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MEDICINE SAN ANTONIO
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VOLUME 67 NO. 12
San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS.
Connecting with Community
A look back...at 90 By Charlotte Narboni................12
EDITORIAL CORRESPONDENCE: Bexar County Medical Society 6243 West IH-10, Suite 600 San Antonio, TX 78201-2092 Email: editor@bcms.org
“Texans helping Texans” By Col. (TX) Robert Morecook ....................................16
Program encourages students to stay in school By Edwin “Eli” J. Whitney, MD.......................................18
MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org
Having the PRIDE to heal By Gilberto Vazquez .....................................................20
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BCMS President’s Message ........................................................................................................8
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Lifestyle: Ring in the holidays at the theater by Mauri Elbel........................................................26
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HASA: HIE is like Facebook for Doctors? by Gijs Van Oort ..................................................................30 UTHSCSA Dean’s Message by Francisco González-Scarano, MD ......................................................32 Book Review: ‘In the Kingdom of Ice (The Grand and Terrible Polar Voyage of the USS Jeannette)’ written by Hampton Sides, Reviewed by J.J. Waller Jr., MD ..........................................34 BCMS Circle of Friends Services Directory ..........................................................................................35 Business of Medicine: PODs, fraud and ‘Who’s my doctor?’ by Pamela C. Smith, PhD ............41 In the Driver’s Seat ................................................................................................................................43 Auto Review: Nissan Rogue by Steve Schutz, MD ................................................................................44
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Email: louis@smithprint.net San Antonio Medicine is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS or its staff. San Antonio Medicine, the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume responsibility should such advertising or editorial appear. Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or discrimination.
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BOARD OF DIRECTORS
OFFICERS K. Ashok Kumar, MD, President Jayesh B. Shah, MD, Vice President Leah Hanselka Jacobson, MD, Treasurer Maria M. Tiamson-Beato, MD, Secretary James L. Humphreys, MD, President-elect Gabriel Ortiz, MD, Immediate Past President
DIRECTORS Josie Ann Cigarroa, MD, Member Chelsea I. Clinton, MD, Member John Robert Holcomb, MD, Member Luci Katherine Leykum, MD, Member Carmen Perez, MD, Member Oscar Gilberto Ramirez, MD, Member Adam V. Ratner, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Miguel A. Vazquez, MD, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Luke Carroll, Medical Student Representative Cindy Comfort, BCMS Alliance President Nora Olvera Garza, MD, Board of Censors Chair Rajaram Bala, MD, Board of Mediations Chair George F. "Rick" Evans Jr., General Counsel
CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer
CHIEF OPERATING OFFICER Melody Newsom
DIRECTOR OF COMMUNICATIONS Susan A. Merkner
COMMUNICATIONS/ PUBLICATIONS COMMITTEE Fred H. Olin, MD, Chair Estrella M.C. deForster, MD, Member Jay S. Ellis Jr., MD, Member Diana H. Henderson, MD, Member Jeffrey J. Meffert, MD, Member Sumeru “Sam” Mehta, MD, Member Rajam S. Ramamurthy, MD, Member John C. Sparks Sr., MD, Member Chittamuru V. Surendranath, MD, Member J.J. Waller Jr., MD, Member Jason Ming Zhao, MD, Member
6 San Antonio Medicine • December 2014
PRESIDENT’S MESSAGE
Past accomplishments, future challenges By Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP 2014 BCMS President I can’t believe it is time to write my last column as president of the BCMS. First, I thank each of you for electing me to serve as your president. Second, I thank our amazing board of directors, extraordinary executive committee and hard-working staff who made my tenure memorable. In my presidential installation speech, I promised to increase BCMS involvement in community activities, increase student participation in organized medicine, and unite the BCMS and the BCMS Foundation. It is rewarding to see that each promise has been met. Here are some details about these and other key accomplishments:
COMMUNITY INVOLVEMENT BCMS is represented in many community organizations. For example, we have a seat on the Mayor’s Fitness Council (MFC), and I represent our medical society on the MFC executive committee. At the executive committee’s first meeting, the MFC created a new healthcare committee that I was asked to chair. The healthcare committee is developing a toolkit to help physicians participate in the goal of preventing obesity in our community. When completed, this toolkit will be an online resource that physicians can use to educate their patients about how healthy eating and physical activity can improve health. The BCMS board endorsed the initiatives of Metro Health, under the leadership of Dr. Thomas Schlenker, to reduce obesity in San Antonio. I believe these resources will be helpful to all physicians in Texas. This year, for the first time in history, our medical society was honored with a mayor’s proclamation on Doctors’ Day, and a County Commissioners Court proclamation honoring the BCMS and Women in Medicine. I also served as the honorary chair of the 10th Annual Texas Health Literacy Conference and worked with the San Antonio Health Collaborative to increase health literacy initiatives.
that we now have a strong and active student body (UTHSCSA Medical Student Section of TMA). We have more than 20 students who serve on BCMS committees. Also, 16 students attended the recent AMA meeting and now are leaders in TMA and AMA.
INTERNATIONAL AFFAIRS We hosted the delegation from Kumamoto, Japan. This is the 22nd anniversary of our sister medical society relationship. The news spread to Japan that I paid special attention to medical student involvement in organized medicine, so this year we had several medical students and pre-med students in the Japanese delegation. These students were excited to hear about our medical school admissions process and medical education. As usual, Hiroko Fay’s participation made this visit a phenomenal success. Earlier this year, with the approval of the BCMS board, I signed a sister-city medical society relationship with the medical society in Monterrey, Mexico. Our BCMS delegation headed by international committee chair Dr. Roberto San Martin attended their annual meeting and presented the declaration. In turn, the Monterey delegation will visit us in the future. We also have a sistercity relationship with Tamilnadu Medical Association in Chennai, India. Our delegation visited Chennai two years ago, and we recently invited their delegation to visit San Antonio.
BCMS FOUNDATION I am delighted that we successfully brought the two organizations together to restore the functions of the foundation as envisioned by the founders. Both groups worked diligently to enhance the bylaws so they remain strong collaborators. I congratulate the foundation board’s newly elected president, Dr. Geraldo Ortega, and the foundation board members. I am confident that this remarkable body will work assiduously to realize our dreams of supporting young people wishing to join the healthcare professions by awarding scholarships and other activities.
MEDICAL STUDENTS I believe our medical society needed to tell our students that we welcome them to the organization, want them to train to become leaders, and cherish their participation in our society. I am delighted
BCMS ALLIANCE It was an honor to work with the BCMS Alliance to provide community service activities. I applaud Cindy Comfort, BCMS Alliance Continued on page 25
8 San Antonio Medicine • December 2014
BCMS ALLIANCE
Thanks to all for their support of BCMS Alliance in 2014 By Cindy Comfort 2014 Bexar County Medical Society Alliance President As I prepare to write my last president’s message for San Antonio Medicine, I reflect on this past year and all of the positive changes in the Alliance. Our mission statement, “to create fellowship among the families of physicians and to foster activities in benevolent, philanthropic, charitable, and patriotic endeavors,” has been my North Star. It has guided the board in our decisions and kept us focused on our heritage and future. Past presidents Mertie Wood and Rebecca Waller and board members Rena Baisden and Shirley Sanders have been instrumental in advising me throughout the year and in making it so successful in recruiting new members, building a stronger board, and interfacing within the community. Membership engagement at our general meetings was kicked off in February at the New Member Welcome Luncheon at The Argyle Club. We had the honor of TMAA officers Cheryl Jones and Angie Donahue attending the event that featured national speaker Mary Sue Koontz Nelson, who spoke about “Living ... and Loving It Texas Style!” The dining room was filled with members, friends and laughter as we enjoyed the program that featured the August Heart Foundation. In May, we honored our past presidents at “The Affair to Remember” Fashion Show and Luncheon at Julian Gold. “The Annual Fall Coffee” was well-attended at Mary Henrich’s home with guest speaker Veronica Galvan, PhD, on Alzheimer’s disease and current aging research. In October, we had a special hosted luncheon at The Argyle Club with Michael Clark speaking on “The Current State of the Economy in the USA.” Our final program will be the December “Holiday Coffee” at board member Reema Shroff Kella’s home. Mary Anne Roman's program experience and creativity has made our events fun and profitable. Civic and Philanthropic Vice President Jennifer Lewis led an outstanding committee of dedicated volunteers that reinstituted programs and started new programs in our community. We helped with the City of San Antonio Pre-K program and Metropolitan Health District’s immunization program as part of the TMAA Be Wise, Immunize program. San Antonio’s Sicolvia spring and fall events were well-attended and there we presented helmets to needy children with the TMAA initiative, “Hard Hats for Little Heads.” We partnered again with the Metropolitan Health District at their back-to-school Immunization clinic where we gave out helmets to children after they received their immunizations. The most important community accomplishment was the formation of the Junior Volunteer Committee and Junior Volunteer Council under the guidance of Mona Talukdar. This program has brought new life into our organization 10 San Antonio Medicine • December 2014
while fulfilling our mission statement of working with medical families in our community. The Junior Volunteer Council, composed of high school students of BCMS and BCMSA members, has participated in all of the BCMSA community service events and other community volunteer programs. This program has drawn interest from other Texas alliances across the state as the success of the group has grown. Doctor’s Day, honoring the physicians of Bexar County and chaired by Katrina Theis, was held in a packed auditorium at UTHSCSA Medical School, with Mayor Julian Castro’s proclamation read by San Antonio District 8 Councilman Ron Nirenberg and an address by BCMS President K. Ashok Kumar, MD. Jennifer also has interfaced with the City of San Antonio, the YMCA, UTHSCSA Medical School, Metropolitan Health District and other agencies bringing more visible name recognition to our organization among city leaders and at TMAA. Sandra Vela, Vice President of Social, initiated several new social groups that have provided fellowship while promoting the BCMSA in the community. “Jazzed About Jewels” raised money for our “Hard Hats for Little Heads” funds and provided the members attending an informative lecture and social time. The Alliance also started “Chairs for Charity,” where BCMSA had a group table at citywide fundraisers for ACS, Cancer Center Council and other groups in town. “Sips and Dips” was another new interest group, hosted in homes of members. Danielle Hankes led monthly book club meetings with great discussions where new friendships were made. Representing the Alliance on the BCMS Board of Directors and BCMS Foundation has been an honor. The medical society has been generous in offering guidance, meeting rooms and staff help throughout the year under the leadership of Steve Fitzer. Dr. Kumar has been a joy to work with, and his support of the BCMSA has been much appreciated. The medical society has welcomed us at their events throughout the year and has partnered with us at our community service events. My sincere thanks goes out to the BCMS and staff. Rebecca Christopherson, incoming president, has been beside me every step this year, attending every meeting and function and offering her great support and ideas. She has attended the TMAA conferences alongside me and is well prepared to serve as president in January. I want to thank her, the board, the members, and especially the past presidents whose positive support has helped me throughout this year. Lori Boies has kept our financial records in order, and Gigi Gross has kept us abreast on legislative issues facing medicine during this election year. Thanks to all of you for all you have done to further the Alliance and our mission during 2014.
