidents for 2006-07. District presidents provide leadership to district members, host meetings and foster networking within the organization. To find out about events in your area, call or e-mail your LACMA district president.

Healthcare delivery can never be considered an industry completely subject to all the antitrust rules of a free market. Unlike other industries that are not conflicted with moral dilemma, health keepers--thankfully--are not willing to refuse life or death services to those who cannot pay. The time is ripe for physicians to unite behind a renewed effort to urge Congress to pass an antitrust exemption bill for healthcare.

Jonathan Fielding, MD, MPH, director of public health and health officer for the Los Angeles County Department of Health Services, was keynote speaker at a lecture on pandemic flu preparedness. Hosted on May 25 by the Los Angeles County Medical Association at the UCLA Fowler Museum, the event drew more than 50 local physicians eager to prepare for a potential outbreak.