ECMS Bulletin Sep/Oct 2010
Escambia County Medical Society Newsletter
ESCAMBIA COUNTY MEDICAL SOCIETY SEPTEMBER/OCTOBER2010 Volume 40, No. 5 President's Message By Wayne Willis, MD Dr. Wayne Willis Mandatory Medical Managed Care CME Event Tuesday | October 12 Heritage Hall 6:00 pm Social Hour 7:00 pm Dinner Sponsor: Pat Windham/ Wells Fargo Wealth Management Speaker: Dr. Eric Nilssen RSVP: 478-0706 ECMSinfo@bellsouth.net Founded in 1873 The delivery of Florida Medicaid services through a Managed Care Organization- MCO, has grown from 10% in 1991 to 71% in 2008. State governments around the country believed that they could control costs by having capitates contracts and other risk arrangements with MCOs. The facts are that Medicaid spending has grown about the same rate in states with and without managed care. One of the reasons for this is that MCOs have limited ability to negotiate lower costs since Medicaid fee for service already underpays providers. In 2006, a Florida Medicaid pilot program was started. It gave MCO's more flexibility to meet special needs and promoted healthy lifestyles. It also provided "Choice Counselors" to help beneficiaries pick the right plan. A May 2009 FMA report concluded that the provision of care was no better, the administrative burden to physicians was high and access to specialist continue to be a problem. As reported in a White Paper on Mandatory Medicaid Managed Care, alternative models have shown equal or greater ability to curb rising Medicaid costs. States that have attempted widespread expansion of Medicaid Managed Care, such as Tennessee, have experienced financial collapse and reduced access to care. In contrast, North Carolina implemented a Medicaid Medical Home which resulted in improved access to care and significant cost savings while at the same time increasing reimbursement to providers. It seems that the trend in both Medicare and Medicaid is to move toward a Medical Home Model with coordination of care being directed from PCP and away from central control. This is a good thing, but still relies on the government manipulating and controlling the health care industry. I believe combining a medical home model with a consumer driven approach with things like health savings accounts (HSA) and more transparency about medical costs would allow our free market to more efficiently bring costs down. Government's role should be safety and oversight. FMA President, Dr.Madelyn Butler has expressed her concern, as well, and hopes to influence legislative changes in how Florida Medicaid pays physicians. A telling statistic shows that only 5% of the $18 billion dollar Medicaid budget goes towards physician payments. Not surprisingly she is a supporter in the Medicaid community to champion for the medical home model of care versus managed care. Watch For Your Dues Statement October 1. 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 � � page: $300 � � page: $150 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 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. 2010 ECMS Officers President Wayne Willis, MD President-Elect Michelle Brandhorst, MD Vice President George Smith, MD Secretary /Treasurer Wendy Wozniak, MD Page 4 From the Fish Bowl to the Frying Pan! Page 7 In Memoriam: Braden & Beidleman Pages 9-12 Vendors of Choice 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. 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 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. Membership Announcements: The Executive Board is pleased to welcome you as a new member Donald Denby, MD! Medical Center Clinic Gastroenterology Medical School: Texas Technical University of Health and Science, 1999 Residency: University of Missouri, 2002 Board Certified: American Board of Internal Medicine American Board of Internal Medicine - Gastroenterology www.medicalcenterclinic.com The Medical Center Clinic 8333 North Davis Hwy Pensacola, FL 32514 Phone: 474-8428 | Fax: 969-2906 Dr. Stephen Kimura has a new location! 2114 Airport Blvd Suite 1500 Pensacola, FL 32504 www.allergyasthmamd.net Phone: 969- 2340 | Fax: 969-2345 Name Change: Carla Rose Tillery, M.D. West Florida Primary Care 1190 East Nine Mile Rd Pensacola, Fl 32514 (850) 474-8771 Transitional Care � What Our Pharmacists Think By Dr. Donna Jacobi This spring, Suzanne Kelley, PharmD (Covenant Hospice), Janice Hoff, ARNP in long term care (WF Senior Health Services), and I gave a presentation to the local pharmacists' association on transitional care and medication reconciliation. There was excellent participation, and the discussion that night raised these issues for your consideration: � Typicallyreconciliationofhomeandhospitalmedsisthroughthenurse and/or physician; the pharmacist is not involved but could be a valuable resource. � CallsfromERorhospitaltolocalpharmaciestoclarifyprescriptions are welcomed, BUT they suggested that the pharmacists could potentially help with whether patients appeared to be adhering to their planned regimen (based on frequency of refills and their interactions) and whether the med list from a given pharmacy was felt to be a complete one (often not). � Changes in level of care present a challenge: one MD writes the orders but doesn't always address care ordered by