APRIL EDITION, VOLUME 2015, NO. 4
Rosalie Carlin – A True Administrative Professional By Pam Wilson, CMS Executive Director
To be an outstanding Administrative Professional requires more than strong administrative skills like typing letters and answering phones, ordering lunch for Board meetings, ordering office supplies, and strong organizational skills. It requires an understanding that you are more than a gatekeeper and problem-solver, but that you are an ambassador for the organization you represent. Rosalie Carlin, Administrative Assistant at Capital Medical Society for almost 30 years, is the lifeblood of the association for physicians and osteopaths of Leon, Gadsden, Jefferson, and Wakulla Counties. Rosalie provides a wide range of support for the Executive Director and the Board of Governors for the association. She demonstrates a level of competence that has developed over time as changes have occurred in software, database management,
membership, and management style. With excellent communication and interpersonal skills, Rosalie consistently uses her warm personality to be the first point of contact for members, vendors, and patients. She is organized, helps leadership stay organized, and maintains confidentiality in matters that should remain so. With constant interruptions during her day, she still manages to prioritize her day efficiently and with grace.
“I want to be like Colonel Potter’s Radar,” described Rosalie Carlin, making a reference to the T.V. series M.A.S.H., when asked recently how she viewed her role as an
Administrative Professional at Capital Medical Society. Rosalie gives Administrative Professional new meaning, in that as a multi-tasker she keeps all things administrative moving forward for the 600+ member association. More importantly, she is the consummate relationship-builder and ambassador for an organization with members who have little extra time to communicate beyond their medical practices and families. With wit and creativity she garners responses for meeting invitations, sponsorships, continuing education documentation, and more when a lesser professional might end up in a spam folder or heaven forbid, simply never have their email opened. People who know her, enjoy her and her emails. Mollie Hill, past Executive Director for Capital Medical Society, who hired Rosalie as Administrative Assistant for Capital Medical Society in September, 1987, reminisces, “Rosalie came to Tallahassee from the Bronx in New York in 1986, and I was fortunate that she chose to become my assistant at Capital Medical Society. Although she didn't drive, know anything about Tallahassee and talked funny, CONTINUED ON PAGE 3
CAPITAL MEDICAL SOCIETY 2015 MEETINGS CALENDAR April 21, 2015 May 19, 2015 CMS Membership & CME Meeting CMS Membership & CME Meeting “Selecting the Best Medical Apps for Your Practice and Patients” and “Using “HCV – Back To The Future” Resources in Interactive Patient Encounters to Assist in Medical Decisions” Amulya Konda, M.D. Ken Brummel-Smith, M.D. & Nancy Clark, M.Ed. 6:00 pm 6:00 pm Maguire Center for Lifelong Learning CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1 Maguire Center for Lifelong Learning at Westminster Oaks at Westminster Oaks
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
BOARD OF GOVERNORS Joshua Somerset, M.D., President J. Daniell Rackley, M.D., President-Elect Tracey Hellgren, M.D., Secretary/Treasurer Alfredo Paredes, M.D., Immediate Past-President Shelby Blank, M.D. Garrett Chumney, M.D. David Dixon, D.O. Shakra Junejo, M.D. Maribel Lockwood, M.D. Amy Pagano, CMS Alliance President Paresh Patel, M.D. Philip Sharp, M.D. Ernesto Umaña, M.D. Kenneth Whithaus, M.D. Pam Wilson, Executive Director Family Medicine Residents William Carlson, M.D./Anna Hackenberg, M.D. Internal Medicine Residents Chris Rosadzinski, M.D./Prerna Satyanarayana, M.D.
PUBLICATION EDITOR Charles E. Moore, M.D.,
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Young Design
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at cmoore5186@aol.com and 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. 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
I N T H I S I SS U E :
CMS FAMILY FUN NIGHT
Administrative Professionals Day … Announcements … CMS Lunch & Learn … Florida Board of Medicine … Reflections from the Editor … Viewpoint … FSU Center for Innovative Collaboration in Medicine and Law … Medical/Legal … CMS Foundation … CMS Foundation: We Care Network … Medical/Legal …
1 4 6 7 9 11 14 16 20 21 22
HAPPY BIRTHDAY! {APRIL BIRTHDAYS}
Amy Reimer Neal, M.D. – 3rd
Stephen Mnookin, M.D. – 15th
Duncan Postma, M.D. – 4th
Stephanie Lee, M.D. – 18th
Michael Ford, M.D. – 5th
Wendy Somerset, M.D. – 18th
Randy Reese, M.D. – 7th
Barbara Demby Abrams, M.D. – 20th
Jeremy Sunseri, M.D. – 8th
William Placilla, M.D. – 20th
Jesse Judelle, M.D. – 9th
R. James Mabry, M.D. – 21st
Ronald Hartsfield, M.D. – 10th
Joy Ablordeppey, M.D. – 23rd
Vikki McKinnie, M.D. – 10th
Jana Bures-Forsthoefel, M.D. – 24th
Edward Jackson, M.D. – 12th
James Davenport, M.D. – 25th
Mansukhlal Padalia, M.D. – 12th
Mary Swain, M.D. – 25th
Charles Cooper, M.D. – 13th
Clifton Bailey, M.D. – 27th
J. Anthony Giralt, M.D. – 13th
Farhat Khairallah, M.D. – 29th
Louis St. Petery, M.D. – 14th
Julian Hurt, M.D. – 30th
Edward Forster, M.D. – 15th
Happy Birthday! We are so glad you were born!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Did we miss your birthday? If so, please email Rosalie Carlin at rcarlin@capmed.org!
ADMINISTRATIVE PROFESSIONALS DAY
she quickly became indispensable and has grown to be indispensable to all of the CMS members. Her dedication, loyalty, and ability to organize are rare traits, and I still treasure our friendship.” And so the journey began for Rosalie Carlin as Administrative Assistant to Mollie Hill, Karen Wendland, Sue Conte, and Pam Wilson. Rosalie’s stated objectives when applying were, “to find a position where I can utilize my secretarial, administrative and personal skills to the fullest potential.” She has done just that and more. Rosalie has been at the frontlines of major transitions within Capital Medical Society and business administration, but more importantly, she has been the “face” and “voice” of CMS to the medical community and to patients seeking physician referrals. Letters frequently arrive from physicians and vendors who have taken the time to express their appreciation for how friendly and nice Rosalie has been to them. “It seems in this day and age we are so rushed we never have time to say, ‘Thank You’. Well, I’m taking the time, because she deserves it. Your management skills and standards are well exemplified in her.” Rosalie has weathered a sea of transition over her tenure at Capital Medical Society. Not only has she watched the staff grow from three to nine, she has moved from a typewriter on her desk to the computer age with a computer system, full membership database, and two monitors to work from. She moved from no fax to a fax machine and then to email and Internet. She went from not being able to drive to now owning her third car. (Not really a work accomplishment, but a big change, nonetheless!) Rosalie has been instrumental in the transition of physically taking the in-house produced Cap Scan newsletter to the hospitals to deliver to physician mailboxes to now having a vendor print it and mail it for us with addresses kept on a database. She has watched the membership grow from 300 to 600+ and the creation of FSU College of Medicine.
