Cap Scan - March 2016

MARCH EDITION, VOLUME 2016, NO. 3

A MESSAGE FROM THE CMS PRESIDENT By J. Daniell Rackley, M.D. to communicate with each other effectively has become compromised. The unfortunate result of this is that our patients’ care can sometimes be fragmented as well. Dear CMS Members, It is my sincere pleasure to serve as your CMS President for 2016! I have served on the Board of Governors for the past 6 years, and I have witnessed firsthand very strong leadership during that time. I feel honored to follow in the footsteps of the physicians who have led CMS so admirably for such a long time. We have a strong medical society in Tallahassee, and our location in the capital puts us in a unique position of having the opportunity for more involvement with state legislature and other aspects of the FMA. We are also practicing in a unique time with seemingly more challenges than ever before. As I mentioned in my remarks at the installation dinner (full speech on page 22), one of those challenges is fragmentation. Geographically, we are now more separated than ever before. We have 2 large hospitals with employed physicians, FSU COM, and multiple private practitioners. As we have become more separated, our ability

CMS is the only entity that has the ability to encompass all of the physicians in this area. One of the strategic goals of CMS is to foster ways to improve physician to physician communication. First, we want physicians to get to know each other better. When we work together as colleagues, we ultimately take better care of our patients. Unfortunately, many of us do not know each other. CMS is trying to create more social events that give us the opportunity to better interact with each other. I would encourage every member to attend some of these events if possible. Another benefit that is free to CMS members that will allow us to better communicate is DocbookMD. This is an application for iPhone or Android devices that allows members to easily send a HIPAAcompliant message to another member regarding a patient. A desktop version is also available. Members can also send compliant messages to members of their care team such as nurses or mid-level providers.

Currently, it can be very difficult and time-consuming for physicians to actually speak with each other; however, DocbookMD will allow physicians to easily and quickly interact with each other directly. In this way, patient information can be shared in a timely fashion. The more members who are signed up, the better this will work. Currently, only 143/514 physician members are signed up. That’s only 28%. Once everyone is signed up, any member can easily send another member a message regarding a mutual patient. This will improve efficiency, as well as, patient care. Many scholarly articles are available that demonstrate that improved physician to physician communication improves patient outcomes. Capital Medical Society wants to improve our ability to communicate with each other. DocbookMD is just a start, and we will continue to look for ways that will allow us to communicate better. Also, we will continue to promote events that bring us together. Please make an effort to come out to these events and meet your colleagues! When we know each other and work together, our patients will ultimately benefit! CMS

CAPITAL MEDICAL SOCIETY 2016 MEETINGS CALENDAR March 24, 2016 Celebration Awards Dinner 6:30 pm FSU University Center Club

April 11, 2016 Connect the Docs Happy Hour 5:30 pm – 7:30 pm Food Glorious Food 1950 Thomasville Road

April 19, 2016 CMS Membership & CME Meeting New Screening, Evaluation, and Treatment Options for Lung Cancer Jeffery Snyder, M.D., Capital Regional Medical Center Heart & Lung Surgical Associates 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks

BOARD OF GOVERNORS J. Daniell Rackley, M.D., President Tracey Hellgren, M.D., President-Elect David Dixon, D.O., Secretary/Treasurer Joshua Somerset, M.D., Immediate Past-President Christie Alexander, M.D. Shelby Blank, M.D. Hien Guyer, CMS Alliance President Rohan Joseph, M.D. Shakra Junejo, M.D. Maribel Lockwood, M.D. Paresh Patel, M.D. Gregory Perry, M.D. Ernesto Umaña, M.D. Kenneth Whithaus, M.D. Pam Wilson, Executive Director Family Medicine Resident Todd Hewitt, M.D. Internal Medicine Residents Sura Jermanus, M.D./Jose “Tony” Martinez, D.O.

PUBLICATION INTERIM EDITOR Frank Skilling, M.D. GRAPHIC DESIGN Gandy Printers

MANAGING EDITOR Shannon Boyle EDITOR EMERITUS Charles E. Moore, M.D.

ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing. Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society.

I N T H I S I SS U E :

MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org

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HAPPY BIRTHDAY! {MARCH BIRTHDAYS}

Margaret Havens Neal, M.D. – 1st

Gregory Perry, M.D. – 19th

John Elzie, M.D. – 3rd

Caulley Soto, M.D. – 19th

Dee Hansen, M.D. – 3rd

John Thabes, M.D. – 19th

Terreze Gamble, M.D. – 4th

Ray Dolly, M.D. – 20th

David Miles, M.D. – 4th

Karen Krueger, M.D. – 20th

Robert Miles, M.D. – 4th

Ronald Machado, M.D. – 21st

William Miller, M.D. – 5th

Lorna Stewart, M.D. – 21st

Christopher Selleck, M.D. – 5th

Andrea Friall, M.D. – 23rd

Andrew Wong, M.D. – 5th

Paul Hartsfield, M.D. – 23rd

Kennessa Hugger, M.D. – 6th

Brian Wilson, M.D. – 23rd

Thomas Truman, M.D. – 6th

Tameka Funny, D.O. – 24th

Tommy Enoch, M.D. – 7th

Charles Williams, M.D. – 24th

Nancy Wright, M.D. – 9th

Flora Danisi, M.D. – 25th

Wilmoth Baker, M.D. – 10th

David Durden, M.D. – 25th

Conor Dolehide, M.D. – 10th

Eric Loevinger, M.D. – 25th

Michelle Bachtel, M.D. – 11th

R. Spencer Stoetzel, M.D. – 25th

Steven Ostrov, M.D. – 14th

Mark Applegate, M.D. – 26th

James Renehan, M.D. – 14th

Acquinonette Bryant, M.D. – 27th

Alma Littles, M.D. – 15th

Charles Moore, M.D. – 27th

Albert Lee, M.D. – 16th

Roland Jones, M.D. – 28th

Celeste Paquette, M.D. – 17th

Leslie Wilson, M.D. – 29th

Mary Elizabeth Seay, M.D. – 17th

Cristin Sampson, M.D. – 30th

Wayne Batchelor, M.D. – 19th

Elbert Prather, M.D. – 31st

HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!

If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you. 2

A Message from the CMS President … CMS Member Announcements … 2016 Celebration Awards Dinner … 2016 I.B. Harrison, M.D. Humanitarian Award … 2016 Outstanding Physician Award … I.B. “Bud” Harrison, M.D. … Doctors’ Day … Letter to the Editor … CMS Lunch and Learn … FSU COM Student Pathographies … 2016 CMS Meetings Calendar ... Alliance Corner … Medical/Legal … 2016 CMS Services, Inc. Board of Directors … CMS Foundation … CMS Foundation: We Care Network … CMS Presidential Installation …

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

DID WE MISS YOUR BIRTHDAY? IF SO, PLEASE EMAIL ROSALIE CARLIN AT RCARLIN@CAPMED.ORG!

CMS MEMBER ANNOUNCEMENTS

CAPITAL MEDICAL SOCIETY IS PLEASED TO WELCOME THE FOLLOWING NEW MEMBERS: Kishor Muniyappa, M.D. Medical School: Bangalore Medical College Internship/Residency: St. Francis Hospital of Evanston Fellowship: Virginia Commonwealth University Specialty: Gastroenterology Practice: GI Medical Specialists

Fang Sarah Ko, M.D. Medical School: Johns Hopkins Internship: Harbor Hospital Residency: Wilmer Eye Institute, Johns Hopkins Fellowship: Moorfields Eye Hospital Specialty: Ophthalmology Practice: Eye Associates of Tallahassee

PROFESSIONAL NOTES Angelo Ayar, M.D. with Dermatology Specialists of Florida served as the House of Representatives ‘Doctor of the Day’ on January 28, 2016. Since its inception in the 1960s, the ‘Doctor of the Day’ program has delivered medical care to the members of the Florida Legislature and all legislative employees. Every year, the physicians of Florida have provided this important voluntary public service each day of the Regular Session.

Shelby Blank, M.D. was selected by the local community as the Tallahassee Memorial HealthCare 2016 Face of the Foundation Honoree. Honorees demonstrate exemplary care and commitment to not only helping patients survive, but to LIVE WELL after a breast cancer diagnosis.

Thank you for your service, Dr. Ayar and Dr. Blank!

CMS Members: If you receive accolades, please let us know so we can include you in this section! Email the details to Shannon Boyle at sboyle@capmed.org. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3

SPECIAL ADVERTISING FEATURE

_________ A good banker will know enough about you to help you reach your desired goals. _________

PRIVATE BANKING by William Smith Maybe you’ve been wondering, Is relationship banking dead?

