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www.escambiacms.org JANUARY/FEBRUARY 2014 VOLUME 44, NO. 1

2014 Membership Dues ECMS mailed early county invoices for membership dues in October of 2013. Please be sure to pay your membership dues for 2014 prior to March to be included in the 2014 ECMS Pictorial Directory. If you recently moved or changed any of your business information (fax, phone number, address, etc.) please submit all changes to the directory by March.

Founded in 1873

BULLETIN Editors: Hillary Hultstrand, M.D. Erica Huffman, Executive Director

Starting the New Year Right Escambia County Medical Society started 2014 with a bang. We enjoyed a festive inaugural ball on Saturday, January 25, 2014 with a nautical theme featuring Dr. Alan Harmon as our speaker. Dr. Harmon is the current president of the Florida Medical Association. He is a practicing gastroenterologist out of Jacksonville, Florida. He delivered an encouraging message about what the FMA has accomplished and was reminiscing about his time spent working alongside some of the longstanding members of the ECMS. The invocation was delivered by Monsignor Luke Hunt from St. Ann Church in Gulf Breeze. Dr. Lanza was on hand to give the We CARE award. The 2013 Bell-Shippey We CARE Doctor of the year award went to Dr. Gerald Lowrey. His total donated services came to $97,028. Music added to the atmosphere and there was plenty of dancing…and much of it was my family! I received many comments from those of you who noticed that my son and daughter seem to get along fabulously for a brother and sister at ages 12 and 15. It also gave me the opportunity to introduce myself as your new president. First and foremost, I am humbled to be in this position. I wish for this medical society to thrive and I hope to recruit new leadership as we are always looking for individuals who can shape the future of organized medicine. I intend to listen. I hope you feel comfortable bringing your concerns to the medical society and particularly to me. Organized medicine exists to promote the practice of medicine and to elevate our ability to effectively care for our patients. We need unity in order to overcome the obstacles that doctors face when trying to deliver quality healthcare. How many of you are like me and are relatively new to the Electronic Health Record? Have you thrown your laptop or just quietly cursed it? I can see the future benefit and many of you who have been on EHR for years have been encouraging, but I will tell you that this time of transition to EHR has been trying and worrisome. I have seen staff and doctors who have needed to input data but forgot to take the extra step of communicating by mouth. This has led to some close calls and miscommunication. The lesson I have learned is that I am a translator. I still do my job, but now I have to translate what I have just done to the

computer to justify my charge. I’m not terribly efficient yet, but I’m working on it. I look forward to 2014 because there are many issues on the legislative front. This past year, Florida passed Dr. Laenger historic medical liability reform requiring fairness in the use of medical experts. Upcoming challenges in medicine nationally include the ACA and changing payment trends, government mandates including ICD-10, the second stage of meaningful use, updated rules for HIPAA, and the Physician Quality Reporting System. The high cost of the EHR includes the fact that most physicians are about 10% less productive and the increased burden of administrative duties has caused higher staff turnover in many practices. This year will also be known for increased implementation of the Patient Centered Medical Home. The vision is that the primary care physicians will lead the delivery of medicine and coordinate care through the maze of specialists. It may sound like the primary care physician is the “gate keeper” just like in the past, but I guarantee it is much more involved than that. Just remember that sometimes when we think of political issues, we think that there is a “them.” It can feel like there is a mass of people who actually control our senators and representatives. Someone else will need to give a donation to the Political Action Committee—I mean, C’mon…I don’t want to be one of those involved in the “dirtiness” of politics, right? Well, I hate to break it to you, but you are already involved. By not voting, you are endorsing the candidate who has views opposite to your own. By not giving to the candidate of your choice or to a Political Action Committee, you are endorsing the candidate that favors the trial lawyers-because they-the trial lawyers- are all giving. Believe me. The action you take may be an act of omission rather than commission, but make no mistake, you ARE involved. Please consider becoming more involved. If you are not voting, inform yourself on doctor-friendly continued on page 3...


