Sponsored byocbj.media.clients.ellingtoncms.com/static/ocbj/supplements/HealthCare_2010.pdfcancer and endoscopic ultrasound (EUS) to diagnose and stage gas-trointestinal cancers. A

An Advertising Supplement to the Orange County Business Journal • January 18, 2010

Sponsored by:

HEALTH-Guide:SupplementS.q 1/15/10 11:38 AM Page 13

Page A-14 Get local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL / HEALTHCARE ADVERTISING SUPPLEMENT January 18, 2010

hile hundreds of hospitals callthemselves cancer centers, only40 have received the NationalCancer Instituteʼs (NCI) presti-gious “comprehensive cancercenter” designation for excel-

lence. Orange County has just one: the ChaoFamily Comprehensive Cancer Center at UCIrvine Medical Center.

Designated as a comprehensive cancer cen-ter in 1997, UC Irvineʼs center treats thousandsof new patients annually and combines a rangeof services that are only available through a uni-versity affiliation. These include cutting-edgeclinical care, strong collaboration among spe-cialists, and cooperative participation in basicscience and medical research – includinggroundbreaking clinical trials.

“There are approximately 3,000 cancer pro-grams in the country,” said Dr. Leonard Sender,medical director of the Chao FamilyComprehensive Cancer Centerʼs clinical oncol-ogy services. “The fact that we are one of only40 NCI-designated comprehensive cancer cen-ters is very impressive.”

Services are broad and include:• UC Irvine Comprehensive Brain Tumor

Program, offering advanced treatments forbrain, spinal cord and peripheral nerve tumors.

• Gynecologic oncology, with internationally renowned leaders in the diagnosis and treat-ment of women with reproductive tract cancers.

• Young Adult Cancer Program, providing medical and psychosocial services designed tomeet the special needs of young adults with cancer.

• Gastrointestinal Oncology Program, which expertly treats malignancies affecting theesophagus, stomach, pancreas, liver and colon.

Other cancer programs include breast cancer, hematologic oncology/leukemia, urologiconcology, lymphoma/myeloma, and head and neck cancer. UC Irvine doctors combat thesecancers with top-flight medical, surgical and radiation treatments. Another differentiating tacticis research, including clinical trials.

“Our research is exceedingly cutting edge,” said Dr. Randall Holcombe, associate director forclinical research. “What the NCI designation indicates is that we offer excellence in clinical careas well as excellence in both population-based cancer research and translational research thatis transferred from the laboratory into clinical practice.”

A key focus is prevention, and ongoing research is investigating various natural products thatmight help to prevent cancer. One is resveratrol, a compound found in red grapes that mayblock a signaling mechanism identified in 85 percent of colon cancers. Holcombe operates alaboratory where researchers, funded by a grant from the Gateway for Cancer ResearchFoundation, are studying the role of a grape-based diet in preventing colon cancer.

“This holds great promise for colon cancer treatment as an adjunct to other therapies and forcolon cancer prevention,” Holcombe said. “Weʼre collaborating with our chemists at UC Irvineand looking at modifying this resveratrol compound to make it more effective at blocking thissignaling pathway.”

WUUCC IIrrvviinnee MMeeddiiccaall CCeenntteerr::

OOCC’’ss OOnnllyy CCoommpprreehheennssiivvee CCaanncceerr CCeenntteerrWhen cancer does develop, UC Irvine doc-

tors are prepared to treat it with surgery,chemotherapy or radiation therapy – or a com-bination – tailored to each patientʼs individualneeds. UC Irvine is Orange Countyʼs only med-ical center to use RapidArc™ radiotherapy, agroundbreaking technique that delivers anenergetic X-ray beam that is faster than con-ventional radiotherapy and conforms to thetumor shape. Other radiation therapy servicesinclude:

Intensity-modulated radiation therapy(IMRT), a form of external beam radiation thatis more precise than previous conformal radio-therapy techniques to treat prostate and blad-der cancer. It lessens the exposure of healthytissue to the radiation, often resulting in lowerincidence of side effects in the urinary tract andbowel.

Brachytherapy, which involves placingradioactive material in a tumor for a prescribedtime. The tumor gets the maximum radiationwhile surrounding normal tissues are protect-ed, reducing side effects.

To increase comfort, reduce anxiety and helppatients remain motionless during long pre-radiation therapy planning sessions using com-

puted tomography (CT), an Ambient Experiencesuite was installed in 2009. Ambient Experience enables patients to control lighting, sound, andthe scenery that is projected on the walls and ceiling within the CT suite, during imaging.