We’re paying bills through our phones, using apps to make mobile deposits and some of us haven’t set foot in a bank lobby in years. Does that mean relationship banking is dead? No. Banking just looks a little different today than in years past. A good banker knows enough about you to help you reach your desired goals – both professionally and personally. But it’s up to you to seek out that relationship and be open to the benefits it offers. That can’t happen if you’re doing business with a number of different financial institutions. Some people mistakenly call that diversity; when, in fact, you could be putting your assets at greater risk due to duplication. A Private Banker will help you properly finance the growth of your practice by evaluating several aspects of your business: • Your risk tolerance • The revenue potential of what you’re buying

A good banker will ask the right questions and help you plan holistically to reach your goals. He or she can help you avoid common mistakes, like investing in something that promises a big return but might put you at great risk. A Private Banker also can take care of the more technical aspects of protecting your practice and building personal wealth, including: • Assuring you have the most efficient debtconsolidation plan • Identifying investment opportunities for potential income to retire debt and build wealth • Reviewing the assets you own to ensure they are titled properly • Helping you avoid the dilemma of buying high or selling low THE BOTTOM LINE: There’s still room for relationships in banking – it’s called Private Banking. Make a friend in the industry. Give me a call today.

• A proper mix of capital to debt About William Smith, Private Banker William Smith is a fourth generation Tallahasseean from a long line of distinguished bankers. He understands the financial challenges of the medical profession and the importance of the local banker/medical professional relationship. To add a private banking partner to your practice, contact William today at 402.8136 or smith.william@ccbg.com.

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

2016 CELEBRATION AWARDS DINNER

WHY AWARDS FOR OUR FELLOW PHYSICIANS? By John Bailey, D.O. I hope that we can encourage CMS members to think about physicians who have served the community and the profession well. Why is it important to keep up Awards? Because the physicians who are recognized are held up as an example to the community and to their younger peers. Because there are so many counter-examples being held up to scrutiny every day in the newspapers and television reports. Because Medicine really is a good cause, a calling, and not a technology to be “managed.” Because practicing medicine is a risky business that places doctors in harm’s way for the benefit of others. Because society, and especially the Capital Medical Society, needs to reward its heroes of today and inspire its heroes of tomorrow.

H. AVON DOLL, JR., M.D. – RECIPIENT OF THE 2016 I.B. HARRISON, M.D. HUMANITARIAN AWARD By Shannon Boyle, CMS Communications and Events Coordinator The Capital Medical Society is pleased to announce Dr. H. Avon Doll, Jr. as the recipient of this year’s I.B. Harrison, M.D. Humanitarian Award. Each year this award is presented to a physician who demonstrates dedication to the humanitarian values we associate with the late

Dr. I.B. Harrison. These values include: compassion, service, respect, wisdom and integrity. Dr. Doll is a board-certified internist and nephrologist, originally from the Pocono Mountains in northeastern Pennsylvania. He received his medical degree from Oral Roberts University in 1985. He was

inducted into the Alpha Omega Alpha Honor Medical Society and strives to live by their motto, “Be worthy to serve the suffering.” He completed his residency in Internal Medicine and fellowship in Nephrology at the University of Florida from 1985 to 1991. He served as Chief Resident for the Department of Medicine from 1988 to 1989. CONTINUED ON PAGE 6

MICHAEL W. FORSTHOEFEL, M.D. – RECIPIENT OF THE 2016 OUTSTANDING PHYSICIAN AWARD By Shannon Boyle, CMS Communications and Events Coordinator

The Capital Medical Society is pleased to announce Dr. Michael W. Forsthoefel, a board-certified internist with added qualifications in geriatric medicine, as the recipient of this year’s Outstanding Physician Award. This award

honors a physician who has been a leader within the field of medicine and political activities while demonstrating clinical excellence, and actively contributing to the education of future medical professionals.

Dr. Forsthoefel grew up in Louisville, Kentucky. He had aspirations to become a chemist. That is, until he met his wife, Dr. Jana Bures-Forsthoefel, in chemistry class at the University of Louisville. She was preparing CONTINUED ON PAGE 7

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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2016 I.B. HARRISON, M.D. HUMANITARIAN AWARD

During his fellowship, Dr. Doll was privileged to share several patients with North Florida Nephrology Associates, and upon completion of his fellowship in 1991, he was asked to join their practice. Dr. Doll was most influenced by his mother Ruth, an ER nursing supervisor, who frequently told colorful stories about patients and doctors. It was those special moments shared at the dinner table that formed his desire to become a physician. Dr. Doll is known to some as “Buddy” but known to all as a humble, sincere, positive, helpful, supportive, and compassionate individual. A few of his greatest accomplishments have been providing quality nephrology care to patients and carrying on the legacy of excellence established by Dr. Bill Applegate and Dr. Gary Hansen. He is affiliated with Capital Regional Medical Center (CRMC) and Tallahassee Memorial HealthCare (TMH). He serves on their Ethics Committee and Pharmacy and Therapeutics Committees. In addition, he serves on the Medical Review Committee for CRMC and as Chair-Elect for the TMH Medical Executive Committee. The physicians at North Florida Nephrology Associates are actively involved with DaVita Dialysis. Dr. Doll serves as one of the medical directors for the Tallahassee region and oversees the Quincy unit. To further expand on Dr. Doll’s commitment to the nephrology field, he serves on the Board of Governors for the Florida Society of Nephrology and on the Medical Review Board for Network 7, the Florida End Stage Renal Disease (ESRD) network. He also serves as the Chair for Network 7’s Patient Grievance Committee. In 2013, he was awarded Volunteer of the Year for the Florida ESRD network. Dr. Doll is a clinical preceptor for the Florida State University (FSU) College of Medicine, FSU College of Medicine Internal Medicine Residency Program at Tallahassee Memorial HealthCare (TMH), and TMH Family Medicine Residency Program. He also serves on the Community Advisory Board for the FSU College of Medicine Tallahassee Regional Campus. He has been an active member, advisor and advocate of the TMH Family Medicine Residency Graduate Medical Education Committee. He has also twice served on their Internal Review Committee to help them get ready for successful accreditation site visits. In 2011, he received the Director’s Award from the TMH Family Medicine Residency Program. His involvement with Capital Medical Society and Capital Medical Society Foundation is plentiful. He 6

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

has been a generous volunteer physician in our We Care Network since its inception. For many years, he served on the Board of Governors, Continuing Medical Education Committee, Public Information Committee, Physician/Patient Relations Committee, and Access to Care Committee. In 2006, Dr. Doll became a member of the CMS Foundation Board of Directors. The We Care Network gained valuable expertise and guidance when Dr. Doll joined the We Care Dental Committee in 2009 and the We Care Network Advisory Committee in 2012, becoming its Chair a year later. He also serves on the We Care Network Medical Review Team. In this position, he reviews complex medical referrals for the We Care Network staff. Dr. Doll has also reached out to those in need outside of our community by going on medical missions to Nicaragua, Peru, Brazil, Cameroon, Uganda, and Ecuador. Dr. Doll has a love for music that started at a young age. He played trombone in his high school’s band and continues to play piano. Taking after their father, each of his sons were in the Trojan Band at Lincoln High School, and later in the University of Florida Music program. Dr. Doll was actively involved in the Trojan Band Boosters and served as President. He has also been involved in the music ministry at Wildwood Church. He is a loving husband to his wife of 35 years, Louie, a devoted father to their three children, Jarrod (Rachel), Logan (Sarah), and Colton, and a proud grandfather to Finley Rose. In those rare moments when Dr. Doll is not caring for patients, teaching residents or attending Board or Committee meetings, he enjoys riding his HarleyDavidson, hiking, wilderness backpacking, and gardening. All with Louie by his side. In April, he plans on running his last marathon at Big Sur, 20 years after doing it for the first time. Dr. Doll’s friend and colleague, Dr. Lisa Jernigan said it best, “Dr. Doll has a lot of compassion for his patients, as well as his colleagues. He is always willing to help…He can be depended upon to provide a thoughtful assessment and plan for virtually any problem, and is always the guy that asks the insightful question I wish I had thought of. With all of these skills and attributes, he is generous with his appreciation for the participation of others. Overall, his is always a good example to follow.” On behalf of all those associated with the Capital Medical Society, congratulations to Dr. H. Avon Doll, Jr. CMS

2016 OUTSTANDING PHYSICIAN AWARD

for medical school and he ultimately decided to take the same path. He received his Doctorate of Medicine and Masters of Science in Biochemistry at the University of Louisville School of Medicine. He completed his residency in Internal Medicine at Grady Memorial Hospital and Emory University Affiliated Hospitals in Atlanta, Georgia, serving as Chief Resident in his final year. While at Emory, Dr. J. Orson Smith presented a lecture and eventually extended an invitation for Dr. Forsthoefel and Jana to visit Tallahassee for a weekend. In 1983, Dr. Forsthoefel became the fifth physician to join Internal Medicine Associates, a precursor to Southern Medical Group. Their mission is to provide the highest quality, state-of-the-art health care in Internal Medicine and Cardiovascular Disease. Southern Medical Group now has 26 board-certified physicians. Dr. Forsthoefel has served on their Board of Directors since 2001 and is currently serving his fourth two-year term as President. Dr. Forsthoefel wholeheartedly believes that he has “the best job in the world.” He is truly grateful to have the opportunity to establish and maintain long-term relationships with patients. In addition to his clinical responsibilities, Dr. Forsthoefel is an Associate Professor at the Florida State University College of Medicine where he serves as the Clerkship Director for Internal Medicine at the Tallahassee Regional Campus. He was elected, by a college-wide student vote, into membership of the Gold Humanism Honor Society. This honor is in recognition of his clinical expertise, compassionate patient care, and altruistic service. He has also received the Outstanding Clinical Professor Award and the Outstanding Community Faculty Award. He has held many leadership positions with Tallahassee Memorial HealthCare including Chairman of the Pharmacy & Therapeutics Committee (1987-1988), Chairman of the Bylaws Committee (1997-2010), Chairman of the Medical Staff (1994-1995), and Chairman of the Board of Directors (2006-2007). He also served as Chairman of the Big Bend Hospice Board of Directors (1991-1992). He served on the Capital Medical Society Board of Governors from 1988 to 1993 along with multiple committees and supports the Capital Medical Society Foundation’s We Care Network program. Since 2000, he has served as a Florida Medical Association Delegate where he reviews resolutions, serves as

