APRIL EDITION, VOLUME 2020, NO. 4
WE’RE IN THIS TOGETHER! By Pam Irwin, CMS Executive Director As COVID-19 first made news in January 2019, in China, for causing pneumonia, it was not on most of our radars. Now, it has disrupted life as we know it. In response, the Capital Medical Society (CMS) has never been more relevant to its members and partners. The CMS partnered with the Leon County Health Department (LCHD) to help distribute updates to healthcare providers and their staff. There is now a network of information-sharing in place. Our distribution list has swelled from 650 to close to over 1,000. Our goal is for the information we provide to be accurate and timely. You've received a mailbox full of emails on testing, CDC guidelines, conference call-in information, Essential Critical Workforce guidance for healthcare workers, and other timely information. We apologize in advance for bombarding you. Many of you have written words of encouragement and gratitude. That has kept us going. We are doing our best to distribute accurate information, help troubleshoot your questions, and assist in any way we can. If you or your key office staff is not on our COVID-19 email distribution list and wants to be, please email Rosalie Carlin at rcarlin@capmed.org. At the request of local medical practices, we emailed a Medical Practice Response & Planning for COVID-19 Questionnaire to practice administrators and office managers. This tool allowed medical practices to share their responses to the pandemic and templates of drafted policies and procedures regarding telework, telehealth, self-reporting by employees, return to work policies following voluntary quarantine, and return to work protocol following an employee's confirmed COVID-19 test. The information will be shared with all who participate. This may seem like one more thing to do when there aren't enough hours in the day, but you will genuinely help your colleagues. You may pick up some helpful information too. For smaller practices, this pandemic can be especially daunting. There is often one person responsible for HR, policies, office management, and a variety of other essential duties. Trying to adjust lives to school closures, new COVID-19 employment laws, staff availability, cease performance orders for elective procedures, quarantines, the shortages of test kits, N95 masks, gowns, and facial shields, conflicting information on tests needed by the CDC and labs, and curfews are just a few of the issues you are trying to sort out. Most of this has happened in about two weeks. I was at Sir James Galway’s concert on March 5. We were just beginning to think about how close we wanted to sit to someone. As we socially-distance from each other and our
refrigerators (yes, we know there is some serious comfort food-eating going on), don’t forget to breath. We will get through this. We have heard from many of you. Please know you can call me at any time if you have a question and need someone to run down an answer. I’ll do my best to help. My cell is 850-559-8611. My email address is pirwin@capmed.org. The return to work guidance for healthcare workers keeps changing. The medical and dental communities are more likely to be exposed to COVID-19 than the general public. Hopefully your practice has already established its own self-reporting and return to work policy. If not and if they are experiencing symptoms that could be COVID-19 or may have been exposed and facing a quarantine, consider encouraging your employees to tell their personal physicians that they are healthcare providers. There is a specific protocol for health care providers. Since Florida physicians have the discretion to order a test, their knowing that their patient needs to confirm if they are safe to return to work in a healthcare environment is essential. It could impact their time out of work. It is also vital that your practice has policies in place that are understood and signed by the staff. The staff must know your self-reporting requirements and return to work protocol. It would be best if you were always consistent. There are also specific OSHA requirements during a pandemic if an organization of ten or more employees has an employee who has a positive COVID-19 test resulting from a particular work exposure. Be familiar with those requirements in advance. (The information below was provided by the LCHD on March 17, 2020 from DOH-Epi) How to Discontinue Home Isolation: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/stepswhen-sick.html (Reference bottom of webpage) • People with COVID-19 who have stayed home (home isolated) can stop home isolation under the following conditions: • If you do not have a test to determine if you are still contagious, you can leave home after these three things have happened: • You have had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers) AND CONTINUED ON PAGE 3
CAPITAL MEDICAL SOCIETY 2020 MEETINGS CALENDAR ~Please note: The April 21, 2020 CMS Membership & CME Meeting has been postponed~ April 21, 2020 CMS Membership & CME Meeting Updates and Debates in Cancer Screening – Panel Discussion
~Please note: The May 5, 2020 Connect the Docs Happy Hour has been postponed~ May 5, 2020 Connect the Docs Happy Hour sponsored by Capital City Bank
CONTINUED ON PAGE 7
BOARD OF GOVERNORS Ken Whithaus, M.D., President
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
Rohan Joseph, M.D., President-Elect Paresh Patel, M.D., Secretary/Treasurer
COVID-19 Updates....................................................................1 CMS Announcements .............................................................4 Professional Notes...................................................................6 CMS News.................................................................................. 7 Legislative Update...................................................................9 Practice Management........................................................... 10 Medical/Legal.......................................................................... 11 Metastatic Breast Cancer Awareness Month................... 12 Reflections from the Editor................................................. 14 CMS Membership Meeting Minutes................................... 15 Viewpoint................................................................................. 18 Simpler Times......................................................................... 19 CMS Foundation Announcements.................................... 20 Donate to the CMS Foundation.......................................... 21 CMS Foundation: We Care Network.................................22
Maribel U. Lockwood, M.D., Immediate Past President Nicole Balmer, M.D. David Burns, M.D. Sybil Holt, CMS Alliance
HAPPY BIRTHDAY!
Marc Inglese, M.D. Sarah Ko, M.D.
{APRIL BIRTHDAYS}
Amulya Konda, M.D. Matt Lee, M.D. Helen Paulson, M.D. Cody VanLandingham, M.D. Julia Weeks, M.D. Pam Irwin, Executive Director, Capital Medical Society Family Medicine Residents Tristan Brooks, D.O./Mary Claire Smallwood, M.D. General Surgery Residents Hamzah Mansoura, M.D./SchMiyah Smith, M.D.
PUBLICATION EDITOR Frank Skilling, M.D.
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Gandy Printers
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. 2
Amy Reimer Neal, M.D. – 3rd
Edward Forster, M.D. – 15th
Amanda Shearer, M.D. – 3rd
Stephen Mnookin, M.D. – 15th
Duncan Postma, M.D. – 4th
Christopher Myrtil, M.D. – 15th
Michael Ford, M.D. – 5th
Stephanie Lee, M.D. – 18th
Maria Andrews, M.D. – 7th
Wendy Somerset, M.D. – 18th
Randy Reese, M.D. – 7th
Luba Muaddi, M.D. – 19th
Barbara Jaeger, M.D. – 8th
Lisa Cook, M.D. – 20th
Jesse Judelle, M.D. – 9th
Gaurav Nigam, M.D. – 20th
Vikki McKinnie, M.D. – 10th
William Placilla, M.D. – 20th
Israel A. Oloye, M.D. – 10th
R. James Mabry, M.D. – 21st
Gillian Richmond, M.D. – 10th
Jana Bures-Forsthoefel, M.D. – 24th
Allison K. Moore, D.O. – 11th
Kenneth DeLay, M.D. – 24th
Adanna Amanze, 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
Briana Thompson, M.D. – 13th
Julian Hurt, M.D. – 30th
Louis St. Petery, M.D. – 14th
Jennifer Sanderson-Smith, M.D. – 30th
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!