CONNECTING WITH COMMUNITY The getaway truck taking Gino Narboni from Algiers to Kairouan, Tunisia, 1943. All photos courtesy Narboni family
A look back...at 90 Retired BCMS member Gino Narboni reflects on two of his many careers By Charlotte Narboni Gino Narboni, MD, retired in 2002 at 79, after practicing medical oncology in San Antonio for 19 years. Many of his colleagues are unaware of Gino’s earlier, non-medical pursuits resulting from his World War II experiences. As he celebrated his 90th birthday in late 2013, it seemed a good time to reflect on earlier career paths, including Gino’s time as a military pilot — authorized to wear the wings of three Air Forces — and later as a commercial airline pilot. 12 San Antonio Medicine • December 2014
His story begins in Algeria, then a part of French North Africa. Although he dreamed of a flying career, in 1941, during WWII, Gino, 18, was instead drafted by the Vichy French government and sent to an army post in Algiers. As a Jew, he was not allowed to bear arms, so he and his fellow Jewish conscripts were assigned as convoy drivers and chauffeurs. Meanwhile, in London, Gen. Charles de Gaulle was mobilizing a fighting force for use outside occupied France. When word
CONNECTING WITH COMMUNITY Gino Narboni in front of his plane after solo flight, 1944.
50th flight, El Al — Tel Aviv-ViennaRome, 1st Officer Gino Narboni (far right).
of the general’s call for volunteers spread through the Algiers barracks, Gino and several other conscripts made plans to desert the Vichy camp. Late one evening, after being picked up at a prearranged corner, the deserters began their journey by truck across the Sahara desert. They were en route to join de Gaulle’s Free French Forces. Upon arrival in Tunisia, Gino was allowed to choose his “arms” so he said, “I want to be a pilot.” Eighteen months later, Gino was sent to the United States for pilot training. At the end of WWII, Gino, now a pilot, returned to Paris. At his father’s urging, he started medical school, but remained in the French Air Force Reserves and fulfilled requirements for a commercial pilot’s license. In 1948, while in his second year of medical school, the United Nations declared Israel a Jewish state. With that declaration, war began immediately between the Jews and their Arab neighbors. As the United States had declared an arms embargo against Israel, the new country had limited access to equipment. The Israelis, who had eight planes at the start of the conflict, began a worldwide search for parts. An Israeli recruiter contacted Gino in Paris and asked if he would ferry a recently purchased plane to Israel. Gino agreed and with a friend from flight school began a series of long, convoluted flights stopping at air bases throughout Europe and the Mediterranean basin, hiding the fact the plane’s final stop was Israel. Over the next few months, Gino made several other trips, always with complicated flight plans. Eventually, he immigrated to Israel and joined the fledgling Israeli Air Force as a captain. After the armistice was signed, Gino signed on with El Al, as one of the first pilots for the newly created Israeli national airline. Continued on page 14
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CONNECTING WITH COMMUNITY
Continued from page 13
Eventually, Gino Narboni became a U.S. citizen, a physician, and a USAF Medical Corps officer and finished his professional USAF career as a chief flight surgeon. While still on active duty, he completed a fellowship in medical oncology at M.D. Anderson. Friends and acquaintances, upon hearing these stories, often declared, “You should write a book.” Gino and I agreed it would be a terrific idea but putting words on paper never seemed to happen — that is, until the beginning of 2013 when we encountered another octogenarian who, after hearing Gino’s story, sent us a copy of his own memoir as encouragement. With that final push, a book was born! “When I Grow Up, I Want To Be ... The Memoir of Gino Narboni as told to Charlotte Narboni” was published in time for his 90th birthday. These episodes from Gino’s early life continue to have ramifications today. His service to Israel during the War for Independence made him a machal, the Hebrew word for “overseas volunteer.” He was one of the 4,400 men and women from other countries who went to Israel during the initial 1948-49 conflict. Today, 66 years later, few volunteers remain, although Smoky Simon, the founder of the Machal (www.machal.org.il), 94, still goes to the Tel Aviv office on a daily basis. For our recent visit to Israel, we asked Smoky to arrange a visit to EKRON, Gino’s former Israeli Air
14 San Antonio Medicine • December 2014
Gino Narboni at 90, November 2013.
CONNECTING WITH COMMUNITY
Force base. Today, it’s Tel Nof, an active Israeli Defense Force installation. An official tour was arranged. We were welcomed by the deputy base commander, briefed by one of the pilots, and taken on a squadron tour. The visit revived many memories. Today, with so many intervening events crowding out the past, it’s nice to be remembered for something one did years ago.
Gino Narboni (right) and IDF pilot, Tel Nof Air Base, Israel, April 2014.
Charlotte Narboni is the wife of Gino Narboni, MD, a BCMS retired member. For information on how to acquire “When I Grow Up, I Want To Be ...” in print or as an eReader, go to www.whenigrowup ginonarboni.com.
visit us at www.bcms.org
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CONNECTING WITH COMMUNITY
“Texans helping Texans” Texas State Guard Medical Brigade assists state residents in hour of need By Col. (TX) Robert Morecook The Medical Brigade of the Texas State Guard is an important medical reserve that the governor of Texas can draw upon in response to disasters in the state. As part of the Texas Military Forces, the Medical Brigade, along with the rest of the Texas State Guard, and the Army and Air National Guards, is ready to respond when Texans are in need. Brig. Gen. David J. Cohen, MD, MPA, is the commanding officer of the Texas Medical Brigade. In late 2013, he was appointed to the position and promoted to brigadier general in the Texas State Guard. Cohen is a cardiothoracic surgeon, adjunct professor of surgery at the Uniformed Services University of the Health Sciences, and a member of the Bexar County Medical Society. He is a member of the BCMS Emergency Preparedness Committee. The mission of the Texas State Guard (TXSG) is to provide mission-ready military forces to assist state and local authorities in times of state emergencies; to conduct homeland security and community service activities under the umbrella of Defense Support to Civil Authorities; and to augment the Texas Army National Guard and Texas Air National Guard as required. “We train to respond, and we do respond quickly,” Cohen said. “We can put state guardsmen in the field faster than the National Guard can move and thus help Texans more quickly.” In the last few years the TXSG Medical Brigade has provided clinics at disaster shelters during and after hurricanes. These included the devastating hurricanes of Katrina, Rita and Ike, as well as others. “During these and other hurricanes, the Medical Brigade manned medical clinics at some of the evacuation sites, or provided shelter management or public health services,” Cohen said. The Medical Brigade and the TXSG are not a part of the U.S. Armed Forces and cannot be activated by the president for federal duty or for duty outside of the United States. As part of the Texas Military Forces it serves only in Texas, or rarely in neighboring states. The commander in chief is the Texas governor. “The Medical Brigade is very active in the area of community service to Texans,” Cohen said. “Each summer, the Medical Brigade is very active in Operation Lone Star in the Rio Grande Valley. We 16 San Antonio Medicine • December 2014
Brig. Gen. David J. Cohen, MD, MPA, is the commanding officer of the Texas Medical Brigade. Courtesy photo
helped staff five free clinics this summer, and in 2013 over a oneweek period provided more than 42,000 services to more than 9,000 people.” Services at Operation Lone Star included primary medical care, dental care, and free eye examinations and glasses. “The Medical Brigade of the Texas State Guard is very active in the community, even when there are not disasters,” Cohen said. “We think of ourselves as Texans helping Texans.” Other recent community service events have included staffing first aid sites for the 13,000 bicycle riders of the annual multiple sclerosis150-mile Houston-to-Austin bicycle ride, and supplementing Uni-
CONNECTING WITH COMMUNITY versity of Texas Medical Branch emergency providers at the Wings Over Houston Air Show. Texas State Guard personnel actively support the state in the event of catastrophic events and ongoing state military missions. Members receive duty pay (currently $121 daily, regardless of rank) when activated by the governor and placed on paid state active duty for a limited number of mandatory training days. Certain expenses may be paid in case the guardsman is called to state active duty for disaster response; for example, car mileage, housing and meals costs. Getting shots is part of the care provided at Operation Lone Star, a joint civilian and military operation The Texas State Guard consists of six each summer in South Texas. Personnel of the Medical Brigade of the Texas State Guard contribute sigCivil Affairs Regiments, two Air Wings, nificantly to mission success. Photo by Texas Air Guard Senior Master Sgt. Michael Arellano the Medical Brigade and a Maritime Regiment. Members' entry rank depends on prior federal military service and/or civilian education. Individuals with no prior military service or ROTC training must attend the Basic Orientation Training (BOT) course. Currently, BOT lasts one or two weekends, depending upon how it is structured. Licensed medical personnel typically serve as officers, often entering with advanced rank. Personnel must be between ages 17 and 70 when joining, but may continue to serve after age 70. The organizational structure follows the federal military component structure, with comparable positions, ranks, protoSgt. William Alford, Tyler Medical Response Group, Texas State Guard, assists with the flow of patients cols and authorities. TXSG personnel are during Operation Lone Star 2013 in Brownsville. Operation Lone Star serves residents of the South eligible for the same state-issued military Texas border region who have no access to medical care or doctors. U.S. Army National Guard photo by Spec. Aaron Moreno. awards and decorations as members of the Texas Army and Air National Guard. The Texas military uniform worn by most of the Texas State Maj. Gen. John F. Nichols, the Texas Adjutant General. Guard is similar to the U.S. Army's combat uniform but with Texas Personnel living in and near Bexar County who want more informarkings; the Maritime Regiment's uniform is similar to the Mamation about joining the Alamo Group of the Texas Medical rine's MARPAT digital desert uniform. Air units wear a Texas variBrigade can send an email to the commanding officer, Col. (TX) ation of the U.S. Air Force uniform. James Gardon, at james.gardon@txsg.state.tx.us. The TXSG is headquartered at Camp Mabry in Austin. It functions under the authority of Title 32 of the U.S. Code and Chapter Col. (TX) Robert Morecook is Medical Brigade public affairs officer 431 of the Texas Government Code. The chief military officer is for the Texas State Guard in Austin. visit us at www.bcms.org
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Program encourages students to
STAY IN SCHOOL By Edwin “Eli” J. Whitney, MD
Motivate Our Students Texas (MOST) is a 501(c)(3) nonprofit organization which we started in 2008 to help improve the public school system. To date, the organization has helped motive more than 49,000 children in more than 44 schools in Bexar County and three schools in Natalia to take advantage of school. We do not believe the public schools are broken; instead, it’s the children’s attitude toward school that is broken. The difference between successful and unsuccessful people is that someone motivated the successful individuals to go above and beyond what is expected. What children in the MOST program learn is, “In the real world, the fun jobs pay more money. To get these jobs, you need education and good behavior.” There are two main components of the
18 San Antonio Medicine • December 2014
SAN ANTONIO INDEPENDENT SCHOOL DISTRICT Davis Middle School, 2010-13
CONNECTING WITH COMMUNITY
MOST program: educational expeditions (field trips) and a speaker program, in which successful people from the community go into the classroom and speak with students about their careers and what it took to get there. The educational expeditions occur monthly; however, to earn the right to go on these field trips, the students must have perfect attendance the previous month. The expeditions take place during school hours and are a lot of fun for the students. For these reasons, in the schools where the MOST program has been implemented, the absenteeism rate typically falls in half. Since the MOST program involves the entire student body, the teachers quickly notice that peer pressure turns positive, and there is an almost immediate fall in discipline problems. The teachers also note an improvement in the completion of homework by the students. At Sam Houston High School in the 2012-13 academic year, there was an average improvement in daily attendance from 90 percent to 94 percent. In Davis Middle School, which feeds into Sam Houston High School, in the same school year, the average daily attendance improved from 91 percent to 96 percent. They
went from last in the district in attendance to first in the district. Referrals to the principal’s office were cut in half and, perhaps most importantly, the average grades among students in all classes improved eight points, or almost a full grade improvement. Similar improvements in attendance, grades and even TAKS testing scores were seen in virtually all the schools where the MOST program was implemented. We hope Bexar County Medical Association members will take time to go into a classroom once a year and talk about their careers and what it took to get there. Hopefully, we can encourage some students to pursue a career in medicine. To learn more, view a short video on the program, and volunteer, visit www.motivateourstudents.org. Edwin “Eli” J. Whitney, MD, is a cardiologist at the Heart and Vascular Institute of Texas and a BCMS member.
