ESCAMBIA COUNTY MEDICAL SOCIETY
President’s Message
MARCH/APRIL2011 Volume 41, No. 2
U.S. Health Care: Best or Most Expensive in the World? by Michelle Brandhorst, MD Florida and the United States are at a cross roads regarding making decisions about our entitlements and mandates. Health care is a major portion
Upcoming Events Tuesday | March 29 The New World Landing 6:00 pm Sponsored by: ECMS & FMA Topic: EHR Implementation Wednesday | March 30 Distinctive Kitchens Doctors Day Celebration 5:30pm
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of this, and I hope that all of you will continue to have thoughtful discussions of these issues with patients, family, friends and colleagues. It is in the interest of stimulating spirited debate, that I write the following. The United States spends more per capita on health care than any other health care system in the world according to research by the Bureau of Labor Education, University of Maine. Three years ago this was just a future concern. Current fiscal realities now make this a looming crisis. According to the Budget office of the U.S. government, in 1970 the two largest entitlements - Social Security and Medicare - made up 18.7% of the budget. In 2006, this was up to 33.3%, and trending upward. We are spending our youths’ treasure and opportunities to fund our later years. Last year, the Affordable Health Care Act was a first attempt at addressing health care access and cost. But will it be effective? Let’s imagine we can look into the future and see where this Act leads us. In Massachusetts, where Mini-Obamacare was implemented in 2006, to increase health insurance coverage and decrease cost, the percentage of the population covered did increase from 88% to 96%. Contrary to intent, the number of Emergency Room (ER) visits continues to increase. According to survey results, half of the visits were not for emergency care. This increase in coverage did make some changes: insurance premiums have increased 6-7% in large group funds, 14% for small businesses and from 10-30% for individuals and small groups. Round one of the intended control didn’t work, so in round two Massachusetts tightened the control further. They created an 18 member board; which now determines how much providers and systems will be paid and forces insurers to accept flat rate fees. This is in spite of the fact that 30 states have tried these solutions in the past, and 29 abandoned them. Health care in Massachusetts seems be evolving into a universal Medicare type system.
What really controls cost? The November election gave hope to those, who understand cost control is best Dr. Michelle Brandhorst achieved via market driven forces rather than governmental mandates. Cost is currently determined by insurance companies, providers including hospitals, physicians and others as well as the government. There’s one important missing element, the consumer. In every other aspect of our lives cost is determined by the individual consumer making an informed purchasing decision. However, in a recent pole by the Wall Street Journal and NBC showed that 32% of the population said Medicaid cuts were unacceptable, 23% said Medicare cuts were unacceptable and 22% said Social Security cuts were unacceptable. Our consumers seem reluctant to take on managing their health care costs and taking responsibility for those costs. Who will make the difficult decisions? If we allow consumer/market driven forces to control costs can we see ourselves telling grandpa that he can’t have a heart cath because his family can’t afford it? This leads us to ponder; does the market pendulum swing so that the inflated price supported by private and government insurance companies decline to the point where people can afford these services? Is a six day stay in the hospital with a myriad of test really worth a small house in Pensacola? Will physicians be more cognitive of cost when they know the impact it will have on their patients family. What is the best way to arrive at the relative value of what we do? If we proceed on our current trend toward government controlled health care, can we tell grandpa that he can’t have the surgery because he is 80 years old, and based on outcome studies, the government has decided that it is not a cost effective use of limContinued 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
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In a MEDICaL MaLPRaCTICE CLaIM: Be ready for anything and everything.
2011 ECMS Officers President Michelle Brandhorst, MD President-Elect George Smith, MD Vice President Wendy Wozniak, MD Secretary /Treasurer Susan Laenger, 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 5 Protect Your Practice from Identity Theft Exposure Page 7 Some Helpful Contacts Everyone Should Know
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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.
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Membership Welcome New Members!