“By controlling their environment, patients are less intimidated by the CT scanner,” said Dr.Nilam Ramsinghani, director of radiation oncology services. “The idea is to reduce anxiety andhelp them relax.”

For primary liver cancers and liver metastases that require a more directly applied radiation,TheraSphere intra-arterial brachytherapy is used. With TheraSphere, glass microspheresimbedded with a radioactive substance are implanted using a catheter inserted at the tumor site.

An estimated 70,000 adults under 40 are diagnosed with cancer annually. To assist them,Sender established and directs the Young Adult Cancer Program, offering medical and psy-chosocial services for patients with young adult cancers. His philosophy is straightforward:because this population often develops rarer forms of cancer during a formative time of life, spe-cial care is required. Outstanding medical treatment, education, psychosocial counseling andsocial services are key elements of the program.

Through the years the cancer center has become exceptionally accomplished at research andprevention as well as at diagnosing, treating and rehabilitating young adults and older patientswho are facing all forms of cancer.

“Weʼre proud of our ʻcomprehensiveʼ designation because it tells people that we go the extramile,” said Sender. “We donʼt just want to be state-of-the-art—we strive to define the ʻart.ʼ Wewant people to know that we can take care of the sickest cancer patients, and if we can do that,then we can take care of all cancer patients.”

For more information or to make an appointment with a Chao Family Comprehensive CancerCenter specialist, visit www.ucihealth.com/cancer or call 877.UCI.DOCS.

ver the past 20 years, minimally invasive surgery has grown, and University ofCalifornia, Irvine Healthcare has emerged as a leader in researching, developingand performing procedures that require smaller – if any – incisions.

UC Irvine Medical Center – Orange Countyʼs only university medical center andhome to the National Cancer Institute-designated Chao Family ComprehensiveCancer Center – provides a full range of advanced minimally invasive surgeries

and other procedures for diagnosis and treatment of cancer. Minimallyinvasive procedures lessen pain, reduce scarring and speed recovery.

Among the minimally invasive techniques to treat gastrointestinal,rectal, urologic and other cancers are endoscopy and laparoscopy. Withendoscopy, a lighted tube is inserted through natural body orifices, anda tiny camera enables physicians to observe and diagnose difficult-to-visualize real or potential malignancies. Treatment procedures also areperformed using endoscopy.

Laparoscopy involves insertion of a miniature video camera, light andinstruments through tiny incisions to perform surgery and other proce-dures.

Then there is LESS, the newest and biggest innovation in minimallyinvasive procedures. LESS is laparoscopic-endoscopic single-site sur-gery, and UC Irvine surgeons are among the first to offer it.Gastrointestinal surgeon Dr. Ninh T. Nguyen is one of the pioneers of this approach, using itroutinely to perform such operations as bariatric (weight-loss) surgery and gallbladderremoval.

Most minimally invasive procedures require up to six small incisions, but LESS proceduresare performed through one hidden incision in the navel or other concealed site. Even morecutting-edge is “natural orifice transluminal endoscopic surgery” (NOTES), an area of activeresearch. NOTES involves passing a flexible endoscope through natural body openings –with no external incision – in order to access organs that require surgery.

“What weʼre trying to do is minimize trauma and the surgical footprint on the patient,” saidDr. Michael Stamos, an expert colon and rectal surgeon. “The primary advantage of LESS

over traditional minimally invasive surgery is less scar tissue. Weʼre making surgery a morepositive experience for the patient.”

Stamos recently pioneered “no-visible-scar colectomy,” which involves laparoscopicremoval of some or all of the large intestine as well as tumors and lymph nodes, all througha tiny incision that is hidden by natural contours at the bikini line. Nationwide, only a dozen orso hospitals – including UC Irvine Medical Center, where 80 percent of all gastrointestinal pro-cedures are minimally invasive – perform this or similar procedures. Stamos continues toevaluate less-invasive and scar-reducing methods to remove diseased or cancerous colontissue through other orifices, such as the vagina.

Among the other minimally invasive procedures available through UC Irvineʼs Chao FamilyComprehensive Cancer Center are gene therapy to treat pancreaticcancer and endoscopic ultrasound (EUS) to diagnose and stage gas-trointestinal cancers. A related procedure, EUS-guided fine needle aspi-ration, is an alternative to surgical biopsy and was developed by Dr.Kenneth J. Chang, medical director of the H.H. Chao Digestive DiseaseCenter at UC Irvine Medical Center.