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CONNECTING WITH COMMUNITY
Students establish group on LGBTQ health By Gilberto Vazquez PRIDE is a multidisciplinary organization of current and future clinicians at the UT Health Science Center San Antonio (UTHSCSA). The mission of the organization is to bring equitable healthcare to medically under-served gender and sexual minorities, including lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals. PRIDE works toward this goal through community outreach, health education and research. However, building PRIDE was not always an easy task, said former co-presidents Nicole Clifton and Chris Alonzo. “Advocacy, education, fellowship, hospitality and service – these objectives really fueled everything we planned for PRIDE,” Clifton said. “I was in the education group – our group of students came up with the idea of a LGBTQ health education program which eventually evolved into the idea of Safe Space.” Safe Space training aims to provide a more hospitable environment for LGBTQ people by establishing an identifiable network of people who can provide support and information, and act as allies to LGBTQ individuals within the university. In 2011, Alonzo led the implementation of the Safe Space program. “The campus attitude at the onset of Safe Space was one of more passive resistance than anything else,” he said. “The office of undergraduate medical education and student center were willing to support the research and goal, but higher-level support was nearly absent. Even after several attempts, it was still difficult to be acknowledged.” As Safe Space has grown, more than 200 students, faculty and staff have participated within the past three years. Training has expanded to the Regional Academic Health Center (RAHC) in Harlingen. “With the success of the program now and implementation at other sites, I believe that attitude has been changing,” Alonzo said. PRIDE also has made significant efforts to serve the transgender community in San Antonio. In collaboration with the San Antonio Gender Association (SAGA), PRIDE has set up a number of transgender health panels that have been open to the campus. The panels allow members of the transgender community to share their experiences and the challenges they face in receiving healthcare. “Working with SAGA has been an eye-opening experience,” said Chris Lam, a current PRIDE co-president. “Not only did I learn that clinicians will refuse to have transgender patients in their waiting rooms, but the attempted suicide rate of transgender 20 San Antonio Medicine • December 2014
persons is 41 percent. That’s about 25 times the national average of 1.6 percent.” With the rise of student interest for transgender health education, PRIDE has worked with faculty to incorporate a transgender health panel into the required medical school curriculum and the physician assistant program as well. “We have already received great feedback from PA students on their clinical rotations, who have had wonderful encounters with transgender patients,” Lam said. Faculty support for PRIDE also has been remarkable. Dr. Robert Esterl, professor of surgery and associate dean for undergraduate medical education in the School of Medicine, and Dr. Peter Andrew Guarnero, assistant professor in the Department of Family and Community Health Systems in the School of Nursing, are the faculty co-advisors for the group. Additionally, PRIDE has found more support in the School of Medicine. Dr. Dana McDowelle, assistant dean of diversity and professional development, aided the group as it held the first Texas LGBTQ “OUT for Health” medical summit. The inaugural “OUT for Health” summit was held April 12 at UTHSCSA in partnership with the School of Medicine's Diversity and Student Professional Development program. The event attracted more than 80 registrants and included medical students from every Texas medical school. The Texas Association for GLBTQ Health was founded by these medical students to bring equitable healthcare to persons across the state. “It’s been an exciting experience,” Lam said. “We are continually in contact with other schools to share resources, and I can’t wait to go to the next summit hosted by the medical school at UT-Houston.” PRIDE continues to move forward in promoting equitable healthcare. The group currently is leading a LGBTQ needs assessment survey with the purpose of understanding the medical disparity that the community faces in San Antonio. The information gathered with the survey will bring the group one step closer to establishing a LGBTQ student-run free clinic. Gilberto Vazquez is a second-year medical student at the University of Texas Health Science Center San Antonio. He serves as a co-president for UTHSCSA PRIDE. He may be reached at vazquezg@livemail.uthscsa.edu.
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BCMS LEGISLATIVE AND ADVOCACY NEWS
BCMS physicians participate in legislative events By Mary E. Nava, MBA BCMS Chief Governmental and Community Relations Officer
1. On Oct. 14, BCMS members Michael Battista, MD, and Buddy Swift, DO, attended a reception in honor of another friend of medicine, state Rep. Lyle Larson (District 122), at the Islamorada Fish Company. Pausing for a photo (from left) were Dr. Swift, Mary Nava, Larson and Dr. Battista. 2. A reception hosted by Drs. Michael Battista and Pamela Ray was held Oct. 22 in honor of State Rep. Philip Cortez (District 117). Cortez, a strong supporter of medicine's issues, sits on the Texas House Committee on Public Health. Pausing for a photo were (from left) Alex Kenton, MD, Cortez and Dr. Battista.
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3. A reception honoring Congressman Pete Gallego (Texas District 23) was held Oct. 23 in the home of Gustavo Medellin, MD. Those attending were (back row, from left) Jesse Moss Jr., MD; Bacel Nseir, MD; David Valdez, MD; and David Friedman, MD; (front row, from left) Michael Battista, MD; Gustavo Medellin, MD; Dianna Burns-Banks, MD; Gallego; and Shamsa Saleem, MD. 4. Drs. Michael Battista and Pamela Ray hosted a reception in their home Oct. 29 in honor of State Sen. Donna Campbell, MD (District 25). Pausing for a photo with Campbell were (from left) Isabel Basaldu-Prado, MD; Buddy Swift, DO; Campbell; Michael Battista, MD; Rodolfo Molina, MD; Scott Farhart, MD; and Mary Wearden, MD. Also attending but not in the photo were Alex Kenton, MD; Candace Campos-Kenton, MD; and Mark Welborn, MD. On Oct. 15, BCMS President-elect James Humphreys, MD, joined TMA advocacy staff Darren Whitehurst and Dan Finch, and BCMS executive staff CEO Steve Fitzer and Mary Nava in a meeting with Congressman Joaquin Castro (District 20) to discuss a number of issues physicians are facing at the federal level, including SGR, red-tape administrative hassles and the Geographic Practice Cost Index (GPCI).
For local discussion on this and other advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava at Mary.Nava@bcms.org.
22 San Antonio Medicine • December 2014
BCMS NEWS
CALL FOR RESOLUTIONS FOR 2015 It's that time of year again ... Do you have a TMA policy change suggestion or recommendation for a stance on an issue? Submit your resolutions now to the BCMS Delegation to TMA. In order to allow adequate time for resolution review preparations, the deadline to submit your resolutions to BCMS is Jan. 9. For a sample resolution form, visit www.bcms.org/delegation.html.
IN MEMORIAM C. Brandon Chenault, MD, died Sept. 16, 2014, at age 84. Dr. Chenault was an obstetrician/gynecologist and BCMS life member. Francisco “Tito� Armando Gallegos, MD, died Nov. 6, 2014, at age 72. Dr. Gallegos was a plastic and reconstructive surgeon and BCMS retired member. Ernest Gregory, MD, died Oct. 12, 2014, at age 89. Dr. Gregory, a surgeon and World War II veteran of the Army Air Corps, was a BCMS life member. Gerhard A. Meyer, MD, died Oct. 28, 2014, at age 91. Dr. Meyer, who served in the U.S. Air Force Medical Corps during the Korean War and specialized in internal medicine, was a BCMS life member. Richard Tamez, DO, died March 22, 2014, at age 85. Dr. Tamez was a surgeon and BCMS retired member.
CHCS clinic named for Dr. Burns-Banks Dianna M. Burns-Banks, MD (right), and her son, Michael Burns, pause Oct. 8 in front of the new Center for Health Care Services (CHCS) CenterCare Clinic. The clinic, which offers primary care services for patients receiving treatment for mental health and/or substance abuse, is the latest addition to the Restoration Clinic in downtown San Antonio. The clinic was named in honor of Dr. Burns-Banks, who served on the CHCS board of directors from 2007 to 2014, as vice chair of the board of trustees and chair of the policy and operational committee. Courtesy photo
visit us at www.bcms.org
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BCMS NEWS
“Good Health is Always in Fashion” at Women in Medicine event More than 300 people attended the Nov. 1 BCMS Women in Medicine event at the Omni San Antonio Hotel. “Good Health is Always in Fashion” was the theme of the event, which included shopping opportunities, networking with BCMS Circle of Friends representatives, a fashion show featuring women physicians, luncheon, and guest speaker Robin Eickhoff, MD, who discussed “Nurturing Your Soul.”
Thank you to all the sponsors and supporters who made this year’s event a great success!