Practice Updates
Daniel Noyes, DO
Henry Lusane, MD
Edwin Taylor, MD
Radiology Associates of Pensacola Medical School: Philadelphia College of Osteopathic Medicine Residency: University of New Mexico Diagnostic Radiology Board Certified: American Board of Radiology - Diagnostic 1717 North E Street, Suite 423 Pensacola, FL 32501 Phone: (850)432-6851 Fax: (850) 438-6821
Interventional Radiology Consultants Medical School: University of South Alabama Residency: University of South Alabama Medical Center Board Certified: American Board of Radiology 1717 North E Street, Suite 423 Pensacola, FL 32501 Phone: (850)434-5750 Fax: (850) 432-9677
Baptist Medical Group -Westside 6715 Highway 98 West Pensacola, FL 32507 Phone: (850) 453-6737 Fax: (850) 453-1196
James Reynolds, MD
Sacred Heart Medical Group Medical School: Ross University Board Certified: American Board of Family Medicine 4501 N. Davis Hwy, Suite A Pensacola, FL 32503 Phone: (850)476-9000 Fax: (850) 478-2332
West Florida Medical Group Medical School: University of Arkansas College of Medicine Residency: Florida State OB/GYN Residency Program Board Eligible 8333 N. Davis Hwy Pensacola, FL 32514 Phone: (850)969-2038 Fax: (850) 969-2037
Jon Moore, MD
Gary Gotthelf, MD
West Florida Medical Group Medical School: University of Kentucky School of Medicine Residency: Keesler AFB Board Certified: American Board of Surgery 4252 Woodbine Rd Pace, FL 32571 Phone: (850) 995-9882 Fax: (850) 995-9892
Medical School: University of Florida Residency: Pensacola Educational Program Board Certified: American Board of Internal Medicine 4511 N. Davis Hwy, Suite C-1 Pensacola, FL 32503 Phone: (850)477-3252 Fax: (850) 477-2659
David Tenniswood, MD
Pulmonary, Critical Care & Sleep Disorder Medicine Medical School: University of South Florida College of Medicine Residency: University of South Florida Board Certified: American Board of Internal Medicine -Critical Care Board Certified: American Board of Internal Med-Pulmonary Disease 8333 N. Davis Hwy, Suite 6005 Pensacola, FL 32504 Phone: (850) 476-3486 Fax: (850) 471-3410
Thien-An Hoang, MD
West Florida Medical Group Medical School: Wayne State University Residency: University of Missouri at Kansas City Board Certified: American Board of Surgery 4252 Woodbine Rd Pace, FL 32571 Phone: (850) 995-9882 Fax: (850) 995-9892
President’s Message, continued from page 1 ited resources? In this type of scenario, the only cost containment force is artificially applied by government agencies, which in turn becomes a political competition for the biggest piece of the pie. There are many other countries that are struggling with health care and I refer you to T.R. Reid’s The Healing of America, for a review of
Mark Scott, MD
multiple schemes that are being tried in other countries. What are the fundamental questions for physicians? Is a market driven health care system consistent with our ethics and our conscious? Do we have the courage to place the burden of hard health care costs on individuals and can
David Turner, MD The Women’s Group 4900 Grande Dr Pensacola, Fl 32504 Phone: (805) 476-3696 Fax: (850) 477-3573
Elisabeth Tucker, MD Baptist Medical Group – Ladies First OB/GYN 3417 North 12th Avenue Pensacola, FL 32503 Phone: (850) 432-7310 Fax: (850) 432-7320
Tracy Thomas- Doyle, MD Baptist Medical Group – Ladies First OB/GYN 3417 North 12th Avenue Pensacola, FL 32503 Second Location: 3874 Hwy 90 Pace, FL 32570 Phone: (850) 995-2222 Fax: (850) 995-7020
Dr. Michael Redmond
has retired. After 35 years of practicing at Medical Center Clinic as a Pediatric Ophthalmologist, active member of ECMS and the FMA, and beloved physician, Dr. Redmond has retired. He has been compassionately devoted to the care and well being of his patients, and this commitment made him highly respected within the community and among his colleagues. His records will remain in the custody of Medical Center Clinic.
our profession help them make those tough decisions? Do individuals have the courage to take that on? Or do we proceed down the path of being tossed about as we try different iterations of government controls? These are all important questions as the economic health of our country and the economic future of our youth is in the balance.
Membership Your Membership Is More To OUR Community than Your Member Benefits! Your ECMS membership dues and support through our Foundation helps to provide support to our community. Below are three examples of how your membership is making a difference in our community and beyond.