“Rosalie is truly the ‘glue that binds’ the membership and the staff of Capital Medical Society. She maintains the same enthusiasm and cheerful attitude that makes the physician membership hold her so dear. Her historic knowledge and strong relationships with the organization's business partners is a huge value to the changing leadership. Most important to me, even with heavy workloads and deadlines, Rosalie was FUN to work with. She truly cares about the organization and loves the physicians of this community. She embodies all the best qualities of a professional Administrative Assistant,” shared Sue Conte, who retired as CMS Executive Director in 2014. And then, with yet one more change in staff, Rosalie became my Administrative Assistant. Rosalie has a gift. Yes, she’s organized, can manage multiple projects at one time efficiently, and takes on the Holiday Auction fundraiser event with the enthusiasm of a community organizer, but more than that, she’s got that special gift of making each person who comes into the office or calls, feel as if they are the most important person in her day. When she is truly knee-deep in a project, and the phone rings, the caller would never guess she was not simply sitting awaiting their call. That’s a gift. She does the same for me. She truly cares about those she serves and it shows in how she responds to others. She personalizes her approach and affirms her teammates. She is a resource, who humbly guides leadership in how to do their job better, often making suggestions or sharing historical perspective. And yes, she is FUN. She has just the right sense of humor to keep the days and tempo upbeat. Although CMS staff are a family, Rosalie is the cog in the wheel that keeps things rolling. She is truly the glue that binds the CMS family of staff and physicians. As we celebrate Administrative Professionals Day on April 22, please join me in celebrating our outstanding administrative professional, Rosalie Carlin. CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
ANNOUNCEMENTS
Thank You
The CMS Happy Hour on February 19th at The Front Porch was a success! We had over 50 people enjoying the delicious hors d’oeuvres and refreshing cocktails.
It’s a Boy! Roshanda Dorsey, Senior Case Manager for the We Care Network, and her husband, Terrance, welcomed their second child, Caleb Jeremiah “CJ” Dorsey. CJ was born on March 6, 2015 at 7:38 pm. He weighed 5 pounds, 9.4 ounces and was 19 inches long. CJ joins big brother, Kaiden Alexander.
Congratulations, Roshanda and Terrance! We are so happy for you!
Left to Right: Joyce Broeseker, wife of Dr. Broeseker; Tim Broeseker, M.D., TMH Physician Partners Cancer and Hematology Specialists; Paula S. Fortunas, President/CEO, TMH Foundation; Philip Sharp, M.D., TMH Physician Partners Radiation Oncology Specialists; and Janet R. Borneman, Director of Planned Giving, TMH Foundation.
Tim Broeseker, M.D., Hematologist/Oncologist, and Philip Sharp, M.D., Radiation Oncologist, were recognized by the Tallahassee Memorial HealthCare Foundation
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and Tallahassee Memorial Cancer Center for their outstanding work, dedication and passion for oncology care.
Tallahassee Memorial Family Medicine Residency Program Welcomes Russell D. Cole, M.D. Board Certified: Family Medicine Medical School: Emory University School of Medicine Atlanta, GA Residency: McLennan County Family Medicine Residency Waco, TX Accepting New Patients.
Complete Medical Care. Here in Tallahassee. 1301 Hodges Drive | Tallahassee | 850-431-5430 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS LUNCH & LEARN
S
CAPITAL MEDICAL SOCIETY LUNCH & LEARN Capital Health Plan, 1491 Governors Square Boulevard
On February 18th, Colleen Wood, Vice President, Business Development, with Availity gave an excellent program on “Method to the Madness: 10 Payment Collection Strategies That Work”. You can reach Ms. Wood at (919) 622-4241 or Colleen.Wood@availity.com.
Aargus Facility Services sponsored the February 18th Lunch and Learn. Tom McHaffie was in attendance as a representative of Aargus Facility Services. You can reach Mr. McHaffie at (850) 933-8125 or tom@healthcarefacilitiesguy.com.
Mark Your Calendars for the remaining Spring 2015 Lunch & Learn Seminars: April 15, 2015 Affordable Care Act: Status/Overview and Legislative Updates Hear from the only insurer offering coverage in Florida through the federal marketplace-Florida Blue. - Overview of the changing health insurance market - Implications of ACA on the Florida health insurance market - Impacts on operations for insurers and providers Speakers: Gordon F. Bailey, II, Asst. General Counsel, and Kelly James, Senior Manager – Government Affairs, Florida Blue Sponsor: Terry Bush, Office Depot
May 20, 2015
Payment Advocacy 2015 MEETINGS CALENDAR May 28, 2015 CMS Doctor/Daughter Banquet 6:00 pm Golden Eagle Country Club
Hear a legislative update with an emphasis on issues that impact provider reimbursement and practice administration. Speaker: Jarrod Fowler, Florida Medical Association Sponsor: Diana Cureton, Hancock Bank
September 15, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
Time: 12 Noon to 1:30 PM (Seminars start at 12:30 PM)
October 20, 2015
Place: CHP Auditorium, 2nd Floor, 1491 Governors Square Blvd.
CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 10, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
Cost: $10 per person, per seminar
For more information or to register, call Rosalie Carlin at 877-9018.
December 3, 2015 CMS Foundation Holiday Auction 6:30 pm Location: TBA
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
seminarS ARE held at the Capital Health Plan on Governor’s Square Blvd – and we thank them for providing this lovely venue.
FLORIDA BOARD OF MEDICINE
Be Renewal Ready The Florida Department of Health sends renewal notices to licensees at least 90 days prior to the expiration date of their license. To ensure that you receive the renewal notice, it is important that your mailing address on file with the Department is current. Notifying the Department of a change in mailing address or practice address is the responsibility of the licensee, according to s. 456.035, Florida Statutes. If you fail to update your mailing address, you may not receive important correspondence from the Department of Health or the Board of Medicine. Through the Medical Quality Assurance (MQA) Services, licensees are able to update their mailing address online. The following steps will walk you through updating your mailing address online: 1. Go to flhealthsource.gov and click on “Provider Services”. 2. Click “MANAGE YOUR LICENSE” which will take you to the MQA Online Services portal. 3. Select your profession from the dropdown list then enter your User ID and Password.