COVID-19 UPDATES
CONTINUED FROM COVER
•
other symptoms have improved (for example, when your cough or shortness of breath have improved) AND • at least seven days have passed since your symptoms first appeared I f you are tested to determine if you are still contagious, you can leave home after these three things have happened: • You no longer have a fever (without the use of medicine that reduces fevers) AND • other symptoms have improved (for example, when your cough or shortness of breath have improved) AND • you received two negative tests in a row, 24 hours apart. Your doctor will follow the CDC guidelines. •
Use one of the below strategies to determine when a healthcare provider may return to work in a healthcare setting (https://www. cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work. html) • Test-based strategy. Exclude from work until • Resolution of fever without the use of fever-reducing medications and • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens). See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV) - https://www. cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinicalspecimens.html. •
Non-test-based strategy. Exclude from work until • At least three days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, • At least seven days have passed since symptoms first appeared
If an HCP was never tested for COVID-19 but had an alternate diagnosis (e.g., tested positive for influenza), the criteria for return to work should be based on that diagnosis. Return to Work Practices and Work Restrictions for HCPS: • Wear a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer • Be restricted from contact with severely immunocompromised patients (e.g., transplant, hematologyoncology) until 14 days after illness onset • Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles) • Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen The Capital Medical Society Foundation’s Physician Wellness Program recognizes physicians need our support more than ever. For the time-being, we are making a tele-health option available for our Active and Associate members to avail themselves of wellness coaching or to just talk to a psychologist to learn some coping strategies for the enormous stress they are under. If you are not currently an Active or Associate member but would benefit from wellness coaching during this
season, please contact one of the providers of the Physician Wellness Program. Ask them to let the CMS Executive Director know that a nonmember licensed practicing physician has requested coaching. Your first month of coaching will be approved. We’ll make a membership requirement exception until at least the end of May. We encourage you to consider joining the Capital Medical Society when the dust settles. To find out more about the CMSF Physician Wellness Program, visit: https://capmed.org/wp-content/uploads/2020/03/CMSF-PWPBrochure.pdf. The Capital Medical Society and the Capital Medical Society Foundation have adapted to the changing landscape by adding teleworking capability for all staff with a rotating schedule of staff from both organizations in the official office, unless the Governor issues an Executive Order prohibiting going to work. The We Care Network program is still open and patients are still being referred from our referring partners. Although not our first choice, the flexibility allows us to fulfill our responsibilities and, for those who suddenly found their children out of school, the ability to continue working. I am proud of our staff. They have remained positive, resilient, flexible, and patient with me. A little sleep-deprived, they probably have wanted to put me in quarantine. Capital Medical Society has postponed, rescheduled, or cancelled the following events: March 26, 2020 – Celebration Awards Dinner is rescheduled to June 16, 2020, with a back-up date of October 1, 2020. The health and wellbeing of our guests is our top priority. We appreciate the flexibility of our awardees, sponsors, and guests. All sponsorship agreements already confirmed will be honored for the new date. If you have RSVP'd as a guest and already know you cannot attend on June 16, please contact Rosalie Carlin at rcarlin@capmed.org to cancel your reservation. If you have paid for a reservation you are cancelling, you will be refunded. If you do not cancel your reservation, you will not be refunded. Please save those two dates on your calendar. We will plan a lovely event to celebrate Dr. Sergio Ginaldi and Dr. David Saint when we will not endanger the health of our guests. March 25, 2020 – Lunch and Learn Seminar – Employment Law Update by Bill Krizner – RESCHEDULED to September 16, 2020 April 14, 2020 – CMS Board of Governors Meeting – scheduled as a GoToMeeting April 15, 2020 – Lunch and Learn Seminar – Health Policy in 2020 by Kelly James – CANCELLED May 20, 2020 – Lunch and Learn Seminar – Understanding and Managing Stress by Pam Mezzina – POSTPONED; Date TBD May/June 2020 – CMS Family Night Event – CANCELLED DO NO HARM We usually consider the medical profession and the Hippocratic oath when we hear this phrase. If you are seeing patients, you are already on the frontlines taking more risk through this pandemic. But at this critical time, when social distancing is becoming the mandate for society, we should ALL take ownership of this phrase and do our part to minimize the spread of the Coronavirus in our community. Flatten the curve by keeping your distance and staying at home when possible. The models if we don’t are frightening. The number of hospital beds is finite. Don't hoard items, buy what you need for the week, share your extra toilet paper, and give our supply chains a chance to perform their function. Strive to do no harm. Please take care of yourselves first, so that you can take care of your family and your patients. We are here for you! CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
CMS ANNOUNCEMENTS
CMS MEMBERS: ARE YOU RETIRING? If you are planning to retire, please be sure to contact Rosalie Carlin at the Capital Medical Society office - (850) 877-9018 or rcarlin@capmed.org. As a Retired CMS Member, your membership dues change to: Retired - $150.00 with meals (includes dinner at CME meetings) or Retired - $50.00 without meals (you are billed for dinner if you attend a CME meeting). It is your choice. Do you plan to change the status of your Florida Medical License to Retired? Visit this link: https://flboardofmedicine.gov/help-center/howdo-i-change-the-status-of-my-license-to-retired/, or search online for: Florida Board of Medicine How do I change the status of my license to retired? You must formally request Retired status with the Board of Medicine (BOM) for your medical licensure and pay a fee rather than just not renewing. The penalty for being late in requesting a Retired status change with the BOM can be $515.00. Remember, be sure to let CMS know of your change in status.
IT’S TWINS! Abby Edwards, Case Manager for the We Care Network, and her husband, David welcomed their twin daughters, Adaline Elise Edwards and Elianah Elise Edwards on January 22, 2020. Adaline weighed 5 pounds, 4 ounces and Elianah weighed 5 pounds, 11 ounces.
IN MEMORIAM
Adaline Elise Edwards
SAM MOORER, M.D. Elianah Elise Edwards
Congratulations, Abby and David! We are so happy for you! 4
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
1941 - 2020
6957 BUCK LAKE ROAD
2163 GOLDEN EAGLE DRIVE W | 1.59 ACRES
320 OAKS WILL COURT | WATERFRONT
Main: 5 BD, 6 BA, 5 HBA | Guest: 3BD, 2 BA, 1 HBA
5 BR | 4 FULL BA | 2 HALF BA | 7,790 sf
4 BR | 4 FULL BA | 2 HALF BA | 9,998 sf
$4,950,000 | 12,836 TOTAL sf
$2,695,000 | 2.61 ACRES
$1,450,000 | POOL | 5+ ACRES
1147 LIVE OAK PLANTATION ROAD
3705 BOBBIN BROOK CIRCLE
1417 RACHEL LANE
5 BR | 3 FULL BA | 2 HALF BA | 4,200 sf
5 BR | 4 BA | 5,660 sf | 1.72 ACRES
4 BR | 3.5 BA | 3,393 sf
$925,000 | POOL | 1 ACRE
$825,000 | POOL
$709,000 | POOL
1881 WITCHTREE ACRES
3604 N MERIDIAN ROAD
3 BR | 3 BA | 3,959 sf
5 BR |4 BA | 3,778 sf
4 BR | 3 BA | 3,268 sf
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$595,000 | POOL | 2+ ACRES
$445,000 | POOL
502 VINNEDGE RIDE
7869 PRESERVATION ROAD
4650 HERITAGE PARK BOULEVARD
4 BR | 2.5 BA | 3,210 sf
4 BR | 3 BA |2,364 sf
3 BR | 2 BA | 1,690 sf
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$399,000
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405 HOLLY HILL COURT
Hettie Spooner (850)509-4337 Lindsay Elliott (850)545-2463 Calynne Hill (850)545-6140 1390 Timberlane Road Tallahassee, Florida 32312
HILLSPOONER.COM CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
5
PROFESSIONAL NOTES
PROFESSIONAL NOTES H. Avon Doll, Jr., M.D. has been elected to serve as President of the Florida Society of Nephrology (FSN) for 2020-2022 and serves as the Chair of the FSN Political Action Committee (PAC).
