complex office visit

Calif. Docs Among Top Billers for Complex Visits

by Lisa Aliferis, April Dembosky and Lisa Pickoff-White May 22, 2014

When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor's time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.

Three California doctors are among the top five nationally in billing for the most complex office visits, according to data released by Medicare and analyzed by ProPublica and KQED.

Most doctors' billing patterns to the Medicare program fall in the middle ground between simple and complex.

In California, only 5% of doctors' office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine -- and bill -- a large proportion of their office visits as complex.

The analysis of Medicare billing data -- which was made public for the first time last month -- shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.

• In Orange County, Dr. Louis VanderMolen , a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79% of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12% of their office visits the same way.
• In the Santa Cruz County community of Freedom nearly every one of cardiologist Jeffrey Mace 's patients received -- and was charged for -- the highest complexity visit. Mace billed Medicare for these high-level visits almost 10 times more often than other cardiologists in California, and the third most in the country.
• Cardiologist Jay Schapira ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared with the one visit typical of other cardiologists in the state.

"That's unusual for a doctor who's not seeing patients in the hospital," said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. "Usually cardiac patients in the hospital are the ones that are about to die."

KQED conducted this analysis in conjunction with ProPublica, which published a national investigation last week. ProPublica also developed a "Treatment Tracker" tool, which allows consumers and journalists to look up a provider and see how often he or she bills at the highest level for office visits.

Patients Pay More, Too

These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. "Twenty percent of $200, for example, is obviously more than 20% of $100," said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. "There's a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient."

All established patient office visits are coded under a category called "evaluation and management." These visits are billed at one of five levels, with 5 being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.

The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.

"Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided," the agency said. "It's our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code ... for all or nearly all of his or her outpatient visits."

Only 1% of California doctors billed Medicare at the highest level for all of their office visits for their established patients.

Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.

'I'm Not an Average Cardiologist'

We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.

Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. "I'm not an average cardiologist," he wrote. "I spend a great deal of time taking care of patients. I generally spend 12 to 16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week, and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and, hopefully, improved quantity of life (longevity)."

But billing for an individual visit is not about a physician's dedication. Experts say it is about the patient's complaint that day. "What was it about the patient's clinical presentation and condition that warranted billing a level 5 service?" Melnykovych said.

In his statement, Mace said he had been "subject to several audits" over many years in regards to this level 5 billing code. He says that Medicare "has found all of the office visits reviewed to be correctly coded."

While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it's 40 minutes, Melnykovych said.

If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day -- presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.

Overpayment can happen for many reasons, including simple error. "But that doesn't preclude the federal government or any payer from coming to the (doctor) and getting their money back," Melnykovych said.

Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital -- Schapira is a professor at the school of medicine at UCLA -- that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is "currently on staff at Stanford."

A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an "independent community cardiologist who has 'courtesy admitting' privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford's faculty."

VanderMolen's website says that he "has had several university, hospital, and other appointments." It does not indicate any current affiliations with any academic medical centers.

Problems can also arise from the billing set up at a doctor's office. Many doctors don't do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.

"Many times a physician is not even aware of what their claims are or how their claims are coded," Blount says.

He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.

"Those algorithms are subject to human error," Blount says. "Some mistakes are being made by the electronic medical record vendors in how they designed the product that they're selling."

Still, according to Medicare rules, the ultimate responsibility for billing always rests with the doctor.

Frequent Visits

It's not just the total number of visits that could raise red flags among auditors -- repeat complex visits by individual patients could also be a cause for concern.

Dr. Gary Ordog is listed in Medicare's billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, nonurgent complaints, like sore throats, to more urgent matters, like a broken wrist.

According to KQED's analysis, Ordog's patients received -- on average -- 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is one complex visit per patient.

"That's a little suspect," says Patrice Morin-Spatz, a medical coding expert and trainer.

This is not the first time questions have arisen around Ordog's medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.

The California Medical Board tried to revoke Ordog's medical license in 2006 for "repeated negligent acts, incompetence, making false statements, and inadequate record keeping," according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers' compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.

Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.

How We Did This

KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare's Part B program in 2012.

KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.

We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.

Disclosures

This article, which first appeared May 21, 2014, is part of a reporting partnership that includes KQED , NPR and Kaiser Health News. It was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News , an editorially independent news service, is a program of the Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Jones’s life and career during Indian Removal, rebuilding in Indian Territory, the Civil War and Reconstruction will be explored to gain insights into the intertwined histories of the Choctaw Nation and capitalism in the South.

Jones was both a highly successful businessman and Choctaw nationalist, yet his legacy is complex since much of his wealth was amassed through the exploitation of enslaved African Americans. By highlighting his role in the Choctaw Nation’s economic development, politics and social relations, this research presents a nuanced portrait of a figure who was both a benefactor to his nation and a deeply flawed individual. Questions and discussion are welcomed.

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Suspect who shot, killed MPD officer Jamal Mitchell had criminal record, was wanted on gun charge

By Reg Chapman , Jennifer Mayerle , WCCO Staff

Updated on: June 3, 2024 / 5:50 PM CDT / CBS Minnesota

MINNEAPOLIS —  Officials have identified the man who shot and killed a police officer outside an apartment complex in south Minneapolis Thursday during a chaotic mass shooting that left four injured and a civilian dead, as well as the shooter.

The Hennepin County Medical Examiner's Office identified Mustafa Ahmed Mohamed as the third person who died at the scene earlier this week. Several police sources have told WCCO that Mohamed is the man who killed police officer  Jamal Mitchell .

Mitchell responded to a shots-fired call at the apartment and was helping Mohamed, coming to his aid, when Mohamed turned on the officer and shot him. Police officials say Mohamed continued to shoot Mitchell after he fell to the ground. 

Officers returned fire and Mohamed died at the scene. The medical examiner said Mohamed died of multiple gunshot wounds.

Mohamed, 35, was convicted of first-degree burglary in 2007 and was ineligible to carry a firearm. He had an active warrant out for his arrest stemming from a 2022 incident in which, court documents say, police saw him at the scene of a downtown Minneapolis robbery carrying a gun.

Mohamed allegedly hid the gun behind a pillar when he saw police arrive. When police chased him, he threw a gun holster to the side and was arrested at the scene.

In 2014, Mohamed pleaded guilty to federal charges of being a felon in possession of ammunition and a firearm, according to court records. He was sentenced in 2015 to a little more than eight years in prison, with three years of supervised release. According to the Federal Bureau of Prisons, an inmate whose name and demographics match Mohamed's was released in May 2020.

On Thursday, a civilian — later identified as 32-year-old Osman Jimale — was found dead inside the apartment. Another civilian inside the building was injured, as well as a man who was sitting in his car outside the building. A Minneapolis officer and firefighter were also injured.

A memorial is growing outside the 5th Precinct in Minneapolis honoring Mitchell, who joined Minneapolis police in 2022 with the goal of changing community-police relations. Originally from Connecticut, Mitchell was a father of three and engaged to be married.

Community gathered at the Apostle Supper Club in St. Paul for a fundraiser barbecue on Saturday, in which all the proceeds will go to Mitchell's loved ones.

"We wanted to come out and support, so we made a reservation and here we are, and we're running into wonderful friends and family so it's definitely important," said Trinny Cee.

Chef Brian Ingram and other celebrity chefs were on hand to show support for Mitchell's family and all who wear the uniform.

"We want to show them love so when they show up and they see so many people here to support them, I think that's what these officers need more than anything right now, is to know that they are loved and they matter and that's such an important part of it," said Ingram. 

For most, it was a way of doing something that promotes community healing.

"It's not just about the food and the drinks, it's really about showing people we show up for each other," said Jammetta Raspberry.

The Police Officers Federation of Minneapolis, Law Enforcement Labor Services and the Minnesota Police and Peace Officers Association will collect donations through the LELS Benevolent Fund , with all proceeds going to Mitchell's loved ones.

