ESCAMBIA COUNTY MEDICAL SOCIETY
JULY/AUG2010 Volume 40, No. 4
President’s Message
The “New” Medicare Delivery Model By Wayne Willis, MD
CME Event Tuesday | August 10 Angus Resturant 6:00 pm Social Hour 7:00 pm Dinner and Presentation Sponsor: Baptist Heath Care Speaker: Dr. Brett Smith What?s In and What?s Out In Total Joint Replacement RSVP 478-0706 ECMSinfo@bellsouth.net Founded in 1873
The Greatest Generation may be the last group of Americans to enjoy the best healthcare system in the world. The wheels haven’t fallen off but they’re starting to wobble as doctors and patients face the perfect storm. Rising healthcare costs, increasing national debt and a flood of baby Boomers joining the Medicare ranks has the policy wonks working overtime. Adding fuel to the fire will be the forty million uninsured added to the system under the new healthcare reform. Rather than look for bottom-up solutions that are consumer driven, the policy makers and academics have come up with a new acronym and a top down solution called Accountable Healthcare OrganizationsACO. These organizations are designed to provide cost control to Medicare patients in a fee for service arrangement. Unlike the current Medicare HMO type plans (Advantage Medicare Plans such as Wellcare) Medicare patients would not sign up for a plan but would be enrolled automatically in whatever ACO their Primary Care Physician (PCP) belongs to. The hope is that care coordination can be moved from the insurance company down to the level of the PCP working in a Medical Home Model. In the most basic form the infrastructure necessary to make this work includes social workers, dieticians, home health nurses and other resources provided by the ACO. Electronic Medical Records and other forms of electronic data exchange are the glue that will hold all this together. Some portion of money saved in this arrangement would flow back to the providers. Any group thinking about forming an ACO must first figure out how to provide their PCPs with all the necessary pieces required and make the infrastructure profitable. I would also guess that the time required to fill out paperwork- or click through another computer screen- while coordinating all this care, would mean fewer patients seen. Providing the PCP with more nurses to help with all the additional care coordination would help, but drives the cost up. Hopefully the academics proposing this new model of care will work out the detail before going forward. In the meantime, take a look at this question and answer section on ACOs. If you are intrigued and would like additional information go to our website at
www.escambiacms.org. Q: What is an “accountable care organization”? A: An Accountable Care Organization, also called an “ACO” for short, is an organization of health care providers that agrees to be accountable for the quality, cost, Dr. Wayne Willis and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. For ACO purposes, “assigned” means those beneficiaries for whom the professionals in the ACO provide the bulk of primary care services. Assignment will be invisible to the beneficiary, and will not affect their guaranteed benefits or choice of doctor. A beneficiary may continue to seek services from the physicians and other providers of their choice, whether or not the physician or provider is a part of an ACO. Q: What forms of organizations may become an ACO? A: The statute specifies the following: 1) Physicians and other professionals in group practices 2) Physicians and other professionals in networks of practices 3) Partnerships or joint venture arrangements between hospitals and physicians/professionals 4) Hospitals employing physicians/professionals 5) Other forms that the Secretary of Health and Human Services may determine appropriate. Q: What are the types of requirements that such an organization will have to meet to participate? A: The statute specifies the following: 1) Have a formal legal structure to receive and distribute shared savings 2) Have a sufficient number of primary care professionals for the number of assigned beneficiaries (to be 5,000 at a minimum) 3) Agree to participate in the program for not less than a 3-year period 4) Have sufficient information regarding participating ACO health care professionals as the Secretary determines necessary to support beneficiary assignment and for the determination of payments for shared savings. 5) Have a leadership and management structure that continued on page 3
ECMS Bulletin The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/ Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management. Editors Norman Vickers, MD Holly Strickland, Executive Director
AD PLACEMENT Contact Holly Strickland 478-0706 Ad Rates Full page: $600 • ½ page: $300 • ¼ page: $150
In a MEDICaL MaLPRaCTICE CLaIM: Be ready for anything and everything.
2010 ECMS Officers President Wayne Willis, MD President-Elect Michelle Brandhorst, MD Vice President George Smith, MD Secretary /Treasurer Wendy Wozniak, MD
Decades of experience, true financial stability, and a tough-as-nails defense team make First Professionals a well-rounded — and yes, affordable — choice when it comes to protecting your medical reputation and career. No other Florida medical malpractice provider knows the industry quite like we do, nor do they defend our doctors with as much tenacity. We’re committed to protecting you and everything you’ve got, with everything we’ve got.
Page 4 Medical Accounts Receivables Page 6 & 7 Newest Membership Benefits
You save lives. We save livelihoods.
Pages 9-12 Vendors of Choice
www.firstprofessionals.com
Vision for the Bulletin: -Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond. - Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs. - A powerful instrument to attract and induct members to organized medicine. Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.