“We take an endoscope with an ultrasound transducer at the tip andenter the gastrointestinal tract to visualize the extent of tumors throughthe wall of the esophagus, stomach or rectum,” Chang said. “What Ideveloped was the ability to do biopsies using this technology. Weʼvealso been using it in a clinical trial investigating the delivery of anti-tumoragents.”

Also cutting edge is endomicroscopy, in which a probe is inserteddown the throat and placed against the wall of the stomach, esophagus

or colon to enable examination of cells and blood vessels in virtual biopsy fashion.“The appeal of scarless procedures is obviously there,” Chang said. “As far as minimally

invasive surgery goes, we are at the forefront.”

To learn more about the gastrointestinal minimally invasive surgery, visit www.ucihealth.com/cddc or call 714.717.GIMD.

O

Dr. Kenneth J.Chang

Dr. MichaelStamos

LLEESSSS iiss MMoorree,, TThhrroouugghh MMiinniimmaallllyy IInnvvaassiivvee SSuurrggeerryy

UC Irvine oncologist Dr. Leonard Sender, center (with cancer survivor Angelo Guiliano and his wife, Leah), is a renowned advocate for young adult cancer patients.


January 18, 2010 ORANGE COUNTY BUSINESS JOURNAL / HEALTHCARE ADVERTISING SUPPLEMENT Get local breaking news: www.ocbj.com Page A-15



2009 winner of the nationʼs 100 Top Hospitals® for cardiovascular care byThomson Reuters, Hoag Heart and Vascular Instituteʼs physicians and nurseslead the way in cardiovascular care.

Thomson Reutersʼ annual study — 100 Top Hospitals: CardiovascularBenchmarks — examined the performance of 971 hospitals by analyzing clinical

outcomes for patients diagnosed with heart failure and heart attacks and for those whoreceived coronary bypass surgery or percutaneous cardiovascular interventions (PCI) suchas angioplasties.

Thomson Reuters scored hospitals in key performanceareas including: risk-adjusted medical mortality, risk-adjusted surgical mortality, risk-adjusted complications,core measures score, percentage of coronary bypasspatients with internal mammary artery use, procedurevolume, severity-adjusted average length of stay, andwage- and severity-adjusted average cost.

Winners, such as Hoag Hospital, showed:• A full 12 percent lower cost in treating cardiovascular

patients while providing higher quality care.• Significantly lower 30-day mortality rates than peer

hospitals.• Significantly lower readmission rates within 30 days

for patients with heart failure and heart attacks, and thesame rate of readmissions for open-heart surgery.

• Better clinical efficiency, with patients returning to daily life an average two-thirds of aday earlier than in peer hospitals.

“This is a great honor achieved by the hard work and dedication of not only Hoag Heartand Vascular Instituteʼs physicians and nurses but Hoag Hospitalʼs entire staff,” commentedRichard Afable, M.D., president and CEO of Hoag Hospital. “We continue to surpass nation-al benchmarks and provide our patients with the highest possible level of care.”

The study, in its 11th year, found that the 100 Top Hospitals cardiovascular winners have:• 17 percent lower mortality rates for heart attack patients.• 10 percent lower mortality rates for heart failure patients.• 27 percent lower mortality for bypass surgery patients.• 22 percent lower mortality following PCI.• Fewer post-operative complications — 99 percent of patients were complication-free.• Close to 12 percent shorter average hospital stay.

Pioneer in providing progressive cardiovascular careSince 1987, Hoag Heart and Vascular Institute (HHVI) has been a pioneer in providing

progressive cardiovascular care. As one of the preeminent cardiovascular centers on theWest Coast, HHVI has continued to advance and remain the highest volume cardiovascularprogram in Orange County. Its extraordinary team of world-renowned physicians and staffleads the way by delivering the highest level of care, leadership and technology to itspatients 24 hours a day, seven days a week, 365 days a year. HHVI currently has 56 cardi-ologists and cardiovascular surgeons on staff, and provides a broad scope of cardiac pro-grams with the latest in diagnostic, interventional, surgical and rehabilitative services formanaging and preserving cardiovascular health.