colleagues � there needs to be reconciliation at that point. � Whenpatientsaredischarged,therearemajorchallengesinidentifying the right MD to call when clarifications are needed (hospitalists on shifts, no printed names on Rx, MD cannot be reached in a timely manner if identified). � Whendischarged,patientsdonotalwayshaveacurrentlistofmeds, they may be unaware of reasons for meds, and there may be conflicts with previous meds � someone else "in the know" is needed (see above; if not us, then who?). � Timeofdayfordischargecancreatemajorchallengesforaccessto meds both at home and in long term care � the influence of multiple factors influencing discharge is recognized, but keep this in mind whenever possible. � Pharmacists cannot submit an insurance claim without the name of the MD and their NPI � when trainees are signing or prescriptions illegible, that information is not available. Since patients move between hospital systems, and pharmacists often deal with patients from all the local hospitals, a community-wide strategy was felt to be the only effective approach. Are we willing to lead the charge?Letthemknowwhatyouthinkdonna.email@example.com. WOMEN IN MEDICINE CELEBRATION! September is Women In Medicine Month ECMS Invites all of our Female Physicians, Residents, and Medical Students to Brunch! Atlas Oyster House 600 S. Barracks Street 11:30 � 2pm October 3, 2010 RSVP 478-0706 Membership From the Fish Bowl to the Frying Pan! By Michelle Brandhorst, MD & Wayne Willis, MD The Escambia County Medical Society would like to thank our local delegates to the Florida Medical Association (FMA): Wendy Wozniak, DO; Dennis Mayeaux, MD; Eduardo Puente, MD; Michelle Brandhorst, MD; Wayne Willis, MD; Crawford Cleveland, MD; John Lanza, MD; Jill Prafke, MD; Mike Redmond, MD. From our small corner of Florida our delegates represented Escambia and Santa Rosa counties in the heat of the health reform debate. In the following article Dr. Brandhorst and Dr. Willis discuss some of the issues debated and their experience at the FMA Annual meeting this August. Our patients look to us for information and direction. Our direction must not be to walk away from this challenge. Instead we must regroup and gather forces. For the foreseeable future, health care reform will not be a naturally occurring evolution of the physician patient relationship. It will be a political process and our unity is essential if we are to play a role in that process. Primary care and specialist, independent and employed, locally grown and those trained outside the U. S. must come together. It will not, however, be sufficient to have a stronger seat at the table. We need more seats. Through the AMA and FMA, we must learn of and support candidates from all districts and states that have physician's and patient's interests at heart. Visit the AMA and FMA websites, follow the PAC (political action committee) web sites and to paraphrase politicians from my old home city "give early and often". Michelle Brandhorst, MD This years FMA annual meeting was highlighted by debate regarding the lack of confidence in and continued relationship with the AMA. The nidus of this debate was the passage of health care reform and the AMA's failure to have health care reform address three fundamental issues, 1. Sustainable Growth Rate (SGR), 2. eliminating the Independent Payment Advisory Board, and 3. tort reform. In my opinion the health care debate and reform stemmed from three directions. First, the President and a congressionalmajoritybelievedthat health care should be guaranteed to all at no cost. Second, the current health care system (as well as the reformed health care system) has Breakfast with the Northwest Florida Caucus Wayne Willis, MD I was in Orlando recently for the FMA meeting. Our keynote speaker was Jeffery Goldsmith, PhD. a healthcare futurist for health care reform legislation. He is the President of Health Futures, Inc. and he advises both hospital systems as well as physicians groups. He expressed serious concerns about the recent flurry of hospital acquisitions of private practices. He stated these are recycled ideas that were bad ideas in the 90's and may still be bad ideas now. Goldsmith cautioned the audience that if the healthcare system did not find a way to increase primary care salaries two or three times over their current levels our medical delivery system will remain understaffed and inefficient. Dr. Madelyn Butler, M.D., a private practice OB/GYN and 2010- 2011 FMA President gave an inspiring speech at her installation dinner and outlined her agenda as President. She believes that Health Care Reform will push more doctors into employment arrangements with multi-specialty groups and hospitals. These larger organizations will be responsible for the performance outcome and the profits or losses associated with them. In a dramatic show of hands, the audience showed that almost half of the physicians present are already in an employment arrangement. She also articulated excitement regarding the increase in FMA membership recently.TheFMAjustaddedtheentirefacultyofseveralmedicalschools including my alma mater, The University of Florida. While there was a concern at one time that the FMA might lose its relevance as private practice