JUNE EDITION, VOLUME 2022, NO. 6
WE CARE DENTAL NETWORK - 30-YEAR EVOLUTION OF DENTISTRY COLLABORATION By Walter E. Colón, D.M.D., MS, We Care Dental Network Advisory Committee Chair, Donating We Care Dental Network Provider, and Vice President of the CMS Foundation Board of Directors Congratulations to the Capital Medical Society Foundation (CMSF) for their initiative in creating the We Care Network and for its growth and evolution over the last 30 years. Reviewing the yearly records of care produced by the We Care Network is always a humbling experience and one reminder of the awesome medical community we are fortunate to have available. The We Care Network successfully provides valuable structure, organization, a road to access, and support to those in need. The Capital Medical Society Foundation created, and has maintained, a program that is emulated by many. When originally created in 1992, the We Care Network did not have a dental component. However, it was not long before a patient benefited from dental work due to the need to treat an infection prior to a medical procedure. The early value placed on dental care by Tallahassee physicians was, and remains, beyond many other communities without question. Understanding the mouth-body connection is something lacking in many areas around the country. By the late '90s, there was a small group of dentists treating patients when requested by a We Care Network Case Manager in isolated cases. These dentists provided care, free of charge, and when called upon. Most cases arose when a physician expressed a need for emergency treatment prior to their treatment, or due to a patient in pain from dental origin. The office I joined upon arrival to Tallahassee participated in these
requests and gave me the opportunity to treat We Care Network patients and lead our office in this regard. That opportunity led to a seat on the CMSF Access to Care Committee. It was in an Access to Care Committee meeting that the late Dr. Charles Mathews put forward the idea and requested that a Dental Committee be formed. The We Care Dental Network Dental Committee was born in 2003 with Drs. Larry Pijut, Jay Walton, Larry Weaver, and myself. This committee introduced the We Care Network to the Leon County Dental Association and for some time worked with the CMSF staff in advancing the dental component. The Dental Committee was eager to assist the We Care Network donating physicians with their recognized need. Karen Wendland, former Capital Medical Society Executive Director, was instrumental in sparking relationships that have lasted, and in engaging the dental community. A few years later, the late Dr. Ed Zapert’s involvement proved to be vital in contributing in many ways. He offered access to the Molar Express, the health department’s dental clinic, for the We Care Dental Network to host dental clinic days for its donating dental providers. Over the years, the number of dental care providers has increased; the number of committee participants has increased; and CMSF dedicated a Case Manager to the CONTINUED ON PAGE 3
CAPITAL MEDICAL SOCIETY 2022 MEETINGS CALENDAR September 20, 2022 CMS Membership & CME Meeting One-Hour CME Topic: Advances in Migraine Treatment Presenter: Danny Estupiñán, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 18, 2022 CMS Membership & CME Meeting Two-Hour Required CME Topic: Domestic Violence and Human Trafficking Presenter: Suzanne Harrison, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks CONTINUED ON PAGE 3
BOARD OF GOVERNORS Paresh Patel, 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
Sarah Ko, M.D., President-Elect
The We Care Network’s 30th Anniversary....................1 CMS News.............................................................................4 CMS Lunchtime Learning Seminars................................5 Catch My Stride Events.....................................................6 Capital Medical Society Member Benefits....................7 CMS Membership Meeting Minutes................................8 Medical/Legal....................................................................10 Alliance Corner.................................................................. 13 Viewpoint............................................................................ 14 Simpler Times.................................................................... 15 Donate to the CMS Foundation..................................... 16 CMS Foundation: We Care Network............................ 18
Helen Paulson, M.D., Secretary/Treasurer Rohan Joseph, M.D., Immediate Past President Codie Bryant, CMS Alliance President Russell Cole, M.D. Amulya Konda, M.D.
HAPPY BIRTHDAY!
Jonathan Nava, M.D.