For more information, contact Shelly Hakes, Director of Society Relations at (800) 741-3742, Ext. 3294.
Endorsed by
Escambia B-W 3.5x10.indd 1
1/8/10 12:08:25 PM
Membership Welcome New Members! Charles Burns, M.D. Medical School: West Virginia University, 1985 Residency: University of Kansas School of Medicine Board Certified: American Board of Pathology The Pathology Group of Northwest Florida 4724 North Davis Hwy Phone: 438-1154 | Fax: 433-6034 www.pathology-group.com
Herbert Gannon, M.D. Medical School: University of Alabama Medical School, 1972 Residency: University of Alabama Board Certified: American Board of Obstetrics & Gynecology Covenant Hospice 5041 North 12th Ave Phone: 202-5814 | Fax: 202-0600 www.covenanthospice.org
Rodney Durham, M.D. Medical School: Medical College of Georgia, 1980 Residency: University of Michigan, General Surgery Residency: University of Texas, Trauma & Critical Care Board Certified: American Board of General Surgery & Surgical Critical Care Sacred Heart Medical Group Department of Trauma 5149 North Ninth Ave. Phone: 416-6159 | Fax: 416-7198 www.sacred-heart.org
The “New” Medicare Delivery Model, continued from page 1 includes clinical and administrative systems 6) Have defined processes to (a) promote evidenced-based medicine, (b) report the necessary data to evaluate quality and cost measures (this could incorporate requirements of other programs, such as the Physician Quality Reporting Initiative (PQRI), Electronic Prescribing (eRx), and Electronic Health Records (EHR), and (c) coordinate care 7) Demonstrate it meets patient-centeredness criteria, as determined by the Secretary. Additional details will be included in a Notice of Proposed Rulemaking that CMS expects to publish this fall. Q: How would such an organization qualify for shared savings? A: For each 12-month period, participating ACOs that meet specified quality performance standards will be eligible to receive a share (a percentage, and any limits to be determined by the Secretary) of any savings if the actual per capita expenditures of their assigned Medicare beneficiaries are a sufficient percentage below their specified benchmark amount. The benchmark for each ACO will be based on the most recent available three years of per-beneficiary expenditures for Parts A and B services for Medicare fee-for-service beneficiaries assigned to the ACO. The benchmark for each ACO will be adjusted for beneficiary characteristics and other factors determined appropriate by the Secretary, and updated by the projected absolute amount of growth in national per capita expenditures for Part A and B. Q: What are the quality performance standards? A: While the specifics will be determined by the HHS Secretary and will be promulgated with the program’s regulations, they will include measures in such categories as clinical processes and outcomes of care, patient experience, and utilization (amounts and rates) of services. Q: Will beneficiaries that receive services from a health care professional or provider that is a part of an ACO be required to receive all his/ her services from the ACO?
Reducing Avoidable Readmissions – A New Guide By Donna Jacobi, MD The “Health Care Leader Action Guide to Reduce Avoidable Readmissions” was published earlier this year by the Health Research and Educational Trust, an affiliate of the AHA. It lists major strategies and supplies an appendix of interventions that may be utilized. It can be accessed at www. commonwealthfund.org. Search “readmissions” to locate this and other documents. 1. During hospitalization: • Risk screen patients and tailor care • Establish communication with the patient’s primary physician, family, and home care • Use “teach-back” to educate patient/caregiver about diagnosis and care • Use interdisciplinary/multidisciplinary clinical team • Coordinate patient care across multidisciplinary care team • Discuss end-of-life treatment wishes 2. At discharge: • Implement comprehensive discharge planning • Educate patient/caregiver using “teach back” • Schedule and prepare for follow-up appointment • Help patient manage medications • Facilitate discharge to nursing homes with detailed instructions and partnerships with nursing home practitioners 3. Post-discharge: • Promote patient self-management • Conduct patient home visit • Follow up with patients via phone • Use personal health records to manage patient information • Establish community networks • Use telehealth in patient care Which of these items can YOU influence? Directly or through your involvement with your hospital’s medical staff and/or leadership? Are there areas in which the Escambia County Medical Society can provide leadership? Let us know the barriers you continue to see to improving this critical aspect of health care for our patients. Thanks!