On February 12, 2020, John P. Fogarty, M.D., Dean of the FSU College of Medicine, served as ‘Doctor of the Day’ for the Senate. Associate Professor, Christie Alexander, M.D. served as the ‘Doctor of the Day’ for the FL House of Representatives. Joining them for FSU Day at the Capital, and pictured in the center, was alumna and family medicine resident, Meghan Lewis.
On February 20, 2020, the Tallahassee Democrat and presenting sponsor, Moore, congratulated Andrea Friall, M.D., Chief Medical Officer at Tallahassee Memorial HealthCare, for being recognized as one of the 2020 class of 25 Women You Need to Know. We DO know her and love her! Congratulations from your fans at the Capital Medical Society!
Retired plastic surgeon, Louis Hill, M.D. was interviewed by Tallahassee Magazine for their March-April issue about his lifelong passion for archaeology. Dr. Hill’s ten-year excavation of Apalachicola plots has unearthed relics from the 19th century and earlier. His goal is the analysis of the materials he finds and to make them available to the public and professionals. He and his wife, realtor Calynne Hill hope to establish a historic and archaeological museum for the Apalachicola area to display his collections.
Temple Robinson, M.D., CEO of the Bond Community Health Center, has been named to the 2020 Accreditation Association for Ambulatory Health Care (AAAHC) Governance Unit--Primary Care Expert Content Committee. AAAHC, the leader in ambulatory health care accreditation, advocates for the provision of high-quality health care through the development and adoption of nationally recognized standards. It restructured its governance body in 2020 to include Governance Units (selected volunteer applicants) from various disciplines in medicine to facilitate the improvement and growth of the association and advocate for patient safety. Dr. Robinson’s committee will specifically be charged with reviewing and recommending peer-reviewed, evidence-based standards for patient care in the primary care field that ensure quality and are facility specific. The AAAHC Certificate of Accreditation demonstrates an organization’s commitment to providing safe, high-quality services to its patient. Bond CHC was re-accredited in 2019, deemed a Patient Centered Medical Home as well as achieving Patient Centered Dental home recognition. All Governance Unit terms are for one year, however, members may serve up to eight years on any given Governance Unit. For additional details, visit www.aaahc.org.
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. 6
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS NEWS
CAPITAL MEDICAL SOCIETY LUNCH AND LEARN SEMINARS - SPRING 2020 On February 19th, Lindsay Nickle (pictured right), Vice Chair of the Data Privacy and Cybersecurity Team at Lewis Brisbois, gave an excellent program on cybersecurity threats, database breaches, and HIPAA compliance. We thank Keane Insurance Group for sponsoring the February 19th Lunch and Learn. Julie Shumer (pictured left) attended as a representative from Keane Insurance Group. Seminars are held at the Capital Health Plan on Governors Square Blvd. – and we thank them for providing this venue to us.
~Please note: The April 15, 2020 Lunch and Learn has been cancelled~ April 15, 2020 Health Policy as of 2020 ~Please note: The May 20, 2020 Lunch and Learn has been postponed~ May 20, 2020 Understanding and Managing Stress 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, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
CAPITAL MEDICAL SOCIETY 2020 MEETINGS CALENDAR CONT. FROM COVER
~Please note: The CMS Family Night has been cancelled~ May/June 2020 CMS Family Night September 15, 2020 CMS Membership & CME Meeting Brain Health: Primary Prevention of Cognitive Decline and Dementia, including Alzheimer’s Disease 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 20, 2020 CMS Membership & CME Meeting Domestic Violence (2 Hours) 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks November 10, 2020 CMS Membership & CME Meeting Human Trafficking (1 Hour) 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
December 3, 2020 CMS Foundation Holiday Auction 6:00 pm FSU University Center Club
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
LEGISLATIVE UPDATE
FAIT ACCOMPLI - THE 2020 FLORIDA LEGISLATIVE REPORT By Rohan Joseph, M.D., CMS President-Elect “I need to find that bottle of Tums now! Wait, maybe a Nexium would be better? Ah, I need a B-blocker too for that pounding in my chest! Perhaps now that I am selfmedicating, I might as well throw in that Valium for the anxiety I am experiencing. How could this have happened? We were told that we had friendships and relationships that had stood the tests of time!” On March 11, the state of Florida joined 22 other states in passing legislation granting APRN’s autonomy to practice primary care without physician supervision. With this legislation, they deemed a medical (MD/DO) and APRN degree equivalent and also created a new medical degree, i.e. APRNIP (independent practice). Further, they also allowed pharmacists to independently test and treat for strep and the flu and manage patient’s minor ailments and chronic conditions under a collaborative agreement with the treating physician. Sound crazy? Seems to be, but not to all physicians, unfortunately. “This will not affect me, I am a specialist,” some say…you better think again. The days of the nurse dermatologist, nurse cardiologist, nurse nephrologist, nurse (insert specialty), and nurse surgeon may not be far away. The precedent has been set, the door has been cracked open, the firewall is down! In spite of passionate testimony against expansion of scope of practice by several members from the Capital Medical Society, other county/specialty societies, and the FMA, this was no longer an issue about putting patient safety first. This was politics, pure and simple. The house speaker had announced that APRN, PA, CRNA, and midwife autonomy would be his signature legislation this year. In an unprecedented manner, his reach extended into the senate to force the hand of the senate president (keynote speaker at the 2019 FMA and awarded for being a friend of medicine) to pass this legislation lest nothing else
be accomplished this session. The governor, who also had his agenda for this session, followed suit by signing the bill into law only a couple of hours after the senate passed the bill. There was no possibility for the house of medicine, who saw the governor as their last hope (given their lobbying efforts and early support during his run in the gubernatorial election of 2018), to protest or implore for a veto. Doctors got shafted again! Virtually none of the other major bills pertaining to patient care were even heard in house or senate committees. The business of medicine runs on the professionalism of doctors. How else could this behemoth of American healthcare (33% of the nation’s economy) function daily? Strategic advocacy requires grassroots advocacy, tact, and lobbying. While we primarily rely on the FMA and our specialty societies for advice and lobbying efforts, we as individual physicians have neglected the importance of cultivating relationships with our legislators and grassroots advocacy. Let it be very clear, the bill that passed that day was a result of a decade of APRN grassroots advocacy and lobbying efforts. I finally woke up from this dream, angry and yet comforted. Angry because the legislation had passed. Comforted with the realization this was graduate level politics, no lobbyist had seen this coming - political theater at its finest! The speaker, the senate president, and the governor-hand in hand, in lockstep had decided the outcome from the outset - Fait Accompli! I would like to thank: 1) Members of the CMS legislative committee for their engagement during the session. 2) CMS Executive Director, Pam Irwin for her involvement in collaborating with other county and specialty societies. 3) CMS members who gave testimony at the House and Senate committee meetings. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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PRACTICE MANAGEMENT