Our own Erica Huffman has been chosen as an Independent News Rising Star and the Escambia County Medical Society couldn’t be more proud! We believe Erica is very worthy of recognition and praise. She has done a tremendous job of managing and prioritizing multiple projects. She has excellent interpersonal and communication skills and has a true understanding of the Escambia County Medical Society and its challenges. We are incredibly pleased that the Independent News would go out of its way to recognize Erica as a Rising Star. Way to go, Erica!

-Susan Laenger, MD, FACP President of the ECMS

Save the Date

Saturday, March 1, 2014 Hilton Garden Inn CME Conference Call for Details 850.478.0706 x2 Contents

Page 3 - New Members Page 4 - 2014 Calendar Page 5 - Disconnect from Malpractice Risks Page 6 - Avoid Being Put on the RAC Page 10 - Hospital News

E.C.M.S. Bulletin

The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/ Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

Vision for the Bulletin:

· Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond. · A powerful instrument to attract and induct members to organized medicine.


Membership

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

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candidates, and vote. If you are voting, let your candidate know how you feel about legislative action that favors the medical community by your phone calls and Emails. Consider joining the FMA PAC, because they can take the guesswork out of supporting the candidates that are

doctor-friendly. And, most of all, consider becoming involved at the local level. The Escambia County Medical Society is always looking for doctors who care enough about the medical community to join our Executive Board and provide valuable input.

New January/February Members Mark Ates, M.D. Family Practice Santa Rosa Medical Group 4225 Woodbine Road, Suite A Pace, Florida 32571 (P) 850-994-6575 (F) 850-994-5643 Bradley Hawkins, M.D. Family Medicine Sacred Heart Medical Group at Tiger Point 1395 El Rito Drive Gulf Breeze, Florida 32563 (P) 850-932-9251 (F) 850-932-9199

Luis Marquez, M.D. Emergency Medicine Chairman of the Executive Committee of Medical Staff Naval Hospital of Pensacola 6000 West Highway 98 Pensacola, Florida 32512 (P) 850-505-6601 Leslie Sanders, M.D. OB/GYN Ladies First- Baptist Medical Group 3417 North 12th Avenue Pensacola, Florida 32503 (P) 850-432-7310 (F) 850-432-7320

2014 Executive Officers

2014 Members at Large

The 2014 Inaugural Ball was brought to you in part by the following sponsors:

Congratulations Dr. Gerald Lowery

Susan Laenger, MD, FACP - President Christopher Burton, M.D. - President-Elect Brian Kirby, M.D. - Vice-President Hillary Hultstrand, M.D. - Secretary/Treasurer

Windward Sponsors: Ballinger Publishing | The Blake | & Saltmarsh Cleveland & Gund -ANDAnchor Sponsors: The Doctors Company | Sacred Heart Health System | Underwood Anderson & Associates We would like to thank them for their generosity and support for organized medicine!

Stephanie Duggan, M.D. Thomas Westbrook, M.D. Layne Yonehiro, M.D.

2013 Bell-Shippey We Care Doctor of the Year

Dr. Lowrey’s total donated services were $97,028.74


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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Announcements

2014 Calendar Saturday, January 25, 2014 | Hilton Pensacola Beach Gulf Front | 6:00p Inaugural Ball | Installation of Officers President-Elect Susan Laenger, M.D. Sponsors: The Doctors Company, Underwood Anderson & Associates, Inc., Sacred Heart Health System, Ballinger Publishing, The Blake, Saltmarsh Cleveland & Gund

Tuesday, August 12, 2014 | Angus Pensacola | 5:30p Young Physicians Section | General Membership Meeting Topics TBD Sponsors: Safe Harbor Tax Advisory, Catalyst CRE, Fisher Brown Bottrell, Southern Cloud Accounting, Dyken Wealth Strategies, McMahon & Hadder Insurance