Every Child Deserves a Chance to Play Baseball
The ECMS 2011 Miracle League of Pensacola Team provides physically and mentally challenged children a safe and spirited program in which they can hit, run, and catch on a baseball field – just like other kids. MLP offers a unique and memorable opportunity these children would not otherwise have. The Miracle League of Pensacola is a place where every player plays, every player hits, every player gets on base, every player scores, and every player wins – every inning. Players who need help with hitting, catching, and throwing the ball are paired with a “buddy” who helps out. Rainer Maria Rilke, a German lyric poet at the turn of the 20th century, wrote: “This is the miracle that happens every time to those who really love; the more they give, the more they possess.” Watch a Miracle League game from the bleachers and you will be moved as you have never been moved at any other athletic event.
West Panhandle Regional Science and Engineering Fair By Michelle Brandhorst, MD Can you pitch faster from the wind-up or from the stretch? Does your skin feel smoother using vitamin E? Does water, coffee or gatoraid make you go pee faster? Does chewing gum really lose its flavor on the bedpost overnight? As a judge at the recent science fair I, as well as fellow judges Dr. Warren Hodge and Dr. John Lanza, had all of these questions answered (except for the last one). Each year the Escambia Count Medical Society and Foundation presents an award in the medical category to two students at the annual Science Fair. There are over a thousand students from around the area presenting research projects in chemistry, physics, zoology and many other areas including medicine. The spark of curiosity behind these studies come from the students and their need to answer practical questions. They are responsible for the studies design, intergretity of the scientific method, obtaining, analyzing, summarizing and presenting their data to other stu-
dents, teachers, and judges. Our award in the junior category went to a study that used ultraviolet beads to determine the efficacy of sunscreens. I now know that SPF 50 was indeed superior but not that much better than SPF 30. Forget about SPF 15. Our award in the senior category went to “Oh, I got to go” and answered the water, coffee, gator-aid dilemma. Gator-aid seems to get in and out the quickest. This study was well conceived and executed and I think our urology colleagues would agree that if teenagers show interest in this area they should be rewarded. This event is one of the most gratifying of the many events in which the Medical Society participates. Seeing the work of the young people, the future of our country is indeed bright.
Breaking Down Barriers With Books While Rebuilding Iraq Medscape’s Iraq Book Project If you could do something simple to help healthcare professionals halfway around the world provide more up-to-date patient care, would you do it? That is an affirmative yes from ECMS physicians. The physicians, nurses, and other healthcare professionals of Iraq are in great need of recent medical literature -- books and journals that you no longer needed -- and English is no problem. The “Iraq Book Project” has been going on since 2003. In a nutshell, Medscape readers have been boxing up and mailing their used but still up-to-date medical books and journals to a domestic-rate APO address and shipped to Iraq. There, Lieutenant Colonel Vincent Barnhart, MD, Army Surgeon with the 1st Armored Division, unpacks and sorts the books, and he and his staff deliver them to hospitals, clinics, and medical colleges throughout the country, where they are gratefully received by Iraq’s medical professionals. Thank you to our ECMS physicians who donated books and journals to the Iraq Book Project. We strive to meet our mission in encouraging physicians to pursue high standards in medical care, education and ethics in the US and abroad. Above you can see over twenty boxes containing donated books and journals. They were sent this month APO addressed with care.
Practice Management Protect Your Practice from Identity Theft Exposure By the Risk Management Experts at First Professionals Insurance Company Medical records contain a wide range of information, from protected health information (PHI) to detailed personal financial information including social security numbers, insurance data, and bank and credit card data. All of this information poses a significant exposure for misuse and theft. It can be used to access bank accounts as well as to obtain medical services and benefits under assumed identities. In order to protect your practice from a potential information security breach, an assessment of your practice’s current exposure regarding information security should be conducted. The assessment should encompass the following questions: What types of information are kept? • PHI • Financial Where is the information kept? • File room • File cabinet • Open shelving • EMR How is the security of the information protected? • Locked file room • Locked file cabinets • Password protected EMR Who has access to the information? • Staff members • Vendors • Janitorial/maintenance personnel What type of information is transmitted to other parties? • Insurance claim processing • Referrals • Laboratory/Diagnostic study reports How is information transmitted to other parties? • Fax • Internet • Telephone Once you have identified the exposure(s) that your office faces, a written plan to address and mitigate the risks should be developed. The plan should identify what and how information will be kept, how it will be secured, how long it will be kept, and how it will be disposed of when the appropriate retention period has been reached. It should also address specific actions that will be taken to provide ongoing security and protection of the information maintained by the practice, as well as the procedures to be followed in the event of an information security breach. Document Retention: Medical Record Retention It is impractical for practices to retain medical records indefinitely. Most practices archive medical records for non-active patients and consider destroying non-active patients after a period of time. The time frame for retention of records is regulated by each state with consideration of current statutes of limitations. Some states allow microfilming or photographic reproduction of medical records. Record retention policies must comply with applicable state and/or federal laws. Seek legal or risk management guidance to determine the appropriate retention period required by the jurisdiction of your practice.