TITLE SPONSOR
SPECIAL SPONSOR
IN-KIND SPONSORS
CONTRIBUTING SPONSORS
FASHION SHOW SPONSOR
Special thanks to our door-prize donors: Alamo Travel Group, Aspect Wealth Management, Bariatric Medical Institute of Texas, BBVA Compass, Cano and Cano Co., Clinical Pathology Laboratories, DataMed, Dermatology San Antonio -- Dr. Stephen Miller, Diamante Custom Homes, Doctor's Company, Favorite Healthcare Staffing, First Choice ER, Fleming's Steakhouse, Galen College of Nursing, Gastroenterology Consultants of San Antonio, Generations Federal Credit Union, Kathy’s Kreations, Know Your Doctor, Massage Heights — Medical Center, Mudfire Pottery, Myke's Hair Studio, Northwestern Mutual, Perry's Steakhouse, SA Luxury Realty, San Antonio Symphony, Scentsy, Select Rehabilitation Hospital of San Antonio, SmithPrint, Stella and Dot Jewelry, Stone Oak Dermatology, Time Warner Cable and Warm Springs Rehabilitation Hospital. For information on the BCMS Women in Medicine Committee, contact Brissa Vela at Brissa.Vela@bcms.org.
Members of the BCMS Women in Medicine Committee gather at the Nov. 1 luncheon and fashion show (from left): Dr. Lan-Anh Le Ngo, Dr. Leah H. Jacobson, Dr. Linda J. Banta, committee chair Dr. Chelsea Clinton, Dr. Carmen Emery, Dr. Nancy Dru Bryant, Dr. N. Carol Dornbluth, committee vice chair Dr. Maggie Beato and Dr. Wendy B. Kang. 24 San Antonio Medicine • December 2014
Dr. Robin Eickhoff offered suggestions on ways busy professionals can create life-work balance.
PRESIDENT’S MESSAGE Continued from page 8
president, and her entire team. We worked closely to establish a collaborative relationship among the UTHSCSA Medical Student Section, Junior Volunteers and the BCMS Alliance to accomplish many community activities, such as “Hard Hats for Little Heads” and “Be Wise, Immunize.”
NEW HOME FOR BCMS As you know, our board members and the staff are working hard to build our new home. You have already seen the artist’s rendition of the building and other details of fundraising for this purpose via U.S. mail. I urge you to contribute to this worthy cause and identify some prospective donors the society can approach to achieve the goal of a home for our medical society.
OUR FUTURE IS HERE Today’s students are the “future of our organization.” I believe that they are more informed, and more energetic than ever before with current budding student leaders in the TMA and AMA student sections. These are the individuals who will lead BCMS, TMA and AMA in the future.
CHALLENGES Our medical society has many challenges ahead. Examples of these challenges include changes in healthcare and payment reform, repealing of SGR, getting San Antonio’s own Geographic Practice Cost Index, increasing patient access to care, and preserving the doctor-patient relationship and scope of practice. We can achieve our goals if we work together. I am reminded of President John F. Kennedy’s famous quote, “Ask not what your country can do for you, ask what you can do for your country.” I encourage you to become active in the society, contribute your ideas to solve our problems, participate in committee work, and show our strength in numbers so that we can represent the medical community with one voice. On my part, I will continue to serve the society. I thank you again for supporting me throughout the year. I thank BCMS CEO/Executive Director Steve Fitzer and our dedicated staff for helping me to serve you better. Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP, is the 2014 president of the Bexar County Medical Society.
visit us at www.bcms.org
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LIFESTYLE
Ring in the holidays
AT THE THEATER By Mauri Elbel
Six family-friendly San Antonio shows to see this season
As the holidays approach, get the whole family into the spirit with San Antonio’s seasonal theater performances guaranteed to entertain everyone from grandma to junior. This December, this city brims with holiday shows playing out on various stages big and small from the brand-new $203 million Tobin Center for the Performing Arts to the Magik Theatre and Rose Theatre Company. Below are six holiday shows you and your children won’t want to miss this month.
If you haven’t checked out the impressive Tobin Center, which opened in September, there is no better time to do so than December –– three holiday performances are going on this month. “The Tobin Center takes pride in its family programming for the holidays –– a perfect time to come out and check out the new state-of-the-art center for San Antonio,” says Christopher Novosad, senior marketing manager. “Careful thought and care have been given to creating something for everyone at the Tobin Center, from the only San Antonio-based Nutcracker in town to the Cirque twist on the holidays.”
The Nutcracker H-E-B Performance Hall Nov. 28-Dec. 27 The Nutcracker is a must-see production by Ballet San Antonio and the San Antonio Symphony. Created by San Antonio artists for San Antonio audiences, this enduring classic realizes Tchaikovsky's original vision with exquisite choreography, sets and costumes, performed to live symphonic music. The Nutcracker follows Clara and her beloved nutcracker on a magical Christmas Eve journey as the two survive a raging bat26 San Antonio Medicine • December 2014
Cirque Dreams, Ringing in the Holidaze, Courtesy photo, Tobin Center.
TOBIN CENTER FOR THE PERFORMING ARTS www.tobincenter.org (210-223-8624)
tle between a horde of mice and toy soldiers, experience the wintry beauty of the Land of Snowflakes and savor an array of delights in the Kingdom of Sweets.
Cirque Dreams Holidaze H-E-B Performance Hall Dec. 11-14 Lighting up the 2014 holiday season, Cirque Dreams Holidaze is a not-to-miss cirque performance, Broadway musical, holiday spectacular and family show all in one. With rave reviews spanning The Washington Post to the New York Daily News, Broadway director Neil Goldberg reimagines the holi-
day season with more than 300 costumes, 20 acts and 30 performers from 12 countries showcasing an endless variety of heartpounding and gravity-defying feats you have to see to believe –– think gingerbread men flipping mid-air and toy soldiers marching on thin wires.
Rudolph the Red-Nosed Reindeer: The Musical H-E-B Performance Hall Dec. 22-24 A half-century later, this beloved Christmas classic which first aired in 1964 still captures the hearts and wonder of fans of all
LIFESTYLE Rudolph the Rednose Reindeer, Courtesy photo, Tobin Center.
The New York Times bestselling Junie B. Jones series. Between Junie B. participating in the holiday pageant and picking a Secret Santa gift for her big rival, Tattletale May, there’s never a dull moment in the life of the world’s funniest first-grader. Laugh along with your family as you discover together whether Junie B. will make the right choice and give May something other than a lump of coal –– but no matter the outcome, Junie B. is sure to capture your hearts and uplift your spirits. “Share the book at home, then watch it come to life on stage,” Graham says.
Holy Holidays B@tman, Courtesy photo Rose Theatre Co.
Irish Christmas, Courtesy photo, Tobin Center.
MAGIK THEATRE www.magiktheatre.org (210-227-2751) Junie B. Jones: Jingle Bells, Batman Smells! Nov. 21-Dec. 27 Gather the entire family for a holiday outing to Magik Theatre, designed to educate young people and adults while nurturing the
Junie B. Jones Jingle Bells, Batman Smells. Photography by David Frank, ArtGives.org, Junie B. Jones, Kacey Griffin.
ages. Soaring off the screen and onto the stage, the Tobin Center brings all of your favorite characters from the animated television special, including Santa and Mrs. Claus, Hermey the Elf, Bumble the Abominable Snow Monster, Clarice, Yukon Cornelius, the Misfit Toys and, of course, Rudolph, in the all-new Rudolph The Red-Nosed Reindeer: The Musical, a theatrical adventure that teaches us what makes you different is also what makes you special.
next generation’s theater audience. The theater is a miraculous place, says Magik Theatre’s Beth Graham. What better time to share in the magic of the theater than during the holidays? Watch as Junie B. returns to Magik Theatre’s stage presenting a hilarious holiday tale based on the book Jingle Bells, Batman Smells! by Barbara Park, author of
THE ROSE THEATRE CO. www.therosetheatreco.com (210-360-0004) Rudolph the Red Nose Reindeer, Dec. 17, 18, 20 and 23 Holy Holidays B@tman!, Dec. 5-20 The Rose Theatre, a black box theater tucked away in the Elms Shopping Center located off Wurzbach and Lockhill Selma roads, prides itself on being a theater that non-theater go-ers love, says co-owner Jessie Rose. Formerly known as the Steven Stoli Playhouse, the Rose Theatre Company has become a popular production house in San Antonio that organizes theater workshops and acting classes for adults as well as kids and conducts comedy shows, improvisational theater, live musicals and concerts. This holiday season, the Rose Theatre will be running its children’s show, Rudolph the Red Nose Reindeer. “Children see how Rudolph became the famous reindeer that he is today,” Rose says. “This play has everything you need to get into the spirit, Christmas carols and fun for the whole family. Every show is geared toward children 1 to 8 years old and packed with audience participation allowing the kids to be a part of every moment.” As nighttime rolls around, treat the family with tickets to Holy Holidays B@tman! which runs on Friday and Saturday nights Dec. 5-20. This familyfriendly comedy is a hilarious holiday spoof of the famous 1960s Batman and Robin that promises to have the whole family laughing as the duo takes on the many villains who try to sabotage Christmas. visit us at www.bcms.org
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28 San Antonio Medicine • December 2014
HASA
HIE is like Facebook for doctors? By Gijs Van Oort That’s just what a new study, published in the prestigious journal, Information Systems Research, and highlighted in a Brookings Institute blog post, concludes. The authors ask, “Would you have joined Facebook if you had no friends who were already using the social network?” Then answer the question with a resounding, “Probably not!” “Facebook,” the authors say, “with no friends is a lonely place.” And so is an HIE without a critical mass of clinical data. The study tracked HIE adoption and usage patterns among more than 2,000 physicians and 430 practices over three years. It found that doctors are like anyone else, they want to be where their peers and colleagues are. And if their fellow physicians and referral colleagues are connected to and sharing data via an HIE, then that’s where they also want to be. The problem with all of this is the classic “chicken and egg syndrome.” The study’s authors correctly state that “the potential of a HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services.” By the same token, if doctors are waiting for all of their fellow physicians to jump on before taking the plunge, then what we have is a kind of standoff. According to two studies published in the journal Health Affairs, hospitals and healthcare systems made “phenomenal progress” in adopting electronic health records in 2013, but still have a ways to go to meet all the criteria for Meaningful Use (MU) Stage 2 and the implementation of HIEs. Susan Hall, an editor and author writing in FierceHealthIT, a daily newsletter covering IT in healthcare, says, “Despite their dependence on data to improve care, most ACOs – 76 percent -- do not participate in a health information exchange at a community level.” In South Texas, HASA’s 22-county service area, the situation is similar. In Bexar County, five of the six hospitals are on board and participating. But physician groups in the community are lagging behind. In part, it is an issue of the cost to interface from their EMR systems to HASA, which can vary greatly, but also it is exactly what the 30 San Antonio Medicine • December 2014
national study reported. Physicians have their own set groups of other doctors they work with on a regular basis. The primary care groups want to wait until the specialty groups are participating and vice versa. In a perfect world, everyone would sign up at the same time and the benefits would be overwhelming to the community. We fundamentally believe that as more hospitals and practice groups sign on, and their physicians and administrators see the business and patient care benefit, those numbers will grow.