continued on next page L:R Dr.Prafke, Dr.Redmond, & Dr. Cleveland no economic impetus to control cost. And third there was a minority that recognized the economic reality that both the current and proposed systems are non-sustainable. If health care reform was to pass and have presidential signature, some of compromise was inevitable. Whether patient care will improve as a result of this bill or if the country can afford it remains to be seen. However the content of the bill does not necessarily represent a failure of the AMA. The result was a function of physicians having the weakest seat at the compromise table. Given the result, my first instinct is to walk away in disgust. But if you think this reform bill was bad (as I do) it could have been much worse. So what to do? Our medical societies are what we make of them. The AMA, FMA and the ECMS have been in existence for over one hundred years. They have all the respect as well as the inertia that go along with this history. Further change to health care is an economic certainty. To abandon them and indeed not to bolster them is, at this time, dangerous both to our profession and to quality patient care. Membership shrinks, those concerns are proving unfounded. The consensus of comments by private and employed physicians is that they need the political clout of a group like the FMA. Finally Dr. Cecil Wilson, the current AMA President, answered criticism from many FMA delegates that were unhappy with the AMA's support of President Obama's Health Care Reform. The general feelWayne Willis, MD middle, top row. ing of the Florida delegation was that the AMA leadership needs reorganization to more accurately represent practicing physicians. The FMA addressed several of the above concepts in Resolutions: Resolution 10-201 Formal Withdrawal of Florida Medical Association From the American Medical Association RESOLVED, That the FMA submit a letter to the AMA expressing it has no confidence in the ability of current AMA leadership to effectively protect the Profession of Medicine in America. Resolution 10-304 Implementation of Health Care Reform Legislation RESOLVED, That the FMA should be proactive and create a statewide committee to analyze the implementation of the new Health Care Reform Legislation, and develop strategies to protect and preserve the private practice of medicine. Resolution 10-407 Medical Home RESOLVED, That the FMA make it a priority in the 2011 Legislative Session to promote the establishment of the Medical Home Model of healthcare statewide as passed out of the House Health Policy Council in the 2010 Legislative Session and supported by the FMA and FHA; and be it further RESOLVED, That the FMA actively advocate that equitable payment to physicians must be not less than 2009 Medicare reimbursement per CPT Code. As you read this article and see future correspondence from the FMA I hope this reaffirms, as I have seen that organized medicine through the FMA is working overtime to protect the private practice of medicine. Northwest Florida County Medical Execs: Michelle Flaat, Karen Wendland, and Holly Strickland Carnival Educates Children About Activity and Nutrition - Event teaches youth how to live a healthier life Unite Escambia, with the support of Play Pensacola and the Escambia County Medical Society Alliance, held a Healthy Carnival at the Fricker Community Center on July 30th from 10 a.m to 2 p.m. Recognizing that children are the future of Escambia County, the 2010 Healthy Carnival educated over 300 youth from Play Pensacola summer camps on the importance of physical activity and healthy eating. The event included carnival games, food tasting booths, contests, and prizes (see attached event agenda). Each child left the event with a goody bag of active items. "Overweightandobesitycanleadtomajorhealthissues,suchasdiabetes, heart disease, high blood pressure, and some cancers," said Robin Herr, chair of the Unite Escambia: Health Solutions Team. "I am thrilled thatsomanycommunityorganizationscouldjointogethertoeducateour youth on the importance of nutrition and physical activity and encourage them to adopt healthy habits to prevent later health problems." Unite Escambia is a community-wide movement in pursuit of a shared community vision: "A healthy community where all have the inspiration and opportunity to succeed." The Health Solutions Team consists of community members who are passionate about reducing childhood overweight/obesity in Escambia County to 20% by 2020. To learn more about Unite Escambia, the Health Solutions team, or other initiatives, please visit www.uniteescambia.com. Practice Management Will Pharmacogenetics Impact Your Practice? Provided By First Professionals Insurance Company Pharmacogenetics is the science that studies, among other things, how an individual may react to medications based on their genetic profile. Referred to as "personalized medicine" by some, pharmacogenetics offers the potential to recommend drug treatment based on a patient's particular genetic background. The goal is to determine the right treatment at the right dose for the right patient. Benefits of Pharmocogenetic Testing In an ideal world, drugs would be effective in all patients, would not cause toxicity, and the same