With angioplasty and cardiac stent placement services available 24/7, and response timesfrom the ER to the cardiac cath lab that are nearly 20 percent faster than the national aver-age, Hoag is a proven leader in emergency heart care. Hoag Heart and Vascular Instituteoffers the latest in cardiovascular medicine with advanced and pioneering surgical tech-niques including minimally invasive heart surgery, ablation for treatment of arrhythmias, andcoronary artery bypass surgery with endoscopic vein harvesting. Additionally, as the firstdedicated heart and valve center on the West coast, Hoagʼs valve surgery program is inter-nationally recognized for expertise in complex valve surgery and mitral valve repair.Highest rating by Society of Thoracic Surgeons

As Orange Countyʼs highest-volume cardiovascular program, Hoag Heart and Vascular

AHHooaagg NNaammeedd AAmmoonngg 110000 TToopp HHoossppiittaallss

ffoorr CCaarrddiioovvaassccuullaarr CCaarree

Hoag Heart and Vascular Institute

Institute performs nearly 400 surgeries each year. On a yearly basis, the cardiovascular sur-gical team at Hoag Heart Valve Center repairs more heart valves than any other medicalcenter in Orange County. Hoag combines the expertise of internationally recognized cardi-ologists and cardiovascular surgeons with state-of-the-art technology to offer patients world-class care at a dedicated center.

For HHVI patients who have or will undergo valve or coronary artery bypass surgeries,they can rest assured that they are in the most capable hands.

According to the Society of Thoracic Surgeons (STS),Hoagʼs cardiac surgical program ranks within the top 10percent of programs in the country for quality and suc-cessful patient outcomes. The STS designated Hoagʼscardiac surgical program a three-star, the highest possi-ble rating awarded, now includes Hoag as one of theelite heart and vascular programs in the country.

“While it is an honor for Hoag to receive an award suchas this, we believe it is of much greater importance to ourpatients,” said Aidan A. Raney, M.D., Hoag Hospitalʼsmedical director of cardiac surgery. “The distinction insurgical performance and outcomes at Hoag is at a levelof care currently superior to 85 percent of hospitals in thecountry. Itʼs important to let our community know aboutdesignations such as this so that when facing cardiac

surgery, patients can feel confident, and make an informed decision as to where to havesuch a highly technical procedure. In cardiac surgery, it does make a difference. We wantour community to know world-class health care is right here at home.”Nationally accredited for all HHVI programs

To further qualify Hoag as a top heart and vascular program, HHVI has received nationalaccreditation for all of its programs. HHVIʼs echocardiography laboratory has receivedaccreditation from the governing body of the Intersocietal Commission for the Accreditationof Echocardiography Laboratories (ICAEL). HHVI also has the longest-running accreditationin Orange County for its vascular laboratory through the Intersocietal Commission for theAccreditation of Vascular Laboratories (ICAVL) and has received national accreditation forits cardiac rehabilitation program through the American Association of Cardiovascular andPulmonary Rehabilitation (AACVPR).

Hoag is also one of the first hospitals in the U.S. to provide drug-eluting coronary stentsand has been involved in a series of clinical trials for carotid stents to evaluate the potentialfor these devices to prevent stroke. Hoag is one of the Regional Education Centers inCalifornia, and one of just a few nationwide authorized to educate other physicians in thisnew technology.

Hoag remains committed to supporting clinical research to complement our patient careinitiatives. The clinical trials program at HHVI includes numerous industry-sponsored stud-ies that consist of medical devices and drugs. By researching investigational drugs and pro-cedures, HHVI can offer patients opportunities generally available only at university hospi-tals.

As the field of cardiology continues to transform, Hoag Heart and Vascular Institute willcontinue to be at the forefront of its evolution.

“Without a doubt, cardiology in the next 20 years will be transformed in ways we cannotimagine today, just as it has over the last 20 years,” commented Robert Tancredi, M.D.,F.A.C.C., executive medical director of Hoag Heart and Vascular Institute. “As this transfor-mation happens, and new technologies and innovations surface, the team at Hoag Heartand Vascular Institute will continue to provide cutting-edge, specialized medical care and theability to respond urgently to a patientʼs needs through our Newport Beach facility andthrough our expansion to Hoag Hospital Irvine.”

For more information about Hoag Heart and Vascular Institute, please call 949-764-5871or visit www.hoaghospital.org/heartinstitute.

Hoag Hospital in Newport Beach





tʼs no secret that information technology (IT) has transformed the way most industries inthe United States function. From retail to manufacturing to banking, computers make amajor difference.

Whatʼs truly surprising is that the health care industry has lagged behind others in mak-ing the transition to IT systems. While advances in medical technology such asimplantable defibrillators, molecular diagnostics, and remote monitoring are available to

medical personnel, doctors and nurses in the U.S. primarily depend on paper records to man-age treatment decisions and patient information.

Patient medical information is typically kept by a variety of physicians at multiple locations,often making vital medical records unavailable in an emergency. Patients and their loved oneshave to rely on memory or their own paper records for important medical history informationsuch as medications and allergies. Critical records can be located and faxed to the EmergencyDepartment, but this takes time, and time is a crucial factor in any emergency.