A: No. Medicare beneficiaries will continue to be able to choose their health care professionals and other providers. Q: Will participating ACOs be subject to payment penalties if their savings targets are not achieved? A: No. An ACO will share in savings if program criteria are met but will not incur a payment penalty if savings targets are not achieved. Q: When will this program begin? A: We plan to establish the program by January 1, 2012. Agreements will begin for performance periods, to be at least three years, on or after that date. Q: How do I get more specific information? A: CMS plans to hold a listening session to hear stakeholder ideas on ACOs this summer. Further details about this listening session, to be held as a special open door forum, will be posted by June 11 on the following special open door forum website: http://www.cms.gov/OpenDoorForums/05_ODF_ SpecialODF.asp#TopOfPage Further details for the shared savings program will be provided in a Notice of Proposed Rulemaking which CMS expects to publish this fall. Don’t miss our next membership meeting August 10, 2010 at the Angus Restaurant. Dr. Brett Smith will be our guest speaker. Please see the insert to signup for the Pertussis vaccine and meeting. We look forward to seeing you.
Practice Management Medical Accounts Receivables “The right medicine for the right symptom” By Doug Hillis and Mark Wilson, Transworld Systems There is little argument these days that lower reimbursements and higher costs are putting more emphasis on the unpaid dollars in the “patient buckets” on your accounts receivables. However, there does seem to be some question on which approach is best to accomplish this task. The real answer may come from improved segmenting of your patients based on the information you already have. Traditional Approach Many practices have viewed the patient accounts receivables process as a two step process that begins with internal billing/follow-up and ends with third party collections. The real problem with this approach is it forces the practice or medical facility to do one of two things: a. Continuous Internal Billing and follow-up OR… b. Early usage of a third party Continually billing patients and following up with internal letters and phone calls can improve the revenue stream somewhat. However, with rising FTE, administrative and overhead costs; this approach is expensive and the lift achieved in cash-flow is considerably offset by the associated costs. More importantly, sending a 3rd, 4th or 5th statement to a patient may actually be counter-productive. If the patient perceives that the practice will simply continue to send ANOTHER statement or internal letter, it is easy to conclude that nothing more will happen. This perception may well have been reinforced from their past experiences as a patient with many of their physicians over the years. The patient concludes that waiting it out may get them off the hook. Complicating matters further is expectation that their insurance will cover more than it really will cover. To many patients the EOB is incomprehensible and they think it is the responsibility of the practice to figure out how to get the insurance to pay. So they wait… for the next statement! Early usage of a third party also makes sense if the agency is willing to drop from the typical 33% contingency rate to 30% or even 25%. A quick call by a collector certainly sends a message to the patient that the statements were real and that you meant what you said. Getting accounts to your agency at 60 or 75 days will also increase the recovery rates. The downside is that most of those patients are not really “collection problems”. These patients just need a nudge, or motivation to get back on their payment plan. Furthermore, with the focus on patient care, many doctors won’t even use an agency (much less use them at 60 days). Proper Segmentation To get an idea of the solution, lets first take a new look at the patients and what we know about them. To do this we will segment your patients with balances due into 3 catagories: 1. Billing accounts – these are the patients that will get one statement and pay the bill. If they do not understand the EOB, your staff gets a call the very next day. 2. Delinquent account Billing – these are “the stubborn payers”. If they do not understand the Explanation Of Benefits (EOB) , your staff gets a call the very next day. They may have had previous experiences where they let medical bills slide without adverse consequences. Most of these
patients are not collection problems, but they do need to know you are serious about getting paid. Sending another statement could actually send the WRONG message to this patient. Sometimes they are simply embarrassed and won’t ask for payments but instead are hoping it will go away. What they need is a gentle nudge to get them to pay. 3. Collection accounts – these are the patients that may think they can get out of paying altogether. These patients may not be as numerous as we have been lead to believe. Those “bad apples” do exist; however, if some of the patients in the 2nd segment are not managed properly, they may slip into this 3rd category. If they have not been sent a clear message that YOU expect to get paid and that your services are worth EVERY penny, they could require collection agency attention. If they think that the statements will continue and that is all, then it may be a savvy decision on their part to wait and see what happens next. Meanwhile they are making buying decisions every day. These decisions likely will lead to more debt and obligations that take precedence over YOUR bill. It is not necessarily personal or because they don’t like you, but now they have other priorities. Now they are a COLLECTION PROBLEM. Recognizing and Managing “Delinquent Billing Accounts” Regardless of your approach, there will always be patients that can be identified as “Delinquent Billing Accounts”. The first step is to define which patients fall into this category. There seems to be a growing consensus that any patient that has not responded after 2 communications(usually statements) can be identified as a “Delinquent Billing Account”. It is also important to recognize that a 3rd statement or reminder is NOT the answer. In fact, it may send the wrong message! These patients need to be managed through a different process. Transworld Systems has been providing an innovative system to manage delinquent accounts as they enter the Delinquent Billing Stage. By contacting the patient as a third-party we get them to pay attention to YOUR bill. However, our diplomatic approach is so reasonable that even the most lenient doctors consider the process to be completely fair and courteous. We provide the “gentle nudge” that these patients need. Our on-line interface makes it possible for an integrated approach that encourages the patient to pay the practice directly. The practice can let us know on-line when payments are made or when a payment plan is implemented. The patient maintains their honor and integrity while making proper decisions to keep their obligations to their doctor or hospital. The practice or medical facility gets the patient engaged before other obligations interfere. This service is called Profit Recovery and has been offered by Transworld Systems since 1970. Transworld has been recognized as one of only 14 Administrative Partners with the Medical Group Management Association (MGMA). We have also earned the “Peer Review Designation” from the Healthcare Financial Management Association(HFMA). For more information on how to manage YOUR “Delinquent Billing Accounts”, contact Doug Hillis at: 251-343-3913 or douglas.hillis@transworldsystems.com