dose would be optimal for all patients. Unfortunately, weliveinarealworldandintherealworldthemajorityofdrugsworkin30 to 50% of patients. As a result, more than 2 million patients per year are hospitalized due to drug toxicity or adverse reactions, resulting in the death of over 100,000 patients. Pharmocogenetic testing has the potential to offer many benefits: � Makingbettermedicationchoices � Saferdosingoptions � Improvementsindrugdevelopment An individual's genetic make-up determines their reaction to a medication. This reaction may cause the drug to metabolize longer than normal, causing serious side effects. In addition, a genetic variation can cause drugs to be rapidly metabolized making the medication less potent or completely ineffective. Utilizing pharmacogenetics, physicians have the ability to perform genetic testing before writing a prescription to identify poor responders and drug toxicity for the patient. Bob White, president of First Professionals Insurance Company states, "Although the use of pharmacogenetics does not represent the current standard of care, physicians should consider its use because of the potential benefits for increased patient safety, improved medical outcomes, cost savings and reduced exposure to malpractice claims." FDA Participation The FDA is already involved in drug label warnings that include pharmacogenetic testing for certain medications. The first drug was 6-MP, a drug to treat acute lymphoblastic leukemia. Without testing to determine the presence a specific gene, a standard dose could kill some patients. The label recommends that patients consider testing and the dose reduced accordingly. For the anti-clotting drug Plavix, the FDA label contains a warning that the use of other medications with Plavix makes the drug less effective. Another widely-used medication, warfarin, contains an FDA message on its label indicating that patients with variations in two different genes might need a lower dose. Although the FDA has not placed a label on tamoxifen, it seems likely that it will do so in the near future. The FDA's advisory panel initially recommended a label to inform patients without specific fully working genes that a higher breast cancer recurrence is possible and that certain antidepressants could make the drug less effective. While the FDA did not support the initial research behind the recommendations, subsequent research has caused the FDA to reconsider the label warning. Cost Benefit Analysis An excellent example of a significant cost benefit involves the drug warfarin. It is estimated that formally integrating genetic testing into routine warfarin therapy could prevent 85,000 serious bleeding events and 17,000 strokes annually. The cost benefit of integrating genetic testing into warfarin therapy is approximately $1 billion annually. Performing genetic testing before writing a prescription may avoid repeated visits by patients to determine the most efficient medication and dosage, resulting in cost savings for physicians. Routine � or even periodic � testing has the potential to save doctors the added expense of additional testing and the possibility of a decrease in office visit time. Pharmacy benefits managers and 200 employers nationwide who manage their own health insurance programs have been working together since 2008 to test the benefits of genetic testing. They focused on two drugs, warfarin and tamoxifen. Their data showed that 25% of people placed on warfarin had excessive bleeding or a blood clot within six months of starting warfarin therapy. Their research showed that 10% of women using tamoxifen don't metabolize the drug and have a 30% higher rate of recurrence within two years. In the case of warfarin users, a $300 test can identify those patients that carry the genes that cause them to be slow metabolizers of the drug and they can be placed on a lower dose. Health insurers save $39,000 on average for each stroke that is prevented and $13,500 for each bleeding event that is prevented. From a medico-legal perspective, complications from warfarin therapy are a frequent cause for suits against physicians and these cases are very difficult to defend because the standard of care is ill-defined. In the case of tamoxifen, identifying non-responders will allow alternative drugs or treatment modalities to be considered early on in the process and create the opportunity for better outcomes. Obstacles Pharmacogenetic testing is still in its early stages. How a patient responds to a particular medication is very complex and may not be determined by justonegene.Consequently,identifyingthemallcouldtakemanyyears and will be expensive and time-consuming. Before paying for pharmocogenetic testing, some insurers want more evidence that it leads to better patient care. Current research is beginning to establish the case for genetic testing to be routinely utilized for certain drugs. Currently, there is a lack of physician experience with genetic testing. The United States has only 500 board certified medical geneticists in clinical practice. Few practicing physicians have had pharmacogenetic instruction continued on next page In Memoriam God Loves It 1925 - 2010 By F. Norman Vickers, MD The medical and the larger community mourn the loss