The news came unbidden, unwelcome and-so far-unfunded. The court-appointed receiver operating state prison healthcare plans to build a 1,500-bed prison hospital at the site of the Ventura Youth Correctional Facility in Camarillo.

The Access Coverage Enrollment Program of Ventura provides a medical home in the Ventura County Medical Center medical system and reduced-cost healthcare for low-income, uninsured adults.

It's a no-brainer: Who wants to pay for non-performance?
But wait. Who's to say what's performance? Therein lies the rub.

Zagat is going to the doctor this year. The 30-year-old Zagat Survey guide has signed up with Blue Cross of California to rate physicians.

In a recent survey, 96 percent of physicians agreed that significantly impaired or incompetent colleagues should be reported to authorities.

On Dec. 17, 2007, the five-year investigation of a hospital administrator's malfeasance came to an end. Community Memorial Hospital of San Buenaventura agreed to pay $1.52 million to the federal government to settle allegations of improper payments, gifts and loans to physicians over a 10-year period.

The "Medical Board of California vs. Gregory House, MD" article, which was featured in the November MBC newsletter, arrived at the Ventura County Star editorial desk before I received my copy in the mail. The medical board had e-mailed it to newspapers all around the state to stir discussion. A Star reporter wanted my reaction, but he had to wait until I accessed the MBC Web site to have a look.

Nearly 100 physicians and guests attended the Nov. 9 event to welcome the new leadership of the Ventura County Medical Association and raise money for worthy charitable causes. Radiologist Robert Lum, MD, passed the VCMA president gavel to psychiatrist Ron Thurston, MD, who takes over in January 2008. Adding to the excitement, doctors played casino-style games with the proceeds benefiting the VCMA Health Career Scholarship Fund and the Ventura Chapter of the National Alliance on Mental Health.

As of April 2007, there were about 110,000 patients with Medi-Cal coverage in Ventura County. Yet in the future, the manner of coverage for many of them may change because the county has been earmarked by the state for Medi-Cal managed care starting in 2008. What does this mean for doctors?

Want to know what to pay a new staff member? Call the Ventura County Medical Association for the 2007 salary survey. Thanks to the effort of the local Professional Association of Health Care Office Managers, the data captures information from 420 employees in Ventura County medical practices. Figures are available for 18 different job titles. Call 805/484-6822. Please note that the survey will be released to physicians only.

The only thing that may change the course of our future is our resistance to unsatisfactory contracts. The Borg from Star Trek said, "Resistance is futile." But I don't believe it is. Our strength comes from the fact that we are still the oil that makes the engine of healthcare go.

All Ventura County physicians are invited to attend the Ventura County Medical Association General Membership Dinner Meeting at the beautiful and historic Ronald Reagan Presidential Library on Tuesday, Sept. 25.
Featured at the event is a president of another sort--Anmol Mahal, MD, president of the California Medical Association. Dr. Mahal will discuss the organization's latest advocacy efforts on behalf of physicians.

Doctors, lace up your track shoes and join the fun at the Relay for Life, a unique 24-hour event that increases cancer awareness while raising funds for American Cancer Society programs and services.

Submitting a resolution to the California Medical Association House of Delegates gives you direct input on the direction of organized medicine while enhancing the value of your Ventura County Medical Association membership. Paying your dues is only the beginning of your participation; you must think and act like a member. Involve yourself in the association's democratic process.

Twenty-five years ago there was much concern in the medical community that we would have a glut of doctors. As a result, medical school graduates have only increased 4 percent over that time. Fast-forward to today and there is much talk about a severe doctor shortage by 2020.

Three brief statements from Michael Ciano, MD, Nicholas Bednarski, MD, and Joe Dunn add to the discussion about lobbying Sacramento politicians on health reform.

Two physicians share their impressions--positive and negative--of the major lobbying event sponsored by the California Medical Association in April.

Doctors coping with the difficult practice environment of rising costs, onerous paperwork and decreasing reimbursement now have a new worry--trickier insurance companies. We have found many insurance companies engaging in silent PPO tactics to lower physician reimbursement. The newest culprit: Medicare.

Think association meetings aren't funny? Well, try this one. To get the crowd going, Joel Weintraub, MEd, BS, will present "Humor for the Health of It!" on Tuesday, May 24, at the Ventura County Medical Association General Membership and SCPIE Town Hall Dinner Meeting.

On Feb. 20, 2007, the Ventura County Medical Association general membership dinner meeting featured special guest speaker Joe Dunn, the new CEO of the California Medical Association. He is a dynamic gentleman with excellent insight into politics and a vision for our future. The CMA is in good hands with him at the helm.

Contact the Ventura County Medical Association at 805/484-6822 or www.venturamedical.org for information and reservations on these three events.

We survived the Medicare cuts for another year. But no sooner than we won that battle, Gov. Arnold Schwarzenegger launched another struggle for us. He wants to partially fund his proposed universal health plan with a new tax on physicians. Reporters started to call, asking for my opinion. The situation made me think about the importance of physicians being media savvy.

Our spouses and the Alliance are two of our greatest untapped resources. Just as many of us could not be effective physicians without our spouses, a healthy Alliance would benefit our medical association.

Join your peers on Tuesday, Feb. 20, as the new CEO of the California Medical Association, Joe Dunn, JD, takes the podium as keynote speaker at the Ventura County Medical Association General Membership Dinner. The former state senator from Orange will share his vision for the CMA and discuss top political issues affecting medicine in California.

Thanks to the American Medical Association, the California Medical Association and the grassroots campaign that many physicians participated in by contacting their members of Congress and senators, the 5 percent cut planned for 2007 was rescinded. However, we are not done yet.