While many continue to mourn the loss of a hero, there is still a lingering question of why the man would shoot and kill an officer responding to a call for help.

The Minnesota Bureau of Criminal Apprehension is investigating the case. 

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Reg Chapman joined WCCO-TV in May of 2009. He came to WCCO from WNBC-TV in New York City where he covered an array of stories for the station including the Coney Island plane crash, the crane collapse on the city's east side, 50 shots fired at motorist Sean Bell by New York Police, and a lacrosse team assault at Fairfield High School in Connecticut.

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Knowing how your services are valued is key to understanding and improving your productivity.

ANNE C. KANTNER, MD, FAAP, FACP

Fam Pract Manag. 2023;30(2):4-8

Author disclosure: no relevant financial relationships.

Although the use of value-based payment models is growing, 1 the most common payment method in physicians' employment contracts is still a base salary plus a production bonus based largely on relative value units (RVUs). 2 RVUs reflect a physician's volume of work and level of effort in treating patients. The more RVUs a physician generates, the more income the practice (and the physician) should receive.

Knowing the RVUs assigned to different types of services allows physicians to understand how their productivity is measured. And knowing their RVUs per visit and per year allows physicians to understand how they compare to their peers. They can then assess whether they need to see more patients, work more efficiently, or change key processes such as billing and coding to better reflect the amount of work they are doing.

The four questions outlined in this article can help physicians get started in understanding and improving their RVUs.

Knowing the work RVUs assigned to different types of services can help you understand how your productivity is being measured.

Work RVUs vary depending on the work and effort required; for example, a 99212 has 0.70 work RVUs while a 99214 has 1.92 work RVUs.

To improve your total work RVUs per year, you may need to work more efficiently so you can see more patients, improve your coding practices to capture the full value of your work, or offer more high-value services, such as procedures or transitional care management.

1. WHAT ARE RVUS?

RVUs are part of the Resource-Based Relative Value Scale (RBRVS), which Medicare and other payers have used for decades to determine payment for physician services. RVUs are just one of three components that factor into the payment calculation. 3 The other two components are geographic practice cost indices (GPCIs), which adjust RVUs to reflect regional differences in the cost of physician services, and a conversion factor (CF), which is the dollar amount by which total, geographically adjusted RVUs are multiplied to arrive at the payment amount for a given service. (See “ How payment for a service is calculated. ”)

Total RVUs are the sum of three types:

Work RVUs , which reflect the physician's work, including mental effort, decision making, technical skills, physical effort, stress related to patient risk, and amount of time spent,

Practice expense RVUs , which reflect the clinical and nonclinical labor costs and practice expenses,

Malpractice RVUs , which reflect the liability insurance costs.

The remainder of this article will focus on work RVUs because they are a key measure of physician productivity. Work RVUs for common services in primary care are listed at the end of this article. For example, a 99214 established patient evaluation and management (E/M) office visit has 1.92 work RVUs, a “Welcome to Medicare” visit has 2.6 work RVUs, and a 99223 initial hospital visit (admission) has 3.5 work RVUs.

HOW PAYMENT FOR A SERVICE IS CALCULATED

Relative value units (RVUs) are just one of three components that factor into physician payment under the Resource-Based Relative Value Scale:

Total RVUs , which is the sum of work RVUs, practice expense (PE) RVUs, and malpractice RVUs,

Geographic practice cost indices (GPCIs), which adjust RVUs to reflect regional differences in the cost of physician services,

A conversion factor (CF), which is the annually updated dollar amount by which total, geographically adjusted RVUs are multiplied to arrive at the payment amount for a given service.

Payments are calculated as follows:

[(Work RVUs x Work GPCI) + (PE RVUs x PE GPCI) + (Malpractice RVUs x Malpractice GPCI)] x CF = Payment amount

2. WHAT ARE YOUR WORK RVUS?

If you are an employed physician, you likely receive productivity reports from your employer, but you may not be in the habit of looking at them closely or you may not know what to do with the information. A helpful report should provide you with the following individualized data:

Annualized work RVUs (projected total if you continue to generate the same amount of work for the rest of the fiscal year),

Number of visits,

Annualized number of visits,

Types of visits you are seeing (such as preventive care visits, E/M visits, hospital visits, and Medicare wellness visits),

A breakdown of your E/M visits (i.e., what percentage are coded as level 1, 2, 3, 4, or 5).