REFERENCE Yaraghi, Niam and Du, Anna Ye and Sharman, Raj and Gopal, Ram D. and Ramesh, Ram, Health Information Exchange as a Multi-Sided Platform: Adoption, Usage and Practice Involvement in Service Co-Production (August 13, 2014). Available at SSRN: http://ssrn.com/abstract=2480093
Gijs van Oort, PhD, is the executive director for Healthcare Access San Antonio (HASA), the local Health Information Exchange (HIE) provider authorized by the State of Texas to create a community-based, region-wide HIE in Bexar County and 22 surrounding counties. Visit www.hasatx.org.
visit us at www.bcms.org
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UTHSCSA DEAN’S MESSAGE
Alonso N. Gutierrez, PhD (left), and BCMS member Chul S. Ha, MD, talk with a CTRC patient. Courtesy photo
THE CANCER THERAPY & RESEARCH CENTER: 40 years of serving Central and South Texas By Francisco González-Scarano, MD This has been an eventful year for the Cancer Therapy & Research Center (CTRC), the National Cancer Institute-designated Cancer Center for San Antonio and South Texas. In 2014, we celebrate the 40th year of service to the 4.5 million men, women and children of South Texas. Re-competition for our NCI grant extending our Cancer Center designation for another five years was time consuming, but ultimately rewarding; thanks to the hard work of more than 450 individuals, we received a “high-impact” score and consequent funding. Our mission is five-fold: (1) comprehensive, multidisciplinary care for all forms of cancer, (2) basic science discoveries of mechanism of oncogenesis and how we can better target them for therapy, (3) clinical trials of the next generation of methods to prevent, diagnose and treat cancer, as well as to prevent and control side effects of cancer and its treatment, (4) education of the next generation of cancer physicians, surgeons and scientists, as well as (5) a major focus on cancer prevention for the 38 counties of South Texas. These are the distinguishing characteristics of National Cancer Institute-designated Cancer Centers. 32 San Antonio Medicine • December 2014
Since our last NCI review in 2008, our progress has been formidable. Metrics include a three-fold increase in accrual to clinical trials (to over 2,000 in 2013), a seven-fold increase in accrual to investigator-initiated trials (those that are developed by our own faculty), a more than doubling of publications, and, despite a dramatic flattening in NIH funding, a 32 percent increase in total peer-reviewed funding to more than $23 million in grant funding in 2013.
HISPANIC PATIENTS The CTRC has a major focus on cancers that disproportionately affect the South Texas region, including liver cancer (which is seven times more common in Hispanic men than in the U.S. population at large) cervical and stomach cancer, and pediatric leukemias. We also have a very special interest in prevention, diagnosis and treatment of cancer in Hispanics, the fastest-growing segment of the U.S. population. Unfortunately, at a national level, few studies include many Hispanic patients, making conclusions regarding treatment in this important population diffi-
UTHSCSA DEAN’S MESSAGE cult. At the CTRC, by contrast, 46 percent of patients on treatment trials are of Hispanic ethnicity and 76 percent on non-treatment studies (such as prevention or early detection studies) are Hispanic. We are very proud that much of the national knowledge base on how best to prevent and treat cancers in this important segment of the U.S. population comes from San Antonio and the CTRC. With the growing San Antonio and South Texas population, in mid-2014 the CTRC recruited a host of new physicians to provide the subspecialty cancer care that is state-of-the-art today. These include: Meghan Lautner, MD, breast cancer surgery; Virginia Kaklamani, MD, and Kate Lathrop, MD, breast cancer medical oncology; Sukeshi Patel, MD, and Laura Tenner, MD, gastrointestinal medical oncology; Woondong Jeong, MD, urologic medical oncology; Michael Liss, MD, and Dharam Kaushik, MD, urologic surgical oncology; Sumit Madan, MD, hematologic oncology; and Ian Makey, MD, cardiothoracic /lung surgery. These new physicians have joined the CTRC’s multidisciplinary cancer treatment teams including breast cancer, prostate and urologic cancers, colorectal, pancreas and liver cancers, brain cancers, sarcomas and bone cancers, hematologic cancers, gynecologic cancers, endocrine cancers, lung cancer, and head and neck cancer. The CTRC also is blessed to have a comprehensive skin cancer clinic including the availability of MOHS surgery. These treatment teams are augmented by subspecialists in radiologic imaging, pathology, genetics and epidemiology. Together, they work to develop individualized treatment plans for patients with common and uncommon conditions. The CTRC’s clinical research programs further augment the care of cancer patients and those who are at risk of cancer including individuals with a family history of cancer. This program benefits from the presence of the storied Institute for Drug Development, one of the oldest and most successful Phase I programs in the United States where first-in-human clinical trials are conducted, including therapies developed by our own physicians. The newest example of this success is the development of an extremely promising new treatment for recurrent brain cancer, a disease that is almost always lethal within a very short time. A team of scientists and physicians developed a formulation that packaged a high-intensity radiation source into microscopic fat bubbles – 186Rhenium Nanoliposomes (or RNL). In early studies, this treatment almost universally cured experimental brain tumors. After years of intensive research, the U.S. Food and Drug Administration approved a Phase I clinical trial at the CTRC that will begin soon, offering this promising treatment first to our own patients from San Antonio and South Texas. Other promising drugs
are in the CTRC pipeline, including repurposing of older drugs to make current cancer medications more effective, often in a dramatically more cost-effective manner; in one CTRC study, a generic antimalarial drug – hydroxychloroquine – made chemotherapy more effective at a cost of only 50 cents per day. The CTRC’s 80 scientific Full Members (MDs and PhDs) and 66 Associate Members provide the scientific discoveries that push scientific discovery into improving cancer care and reducing the burden of cancer. They work side-by-side with our physicians to develop the next generation of cancer care therapies.
REDUCING THE BURDEN An overarching goal of the CTRC is to reduce the burden of cancer for our 38-county region of South Texas, an area about the size of Pennsylvania, where many patients have to drive up to five hours for our specialty care. To reduce this burden, a group of Virtual Tumor Boards have been developed. For patients seen at the CTRC, a group of specialists in the specific cancer (for example, breast cancer) will evaluate new cases to develop an individualized treatment plan, often for very complex cancers. The tumor boards are conducted in real-time format over high-speed Internet connections allowing physicians in distant locations to present their patients to these panels of experts. Virtual Tumor Boards have been established in Edinburgh and Laredo, with multiple other sites in planning stages. Ultimately, it is the CTRC’s goal to provide the highest-level cancer care in our patients’ own communities where they are supported by their families, avoid long drives for therapy, and “sleep in their own beds at night.” There is much work to do to provide the very best cancer care for South Texas. We are fortunate to have a National Cancer Institute-designated Cancer Center like the CTRC in San Antonio, thanks to the vision of a group of San Antonio leaders 40 years ago. The CTRC’s growth and contributions to the health of our community have been made possible only through community support, support of the UT Health Science Center and the University of Texas system, and the dedicated service of our staff, physicians and scientists. Ultimately, it is our mission to dramatically reduce the burden of cancer for our region and provide “the answer to cancer.” Dr. Francisco González-Scarano is dean of the School of Medicine, vice president for medical affairs, professor of neurology, and the John P. Howe III, MD, Distinguished Chair in Health Policy at the University of Texas Health Science Center at San Antonio. His email address is scarano@uthscsa.edu. visit us at www.bcms.org
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BOOK REVIEW
‘In the Kingdom of Ice (The Grand and Terrible Polar Voyage of the USS Jeannette)’ Reviewed by J.J. Waller Jr., MD
During the latter portion of the 19th century, the world was excited about the possibility of some country accomplishing the challenge of attaining the North Pole. This was the last unexplored area of the world, and several unsuccessful attempts had been made by Europeans. International esteem would fall to the country that could plant their flag on the north tip of the world. Many theories existed as to the nature of the polar ice cap and how to navigate to the North Pole, but the true geography was not understood. Writer Hampton Sides relates the story in his book, “In the Kingdom of Ice (The Grand and Terrible Polar Voyage of the USS Jeannette).” The U.S. Navy prepared an expedition to accomplish this feat, and it was underwritten by James Gordon Bennett Jr., the ultrawealthy owner of the New York Herald newspaper. He had sent Stanley to Africa to successfully find Dr. Livingstone several years previously. The expedition was under the command of a young naval officer, George Washington DeLong, who had gained recognition for a rescue attempt off the north shore of Greenland. The group set sail on the USS Jeannette, a refitted ship for the polar exploration, on July 8, 1889, heading north from San Francisco to the Bering Sea and hopefully farther north to the pole. With a select crew of 32 men, they set sail to bring recognition to this young country just emerging from its catastrophic Civil War.
LEAD POISONING They arrived at the polar ice cap, but being unable to find an open water passage they became entrapped in the ice. They remained such for almost two years, constantly moving with the ice flow northwesterly. Survival during this period was relatively easy while still on board the ship. There was plenty of coal on board for energy needs, supplies, and plenty of game (polar bears and seals) for additional food. All hands became ill at one point with strange symptoms that were finally diagnosed by the ship surgeon to be lead poisoning from the cans containing tomatoes used primarily to prevent scurvy.
34 San Antonio Medicine • December 2014
Finally open water was encountered but the ship was struck in the hull by an underwater iceberg and shortly sank. All hands, considerable supplies, and equipment were saved, but the expedition found itself trapped on the ice with the nearest land being the northern shore of Siberia 1,000 miles distant. Thus with the crew, tons of supplies, sleds, and three small open boats began one of the most perilous and heroic journeys recorded in naval history. To move south over the erratic ice and reach open waters and then sail to Siberia in three open boats produced challenges never imagined. With the ice flow moving north while they marched south, occasionally they made only a few miles a day against the subzero weather and treacherous terrain. They managed to gain ground overcoming immense odds. Finally reaching open water, they manned the boats and set off south for Siberia. Combatting constant storms, frequent fog, unbearable cold, and lack of sufficient food, they continued but the three boats became separated. They eventually reached Siberia in different areas. The crews were now fully exhausted mentally and physically. Desperate from the inhumane environment and dwindling food supplies, they made for the nearest settlement hundreds of miles to the south. Some froze to death and others died from frostbite leading to infection and gangrene. Finally, a settlement was reached and eventually a town with telegraph, and word was flashed to Washington and the world about the plight of the Jeannette and her crew. The journey had taken more than three years, but most of the information was recorded in detail in the logs by Captain DeLong. Their accomplishment of survival became international news, and they were acclaimed as heroes. This story of dedication, perseverance, determination and sacrifice makes for an extremely interesting, exciting and enjoyable read. J.J. Waller Jr., MD, is a member of the BCMS Communications/Publications Committee.