PRESCRIPTION AND MEDICAL SHARPS WASTE DISPOSAL Prescription medicines and medical sharps can provide life-saving treatment, but what do you do when you no longer need the medicine or have empty sharps after treatment? These items should not be thrown away as regular trash because they can contaminate the environment, injure citizens or workers, or even end up in the hands of the wrong people. HOW CITIZENS CAN PROPERLY DISPOSE OF MEDICAL SHARPS The Florida Department of Health in Leon County established a medical sharps disposal program in 2002. In order to participate, citizens must show proof of Leon County residency. Once approved, citizens will be given a free sharps container that must be returned once full. A new container will be given at no charge. You may pick up a free medical sharps container at the Florida Department of Health in Leon County’s Main Office: 1515 Old Bainbridge Road. For questions, please call 850-404-6400. HOW CITIZENS CAN PROPERLY DISPOSE OF PRESCRIPTIONS With the rise in prescription medicine use and the knowledge of the dangers it can cause when not used properly, it is vital to properly dispose of unused or unwanted prescriptions in a way that is safe for the environment, other citizens and their pets, and for our waste workers. Properly dispose of unwanted medicine at one of five permanent Drug Enforcement Administration (DEA) authorized collection locations in Tallahassee and Leon County: • Tallahassee Police Department (234 E 7th Ave) • Walgreens (1202 N. Magnolia Drive) • Walgreens (3531 Thomasville Road) • Walgreens (2009 W. Tennessee Street) • CVS (5466 Thomasville Road N.) 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
These locations are authorized to collect unused prescriptions at any time. If the pharmacy closest to you is not listed above, you can ask your pharmacist about DisposeRX packets that will properly render unwanted medications unusable, allowing for safe at-home disposal. To help further ensure education on and disposal of prescription medicines, local organizations host two annual drug take back events—Operation Medicine Cabinet in April and National Prescription Drug Take Back Day in October. ** If none of these options are open to you, the EPA recommends placing the medication in a sealed container, mixing it with an undesirable substance like coffee grounds or cat litter, and placing the container in the trash. ** Reprinted from http://cms.leoncountyfl.gov/Home/ Departments/Office-of-Resource-Stewardship/SolidWaste/Hazardous-Waste-Center/Medical-Waste
MEDICAL/LEGAL
5 THINGS DOCTORS NEED TO KNOW ABOUT 2020 MEDICARE FEE SCHEDULE By Andis Robeznieks, Senior News Writer, American Medical Association The 2020 Medicare physician payment schedule contains news about coding revisions for outpatient evaluation and management (E/M) services that promise to greatly reduce administrative burdens for physicians in 2021. But the 2,475page document also contains information on a multitude of tweaks to the Medicare Quality Payment Program (QPP) and a plethora of other details affecting how physicians will be paid by Medicare starting Jan. 1. The AMA’s experts have prepared a summary of the 2020 changes to QPP and Medicare physician payment. Here are five things physicians need to know. 1.
Raising the performance threshold is expected to lead to corresponding growth in the cost of MIPS compliance, but statistics also show that more clinicians are scoring at the high end of the scale than at the low end. For calendar year 2018, which will determine payment levels for 2020, CMS said the average score was 86.9 and 99.6 was the median. This far exceeded CMS projections of 80.3 and 90.9. MIPS high-performer threshold goes up.
Clinicians deemed “high performers” are eligible to split an additional $500 million in available bonus money. CMS proposed setting the 2020 high-performer threshold at 80 points but raised it in the final rule to 85. “We believe it is important to incentivize exceptional performance in MIPS,” the final rule states. “This adjustment would raise the bar on exceptional performance and provide an appropriate financial incentive for high performers.” CMS estimates 92.5% of the 880,000 MIPS-eligible clinicians will avoid a penalty or earn an incentive payment, with 45% eligible for the exceptional performance bonus. 3.
“We are committed to improving the feedback experience, including aiming to provide more granular and real-time data, for clinicians to better understand how they can improve their performance on these measures and in turn reduce the cost of care for Medicare beneficiaries,” the rule states. “Once clinicians better understand and are more accustomed to reviewing the performance feedback reports on these episode-based and global cost measures, we would then expect to increase the cost performance category weight.”
A heavier lift will be required to avoid a MIPS penalty.
The Centers for Medicare & Medicaid Services (CMS) raised the minimum score needed to avoid a penalty for physicians participating in the QPP’s Merit-based Incentive Payment System (MIPS) to 45 points from 30. The maximum penalty, which would affect 2022 payment, will be raised to 9% from 7%. In addition, CMS set the minimum score for 2021 at 60.
2.
In the final rule, CMS said it agreed with the AMA concern about the lack of detailed, timely and actionable feedback on cost measures.
No change to MIPS cost and quality weights.
CMS had proposed lowering the weight of quality measures in MIPS scoring from 45% to 40% while raising the weight of cost measures from 15% to 20%. The final rule states that those weights will remain the same.
The AMA also remains concerned about Medicare Spending Per Beneficiary and Total Per Capita Cost measures as they hold physicians responsible for costs that they have little control over. CMS said this approach “helps to align incentives across care settings through the patient care continuum, which encourages care coordination.” Bonus points are still available for small practices and for those serving “complex patients,” defined as those with high medical risk or with dual Medicare Medicaid eligibility. 4.
Framework to cut MIPS burdens.
CMS is moving ahead with MIPS Value Pathways, which— starting in 2021—will create a framework to reduce the complexity and administrative burdens associated with MIPS. CMS is looking to eliminate the reality that the four MIPS reporting categories seem like four different programs and replace it with a pathway that: • Is more aligned with a physician’s specialty. • Includes fewer reporting measures. • Facilitates movement toward advanced alternative payment models (APMs). The AMA is committed to working with CMS and specialty societies to shape the pathways with the goal of making MIPS less complex and burdensome and more clinically relevant. 5.
APM 2022 payments estimated, 2019 payments paid.
CMS estimates that between 210,000 and 270,000 clinicians will be eligible Qualifying APM Participants in 2020 and exempt from MIPS reporting requirements. It also estimates that APM incentive payments will total between $535 million and $685 million. Five percent APM incentive payments earned in 2017 have only recently been paid. The AMA joined eight other organizations in a September letter to CMS protesting the delay in payment.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11
METASTATIC BREAST CANCER AWARENESS MONTH
KICKIN’ CANCER’S BUTT – APRIL IS METASTATIC BREAST CANCER AWARENESS MONTH By Philip V. Sharp, M.D. I met Peggy almost 20 years ago. It was 2002, and we both had a head full of healthy brown hair. She had been treated for early-stage breast cancer in 1999, and by all accounts the likelihood of success should have been high. But in 2002 she developed brain metastases and underwent radiation. At that point, she lost her head of healthy brown hair and my hair began turning gray (or platinum, as I like to say). She went from a potentially curable stage to an incurable one, stage IV metastatic breast cancer.
Peggy loved her family. Her son was the apple of her eye and we both got to see him grow up. She showed me pictures of when he went to Camp Lejeune to become a fine Marine. And when she danced with him at his wedding she was beaming with joy and pride as they both hugged each other with him in his uniform. After that she usually came for checkups wearing her “US Marines” hat and a “Semper Fi” shirt. She was present at the birth of her grandson and enjoyed playing with him for many years. For the most part, Peggy did not suffer horribly from her breast cancer including the blessing of a peaceful death with family by her side.