{JUNE BIRTHDAYS}
Kaushal Patel, M.D. Shawn Ramsey, D.O. Brence Sell, M.D. Kiana Taba, M.D. Julia Weeks, M.D. Graham Whitaker, M.D. Pam Irwin, Executive Director, CMS
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
Melissa Martin, M.D. - 1st Connie L. Speer, M.D. - 2nd Christopher Sundstrom, M.D. - 2nd Stephanie Evans, M.D. - 3rd A. Lane Janney, M.D. - 3rd James S. Killius, M.D. - 3rd Hiren Joshi, M.D. - 4th Winston R. Ortiz, M.D. - 5th Robert S. Glickenberger, M.D. - 6th Brian Zirgibel, M.D. - 6th Shane Rignanese, M.D. - 8th Okanta Jackson, M.D. - 10th Suzanne Morgan, M.D. - 10th Neelima Ravi, M.D. - 11th Gizem Reyhanoglu, D.O. - 11th David L. Saint, M.D. - 11th Scott Sellinger, M.D. - 11th Timothy W. Bolek, M.D. - 12th Leonard Leichus, M.D. - 13th Earl McKenzie, III, M.D. - 13th Davis A. Rierson, M.D. - 13th Nancy Loeffler, M.D. - 14th Misty Leeana Gangar, M.D. - 15th Andres M. Vargas, M.D. - 15th George R. Whiddon, M.D. - 15th Katherine Cone, D.O. - 17th
Lucille Tucker Saha, M.D. - 17th Carlos Zapata, M.D. - 17th Deanna Louie, M.D. - 18th H. Whit Oliver, M.D. - 18th Cheau Williams, M.D. - 18th Barbara A. Williams, M.D. - 19th William Yaakob, M.D. - 19th Jitendra Padalia, M.D. - 20th Kristin A. Harmon, M.D. - 23rd Jose Roberto Mendoza, M.D. - 23rd Joseph Mazziotta, M.D. - 24th Myrle R. Grate, Jr., M.D. - 25th Kishor Muniyappa, M.D. - 25th Madhuri Sankuratri, M.D. - 25th Matthew C. Davis, M.D. - 26th Amanda B. Aronchick, M.D. - 27th Ricardo Bailey, M.D. - 27th James Cade, M.D. - 27th Ryan D. Curran, M.D. - 27th Ronald Saff, M.D. - 27th Leslie Emhof, M.D. - 28th Russell D. Cole, M.D. - 29th Margarett Conklin Ellison, M.D. - 29th Amit Jain, M.D. - 29th Alexandra Nevett-Fernandez, 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!
THE WE CARE NETWORK’S 30TH ANNIVERSARY
CONTINUED FROM COVER
We Care Network Dental case management. We are fortunate to have Roshanda Dorsey, who has served in that capacity for seven years. She assists We Care Network patients referred with dental issues and helps guide them through the process. The We Care Dental Network Dental Committee is also fortunate to have Diana Bixler, a persistent star in organizing and keeping this committee on task and evolving. In addition, Drs. Avon Doll, John Mahoney, Jim Stockwell, and Julia Weeks have been incredible contributors to the committee and present to assure our collaborations align with the patient and physician needs as well as the We Care Network mission. We are proud that the dental component has evolved from calls to a dentist for help in isolated cases to a system that has been awarded the Florida Blue Foundation Sapphire Award, has received recognitions throughout the state, and has an established group of consistent donors. Several supporters include the Florida Dental Association Foundation, Rotary Club of Tallahassee, and dentists’ individual donations. Patient care is at a high level and has expanded to provide patients with prosthetics, such as dentures from
participating laboratories. Transportation assistance is available as well as several other avenues of assisting patients with medications. Some patients have had endodontic care in order to retain teeth. Through Executive Director Pam Irwin and the CMSF staff, the interest in providing dental care has expanded, and the We Care Network team members are often present at other dentistry pro-bono events year after year, such as Dentistry from the Heart (local event), Mission of Mercy (Florida Dental Association event), and others. The We Care Dental component provides a wonderful avenue for those in need to obtain care. The dental community is fortunate to collaborate with the We Care Network. We look forward to the future evolution of the We Care Dental Network and celebrating the 40th and 50th year anniversaries with you! Thank you for the resources you allot to dentistry and for endorsing the importance of dental care in patient care. _______________ To bring attention to the importance of oral care, the American Dental Association and Colgate joined forces and declared June as Oral Health Month.