4. Once you have successfully logged in, click “Update Addresses” on the left side of the page. 5. Enter your current address into the form and then click “Process”. 6. You will receive a confirmation page that displays the updated address. We encourage you to update your mailing address with the Department before your renewal window opens. For licensees whose licenses are expiring on January 31, 2016, the renewal window opens around late September/early October of 2015. If your mailing address is not up-to-date before this time, you may not receive your renewal notice, which contains important renewal information. Remember: Update your mailing address far before the deadline and be renewal ready. Visit the Florida Board of Medicine’s website at flboardofmedicine.gov/renewals and learn more about being Renewal Ready. CMS
o Note: Your User ID and Password were mailed with your initial physical license. If you do not have your User ID and Password, click Get Login Help?
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
DS EN 15 IT 20 HIB 0, EX AY 1 M
EXAMINE MORE THAN 50 UNIQUE ARTIFACTS on loan
from the Florida Department of Health and State Archives of Florida. View personal stories, interpretive text, historical photographs, and more while witnessing the remarkable 125-year journey of Florida Public Health.
The Florida Historic Capitol Museum gratefully acknowledges the following sponsors and partners:
400 S. MONROE STREET | TALLAHASSEE, FL 32399-1100 | (850) 487-1902 |
WWW.FLHISTORICCAPITOL.GOV
Tallahassee Memorial Family Medicine Residency Program Welcomes Julia G. Weeks, M.D. Board Certified: Family Medicine Medical School: University of Alabama School of Medicine, Birmingham, AL Residency: Tallahassee Memorial Family Medicine Residency, Tallahassee, FL Accepting New Patients.
Complete Medical Care. Here in Tallahassee. 1301 Hodges Drive | Tallahassee | 850-431-5430 8
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
REFLECTIONS FROM THE EDITOR
CAPRICCIO IN C
to still be upright. But when one reaches the age of “the elderly,” and threats of cerebral ischemia loom, even forgetting a name you almost automatically should know, it does dawn on you maybe to grasp the fact that lest it be lost the poor brain needs exercise.
By Charles Moore, M.D.
They say, and I would guess truly, that if you don’t use it, you lose it. And so I was brought eight or ten years ago to think of what I am going to generously call my “mind.” About then I lost a bit of mine, which led me to think I had better pick up the bits and pieces remaining, pat them together, and come to a propitious way…ah, “once again into the breech…” of practicing what I am going to call “thinking.” Maybe you know how to think; but it has always slightly eluded me. I think of philosophers, sitting beneath a tree, thinking up things like “I think therefore I am,” or even the Buddha, who sitting beneath his banyan discovered enlightenment. I have never done either of those things. Of course, at possibly the other end of the spectrum, there are those yoga practitioners who sit in awkward positions, with their thumb and index finger making “O”s, who are concentrating very hard on “not thinking,” but by which means they get in touch with something very deep within, deeper even than mere “thinking.” Can’t do that, either. When I think I am thinking it seems to me that on the whole I am merely reacting to some external stimulus, or response to a comment by someone else, or whether when I am putting on my socks the heel of the sock is going to find its way readily into the heel of my foot. Nor do I think that “concentration,” in itself, is necessarily a good substitute for thinking. It probably does light up the brain, which may be a good thing on general principles; but I know from my own surgical experience, which does require some greater or lesser degree of focused concentration, that I was not particularly thinking. If someone is bleeding you respond to the circumstance almost thoughtlessly to stop it, no room being left for contemplation of the spheres. But at least the brain lights up. We plod along, according to the neat pattern we have devised, and which works to get us quietly from A to B. I am now about to “V,” approaching “W,” and am delighted
As for myself, let me here interject my thanks to Cap Scan. Perhaps as much as anything else I have done over the years past writing an essay for this distinguished organ is the one steady action that, once a month, I conceive compels me to nearly THINK. To write something, no matter how trivial, you have to have an actual thought. And then, all the better, you have to organize the thought, which in itself, let me allow, demands some thinking in its own right. Let me, as an aside from this observation, accordingly invite those of you who would like to wrestle with some thought, and so “light up your brain,” to put it on paper and send it to us. By this means we will take pride in doing our prophylactic bit to keep your own delightful brain exercised. Don’t get me wrong: of course our brains respond vigorously to the exigencies and clamor of our medical practices; of our domestic life; our plots respecting vacations; our children; and what we are going to have for dinner tonight, and whether or not our present weight can afford it. But again, that’s the brain in response to demand, and when those demands, after retirement, after the children have fled the nest, after you have been everywhere you want to go, are no longer so demanding, what is one to do with one’s brain? We are forced to find other means to keep it, if not aflame, lit. And so, eight years or so ago, I felt myself confronted with just that question. “Let’s see,” said I: I could take up Sudoku, my wife being a wonderful example at the time, rapt in the mental effort of it all: but I could not bear the fact that even if there was personal satisfaction in beating those numbers back, there was no tangible result. Golf, of course, is a fine panacea, but my shoulder joints don’t have it in themselves anymore, even with a steroid injection, and the effort and expense of trying to put a little ball into a little tin cup appealed no more than Sudoku, even though I grant you it gets many fine men off the streets and out of the house. CONTINUED ON NEXT PAGE CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
REFLECTIONS FROM THE EDITOR
Reading is too passive, even if you are into Dostoyevsky. The mind wanders amidst all those Raskolnikovs and brothers Karamazovs. Learning another language is highly touted, but with whom was I to practice Arabic? So, if not Sudoku, golf, Dostoyevsky, or Arabic, what? I thought (actually): and it dawned on me that I had, like others I have overheard, too terribly often said, and aloud, too, “the one thing I really wish I had learned to do (in this life) was play the piano.” And then I thought (yes, actually!) “well, Stupid, instead of whining, why don’t you try to learn to do it.” And so, ten years ago and despite the fact that there is not a “musical bone” in my or my family’s body, I bought a cheap, little, old (1938, but with ivory keys) baby grand, built a room for it, with great windows to the east, the sun coming up like thunder behind the live oaks in the middling distance. I thought (well, yes, yet again, indeed!) that I saw myself playing some brilliant Nocturne by Chopin, touching the keys with the most exquisite sensitivity as through the windows the rain could be heard as an accompaniment, falling gently from the eaves and eglantine, the garden abloom, and Lynn dressed as Georges Sand writing a brilliant novel with a scratchy pen and real ink. All of that duly arranged (in my thinking brain) all that was left was to ring up Velma Frye and beg that she teach me, just for starters, the difference between the black and white keys, and where in the world was middle C. Oh, long suffering lady, she said she would accept the challenge. “Look,” I said, “I can type, and both piano and typing share, after all, what is called a ‘keyboard.’ I mean really (my ‘thinking’ at this point altogether delusional!) it is just a matter of hitting the right keys with the right fingers.” “Isn’t it?” I said, ever so weakly. Ah, sweet Velma! Consummate lady! She did not roll her eyes, allow her tongue to fly out of her mouth, gag or turn at least very green. “This,” she said, “is a piano.” “Ah yes, I have one of these,” I said, if rather too smugly, affecting a certain bravodacious surgical posturing, which I had, at least, for years practiced and brought to some degree of perfection. 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Of course, I don’t practice enough; no one ever does. And I break almost into tears at some of my lessons. But let me tell you this, if you are looking for a relatively low impact physical and mental exercise, that demands a degree of concentration, call it even cerebral exercise, that I can only equate with doing a delicate bit of surgery, take up the piano. Aside from its being such a physical and mental exercise, you will grant yourself the added benefit of becoming an intimate participant, maybe, one day, if you practice, in one of the great glories of our civilization. Think about that! And where have I got to? Well, begging your indulgence, how about this that, who knows, one day I may set to music. Call it “Capriccio in Middle C.” A pianist I will never be, Nor quite distinguish key from key, But 10 years on, I’m glad to say, I’ve learned to locate middle C, Just to the left of what is D. Time flies, is gone, But happy day! By F, I do believe, I’ve now found E, And so, quite confidentially, I trust that somewhere, Just out there, I will discover, someday, G, And farther past, At last, Comes A, And so discover, even B. Laurels are not simply won, But this is fun, Don’t you agree? To have the diapason done! CMS
VIEWPOINT
Editor’s Note: How in the world did a lady get into Medical School? It is, of course, many years ago that Barbara Williams, M.D. did just that, a pioneer breaking into what had been for so long “a man’s world.” And then, that done, for having so long been such a brilliant presence in our own medical community thoroughly excites Cap Scan’s curiosity. “How do we be what we be?” that is the question, and our thanks to Dr. Williams for sharing how she went about it. We thank her, too, for years and years of being so actively involved with both CMS and the CMS Foundation, where she is renowned for simply having great ideas all the time.
veins and if unsure of an easy stick, I would suddenly be called away never to return. I justified this with our oath, “First, Do No Harm.”
Miss Match By Barbara Williams, M.D.
The medical school application landscape was different 45 years ago. As a prospective applicant, I had no foreign mission experience or research achievements. No one in my family had ever attended college. Perhaps worst of all, I was a woman. Maybe it is good I didn’t realize what I was getting myself into when I decided to pursue a career in medicine! During the application process, I learned only 10% of incoming medical school classes were “the fairer sex.” Emory Medical School interviews were spent answering questions about how I planned to have both a family and a medical career. I figured that was a bad sign, so to hedge my bets I announced I could be a flight attendant. But I doubted the wisdom of my back-up plan when I got miserably ill on my first airplane ride. My options felt limited until I interviewed at the University of Florida with Dr. Lynn Miller, who was actually the first female physician I had ever met. She was so helpful and kind, it made UF seem like an obvious first choice. When I received my admissions letter, it felt like a dream come true. My first two years at UF were spent on basic science, getting involved with some research performing chromatography studies on diabetic blood to find out if hemoglobin A1C levels were high in diabetic patients (common knowledge now) in the bowels of the VA Hospital. Many thanks to Dr. Robert S. Eliot for putting up with me. I went on the wards to actually draw blood from real patients, which felt very intimidating! To spare them undue misery, I looked at their
Many experiences come to mind like when I first spent time with Dennis, my future husband, on our OB rotation as resident Dr. John Taylor (one of Capital Medical Society’s own) demystified the birthing process. He was a real comedian and made learning OB painless - although not for the patients! I was in love, but not with the matching process. Dennis and I were married by our senior year and got unheeded warnings on our internship trip that we would have trouble matching as a couple. I had decided on Family Practice thanks to a great program offered by the Student AMA (when I spent a summer break with multiple specialists near my hometown, including a family physician who was never bored and much loved by his patients.) Dennis liked cardiology, but our preferences didn’t matter on that infamous matching day when we went unmatched. We were initially stunned at our misfortune, but all’s well that ends well. We eventually made it to UNC by way of Vanderbilt and never regretted the extra experiences that helped to shape our careers. What a privilege it has been to have known patients and their families for over thirty years now. I have shared joyous times with parents as infants are born. I have watched these same infants grow to adulthood and have children of their own. Unfortunately, the cycle of life includes sad times of death and illness and injury. In fact, as I tell this story it is hard to believe that all the physicians mentioned above are no longer with us, except Dennis, of course. They each hold a special place in my heart, as they generously shared their time with me as a medical student. I try to do the same to honor them. CMS
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VIEWPOINT
PENS
By Frank Skilling, M.D.
As long as I can remember I’ve liked pens, perhaps I could even say loved pens. This may have been in honor of the dictum, “The pen is mightier than the sword,” which I learned as a youngster. When I was in elementary school I requested a fountain pen for Christmas, and I was given, by my parents, a new Sheaffer black snorkel style. This was a clever design which had recently been introduced. When the barrel was rotated, a thin hollow tube was extended from under the tip which could be inserted into the ink bottle. A plunger mechanism then drew the ink up into the barrel, and the snorkel was retracted with another rotation. This theoretically kept the tip from being coated with ink that then had to be wiped off. The Sheaffer Company also made ink bottles with a small side well that was used to hold the amount of ink that could easily be drawn up by the snorkel. It was a really cool device for a 10 year old. My father, a physician, always used a fountain pen and had a desk set with one mounted in a marble base. He used the pen to sign letters, checks and patient files. He preferred Sheaffer standard blue ink, but I chose Peacock Blue for myself. As I recall, it was a rather brilliant color that was closer to aquamarine than blue, and it almost seemed to shine on the paper. I don’t recall using that pen much in middle school since we used pencils and ruled paper for just about everything, but I loved having a fountain pen. I switched to ball point pens in high school, and I think I used a Parker T-Ball Jotter for most things. The ink was still blue, and I used it to write my history reports, English papers and tests. When I was “wealthy” one year out of medical school I bought a sterling silver Parker with a matching fountain pen. I still have the set over forty years later. For college I used a blue ball point, but by then I’d started typing a lot of my papers on a portable Hermes typewriter. I still had the Sheaffer snorkel, but didn’t use it as much.