Chair of the Finance and Administration Reference Committee, and attends the FMA Annual Meeting. Dr. Forsthoefel was integral in bringing the Honor Flight program to Tallahassee. Honor Flight Tallahassee’s mission is to transport North Florida and South Georgia veterans to Washington, D.C. to visit those memorials dedicated to honor their service and sacrifices. He serves on the Board and as flight physician. He feels privileged to have gone on every flight since it was established in 2012 and is planning for the next flight on April 30, 2016. In 1986, shortly after moving to Tallahassee, Dr. Forsthoefel became a member of the Rotary Club of Tallahassee after being nominated and encouraged to join by Dr. I.B. “Bud” Harrison. He served on the Board of Directors for three years and was a founder of the Ethics in Business Award, which he has cochaired since 2001. The Rotary Club of Tallahassee recognized Dr. Forsthoefel’s outstanding service to the community with the Frederick Clifton Moor Award in 2007. This award represents the highest honor bestowed upon one of its members. In 2014, he was chosen as the honoree for the annual Rotary Roast and Toast. Dr. Forsthoefel truly embodies Rotary’s motto – “service above self.” With his strong Catholic faith, Dr. Forsthoefel was instrumental in the establishment of Tallahassee’s first Catholic high school, John Paul II High School. He served as the first Board Chairman and has remained an active member on the Board of Directors. Dr. Forsthoefel and Jana have been married for almost 39 years and are the proud parents of eight children, Eric, Jennifer, Kevin, Dana, Kelly, Carl, Luke, and Katarina, and one grandchild, Jack William Forsthoefel. In his spare time, Dr. Forsthoefel enjoys spending precious moments at the family’s beach house in St. George Island, fishing in Canada, and traveling. Dr. Forsthoefel may be recognizable by his boisterous laugh, but he is respected for his hardworking, caring, and selfless nature. He epitomizes the best of the best in our community. On behalf of all those associated with the Capital Medical Society, congratulations to Dr. Michael Forsthoefel. He certainly exemplifies what we consider to be qualities of an outstanding physician.

CMS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7

2016 CELEBRATION AWARDS DINNER

DON’T MISS THE CELEBRATION AWARDS DINNER! Thursday, March 24, 2016 6:30 pm University Center Club at Florida State University Presenting the 2016 Outstanding Physician Award to Michael W. Forsthoefel, M.D.

Presenting the 2016 I.B. Harrison, M.D. Humanitarian Award to H. Avon Doll, Jr., M.D.

CMS Members and We Care Dentists – No Charge v Spouse/Guest – $40.00 Invitations were e-mailed on March 2. Advance reservations are required by March 17. Please RSVP to Rosalie Carlin at 877-9018 or rcarlin@capmed.org. ㈀ 㠀 刀漀猀攀栀椀氀氀 䐀爀椀瘀攀 圀攀猀琀 ㄀Ⰰ㐀㜀㔀Ⰰ   簀  㔀 䈀䐀 㔀⸀㔀 䈀䄀  簀  㔀Ⰰ㠀㔀㄀ 猀焀 昀琀

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

䠀䤀䰀䰀匀倀伀伀一䔀刀⸀䌀伀䴀

I.B. “BUD” HARRISON, M.D.

WHO WAS I.B. “BUD” HARRISON, M.D.? By J. Orson Smith, M.D.

Again this year, we will honor a recipient of the I.B. Harrison, M.D. Humanitarian Award. I was asked to tell the many new doctors in this community who Dr. I.B. “Bud” Harrison was. He remains the icon in this community for an intelligent, competent, and compassionate physician. He was also a leader and role model to many family practice physicians. Bud was 8 years older than I, but we were both Cardiology Fellows under Dr. Bruce Logue at Emory. Dr. Logue was our role model. In 1961, while serving in the army at Fort McPherson and attending a Cardiology conference at Grady Hospital, Bud approached Bruce to ask if he knew anyone that might join him and Fred Butler in medical practice. Bruce pointed to me and said, “Orson will.” I always did what Dr. Logue told me to do. In 1962, we became Butler, Harrison and Smith, P.A., which after a number of additions and mergers became Southern Medical Group. Bud taught me about dealing with people, just as he later taught his residents. He always said that if you do a good job practicing medicine, the financial portion would fall into place. However, he hated to charge patients. It seemed

that everyone had “professional courtesy” or were “no charge.” This was before Medicare and many of his patients were poor. He treated everyone the same.

Memorial Hospital. This led to the most important contribution of his life, namely becoming a teacher in the Residency Program.

Bud drove an old car that was always dirty and full of old papers. In 1964, I had saved enough money to put a down payment on a Comet Convertible and was in the Mercury

The following is an excerpt from Dr. Whit Oliver’s acceptance speech as he was awarded the 2010 I.B. Harrison, M.D. Humanitarian Award. He shared wonderful insight into Bud’s “make-up.”

Dr. I.B. “Bud” Harrison

dealership to have a check-up. Bud’s old beat up Mercury was there for repairs. I heard two mechanics discussing the car. One said, “I hear this is a doctor’s car.” The other mechanic said, “Well if it is, he ain’t no good.” Time certainly proved this to be wrong! In the early 1970’s, Bud had a catfish fin him in the knee and he developed a pseudomonas infection, which led to the need for a Charnley fusion. This made night call very difficult and he took a position as Chief of Medical Affairs at Tallahassee

“Dr. Harrison was loved by most and respected by all who knew him. When dealing with patients he was compassionate, caring and totally focused on the patient regardless of their life circumstances. He had a marvelous bedside manner. He always tried to sit on the patient’s bed, touch the patients and listen to them, letting them describe their plight, being supportive of their problems. He was an excellent clinician who could synthesize the data and zero in on the diagnosis and management, directing us toward the most efficient way to achieve the best outcome for a particular patient, including the most appropriate consultation or referral for specialty input. He approached problems with commonsense and was pragmatic and practical.” Tallahassee is blessed with an excellent Family Practice community, and I think that will always remain Bud Harrison’s legacy. CMS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9

DOCTORS’ DAY

WHAT IS DOCTORS’ DAY? WHY WAS IT FOUNDED? The first Doctors’ Day observance was held on March 30, 1933, by the Barrow County Alliance, in Winder, Georgia. The idea of setting aside a day to honor physicians was conceived by Eudora Brown Almond, wife of Dr. Charles B. Almond, and the recognition occurred on the anniversary of the first administration of anesthesia by Dr. Crawford W. Long in Barrow County, Georgia, in 1842. The Alliance immediately adopted the following resolution: “WHEREAS the Alliance to the Barrow County Medical Society wishes to pay lasting tribute to the Doctors, therefore, be it RESOLVED by the Alliance of the Barrow County Medical Society that March 30, the day that famous Georgian Dr. Crawford W. Long first used ether anesthesia in surgery, be adopted as ‘Doctors Day,’ the object to be the well-being and honor of the profession, its observance demanding some act of kindness, gift or tribute in remembrance of the Doctors.” This first observance included the mailing of cards to physicians and their wives, flowers placed on graves of deceased doctors, including Dr. Long, and a formal dinner. After the Barrow County Alliance adopted its resolution to pay tribute to the doctors, the plan was presented and passed by the Georgia State Medical Alliance in 1934 in Augusta, Georgia. The resolution was introduced to the Women’s Alliance of the Southern Medical Association at its 29th annual meeting held in St. Louis, Missouri in 1935. Since then, Doctors’ Day has become an integral part of and synonymous with, the Southern Medical Association Alliance. Through the years the red carnation has been used as the symbol of Doctors’ Day. On March 30, 1958, the United States House of Representatives adopted a Resolution Commemorating Doctors’ Day. In 1990, Congressmen Mike Parker (D-Mississippi) and G. V. Montgomery (D-Mississippi) and Senator 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Thad Cochran (R-Mississippi) introduced legislation in the House and Senate to establish a national Doctors’ Day. Following overwhelming approval by the US Senate and the House, on October 30, 1990, President George Bush signed S.J. RES. #366 (which became Public Law 101473) designating March 30 as “National Doctors’ Day”: Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That – 1. March 30, 1991, is designated as “National Doctors’ Day”; and 2. The President is authorized and requested to issue a proclamation calling on the people of the United States to observe the day with appropriate programs, ceremonies and activities. Doctors’ Day is the result of dedicated Alliance members across the country. The enactment of this law enables the citizens of the United States to publicly show appreciation for the role of physicians in caring for the sick, advancing medical knowledge, and promoting good health.