I like to think that all patients with metastatic breast cancer are able When Peggy learned that she had an to live as long and as full of a life incurable cancer, it was a devastating as the one Peggy had. Heck, I look time for her. But that didn’t keep her forward to the day when they live down long. I once read a blog whose even longer! Unfortunately, that author had metastatic breast cancer is not currently the case as the where she described being asked by 5-year survival rate for women with a friend, “If you had five minutes metastatic breast cancer is only 27%. to live, would you spend a second Approximately 276,000 women will being sad?” I think Peggy must have be diagnosed with breast cancer in read that same blog because she BUTT!!! the US in 2020 and approximately didn’t allow the diagnosis to keep 43,000 women will die from breast her down much. In fact, most times cancer. About 6% of women have when we met after her diagnosis of metastatic breast cancer when they metastatic incurable breast cancer, are first diagnosed and somewhere I was greeted with the greatest and around 30% of all women with biggest of smiles, bright eyes, and a Dr. Sharp's latest pair of socks. earlier stage breast cancer will big hug. She had the most wonderful eventually develop metastases. We are doing a better job smile that lit up the room and gave you a warm feeling. as breast cancer death rates have been steady in women She was a small petite person that gave big bear hugs. I younger than 50 and have continued to decrease in older am thankful to her for brightening my day whenever we women. From 2013 to 2017, the death rate decreased met. I sure do miss her and those great big hugs. There by 1.3% per year, probably due to finding breast cancer were only a few visits when the news was bad and a few earlier through screening and increased awareness, as tears would fall, but she still gave me a big hug at the end well as better treatments. Still, we have a lot of work of the visit. I bet she gave lots of hugs to lots of people in ahead of us. those 20 years. In 2002 Peggy would have never thought that she would be alive to give all the hugs that she did. Metastatic breast cancer has lately been getting some well-deserved attention. In the state of Florida, I am She lived 20 years after her initial diagnosis of breast happy to report that Gov. Ron DeSantis has issued a cancer. Her hair grew again but it was never as thick proclamation naming April as Metastatic Breast Cancer and brown as it was when we first met and mine grew Awareness Month. That is important as it brings to the thinner and more platinum. She underwent multiples of forefront a large group of people who are thirsty for the chemotherapies, endocrine therapies, immunotherapies, attention. They feel the majority of attention in research and radiotherapies. They worked to keep her alive longer with a good quality of life. 12
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
METASTATIC BREAST CANCER AWARENESS MONTH
has been for the subset of patients who are curable and less so for those who have metastatic disease and are therefore uncurable. There are some in the metastatic breast cancer community who feel so disappointed and left behind by the “pink machine,” as they call it, that they created their own ribbon–it’s teal and purple with a little pink. They created new names like metavivor, forever fighter, and lifer. They are defining what it means to live with stage IV breast cancer. But more than anything it comes down to research. There are newer and more effective drugs being approved routinely. There are “older” drugs that are being conjugated with newer ones that make them more effective. During a recent breast cancer conference a new targeted therapy was reported to have a rather significant effect on brain metastases so maybe someone like Peggy wouldn’t have had to undergo radiation to her brain. At another recent conference a study showing improved radiotherapy techniques resulted in significantly less toxicity for patients with brain metastases. Those are some of the things Peggy might have been able to benefit from. Funding for research in the area of metastatic breast cancer needs to increase so that we can turn this deadly disease into a chronic one and to eventually
eradicate it entirely. Gov. DeSantis’s proclamation will help to make that a reality. I think often of Peggy and other patients that have passed. Many times it is as I try to provide encouragement and support to others when they are down and I tell them parts of Peggy’s life story. Other times it is when I read a study about a treatment regimen that I imagine may have benefitted her. I look forward to the day when her story is no longer the exception. I look forward to the day when no one dies from metastatic breast cancer. Some think that day will never come, but I disagree. Right now I see the glass as half full, but look forward to the day it will be overflowing.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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REFLECTIONS FROM THE EDITOR
A LIFE IN MEDICINE By Frank Skilling, M.D. “Life is short, Art long, Occasion sudden and dangerous, Experience deceitful, and Judgment difficult.” - Hippocrates (attributed) One of the great gifts of living to an old age, after being in the field of medicine for over fifty years (including medical school), is working with today’s medical students who are striving to achieve proficiency in one’s chosen field. Their intellectual and emotional struggles are reminiscent of those that I endured a half century ago when I was straining to learn the complexities of human medicine with the overlay of knowing that every move was being evaluated against my peers. Medicine is not a field for slackers. I’m a preceptor in the Clinical Learning Center (CLC) at the Florida State University College of Medicine where I supervise second year medical students in their clinical encounters with standardized patients, who are essentially trained actors. The “SPs” memorize a script that they act out for the students in a controlled environment, which is video-taped and graded. The pivot for this type of training is the encounter itself in which the students are required to make a diagnosis. Most of these encounters are twenty minutes and aim to allow enough time for the student to conduct a history, perform a physical exam, and then discuss their findings with the patient. There are preliminary lectures and videos that the students are expected to review before the CLC session. Some students are slow starters, but quickly catch on to the essentials of the clinical encounter. Some shine immediately, and some don’t seem to grasp the essence of what they’re supposed to do. The goal is to eventually have all of them demonstrate their proficiency in the basics of clinical medicine before being turned loose on real patients in clinical encounters. Recently, I had one student who I’d supervised before. She conducted an outstanding history, review of systems and analysis of the SP’s complaints. During my feedback with her, she expressed disappointment in herself that she hadn’t fully grasped the results of the encounter until I explained them. Her list of differential diagnoses was shorter than expected, but in my mind, adequate for someone who was still only a year and a half out of college. As she was leaving the exam room I casually said, “Don’t worry. In thirty years, it will all make sense to you.” She sighed. Malcolm Gladwell, the social science writer, has popularized the concept that it takes ten thousand hours of practice to become an expert. For example, if you want to learn to play the guitar, it will take ten thousand hours, etc. I have come to realize that to become a good doctor takes a lifetime. The nuts and bolts of medical terminology can be learned in four years. The basics of clinical practice take three to eight additional 14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
years, depending on one’s specialty. The finesse and fluidity of clinical applications take a lifetime. As I look back, I realize that I was a competent ophthalmic surgeon and clinician when I started my practice in Tallahassee in 1978 after completing my residency at the University of Texas Medical Branch in Galveston. I thought I was a good diagnostician because of my extra years in general medicine in the Navy. But I didn’t have the knowledge that comes from following myriad patients over many years. I didn’t know that women who developed chronic iritis from a herpes eye infection often went on to have complicated cataracts with poor results when they eventually had surgery. Nor had I previously cared for children with significant developmental disabilities, many of whom were institutionalized during my training era. However, I subsequently came to learn that while they rarely attended college or achieved white collar jobs, they sometimes became productive citizens if they had supportive families around them. I learned that mothers, and especially grandmothers, are important if such children aren’t going to end up in foster care. I hadn’t learned firsthand that certain types of strabismus (eye muscle balance problems) in infants sometimes improved with time, but sometimes they didn’t, and required extensive treatment and surgery to correct. The psychological aspects of not having straight eyes may be the most distressing aspect for the families and patients themselves. Even though I’d had experience with different types of brain tumors and their effects on vision, I didn’t realize that surgery or radiation treatment sometimes left patients with debilitating visual deficits that precluded driving or being able to work. I learned that even “minor strokes” or brain trauma sometimes left people unable to read or maintain employment. The list goes on. There are some lessons of clinical medicine that can only be learned with the passage of time. Once, after I gave a lecture on ocular anatomy to second year medical students, one of them approached me and said, “Ophthalmology. It sounds like a pretty easy field to me.” I was surprised at his cavalier observation, but I responded immediately, “Try taking care of someone who’s going blind!” He admitted that he never thought of that. This is what I meant when I responded to the woman in the CLC: medicine is a tough field. It’s always full of challenges, everchanging, often under-appreciated and under-compensated. It’s a lifetime learning curve, and time is the ultimate enemy for the patient and the practitioner. The writer Doris Lessing elucidated the process: “That is what learning is. You suddenly understand something you’ve understood all your life, but in a new way.” Louis Pasteur said that chance favored the prepared mind, but observation over a long time also reveals details that are not immediately obvious. Fortunately, I had a chance to supervise the same student again a week later and gave her the above quotation attributed to Hippocrates. It’s both reassuring and daunting to know that the challenges of medical practice (art) are still with us two thousand years later.