Practice Management Liability Concern: School & Sport Physicals By Cliff Rapp, LHRM, Vice President, Risk Management, First Professionals Insurance Company Physicians that conduct school and sport physicals, such as pre-participation physical evaluations, need to be aware of the inherent liability exposure, particularly in the absence of an existing physician-patient relationship. The most common types of conditions giving rise to malpractice claims involving pre-participation physician examinations are cardiovascular. Failing to discover a latent asymptomatic cardiovascular condition is a prevalent allegation that in most cases requires proof that the physician deviated from the standard of care in terms of the pre-participation evaluation. Depending on the legal venue, courts may hold that the mere performance of a pre-participation physical exam serves to create a physician-patient relationship with the same legal duties as that of an established, private practice patient. Therefore, it is important to emphasize the precise nature and limited scope of the physician-patient relationship, delineated solely to the examination. Generally, physicians that provide medical clearance for participating in competitive sports are not legally liable per se for injury or death caused by an undisclosed cardiovascular abnormality. Most courts have recognized that the pre-participation screening standards of athletes may follow current consensus guidelines in determining cardiovascular fitness. Again, this will depend on the legal venue. Cardiovascular screening is the primary, inherent liability exposure associated with school and sports physicals. Congenital aortic valve stenosis is the most likely condition to be detected reliably during routine screening.(1) Primarily, differentiating common heart murmurs from potentially lethal cardiovascular conditions. Of course, other insidious and chronic underlying medical conditions are also a consideration in terms of the liability exposure inherent to these kinds of physical exams. High-risk Symptoms Subjects with a personal or family history of the following may be at highrisk for cardiovascular conditions (and thus potential claimants for failure and delay in diagnosis): • exertional chest pain/discomfort • syncope/near syncopal episodes • excessive, unexpected shortness of breath • excessive, unexplained fatigue with exercise • history of heart murmur • elevated systemic blood pressure • family history of cardiovascular disease It is important that the parents or legal guardians not only provide their consent for the student or child to be evaluated, but in doing so acknowledge the limited nature of the pre-participation evaluation, the fact that no physician-patient relationship is created or intended, and that the exam does not replace an annual well-child exam by the students primary care physician.
Case Summary Consider the case involving our insured physician and ARNP who were doing pre-participation sports physicals at an athletic facility on behalf of the local high school. Both had performed school physicals on a young male student whose father had died of an MI at a young age. After being cleared two years in a row by our insureds, the student died while participating in vigorous physical training while on a treadmill at the school. A wrongful death action was filed alleging that the student should not have been cleared for sports activity without further evaluation in light of his family history. Medical experts could not support a defense in light of the fact that both of the student’s examination consent forms noted the family history of MI. Medical clearance to participate in the sports program should not have been granted. Our insureds should have either pursued further diagnostic testing or referred the student to his primary care physician. Risk Management Guidelines • Seek an indemnification and hold harmless agreement from the school or facility requesting the pre-participation evaluation • Determine if you are entitled to sovereign immunity by the school or recreational entity • Confirm that your existing professional liability coverage does not exclude claims arising from school and sports physicals • Require that parental consent to conduct the evaluation has been provided and waives creation and expectation of a physician-patient relationship • Require that informed consent is obtained relating to the purpose and scope of the evaluation • Ensure that documentation of the evaluation is maintained when evaluations are conducted externally to your practice • Maintain a log identifying every subject evaluated • Include a brachial BP measurement in the sitting position, precordial auscultation in both the supine and standing positions, assessment of the femoral artery pulses, recognition of the physical stigmata of Marfan syndrome, BP >95th percentile, systolic murmur equal to or greater than 3/6 intensity, any diastolic murmur, any murmur that intensifies with Valsalva. (1) • Retain a copy of any evaluation record entailing a subject diagnosed with potentially compromising factors • Communicate potential concerns or medical conditions to the subject of the exam, the subject’s parent or legal guardian, and the subject’s primary care physician • Utilize a student medical history form, executed by both the student and the student’s parent or legal guardian • Document any limitations with specificity • Document any medical recommendations on the pre-participation form • Advise the requesting party and the subject of the evaluation that such screening should be repeated every 2 years (1) American Heart Association. Recommendations and Considerations related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. AHA Journals
Membership ECMS would like to highlight our newest benefit.