LETTER TO THE EDITOR

LETTER TO THE EDITOR By Charles E. Moore, M.D. Dear Sir/Madame/Charlie/Frank/Pam/ Shannon/Rosalie: I have never aspired, even in the least, to the embarrassment of being the feature of a lead article on the frontispiece of a distinguished journal of arts, science, and letters. But there I was, horrified to find myself on the veritable cover page of Cap Scan. How could they have done it, particularly Charlie Williams towards whom I have always been so considerate? Now I have to pen something extraordinarily nice to him, full of subterranean, subversive syllabubs that will drive him to some dictionary of “inadvertent, arcane, solecisms that no one can fathom.” Oh well, so be it. As for Charlie’s article about me, it was pure “Charlie,” of whom there is no other like. He can get away with saying anything, because he has a background of that wonderful, honest, cottonpatch vernacular that has no need to apologize for anything since it springs from the same essential roots as Abraham Lincoln and Mark Twain. So there. I will take it like the man I just barely am, surgeon though I was. Except for one thing. I cavil only with the fact, understanding that in the cotton fields of Moultrie, Georgia, “ascots” were not allowed, that what I wear around my neck is NOT an “ascot.” “Ascots” are only worn by villains in British movies…I think of George Saunders and so forth. Wish it though I might, I could never be a villain in such a suave, debonair sense. What I wear is a simple cotton bandanna, simply tied, because in this sere of my years I have found that if my neck is exposed to inclement weather, temperature below 60 F, a chill gathers about my larynx, from thence is apt to descend precipitously down my shirt front (who wears a tie anymore?), and chill my heart, which forthwith stops. This is bad.

And so I tie a protective scarf about my neck, quite like John Wayne. As well I am very happy to have it handy in case, as sometimes may happen: 1.) a lady may burst into tears and need a little kerchief with which to dab her eyes 2.) you need to blow your nose and don’t have a hankie 3.) someone or yourself loses a limb, and quick as quick you can strip off your bandanna to use as a tourniquet 4.) in the event you need a little sac to hold seashells while seeking by the seashore, tying the four corners 5.) wave it to flag down a search and rescue plane when stranded on a desert island, and 6.) in the event you want to suddenly rob a bank, you can simply pull your scarf up over your nose and do it fully incognito. I am sure you can think of other reasons beyond these simple ones I have myself used it for. Which is, finally, to say enough is enough. If I had known I was going to have to be the subject of a lead article in Cap Scan when I quit being its “editor,” I never would have quit being its editor. But thank you all. It was a privilege. And now I am going to go write something else that no one will ever read, or much want to…. but first must find my precious dictionary of meaningless words. CMS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11

CMS LUNCH AND LEARN

CAPITAL MEDICAL SOCIETY LUNCH & LEARN SEMINARS - SPRING 2016 March 16, 2016 Cybersecurity, Identity Theft and Your Practice Most everyone has seen news reports of cyber-attacks. Many people believe that if they are small and low profile, they will escape the attentions of the “bad guys” who are running these attacks. It is vital to do as much as possible to protect sensitive health information. The consequences of a successful cyberattack could be very serious, including loss of patient trust, violations of the Health Insurance Portability and Accountability Act (HIPAA), or even loss of the practice itself. This presentation will be going over the key risk areas that a Healthcare entity has as well as good cyber defense habits. Speaker: Mike Rosciam, Thomas Howell Ferguson, P.A. Sponsor: Traci S. Poucher, CampusUSA

~ April 20, 2016 Legislative Session and How It Impacts Your Practice Speaker: Jarrod Fowler, MHA, Director of Payment Advocacy, Florida Medical Association Sponsor: TBA

~

May 18, 2016 Beyond Meaningful Use Though Meaningful Use and CMS’ EHR Incentive program is not over, the healthcare landscape continues to shift with practices facing new mandates to keep up and opportunities to evolve. This session will touch on the following: • The most pressing challenges in Meaningful Use today • What may be on the horizon • Best practices for long-term success • How the lessons of Meaningful Use benefit practices engaged in value-based reimbursement 12

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

• IHI’s Triple Aim and why it matters • How Meaningful Use ties into Medical Home models • Defining Care Transformation Speaker: Diane Gaddis, CPHIMS, FHIMSS, BSMP, President/CEO, The Center for the Advancement of Health IT Sponsor: Liz Thiele, TMH Federal Credit Union Time: 12 Noon to 1:30 PM (Seminars start at 12:30 PM) Place: CHP Auditorium, 2nd Floor, 1491 Governors Square Blvd. Cost: $10 per person, per seminar For more information or to register, call Rosalie Carlin at 877-9018.

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FSU COM STUDENT PATHOGRAPHIES

FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE – STUDENT PATHOGRAPHIES (Student essay on one of their patients from their rotation. All patient names are fictitious.)

My patient is Mr. H who is a 75 year old white male. He has been retired for a little over 9 years now, but he worked for many years as a middle school teacher in the state of Georgia where he grew up. “I don’t think I’ll ever leave this place. It has so many memories. I met this lovely young lady here (referring to his wife).” He loved his job as a teacher and enjoyed “building the next generation.” He had always wanted to be a teacher growing up, so he feels like he has been blessed to live his dream. Today, he lives at home with his wife and has 3 grown children and 5 grandchildren, who all live in surrounding cities in the state of Georgia. He and his wife love to go and visit their children as often as they can (and as often as their kids let them!) Mr. H has enjoyed being retired. He loves spending time with his wife, having extra time to go fishing, be involved with his church, and socialize with friends around town. He still tries to stay active now by working around the house and doing work in the yard. Mr. H has a long history of kidney disease in his family, both maternally and paternally. So when he found out he had to go on dialysis a year and a half ago, he wasn’t too surprised, although it was difficult news for him and his wife. Mr. H has never had diabetes or suffered from high cholesterol. He has been taking medication

for high blood pressure for several years now and it is controlled. When his kidneys started failing him shortly after he retired, he was in denial at the beginning. He knew several people in his family who were on dialysis or ended up dying because of renal failure and he didn’t want to think that could be him. His wife, along with his primary care doctor, encouraged him to see a kidney doctor. He was very reluctant at first. He would say things like, “If it’s going to kill me anyway, why do I gotta spend money seeing this doc and getting all these blood tests?” I asked Mr. H what changed his mind about following through with the kidney doctor. He said his wife was the “driving force.” At the beginning of his renal failure, his creatinine was elevated, but since it was not extremely high, they decided to just monitor it, thinking it might be acute for various reasons. He was told to be adherent with his blood pressure medications and to watch his diet so he didn’t add diabetes or high cholesterol to the picture. “My wife changed all the cooking since then,” he said. “I usually get a special treat on my birthday though; like a piece of cake or something!” He also mentioned drinking “gallons” of water every day. As the years went by though, his creatinine was slowly increasing and his kidney function declined. In July of 2014, his creatinine

had gotten up to 10.5. It was time for dialysis. Mr. H said he can still remember the visit with his kidney doctor when dialysis was first discussed. He said he doesn’t remember exactly what was said, but he remembered feeling very overwhelmed and helpless. After that meeting, Mr. H and his wife had several meetings with the dialysis center doctors and nurses. They gave him the option of coming to the dialysis center several days a week for several hours at a time to receive dialysis or doing peritoneal dialysis (PD) at home. “Me and my wife talked about it and prayed about it. We figured doing it at home would be the best for the both of us.” So he and his wife went to the dialysis center to be educated on PD and they brought the machine and all the materials home. Mr. H says using the PD has been very easy for him. He is hooked up to the machine to receive PD every night and goes to the dialysis center once a month for blood work. As mentioned earlier, he and his wife travel a lot to see their kids who all live in Georgia. They recently all went on a trip to the beach where they stayed at a beach house for several days. He says the PD machine has not been a hassle for him to carry with him on trips like this. He feels like he is an expert at using it and he is meticulous about keeping it clean so that he doesn’t get an infection. Over the years, his kidney health CONTINUED ON PAGE 14

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 13

FSU COM STUDENT PATHOGRAPHIES

has become very important to him and he has come to be more passionate about his health. So he does everything he can do to be healthy. He says, though, “I know my life is not in my control. Ultimately, whatever God wants to do is gonna happen.”

DennisDennis A. Fried, Dennis A. Fried, M.D., A. M.D., Fried, J.D. J.D. M.D., J.D.

Licensing, Licensing, Discipline Licensing, Discipline &PeerDiscipline Review &Peer Defense Review &PeerDefense Review Defense for All Medical for All Medical Professionals for All Professionals Medical in Florida Professionals in Floridain Florida I talked to Mr. H about kidney transplants. He said he and his wife talked about that as well and decided to not be placed on the list. He felt he was too old and Free Initial Free Consultation InitialFree Consultation Initial Consultation someone younger who had a lot of years ahead of Blanchard, Blanchard, Merriam,Blanchard, Merriam, Adel & Kirkland, Adel Merriam, & Kirkland, P.A. Adel &P.A. Kirkland, P.A. them probably needed it more than he did. 4 S.E. Broadway 4 S.E. Broadway Street, 4 S.E. Broadway Street, Street,

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Mr. H’s creatinine today is 7.9. He seems to be to be a joyful person who loves life, loves his 352-732-7218 wife and 352-732-7218 loves 352-732-7218 and enjoys his family. He wants to be around as long as possible to see them grow.