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At my graduation I received a pen set with a stainless steel Parker ball point and a mechanical pencil. I used the ball point a lot, but as med students we were instructed never to use pencils to write in charts, so the mechanical pencil lay dormant in my desk drawer. I was still using blue ink until I watched one of the senior attending surgeons sign a note in a chart with a fountain pen using black ink. He was John Kirklin, M.D., one of the pioneers in cardio-vascular surgery and the chairman of the surgery department at UAB. Kirklin was a living legend among the medical students and house staff. While I was on his service as a senior medical student I watched him sign a chart note with his gold Parker fountain pen in black ink. After a pre-op patient was presented to him at surgical rounds he wrote his characteristic comment: “I approve of the planned surgery for this patient. The risks, benefits and imponderables have been discussed. John Kirklin, M.D.” I decided that I needed to switch to black ink as well. If I couldn’t be a heart surgeon like Dr. Kirklin, at least I could use a fountain pen to write in the charts like he did. I also learned that the word “imponderable” covered a variety of unforeseen circumstances. While I was visiting Paris during my senior year in medical school I found out about Bic disposable pens whose parent company was in France. I bought several dozen at Galleries Lafayette in preparation for my intern year at Jackson Memorial Hospital in Miami, and during that time I switched to using Bic pens with yellow plastic barrels, black end caps and black ink. Interns on the internal medicine service were continuously writing: chart notes, patient orders, lab slips, specimen containers, x-ray orders, x-ray reports. All paperwork was supposed to be completed by the end of the day before we were allowed to go home, and I frequently found myself writing in charts well into the evening on the days when I wasn’t on call. The in-house thirty-six hour shifts were filled with hours of scribbling in
VIEWPOINT
charts well past midnight. I usually had a pocket protector filled with Bic pens and a red fiber-tipped Flair which I used to initial lab reports once I had read them. During my ophthalmology residency I used mostly the cheap black Bics, but I still liked fountain pens and often carried one in the clinic. After I was married at the start of my third residency year, my wife found out how much I liked pens. For my “graduation” from the program she gave me a Mont Blanc Meisterstuck…the grandfather of all fountain pens. It was a beautiful piece: thick gleaming black barrel with a platinum and gold tip that was filled only from an ink bottle. Mont Blanc made its own premium ink, and I loved the jet black liquid. The factory recommendations were to not use a bottle once opened for more than a year, use only a chamois cloth to wipe the tip, and never store for long periods with ink in the barrel. I thought it was outrageously expensive, but Karen knew how much I valued pens and even had my name engraved on the gold clip. I have subsequently collected several more fountain pens, and I can probably still discuss the differences between Pelikan, Waterman, Parker, Lamy and Mont Blanc. I always regarded pens as instruments to be used for writing, not just collecting, and they were my preference for hand-written notes.
Unfortunately, fountain pens have become a casualty of our technological age. I stopped carrying one to sign charts after a custom silver Parker, which was an anniversary gift from Karen, disappeared from my locker during surgery. I’m not sure if it was lost in the laundry or purloined. Now I never use a pen, fountain or otherwise, to write in office charts. Our office converted to electronic health records several years ago, and I feel adept at using a keyboard, so there’s no need to keep a fountain pen in my pocket any more. Still I miss the feel of one when I’m staring at a piece of paper trying to get my thoughts sorted out. Since cursive writing is now being dropped from elementary school I wonder if today’s children will have a chance to know the true joy it is to write with a fine fountain pen on vellum or high cotton content paper. The art of penmanship is long gone. When I think of no longer being able to easily write with a smooth fountain pen on fine paper, I have the sensation of a palpable loss. CMS
Editor’s Note: Cap Scan thanks Dr. Skilling for having submitted this article, so demonstrative of the fact that the smaller but “finer things of life” are worth recording. I appreciate his granting me a minor footnote of my own to all that he has so well written: namely, that the use of a careful fountain pen when signing checks elevates one, to some happy degree, beyond the sting of the debit being created. A kind of “living well is the best revenge” sort of thing...at least until your pen leaks all over your best white shirt!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 13
FSU CENTER FOR INNOVATIVE COLLABORATION AND LAW
Mollie and Paul Hill Student Writing Competition Each year the Florida State University Center for Innovative Collaboration in Medicine and Law sponsors a national Student Writing Competition in Medical-Legal Interprofessional Collaboration. This writing competition is made possible by a generous donation from Mollie Hill (Director of Community Clinical Relations at the FSU College of Medicine and former Executive Director of Capital Medical Society) and Paul Hill (General Counsel, Florida Bar). The assigned discussion topic for the most recent round of this competition was: There is a growing consensus that the U.S. health care system is frequently characterized by the excessive and unnecessary provision of medical services. One of the impediments to rationalizing medical practice to reduce tests, procedures, and treatments that are not clinically indicated and appropriate for particular patients is the perception by practicing health care professionals that the prevalent and often overused tests, procedures, and treatments are compelled by the current American legal system, and that health care professionals’ efforts to reduce the current waste and inefficiency will result in their expanded exposure to malpractice litigation and liability. Discuss the ways in which the medical and legal professions may work together collaboratively to address the problem of excessive, unnecessary, wasteful, and inefficient provision of medical services in the U.S. The 2015 winning essay, as determined by a panel of judges with expertise regarding the intersection of health care and law, was Practicing Quality Medicine Instead of Defensive Medicine, submitted by Gurney F. Pearsall, III, a student at the University of Colorado School of Law.
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Gurney F. Pearsall, III
Individuals interested in reading this essay or in obtaining information about the 2016 round of this Student Writing Competition, which is open to both medical and law students, should contact the Director of the Center for Innovative Collaboration in Medicine and Law at marshall.kapp@med.fsu.edu or 850-645-9260. CMS
Let Your Inner-Writer Out We are looking for more contributors to Cap Scan! If you are interested in submitting an article, please contact Shannon Boyle at (850) 877-9018 or sboyle@capmed.org. We do not have assigned topics, you can submit an article on almost any topic (for example: your view of the healthcare environment, a book or movie review, an article about a recent vacation, the medical family, how you balance your medical and personal life, an unusual case you have encountered, a personal experience, etc.). Articles should remain between 800-1000 words…and don’t forget pertinent photos!