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.
• ACCOUNTING Anderson, Johns & Yao CPAs (HH Silver Sponsor) We strive to provide a professional and friendly atmosphere for all your accounting and financial needs Ann Yao, CPA/PFS, 210-696-9400 yao@ajycpa.com www.ajycpa.com San Antonio based CPA firm with 30 plus years of experience Padgett Stratemann & Co. LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally-owned CPA firms, providing sophisticated accounting, audit, tax, and business consulting services. Vicky Martin, CPA 210-828-6281 Vicky.Martin@Padgett-CPA.com www.Padgett-CPA.com Offering Service. More Than Expected. On every engagement. Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets. Jim Rice, CPA, 210-384-8000, ext 112 jprice@ssacpa.com www.ssacpa.com Dedicated to working with physicians and physician groups
• ATTORNEYS Pulman, Cappuccio, Pullen, Benson & Jones (H Bronze Sponsor) The attorneys at Pulman, Cappuccio, Pullen, Benson & Jones, LLP have over 150 years of combined experience providing exemplary representation for clients. Eric Pullen, 210-222-9494 EPullen@pulmanlaw.com
• BANKING
Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with 5 core values; Attention, Accountability, Appreciation, Adaptability & Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett, 210-343-4556 jeanne.bennett@amegybank.com Karen Leckie, 210-343-4558 karen.leckie@amegybank.com www.amegybank.com Community Banking Partnership
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Broadway Bank (HHH Gold Sponsor) Broadway Bank is a full service personal and commercial bank with a specialized Healthcare banking team committed to supporting our medical community. We offer 40 convenient locations in San Antonio, Austin and surrounding areas. Ken Herring, 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com We’re here for good.
Crockett National Bank (HHH Gold Sponsor) Crocket National Bank is a leading Texas community bank specializing in mortgage, ranch and commercial real estate lending providing superior customer service and competitive financial products. Lydia Gonzales, 210-384-9304 lydiagonzales@crockettnationalbank.com www.crockettnationalbank.com Doing what we promise.
Frost (HHH Gold Sponsor) As one the largest Texas-based banks,Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Lewis Thorne, 210-220-6513 lewis.thorne@frostbank.com www.frostbank.com Frost@Work provides your employees with free personalized banking services.
The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are one of the few agents in the state that specialize in Medical Malpractice and all lines of insurance for the medical community. Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com Baptist Credit Union (HH Silver Sponsor) It is Baptist Credit Union’s mission to meet our members needs by providing extraordinary service, quality financial products, and personal financial education. Sarah Chatham 210-525-0100, ext 201 memberservices@baptistcu.org www.baptistcu.org We commend your dedication to the health & wellbeing of our community. Cadence Bank (HH Silver Sponsor) Cadence Bank is a full-service financial institution serving commercial, consumer, treasury and wealth-management clients in Texas and the Southeast. Margarita Ortiz, 210-764-5500 maggie.ortiz@cadencebank.com Steve Edlund, 210-764-5573 steve.edlund@cadencebank.com http://cadencebank.com Explore Cadence Bank’s innovative financing options and treasury management solutions. Citi Commercial Bank (HH Silver Sponsor) Chris McCorkle 210-408-5014 christopher.a.mccorkle@citi.com www.citi.com Continued on page 36
visit us at www.bcms.org
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 35
Firstmark Credit Union (HH Silver Sponsor) Address Your Office Needs. Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs. Competitive rates, favorable terms, and local decisions. Gregg Thorne, SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org St. Joseph's Credit Union (HH Silver Sponsor) A Credit Union providing savings, checking, IRA, club, and CD accounts. Plus, Auto, signature, Lines of Credit, MasterCard and Real Estate Loans. Debra Abernathy, 210-225-6126 lending@sjcusatx.net www.sjcusatx.com Better Rates on Auto loans, Signature loans and Platinum MasterCard Jefferson Bank (H Bronze Sponsor) Full service bank specializing in mortgages, wealth management & trusts. Ashley Schneider 210-734-7848 ext 7848 aschneider@jeffersonbank.com www.jeffersonbank.com Security Service Federal Credit Union (H Bronze Sponsor) Business financing, specializing in low interest commercial real estate transactions Luis Rosales, 210-845-8159 lrosales@ssfcu.org BCMS members can get up to half a percent off the origination fee Texas Farm Credit (H Bronze Sponsor) Rural, homestead and acreage lending. Tiffany Nelson, 210-798-6280 www.texasfcs.com
• CATERING Corporate Caterers (H Bronze Sponsor) A locally owned family franchise business serving the San Antonio area. Ricardo Flores 210-789-9009 rflores@corpcatererstex.com
Heavenly Gourmet Catering (H Bronze Sponsor) 210-496-9090 www.heavenlyg.com
• CONTRACTOR/ BUILDERS Huffman Developments (HH Silver Sponsor) Steve Huffman, 210-979-2500 Shawn Huffman, 210-979-2500 www.huffmandev.com San Antonio Retail Builders (HH Silver Sponsor) Specializing in remodeling/finish out of medical offices. H.B. Newman 210-446-4793 brett@texaspremiercapital.com Rick Carter 210-367-7909 rick@texaspremiercapital.com Next 6 months Architectural Space Plan / Rendering No Cost or Obligation
• CUSTOM HOMEBUILDING
Diamante Custom Homes (HHH Gold Sponsor) Experience your new custom homebuilding process through San Antonio’s leading designbuild firm. Over two decades of streamlining the balance between your budget and your dreams. The name you know from the builders you trust! Keith Norman, 210-341-6430 knorman@diamantehomes.com www.diamantehomes.com Special promotions for all BCMS members – call us today!
• EDUCATION Alpha Bilingual Preschool (H Bronze Sponsor) Our mission is to provide young children with an integral early education in a Spanish immersion environment. Tania Lopez de Pelsmaeker 210-348-8523 tldp@hotmail.com Give your children the gift of speaking a second language.
36 San Antonio Medicine • December 2014
• ELECTRONIC MEDICAL RECORDS
Greenway Health (HHH Gold Sponsor) Greenway Health offers a fully integrated electronic health record (EHR/EMR), practice management (PM) and interoperability solution that helps healthcare providers improve care coordination, quality and satisfaction while functioning at their highest level of efficiency. Jason Siegel 512-657-1259 jason.siegel@greenwayhealth.com www.greenwayhealth.com
• FINANCIAL SERVICES
Northwestern Mutual Wealth Management Company (HHHH Platinum Sponsor) Comprehensive Financial Planning Insurance and Investment Planning Estate Planning and Trust Services. Eric Kala CFP, CLU, ChFC, Wealth Management Advisor 210-446-5752 eric.kala@nm.com www.erickala.com
As one the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com Commercial leasing for a doctor’s business equipment and vehicle. Platinum Wealth Solutions of Texas LLC (HH Silver Sponsor) Comprehensive financial planning firm who assists medical professionals to protect their income, their wealth, their practice and legacy. Tom Valenti, 210-998-5023 tvalenti@jhnetwork.com Eric Gonzalez, 210-998-5032 ericgonzalez@jhnetwork.com www.platinumwealthsolutionsoftexas.com Understanding the uniqueness in the financial life as a physician. Bold Wealth Management (H Bronze Sponsor) Comprehensive Investment Advisory and Retirement Planning Services for Businesses and Individuals. Richard A. Poligala, 210-998-5787 richard.poligala@natplan.com www.boldfinancialgroup.com Complimentary no-obligation retirement plan review to BCMS members
• GOLF Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction,confidence, and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com Get what you deserve… Maximize your Social Security benefit!
Frost Leasing (HHH Gold Sponsor)
TPC San Antonio (H Bronze Sponsor) 18-hole championship golf courses designed by two of golf's most innovative architects, Pete Dye and Greg Norman. Matt Flory, 210-491-5816 www.tpcsanantonio.com
• HOSPITALS/ HEALTHCARE SERVICES
First Choice Emergency Room (HHH Gold Sponsor) The nation's oldest and largest
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY network of independent freestanding emergency rooms. Patients seen almost immediately. Board-certified physicians and emergency-trained registered nurses. In-house CT scanner, ultrasound, digital X-ray and COLA/CIA accredited on-site lab to handle emergencies 24/7/365. Nacogdoches Road 24-hour 210-447-7560 Hardy Oak Boulevard 24-hour 210-451-8340 Tezel Road 24-hour 210-437-1180 www.fcer.com Check in online – free, easy, fast!
Select Rehabilitation of San Antonio (HHH Gold Sponsor) At Select Rehabilitation Hospital of San Antonio, we provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges. Miranda Peck, 210-482-3000 mipeck@selectmedical.com http://sanantonio-rehab.com/ Offers patients a higher degree of excellence in medical rehabilitation.
South Texas Sinus Institute (HHH Gold Sponsor) The South Texas Sinus Institute is a state of the art facility dedicated to in-office Balloon Sinuplasty using the unique Painless Sinuplasty Anesthetic Linked Method. Sue Musgrove, 210-225-5666 stsisue@gmail.com www.southtexassinusinstitute.com. We will offer convenient same day or lunch appointments to BCMS members.
Warm Springs Medical Center Warm Springs Thousand Oaks Warm Springs Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate,expert care during the rehabilitation process
& support recovery through education & research. Central referral Line 210-592-5350 Joint Commission COE Elite Care 24 Hour Emergency Center (HH Silver Sponsor) We are a fully equipped emergency room open 24 hours a day and 7 days a week, staffed by experienced emergency physicians. We provide the same level of emergency medical care that you would receive in a hospital ER. Clemente Sanchez, 210-269-8028 csanchez@elitercaremarketing.com Rosie Clark, 210-771-0141 rclark@elitecaremarketing.com www.elitecareemergency.com Get seen by an experienced physician within 10 minutes. Methodist Healthcare System (HH Silver Sponsor) Palmira Arellano, 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Seasons Hospice and Palliative Care (HH Silver Sponsor) Deb Houser-Bruchmiller 210-471-2300 dhouser@seasons.org www.seasons.org Southwest General Hospital (HH Silver Sponsor) Southwest General Hospital is a 327-bed, state-of-the-art hospital located in San Antonio, Texas. Southwest General offers comprehensive healthcare services. Craig Desmond, 210-921-3521 Elizabeth Luna, 210-921-3521 www.swgeneralhospital.com
• HUMAN RESOURCES
Employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page. John Seybold, 210-447-6518 jseybold@employerflexible.com www.employerflexible.com BCMS members get a free HR assessment valued at $2,500.