CMS MEMBERSHIP MEETING MINUTES
MINUTES: CMS MEMBERSHIP MEETING FEBRUARY 18, 2020 The mission of the Capital Medical Society is to promote the practice of medicine for the ultimate benefit of the patient. I. Business Meeting A. Welcome – Dr. Ken Whithaus, President, called the meeting to order at 6:30 pm. Dr. Whithaus thanked Westminster Oaks for use of their incredible facility. B. Dr. Whithaus welcomed and thanked our supporters for the evening: Title Sponsor Capital City Bank – Ben Bowersox and Melissa Wright Meeting Sponsor Stearns Weaver Miller, PA – Kelly O’Keefe Displayer Novo Nordisk, Inc. – Stephanie Ellis and Michelle Glazier C. Legislative Update Dr. Whithaus gave a brief update on Senate Bill 1676 regarding the independent practice of APRNs and Physician Assistants. D. Mark Your Calendars Dr. Whithaus announced the upcoming meetings and events:
Thursday, March 26, 2020 Celebration Awards Dinner FSU University Center Club 6:30 pm Tuesday, April 21, 2020 CME and Membership Meeting “Updates and Debates in Cancer Screening” Maguire Center for Lifelong Learning 6:00 pm Tuesday, May 5, 2020 Connect the Docs Cinco de Mayo Party Sponsored by Capital City Bank The Wine House on Market Street 6:00-8:00 pm II. Tonight’s Program Topic: Decisions Through Our Stages of Life: The Good, the Bad, and the Ugly Moderator and Panelists: J. Alan Cox, J. Alan Cox Attorney-At-Law and CMS Foundation Board Director, MODERATOR; Ben Bowersox, Capital City Trust Company; Jana McConnaughhay, Waldoch and McConnaughhay, P.A.; Kelly O’Keefe, Stearns Weaver Miller, PA; and Melissa Wright, Capital City Bank The moderator and panelists gave an informative program on financial planning. III. Adjourn – Dr. Whithaus adjourned the meeting at 8:20 pm.
Honor a Doctor – gifts given to honor a physician support the Capital Medical Society Foundation. This opportunity runs through National Doctors’ Day on March 30, 2020. Wednesday, February 19, 2020 “Do No Harm” Documentary Screening and Q&A Discussion FSU College of Medicine Auditorium 7:00 pm Spouses and Dentists Welcome CONTINUED ON NEXT PAGE
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CMS MEMBERSHIP MEETING MINUTES
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Captions for above photos: 1 – (L-r) Panelists and Title Sponsor, Capital City Bank: Ben Bowersox and Melissa Wright; Panelist, Jana McConnaughhay; Panelist and Meeting Sponsor, Stearns Weaver Miller, PA: Kelly O’Keefe; Paula S. Fortunas, M.A., CMS Foundation Board Director; and Moderator, J. Alan Cox.
3 – (L-r) Pam Irwin, CMS Executive Director; Dr. Ken Whithaus, CMS President; Dr. John Mahoney, CMS Foundation President; Judi Wills, CMS Foundation Development Director; and Dr. Faisal Munasifi, Chair, CMS Foundation Physician Wellness Program.
2 – Displayer, Novo Nordisk, Inc.: (l-r) Michelle Glazier and Stephanie Ellis.
4 – Panelists and Moderator: (l-r) Kelly O’Keefe, Melissa Wright, Jana McConnaughhay, Ben Bowersox, and J. Alan Cox.
Please Thank Our Supporters for the February 18th CMS Membership Meeting
Meeting Sponsor Stearns Weaver Miller, PA
Title Sponsor
Displayer Novo Nordisk, Inc.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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VIEWPOINT
Editor’s Note: Readers of Cap Scan may recall that last year Dr. Karl Hempel and his wife Mackie departed on a one-year voyage in their boat to make the Great Loop around the eastern seaboard and back down the Mississippi River to their home in Tallahassee. We are glad that they made the trip safely with their dog, Salty. This is a summary of their trip of a lifetime and some of their adventures along the way.
A LIFE IN MEDICINE By Dr. Karl and Mackie Hempel We woke up this morning and looked at each other and said, "Let's go home!" We traveled 90 miles on our boat from Orange Beach, Alabama to Sandestin, Florida to reach our home port at Baytowne Marina, on a beautiful November day. We were filled with mixed emotions when we crossed under the bridge into the Choctawatchee Bay with only 10 miles to go! We were proud of ourselves for accomplishing what we set Dr. Hempel, Mackie, and Salty out to do about eleven months completed the Loop in Sandestin, ago. We can now say we Florida at Baytowne Marina. belong to the exclusive group of Gold Loopers! We traveled 5,511 miles, stayed in over 110 marinas, anchored in beautiful remote areas, weathered a few scary storms and dense fog, but more often enjoyed beautiful sunny days, watched so many gorgeous sunrises, sunsets and starry nights, visited small towns and large cities and tried to do as much as we could to learn about those places by visiting their parks, beaches, museums, restaurants and taking walking tours! Karl even ran in a few local races! We learned so much American history by visiting forts, battlegrounds (Shiloh National Military Park in Mississippi was especially moving), southern plantations, colonial Williamsburg, historical Charleston, the US Naval Academy in Annapolis, where we watched the Blue Angels perform for graduation and exploring iconic New York City! We experienced an awe-inspiring launch of the Space X Crew Dragon in the middle of the night at the Kennedy Space Center! These are just a few of the many highlights of the places we visited! We certainly improved our boating and navigation skills! After crossing the open Gulf of Mexico, we traveled down the west coast of Florida, through the beautiful Keys, then proceeded up the East Coast of the United States. We traveled mostly through the protected waters of the ICW, and stopped along the way in so many charming coastal towns. We loved the Carolinas, the Outer Banks and the Chesapeake Bay! A highlight of the trip was passing the Statue of Liberty in New York on our boat! After spending a week in New York, we proceeded up the Hudson River, to the Erie Canal, crossed Lake Ontario into Canada, and traveled through the Trent-Severn Waterway, Georgian Bay and North Channel. We spent six weeks anchoring out, fishing, swimming, hiking and paddle boarding in the beautiful, clear pristine waters and shores of Canada. Imagine our surprise when we ran into patients of Karl’s on the first day in Canada, who happened to be staying at the same marina! 18 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
We visited Mackinac Island, only accessible by boat! Then we continued through Lake Michigan to Chicago and headed down the Illinois River, the Mississippi River, Ohio River to the Tennessee River at Paducah and Grand Rivers, Ky where we enjoyed seeing our family! We loved being in our "home" state of Kentucky, where we grew up, via our own boat! We then moved south through the Tennessee-Tombigbee Waterway all the way to Mobile, Alabama. We negotiated through over 100 locks, and learned how to communicate with the Tow captains, pushing their huge barges on the river systems! We luckily dodged the debris that was is in the river systems, due to the high flooding that has happened this year. Exploring and seeing areas from a boat gives you a different perspective on life! The best part of our adventure was meeting new friends along the way! By flying the AGLCA burgee, boaters would recognize each other on the open water and in port! Whenever we pulled up to a marina, fellow Loopers would jump out of their boats and help us tie up! We enjoyed their company and sharing boat stories. We would help each other by sharing our experiences and exchanging information with them. We really never felt alone! Loopers know how to have fun! We would often join each other for impromptu "docktail" parties and dinners! What will we miss about the Loop? Getting up in the morning, drinking coffee and planning our day! Reading about our destinations and studying the Guide books! Plotting our courses! Every day was different and challenging! What would our next port be like? Will we have enough groceries before we find another market? How long will we have to wait for a lock opening, often it was several hours! Arriving at a new place and finding an interesting Farmer's Market, music, art or festival happening! Experiencing eating regional foods and soaking up the local culture! The sense of adventure! When we began this journey on January 5th, 2019, we asked ourselves, "Can we do this?" And we did it, came full circle! We are blessed and thankful to have had this opportunity. It truly has been a trip of a lifetime! But more than that, we learned so much about ourselves and our partnership together! We are still happily married; I am pleased to report! We have been asked, “what are you going to do for an encore?” For now, we are happy to be safely home! But one thing we do know for sure, there will be plenty of new boating adventures in our future! _____________ If you’d like to look back at their 2019 adventure of cruising America’s Great Loop, visit their blog at: https://endorphinvoyager.blogspot.com.