Saturday, March 1, 2014 | Hilton Airport Blvd. | 8:00a-11:00a Spring CME Conference | General Membership Meeting CME Sessions “Florida Laws & Rules” | Jason Winn [1AMA PRA Category 1 Credit™] “Affordable Care Act” | Jarrod Fowler [1 AMA PRA Category 1 Credit™] “Technology Risk Management” | Ginger Kelley [1 AMA PRA Category 1 Credit™] Cost: ECMS Physicians FREE | Non-member Physicians: $75 before 2/22, $100 day of Sponsors: Danna Gracey Insurance, Safe Harbor Tax Advisory, Catalyst CRE, Southern Cloud Accounting, Florida Blue, Florida Doctors Insurance Company

Sunday, September 28, 2014 | Hemingway’s Bimini Bar | 11:00a-1:00p Women in Medicine Brunch Sponsors: Danna Gracey Insurance, Fisher Brown Bottrell, ProAssurance

Thursday, May 8, 2014 | Pensacola Yacht Club | 5:30p General Membership Meeting Topic: “Sexual Dysfunction Comedian” Speaker: Maureen Whiliham, M.D. [1 AMA PRA Category 1 Credit™] Sponsors: Danna Gracey Insurance, Safe Harbor Tax Advisory, Gulf Coast Health Care, Home Instead

Saturday, October 18, 2014 | Holiday Inn Pensacola Beach | 8:00a-12:00p Fall CME Conference | General Membership Meeting CME Sessions “Prevention of Medical Errors” [2 AMA PRA Category 1 Credit™] “Domestic Violence” [2 AMA PRA Category 1 Credit™] “Federal & State Laws, Prescribing Controlled Substances” [1 AMA PRA Category 1 Credit™]. Cost: ECMS Physicians FREE | Non-member Physicians: call for details Sponsors: Safe Harbor Tax Advisor, Underwood Anderson & Associates, Dyken Wealth Strategies, Florida Doctors Insurance Company, McMahon & Hadder Insurance


Announcements

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Please Fax or email any updates or changes to the 2014 Pictorial Directory by March 1st. fax: 474-9783 or email: info@ escambiacms.org

ADDED MEMBER BENEFITS • The Florida Doctors Insurance Company is offering ECMS members medical professional liability insurance at a 10% discount. Contact your agent or call Dennis Wilson at FLDIC at dwilson@fldic.com or 904-296-2887 ext. 246 • Danna Gracey Insurance is now offering up to 24.8% back on your workers comp divined. Call Arlene or Julie at 850-995-9118


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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Mgmt.

Disconnect from Malpractice Risks by Following These Telephone Triage Tips Miscommunication is one of the most common causes of adverse patient events in the physician’s office setting. Telephone triage, a critical part of the patient’s overall care and management, presents a significant area of liability exposure. Implementing an effective telephone triage system can improve physician-patient communication, confidence, service, satisfaction, and care. It can also reduce emergency medicine department (EMD) visits. Telephone triage guidelines require accurate assessment without the benefit of a face-to-face encounter. For this reason, only licensed professional staff with appropriate training should provide assessments. Patients should be informed in writing about situations that are appropriate for telephone advice. To avoid some of the risks of telephone triage: • Develop policies and protocols for licensed professional staff to follow. These policies and protocols should: o Require that licensed professional staff check with the doctor first if there is any doubt about proper instructions or advice. o Instruct licensed professional staff not to give advice beyond their competence. • Develop written protocols for staff members who take initial calls but who are not RNs or midlevel practitioners. These written protocols should: o Include specific examples of questions to ask the caller, such as: • Whom am I speaking to? (Find out whether or not you are speaking with the patient.) • What is the reason for your call? (Use the caller’s own words to describe the situation.) • What medications are you taking? What are the dosages and frequency and how are they administered? • Is there anything else you would like me to know?