CAPITAL MEDICAL SOCIETY 2022 MEETINGS CALENDAR CONTINUED FROM COVER
November 3, 2022 CME Meeting Two-Hour CME Topic: Physician Resilience in the Face of Stress and Trauma Presenter: Quint Studer, Partner, Healthcare Plus Solutions Group 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 15, 2022 CMS Membership & CME Meeting One-Hour CME Topic: A Year Later: The COVID-19 Long Hauler Presenters: Carlos Campo, M.D., Bayard Miller, M.D., and Thomas Noel, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks December 1, 2022 CMS Foundation Holiday Auction 6:30 pm Venue TBA
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS NEWS
PROFESSIONAL NOTES Leon County EMS Chief Mac Kemp invited Dr. Michael Forsthoefel to participate in the inaugural Honor Flight Tallahassee as its Flight Physician. On April 23, 2022, Dr. Forsthoefel completed his eighth flight in this capacity. In reverence to those World War II, Korean, and Vietnam War veterans who served, fought, and fell for our country, Honor Flight Tallahassee salutes their service each year by sponsoring a flight to Washington, D.C. This is a oncein-a-lifetime opportunity for military veterans to visit the various monuments raised in their honor. Each flight costs about $120,000. The planning for the next flight starts as soon as one is completed.
Dr. Andrea Friall delivered the commencement address to the FSU College of Arts and Sciences Spring 2022 Graduating Class on April 29, 2022.
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.
IN MEMORIAM JAMES “JIM” CAVANAGH, M.D. 1930 – 2022
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS LUNCHTIME LEARNING SEMINARS
CAPITAL MEDICAL SOCIETY VIRTUAL LUNCHTIME LEARNING SEMINARS MARK YOUR CALENDARS FOR A SPECIAL SUMMER 2022 LUNCH AND LEARN SEMINAR: background on the IRC, the populations they serve, and a summary of the unique cultural practices around medical care for each population. She will share information about interpretation service options, insurance, and bill payment, etc. Sponsor: Rambana & Ricci, P.L.L.C. Concentrating on Complex Immigration Across the Nation
June 15, 2022
Presenter: Karen Duncan, Community Engagement & Outreach Coordinator, International Rescue Committee (IRC) Tallahassee The International Rescue Committee is a resettlement agency that contracts with the federal government to provide services and welcome to refugees in Tallahassee. Refugees face challenges when rebuilding their lives in a new country and connecting with and receiving health care is one of their large hurdles to overcome. Karen Duncan will give a brief
Registration Required Time: 12:30 PM to 1:30 PM No Cost for these virtual seminars.
For more information or to RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
THANK YOU TO OUR MAY 18TH LUNCHTIME LEARNING PRESENTERS!
Shannon B. Hartsfield
Mia L. McKown
Eddie Williams III
On May 18th, Shannon B. Hartsfield, Mia L. McKown, and Eddie Williams III, Partners with Holland & Knight Tallahassee, gave an excellent program on HIPAA and Data Access – What’s New in 2022. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CATCH MY STRIDE EVENTS
CMS MEMBERS, ALLIANCE MEMBERS, AND THEIR CHILDREN ENJOYED AN AFTERNOON AT THE TALLAHASSEE MUSEUM ON APRIL 23, 2022. THEY HAD BEAUTIFUL WEATHER AND ENJOYED EACH OTHER’S COMPANY. THANK YOU TO DR. ROHAN JOSEPH, CMS IMMEDIATE PAST PRESIDENT, FOR HOSTING THE EVENT!
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CAPITAL MEDICAL SOCIETY MEMBER BENEFITS
CAPITAL MEDICAL SOCIETY MEMBERSHIP HAS ITS PRIVILEGES So how does a Capital Medical Society (CMS) membership benefit you? In many, many ways! We’re committed to making Capital Medical Society an even stronger medical association. Here are just a few of the benefits you receive as a Capital Medical Society member: PHYSICIAN REFERRALS – Each year, the Capital Medical Society receives numerous calls from the public seeking information to select a physician. The Capital Medical Society makes referrals to CMS physician members. The medical society provides the public with information about member physicians’ medical backgrounds, board certifications, and accepted insurance. PHYSICIAN VOICE – The Capital Medical Society and its members work in conjunction with the Florida Medical Association and the American Medical Association to inform legislators at the state and national level on key legislative issues that impact physicians and their patients. PHYSICIAN WELL-BEING – The Physician Wellness Program, available to Active and Associate members and TMH Residents, provides a safe harbor for physicians to receive wellness coaching to address normal life difficulties in a confidential and professional environment. Each member may receive six, free wellness coaching sessions a year. RELATIONSHIP-BUILDING – Building lasting relationships with colleagues and their families is encouraged through Capital Medical Society’s “Connect the Docs” and “Catch My Stride” events. EDUCATIONAL OPPORTUNITIES – CME courses are offered throughout the year. These are often in conjunction with membership meetings or are promoted for other entities who offer free or reduced-fee educational events. MEDICAL PRACTICE EDUCATION – The Capital Medical Society offers Lunchtime Seminars during the year to medical practice clinical and non-clinical office staff. Past topics have included: “Take Your Practice’s Revenues to the Max,” “What’s the Cure? Proper Reporting and Use of Your COVID Funding,” “Clinical Best Practices in Patient Documentation,” and “The Role in Avoiding Medical Liability.”