Connect with members on the go IPHONE APP! I’d like to introduce our new ECMS Mobile application, which we believe is a revolutionary design to connect with members. Our intention is to create a simple but effective way for our community of physicians to communicate across hospitals and above physician directories. ECMS has partnered with DocBook to help keep our community of physicians up-to-date with the latest physician and pharmacy information. We’ve worked hard to create an electronic directory that is a living document. This application has a great design which allows physicians the ease to search for important information on the fly. A quick reference tool located in your pocket everywhere you go. By design this app gives our physicians a platform structure to create their own personal communication outcomes. We have loaded the ECMS Mobile app with physician information that can be tailored to each physician’s communication preference. You may opt to text, email, or call your fellow physicians.
The app has been planned, designed, tested, and developed with physicians to truly offer an engaging and convenient resource. The investment involved in this requires us to ask a small fee in return, and I do believe that our chosen price point of $50 per year for members and $100 per year for non-members offer great value for the money. The ECMS Mobile app is currently formatted on an Apple platform. However, there are exciting plans to move this application to the Android in the very near future. Our primary goal is to also keep physician information private and secure. Therefore, DocBook uses the highest form of encryption and verification for safety. The information provided is secure in our database and the information you store on your personal IPhone is limited to your use. This application is currently a benefit of membership; therefore a physician must apply for membership, receive member number, and sign up for the application. Only MDs and DOs are eligible for the benefit. As the emerging technology changes and DocBook implements improvements the cost will not increase. We are excited to see the future of physician communication reach beyond the yellow pages and hospital directories to the velocity of mobile technology.
Attention Golfers 1. Keep Your Back Straight, Knees Bent & Feet Shoulder-Width Appart. 2. Form a Loose Grip. 3. Keep Your Head Down. 4. Stay Out Of The Water 5. Try Not To Hit Anyone.
WELL DONE! NOW DO NOT MISS OUR 2ND ANNUAL GOLF TOURNAMENT October 16, 2010 • 8AM • Scenic Hills Country Club
Membership Sponsorship Opportunities with the Escambia County Medical Society Escambia County Medical Society (ECMS) gladly welcomes a variety of opportunities for diverse businesses to interact with our physicians. Creating opportunities for physicians to interact with local businesses and services is valuable to our community and our organizational goals.
2010 /APRIL MARCH 2 BIA COU ESCAM
DICAL NTY ME
age
t’s Mess
Presiden
SOCIETY
form
ad to Re e Ro ThWay s, MD ne Willi
Volume
40, No.
ECMS Bulletin Published six times a year and mailed to over 500 physicians and community leaders, as well as electronically sent to an additional 450 contacts. Visit our website to view our current newsletters. Call ECMS for Ad sizes and contracts.
across care integrate system. of h care bet soup ture” the healt Willis had r the alpha “infrastruc Dr. Wayne 80’s. We remembe Second, patient of you orts the in the early new set Many started that supp include have a , care that smile. Now we This will retechnology aucrat managed care. HMO’s. a bure medical ’s and ions information quality make icine, IPA’s, PPO Organizat electronic would e and local that d med yms C and national Healthcar ately innce base of acron cords, untable H ultim hcare –CDH to evide al of PCM to Acco itment ted healt concept profession direc H. Welcome comm h core –PCM pt to y. The consumer care healt Home an attem primary –AHCO, and safet Medical care. care is ss to a strucCentered inated s acce managed down coord of Patient clude top form in a norehensive healthmodel This new stic and and comp h care directed H is altrui : the healt consumer refer to are ever the PCM transform Strengths ption of ept of companies disparities and the exce health theoretiThe conc insurance rinsured, ture, with gap in The goal s itals and the d. The rated. ured, unde ibilitie told Hosp indee integ unins care. ally ble The poss de the mber being to inclu ployed. being vertic ment first . I reme providing ” unem this as growing ol costs care move gaps and care “terminally to contr ng the long been managed cally is now the managed for closi . It has when the s, the omenal olling patient coverage same thing a few exception as far as contr are phen patient have every better term to With dud long is icine to be a started. better ly Med . There proved the and of Fami physician about gement movement the goal ry care to talk mana n like prima ada ician I’d medicatio MH by costs. maintain y phys on n of care, will Home-PC As a famil ily rely | April 20 es. This Medical coordinatio . H will heav Tuesday weakness but could ician Centered prevention the PCM Patient gths and disease The phys doctors ture of , the stren Hall practice. ry care The struc efficiently also. The dressing of the Heritage all prima icians system orize tructure involve ate the ialty phys ry care directly the infras need to navig r ange, optim n. ve spec four prima ly Mediation exch Social Hou inatio ctly invol of the tice will pm inform Fami coord indire prac h child n of 6:00 healt icatio a safe is the brain rican Academy ion, the tive med physician PCMH secure Organizat ry care cost effec Dinner s: the Ame opathic the prima rals, and American 7:00 pm