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MEDICAL/LEGAL
An Ounce Of Prevention Is Worth A Pound Of Litigation: The Annual Employment Law Audit Is Every Medical Practice’s Best Friend By Bill Krizner, The Krizner Group
Many Practice Administrators and Physician Owners shudder when they hear the word “audit,” as images of firebreathing wage and hour agents, rushed I-9 forms, and their Practice’s profitability flashes before their eyes. Indeed, some of the numbers related to state and federal governmental audits are downright traumatizing: $467 million dollars: the amount of money that US companies paid in settlements with the Department of Labor in 2012. 3 out of 4: the number employers that were in violation of ERISA when audited. $16,000: maximum I-9 monetary penalty per violation 93,727: the number of discrimination charges filed with the EEOC in 2013. Countless: the number of Morgan & Morgan “For The People” billboards and television commercials targeting employees that have been improperly paid. However, a compliance strategy quickly growing in popularity has been developed to assist medical practice in mitigating against, and even avoiding, the consequences of these devastating governmental audits and investigations. The elective employment law audit has become a crucial tool to evaluate legal compliance, institute preventative safeguards, and allow human resource and leadership teams the opportunity to resolve deficiencies without the expense or embarrassment created by an employment based lawsuit or governmental audit. Yet, many Practice Administrators avoid engaging counsel to conduct such proactive audits because they fear that the results may cast doubt upon the quality of work being provided by their department. However, well designed audit programs actually affirm the value of the human resource
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function by allowing practitioners to best convey the potential consequences of failing to abide by crucial everyday risk management practices such as failing to regularly execute interview assessment documents, interrupting non-exempt employees’ lunch breaks, and rushing into termination decisions without properly consulting with the human resource office. To best ensure such practices are thoroughly communicated, the highest quality audit relationships always include onsite interactive training that includes each member of the Organization’s leadership team. The audit itself should be conducted annually by an external legal firm to ensure that the attorney-client privilege will provide crucial protections from external disclosure when sensitive communications involving issues such as regulatory failings, misclassified exemptions, and inadequate documentation need to be conveyed. Moreover, a legal firm that regularly provides such service is superior to those that primarily engage in litigation since such practices often are far more current on regulatory additions and trends. Most human resource professionals that enjoy such relationships also regularly consult with the auditing firm throughout the year to ensure that the provided audit recommendations are best implemented. The areas of consideration in a comprehensive audit should vary from year to year but frequently include review of such topics as: à Proper Wage And Hour Classification Under The FLSA à Review And Edit Of Key Employment Forms, Handbooks & Policies
à Consideration Of Performance, Corrective Action, Evaluation, & Termination Processes à Leave Administration And Compliance Under The Family Medical Leave Act, The Americans With Disabilities Act, & Workers Compensation Laws
MEDICAL/LEGAL
à Pay Equity & Discrimination à Affirmative Action & Equal Opportunity Efforts à Compliance With Changing HIPAA And Cyber Security Laws à Immigration Compliance, Including E-Verify & I-9s à Trending Topics Such As Implementing Green Memorandums With Criminal Background Screens, Social Media Policies Under The NLRB, & Educating Leadership On Sexual Orientation And Gender Identity Given the complexities of today’s laws and the dramatic increase in the number of employment-based lawsuits being filed throughout Florida, every Practice’s Administrator
should ensure that an in-depth employment law audit occurs annually. Such an ongoing review will provide the practitioner with the tools needed to plan and efficiently implement the best practices to mitigate against potential employment liability while simultaneously encouraging leadership toward greater human capital outcomes. Recognizing that the negligible cost of an annual elective audit is dramatically less than that of protracted litigation or fines caused by an actual governmental audit, this tool is one of the wisest investments a human resource practitioner can make. CMS
The Krizner Group is the leading employment law audit practice in Florida and provides counseling, training and audit services for dozens of medical practices in the local Big Bend area. Mr. Krizner can be reached at bkrizner@thekriznergroup.com for assistance.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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MEDICAL/LEGAL
Managing Your Cyber Risk As a physician it is your job to ensure that your patients’ protected health information is safeguarded. Cyber attacks against hospitals and medical practices are on the rise, and it’s more important than ever for physicians to take the necessary precautions to protect their practice. Five Tips for Protecting Patient Data 1. Internet access should be provided through a quality router/firewall. 2. Ensure all computer operating systems are patched on a monthly basis. These patches fix bugs and close security gaps. 3. Use an anti-virus program. Though the program is not an absolute solution to keeping others from accessing your information, it is an important element of any comprehensive security system. 4. Any site, program, or computer that requires a password should be given a strong and unique password. 5. Consider using contracted IT support to ensure that all elements of security are in place and functioning properly. Five Security Components for Managing Your Risk 1. Physical Safeguards – To protect your facilities, computer equipment, and portable devices you should consider alarm systems, locked offices, and screen shields. 2. Administrative Safeguards – Hire a security officer, provide workforce training and oversight, control access to information, and perform periodic security reassessments. 3. Technical Safeguards – Implement controls on access to EHRs by requiring passwords and having different access levels. Utilize audit logs to monitor users and other EHR activities. Install measures that keep electronic patient data from being improperly changed and perform data back-ups regularly. Secure electronic exchange of patient information by performing virus checks and keeping data encrypted. 4. Policies and Procedures – Having written policies and procedures will help assure HIPAA security compliance, proper documentation, and good security measures. Written protocols on authorized users and record retention are also a good measure.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
5. Organizational Requirements – Ensure the practice has breach notification and associated policies as well as business associate agreements. Cloud Storage vs. HIPAA Compliant Hosting Cloud – When using cloud storage software for patient information, the data center is the only piece of equipment that is located off site. The information that is stored in the cloud can be accessed anywhere. When in transit to, and at rest in the cloud, data must be encrypted. The cloud storage service chosen must support the data in an encrypted state to be considered HIPAA compliant. Compliant Hosting – This is a server-based solution and is required when a medical practice chooses not to house the hardware or data locally. Webserver, application server, and database sever are all located in the data center of a HIPAA compliant hosting provider. This service includes firewall, web or application server, and database server. After choosing the right data storage method, utilize the aforementioned tips to help protect your medical practice from being exposed to a cyber attack. Though these tips and practices may help to minimize your risk, they do not entirely eliminate it. To protect your practice against the damages attributed to a cyber breach, consider talking to your medical malpractice carrier about cyber liability coverage. Contributed by MagMutual. For more information, visit www. MagMutual.com. Works Cited Cowperthwaite, Eric. (2014, July 23). 6 steps for reducing cyber risk. http://www.medicalpracticeinsider.com/bestpractices/6-steps-reducing-cyber-risk HealthIT.gov. 10 Best Practices for the Small Health Care Environment. http://www.healthit.gov/providersprofessionals/cybersecurity Pollard, David. 2013, July 30. HIPAA Cloud Storage vs. HIPAA Compliant Hosting- Key Differences. http://www. connectria.com/blog/the-difference-between-hipaacompliant-hosting-and-hipaa-cloud-storageindex-php/ Taitsman, M.D., J.D. Julie K. Grimm, M.P.A Chrisi Macrinca, and Agrawal, M.D. Shantanu. 2013, March 14. Protecting Patient Privacy and Data Security. http://www. nejm.org/doi/full/10.1056/NEJMp1215258 CMS
MEDICAL/LEGAL
Disability Insurance: Own Occupation - What Does It Mean? Probably the biggest undervalued piece of risk management for Americans, and one of the most misunderstood, is disability insurance. Since disability insurance isn’t that talked about in the media it’s hard to know where to go to get educated on it. In particular, physicians are targeted as clients who should purchase disability insurance. Most all of the doctors I speak with have heard of disability insurance. With that, most of them have heard one resounding call: Get Own Occupation! While that is sage advice, the next question is, “What does that mean?” In my experience, there is not clarity for the doctors on this answer. Below are two points of consideration for physicians to hopefully understand more about what Own Occupation really means to them. 1. Lack of Language Uniformity Creates Lack of Understanding There is a lack of uniformity in nomenclature that drives a lot of confusion for clients. Own Occupation, Regular Occupation, Any Occupation, True Own Occupation, and Specialized Own Occupation are the predominant terms insurance carriers use. What my physician clients ask me regarding their policy is, “What happens with my benefits if I can’t do my current job and go work in a different specialty or different vocation?” The main reason why Own Occupation is preferred, is the thought that the physician can perform other jobs should they not be able to work as a physician any longer. Unfortunately, however, that’s not always the case. In the contractual language for virtually every carrier, there are partial disability benefits and total disability benefits (which means you cannot perform all of the material and substantial duties of your current occupation). To truly understand what that jargon means, let’s look at how claims are typically processed. 2. How Do Claims Occur? This is the crux of disability insurance contracts, where the rubber hits the road. How are benefits determined? CPT codes are the short answer.