o Outline the types of calls to either refer immediately to licensed professional staff or to schedule for an office appointment. o Instruct non-licensed office staff to never practice medicine over the phone. • Train all staff members to refer a call to the physician immediately if the patient has an urgent or emergent need. • Document all calls in which medical information or advice is provided. Documentation should include the date, time, patient’s name, name of caller/relationship to patient, complaint/concern/ question, and advice given. • Document critical negative information that helped determine the advice that was provided. Examples: “mother stated the child has no fever, no lethargy, or neck stiffness” and “mother stated the child has a good appetite and is taking fluids.” • Establish a reasonable time frame in which non-urgent calls are expected to be returned. If possible, build time into the physician’s schedule to return calls. Inform patients when they can expect a return call. • Review telephone procedures and protocols with staff periodically to ensure that inquiries are being appropriately managed. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. Article Description: Disconnect from Malpractice Risks by Following These Telephone Triage Tips Implementing an effective telephone triage system can improve physicianpatient communication and patient care. It can also reduce emergency medicine department visits while ensuring that patients have access to the appropriate level of care. However, telephone triage, a form of telemedicine, has its own risks. This article provides tips on how to prevent malpractice risks from telephone triage. Tweet: #Physicians: Learn how your office practice can reduce #medmal risks of telephone triage @doctorscompany: http://ow.ly/rYelD


Medical/Legal

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Avoid Being Put on the RAC: Be Prepared for a Recovery Audit Contractor Audit What is a RAC Audit? Any medical practice submitting claims to a government program, such as Medicare, may contend with a Recovery Audit Contractor (RAC). RAC audits are not one-time or intermittent reviews; they are a systematic and concurrent operating process for ensuring compliance with Medicare’s clinical payment criteria, documentation, and billing requirements. The RAC program was signed into law by the Medicare Prescription Drug Improvement and Modernization Act of 2003 and made permanent by the Tax Relief and Health Care Act of 2006. Its purpose is to identify improper Medicare payments—both overpayments and underpayments. The RACs use proprietary software programs to identify potential payment errors in such areas as duplicate payments, fiscal intermediaries’ mistakes, medical necessity, and coding. RACs also conduct medical record reviews. In fiscal years 2010 and 2011, RACs identified half of all claims they reviewed as having resulted in improper payments. The program’s mission is to detect and correct past improper

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By Kathleen Stillwell, MPA/HSA, RN, CPHRM, Patient Safety Risk Manager II, The Doctors Company

payments so that the Center for Medicare and Medicaid Services (CMS) can implement actions that will prevent future improper payments: • Providers can avoid submitting claims that do not comply with Medicare rules. • CMA can lower its error rate. • Taxpayers and future Medicare beneficiaries are protected. Who Is Subject to a RAC Audit? • Hospitals. • Physician practice. • Nursing homes. • Home health agencies. • Durable medical equipment suppliers. • Any provider or supplier that submits claims to Medicare. Who is the RAC Auditor? CMS has contracted with RAC auditors for each region in the United States. It is important to know who the RAC


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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Medical/Legal

Avoid Being Put on the RAC: Be Prepared for a Recovery Audit Contractor Audit cont.

auditor is in your region. Never ignore a letter from one of these organizations. The United States is divided into four regions. Each region has a designated recovery audit contractor. Florida, Georgia, and South Carolina are in Region C. • Region A RAC Auditors: Performant Recovery, Inc., and subcontractor, PRG-Schultz USA, Inc. • Region B RAC Auditors: CGI Technologies and Solutions, Inc., and subcontractor, PRG-Schultz USA, Inc. • Region C RAC Auditors: Connolly Consulting Associates, Inc., and subcontractor, Viant Payment Systems, Inc. • Region D RAC Auditors: HealthDataInsights, Inc. Las Vegas, Nevada, and subcontractor, PRG-Schultz USA, Inc. What Does the RAC Review? The recovery audit looks back three years from the date the clam was paid. RACs are required to employ a staff consisting of nurses, therapists, certified coders, and a physician. The RAC reviews claims on a post-payment basis. There are three types of review: • Automated—no medical record needed. • Semi-automated—claims review using data and potential human review of a medical record or other documentation. • Complex—medical record required. What Can You Do to Prepare for a RAC Audit? Assess your risk for billing issues by performing a risk analysis of your billing practices. Assign a knowledgeable member of your staff to review your billing processes and to develop a billing compliance plan. Consider hiring a contractor for this task. Identify billing issues, keep track of denied claims, and look for patterns and determine what corrective actions you need to take to avoid improper payments. Common billing errors include:

• Inadequately trained staff. • Lack of time. • Did not follow recommendations in Federal Register bulletins. • Did not consult Health and Human Service bulletins. • Misinterpretation of rules. • New staff/New billing company. The person responsible for implementing the billing compliance plan should regularly monitor RAC progress in your region. Each RAC must maintain a website with information on new audit focus areas and the status of a provider’s audits. Areas to include in your assessment and monitoring plan include: • Review denied claims categories by RAC audit. • Keep abreast of notifications on CMS website. • Review annual Office of Inspector General (OIG) work plan to identify audit areas. • Monitor RAC progress at regional RAC (their web postings). • Perform audit of your billing practices. Potential Issues with Electronic Medical Records The OIG is studying the link between electronic medical record (EMR) systems and coding for billing. There is a concern that some EMR systems may upcode billing through automatically generated detailed patient histories, cloning (when you cut and paste the same examination findings), and templates filled in to reflect a more thorough or complex examination/visit. Review these issues with your EMR company and determine if your EMR program has the potential to automatically upcode billing based on EMR documentation. Fundamentals for Compliance Establish compliance and practice standards and conduct internal monitoring and auditing to evaluate compliance. Conduct appropriate training and education for staff and respond to deficiencies identified during internal audits. Establish corrective action plans and enforce disciplinary standards when necessary. Medical billing is complex. Billers and coders must be knowledgeable about many areas pertaining to billing/ reimbursement. Be sure your billing staff understands local medical review policies and is knowledgeable of practice jurisdictions. Billing personnel must staff stay current on coding requirements and keep up with industry changes, understand denial and appeal processes, and be able to


Medical/Legal

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Avoid Being Put on the RAC: Be Prepared for a Recovery Audit Contractor Audit cont.

identify resources for support. What to Do if You Are Audited Do not ignore a letter from the RAC auditor. It is recommended you have an attorney assist you with your response to a RAC audit. Check with your insurance company to determine if you can get help with the audit. The Doctors Company, for example, provides RAC audit legal assistance for all members as part of its MediGuard® coverage. Before you send records to the auditor, be sure to review them in a “self-review.” Are there common themes? Are you coding with the correct documentation? Make copies of everything you send to the RAC auditor and be sure to keep a copy of all documentation. Send medical records via certified mail. Staying on top of the RAC audit process is important as there are multiple policies and procedures governing RAC audits. The RAC can request a maximum of 10 medical records from a provider in a 45-day period. The time period that may be reviewed has changed from four years to three years. Responses are time-sensitive, and significant penalties may result if they are not handled properly. RACs are paid on a contingency basis for overpayments and underpayments. If you agree with the RAC demand letter you have the choice of paying by check or recoupment from future payments, or you may request an extended payment plan. If a recoupment demand is issued, you may pay by check within 30 days with no appeal, allow recoupment from future payments, or request or apply for an extended payment plan. There is an appeal process if you do not agree with the audit findings. Do not confuse the RAC Discussion Period with the appeals process. If you disagree with the RAC determination, do not stop with sending the discussion letter detailing why you disagree with the findings. File an appeal before the 120th day after the demand letter. Send correspondence to RAC via certified mail. It is recommended you have legal representation to advise you in the response to a recoupment demand, to determine if you should appeal, and to ensure you meet the required regulatory requirements of the appeal process.