If you are expected to meet a goal for work RVUs, you should receive your data on a regular and predictable basis — e.g., monthly, bimonthly, or quarterly — allowing you to analyze the data and make adjustments in scheduling, coding, or practice efficiency to meet the goal. Waiting until the end of the fiscal year to distribute a finalized report does not allow physicians enough time to make effective changes.

Data should be accurate, trustworthy, and presented to physicians in a user-friendly way. Practices should have a contact person who understands the information well and can answer physicians' questions or investigate discrepancies should they arise.

If your employer does not provide you with a productivity report, or does not provide it in a timely manner, ask for it. Most EHRs and practice management systems capture the required data and can generate customizable reports.

You can estimate your work RVUs on your own using the process described in the physician example .

HOW TO CALCULATE WORK RVUS PER VISIT AND PER YEAR: AN EXAMPLE

Dr. Smith is a family physician in a physician-owned outpatient practice. He sees an average of 10 patients per session, or 20 visits per day, and his average work RVUs are 1.69 per visit. Out of 260 total workdays per year, Dr. Smith has 40 days for vacation, continuing medical education, holidays, etc., leaving 220 workdays per year. That means he averages 4,400 visits and 7,436 work RVUs per year, which puts him well above the 50th percentile in national benchmarks but below the 90th percentile.

Here's the method used to estimate his work RVUs:

First, list the types of visits in an average session, assign work RVUs to each visit, and add the values to get the total work RVUs per session.

Next, complete the following calculations:

Work RVUs per session ÷ Visits per session = Work RVUs per visit

16.88 ÷ 10 = 1.69

Workdays per year x Visits per day = Visits per year

220 x 20 = 4,400

Visits per year x Work RVUs per visit = Work RVUs per year

4,400 x 1.69 = 7,436

3. HOW DO YOUR WORK RVUS COMPARE TO BENCHMARKS

Practices should establish work RVU benchmarks at the beginning of the fiscal year and include them in productivity reports so physicians can see whether they are meeting work RVU goals. Practices may use internal data to set benchmarks, comparing you to your peers, or they may rely on national benchmarks from external sources. Benchmarks should be specialty-specific, but they may differ for inpatient versus outpatient practice, new versus established physicians, and physician-owned practices versus practices owned by hospital or health systems.

For example, according to data from the Medical Group Management Association, for family medicine physicians in physician-owned outpatient practices, the 50th percentile is 5,945 annual work RVUs and the 90th percentile is 9,063. 4 Meanwhile, for those in hospital-owned or health-system-owned outpatient practice, the 50th percentile is 4,715 annual work RVUs and the 90th percentile is 7,451. One possible reason for the difference is that physician-owned practices may be more likely to reward productivity, while practices owned by a hospital or health system may be more likely to use straight salary compensation.

4. HOW CAN YOU INCREASE YOUR WORK RVUS?

If your work RVUs are below goal, there are several ways you may be able to increase them. Start by examining the following factors.

Visit volume . To assess whether low patient volume is contributing to low work RVUs, identify how many patients you see per day. A 2018 survey by the Physicians Foundation found an overall average of 20.2 patients per day across all specialties. 5 According to data from the American Academy of Family Physicians, family physicians average 84 patient encounters per week — 63 in the office, 12 e-visits, seven in the hospital, and two in nursing homes or house calls. 6 What ultimately matters is the benchmark your group is using. If your visit volume is too low, that does not necessarily mean that you need to work longer each day, but you may need to work more efficiently in order to see more patients. For example, you may need to delegate more tasks to your team, or you may need to address a high no-show rate.