Most insurance companies have a range of income loss for partial disability (20%-80% or 25%-75% is common). Less than that you’re not considered disabled, and higher than that you’ll be considered fully disabled. At claims time, insurance companies typically use your CPT codes to determine which areas of your practice produces which percentage of income. For example: Dr. Smith, a neurosurgeon, makes $1,000,000/year. Per her CPT codes, she bills $650,000 for surgical procedures and the other $350,000 patient care. She has a True Own Occupation disability insurance contract. She gets in a car accident and crushes her hand, rendering her unable to perform surgical procedures. However, she can still conduct patient care. In this scenario, Dr. Smith would be on partial claim because her income loss is only 65% regardless of the own occupation definition. With some companies (and this is a key point) she could stop working if she wanted to, but she’d only collect 65% of her disability benefits. However, some companies have in their language that you must continue working if you can do any portion of your job or else they’ll deny the entire claim! Another option is that Dr. Smith could go into radiology, for example, if she chose, and make $500k a year. Because she was never on a total disability claim though, this option would offset any benefit she’d get since she’s only on partial claim. The idea of Own Occupation truly only exists for a Total Disability claim. Where a physician cannot perform any of the material and substantial duties of their current job. They could then, with some companies/contracts, take another job such as teaching or a different medical practice, and collect a full disability benefit with no offset from their new income. In summary, don’t settle for a disability insurance contract because it states Own Occupation. Work with an expert planner, one who deals with disability insurance regularly, to audit your specific needs for your situation. There are too many variances amongst companies and their contracts to not spend the time with an expert to guide you. Contributed by Tyler Huston CFP®, AEP®, CLU®, ChFC®, CASL®, Pyxis Advisors, 850-629-7220 or THuston@financialguide.com. CMS CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19
CMS FOUNDATION
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: The mission of the Capital Medical Society Foundation is 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.
For the CMS Foundation AmazonSmile
For the We Care Network SunTrust Foundation
Reasons to Give: Funds raised by generous donors benefit the We Care Network. The We Care Network is a past
Blue Foundation Sapphire Award winner and its impact on the community was featured in the Sept/Oct 2014 issue of the Tallahassee Magazine. The We Care Network provides over $5 million in donated specialty medical and dental care to the community’s low-income uninsured annually. In addition, donations support medical school scholarships for first and second year students at FSU College of Medicine committed to returning to NW Florida after completion of their residencies. In 2014, $40,000 in scholarships were awarded to nine FSU College of Medicine students.
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 will send an acknowledgement letter to those you memorialize and honor.
Left to right: Tom Pennekamp, Pam Wilson, and Brett Allen.
Tom Pennekamp, City President, SunTrust Banks and Brett Allen, Vice President, Client Advisor, SunTrust Private Wealth
How to Give:
Management, Medical Specialty Group presented a $5,000 check
Capital Medical Society Foundation has created three board-designated funds in order to establish financial stability to meet our mission. You can donate at any time to one of CMS Foundation’s funds.
on behalf of SunTrust Foundation to Pam Wilson, Executive
1) The CMSF Endowment 2) The We Care Network Endowment 3) The Scholarship Fund Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which fund you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308.
Director, Capital Medical Society Foundation in support of its We Care Network program in conjunction with National Doctors’ Day. National Doctors’ Day is March 30th, which marks the date ether was first used as an anesthesia in 1842. Doctors’ Day recognizes all physicians for their contributions to health and healthcare worldwide. “We are grateful for the opportunity to support the mission of the We Care Network in its efforts to provide specialty medical and dental care to the neediest in our community. We applaud the physicians and dentists in this community who volunteer their services to these patients every day,” said Tom Pennekamp.
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CMS
CMS FOUNDATION: WE CARE NETWORK
Thank you!
To our CMS members and We Care partners who saw new patients for the We Care Network in February 2015. Your generosity and support of the We Care Network makes a difference. Physicians Aaron Appiah, M.D. Scott Asher, M.D. Emily Ashmore, M.D. Marie Becker, M.D. Tim Broeseker, M.D. Viet Bui, M.D. Joseph Camps, M.D. Michael Cavallaro, M.D. Armand Cognetta, Jr., M.D. W. Harris Green, M.D. Celeste Hart, M.D. David Huang, M.D. Marc Inglese, M.D. Amit Jain, M.D. Matthew Lawson, M.D. Stephanie Lee, M.D. Carey Linker, M.D. Maribel Lockwood, M.D. Kurt Luhmann, M.D. Michael Mangan, M.D. Richard Palmer, M.D. Praful Patel, M.D. James Renehan, M.D. Jason Ross, M.D.
Eliot Sieloff, M.D. Gadi Silberman, M.D. Jeannine Silberman, M.D. Hardeep Singh, M.D. Joseph Soto, M.D. Jean Paul Tran, M.D. Ernesto Umaña, M.D. David Vermess, M.D. William Yaakob, M.D. Richard Zorn, M.D. Dentists Eric Amundson, D.D.S. Susan Byrne, D.M.D. Walter Colón, D.M.D. 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. 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 February 2015 and your name is omitted.