Oste ring the ganization refer and H American that ntly, resto atrics, nt care. of Pedi of the PCM cine, the Subseque recognize tion r of patie to Academy principles e groups qualr Presenta cente pting the rican Thes the highe ting attem Ame as ent, icians. d by: y, adop and are of Phys cost effici doctors will also In theor Sponsore support College ry care system on life only more de not care is h care what prima healthcare Merck primary will provi entire nce of olling healt has but the the esse of contr Practice “brand” ity care, benefits Family financial RSVP emy of ct of 150 do. reap the rican Acad onstration Proje has ion. Project The Ame H and 478-0706 .net cost inflat nal Dem a PCM onstration of iity a Natio Dem ses: outh epts nal bells from phys e for Qual developed test the conc Weaknes the Natio reviews ECMSinfo@ Committe to venmixed to meaThus far, National members criteria expensive receiving with the ns are t the lop thirty been an that parIt has partnered conclusio that adop A) to deve 3 and staff analysts. e (NCQ practices icians ition of d in 187 ation of Assuranc le defin cians and to phys mes in Founde implement page 9 a simp ty outco stressful “Care on rent that not found . First, sure quali ture and continued I have also appa categories to patients model. ted. It’s ves two PCMH ticipa des invol it a care provi H, but develops primary a PCM onship, ” the care ing relati inate and principles an ongo that coord urage specialists that enco oach with team appr
By
General hip Members Meeting
Dinner Meeting Sponsorship Educational dinners provided to our physicians six times annually. Sponsors can enjoy socializing with members, display before the meeting, and dinner. This includes advertising in our member directory, website, faxes, and emails. Cost of sponsorship: $2,500 solo $500 co-sponsor.
ECMS Pictorial Directory Published annually, this directory is distributed to local physicians, hospitals, community liaisons, and new residents moving to the area with the help of Pensacola Chamber of Commerce. Call Ballinger Publishing for details at 850-433-1166. Website Sponsorship ECMS has a newly renovated website that benefits the public and physician members visit our site at www.escambiacms.org. Banner space available. Weekly E-Newsletter ECMS has a weekly newsletters that update our physicians on current events and legislative advocacy. Add your link to each weekly webcast. Call for details only one vendor for six months webcast. April Mini Health Fair Our April Mini Health Fair is a fun & eventful evening. This event is held in conjunction with the ECMS dinner meeting and space is limited. Sponsorship is $500 which includes a display table and dinner for two. Annual Golf Tournament Join the FUN! $40.00 Tee sign sponsor or put a team together.
Medical/Legal Eat Less, Exercise More: The Dreaded Conversation By Laurel Hinote Thorpe, Esquire, Bozeman, Jenkins & Matthews P.A. One patient may stare nervously at his feet, avoiding eye contact, in hopes that the doctor will not notice his steadily increasing weight that is dutifully documented every visit. Another patient may anxiously and tearfully bring up the issue of a forty pound weight gain while pulling a box of tissue out of her purse. Either way, a delicate conversation should soon take place. Some physicians believe they do not have adequate knowledge or training to address obesity. In studies physicians have reported feeling incompetent and uncomfortable when the topic comes up. Other factors in the failure to address issues of weight have been noted. These include, physician concern that the patient may be hurt or offended, that there is just not enough time to address the complex issue, and that reimbursement for preventive care has been insufficient. Further, the physician may perceive that the patient is not ready or motivated to make lifelong changes. These factors helps to shed light on a study conducted by the Mayo Clinic which indicated that the medical charts of only 1 in 5 obese patients listed them as obese. Documentation of the physician and patient having formulated a weight-management plan is even less likely to be found in the patient’s records. The Center for Disease Control (CDC) reports that 30 percent of adults are obese and another 35 percent are overweight. This translates into increased risks of heart disease, diabetes, hypertension, and high cholesterol. With increased prevalence and stronger scientific correlations between risk factors and outcomes, there is potential danger in not having a frank and informative discussion with the obese or overweight patient. Although avoidance of liability is probably not the only motivating factor it may become an important one. It is easy to imagine the plaintiff’s argument. Mr. Smith, the obese father of four children does not survive a heart attack. He has been seen by the same family physician for years and his medical records have no indication that weight-management or the risks associated with obesity have ever been discussed. Of course, the information is widely available from other resources and it is a tenuous argument that the physician’s failure to warn or develop a treatment plan for obesity was the cause of death. However, there is never any real certainty for novel issues of liability. Therefore, the safest approach is to take a deep breath and with gentleness and respect discuss a diagnosis of obesity with the patient. From a psychological perspective some have advised that the physician refrain from using the word “obese,” substituting words such as “unhealthy body weight.” However, from a legal standpoint, if a patient meets the medical definition of obese it may be advisable to use and define the actual term.