of retired Obstetrician-Gynecologist Fred Braden. He arrived in Pensacola in 1957 and practiced for forty years. He was a humanitarian in every sense. Dr. Bob Andrews, OB/GYN who practiced with him briefly before Fred retired spoke of his many kindnesses to patients, family and staff. One of his admonitions to the new physician was, "If you take care of your patients, they will take care of you." Andrews said that Dr. Braden gave the same care to his patients regardless of ability to pay. Jean Andrews, longtime nurse at Baptist Hospital Labor and Delivery department, said that she had known Dr. Braden for over thirty years. She also spoke of his good humor and kindness to his patients. She reported that one of Fred's frequent sayings was, "God loves it!" Fred, I'm told, when he first came to Pensacola even did some home deliveriesinthehousingprojects,whereverhispatientsneededhim. Details of Fred's honors and accolades may be found in his printed obituary, so I need not recount them here. He was honored as Baptist Hospital physician of the year in 1986. He was an active member of First United Methodist Church and served on various boards and committees. He was a dedicated gardener/horticulturalist and shared a greenhouse with his neighbor, the late Dr. Frank Creel. He was especially fond of orchids. Some years after his wife Ruthie died, he married a longtime friend and neighbor Judy Davis. He is survived by wife Judy; three daughters Susie Schmidt, Jennifer Webster, and Laurie Braden, as well as a numerous grandchildren. Fred Braden, MD Barkley Beidleman, MD 1920 - 2010 Barkley Beidleman is survived by his beloved wife of 62 years, Statia McNeese Beidleman of Pensacola; daughter, Katharine Thompson of Richmond, VA; son, William Barkley Beidleman and his wife, Robin, of Birmingham, AL; and daughter, Anne Yniguez and her husband, Dennis, of Berkeley, CA; as well as grandchildren, Daniel Barkley Thompson of Richmond; Pamela and Mathew Barkley Beidleman of Birmingham; and his brother, Edward Beidleman and his wife, Sadako, of Honolulu, HI. Dr. Beidleman was born on June 30, 1920 in Frostburg, MD. He grew up and graduated from high school in Hanover, PA. He was an Eagle Scout. He was a graduate of Gettysburg College, Gettysburg, PA, Magna Cum Laude and Phi Beta Kappa; and Harvard Medical School. In 1952, he joined the Department of Internal Medicine of the Medical Center Clinic in Pensacola. He served as Chairman of that department as well as Medical Director of the Clinic and President of the Medical Staff of West Florida Hospital. He was also a staff member of Baptist, Sacred Heart and Escambia General Hospitals; consultant to Air Products and Chemicals, Pace, FL; and to the United States Air Force Hospital in Ft. Walton Beach, FL. Dr. Beidleman was a Diplomate of the National Board of Medical Examiners, was certified by the American Board of Internal Medicine and was a Fellow of the American College of Physicians. He authored 25 articles publishedinmedicaljournalsandchaptersinfourmedicaltextbooks. He served as an officer and/or member of the American, Florida and Escambia County Medical Societies, the Endocrine Society, the Escambia County Juvenile Court Advisory Board, the Pensacola Art Association, Legal Aid Society, Northwest Florida Music Series, Regional Health Planning Council and the University of West Florida Foundation. Dr Beidleman was also instrumental in organizing the medical residency programs of the existing hospitals, known as the Pensacola Educational Program (PEP), and served as a Board Chairman. He will be remembered for his passion for medicine and generous spirit. Pharmacogenetics Impact, continued from page 6 as part of their training. For those that have not had training, managing the demands of a busy practice make it difficult to keep up with new developments. The Future of Pharmacogenetics "In light of the current benefits and emerging advances in pharmacogenetics, the future of medicine may well rely on testing to determine the role that genes play in the effectiveness of medication," said Bob White. "Results will helpdecidewhichdrugandhowmuchtoprescribe�amajorbenefitfor both patients and physicians." Doctors can expect to see more patients who already know their genetic status when it comes to metabolizing certain drugs. The patient population is increasingly demanding genetic testing services from their providers. In the case of at least warfarin, it may be wise to inform the patient of the availability of genetic testing to lessen the likelihood of an adverse reac- tion and let the patient work with their health insurer as to who pays for the test. Some patients may wish to pay for the test themselves once properly informed of its availability. While it may be true that it pharmacogenetics may eventually offer significant results, challenges remain before patients and doctors experience the anticipated benefits. Information in this article does not establish a standard of care, nor is it a substitute for legal advice. The information and suggestions contained here are generalized and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide only. Medical/Legal Implementation Issues for Accountable Care Organizations By Laurel Hinote Thorpe, Esquire, Bozeman, Jenkins & Matthews P.A. The accountable care organization (ACO) has been heralded by some as the hope of health care reform. This organizational structure is designed to realign provider incentive by discouraging the overutilization of services and encouraging the integration of care between providers. Proponents argue that this would increase the overall quality of health care and reduce its financial burden on society. In essence ACOs are collaborations that integrate primary care physicians, specialists, hospitals, and other care providers. As a group they are able to receive savings bonuses when quality targets are met and overall spending is reduced. These bonuses are then shared by all members of the ACO. Some analysts, citing the risk-sharing, preferred provider and managed care organizations of the 1990's as primary examples, are concerned that ACOs are simply a new name for an already failed experiment. They point out that ACOs would be vulnerable to the same challenges, including inability to manage risk, lack of infrastructure, lack of collegiality and collaboration between physicians and hospitals, and inhibition of patient choice and decision making power. Despite the criticism, recent health care legislation has embraced the promise and brought the organizational model from behind the closed doors of academia to the forefront of what is expected to be new paradigm of health care delivery. As a result CMS is strategically rolling out a shared savings program for ACOs that will take effect no later than January of 2012. Many of the specifics are yet to be determined, but preliminary eligibility requirements have been set forth. As envisioned by Congress and CMS, an ACO would have at least one hospital, a minimum of 50 physicians, commit to be in business at least 3 years, and have at least 5,000 assigned beneficiaries. The ACO must have a formal legal structure that allows it to receive and distribute shared savings and have a leadership and management structure that includes clinical and administrative systems. If an eligible organization meets established quality goals and financial benchmarks, it would begin to receive incentive payments which would be split by all members. A variety of models have been proposed to accommodate a range of financial risk, including anything from high risk, global capitation arrangements to low risk, fee-for-service arrangements. Physicians considering participation in the innovative payment and incentive structure provided by ACOs will need to consider the various legal hurdles that may be involved in implementation. First, there will be contractual issues to consider. Because the ACO does not represent a standard organizational structure, custom contracts will likely need to be designed for all of the parties. The contracts will need to define the scope of the relationships within the network and between the providers. The health care reform act does not specifically define the tax status of ACOs, therefore, organizers must strategically consider the tax issues associated with the new entity. In addition, there will likely be tax implications for any overarching nonprofit hospital that aligns with a tax paying entity. Participants must, also, consider the governance structure of the ACO, including the formation of a seperate corporate entity and the allocation of resources and decision making authority within the organization. In addition to the corporate decisions that must be made, there are regulatory issues that should be addressed. First, as physician organizations partner with other providers and hospitals to form ACOs, antitrust laws may be implicated. Concerns have been raised about the market power that some ACOs may develop, particularly in rural areas. Recently, the Federal Trade Commission and the Department of Justice issued revised guidelines for horizontal mergers that could impact the movement toward ACOs. The guidelines replace a rigid, formulaic analysis with a flexible set of tools that are less predictable, but arguably more tolerant of mergers. Further issues are raised with regard to the Stark law, anti-kickback statute, and civil monetary penalties statute. The health care reform law authorizes CMS to waive the regulatory requirements of these laws. However, waivers have not yet been defined. Absent such waivers payment allocation arrangements, referral relationships, and compensation plans would have to be strictly scrutinized for compliance. For example, the proposed bundled payment systems, especially the splitting of incentive payments between hospitals and physicians, were not contemplated by the Stark law and could potentially violate the anti-kickback statute as previously interpreted. Thus, in order for ACOs to be viable entities for the delivery of health care services new regulations will need to clearly define acceptable referral arrangements, incentive programs, and cost-reduction mechanisms. Physicians considering participation in ACOs outside of Florida will also need to consider whether there is an applicable corporate practice of medicine doctrine that would constrain the compensation or employment relationship with the hospital. Because of the increased emphasis on consolidation of health care services