Visit levels . Identify what percentage of your E/M visits are level 1 through 5, and compare this distribution to that of your peers. If your practice cannot provide this data, you can use national benchmarks derived from Centers for Medicare & Medicaid Services data (see this FPM worksheet , which has been updated with 2021 data). If you find that you are billing a higher percentage of lower-level visits than your peers, you will need to either see more patients to achieve the same overall work RVUs or investigate other issues. For example, it could be that your billing, coding, and documentation practices are inefficient, leading to under-coding or missed coding.

High-value visits . Identify which high-value visits you frequently provide, and which ones you should be providing. (See the list of work RVUs for different visit types on page 7 .) For example, new patient visits have higher work RVUs than established patient visits, so if you've closed your panel to new patients, this could be affecting your work RVUs. Many procedures are also valued highly, so you may want to consider expanding your scope of practice by adding skin procedures, joint aspirations and injections, treadmill stress tests, etc. Transitional care management visits and Medicare annual wellness visits are also higher-value services. Consider whether you can provide these to patients who need them, and how your care team can assist with the workload.

Visit lengths . Track your visit lengths for various visit types to see whether you need to adjust your scheduling practices. Adjusting visit duration in your scheduling template can allow you to see more patients per day or per session to meet your work RVU goals. For example, a physician who has a goal of 30 work RVUs per day and averages 1.3 work RVUs per visit (the equivalent of an established-patient, level 3 office visit) would need to see 23 patients per day. In an eight-hour workday, that would allow for an average of 20-minute visits. Note that time-based billing became easier following the 2021 E/M coding changes and now includes the physician's total time spent on the day of the visit (not only face-to-face time but also pre-visit planning, coordination of care after the visit, and other physician activities).

WORK RVUS FOR COMMON VISIT TYPES

FOCUSING ON WHAT YOU CAN CONTROL

Some aspects of physician productivity are beyond your control. For example, you can't really control whether your schedule is full every day or what level of care your patients need. However, it's still beneficial to understand the factors that are affecting your work RVUs so you can assess your performance and make the case for what you need, such as more clinical support staff or a second exam room. Improving productivity isn't just about working harder, but working smarter and identifying changes in practice operations and efficiency that will actually make a difference.

Johnson K, Rittenhouse D. From volume to value: progress, rationale, and guiding principles. Fam Pract Manag . 2023;30(1):5-7.

Singleton T, Miller P. Employment and contract considerations for family physicians in the era of COVID-19. Fam Pract Manag . 2021;28(1):11-16.

What are relative value units? AAPC. Updated June 21, 2022. Accessed Jan. 27, 2023. https://www.aapc.com/practice-management/rvus.aspx

Medical Group Management Association. DataDive provider compensation: 2022 report based on 2021 data; 2022. https://www.mgma.com/data/data-reports/2022-mgma-data-dive-provider-comp-report

• 2018 survey of America's physicians. The Physicians Foundation and Merritt Hawkins. September 2018. Accessed Jan. 27, 2023. https://physiciansfoundation.org/physician-and-patient-surveys/the-physicians-foundation-2018-physician-survey

Slideshow: a week in the life of a family physician. FPM . 2020. Accessed Jan. 27, 2023. https://www.aafp.org/pubs/fpm/multimedia/slideshows/fp-hours-compensation.html

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Apple Park Visitor Center

Welcome to Apple in California. Apple Park has created a special place just for visitors. An architectural extension of the private campus, the Apple Park Visitor Center offers guests a place to learn, explore, shop, and more.

Created to illustrate the intention of building an office park that fits into the natural landscape, discover the Exhibition space within the Visitor Center that showcases the innovative design principles of Apple Park. Then, shop at the Store, which includes exclusive Apple and Apple Park branded merchandise. The merchandise is a highly curated selection of Apple products and accessories.

After exploring the Exhibition and Store, relax at the Apple Cafe. With comfortable seating both inside and out, the Cafe serves refreshments for guests to enjoy as they take in the surrounding olive grove. Lastly, head up to the Roof Terrace, which features a unique view of Apple Park and its rolling landscape.