information impacting the practice of medicine through emails to CMS members and their staff. This has proven invaluable during the pandemic. Cap Scan, the Capital Medical Society’s monthly magazine, is sent electronically to each Capital Medical Society member and their office manager. CapMed Today, the Capital Medical Society’s weekly newsletter, is sent each week via email on relevant legislative, regulatory, and healthcare-related issues that impact the practice of medicine. CE BROKER – Every licensed CMS member has access to a discounted fee Professional CE Broker account as part of their membership. The Capital Medical Society and CE Broker have joined together to offer our Members an exclusive rate of only $12 per year for the Professional Account ($29) with CE Broker. This is a savings of $17! GIVING BACK TO THE COMMUNITY – The Capital Medical Society physicians are passionate about their communities. Each year, CMS members, who have signed up to be part of the CMS Foundation’s We Care Network, donate healthcare to low-income, uninsured adults coordinated by the We Care Network staff. Over $120 million in donated healthcare has been coordinated since 1992. PAYING IT FORWARD FOR THE FUTURE OF MEDICINE – Through the Capital Medical Society Foundation’s Scholarship Fund, local medical students are awarded scholarships to help defray the cost of medical education. CMS members support the fund through their donations. By paying it forward through scholarships, the local medical community has benefited. Many of these scholarship recipients are now practicing in Tallahassee. Thank you for being a valued Capital Medical Society member. We hope you will let us know how we can serve you better.
Yours in Capital Medical Society service, Pam Irwin
STAY TUNED – The Capital Medical Society takes a leadership role in communicating time-sensitive CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS MEMBERSHIP MEETING MINUTES
MINUTES CMS MEMBERSHIP MEETING APRIL 19, 2022 - CAPITAL CITY COUNTRY CLUB 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. Paresh Patel, President, called the meeting to order at 6:30 pm. He welcomed everyone to our first in-person CMS Membership and CME Meeting since February 2020. B. Dr. Patel welcomed and thanked our supporters for the evening: Presenting Sponsor Southern Medical Group - Cardiology – David Saint, M.D.
Tuesday, September 20, 2022 – CMS Membership & CME Meeting “Advances in Migraine Treatment” Presented by Danny Estupiñán, M.D. 6:00 PM Maguire Center at Westminster Oaks II. Tonight’s Program – this is a 1-Hour Category One Program Topic: “Advances in Cardiac and Thoracic Treatment: Minimally Invasive and State of the Art Procedures” Presenter: Juan Gallegos, M.D., Southern Medical Group Dr. Gallegos gave an informative presentation on minimally invasive surgical options.
Meeting Sponsor TMH Federal Credit Union – Harry Burn and Liz Thiele
CME Proof of Attendance Forms were sent to participants who stayed for the entire CME program and completed an evaluation form.
Displayers
III. Special Drawing
Bristol Myers Squibb – Cynara Miller Novo Nordisk, Inc. – Gavin Boone and Loren Whyte C.
Dr. Patel announced the upcoming meetings/events: Saturday, April 23, 2022 – Catch My Stride Event Tallahassee Museum - 2:00 PM – 4:00 PM Join Dr. Rohan Joseph for a visit to the Tallahassee Museum. See your email for details. Thursday, June 2, 2022 – CMS Family Movie Night “DC League of Super-Pets” CMX Cinemas Fallschase 6:00 PM Check in, 6:30 PM Viewing Private Showing for CMS Members and their guests. Watch your email for your invitation, pre-registration required.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Dr. Patel asked Liz Thiele with TMH Federal Credit Union to pick the name out of a bucket for their special drawing. Dr. Jitendra Padalia won the soft cooler bag with beach blanket. IV. Adjourn Dr. Patel adjourned the meeting at 7:30 pm.