brought about by recent reforms, many physicians will be faced with difficult choices in the future. All physicians, particularly those with solo or small group practices, should remain aware of the potential effects of innovative delivery and incentive systems and begin to plan ahead for the challenges and opportunities that they may bring. In the Community Hospital News Baptist Health Care Baptist Health Care (BHC) and the Andrews Institute for Orthopaedics & Sports Medicine recently returned from an innovative strategic planning workshop at Harvard University. The intensive summit, led by Cloud Industries Health, is resulting in revolutionary advances that will deliver the institute's cutting-edge sports medicine knowledge across the globe through Web portals for citizens, medical professionals, coaches and athletes, as well as through educational seminars using advanced technologies. BHC also continues to see growth in its employed physician enterprise, Baptist Medical Group, now totalling 84 physicians. Most recently, Baptist Medical Group welcomed a gynecologic oncologist, medical oncologist and rheumatologist. See BaptistMedicalGroup.org for details Lastly, Cardiology Consultants, an affiliate of BHC, recently added three new physicians to their staff, including a new interventional cardiologist and electrophysiologist as well as the return of an interventional cardiologist who has spent time abroad. Additionally, BHC and Cardiology Consultants look forward to expanding their service area to include Jay, Fla., Atmore, Ala., and Brewton, Ala., in October. West Florida Healthcare Gulf Coast Primary Care Physicians Join Medical Staff of West Florida Healthcare ThephysiciansofGulfCoastPrimaryCarehavejoinedWestFloridaMedical Group and the Medical Staff of West Florida Healthcare. Located at 1921 E. 9 Mile Road in Pensacola, the group consists of Karen Snow, M.D., Alicia L. Chen, M.D., and Hillary Hultstrand, M.D. The office number for Gulf Coast Primary Care is (850) 479-4791. West Florida Healthcare is proud to be the only hospital in the area to offer all-private rooms as well as the area's only Certified Chest Pain Center. The West Florida Healthcare campus includes the all private room acute care hospital, the area's only comprehensive physical rehabilitation hospital, and a mental health facility. Sacred Heart Hospital Pediatric Oncology Grant: The Hyundai Hope on WheelsTM program recently presented a $100,000 grant to Sacred Heart Children's Hospital to enhance the quality of care for children fighting cancer. The grant will be used to purchase equipment for mixing and storing chemotherapy medications in a new designated chemotherapy pharmacy area inside the hospital's pediatric oncology unit. Because pediatric cancers require dosages and treatment plans differing from those of adults, the Joint Commission recommends healthcare facilities create separate pediatric pharmacies to serve young cancer patients. Annual Meeting Date Change: Sacred Heart's Medical Staff Annual Meeting has been postponed to Tuesday, Nov. 9, at 5:30 p.m. in the Greenhut Auditorium. The featured speaker will be Neal C. Hogan, PhD., who will speak on "Deflating the Healthcare Bubble." Medical Staff members of Sacred Heart Hospital should RSVP to 850-416-7000. New Imaging Technology: Sacred Heart Hospital has acquired a new 3T MRI system that will will be installed by late November. The latest MRI technology provides faster, highly accurate images allowing physicians to see smaller structures in greater detail. Cardiac imaging will be one of the capabilities of the latest MRI technology. The scanner has specific clinical applications for neurological, vascular, musculoskeletal, cardiac and pediatric exams. Tobacco-Free Campus: All of Sacred Heart Health System's facilities are now tobacco-free campuses. Please help prepare your patients who smoke for inpatient stays at our facilities. 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 In a MEDICaL MaLPRaCTICE CLaIM: Be ready for anything and everything. Pensacola Fort Walton Beach Destin Foley Fairhope 850-435-7400 www.osullivancreel.com 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. You save lives. We save livelihoods. www.firstprofessionals.com 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 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 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 www.fldic.com (800) FLA-DOCS (352-3627) (904) 296-2887 BBVA Compass is a trade name of Compass Bank, Member FDIC. 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 PRSRT STD U.S. POSTAGE PAID PERMIT #258 PENSACOLA, FL RETURN SERVICE REQUESTED Save the Date Upcoming Conferences: Free! Core Measures Community Conference with Physician HIV/AIDS Requirement October 23, 2010 Civic Center Call MECOP for Details 477-4956 WANTED! ECMS Bulletin Editor Job Description: Attention to detail, short hours, lots of free PR, and light reading. Call 478-0706 for Details. 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%!* Physician Ownership and Leadership � Financial Stability Stronger than ever. $12.5 Mi llion Dividend Declared in 2010!** Call MAG Mutual's Dennis Wilson toll-free at 1-888-892-5216 or 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.