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CAPITAL MEDICAL SOCIETY 2016 MEETINGS CALENDAR (continued from page 1)

April 23, 2016 Connect the Docs Family Fun Day Picnic 11:00 am – 2:00 pm Maclay Gardens ($6 entrance fee) May 10, 2016 *Change of date* CMS Membership & CME Meeting Medical Use and Risks of Radiation Sergio Ginaldi, M.D., Radiology Associates of Tallahassee 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks May 2016 CMS Doctor/Son Banquet Time & Location: TBA August/September 2016 CMS Meet the Candidates Forum Time & Location: TBA September 20, 2016 CMS Membership & CME Meeting Palliative Care and Decision Making from Chemo Patients to End of Life Monica Williams-Murphy, M.D., Huntsville Hospital, author of “It’s OK to Die” and J. Brian Sheedy, M.D., TMH Palliative Care Consultation 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks 14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

October 18, 2016 CMS Membership & CME Meeting Domestic Violence and Human Trafficking – 2-Hour Required CME Terry Coonan, J.D., Executive Director at FSU Center for the Advancement of Human Rights and Suzanne Harrison, M.D., Associate Professor and Education Director, Family Medicine, FSU College of Medicine 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks November 15, 2016 CMS Membership & CME Meeting Periodontal Disease and Systemic Disease William Baldock, D.D.S., Capital Periodontal Associates and Spencer Gilleon, M.D., Tallahassee Ear, Nose & Throat-Head & Neck Surgery 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks December 1, 2016 CMS Foundation Holiday Auction 6:30 pm FSU University Center Club

ALLIANCE CORNER

MESSAGE FROM THE PRESIDENT By Hien Guyer held on January 27 at the home of Tami Frankland. Our guest speaker, Michael Kelly, FMAA President, not only swore in the new board but also gave an informative presentation on Florida Medical Association Alliance updates.

Welcome back to another year of the Alliance! I hope you all had a wonderful Holiday season. The Alliance is an evolving organization that welcomes everyone’s participation. There are so many members who have been involved in the past and brought the Alliance to where it is today. I encourage you to become more active. Our medical family in Tallahassee is friendly and generous with their time and resources. Being a member is not only fun but also very rewarding! I am very honored to be serving as your President this year. The year is already underway with the installation of the 2016 Executive Board Officers

Many exciting events are planned for 2016. Our annual community outreach project will center around The Brehon Family Services. At the February 24 general membership meeting, Jackie Malone educated us on how we can assist as a group with the utilization of their services. A wine tasting event for our Alliance members with a portion of the proceeds benefiting the Brehon House is being planned for September. Although we do not have a meeting set for March, the CMS Celebration Awards Dinner will be on March 24 at the FSU University Center Club. In addition, Tallahassee

Community College Nursing School will be our 2016 scholarship recipient. Heather Mitchell, Director of TCC Foundation, will be present to share all of their exciting campus developments at the April 27 meeting. I am also happy to announce that the first CMS/CMSA Connect the Docs Family Fun Day Picnic is scheduled for April 23 from 11 a.m.-2 p.m. at the Maclay Gardens pavilion. Programs for the second half of the year are being finalized and details will be communicated soon. I look forward to having a great year and building on the momentum of past CMSA presidents. Thank you in advance to all my board members, committee chairs and co-chairs who have graciously volunteered to serve. I hope to see you all at our upcoming events. CMS

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15

MEDICAL/LEGAL

MEDICARE PROHIBITS WAIVER OF CO-PAYS AND DEDUCTIBLES; PROFESSIONAL COURTESY DEEMED ‘UNLAWFUL’ The heavily regulated health care environment of today makes it difficult to practice the time-honored tradition of professional courtesy. Professional courtesy originally referred to the provision of health care to physician colleagues or their families free of charge or at a reduced rate. Many argue, rightfully so, that the Hippocratic Oath even requires this for the patient who is a physician and his or her family. More recently the scope of professional courtesy has been extended to include patients who may face financial hardship, and physicians commonly forgive or waive co-payments to facilitate patient access to necessary medical care. Because of the government’s aggressive approach to ensure that all claims are billed correctly, the once common practice of professional courtesy is now considered illegal. According to the Department of Health and Human Services (HHS), Office of Inspector General (OIG), “It is unlawful to routinely waive co-payments, deductibles, coinsurances or other patient responsibility payments.” (67 Fed. Reg. 72,896 (Dec. 9, 2002)). This applies to health care and services paid by Medicare, TRICARE/CHAMPUS, and any other program paid partially or in full with federal funds. It also includes professional courtesy, as well as “take what insurance pays” (TWIP) policies. Although we know of no prior instance of the OIG or Department of Justice prosecuting a physician’s extension of professional courtesy, arrangements for free or discounted care implicate fraud and abuse laws, including the Federal False Claims Act, and the Federal AntiKickback Statute. There have also been private insurance fraud actions based on illegally waiving co-pays and providing discounts that were not extended to the insurer, as well as Federal actions for these violations and using waivers and discounts to induce Medicare patients to use other health care services. Physicians must be extra cautious in bestowing professional courtesy, including discounts and waivers, so that they are not punished for genuinely good deeds. While there may be situations where it is defensible to not charge for services to health care professionals, the physician should assure that this professional courtesy is not linked to referrals, either in reality or in appearance. Waiving Co-Pays Some physicians commonly reduce the cost of care for patients by waiving the co-pay. However, waiving a co-payment has been interpreted as a fraudulent misrepresentation of physician charges against all types of payers. For example, under traditional Medicare, physicians are paid eighty percent (80%) of the “allowable amount” or the “actual charge,” whichever is less. In the instance where Medicare allows $100, the program pays $80 and the co-payment amount is $20. By the physician accepting “what insurance pays” as the only payment, this is viewed as the physician’s having an actual charge of $80, so the resulting payment from Medicare should be only $64. Therefore, by Medicare’s rules, the physician has overcharged Medicare.

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Discounts In the health care industry, a discount is a reduction in the normal charge based on a specific amount of money or a percentage of the charge. To comply with government and insurance policies, the discount must apply to the total bill, not just the part that is paid by the patient. For example, if a patient owes a 20% co-pay on a $25 charge ($5) and the physician applies a discount of $5, then the patient must pay $4 and the insurance company will pay $16. In addition, private insurance plans and some federal programs have a “most favored nation” clause in their contracts with physicians. This entitles the plan to pay the lowest charge the physician bills to anyone. Any pattern of discounts could result in a reduction in the physician’s allowable reimbursement schedule to the discounted amount. “Kickbacks” and Inducements to Refer Patients The federal government and some states have specific laws governing financial transactions between health care providers, including the Medicare Fraud and Abuse laws and the Stark I and Stark II. These laws prohibit any incentives that influence physicians to refer patients. For example, a physician who only extended professional courtesy to other health care providers who referred him or her patients would violate the law. These laws have been interpreted very broadly by the courts. Any payment or inducement that might have a tendency to affect referral decisions is prohibited, even if it has other valid purposes. Professional courtesy based on being on the same hospital staff would raise the same issues, although the link to referrals is more tenuous. Giving professional courtesy to all physicians without conditions would be more defensible, but if the government could show that a disproportionate number of physicians receiving the courtesy were also referring physicians, the court would probably rule that this was a prohibited inducement. Penalties In the past, if physicians violated the terms of their contracts with private insurers, the insurer could refuse to pay the claim and/or deselect the physician from the plan. The insurer could also sue the physician for fraud. However, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), it is now a federal crime to defraud private insurance companies. Violations can result in fines and criminal prosecution. The federal government can also refuse to pay the claim and can ban the physician from participation in Medicare and Medicaid. In addition, when the physician files a claim for services that were provided in ways that violate the federal regulations, that claim violates the False Claims Act (FCA). Violations of the FCA are punishable by a $5000 per claim fine and imprisonment.

Article submitted by The Health Law Firm. The contents of this article do not constitute legal advice. For more information on waiving copays and deductibles, health care discounts, professional courtesy and other billing issues, please visit www.TheHealthLawFirm.com.

2016 CMS SERVICES INC. BOARD OF DIRECTORS

SERVICES, INC.

2016 Board of Directors Francis C. Skilling, Jr., M.D. President Ophthalmology Eye Associates of Tallahassee Married to Karen Skilling University of Alabama

Brian Wilson, M.D. Allergy, Asthma, Immunology Tallahassee Allergy, Asthma & Immunology Married to Meredith Wilson University of Florida

Karl F. Hempel, M.D. Vice President Family Medicine Tallahassee Primary Care Associates Married to Mackie Hempel University of Kentucky

J. Daniell Rackley, M.D. CMS President Urology Southeastern Urological Center Married to Jennifer Rackley Medical College of Georgia

Terence N. Reisman, M.D. Secretary/Treasurer Gastroenterology Retired Married to Marilyn Reisman Duke University

Tracey Hellgren, M.D. CMS President-Elect Family Medicine Patients First University of Florida

Armand B. Cognetta, Jr., M.D. Dermatology Dermatology Associates of Tallahassee Married to Suzanne Cognetta University of Connecticut

Pam Wilson Executive Director, Capital Medical Society

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

17

CMS FOUNDATION

The Impact of Private Support: Capital Medical Society Foundation’s community of donors strategically help fulfill its mission “to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified.”