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50 AWESOME THINGS TO DO IN SANTA CLARA

1. attend an event at  levi’s stadium   – where super bowl 50 was played, 2. ride a rollercoaster or see a show at  california’s great america theme park , 3. explore the people and technology that changed our world at the  intel museum ,  4. walk through the pedestrian mall at santa clara university,     , 5.  have a picnic, take a walk, or just relax in beautiful central park, 6. visit the art galleries and sculpture garden at the  triton museum of art ,  7.  visit “winterfest” at california’s great america – november – december., 8. dine, shop, or see a movie at mercado santa clara – less than a mile from levi’s stadium, 9. go back in time at historic  mission santa clara de asis,  10.  visit the  49ers museum presented by sony, 11. shop at westfield valley fair,   ,  12.  fill your day viewing art at the de saisset museum , 13. take a photo next to the 32 ft. high  shrine of our lady of peace  statue,  14. take a self-guided walking tour of santa clara history at “stroll into the past”,  15.  see the statue of one of the iconic popes – st. john paul ii,  16. take a selfie with the bronze statue of a bronco at santa clara university,  17. go for a swim at george f. haines international swim center,  18. spend your saturday at the  farmer’s market  (open year-round), 19. stop by the santa clara depot & edward peterman museum of railroad history,  20. test your driving skills at k1 speed kart racing,  21. jump at sky high sports,  22. enjoy music, theatre, and dance with scu presents at santa clara university,  23.  hike along the san tomas aquino creek trail ,  24. showplace icon theatre & kitchen at valley fair.

 25.  JOURNEY BACK IN TIME TO THE LAST FARM SITE IN SANTA CLARA AT THE HARRIS-LASS HOUSE MUSEUM

26.  enjoy free “concerts in the park”   at the central park pavilion, 27.  see former nba superstar steve nash’s alma mater the santa clara university broncos play basketball, 28. have fun at  bay area travel & adventure show ,  pacific international quilt festival ,  stitches west ,  coin, stamp, & collectables show  at the  santa clara convention center, 29.  play a relaxing nine holes of golf at pruneridge golf club, 30. beat the lock live escape room, 31. see the universal child 85 ft. tall statue whose shape and lines represent the 1960’s missile and space era, 32.  watch renowned santa clara university women’s soccer. the “bend it like beckham” – movie depicts two young girls’ dreams of playing soccer in santa clara, 33. take a photo of the patron saint of santa clara (st. clare) at civic center park, 34. “anything’s possible,” a bronze sculpture by linda serrao, was designed to convey the spirit of santa clara’s motto the “center of what’s possible.”, 35. get spooked september & october at “tricks and treats”.

 Tricks and Treats at California’s Great America

36. VISIT THE SHOPS AND EATERIES AT RIVERMARK VILLAGE

37.  spend the day visiting santa clara’s only natural open space at  ulistac natural area., 38. sit back and enjoy a santa clara players theater performance at the triton museum – hall pavilion, 39. save on california’s great america hotel packages  (friday and/or saturday night stays based on availability),  40.    enjoy the booths, foods, fine wines, micro-brewed beer, and live entertainment at the  santa clara art & wine festival,  41. see an affordable, family friendly youth theater production at roberta jones junior theater ,  42. shop or dine at the santa clara town centre,  43. relax with good food, shops, and more at franklin square,  44. see the beautiful mission gardens   at santa clara university,  45. visit california historical landmark #249 – santa clara woman’s club adobe,  46. go to an awesome annual summer event like the santa clara parade of champions, santa clara arena pro swim meet, and/or the silicon valley bbq championships,  47.  commute on caltrain from san francisco or the peninsula to the santa clara station,  48.  visit santa clara square to dine and drink at one of the city’s newest restaurants: fleming’s prime steakhouse & wine bar, ii fornaio, opa, and/or puesto,  49.  enjoy the santa clara sports environment at any one of a number of sports bars, including bourbon pub, character’s sports bar & grill or the halford., 50.   stroll through the beautiful, peaceful mission city memorial park, share this post.