Next, the physician should outline, in quantifiable terms, the health risks of being overweight or obese. Assessment and management information, including patient questionnaires and handouts, is readily available through organizations such as the American Medical Association and the American Academy of Family Physicians. The physician should then develop a treatment plan in consultation with the patient and document that plan in the patient’s record. If the patient refuses to discuss or follow recommendations, a simple documentation of this fact should go a long way to providing a defense to a legal claim that may arise in the future. In addition to the liability issues associated with obesity there are administrative issues that should be considered in light of recent legislation. First, under the health care reform law insurance companies will now be required to cover preventative-health services, which include obesity screening and nutritional counseling. Careful coding and documentation should help to alleviate reimbursement concerns and free physicians to spend the amount of time necessary to adequately address the complex issues associated with counseling and treating obesity as a primary disease. Second, the economic stimulus package provides financial incentives for physicians to adopt electronic health records. In order to qualify, the physician must demonstrate a “meaningful use” of electronic health records. One of the leading factors outlined by Center for Medicare & Medicaid Services (CMS) is the documentation of BMI at every visit. Over the next few years the standards for meeting the definition of “meaningful use” will increase to the point where physicians will have to show that such use leads to better health outcomes. So not only must physicians document BMI in the electronic health record, but that information must then be used in a meaningful way to improve patient health. Eventually, physicians will face decreased reimbursement if they do not meet the standard. Now is a good time for physicians to consider their approach to the diagnosis and treatment of obese and overweight patients. It may help to avoid medical liability and ultimately may provide a financial benefit to the practice. If that is not incentive enough to have the conversation, consider that a patient is three times more likely to lose weight if advised to do so by a physician.
In the Community Hospital News Sacred Heart News
Baptist Health Care
Cardiac Imaging: The PET/CT Imaging Center of Northwest Florida, located at Sacred Heart Hospital in Pensacola, is now offering the area’s only cardiac PET/CT imaging services to evaluate the health of your heart by measuring the blood flow it receives. Sacred Heart is one of only two hospitals in Florida to offer this new technology. For more information, please call (850) 478-6336.
Baptist Health Care Breaks Ground on $29 million Construction Project; Seeks Physician Feedback Baptist Health Care (BHC) continues its passion for growth and employee satisfaction with new construction efforts, physician satisfaction initiatives and recent honors for excellence. Following their May 25 ground breaking at Gulf Breeze Hospital, BHC broke ground at Baptist Hospital on July 7 to begin their expansion. The construction initiatives across the BHC System are expected to total $29 million and create many employment opportunities in our community.
New COO: Sacred Heart Health System has selected Carol L. Schmidt as its new chief operating officer. She joins Sacred Heart after serving with Ascension Health and previously the Daughters of Charity National Health System for 12 years. “Carol is widely respected across Ascension Health,” said Laura Kaiser, President and CEO of Sacred Heart Health System. “She brings to Sacred Heart a passion for quality healthcare. She has a proven ability in diverse areas, such as operational performance improvement and physician partnering.” Tobacco-Free Campus: On September 1, all Sacred Heart Health System facilities will be tobacco-free, inside and outdoors, on all of its campuses. The goal is to help provide a safer environment for all who visit and work at our facilities. Our move toward a tobacco-free environment reinforces our commitment to improving the health of our patients, associates, physicians and community.
BHC seeks physician feedback and encourages all Baptist affiliated physicians to take part in our annual physician satisfaction survey going on now through August 23. This valuable tool gives all physicians the opportunity to share insights and opinions so that BHC can further enhance systems and processes to meet your needs and enhance quality patient care. Lastly, thank you for voting BHC as the “Best Place to Work” in the Pensacola News Journal’s 2010 “Best of the Bay” reader survey. The Independent News also recognized BHC president and CEO, Al Stubblefield, on the 2010 “Power List.” The list includes names of 75 area leaders who are positive ambassadors in the Greater Pensacola area.