It also can be difficult for doctors to make the best treatment decisions for their patients wheninformation on new advances or best practice guidelines isnʼt readily available when needed.And consumers canʼt fully participate in managing their own health when they donʼt haveaccess to information to help them make informed choices about doctors, treatments, or hos-pitals.Lack of health information technology has a measurable effect

Patient safety, health care costs, and quality and efficiency of care are all affected by the lackof health information technology (HIT):

• An April 2009 HealthGrades study found approximately 22,771 Medicare deaths attributa-ble to potentially preventable, in-hospital medical errors. Studies have shown that HIT can helpreduce medication errors by as much as 80 percent.

• As much as $300 billion a year is spent on the overuse of antibiotics and lab tests. At onehospital, a study indicated that most redundant tests could be eliminated by computerizedreminder systems, saving $930,000.

• Physicians ordered 14 percent fewer tests per outpatient visit when using computer work-stations, because the workstations showed prior test results.

• Widespread adoption of electronic medical record systems and other HIT could save theU.S. health system as much as $162 billion a year in health costs.Electronic records have high level support

Beginning as early as 2004 President Bush outlined a plan to ensure that most Americanswould have access to electronic medical records within 10 years. President Obama is keepingthe momentum going by making HIT a key component in the health care reform debate. Theefforts of both administrations have prompted some communities, health insurance providers,hospitals, and information technology companies to improve their HIT systems by implement-ing technologies such as electronic medical records and computerized prescription ordering.However, capabilities and consumer access to information vary widely.Moving HIT forward with Kaiser Permanente HealthConnect®

At Kaiser Permanente HIT has moved well beyond the research phase with the implementa-tion of Kaiser Permanente HealthConnect®, our comprehensive, secure database incorporat-ing what may be the most sophisticated electronic medical record in civilian health care.Recently, we looked into KP HealthConnectʼs ability to share critical member health informationwith other systems. Portability of health records ensures that a personʼs health information cantravel with them if they change insurers or providers.

In December 2009, we began a pilot program that connected two of the nationʼs largest andmost successful electronic health record systems – the United States Veterans Administrationand KP HealthConnect. Veterans who receive care from both organizations were invited to par-ticipate and give permission to share specific health information electronically. The goal was todesign a secure way to transfer health data electronically so that patients could visit other sys-tems and have their medical information follow them. The pilot program was a success.Understanding the terminology

With the growth of HIT, several new terms have emerged. Itʼs important to understand the dif-ferences between an electronic medical record (EMR), an electronic health record (EHR), anda personal health record (PHR).

• Electronic medical recordAn EMR is a computer-based record that contains the information normally found in a

patientʼs paper medical record. Data in an EMR is controlled by and intended for use by med-ical providers. An EMR is typically created and maintained by a single physician or practice.

• Electronic health recordAn EHR includes an EMR but contains information across primary care, specialty care, ancil-

lary care (pharmacy, labs, radiology), and hospital settings. An EHR may also link a patientʼshealth plan, scheduling, and billing information into a single record. Because of the integrated

IWWhhyy HHeeaalltthh CCaarree NNeeeeddss aa TTeecchhnnoollooggyy MMaakkeeoovveerr

by Kate Christensen, MD, Medical Director, Kaiser Permanente Internet Services Group

Kaiser Permanenteʼs My Health Manager is a personal health record that empowers members to log on to aWeb site and access their medical information—taking control of their health, anytime, anywhere.

nature of an EHR, it has the ability to offer computerized physician order entry (CPOE) andadvanced decision-support tools to increase quality and patient safety.

The computer becomes a part of the normal physician office exam room equipment, allowingthe doctor to see each patientʼs information onscreen as needed, right at the point of care. Dueto HIPAA privacy concerns, this type of technology is most likely to succeed in an integratedcare delivery system, in which all providers, hospitals, pharmacies, and insurance billing func-tions are part of the same organization.

• Personal health recordIdeally, a PHR provides comprehensive health information such as medications, allergies,

immunizations, lab test results, office or hospital visit information, and e-mail exchangesbetween patients and doctors, as well as key health financing information such as coveragedetails and billing information. Most PHRs are Internet-based, with security and privacy controls,although some stand alone.

A fully realized PHR empowers consumers to take charge of their own health and accomplishtheir health tasks. It also gives them the ability to manage their loved onesʼ health care, with theright privacy protections in place. with the most advanced and integrated systems, consumerscan schedule appointments and refill prescriptions online, review lab test results and benefitsinformation, and even view and print their childrenʼs immunization records. With secure e-mailmessaging, members can also communicate with their doctors anytime, from anywhere.