DONATE TO THE CMS FOUNDATION

WE THANK OUR DONORS We thank the following people who made a donation to the CMS Foundation this past month: Scholarship Fund Alice Pomidor, M.D. Your gifts to Capital Medical Society Foundation transform lives in the Big Bend.

“Dentistry from the Heart” celebrated its third year of providing free dental care in Tallahassee at the office of Walter Colón, We Care Network II, D.M.D., Periodontist, Walt Colón, Periodontal II, D.M.D., and Roshanda Associates of Dorsey, We Care Network North Florida, Dental Coordinator. on February 6th. Dentists from across Tallahassee volunteered their time and expertise. Extractions, fillings, and routine cleanings were provided at no cost to low income patients without dental insurance. Dr. Walter Colón said, “We’re trying to not only help people with their initial emergencies and problems but also get the word out and educate them so they can help themselves.” At least 40 staff members from the dentistries in Tallahassee volunteered to provide free dental care.

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• Access to healthcare is increased through gifts to We Care Network and the We Care Network Endowment Fund. $60 million in donated specialty medical and dental care has been provided to low income, uninsured patients since the program was created in 1992. Gifts support the salaries and benefits of the case management team who coordinate donated care. • To provide incentives to keep medical students trained at FSU College of Medicine in the Big Bend after completion of their residencies and help meet the growing demand for physicians in Florida, gifts to the Scholarship Fund provide scholarships to FSU College of Medicine students who have expressed an interest in returning to the Big Bend to practice after completion of their residencies. $50,000 was distributed to seven medical students in 2015. • Gifts to Capital Medical Society Foundation help provide operational resources for Capital Medical Society Foundation, including building maintenance, computer upgrades, as well as, modest grants to area non-profits whose programs improve access to health care for the underserved. In 2014, CMSF was able to repave its parking lot after 17 years, install a front door security and intercom system to improve the safety of staff, and purchase a new computer server. $11,000 in grants were awarded for Big Bend Hospice’s Bereavement Services Program, Elder Care’s In-Home Services Program, and FSU College of Medicine’s Chapman Community Health Program were awarded in 2015. Gifts to Honor and In Memoriam: You can make a donation to the CMS Foundation in memory of someone who has passed away or in honor of someone, such as a fellow physician, you hold in high esteem or has taken care of you or your family. CMS Foundation will send an acknowledgement letter to those you memorialize and honor. How to Give: Through the generosity of donors, funds have been created in order to establish financial stability to meet our mission. You can donate at any time to one of CMS Foundation’s current funds: 1) Capital Medical Society Foundation-area of greatest need 2) The Capital Medical Society Foundation Endowment 3) We Care Network 4) We Care Network Endowment 5) Scholarship Fund Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. If you would like to discuss a gift of appreciated securities, an insurance policy, designation of retirement plan assets, estate gift, or multi-year pledge, please contact: Pam Wilson, Executive Director pwilson@capmed.org or (850) 877-9018

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

CMS FOUNDATION: WE CARE NETWORK

Jean Paul Tran, M.D. Ernesto Umaña, M.D. Tony Weaver, M.D. William Yaakob, M.D. Daniel Yang, M.D. FOUNDATION

We Care Network

THANK YOU To our CMS members and We Care partners who saw new patients for the We Care Network in January 2016. Your generosity and support of the We Care Network makes a difference. Physicians Kalil Al-Nassir, M.D. Greg Albright, D.O. Marie Becker, M.D. David Bellamy, M.D. Robert Bradford, M.D. Viet Bui, M.D. Joseph Camps, M.D. Michael Cavallaro, M.D. Gilbert Chandler, M.D. C. Raymond Cottrell, M.D. Marilyn Cox, M.D. David Dixon, D.O. Ray Dolly, M.D. David Dolson, M.D. Akash Ghai, M.D. Larry Harper, M.D. Celeste Hart, M.D. Okanta Jackson, M.D. Arjun Kaji, M.D. Farhat Khairallah, M.D. James Killius, M.D. Amulya Konda, M.D. Michael Mangan, M.D. Hector Mejia, M.D. T. Adam Oliver, M.D. Rodolfo Oviedo, M.D. Timothy Paulk, M.D. Michael Pentaleri, M.D. L. Stephen Sarbeck, M.D. Scott Sellinger, M.D. Gadi Silberman, M.D. Hardeep Singh, M.D. Robert Snider, M.D. Joshua Somerset, M.D. Timothy Sweeney, M.D.

Dentists Eric Amundson, D.D.S. William T. Baldock, D.D.S. JP Bastien, D.M.D. Steven Bryan, D.M.D. Darrh Bryant, D.M.D. Susan Byrne, D.M.D. Walter Colón, D.M.D. Brittney Craig, D.M.D. John S. Dozier, D.M.D. Ben Grooters, D.D.S. Michael Hartley, D.M.D. William McFatter, D.D.S. E. Lynn McLarty, D.D.S. Jim McSoley, D.M.D. Lawrence Pijut, D.M.D. Frank Swerdzewski, D.D.S. James Sykes, D.M.D. Jay Walton, D.D.S. Lawrence Weaver, D.D.S. Ed Zapert, D.M.D.

Facilities Affordable Dentures Anesthesiology Associates Beachton Denture Clinic Capital Regional Medical Center Dermatology Associates Desloge Home Oxygen Leon County Dental Clinic Pathology Associates Radiology Associates Seven Hills Surgery Center Southeastern Surgery Center Tallahassee Diagnostic Imaging Tallahassee Endoscopy Center Tallahassee Health Imaging Tallahassee Memorial HealthCare Tallahassee Orthopedic and Sports Physical Therapy Tallahassee Outpatient Surgery Center TMH Family Medicine Residency Program Women’s Imaging Center

The We Care Network strongly encourages our volunteer physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. Also, up to five hours per biennium of CE Credit may be fulfilled by performing pro bono medical and dental services to We Care Network patients, if we have received documentation of value of services. You can send your value of donated services via fax to Sue Michaels, R.N. at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you! Please contact Sue Michaels, R.N. at smichaels@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of January 2016 and your name was omitted.

We thank our referring providers from January 2016: Anne Ananga, ARNP

Howard Kessler, M.D.

Erin Ayers, ARNP

Elaine Larkins, ARNP

Arvind Bakhru, M.D.

Esaias Lee, M.D.

Viralkumar Bhanderi, M.D.

Ashok Manocha, D.D.S.

Robert Bradford, M.D.

Damon McMillan, M.D.

Sherry Bramblett, ARNP

Thomas Noel, M.D.

Daniel Breivogel, ARNP

T. Adam Oliver, M.D.

Alexander Brickler, III, M.D.

Rose Origa, ARNP

Acquinonette Bryant, M.D.

Paresh Patel, M.D.

Jana Bures-Forsthoefel, M.D.

Lisa Perkins, ARNP

Kendall Campbell, M.D.

Marlaine Registe, ARNP

Lysmar Carrion-Dinguis, M.D.

Charlie Richardson, M.D.

Sheryl Cowan, ARNP

Jose Rodriguez, M.D.

Brittney Craig, D.M.D.

Karen Russell, M.D.

Julia Drude, M.D.

William Shaner, D.D.S.

Susan Dunbar, ARNP

Philip Sharp, M.D.

Shirley English, ARNP

Gadi Silberman, M.D.

Cynthia Evans, ARNP

Jeannine Silberman, M.D.

Edward Forster, M.D.

Robert Snyder, M.D.

Sharron Foster, M.D.

Bob Soni, M.D.

Anneka Gaffney, ARNP

Joseph Soto, M.D.

Judy Griffin, ARNP

Alanna Steaple, ARNP

Ben Grooters, D.D.S.

W. Brad Stephens, M.D.

Celeste Hart, M.D.

Frank Swerdzewski, D.D.S.

Sarah Hinson, ARNP

Tallahassee VA Clinic

Dwight Hooper, M.D.

TMH Family Medicine

Susan Horton, ARNP

Residency Program

Iman Imanirad, M.D.

Marianne Towler, ARNP

Okanta Jackson, M.D.

Franklin Watson, D.D.S.

Faith Jones, ARNP

DURING THE MONTH OF JANUARY, THE WE CARE NETWORK: RECEIVED 156 REFERRALS, WITH 108 PATIENTS NEW TO THE PROGRAM

SCHEDULED 99 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS

$76,199 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19 19

CMS PRESIDENTIAL INSTALLATION

MINUTES CMS PRESIDENTIAL INSTALLATION, JANUARY 21, 2016, FSU ALUMNI CENTER We Thank Our Sponsors for the Event Presenting Sponsors

(L-r) Event Sponsor, Capital City Bank, Ed Canup; Outgoing CMS Foundation Board Member, Katrina Rolle, J.D.; and Event Sponsor, Capital City Bank, William Smith.