Financial Record Retention Consult with your accountant/attorney/financial consultant regarding appropriate retention schedules for financial records including ledger cards, receipt books, credit card transactions and insurance company explanation of benefits (EOB) forms. Information Storage Paper records which are stored in the office should be kept in a secure location, preferably isolated from the general office area. Access to the file area should be limited to those individuals who have a need for such access. If records are kept in a locked area or in locked file cabinets, records should be kept of those individuals who have access to keys and/ or access codes. All charts/records should be returned to the file storage area daily. If charts and records are stored offsite (such as inactive charts prior to the destruction date), access should be limited. The security of the material should be checked on a regular basis. Electronic medical records (EMR) should be maintained in accordance with the security provisions supplied by the vendor. Software systems should be updated regularly. If your practice has its own website, particular attention should be paid to its security. Anti-virus and anti-spyware software should be installed, maintained and run on a regular schedule to safeguard your system from unauthorized/unwarranted intrusions. Information that is sent to third parties (such as insurance companies and banks) should be encrypted. Personnel policies should be reviewed to verify that the employment process adequately identifies and selects suitable and qualified candidates. Employment applications should clearly state that background checks (including credit reports and criminal activity reports) and reference verification will be conducted. The application should include an authorization for such reports as well as provide a liability release for all persons who obtain or use such information. If third parties are used for ancillary services, such as billing, verification should be obtained from the vendor that they have an information security policy in place to protect the information you provide to them. Likewise, other vendors should be selected carefully, especially with regards to safeguarding the integrity and security of patient information. Employees should be trained on the importance of maintaining the confidentiality of patient information. Training should include information on maintaining the necessary level of vigilance to avoid being duped into providing information to unauthorized individuals. Employees should be trained to report all suspicious activity immediately. Document Destruction Patient records which have reached the end of the required retention period should be destroyed according to established procedures. A listing of those records which are to be destroyed should be made so that the practice has a record of when an individual chart was destroyed. Preferably, paper documents should be shredded. Document destruction services are also an option. These vendors can provide certification that records have been destroyed and should be able to provide the practice with evidence that their services are bonded and insured. Electronic records should also be disposed of properly. CDs can and should be shredded. Old computers, or computer equipment which has information stored therein, should be disposed of in a manner which Continued on next page
Practice Management How to Qualify for Stimulus Money from ARRA (American Recovery and Reinvestment Act)
By Lin Engie, Transworld Systems on the Gulf Coast, Phone: 850-366-2328, Email: lin.engie@transworldsystems.com Over the past two years, much has been discussed about the stimulus money for implementing EHR (Electronic Health Records) technology, but many questions remain unanswered for the physicians. In this five part series, we will try to lay out everything you need to know about collecting your share of the ARRA stimulus. What is the incentive? The ARRA of 2009 allocated $19B for Healthcare IT. Over a 5 year period starting 2011, each ‘Eligible Provider’ can qualify for up to • $44,000 from Medicare (OR) • $63,750 from Medicaid Who is eligible? The definition for ‘Eligible Professional’ differs between Medicare and Medicaid. For Medicare, the provider must be a Doctor of Medicine/Osteopathy (M.D. or D.O.), Doctor of Podiatric Medicine (D.P.M.), Doctor of Chiropractic (D.C.), Doctor of Optometry (O.D.) or Doctor of Dental Surgery/ Medicine (D.D.S or D.D.M). For Medicaid, the provider must be a Doctor of Medicine/Osteopathy (M.D. or D.O.), Doctor of Dental Surgery/Medicine (D.D.S or D.D.M), Certified Nurse Mid-wife, Nurse practitioner (NP, ARNP) or a Physician Assistant (eligible only if working in a rural health clinic or FQHC ( Federally Qualified Health Center) led by a Physician Assistant). Mental health providers and social workers are currently not eligible unless they are Psychiatrists (M.D.). In addition, the ‘Eligible Professional’ cannot be a hospital based physician. Also, the physician cannot receive payments under both the Medicare and the Medicaid programs. To be eligible for the Medicaid program, more than 30% of the physician’s volume must be Medicaid patients. What does “meaningful use” mean? There are three parts to meaningful use 1. Meaningful use of Certified EHR software including electronic prescription 2. Information Exchange with other providers to promote care co-ordination