Demand for HIT is growingAccording to the U.S. Centers for Disease Control and Prevention, between 2001 and 2007

there was a 60 percent increase in the number of physicians using EMRs. The Deloitte 2009Survey of Health Care Consumers showed that the number of respondents who have a com-puterized personal health record grew from 8 percent in to 9 percent. According to the study, thefigures for Americans who want better HIT are impressive:

• At least 57 percent of those surveyed want a secure Internet connection that would let themaccess their personal health information.

• Up to 55 percent of survey respondents would like to communicate with their doctor by e-mail.

• Six in 10 consumers have looked online for treatment option information in the past year.

Prepare for a positive changeAt Kaiser Permanente electronic health records are available 24/7 in all of our medical offices

and hospitals. Members can access their My Health Manager electronic health record onlineanytime to set up office visit appointments, order prescription refills, check lab test results, andmore. In 2009:

• More than 5 million lab reports were viewed electronically by members.• Members exchanged more than 2 million e-mails with their doctors.• More than 1 million prescription refill orders were submitted online.

Focus on wellnessKaiser Permanenteʼs philosophy centers on keeping our members healthy, not just treating

them when they are ill. We promote our membersʼ wellness by combining preventive care andhealth education with appropriate clinical intervention. The technology of KP HealthConnectgives us another tool for protecting member health.

Advances have already been made in preventing manageable diseases. In one study, wereduced cardiac deaths by 73 percent. Now weʼre testing the same technologies and process-es on other chronic conditions.

If youʼd like to know more about HIT use at Kaiser Permanente, contact your broker or KaiserPermanente representative. Visit kp.org for a test drive of the My Health Manager electronichealth record.

Kaiser Permanenteʼs electronic medical record is a secure database that connects 8.6 million Kaiser Permanentemembers to their health care teams, their personal health care information, and the latest medical knowledge.

In a recent study of members registered on Kaiser Permanente HealthConnect®,annual adult primary care outpatient visits decreased by nearly 7 percent among

patients using electronic messaging.“Patient Access to an Electronic Health Record with Secure Messaging: Impact on Primary Care

Utilization,” Yi Yvonne Zhou, PhD; et al., American Journal of Managed Care, July 2007, page 418.

A 2009 Lightspeed Research study revealed that 59 percent of people agreed that being able to communicate with their doctor via e-mail would

help them avoid making an office visit.



or many healthcare practice shareholders, buy-sell agreements hold about as muchnear-term importance as estate planning. They know that it is important but the issueseems so far away that they would prefer to put it off until later. However, putting offa buy-sell agreement can cause major problems if the event (e.g., death of a share-holder) comes sooner than expected. It is certainly much easier to address theseissues while all parties get along rather than deal with disgruntled shareholders or the

heirs of a deceased shareholder.A buy-sell agreement is intended to provide for the continuity of ownership and, hopefully, the

future continuation of the practice. These agreements usually address several key issues:Who can buy a departing shareholderʼs share?

It is important to consider if the purchase is limit-ed to shareholders or if outsiders can be owners.The buy-sell agreement can be designed to fulfillthe wishes of the shareholder, which is very impor-tant for an asset that may have taken a lifetime tobuild.What can trigger a buyout?

The review of “trigger events” may take sometime to consider. In addition to death, disability, orretirement, other reasons to purchase the businessmay develop, such as shareholder disputes andpersonal reasons (e.g., divorce or bankruptcy).These events should also be considered in terms ofhow the practice is valued under each scenario.How will the buy-sell be funded?

Business succession specialists often recommend that a buy-sell agreement should be fund-ed, at least partially, with life insurance, since most purchasers do not have enough cash on-hand. If a life insurance policy is desired, a valuation will likely be necessary. Once a value isset by an appraiser and agreed on by all shareholders, the amount becomes the value used forthe buy-sell agreement. Of course, certain trigger events, such as divorce, will not be paid forvia a death benefit at all, so other funding vehicles should be considered.How will the practice be valued?

The actual valuation of the practice is, of course, a critical element. Purchasers often have avery different idea of what a practice is worth versus an owner. A valuation can be used to deter-mine the purchase price for a shareholderʼs interest in the partnership, which can be a fixedprice, a formula or a valuation process completed by a valuation professional. Valuation firmsconsider several methods in valuing a practice, including market (i.e., similar practice sales),income, and asset-based valuations. To avoid litigation, a fair and clear valuation process isimportant, as well as other stop-gap measures to resolve disagreements. Your business valua-tion professional can explain all of these issues and how to best deal with them in your situa-tion.What process will be used to purchase the practice?