SIMPLER TIMES
SOUTHERNERS AIN’T IGNORANT By Charles D. “Pedro” Williams, M.D., FACR, FAAP I was sitting at a table in the Dr.’s cafeteria with Dr. Yang, Dr. Patty, and Mr. Moore and we were talking about Southerners and how some folks think all Southerners are ignorant. This put me to thinking. There’s more to the South and Southerners than blackeye peas, moon pies, kudzu, dinner on the ground, porch swings, prayer meetings, ice tea, wrestling and fishing. There’s a lot more. There’s things like ugly dogs and boiled okra. Ugly dogs are happier in the South and boiled okra gives us our minimal daily requirements of fuzz and slime. There’s other things like straw hats, overalls, funeral home fans, and collard greens. Collards brought the races closer together. Southerners meet and say “How’zit goin?” and “Howyah doin?”. These are greetings and not questions. When Southerners congregate the first type of conversation is weather, overnight comparison of thermometer readings and the daily forecast. With the arrival of ever new good ol’ boy, these comments will be rediscussed. Then there’s discussion of recent deaths, funerals and ailments followed by crops, trucks, government, fishing, firearms and whiskey. Whiskey is probably the most popular remedy that wudn’t cure colds. One past time of Southerners seems to have gone by the wayside. That is snuff dippin’. I don’t think it was the fear of cancer that stopped it but dippin’ and spittin’ didn’t seem to go well with lovin’. Another past time is setting off firecrackers. One time us younguns went over to the county line and bought some fireworks for Christmas. We lighted our Roman candles and firecrackers and Grandma said, “You’d thought Jesus was a Cavalry officer.” We then asked Grandma if she thought Jesus was a Southerner. She studied on it and said, “I don’t think so but he was good enough to have been one.”
Southerners do is fish, tell stories, and read the bible. That’s not true. We also like to eat and eating with family and friends was important. I’m not sure what our eatin did to our bodies back then but eating and fellowship brought our families closer together. In South Ga. us Southerners had to learn about makin do. We had to make do, make over, or do without. It’s about being good to your neighbor and neighbors helping neighbors and family helping family. It seems that being Southern is a bunch of things. It’s knowing where your people came from, how they got there, where they’re buried, who married who or should’ve but didn’t. It’s the ability to be happy and thankful with simple things. Southerners try to keep things simple cause they’re goin to git complicated soon enough without us helping them along. Being Southerner is also the willingness to defend one’s country and to fight for our freedom like many of ’em did in World War II. It’s the ability to hold your head up, to keep your feet on the ground, to don’t give up, to tough’en up and hunker down. It’s the ability to git your spirits energized with your hands in the soil. Being a Southerner is being proud of who you are and where you came from. Apparently, being a Southerner is also feeling comfortable with ending a sentence with a preposition. One good thing about being a physician Southerner and having an M.D. back of your name is that it allows you to be yourself and talk the way you know how without folks thinking you’re ignorant. That is – sometimes. That is – if you remain in the South. Reprinted with author permission from More Simpler Times.
Dr. Williams’ sequel book, More Simpler Times, can be purchased from the Capital Medical Society. All proceeds from the book are donated to the Capital Medical Society Foundation’s We Care Network program. The total sales from his books have raised over $39,000 for the CMS Foundation’s We Care Network.
Some folks say us Southerners shoot anything that moves and put beer on our grits. Other folks say all us CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19
CMS FOUNDATION ANNOUNCEMENTS
THE CMSF PHYSICIAN WELLNESS PROGRAM: NEW YEAR MENTAL HEALTH "CHECK-UP" CMS Members, The CMS Foundation offers a Physician Wellness Program, which features confidential, convenient, cost-free access to professional psychological, wellness coaching services for the CMS Active and Associate members. We invite all members to take advantage of the program for a "New Year Mental Wellness Check-up" session. The Physician Wellness Program provides a safe harbor for you to address normal life difficulties and the challenges of a medical career, and help you reclaim satisfaction in your career and personal life. You deserve it. How it Works: • As an exclusive benefit to CMS members, CMS provides up to 6 confidential sessions a year at no charge with independent, doctorate-level clinical psychologists. • Use a session to help with your mental wellness self-assessment; make your new year's resolutions stick; receive tips on time management & communication skills; address lawsuits/disciplinary action; discuss if you are using your strengths to their full potential and if not, discuss the obstacles; or simply talk. You can learn more about the program at https://capmed.org/members-only/physicianwellness/, by emailing Pam Irwin at pirwin@capmed.org, or calling CMS at (850) 877-9018.
The Rotary Club of Tallahassee presented a $2,500 check to Diana Bixler, We Care Network Program Coordinator and Pam Irwin, CMS Foundation Executive Director for the We Care Network Program during its Non-Profit Fair on February 26, 2020. Also pictured are Rotarians Pam Griggs and Larry Kubiak.
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DONATE TO THE CMS FOUNDATION
The Impact of Private Support:
Donate to the CMS Foundation We Thank Our Donors We thank the following individual donors who made a donation to the CMS Foundation this past month: Capital Medical Society Foundation – Area of Greatest Need AmazonSmile Honor a Doctor – Area of Greatest Need Jill Bauer – In Honor of Jesse Blake Bauer, M.D. Nancy Loeffler, M.D. – In Honor of Richard Henry, M.D. John P. Mahoney, M.D. – In Honor of Faisal Munasifi, M.D. Dr. and Mrs. Charles D. Williams – In Honor of Armand B. Cognetta, Jr., M.D. Scholarship Fund David Bellamy, M.D. – In Memory of Harold Logan Brooks Carol and Mike Martin – In Honor of John and Jean Thrasher, President - FSU We Care Network Anonymous Dr. and Mrs. Ray Bellamy – In Memory of Reverend Franklin Pompey Rotary Club of Tallahassee St. Elizabeth Ann Seton Catholic Church
The 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.” ➢ Access to healthcare is increased through gifts to the We Care Network and the We Care Network Endowment Fund. More than $105.4 million in donated specialty medical and dental care has been provided to low-income, uninsured patients since the program was created in 1992. In fiscal year 2018-19, which ended June 30, 2019, more than $7.4 million in health care was donated. Gifts support the operational expenses of the program including salaries and benefits of the case management team who coordinate the donated care. ➢ To provide incentives to keep medical students trained at the 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 awarded in 2019. ➢ Gifts to the Capital Medical Society Foundation help provide operational resources for the Capital Medical Society Foundation. In addition, modest grants are awarded to area non-profits whose programs improve access to healthcare for the underserved. In 2019, the CMSF awarded a total of $10,000 in grants to Elder Care Services for their In-Home Services Program, the Big Bend Hospice for bereavement services, and the Lighthouse of the Big Bend to provide clients who have vision loss with the aids needed to manage their health and medical care independently. Gifts to Honor and In Memoriam: You can make a gift 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. The 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 make a gift at any time to one of the 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 6) The Ronald G. Pickett Endowment 7) Physician Wellness Fund Gifts should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to give. Bring your check to the CMS Office or mail it: Capital Medical Society Foundation ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. Gifts may be made by credit card or direct debit from the CMS website. 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:
Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.