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Where to Get More Information on Government Audits More information on the growing risk of government investigations and audits can be obtained through five short videos featuring tips from Kevin R. Warren, Esq., of Michelman & Robinson LLP’s Healthcare Practice at http://ow.ly/rP02n. The videos address how to create an effective compliance program, why it’s important to train staff to avoid improper and exaggerated coding, what steps to take if your practice receives a subpoena, and how to properly protect electronically stored information. i Medicare Recovery Audit Contractors and CMS’s Actions To Address Improper Payments, Referrals of Potential Fraud, and Performance. Office of Inspector General. U.S. Department of Health and Human Service. August 2013. https://oig.hhs.gov/oei/reports/oei-04-11-00680.asp. Accessed Dec. 16, 2013. ii The Recovery Audit Program and Medicare: The Who, What, When, Where, How and Why? Centers for Medicare & Medicaid Services. May 13, 2013. http://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/Recovery-Audit-Program/Downloads/The-Recovery-Audit-Programand-Medicare-Slides-051313.pdf. Accessed Dec. 16, 2013.


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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

In the Community

Baptist Hospital

Sacred Heart Hospital

Baptist Health Care Selects Daniel Sontheimer, M.D., as Chief Clinical Transformation Officer Baptist Health Care announces the appointment of Daniel Sontheimer, M.D., MBA., as the new chief clinical transformation officer (CTO) and senior vice president (SVP). Dr. Sontheimer joins BHC from Cox Health in Springfield, MO. Dr. Sontheimer earned his medical degree at the University of Kansas Medical School in Kansas City, Kan., and completed his residency in family medicine at Spartanburg Regional Medical Center in Spartanburg, S.C. In addition, he holds a Master of Business Administration from Regis University in Denver, Colo.

Dr. Robert Patterson, a board-certified Pediatric Intensivist, has been named the Medical Director of The Children’s Hospital at Sacred Heart. In his new role, Dr. Patterson is responsible for formulating and implementing pediatric policies and protocols, overseeing resolution of pediatric physician and patient concerns, assisting in the recruitment of new physicians and clinical staff, overseeing the quality of care for The Children’s Hospital, and defining the vision for growth of pediatric services throughout Sacred Heart. Dr. Sidney Stuart, a board-certified OB/GYN with The Women’s Group, PA, has been named the Medical Director of Women’s Services at Sacred Heart Hospital. In his new role, Dr. Stuart is responsible for formulating and implementing OB/ GYN policies and protocols, overseeing resolution of OB/GYN physician and patient concerns, assisting in the recruitment of new physicians and clinical staff, and overseeing the quality of care for women’s services. Roger A. Poitras, DHA, is now leading Sacred Heart Medical Group as its new President. “Roger is committed to building lasting relationships with physicians, staff and our community, says Susan Davis, President and CEO of Sacred Heart Health System. “Roger is an experienced healthcare executive with an exemplary record of leading organizations through transformational change. We are very happy to have him here in Pensacola.”

Ramon Ryan, M.D., Receives Excellence in Instruction Award Ramon Ryan, M.D., occupational health medical director, Baptist Medical Park, received the Excellence in Instruction Award for his work with the United States Navy and Army residency program. Votes for the honor were cast by physician residents participating in the program. Victor Hall Selected as Vice President of Heart and Vascular Services for Baptist Health Care Baptist Health Care (BHC) has selected Victor Hall as vice president of heart and vascular services. Hall comes to BHC from the Cleveland Clinic where he served as the regional vice president for cardiovascular services. In addition to his new role, Hall serves as a reservist at the Navy Medicine West Headquarters in San Diego, CA and was recently promoted to Rear Admiral. Hall holds his master’s degree in hospital and health care administration from Xavier University and his bachelor’s degree in nuclear medicine from the University of Cincinnati.


2014 Installation of Officers

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www.escambiacms.org

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January/February 2014 ECMS Bulletin