The actual process used to purchase the practice can be specified in the buy-sell agreement,such as a cross-purchase plan or a repurchase plan. If funding is from a life insurance policy,certain structures are established to facilitate this process.

Since the ownership interest in a practice is often the largest financial asset of the share-holder(s), it is crucial to seek the advice of qualified advisors in structuring your buy-sell agree-ment. Contact HMWC CPAs & Business Advisors with your questions.

F

Steve Williams, CPA, is the managing partner of HMWC CPAs &Business Advisors (www.hmwccpas.com) in Tustin. He also headsthe firmʼs Healthcare Practice and has served healthcare clients forover 25 years. Steve can be contacted at (714) 505-9000.

Steve Williams, CPA

BBuuyy--SSeellll AAggrreeeemmeennttss ffoorr HHeeaalltthhccaarree PPrraaccttiicceess



Itʼs been about six months since Mission Hospital acquired what is nowMission Hospital Laguna Beach. Looking back on the last six months,what have been the biggest challenges so far?A: One of the biggest has been with the facility structure itself, but weʼve tried

to meet it all in stride. If youʼve ever bought a home, you know that youʼre alsoinheriting any improvements or upgrades needed to fit your current standards.In the same sense, weʼre addressing aspects within the hospital building thatneeded improving, such as the central plant – the

heating, cooling and electrical systems. Weʼre currently in the processof updating the technology that runs this to ensure the system canmeet our current and future needs. After all, weʼre here for the longhaul.

Q: How much has Mission Hospital actually invested in thefacility since it took ownership?A: Before we came on board last July, we had already invested

about $3 million in information technology improvements. Weʼre nowlooking at refurbishment costs close to $10 million. This facility is 50years old, so itʼs not surprising that some things would have to getupdated. But our focus and commitment remains on making sure ourpatients and staff are in a place that best meets their needs. You canʼtput a price on that.

Q: Speaking of patient needs, how have you integrated the medical services offered atthe two campuses?A: Although both campuses operate under the same Mission Hospital license, there are cer-

tain vital services needed in each community. In Laguna Beach, these include a 24-hour emer-gency room, operating rooms to support the ER, medical-surgical beds, critical care and behav-ioral health including inpatient and outpatient psychiatric services and chemical dependencytreatment. Weʼve also kept other services such as MRI, mammography and even the pet ther-apy program. Mission Hospital has been caring for the community for 40 years, so we are morethan familiar with the core services needed. What weʼve had to really take a good look at arethe needs that are unique to this specific community. Weʼre currently conducting a communityhealth needs assessment for the Laguna Beach area, something that the Mission Viejo campushas been conducting every three years. This will help guide us in developing programs andservices that are needed most.

Q: Do you plan to share the results of your assessment?A: Yes, we plan to present the results this month, followed by prioritization forums in February

and March. Weʼll then look at the raw data from our assessment alongside the feedback fromthese forums. Together, these will help guide us in the strategic planning process.

Q: Why such an effort to include feedback from the community?A: We understand that weʼre the new kid on the block. We donʼt assume to have all the

answers coming in here, and we welcome any feedback from those who are already here.Creating an open, genuine dialogue is an invaluable education process for us. Weʼve been hold-ing monthly Neighbor Forums for community members to ask questions and voice their con-cerns. Weʼve also established a Community Advisory Council, which includes business andcivic leaders, past board members of the hospital, neighbors, among others. Even during the

Q:MMiissssiioonn HHoossppiittaall LLaagguunnaa BBeeaacchh

Questions and Answers with Michael Beck

Michael Beck, Vice President of Operations at Mission Hospital Laguna Beach (MHLB), works to align MHLB with Mission Hospitalʼs core values and business objectives as part of the St. Joseph Health System.

acquisition phase, we asked for community feedback via our Web site and a community hotline.Only through open communication can we take an honest look at what we need to do, and howbest to do it. What folks may not realize is that our Catholic heritage calls us to reach out to ourcommunities and discover what is needed, and then pull people together to meet those needs.Of course, weʼre realistic in knowing we canʼt please everyone. But we are committed to beinggood neighbors while providing excellent healthcare.