Judi Wills Development Director jwills@capmed.org or (850) 877-9018 or after hours at (850) 509-2058 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS FOUNDATION: WE CARE NETWORK
FOUNDATION
We Care Network
THANK YOU To our CMS members and We Care Network partners who provided healthcare to new patients in February 2020. Your generosity and support of the We Care Network makes a difference.
Physicians David Alvarez, M.D. Scott Asher, M.D. Emily Ashmore, M.D. Dhananjay Bendre, M.D. Tim Broeseker, M.D. J. Brewster Caldwell, D.O. Carlos Campo, M.D. Gilbert Chandler, M.D. George Cohen, M.D. Matthew Connor, M.D. Jeffrey Crooms, M.D. William Dixon IV, M.D. David Dolson, M.D. Chesley Durgin, M.D. Celeste Hart, M.D. Todd Hewitt, M.D. Marc Inglese, M.D. Floyd Jaggears, M.D. Ben Kirbo, M.D. Matthew Lee, M.D. Gordon Low, M.D. Michael Mangan, M.D. Kenneth McAlpine, M.D. Jayan Nair, M.D. Stephen Richardson, M.D. Andres Rodriguez, M.D. Scott Sellinger, M.D. Gadi Silberman, M.D. Hardeep Singh, M.D. David Smith, M.D. Joshua Somerset, M.D. Matthew Standridge, M.D. Kris Stowers, M.D. William Thompson, M.D. Robert Thornberry, M.D. Jean-Paul Tran, M.D. Tony Weaver, M.D. Graham Whitaker, M.D. Brett Wenlender, M.D. Brian Wilson, M.D. Dentists Briano Allen, D.D.S.
Julie Bailey, D.M.D. Laban Bontrager, D.M.D. Walter Colón, D.M.D. John Dozier, D.M.D. William McFatter, D.D.S. Frank Swerdzewski, D.D.S. Facilities Airway Works, LLC Anesthesiology Associates Apalachee Primary Care Beachton Denture Clinic Bond Community Health Center Bristol Dental Clinic Capital Health Plan Capital Regional Surgical Associates Care Point Health & Wellness Center CESC Dental Clinic Dermatology Advanced Care Dermatology Associates Desloge Home Oxygen Digestive Disease Clinic Eye Associates of Tallahassee Frank Swerdzewski DDS FSU PrimaryHealth Gadsden County Health Department Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Madison Medical Center Neighborhood Medical Center North Florida Nephrology Associates North Florida Regional Thyroid Center North Florida Women’s Care North Monroe Medical Center Periodontal Associates of North Florida Radiology Associates of Tallahassee Red Hills Endodontics Southeastern Plastic Surgery Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Allergy, Asthma, and Immunology Tallahassee Community College Dental Hygiene Clinic Tallahassee Dental Associates, PLLC Tallahassee Diagnostic Imaging Tallahassee Ear, Nose, & Throat
22 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Tallahassee Memorial HealthCare TMH Family Medicine Residency Program TMH Physician Partners Cancer & Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Clinical Genetics Center TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Pulmonary, Critical Care, and Sleep Specialists TMH Physician Partners Radiation Oncology Specialists TMH Physician Partners Surgical Specialists TMH Physician Partners Urology Specialists TMH Physician Partners Quincy TMH Rehabilitation Center TMH Transition Center Tallahassee Orthopedic Clinic TOC Clinic at TMH Tallahassee Outpatient Surgery Center Tallahassee Surgical Associates Tallahassee VA Clinic Vascular Surgery Associates Wakulla County Health Department Wakulla Medical Center Wakulla Urgent Care Women’s Imaging Center
Please contact Diana Bixler at dbixler@ capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of February 2020 and your name is omitted.
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. In addition, 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 Diana Bixler at (850) 2010085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
CMS FOUNDATION: WE CARE NETWORK
We thank our referring providers from February 2020:
Ebonie Allen, APRN
Anneka Gaffney, APRN
Cybelle Pfeifer, M.D.
Anne Ananga, APRN
Hong Gao, M.D.
Andrea Plagge, D.O.
Scott Asher, M.D.
Wanda Goodreau, D.M.D.
Charlie Richardson, M.D.
Clifton Bailey, M.D.
Judy Griffin, APRN
Carla Robertson, APRN
Karen Bartley, M.D.
Alcius Guerdine, M.D.
Andres Rodriguez, M.D.
Megan Bassett, APRN
Muhanad Hasan, M.D.
Garrison Rolle, M.D.
Amanda Bertoli, M.D.
Tracey Hellgren, M.D.
Cielo Rose, D.O.
Kendra Brady, APRN
Hantz Hercule, M.D.
Karen Russell, M.D.
Sherry Bramblett, APRN
Rohan Joseph, M.D.
Hardeep Singh, M.D.
Daniel Breivogel, APRN
David Keen, M.D.
Denise Smith, M.D.
Tim Broeseker, M.D.
Ben Kirbo, M.D.
Thomas W. Smith, M.D.
LaToya Butler, D.D.S.
Fang Sarah Ko, M.D.
Alanna Steaple, APRN
J. Brewster Caldwell, D.O.
Stefanie Kreamer, M.D.
Frank Swerdzewski, D.D.S.
Frances Carney, APRN
Elaine Larkins, APRN
John Thabes, M.D.
Francisco Carpio, M.D.
Matthew Lee, M.D.
Faye Tinson, APRN
Lysmar Carrion-Dinguis, M.D.
Gordon Low, M.D.
Ramona Vossler, R.D.H.
Gilbert Chandler, M.D.
Michael Mangan, M.D.
Dwanna
Melba Colon-Renta, M.D.
Ovidiu Marina, M.D.
Deborah Congdon, APRN
Kenneth McAlpine, M.D.
Jeffrey Wasserman, D.O.
Jeffrey Crooms, M.D.
Damon McMillan, M.D.
Lucas Watkins, M.D.
William Dixon IV, M.D.
Kelley Miller, APRN
Tony Weaver, M.D.
Marlisha Edwards, M.D.
Marcia Morris, APRN
Shynequria
Cynthia Evans, APRN
Jayan Nair, M.D.
Alberto Fernandez, M.D.
Rose Origa, APRN
Brian Wilson, M.D.
Michael Forsthoefel, M.D.
Kaushal Patel, M.D.
Shana Wood, APRN
Sharron Foster, M.D.
Jorge Perez de Armas, M.D.
Charles Yowell, M.D.
Dale French, D.O.
Lisa Perkins, APRN
Ward-Boahen, APRN
Williams-McNealy, APRN
DURING THE MONTH OF FEBRUARY 2020, THE WE CARE NETWORK: RECEIVED 205 REFERRALS, WITH 117 PATIENTS NEW TO THE PROGRAM
SCHEDULED 89 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$466,081.50 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 23
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