How do I know if my EHR is certified? The Certified Health IT Product List (CHPL) provides the authoritative, comprehensive listing of EHRs at http://onc-chpl.force.com/ehrcert. It is important to verify that the product is certified as a Complete EHR. Some products are only certified as a Modular EHR, but if the physician can meet all Meaningful Use requirements using complementary products, then the physician will still qualify for the stimulus money. If I purchase a certified EHR does that mean I qualify? No, purchasing a certified EHR that covers all 33 certification criteria is just the first step. To qualify, the physician must use the EHR and meet the meaningful use objectives set by The Department of Health and Human Services (HHS). Can I choose not to use an EHR? Yes, you have the option to not use an EHR. But starting 2015, there is a penalty of 1% of Medicare reimbursements increasing by 1% each year up to 3% for not being compliant with Meaningful Use requirements. Is there a difference between Medicare and Medicaid programs? There are a number of differences between them but the two big ones are 1) Medicaid pays nearly $20,000 more than the Medicare program and 2) Medicare pays 75% of the allowed charges in a year while Medicaid pays 85% of the net costs of EHR technology and implementation/support costs. On March 29, 2011 ECMS and the FMA will host an EHR Implementation workshop at the New World Landing at 6pm. Please RSVP there are a limited number of seats available. The workshop will address: Understanding and evaluating why and when an EHR needs to be upgraded or replaced; Evaluating the practice workflow process to optimize EHR functionality; Understanding what is required to effectively implement an EHR, Practice Management system and Patient Portal; Using tools to help redesign practice workflow to improve use of EHR and improve practice efficiency; Understanding the role of ARRA HIT meaningful use and how effective implementation maximizes opportunity to access incentive criteria.
Protect Your Practice, continued from page 5 completely eliminates the data. Simply deleting a document does not mean it has been totally erased from the computer’s memory. “Wipe utility programs” are available and overwrite the data on the system’s hard drive, making the original files unrecoverable. If in doubt, consult with a computer specialist who can guide you to make sure that all records are completely destroyed. Responding to an Information Security Breach When you become aware of a breach involving patient information, either medical or financial, the following steps should be considered: • Reports may be required to local law enforcement agency as well as other regulatory agencies • Contact should be made with your general liability insurance company as well as your professional liability insurance company
• Notify the affected patient(s) of the breach, as well as other businesses or vendors who may be impacted by the loss of information • You may also want to discuss the issue with your personal attorney for guidance • If the breach involves a single computer or terminal, that machine should be immediately removed from your system and secured for later inspection For more information regarding this and other medical professional liability insurance risk management issues, please contact the risk management consultants at First Professionals Insurance Company at (800) 741-3742, ext. 3016 or send an e-mail to rm@fpic.com. Resources www.ftc.gov/infosecurity
Some Helpful Contacts Everyone Should Know State of Florida Governor Rick Scott phone: (850) 488-7146 fax: (850)487-0801 The Capitol 400 S. Monroes St, Tallahassee, FL 32399 www.flgov.com
United States Congress U.S. House of Representatives
Lt. Gov. Jennifer Carroll phone; (850) 488-7146 fax: (850) 487-0801 The Capitol 400 S. Mnroes St, Tallahassee, FL 32399 www.flgov.com
Congressional District 1 Congressman Jeff Miller 2416 Rayburn House Office Building Washington, DC 20515 Office phone: (202) 225-4136 Fax: (202) 225-3414 District office phone: (850) 479-1183 Fax: (850) 479-9394 Email: jeff.miller/house.gov/contact/contactform.htm
State Senate
United States Senate