Pinnacle Workforce Corp HR. Services (H Bronze Sponsor) Dan Cardenas, 210-344-2088 dancardenas@pinnacleworkforce.com
• INFORMATION TECHNOLOGY
Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes. Stephanie Stephens, 210-332-4924 sstephens@dahill.com www.dahill.com Allison Royce Business Technologies (H Bronze Sponsor) Business Technology Provider, specializing in HIPAA Compliant Managed IT Services and IT Support since 1993. Jeff Tuttle, 210-564-7000 jtuttle@allisonroyce.com www.allisonroyce.com PitCrew IT Services (H Bronze Sponsor) Provides reliability for your business computers or network, enabling you to operate smoothly. Eric Murcia, 210-547-0305 eric@pitcrewit.com
• INSURANCE
Blue Cross Blue Shield of Texas (HHH Gold Sponsor) Edna Pérez-Vega, 210-558-5162 Edna_Perez-Vega@bcbstx.com www.bcbstx.com
Frost Insurance (HHH Gold Sponsor) As one the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com Business and personal insurance tailored to meet your unique needs.
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Donnie Hromadka 512-338-6151 dhromadka@humana.com www.humana.com
Texas Medical Association Insurance Trust (HHH Gold Sponsor) Created and endorsed by the Texas Medical Association (TMA), the Texas Medical Association Insurance Trust (TMAIT) helps physicians, their families, and their employees get the insurance coverage they need. James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org We offer BCMS members a free insurance portfolio review. Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States. Crystal Metzger James L. Hayne Jr. 210-222-2161 www.catto.com Continued on page 38
visit us at www.bcms.org
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 37
Texas Drug Card (H Bronze Sponsor) The Texas Drug Card program is a FREE statewide Rx assistance program available to all residents. Todd Walker 512-569-5547 twalker@texasdrugcard.com http://texasdrugcard.com/index.php
• INSURANCE/MEDICAL MALPRACTICE
Texas Medical Liability Trust (HHHH Platinum Sponsor) Texas Medical Liability Trust is a physician-owned health care liability claim trust, providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 14,000 doctors in all specialties who practice in all areas of the state. TMLT is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, the Dallas, Harris, Tarrant, and Travis County Medical Societies. Patty Spann, 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended Partner of the Bexar County Medical Society.
state that specialize in Medical Malpractice and all lines of insurance for the medical community. Katy Brooks, CIC, 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com Serving the medical community. The Doctors Company Medical malpractice insurance (HH Silver Sponsor) We relentlessly defend, protect and reward the practice of good medicine. As the patient safety industry leader, we proudly offer a comprehensive selection of CME opportunity and risk-mitigation resources. Kirsten Baze, 512-275-1874 KBaze@thedoctors.com www.TheDoctors.com
• INTERNET/ TELECOMMUNICATIONS Time Warner Cable Business Class (HH Silver Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterprise-class technology and communications that are highly reliable, flexible and priced specifically for the medical community. Rick Garza, 210-582-9597 Rick.garza@twcable.com Time Warner Cable Business Class offers custom pricing for BCMS Members.
• MARKETING SERVICES Medical Protective Medical Malpractice Insurance (HHH Gold Sponsor) Medical Protective, the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Thomas Mohler 512-213-7714 thomas.mohler@medpro.com www.medpro.com
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are one of the few agents in the
Know Your Doctor SA (HH Silver Sponsor) Increase your practice’s unique marketing/communications program. Connect with SA community through video, advertising, PR and medical opinion e-news. Limited to 300 physicians. Lorraine Williams, RN 210-884-7505 LWilliams@KnowYourDoctorSA.com www.KnowYourDoctorSA.com
Phiskal LLC Marketing and Promotion (H Bronze Sponsor) A leading edge marketing and development firm using proprietary Artificial Intelligence engines to enhance your presence with websites, apps & database applications. Sundeep Sadheura 210-865-4520
38 San Antonio Medicine • December 2014
Sunnys@phiskal.com HTTP://PHISKAL.COM/
• MEDICAL BILLING AND COLLECTIONS SERVICES
DataMED (HHH Gold Sponsor) Providing your practice with the latest compliance solutions, concentrating on healthcare regulations affecting Medical Billing and Coding changes allowing you and your staff to continue delivering excellent Patient Care. Anita Allen (210) 892-2333 aallen@datamedbpo.com www.datamedbpo.com BCMS members receive a discounted rate for our billing services.
Commercial & Medical Credit Services (H Bronze Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda, 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com Make us the solution for your account receivables.
PriMedicus Consulting Inc. (H Bronze Sponsor) A physician-founded and built company, dedication to your success. Sally Combest MD., 877-634-5666 s.combest@primedicusconsulting.com www.primedicusconsulting.com PriMedicus Consulting for the Health of Your Practice.
Urgent Care Billing Solutions, LLC (H Bronze Sponsor) UCBS provides superior practice management services and revenue optimization services to the healthcare community in a virtual office environment. Ann DeGrassi, CMIS 210-878-4052 adegrassi@ucbillingsolutions.com www.urgentcarebillingsolutions.net
• MEDICAL SUPPLIES & EQUIPMENT
Henry Schein Medical (HHHH Platinum Sponsor) From alcohol pads and band aids to EKG’s and Ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines, and pharmaceuticals serving office based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com/medical BCMS members receive GPO discounts of 15%-50%. McKesson Medical-Surgical (H Bronze Sponsor) MCKESSON is a leading distributor of Medical Supplies and Equipment. Karan Cook, 210-573-2117 karan.cook@mckesson.com
• ORGANIZATIONS Fundacion Teleton USA (HH Silver Sponsor) Ricardo Guzman Hefferan guzman@teletonusa.org www.teletonusa.org
• PAYMENT SYSTEMS/ CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by 250-plus business associations. Tanner Wollard, 979-219-9636 Tanner.Wollard@e-HPS.com http://www.heartlandpaymentsystems.com/ Lowered cost for American Express; next-day funding.
• PUBLICATION MANAGEMENT FIRM Traveling Blender (H Bronze Sponsor) Publication Management Firm Janis Maxymof, 210-413-9731 janismaxymof@gmail.com 10% discount on display advertising in magazine for Circle of Friends members.
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY • PRINTING SERVICES SmithPrint (H Bronze Sponsor) SmithPrint offers custom printing, branding, graphic design, signage and more! Robert Upton 210-846-5268 Robert@smithprint.net http://www.smithprint.net/ New customers: 10% discount on print materials at SmithPrint.
• REAL ESTATE/ COMMERCIAL Cano and Company Commercial Real Estate (HH Silver Sponsor) Experienced and respected commercial real estate representation. We specialize in office leasing, property acquisition, and commercial real estate investment. Dennis Cano, Agent 210-731-6613 www.canoandcompany.com Dennis@canoandcompany.com Effective commercial real estate solutions for your practice and investments. Stream Realty Partners (H Bronze Sponsor) Carolyn Hinchey Shaw 210-930-3700 cshaw@streamrealty.com www.streamrealty.com
• REAL ESTATE/ RESIDENTIAL
830-456-2233 Joe.Salinas@SothebysRealty.com JoeSalinas.com My hometown roots are based in Fredericksburg while my home away from home is San Antonio. Local knowledge, exceptional results. Embrace your new life ... I'll help you become a connoisseur! Becky Aranibar Realty Group Keller Williams (H Bronze Sponsor) Offering Real Estate Services to the San Antonio Medical Community. Carlo G. Aranibar, MBA, 210-862-4022 BARgrouptx@gmail.com www.beckyaranibar.com Offering free comparative market analysis to determine your home's value.
• RESEARCH STUDIES/ BIOTECHNOLOGY
ICON Development Solutions (HHHH Platinum Sponsor) We are a respected clinical research organization that has an extensive reputable history in diabetes research. Depending upon the current studies, ICON may establish working relationships with local physicians. Your expertise may be invaluable to our efforts to identify subjects Dr. Dennis Ruff 210-283-4572 dennis.ruff@iconplc.com www.iconplc.com Find out how ICON can help your Practice.
lic/medicalsocieties/bexar_count y/bexarcounty_index.aspx Favorite Healthcare Staffing offers preferred pricing for BCMS members.
• TRANSCRIPT SERVICES Med MT, Inc. (H Bronze Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records. Ray Branson 512-331-4669 branson@medmt.com www.medmt.com The Med MT solution allows physicians to keep practicing just the way they like.
• STAFFING SERVICES • REAL ESTATE/ INVESTMENTS Texas Premier Capital (HH Silver Sponsor) A real estate development company offering and managing real estate investment funds in the South Texas area. H.B. Newman 210-446-4793 brett@texaspremiercapital.com Rick Carter 210-367-7909 rick@texaspremiercapital.com www.texaspremiercapital.com
Kuper Sotheby's International Realty (HH Silver Sponsor) Joe Salinas III,
As of November 7, 2014
Favorite Healthcare Staffing (HHHH Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency, and protect their revenue cycle! Brian Cleary 210-301-4362 BCleary@FavoriteStaffing.com www.favoritestaffing.com/pub-
For more information, call 210-301-4366, email August.Trevino@bcms.org or visit www.bcms.org.
THANK YOU
to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA Clinical Pathology Associates Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Institute for Women's Health
Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA Renal Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA
Contact BCMS today to join the 100% Membership Program!
South Alamo Medical Group South Texas Radiology Group, PA Tejas Anesthesia, PA Texas Partners in Acute Care The San Antonio Orthopaedic Group Urology San Antonio, PA Village Oaks Pathology Services/Precision Pathology WellMed Medical Management Inc.