Q: You mentioned being here “for the long haul.” Do you haveany long term plans?A: In addition to studying community health needs, weʼre also work-

ing on a long-term strategic plan for the hospital. This plan looks aheadfor the next five years, and weʼre planning to share it sometime earlythis year. Itʼs important to note that accomplishing the goals takes time.Itʼs a thoughtful process and we want to think through every aspect ofeach project. You might not know this, but it took almost 10 years toopen up the new patient tower on our Mission Viejo campus. This typeof long term planning is what helps keep us around to help enhance thequality of life for our staff, patients and communities.

Q: Mission Hospital Laguna Beach is part of St. Joseph HealthSystem, a non-profit Catholic healthcare ministry. What does thismean to the community?A:What the community can take comfort in knowing is that, as a part

of our non-profit, faith-based ministry, we invest back into the communities we serve. Thismeans providing additional services outside our hospital. The Sisters of St. Joseph of Orangehave been caring for the community for nearly a century. We seek to continue their legacy byproviding programs that extend our care to the coastal communities. In the last five years alone,Mission Hospital has invested more than $135 million into programs and services that improvethe well being of South Orange County residents. And these programs have run the gamut, fromsupporting student enrollment into college and career programs to community events that helpfight childhood obesity.

Q: What is the most rewarding part of your job?A: I get to talk to people all day. I believe that if Iʼm going to succeed in this role, I need to be

on the ground level, not stuck behind a desk. I need to be interacting with our physicians andnurses as well as our patients and our neighbors to learn what their needs and concerns are. Ithas been such a pleasure to meet and get to know such skilled and talented professionals. Wehave an excellent group of physicians and staff here, and I am thrilled for the opportunity to workwith them.

Q: Whatʼs the most challenging part of your job?A: The biggest challenge starting off was not knowing what to expect. As with any new role,

you want to succeed and do well. But that quickly faded as Iʼve come to know this campus, andcontinue to learn it inside and out. Though Iʼm new to the role, Iʼve been with Mission Hospitalfor nearly two decades, previously as the Vice President of Quality and Systems Improvementsat the Mission Viejo campus. Thatʼs prepared me well for my role here because I was directlyresponsible for establishing organizational systems, and I was constantly bringing together dif-ferent perspectives to work toward common goals. Much of that translates into what I do today.

For more information about Mission Hospital Laguna Beach, please visit mission4health.com.

Mission HospitalLaguna Beach





ewport Imaging Center is located in Newport Beach, at 360 San Miguel Road,adjacent to Fashion Island. Newport Imaging Center offers many preventivescreening exams, which can identify early illnesses or those at risk for develop-ing illnesses. The tests include Digital Mammogram, Coronary Artery CalciumScoring, Abdominal Aortic Aneurysm (AAA), Dexa Bone Density Test, LungCancer Screening and Virtual Colonoscopy, to name a few. Screening exams are

a proactive necessity, especially duringstressful times such as these, to improveyour health and reduce your risk of develop-ing heart disease, multiple forms of cancer,osteoporosis, and other fatal and debilitatingdiseases.

Depending upon the condition, the tech-nologist may use ultrasound, CT, or MRI. Aboard certified radiologist reads theseexams to rule out the presence of abnormal-ities. Most screening studies are covered by insurance, including Medicare, however NewportImaging Center suggests you check with your insurance provider.Take the proactive approach

Sometimes women tend to put their families and even their jobs before themselves, in turn,neglecting important health care screenings and failing to take preventive steps to insure theirown well-being. It is important for women to be proactive about their own health and to takecare of themselves, so they can be there for their families and others who depend on them.Digital mammograms

An annual mammogram is suggested by the American College of Radiology after the ageof 40, or earlier if there is a family history of breast cancer. Studies support that getting ascreening mammogram can help detect early signs of any problems.Coronary artery calcium scoring

Patients who find they have calcium in their coronary arteries, which supply blood and oxy-gen to the heart muscle, can change their eating and exercise patterns before artery block-age occurs which can lead to a heart attack. CAC is an important test for women and men,which can be a powerful motivator of health and lifestyle changes for patients.

Newport Imaging Center is dedicated to provide you with quality and convenience. Toschedule an appointment or for more information about Newport Imaging Center, please call949-721-8191.

NNNeewwppoorrtt IImmaaggiinngg CCeenntteerr OOffffeerrss

PPrreevveennttiivvee SSccrreeeenniinnggss ttoo HHeellpp YYoouu LLiivveeHHeeaalltthhyy aanndd SSttaayy HHeeaalltthhyy






Documents

Sponsored byocbj.media.clients.ellingtoncms.com/static/ocbj/supplements/HealthCare_2010.pdfcancer and endoscopic ultrasound (EUS) to diagnose and stage gas-trointestinal cancers. A