Senator Greg Evers - District 2 (R) Crestview 308 Senate Office Building 404 S. Monroe St., Tallahassee, FL 32399 Tallahassee phone: (850) 487-5000 VOIP: 5000 District office: (850) 689-0556 VOIP: 40200 Fax: (850) 689-7932 Email: greg.evers.web@flsenate.gov Senator Don Gaetz – District 4 (R) Fort Walton 420 Senate Office Building 404 S. Monroe St., Tallahassee, FL 32399 Tallahassee phone: (850) 487-5009 VOIP: 5009 District office: (850) 897-5747 VOIP: 40400 Email: gaetz.don.web@flsenate.gov
State House of Representatives Rep. Douglas Broxson - District 1 (R) 1003 The Capitol 402 S. Monroe St., Tallahassee, FL 32399 Tallahassee phone: (850) 488-8188 District office: (850) 626-3113 Email: douglas.broxson@myfloridahouse.gov Rep. Clay Ingram - District 2 (R) Pensacola 1301 The Capitol 402 S. Monroe St., Tallahassee, FL 32399 Tallahassee phone: (850) 488-8278 Pensacola: 494-7330 Email: clay.ingram@myfloridahouse.gov Rep. Clay Ford - District 3 (R) Gulf Breeze 317 House Office Building 402 S. Monroe St., Tallahassee, FL 32399 Tallahassee phone: (850) 488-0895 Pensacola: 595-5550 Email: clay.ford@myfloridahouse.gov
U.S. Senator Bill Nelson 716 Senate Hart Office Building Washington DC 20510 Office phone: (202) 224-5274 Fax: (202) 228-2183 Email: www.billnelson.gov/contact/email.cfm
Florida Medical Association 1430 Piedmont Dr E. Tallahassee, FL 32308 (800) 762-0233 www.fmaonline.org
Legal and Governmental Affairs Jeffery Scott, Esq. Director of Legal and Governmental Affairs jscott@flmedical.org Michelle Jacquis Associate Director of Governmental Affairs mjacquis@flmedical.org
Regulatory Affairs Holly Miller Regulatory Affairs Counsel hmiller@flmedical.org
Payment Advocacy Linda McMullen, JD Chief Strategy Officer lmcmullen@flmedical.org Susan Franz Medical Economics Specialist sfranz@flmedical.org Leslie Barber Certified Medical Coder lbarber@flmedical.org
Member Services Cindy Tyler Membership Director ctyler@flmedical.org
American Medical Association 515 N. State Street Chicago, IL 60610 (800) 621-8335 www.ama-assn.org
Center For Medicare and Medicaid Services 1 -800- Medicare www.cms.hhs.gov
Drug Enforcement Administration (DEA) Mailstop:AES 8701 Morrissette Dr Springfield, VA 221152 (202) 307-1000 www.usdoj.gov/dea/contactinfo.htm
Florida Administrative Codes www.flrules.org
Florida Department of Medicine 4052 Bald Cypress Way, BIN # CO3 Tallahassee, FL 32399 (850) 485-0595 www.doh.state.fl.us/mqa/medical
Florida Department of Osteopathic Medicine 4052 Bald Cypress Way, BIN # CO1 Tallahassee, FL 32399 (850) 485-0595 www.doh.state.fl.us/mqa/osteopath/os_home. html
Escambia County Medical Society 8880 University Parkway, Ste B Pensacola, FL 32514 (850) 478-0706 www.escambiacms.org
Medical/Legal ACOs Wobble But They Don’t Fall Down By Jeffrey L. Cohen, The Florida Healthcare Law Firm Accountable Care Organizations are posited as the new healthcare delivery platform for the masses. They are more an idea, an experiment, than they are a thing. The basic elements are: 1. They are a legal entity which consists of physicians, hospital(s) and insurer(s); 2. They have a core of primary care physicians; 3. They must make a three year commitment to function together; 4. They must care for 5,000 patients; 5. They must be prepared to reduce overall healthcare expenditures and improve quality. They are intended to be pro competitive, but watching the early line-up of entities that are positioning themselves as early ACOs looks more monopolistic than anything. It’s a little like a child who planted little butterfly chrysalises, waited idealistically for the small winged things to emerge, then ran in horror when it was Pterodactyls, not butterflies that swarmed. The concept of an ACO is curious, yet hospital systems all over the country are busy preparing themselves to take the lead on ACO development. Why? Who else but hospital systems have the necessary ingredients of (a) time, (b) money, and (c) organizational expertise? Physicians certainly don’t, but they are necessary players. ACOs cannot function without physicians; and physicians must take a key role in ACO development without “joining.” That is, they have to take active roles in the ACO development talks and remember not to simply sign up. The ACO concept is premised on some remarkably questionable assumptions like: 1. Physicians, hospitals and insurers can create the trust, collaboration and transparency necessary to be in business together. That’s a little like hoping cats and dogs will one day roam the neighborhood paw in paw. It’s not impossible, just funny to think about. 2. Primary care physicians can control ACO cost and quality. The truth is that there is a primary care shortage all over the country; and the trend is towards a desophistication of primary care through the use of supervised “physician extenders” such as PAs, MAs, nurses and nurse practitioners. 