Representatives from Presenting Sponsor, Brett Thompson Financial Group of Raymond James with Dr. J. Daniell Rackley and Jennifer Rackley.

Past and present physicians from Presenting Sponsor, Southeastern Urological Center.

(L-r) Incoming CMS President, Dr. J. Daniell Rackley; Supporting Sponsor, Florida Medical Association and Keynote Speaker, FMA President, Dr. Ralph J. Nobo, Jr.; Outgoing CMS President, Dr. Joshua Somerset; and FMA Vice President, Dr. John Katopodis.

Supporting Sponsors Florida Medical Association SunTrust Thomas Howell Ferguson, P.A.

Supporting Sponsor, Thomas Howell Ferguson, P.A.: (l-r) Brian Walgamott, Kavisha McCranie, Michael Kalifeh, and Becca Gilbert. Supporting Sponsor, SunTrust:

(l-r) Brett Allen, Tim Sheppard, Event Sponsors and Mike Dailey. Capital City Bank Hancock Bank James Campbell & Associates The Naumann Group Waddell & Reed, Inc., Financial Advisors 20 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Event Sponsor, The Naumann Group: (l-r) Jason Naumann, Tami Frankland, and Josh Kasper.

Event Sponsor, James Campbell & Associations: Cindy Campbell and James Campbell.

Event Sponsor, Waddell & Reed, Inc., Financial Advisors: (l-r) Michael Davino and Alan Null.

I. Dr. Joshua Somerset called the meeting to order at 6:45 pm. He welcomed the members, spouses, special guests and sponsors. He gave a special welcome to our keynote speaker, FMA President, Dr. Ralph J. Nobo, Jr. and to incoming President, Dr. J. Daniell Rackley’s family in attendance. a. Dr. Somerset reminded CMS members to submit nominations for the upcoming Celebration Awards – the I.B. Harrison, M.D. Humanitarian Award and the Outstanding Physician Award – by January 22nd. The winners will be announced in early February. II. Recognition of Past CMS Presidents, in attendance: Nelson H. Kraeft, M.D., 1961 J. Brian Sheedy, M.D., 1982 David D. Miles, M.D., 1986 C. William Applegate, M.D., 1987 John P. Mahoney, M.D., 1989 R. James Mabry, M.D., 1994 Alma Littles, M.D., 1996 Scott Sellinger, M.D., 2003 David T. Stewart, M.D., 2005 Andres Rodriguez, M.D., 2008 Tracey Hellgren, M.D., 2011 Nancy Loeffler, M.D., 2013 Alfredo Paredes, M.D., 2014 Joshua Somerset, M.D., 2015

CMS PRESIDENTIAL INSTALLATION

III. Introduction of Keynote Speaker

Dr. Ralph J. Nobo, Jr. administered the Oath of Office to new CMS President, Dr. J. Daniell Rackley.

Dr. John Katopodis, FMA Vice President, introduced FMA President, Dr. Ralph J. Nobo, Jr. IV. Remarks – FMA President, Dr. Ralph J. Nobo, Jr. Dr. Nobo shared an update on the FMA’s legislative efforts and encouraged physicians to reach out to him to keep it a team effort.

Dr. Somerset presented Dr. Nobo with a bottle of CMS wine as a token of appreciation.

V. Introduction of New Officers and Board Members

Dr. Somerset introduced the newly elected Officers: President-Elect: Dr. Tracey Hellgren Secretary/Treasurer: Dr. David Dixon Dr. Somerset introduced the newly elected Board Members: Dr. Christie Alexander Dr. Rohan Joseph Dr. Gregory Perry Dr. Ernesto Umaña (starting a new term) Dr. Somerset introduced the newly elected CMS Foundation Board Members: Dr. Terreze Gamble Dr. Maribel Lockwood Dr. Joedrecka Brown Speights Dr. Somerset introduced the incoming CMS Alliance President: Hien Guyer

VI. Introduction of J. Daniell Rackley, M.D.

Dr. James Renehan, a close friend and colleague of Dr. Rackley, gave an excellent introduction.

Dr. James Renehan introduced his colleague and friend, Dr. J. Daniell Rackley.

VII. Installation of J. Daniell Rackley, M.D., 71st President of Capital Medical Society Dr. Nobo administered the Oath of Office to Dr. Rackley. Once installed, Dr. Rackley made a few remarks (they can be read in their entirety on page 22-23). VIII. Recognition of Outgoing CMS President and Board Members

Dr. Rackley recognized our Outgoing CMS Board Members and gave them a bottle of CMS wine as a token of appreciation for their leadership and support of CMS:

Dr. Garrett Chumney Dr. Alfredo Paredes Dr. Philip Sharp

Dr. Rackley recognized the Outgoing CMS Alliance President and gave her a bottle of CMS wine as a token of appreciation for the leadership and support she has given to the CMS Alliance through her Board service:

Amy Pagano

Dr. John Mahoney, CMS Foundation President, recognized the Outgoing CMS Foundation Board Members and gave them a bottle of CMS wine as a token of appreciation for their leadership and support they have given to the CMS Foundation through their Board service and advocacy on behalf of the Foundation:

Katrina Rolle Dr. Joshua Somerset Dr. Hugh VanLandingham Dr. Rackley recognized the Outgoing CMS President: Dr. Joshua Somerset

Dr. Rackley thanked Dr. Somerset for his service this past year. He recognized the hard work and the time given to CMS and presented him with a bottle of CMS wine, a gift, and a commemorative plaque for his outstanding service to the profession and the community in 2015.

Dr. Somerset made a few remarks about his year as President.

IX. Announcement

Dr. Rackley encouraged members to attend the Celebration Awards Dinner on March 24th at 6:30 pm at the Florida State University Center Club.

X. Adjourn

Dr. Rackley adjourned the meeting at 7:45 pm. The Rackley Family: (front row) Rae Rackley and Ruth Rackley, and (back row) Jennifer Rackley, Dr. J. Daniell Rackley, Bonnie Rackley, and Jud Rackley.

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

21

CMS PRESIDENTIAL INSTALLATION

DR. J. DANIELL RACKLEY’S SPEECH AT THE CMS PRESIDENTIAL INSTALLATION Thank you, Dr. Renehan, for the kind introduction. I do know where you live and where you park your car every day. It’s certainly an honor and a privilege to be the 2016 CMS President. I’ve been on the Board of Governors for several years and I’m following some outstanding people who have provided excellent leadership. I’d like to thank Dr. Nobo for being here and I’m honored to have you speak at this installation dinner. I’d like to thank the fantastic staff at CMS including Pam Wilson, Shannon Boyle, and Rosalie Carlin. These folks are the ones who truly make CMS run—I’m really just here to sign the occasional letter or bank document—without them we’d really not have the outstanding organization that we have. Most importantly, I’d like to thank my wife, Jennifer and my daughters Rae, Ruth, and Evie for allowing me to serve in this capacity and I’d like to apologize to them in advance for the dinners, soccer matches, and school performances that I may miss over the next year. Now that I’m President, I’d like to go ahead and address a few changes that I would like to implement within CMS immediately: 1. For the BOG, our meetings are rushed and we often don’t have time to get through the necessary information before folks are leaving for the OR or clinic. To that end, I am recommending that we meet weekly and start the meeting times at 0630 instead of 7. Since we will be meeting weekly instead of monthly and we are under budgetary constraints like most organizations, we will, unfortunately, no longer be able to provide coffee and pastries as before. But, I am going to personally buy a case of graham crackers that we can ration through the year. Further, Pam is working on a sponsorship for a large jar of peanut butter that we should be able to stretch a long way. And of course, unlimited tap water will be available at the CMS office. 2. I have had concerns for several months now that the CMS members are not often as aware of what’s happening within CMS as they should be. To rectify this, I have instructed Rosalie to email each member hourly during weekdays to ensure that all the relevant information is distributed. We are acutely aware that these emails can become cumbersome and fill up your inbox so you will only receive 3 emails per day on the weekends. 3. Due to economic constraints, we are likely going to need to move CMS membership meetings to a location that is slightly farther away than Westminster Oaks. I’m currently in negotiations with the Loyal Order of Moose Lodge in Quincy who is going to give us a heck of a deal. Although the drive may be a little farther, I think you all will find the accommodations there to your liking.