*100% member practice participation as of November 7, 2014. visit us at www.bcms.org
39
BUSINESS OF MEDICINE
PODs, fraud and ‘Who’s my doctor?’ By Pamela C. Smith, PhD When the average person hears the question, “Who’s my doctor?” they simply would say “Dr. X.” As physicians, you should be aware that “Who’s My Doctor?” is a new nonprofit group encouraging doctors to disclose their financial relationships with medical manufacturers. The group’s slogan, “The Total Transparency Manifesto,” has a goal of telling patients that doctors don’t have anything to hide. The group encourages physicians to disclose “every financial connection to pharmaceutical and medical device companies.” The need for more transparency concerning physician fee arrangements is nothing new. What is new, however, is the Centers for Medicare and Medicaid Services (CMS) Open Payments website. According to the CMS, “Open Payments is the federally run program that collects the information about financial relationships.” This data is publicly available for download from the CMS website, with the first reporting period covering transactions from the last five months of 2013. The CMS Open Payments disclosures started Sept. 30. Subsequent reports will be compiled on an annual basis (beginning spring 2015, for 12 months of payments). This database is a requirement of the Physician Payments Sunshine Act of the Patient Protection and Affordable Care Act of 2010.
TRANSPARENCY SOUGHT Patients and the CMS are not the only stakeholders interested in financial transaction transparency. The Justice Department has taken
action on this highly controversial topic. In September, the government filed complaints under the False Claims Act against a physician, a spinal implant company, the company’s distributorships and company owners, for alleged kickbacks deriving from the PODs. PODs are an evolving structure of physician-owned distributorships of medical devices. PODs may provide significant cost savings, particularly with orthopaedic implants. Some proponents of PODs argue that physicians can eliminate the “middle man” and provide significant savings to the patient. PODs also may encourage volume pricing and foster competition, which can lead to significant cost savings. The federal government began its campaign investigating potential POD fraud in March 2013, with the issuance of a special fraud alert by the Office of the Inspector General for the U.S. Department of Health and Human Services (OIG). The OIG claims such arrangements lead to a “strong potential for improper inducements.” The fraud alert outlines certain questionable features of a POD, including (a) selecting investors because they are in a position to generate substantial business for the entity, (b) requiring investors who cease practicing in the service area to divest their ownership interests, and (c) distributing extraordinary returns on investment compared to the level of risk involved. This form of incentive structure may induce physicians to perform more expensive procedures, and use “devices the PODs sell in lieu of other, potentially more clinically appropriate, Continued on page 42 visit us at www.bcms.org
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BUSINESS OF MEDICINE Continued from page 41
devices.” Furthermore, in its September allegations, the Justice Department stated, “Improper payments to physicians can alter a physician’s judgment about patients’ true healthcare needs and drive up healthcare costs for everyone.”
CONFLICT OF INTEREST Supporters of the OIG’s actions reiterate that PODs have an inherent conflict of interest and “produce substantial fraud and abuse risk and pose dangers to patient safety.” Prior to the OIG Fraud Alert, the Senate Finance Committee issued an Inquiry Report in June 2011, concluding PODs raised numerous legal and ethical concerns, and the potential for abuse was enhanced due to the lack of clear governmental guidance on the issue. This report resonated in the healthcare community, causing many hospitals to scale back purchases from these types of companies. For example, effective November 2012, HCA revised its physician-owned vendor relations policy to “discourage its affiliates from purchasing items or services for use in patient care, including but not limited to pharmaceuticals, implants, instruments and other medical devices, from physicianowned vendors.” The future viability of PODs has yet to be determined. Not all physicians are engaged in fraudulent kickbacks, but the actions of a few have raised legislative action. Increasing transparency
42 San Antonio Medicine • December 2014
through more disclosures may or may not reduce allegations of fraud. Financial arrangements in healthcare are complicated, evolving, and ripe for scrutiny – both positive and negative. Oftentimes legislation cannot keep up with advances in technology or strategic business planning. It is yet to be seen how the Justice Department’s pursuits will impact the POD business model — only time and legislative action will tell.
REFERENCES 1 http://www.whosmydoctor.com/ 2 http://www.cms.gov/OpenPayments/index.html. The law requires disclosure of all transfers of value, including gifts, consulting and speaking fees, and meals worth more than $10. 3 http://oig.hhs.gov/fraud/docs/alertsandbulletins/2013/POD_Special_ Fraud_Alert.pdf 4 http://www.justice.gov/opa/pr/united-states-pursues-claims-against-neurosurgeon-spinal-implant-company-physician-owned 5 http://www.policymed.com/2013/04/oig-special-fraud-alert-physician-owneddistributors. html#sthash.X5pl6vil.dpuf 6 http://ec.hcahealthcare.com/CPM/LL027.doc
Pamela C. Smith, PhD, is an associate professor of accounting at the University of Texas at San Antonio. She teaches in the undergraduate and graduate tax program, as well as the MBA program, business of healthcare track.
Tom Benson Chevrolet 9400 San Pedro Ave. Gunn Acura 11911 IH-10 West
* Fernandez Honda 8015 IH-35 South
Ingram Park Auto Center 7000 NW Loop 410
Ingram Park Auto Center 7000 NW Loop 410
Gunn Honda 14610 IH-10 West (@ Loop 1604) Ancira Chrysler 10807 IH-10 West Cavender Audi 15447 IH-10 West
Ingram Park Auto Center 7000 NW Loop 410
Mercedes-Benz of Boerne 31445 IH-10 W, Boerne * Gunn Infiniti 12150 IH-10 West
Ancira Ram 10807 IH-10 West
Mercedes-Benz of San Antonio 9600 San Pedro Ave.
North Park Subaru 9807 San Pedro Ave.
Ancira Dodge 10807 IH-10 West BMW of San Antonio 8434 Airport Blvd.
Ingram Park Auto Center 7000 NW Loop 410 Ancira Jeep 10807 IH-10 West
* Mini Cooper The BMW Center 8434 Airport Blvd.
Ingram Park Auto Center 7000 NW Loop 410 Cavender Buick 17811 San Pedro Ave. (281 N @ Loop 1604)
Batchelor Cadillac 11001 IH-10 at Huebner Cavendar Cadillac 801 Broadway
* Ancira Volkswagen 5125 Bandera Rd.
Northside Ford 12300 San Pedro Ave.
* North Park Lexus 611 Lockhill Selma
Cavender Toyota 5730 NW Loop 410
Ingram Park Nissan 7000 NW Loop 410 * The Volvo Center 1326 NE Loop 410
Cavender GMC 17811 San Pedro Ave. * North Park Lincoln/ Mercury 9207 San Pedro Ave.
Porsche Center 9455 IH-10 West
visit us at www.bcms.org
43
AUTO REVIEW
Nissan Rogue: Crossovers gain popularity for driving ease, economy By Steve Schutz, MD Sedans and SUVs are done. They’re not relevant to car buyers anymore. OK, that’s an overstatement, but the run of three box cars and body-on-frame (non-pickup) light trucks as clear leaders of the U.S. automotive market is over as they are being increasingly overlooked by customers who want crossovers. This is a big deal. Since at least the 1950s, sedans have ruled the roost —and for the record they still do for the time being; the best-selling car through the first half of 2014 is the Toyota Camry sedan — but the growth of crossovers has been astounding. 44 San Antonio Medicine • December 2014
COMBINING ELEMENTS As most readers know, crossovers are vehicles that combine elements from sedans, SUVs and even minivans into one appealing package. Grandparents are increasingly shopping for Mercedes M-classes and BMW X5s, parents of teens and tweens are being seen in more Toyota Highlanders and Audi Q5s, and young couples with or without kids are looking at Subaru Foresters, Ford Escapes, and this month’s test vehicle, the Nissan Rogue. It makes sense. Sedans are relatively fun to drive and fuel efficient but don’t offer much space, let alone flexible space. And traditional
SUVs — think early 2000s Ford Explorers, Toyota 4-Runners and Chevy Tahoes — offer storage room and off-road ability but generally suffer from mediocre fuel economy and drivability. So it should be no surprise that crossovers, with their car-like driving dynamics, good fuel economy and configurable space for dogs, skis, mountain bikes and what-have-you, are growing in popularity. The Nissan Rogue is a small entry-level crossover, competing with the Hyundai Santa Fe, Honda CRV and Toyota RAV4. Like its competitors, the Rogue provides a relatively high seating position — shorter
AUTO REVIEW drivers love this — all the pluses listed above, a good-looking exterior, and a very reasonable price tag. It should be said that calling the Rogue good looking depends, as always, on what you compare it to. If you line it up next to the above-listed competitors, I’d say the Rogue is a six; against all new cars it’s probably just a four. Its inoffensive design seems to have been created by taking a slightly rounded, generic small crossover shape and adding numerous Nissan styling cues. While the end result will not win styling awards, the Rogue’s understated look will appeal to many young couples and families on a budget, as well as thrifty empty-nesters. Inside the Rogue things get more interesting. The diminutive Nissan comes standard with a rearview camera (that projects to a corner of the rearview mirror), a 5-inch touchscreen monitor to control many functions, and Bluetooth audio. And despite its modest starting price, the Rogue can be had with numerous options typically associated with luxury cars, such as lane-departure warning, keyless entry/start-stop, and Nissan’s wonderful “bird’s eye” system that uses cameras on the grille, rear end, and under both side mirrors to give you the impression that there’s one camera looking down from 30 feet above the car. If you haven't experienced it yet, you should. It’s really something. As I found when I reviewed the Juke recently, Nissan, presumably stung by numerous reviewer critiques, has improved the look and feel of the plastics in its interiors. The gap in quality now between the interior of any Nissan and that of its Toyota or Honda counterpart has narrowed markedly. One advantage the Rogue’s cabin has over all of its competitors is the presence of a third seat. As you’d expect, the two seats in the “way back” are very small, but if you are suddenly asked to carry two extra kids to the ice cream shop after a soccer game, you can do it without resorting to the dreaded “double buckling.” Nissan’s familiar 2.5-liter four-cylinder engine that produces 170 hp and 175 lb-ft of
torque is what you get with all Rogues. Unfortunately, you also get Nissan’s CVT transmission, which I and all driving enthusiasts dislike. Front-wheel drive is standard, and all-wheel drive costs an extra $1,200. City/highway fuel mileage is 25 MPG city/32 highway for the AWD model and 16/33 for the FWD model.
GOING ROGUE The 2015 Nissan Rogue S starts at $23,650, including destination, which is pretty cheap. The all-wheel-drive SL model, on the other hand, starts at a more realistic $30,490. Expect to pay between $30,000 and $35,000 for a well-equipped Rogue. The growing popularity of crossovers in this country and around the world is not a
fad but rather a sea change in what people want to drive. Sedans and SUVs may not be irrelevant yet, but the center of gravity of the automotive market is rapidly moving away from those types of vehicles. I guess you could say the market’s going Rogue. Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. For more information on the BCMS Auto Program, call Phil Hornbeak at 3014367 or visit www.bcms.org. visit us at www.bcms.org
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46 San Antonio Medicine • December 2014