3. Physicians can manage other physicians. For an ACO to reduce costs and improve quality, someone has to lead. The Brookings Institute, for instance, has opined that neither hospitals or insurers are well suited to accomplish either of the objectives. Will ACOs empower and reward lead physicians to lead the cost/quality objectives? That would be a first. 4. ACOs are procompetitive. How can that be, when the only players lining up to lead the charge are the “big dogs” like Kaiser and Mayo? 5. ACOs will reduce costs because the participants will be paid on an incentive basis—to reward lower costs and higher quality. Untested, unproven, perhaps even unlikely. 6. This is the end of fee for service medicine. Though FFS medicine is viewed as the root of all evil for healthcare pundits, no one is suggesting there be a mad dash towards capitation (a per member/per month payment). In fact, most think tankers believe shared cost savings is the first and logical wave of payment reform. No down side at all! What is clear about ACOs so far is that they are big business and there is huge interest among hospital systems in preparing for a battle roy-
ale with other hospital systems. Hence, systems have never been more active in gobbling up practices and integrating for greater geographic coverage. Medical practices alike have “integration fever” and are ready to jump into nearly any mega practice arrangement that comes along. Consultants with everything to sell from legal services to “healthcare consulting” services are busy selling in an environment where the motto has quickly become “Do something, anything!” For many businesses (physicians, hospitals, etc.) the answer has been to spend money, lots of it. How many $100K “excellent” EMR systems sit burping uselessly in the offices of physicians who were told “You gotta do this to get the nearly $64K that awaits you.” Plenty. Healthcare reform concepts are not new. The 90s brought a flood of fully capitated primary healthcare clinics and subcapitated specialists. Every entrepreneur had a “network” that skimmed off the top, then sold to some Wall Street guys. Healthcare reform is not new, but it is unique because it is (1) government mandated, and (2) linked to quality accountability (whatever that is). And while it’s likely to change, it’s unlikely to go away. Slow down Stanley! ACOs and the rest of healthcare reform’s measures are changing faster than anything. The ACO concept itself is changing to suggest there may be better alignments than originally considered. “Maybe since physicians, hospitals and insurers don’t want to have lunch together let alone be in business together, other alignments might work better,” some lawmakers and think tankers maintain. And we are likely to see a lot of such rethinking in the next 10 years or so that reform is set to phase in. So, what do you do? Listen, learn, carefully examine your personal and professional plans, then see what might fit you. One size does not fit all. Is a mega practice the right thing for you? Not if you’re gonna retire in a few years. What about an IPA? Sure, if the IPA is willing to break away from pure fee for services contracting. What about going after the “proprietary market” with a concierge or VIP practice? And what about solo practitioners? Are they doomed? Not likely. ACOs, networks, MSOs, GPOs and the like are just part of the rich alphabet soup that physicians must drink from in order to get to the table and find what works best for them and their patients. The truth is there is no way to avoid the change conversation. There is no way to sit this one out. Still, physicians have to resist the notion that the sky is falling and simply take an active role in considering business models which allow them to control and reduce costs and measure and demonstrate quality outcomes. With over 20 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians, Mr. Cohen’s practice immerses him in regulatory, contract, corporate, compliance and employment related matters. As Founder of The Florida Healthcare Law Firm, he has distinguished himself and his firm for providing exceptional legal services with the right pricing, responsiveness and ethics. He can be reached at (888) 455-7702 and also jcohen@floridahealthcarelawfirm.com. Visit him and his firm online at www.floridahealthcarelawfirm.com