Obviously, none of these things are true. With the exception of the oversize jar of peanut butter, all of these things are a little over the top; however, we do have some serious strategic goals at CMS. Almost of all of these involve finding ways to better engage our members and exploring ways to better connect the doctors in our town. With that in mind, I’d like to share a story about the importance of adequate organizational communication: I recently had the opportunity to visit the Normandy coast and several of the D-Day landing sites. Most people have seen Saving Private Ryan and know the brutal images of the first waves of soldiers landing on the beaches; however, the D-Day invasion really began 6 hours before that. At around midnight on June 6, 1944, 20,000 or so paratroopers and glider-borne troops were to land inland to carry out a number of maneuvers to disrupt German communications, impede German reinforcements, and secure bridges to allow for the passage of Allied forces into French inland. The Allied commanders, Eisenhower in particular, who planned the invasion felt that this part of the mission was absolutely critical. Anyone who has ever been a part of an organizational planning can tell you that no matter how much time you spend in preparation, sometimes things just don’t happen as planned. The early operations of D-Day were an abject disaster. As the 300 mile long formation of thousands of C-47 aircrafts approached the coast of France at around 600 feet, the designated jump altitude, the pilots encountered a thick bank of clouds that extended for miles along the coast. They had little to no visibility and their wings were nearly touching. This was not a situation they had planned for. Also, because the operational commanders were so concerned that the element of surprise be maintained, they had given the pilots strict instructions to maintain radio silence no matter what. The pilots, instinctively separated—some climbed above the cloud cover or descended below it, they peeled to the left and right, up and down, zigging and zagging. Those that went above the clouds could not see their landing targets— remember, no GPS in 1944. The platoon jump masters were basically just guessing as to their jump positions. Some pilots descended below the thick cover of clouds. These pilots took on a significant amount of flak from German guns and instinctively sped up to unsafe jump speeds to avoid being hit. I personally would not like to jump out of an airplane at any speed or altitude. This compromised the jumps of the troopers in the low flying planes. Many were inured as they attempted to jump at higher

22 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

speeds and lower altitudes, some planes were destroyed before jumps could be made, but almost no one landed where they were supposed to. The paratroopers had prepared to jump as a long “stick.” If the plane is flying straight and a trooper jumps every 10 seconds or so there is basically a long line of troopers on the ground. They would then assemble on the middle—the troops on each end would move to the middle to form up. Because of the evasive maneuvers made by the pilots and the high speeds, this was not possible—there was no stick. Rather, paratroopers were literally scattered across the French countryside, completely lost with very limited ability to communicate with each other. Now, I’ll be the first to say that physicians are a hyperbolic group. I perform the most difficult partial nephrectomy ever, at least once a month; but, let me be clear, although practicing medicine has gotten more difficult, I am not trying to compare it to a multi-tiered amphibious beachhead assault involving all branches of the armed forces; however, some days do feel like going to battle. Much like the paratroopers in Normandy in the hours before the D-Day invasion, we as practitioners have become fragmented and our ability to effectively communicate with each other has become compromised. As health care has evolved over the past few years, we have become more fragmented geographically, philosophically and sometimes politically. To improve efficiencies, we have become more specialized and sub-specialized, and we may have lost some of our sense of team with a common purpose: the patient. We currently have 2 hospitals, a VA clinic, multiple surgery centers, a medical school, hundreds of private practitioners who rarely, if ever, frequent the hospital, and hospitalists and ER docs who never leave the hospital. In the past, the hospital was a common gathering place. Many of us don’t even know each other. I met Dr. Vermess with radiology last year at a CMS function. I’ve seen his name on dozens of scans over the years, but it took 9 years to actually meet him. There is no singular EHR platform, rather multiple systems that do not talk to each other. As our practices have increased in size and geographic distance there may have even been a loss of the sense that we are peers and we may have lost sight of how essential physician to physician communication is to patient care. Without effective communication between doctors, coordinated patient care does not exist. Nuanced clinical information does not necessarily get transferred when reading a consultation note in the EHR. Every clinician sitting in this room can attest that you can get more clinical information from a 3 minute

CMS PRESIDENTIAL INSTALLATION

conversation with another provider than reviewing medical record for 15 minutes. Once nuance is lost, it is not just key historical and physical findings that get missed, but intangible things like the urgent nature of the consultation or external issues with a family member. The Joint Commission states that communication problems are the most commonly cited root cause of sentinel events. Often there is a critical piece of communication that gets missed. (Example: solitary kidney and stone) I think we all agree that the timely, efficient transfer of information is critical to patient care, and yet, this does not always happen. In a JAMA 2007 meta-analysis looking at hospital discharges— direct communication occurred between hospitalist and primary care physicians in only 3 to 20% of those discharges. In an Archives of Internal Medicine study in 2011, nearly 5,000 physicians were surveyed. Physicians who reported a lack of timely communication regarding referrals, had less confidence in their ability to provide highquality care than colleagues who received timely communication. There are numerous examples of this in the literature. There is no doubt that physician communication is directly linked to quality and this is especially true for complex patients—when vital information does not get conveyed this can lead to delays in care, continuation of improper treatment, increased length of stay, and increased costs. The reasons for this current dearth of communication are many but one of the main ones is that our current model incentivizes volume and largely physician to physician communication is not reimbursed. We are compensated to see more patients and do more procedures. Some us in more hierarchical organizations have the pressure of certain productivity expectations. Another reason for decreased communication is that it can be extremely difficult logistically to get in touch with another physician. Believe me, there are days where I am not successful at getting a human on the line at my own office. These are the inevitable pitfalls of larger organizations and clearly the trend in organized medicine is bigger is better. The greater the hierarchy, the more difficult it is to speak to a fellow physician. Technology has given us multiple new forms of communication (email, texting, etc.), but these are usually asynchronous. We have this system at our office of flags through our EHR and everyone does a pretty good job of sending flags about important matters, but somedays I may not be able to log in to the EHR. Sometimes important information may be missed for a day or two. Texting and emailing can certainly relay information but I think we can get into the trap of believing this is an adequate replacement for having personal knowledge about how another

physician takes care of patients. There can be a loss of collegiality as fellow physicians are seen as an “electronic presence”—just a name on a computer monitor that you come across occasionally. So, how do we overcome these communication hurdles? How do we develop a culture of patient centric medicine where we can effectively collaborate on the best ways to help our patients? I believe that Capital Medical Society plays a key role in this endeavor. There is no other organization in town that envelops all of us like CMS. Whether you are in private practice, an employee of FSU, TMH, CRMC, VA, etc., most physicians in this region are members of CMS. One of our most important initiatives that we have discussed over the past 2 years in our strategy planning sessions are better ways to “connect the docs” and you are going to be hearing about more events like these in the coming months. Basically, we want to have more social events geared only towards physician to physician interaction. Henry Ford said: “Coming together is a beginning; keeping together is progress; working together is success.” Before we can effectively collaborate and innovate, we have to be peers. We are going to be better doctors and our patients are going to get better care when we know our colleagues and CMS wants to play an active role in this. Some of our larger institutions and practices may set expectations for physician to physician communication with policy development and monitoring of peer review feedback. Brigham and Women’s Hospital (a small outfit in the northeast some of you may have heard of) has a published list of expectations on its website. I’m reading directly from it: “These standards were developed because of our belief that communication among BWH specialists, referring physicians and PCPs is part of the comprehensive are we provide to our patients. It is what we expect of our staff and what we teach our residents. Effective communication reinforces the partnership among specialists, referring physicians and PCPs in providing excellent care to our patients.” It goes on to list situations which must require verbal physician to physician communication such a post-operatic patient or a referral for a cortically ill patient. We need to explore ways to use technology to our advantage to help standardize communication among physicians. One idea that some institutions have adopted is a centralized hub where one provider is able to place a call and an algorithm is used to contact the requested provider via his/her preferred method of communication, either text, email or direct call. Another HIPAA compliant physician communication tool is DocbookMD, an application for apple or android phones which allows physicians to

contact each other (or support staff) directly and an alert is sent whenever a message is received. CMS worked out an agreement with DocbookMD that allows all members this service at no cost. The only way this really works is if everyone is signed up. To truly improve physician to physician communication, a collaborative effort will be required. We at CMS are going to continue to explore different ways to make this process easier for our members. We are open to any innovative ideas or suggestions from members, and we would love to hear them. It’s 2 AM on June 6, 1944 and nearly 20,000 paratroopers have landed on the coast of Normandy and virtually no one is where they are supposed to be. The beach invasion is to begin in 4 hours. It is pitch black dark, foggy, and they are mostly in the country with no street lights. Most of them have no idea where they are and most of them are alone. How were they to carry out their missions which were consider critical to the success of the overall invasion? They communicated in creative ways. Of all things, each trooper had a child’s cricket that chirped when squeezed. One troop would click once, the other would then click twice indicating an American soldier. They signaled with Morse code and flashlights, and they communicated with their commanders back in England with messenger pigeons. They assembled as best they could. Most were forced to work with troops they did not know from other companies. Many ended up carrying out completely different missions than the one they trained for. The commanding officers conveyed their purpose to anyone they could find. Despite being completely disorganized at the beginning, with fractured communication, they carried out mission after mission that altered the fate of that day. They took bridges, they secured supply routes, they cut German communication lines. They destroyed access roads that would be used for reinforcements. They succeeded. Despite numerous obstacles, they innovated, collaborated and persevered to help change the outcome of WWII. The main reason that they were able to overcome these challenges was because their purpose was singular—take back Europe from Nazi Germany. Despite all the ongoing changes in healthcare, we also have a singular purpose. The CMS mission statement reads: “To promote the practice of medicine for the ultimate benefit of the patient.” After all, the reason we are all here is for our patients. When we work as a team of physicians, we know our peers, when we develop better, more efficient ways to communicate, we become better doctors. And, our patients will be the better for it. Thank You!

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 23

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