We thank our referring providers from February 2015: J. Galt Allee, M.D.
Farhat Khairallah, M.D.
Eboni Allen, ARNP
Marjorie Kirsch, M.D.
Anne Ananga, ARNP
Elaine Larkins, ARNP
Dhananjay Bendre, M.D.
Matthew Lawson, M.D.
Shelby Blank, M.D.
Esaias Lee, M.D.
Robert Bradford, M.D.
Matthew Lee, M.D.
Sherry Bramblett, ARNP
T. Adam Oliver, M.D.
Daniel Breivogel, ARNP
Whit Oliver, M.D.
Tim Broeseker, M.D.
Rose Origa, ARNP
Acquinonette Bryant, M.D.
Thomas Park, M.D.
Kendall Campbell, M.D.
Kaushal Patel, M.D.
Marilyn Cox, M.D.
Praful Patel, M.D.
Lysmar Dinguis, M.D.
Stephen Quintero, M.D.
Ray Dolly, M.D.
Temple Robinson, M.D.
Susan Dunbar, ARNP
Jose Rodriguez, M.D.
Evan Dussia, II, M.D.
Mark Saunders, M.D.
Shirley English, ARNP
Tamara Sealy, M.D.
Cynthia Evans, ARNP
William Shaner, D.D.S.
Anneka Gaffney, ARNP
Tallahassee VA Clinic
Lynn Garner, M.D.
Scott Tetreault, M.D.
Sergio Ginaldi, M.D.
Marianne Towler, ARNP
Judy Griffin, ARNP
Aaron Ward, M.D.
Celeste Hart, M.D.
Jeffrey Wasserman, D.O.
Hantz Hercule, M.D.
Jillian Weissman, M.D.
Susan Horton, ARNP
Scottie Whiddon, M.D.
Iman Imanirad, M.D.
Mavis Wilson, ARNP
Eve James-Wilson, D.M.D.
Don Zorn, M.D.
Howard Kessler, M.D.
Richard Zorn, M.D.
During the month of FEBRUARY, the We Care Network: Received 107 referrals, with 52 patients new to the program
Scheduled 64 $132,670 in donated care appointments with was reported by We Care volunteer physicians and volunteers CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 21 dentists
MEDICAL/LEGAL
Remote Patient Monitoring: Real-Time Patient Data, Real Liability Risks By Susan Shepard, MSN, RN, Director, Patient Safety Education, The Doctors Company
Three million patients worldwide are currently connected to a remote monitoring device that sends personal medical data to their healthcare provider.1 Each year alone, 600,000 cardiac patients are implanted with pacemakers, one of the most common monitoring devices.2 Remote medical devices allow healthcare providers to closely monitor patients outside of the office. This helps doctors catch potential problems earlier, when they’re easier to treat, and can reduce the number of hospitalizations, improving patient health and containing healthcare costs. Remote monitoring devices perform routine tests—such as checking glucose levels for patients with diabetes or checking blood pressure for patients receiving cardiac care—and send the data to the patient’s doctor in real time over the Internet or through phone lines. The doctor can then assess the information and adjust the patient’s treatment plan as needed. Despite the many advantages, remote patient monitoring has liability risks. Because remote monitoring devices transmit patient data, there is a risk of a data breach if the information is not properly encrypted. The Health Insurance Portability and Accountability Act (HIPAA) requires that all personal health information (PHI) be encrypted when transmitted, and providers who fail to properly safeguard PHI can face significant penalties. Medical devices may be vulnerable to viruses and malware that can compromise patient privacy and the effectiveness of the device. Last year, the U.S. Food and Drug Administration (FDA) outlined serious cybersecurity risks for medical devices. The FDA noted that providers who use
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medical devices cannot rely solely on device manufacturers to ensure security—providers must also take steps to safeguard patient information within their network. These steps include ensuring antivirus software and firewalls are up to date, monitoring the network for unauthorized use, and reporting any medical device cybersecurity problems to the device manufacturer. If a remote device fails or malfunctions, physicians may be named in the lawsuit against the manufacturer, under the claim that the physician failed to use the device properly. To help reduce this risk, physicians should stay up to date on the latest information for the device, including manufacturer’s warnings, the device’s safety record, and the device’s approved uses. Providers should also be aware of any FDA alerts or recalls and should thoroughly read all contracts with medical device vendors. Ensure that the contract outlines who is responsible in the case of device malfunction or failure.
MEDICAL/LEGAL
Providers should also be aware of the need for additional staff members to handle the incoming data. In the case of a potential problem, these staff members should respond either directly to the patient or alert the appropriate professional for intervention. The amount of patient data from a remote monitoring device can be overwhelming, and medical practices often need a dedicated team to process the information and respond to it in a timely manner. Each practice should have written guidelines for: • At what times the device will be monitored. • Which members of the care team will monitor the data at each point in time. • Under what circumstances the appropriate clinician will be alerted to a potential problem. Providers should also be aware of the risk of “alert fatigue,” when an overwhelming number of alerts are received and it causes staff members to ignore, override, or disable them. Anytime an alert or a potential patient problem is ignored, the reason for that decision should be documented. Patient selection is also an important issue, as successful remote patient monitoring is dependent on each patient’s motivation to actively manage his or her health, as well as the patient’s ability to understand and use the technology. Patients who are not tech-savvy may not be good candidates for remote monitoring. To help ensure patients effectively use remote devices:
- What device failure or malfunction looks like, and what the patient should do if that happens. - How to properly maintain the device. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. Susan Shepard, MSN, RN, is the director of patient safety education at The Doctors Company. She earned a master’s degree in nursing administration from Medical Colleges of Virginia– Virginia Commonwealth University, a master of arts degree in management from Webster University, and a bachelor of science degree in nursing from St. Louis University. CMS
References 1Report:
19 million will use remote patient monitoring by 2018. MEDCITY News. http://medcitynews. com/2014/06/biggest-market-remote-patient-monitoring/. Accessed December 1, 2014. 2Remote
monitoring proven to help prolong life in patients with pacemakers. Heart Rhythm Society. http://www. hrsonline.org/News/Press-Releases/2014/05/RemoteMonitoring-Pacemakers#_edn1. Accessed December 1, 2014.
• Complete and document a thorough informed consent process. • Educate the patient on: - How to use the device. Explain the treatment plan, such as at what times the device will be monitored and how alerts will be handled by the healthcare team. Photo credit: Smith & Jones Healthcare Marketing
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 23
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