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Be on the look out for new ECMS features! Starting in April you will be added to our NEW electronic mailing list, The Society Tides. This will be a monthly e-newsletter on local issues and legislation. There is a NEW website function at www.escambiacms.org. You can now login and manage your information or search for members. Our Website currently has a physician search function, however, it only lists public information. By creating a login for the ECMS website you can view additional information only accessible to members, register for meetings, or even opt out of our email and fax system. This NEW function creates the most up to date information possible for Escambia and Santa Rosa County Doctors. Create your user login today! Step 1: Go to the ECMS website www.escambiacms.org and click the For Doctors button on the right side, “Sign-up!” Step 2: Click “Sign up for a member account” on the left side There is a NEW section on our website for your Office Mangers to keep up with meetings with their local professional organizations. Please encourage your Office Managers and Administrators to participate in the various learning opportunities locally. The Professional Associations of Health Care Office Mangers (PAHCOM) and the Medical Group Management Association (MGMA) have several important topics that could be helpful to your office. ECMS wants your office to be the most informed, from our meetings to your office staff meetings. It is time to publish our 2011 Escambia and Santa Rosa County Medical Society Pictorial Physician Directory with Ballinger Publishing. As a benefit to our members, the directory will list the physicians alphabetically and by specialty. The directory will contain the physician name, address, phone number, specialty, NPI, picture, and website address if applicable. Our 2011 ECMS Directory will be distributed to each member at no cost. The directory is paid for by advertising revenue. We encourage our physicians to speak with our friend Malcolm Ballinger 433-1166, and his team of dedicated employees for advertising oppertunities. Don’t Forget Our Ongoing Membership Benefits and Business Relationships. Call Holly for details 478-0706.
Baptist Health Care Among First in Nation to Launch Latest Breast Imaging - 3-D breast tomosynthesis In addition to unparalleled high-quality images and reliable results provided by digital mammography this break-through technology produces 3-D images that improve cancer detection and reduce false positives. 3-D reveals the inner architecture of the breast to allow show abnormalities earlier. BHC is offering digital mammography at four locations: Baptist Hospital, Gulf Breeze Hospital, Baptist Medical Park - Nine Mile, and Baptist Medical Park - Navarre. For more information or tour, please call 850.434.4783. Baptist Medical Group Continues Primary Care Growth The primary care physicians and staff of FirstPhysicians Group have joined Baptist Medical Group’s growing network. Learn more about Baptist’s 14 primary care locations and meet 100+ total physicians now serving our region at BaptistMedicalGroup.org. Baptist Foundation Hosts Special Event Featuring Leigh Anne Tuohy on Fri., April 15, 7 p.m., at Olive Baptist Church Sandra Bullock portrayed Tuohy in the hit movie “The Blind Side.” Proceeds will benefit children cared for at Lakeview Center. Tickets are $35 and can be purchased by calling at 850.469.7906. Learn more at BaptistHealthCareFoundation.org. BHC Begins Phase II of Construction BHC and Baptist Hospital Inc. board of directors recently approved phase two of construction, allocating an additional $9.6 million to upgrade facilities and services at Baptist and Gulf Breeze hospital campuses, bringing the total community investment to $34 million. Learn more at BuildingABetterBaptist.org.
Sacred Heart News Hospital Study Ranks Sacred Heart in Top 5% in Nation The nation’s leading independent healthcare ratings organization has ranked Sacred Heart Hospital in Pensacola among the top 5 percent of all U.S. hospitals for clinical excellence. As part of its ninth annual Hospital Quality and Clinical Excellence study, HealthGrades® identified hospitals with the lowest mortality and complication rates for Medicare patients in 26 of the most common procedures and diagnoses. Based on the results of the national study, HealthGrades recently recognized Sacred Heart as a Distinguished Hospital for Clinical Excellence and presented the hospital with special Excellence Awards in the areas of Stroke Care, Critical Care, Pulmonary Care and Bariatric Surgery. The HealthGrades study shows that the 268 hospitals designated as Distinguished Hospitals for Clinical Excellence had nearly a 30 percent lower mortality rate among Medicare patients compared to all other hospitals nationwide. Each year HealthGrades independently and objectively rates patient outcomes at virtually all of the nation’s 5,000 nonfederal hospitals, utilizing nearly 40 million Medicare hospitalization records during the previous three-year period. For more information visit www.sacred-heart.org/qualityreport
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8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 Fx: 850-474-9783 Email: ECMSinfo@bellsouth.net Executive Director: Holly Strickland
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2011 Pictorial Membership Directories will be mailed to your office in April. 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.
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