Alliance News Beds for Babies Success! We are blessed with wonderful Alliance Members and ECMS Members. We raised $2,000, with the help of our Members and the Florida Medical Society Alliance, for the Beds for Babies Program in Escambia County. Your donation will provide a safe place for needy babies to sleep. This program works to not only provide a bed, but educational material, parenting education, and counseling. Children’s Health Carnival With the ever growing rates of obesity the Florida Medical Society Alliance and the Escambia County Alliance continue to focus on the needs of children. Obesity in children can lead to a lifetime of chronic disease. The ECMS Alliance is sponsoring the 2010 Healthy Carnival for 300 students between the ages of five and fourteen. The event will be located at the Fricker Center, July 30th 10am- 3pm. Please consider your membership as a viable way to make a difference in our medical community. We encourage all spouses to join! Our Next meeting will be Thursday, September 16, 2010 at the Macaroni Grill. Call me if you are interested in membership or leadership 478-0706. Member Announcement Dr. Joseph Howard celebrated a momentous event this year, 50 years in Medicine! He Graduated Medical School, July 1, 1960 and he celebrated an Enthusiatic Birthday on July 1, 2010. Thank you Dr. Howard for your commitment to Medicine and our Community!
Put our team of healthcare banking specialists to work for you and your practice. Todd O’Brien Darlene Schneider (850) 857-5074 (850) 857-5078
BBVA Compass is a trade name of Compass Bank, Member FDIC.
Specialized Wealth Management for Practices and Physicians Your patients look to you for guidance. But when it you turn? At SunTrust, our advisors can help you stay on
Strategies for Growth. Healthy Practice Development. The healthcare specialists at O’Sullivan Creel, LLP have experience assisting practices with financial and operational issues in this complex industry. In addition to traditional accounting services like bookkeeping and retirement planning, we offer consulting services including: Personnel Assessment Accounts Receivable Review Hospitalist Program Implementation Financial Analysis Physician Analysis Daily Practice Operations & Systems Overview Interim Practice Management Benchmarking Strategic Planning Policy and Procedure Development Healthcare and IT System Evaluation New Physician Practice Start-up
payments received and protecting you against fraud. To schedule a conversation with a Client Advisor from our Private Wealth Management Medical Specialty Group, call 850.435.1204 or visit us at suntrust.com/medicine.
Treasury and Payment Solutions
Lending
Investments
Financial Planning
Deposit products and services are offered through SunTrust Bank, Member FDIC.
Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured · Are not Bank Guaranteed · May Lose Value SunTrust Private Wealth Management Medical Specialty Group is a marketing name used by
Pensacola
Fort Walton Beach Destin Foley Fairhope 850-435-7400 www.osullivancreel.com
provided by SunTrust Bank. Securities, insurance (including annuities and certain life insurance products) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC-registered investment adviser and broker/dealer and a member of FINRA and SIPC. Other insurance products and services are offered by SunTrust Insurance Services, Inc., a licensed insurance agency. ©2009 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. Live Solid. Bank Solid. is a service mark of SunTrust Banks, Inc.
Even Better Together. Florida Doctors Insurance Company is proud to announce it has completed the merger and acquisition of Physicians Preferred Insurance Company. This makes us the fourth-largest admitted writer of physicians’ and surgeons’ medical professional liability insurance in Florida. The same service, the same quality, the same expertise— now increased by the power of two. · 0% Financing and Flexible Payment Plans · Demotech A, Exceptional Rated Insurance Company · Extensive Experience and a Strong Focus on Florida · Claims-Free Discounts up to 25% · Retroactive and Tail Coverage Available · Free Online CMEs
www.fldic.com (800) FLA-DOCS (352-3627) (904) 296-2887
PRSRT STD U.S. POSTAGE PAID PERMIT #258 PENSACOLA, FL
8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 Fx: 850-474-9783 Email: ECMSinfo@bellsouth.net Executive Director: Holly Strickland Admin. Asst: Ashley Jacobi
RETURN SERVICE REQUESTED
Save the Date
Upcoming Conferences: 2nd Annual Stroke Conference September 10, 2010 Sacred Heart Hospital Dudley Greenhut Auditorium Call MECOP for Details 477-4956 Heart Conference September 30, 2010 New World Landing Call Dolly Partridge Baptist Hospital 469-7439 Or Fran Kahler-Ropp 444-1756
Visit the ECMS created websites for Dr. Angeli Saith, www.fivepointsfamily.com & Dr. Stephen Kimura, www.allergyasthmamd.net View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.
Our Rates are Decreasing by an Average of 5%!*
Stronger than ever.
$12.5 Mi llion Dividend Declared in 2010!**
Physician Ownership and Leadership • Financial Stability
Call MAG Mutual’s Dennis Wilson toll-free at 1-888-892-5216 or Ray Horn, Fisher-Brown Inc. at 850-994-2620 or visit us at www.magmutual.com. *Medical professional liability insurance rate reduction effective June 1, 2010. Actual rate adjustment depends on your medical specialty, location and other factors. **Dividend effective June 1, 2010. Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.