In November, the Ventura County Medical Association Installation Banquet and Fundraiser was a high-rolling success. Attendees embraced the "Casino Blast" theme and raised more than $8,000 to benefit the VCMA Health Career Scholarship Fund and the American Cancer Society Gold Coast Region.

Late fall brought a flurry of activity at the Ventura County Medical Association. Most significantly, leaders of the VCMA attended the California Medical Association House of Delegates during the final few days of October. I was there for the action, along with Drs. Nick Bednarski, Art Inoshita, Lynn Jeffers, Kelvin Loh, Robert Lum, Gerry Murphy and Ronald Thurston.

On Sept. 19, the Ventura County Medical Association held its quarterly general membership dinner meeting. But the rather generic name of the event doesn't reflect the valuable and meaningful nature of what occurred that evening.

Physicians everywhere hope to avoid beginning 2007 as we began 2006 with a reimbursement cut implemented and retroactive action required to reverse it. In addition, we hope to avoid the situation where physicians must decide to opt out of Medicare due to poor payment rates, which results in reduced access to care.

I have read many passionate e-mails from doctors. And I have had many discussions in hospital hallways with physician colleagues and at my office with my partners about these two issues. We agree the time has come for the physicians of California to stand together.

In June, Oxnard ophthalmologist Lee Wan, MD, received formal commendation from the Ventura County Board of Supervisors for serving a full term on the Tobacco Settlement Allocation Committee. His service began July 22, 2003.

In April, the American Medical Association released a study chronicling the concentration of the U.S. health insurance market. Titled "Competition in Health Insurance: A Comprehensive Study of U.S. Markets," the study analyzed 294 metropolitan health insurance markets. Alarmingly, the study found 95 percent of markets had a single insurer with greater than a 30 percent market share.

I volunteer for Aeromedicos, a Santa Barbara-based nonprofit charity providing medical and dental services to rural villages in Baja California. Aeromedicos is currently recruiting physicians who are looking for a little adventure as well as an exhilarating experience practicing rural medicine.

The California Medical Association, in response to Michael Morales being spared death, has proposed legislation to bar the Department of Corrections from utilizing physician in executions. Once introduced, however, bills become the property of the Legislature, hostage to the legislative process as it were, and are sometimes twisted and turned against their sponsors. There is great risk for us, given the passions generated by death penalty debates.

We physicians are making every effort to increase the funds for uncompensated medical care and to prevent further transfer of funds to the county health system. To support our message, we presented the recent Office of Statewide Health Planning and Development data from the first two quarters of 2005. This data showed a breakdown of the total number of uninsured (self-pay) and underinsured (Medi-Cal) seen at each hospital emergency room in Ventura County. Surprisingly, the majority (67 percent) of these patients are treated through private hospital ERs.

In April, the Ventura County Medical Association board initiated the first countywide chiefs of staff meeting. The chiefs of staff, chiefs of staff-elect and past chiefs of staff of all hospitals in Ventura County were invited. Attendance was outstanding.

As chairman of the Ventura County Medical Association Obesity Prevention Task Force, I've learned the scary statistics. Nearly 60 percent of all Californians are overweight or obese and more than 30 percent of California's children are at risk of obesity.

For the first time in its long-term disability and business overhead expense programs, Marsh Affinity Group Services has negotiated a special, limited open enrollment period for members during which time they will be able to sign up for disability benefits without having to go through underwriting.

When the Medicare Part D drug benefit was enacted on Jan. 1, the Medicare system became responsible for the prescriptions of its 41 million recipients. In essence, the federal government became the largest buyer of pharmaceuticals in the U.S. However, the legislation that authorized Medicare's drug benefit forbids the federal government from negotiating directly with the drug manufacturers to obtain lower drug prices for seniors and the Medicare program.

The Ventura County Medical Association is proud to present a variety of education events for physician members. Take a look at the local offereings and take part in the meetings.

Medical staff concerns about the board's apathy toward medical staff issues are being addressed. Medical staff officers have been reinstalled to the board, including chief of staff, chief of staff elect and past chief of staff. Two medical staff members appointed by the chief of staff and approved by the board are seated on every board committee.

Next year, you will no longer have to keep track of and use multiple identification numbers assigned to you by health plans. Effective May 23, 2007, physicians will instead use a single national provider identifier (NPI).

The Medicare physician reimbursement cut fostered a great debate among physicians. Should we be Medicare-participating provers or nonparticipating providers? Should we opt out of the Medicare system completely?

The California Medical Association played an integral role in the passage of four pieces of legislation profoundly important to the physician community in 2006 and beyond.

Everyone has an opinion. There is no "opinionectomy." I looked for the CPT code, and it doesn't exist. Opinions are not vestigial organs. They are acquired by real-life experiences, good and bad. Now I want you--members and nonmembers--to share your opinions with the rest of us.

Our top priority at the VCMA has and continues to be increasing and strengthening physician membership. We are only as strong as our membership.

On Nov. 1, the Ventura County Medical Association presented Gerald L. Murphy, MD, a Simi Valley obstetrician/gynecologist, with the Charles M. Hair, MD, Award for Outstanding Contributions to Organized Medicine.

It's December. That means it's the perfect time to take stock of the year and add up the tangible benefits provided to Ventura County Medical Association members.

Changes to improve outcomes for our patients and ourselves must be planned, incremental evolutions, using processes already in place.

The Ventura County Medical Association and the Professional Association of Health Care Office Management (PAHCOM) are in the process of conducting the Third Annual Ventura County Local Salary Survey. The results will be available this month.