(L-r) Dr. Juan Gallegos, speaker for the evening; and Dr. Paresh Patel, CMS President.
CMS MEMBERSHIP MEETING MINUTES
Presenting Sponsor, Southern Medical Group – Cardiology: (l-r) Dr. David Saint and Dr. Gian-Carlo Giove.
Meeting Sponsor, TMH Federal Credit Union: (l-r) Liz Thiele and Harry Burn.
Displayer, Bristol Myers Squibb: Cynara Miller.
Displayer, Novo Nordisk, Inc.: (l-r) Gavin Boone and Loren Whyte.
Please Thank Our Supporters for the April 19th CMS Membership Meeting Meeting Sponsor
Presenting Sponsor
TMH Federal Credit Union
Displayers Bristol Myers Squibb CARDIOLOGY
Novo Nordisk, Inc.
NEW DOCS ON THE BLOCK Prasanti Tatini, M.D.
Medical School: Mahadevappa Rampure Medical College Internship/Residency: Kalamazoo Center for Medical Studies Fellowship: McLean Hospital Practice: Florida First Psychiatry Specialist, LLC Specialty: Psychiatry, Geriatric Psychiatry
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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MEDICAL/LEGAL
Fixing prior authorization in Medicare Advantage By Jarrod Fowler, MHA, FMA Director of Health Care Policy and Innovation | Updated May 5, 2022
Last week, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a report showing that Medicare Advantage plans often inappropriately delayed or denied care. The report found that, among the prior authorization requests that Medicare Advantage (MA) plans denied, 13% actually met Medicare coverage rules. In other words, these services would have been approved for beneficiaries enrolled in Traditional Medicare. As the OIG put it, “Medicare Advantage Organizations denied prior authorization requests for services that were medically necessary by applying clinical criteria that are not contained in Medicare coverage rules.” Further, “Medicare Advantage organizations indicated that some prior authorization requests did not have enough documentation to support approval, yet our reviewers found that the beneficiary medical records already in the case file were sufficient to support the medical necessity of the services.” Supposing MA plans regularly deny valid prior authorizations at the frequency found in this study, that indicates inappropriate denial of 84,812 prior authorizations in 2019 alone. In addition, among payments that were denied by Medicare Advantage, 18% met traditional Medicare’s coverage and billing rules. As stated by the OIG, “Eighteen percent of payment denials were for claims that met Medicare coverage rules and Medicare Advantage billing rules, which delayed or prevented payments for services that providers had already delivered.” If MA plans regularly denied medically necessary services at the frequency reported in this study, that means 1.5 million payment requests were inappropriately denied in 2019. In response to these findings, the OIG recommended the following: 1. Issuing new guidance on the appropriate use of MA organization clinical criteria in medical necessity reviews; 2. Updating audit protocols to address the issues identified in this report, such as MA organization use of clinical criteria and/or examining particular service types; and 3. Directing MA organizations to take steps toward identifying and addressing vulnerabilities that can lead to manual review errors and system error.
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MEDICAL/LEGAL
The use of inappropriate and harmful prior authorization (PA) requirements is why the FMA supports HR 3173, the federal Improving Seniors’ Timely Access to Care Act of 2021. This legislation would help reduce physicians’ administrative burdens and improve health outcomes for Medicare beneficiaries by modernizing the PA process in the context of the MA program. Specifically, it contains five improvements to the PA process that the FMA strongly supports and hopes to see included in any final legislative package:
1. The legislation establishes an electronic prior authorization (ePA) program and requires MA plans to adopt ePA capabilities that meet specified standards. The adoption of appropriate ePA standards would reduce the administrative burden associated with PA requirements and support the advancement of interoperability. 2. The legislation requires the Secretary of the Department of Health and Human Services (HHS) to establish and routinely update a list of items and services eligible for real-time decisions under the MA ePA program, taking into consideration current medical practice and technology, healthcare industry standards, and other relevant factors. Standardizing and streamlining the prior authorization process for routinely approved items and services would significantly reduce the amount of unnecessary time and effort spent on PA requests. 3. The legislation requires PA requests to be reviewed by qualified medical personnel. Approval or denial of PA requests can greatly affect the health and well-being of vulnerable Medicare beneficiaries, and such determinations should be made only by those with appropriate training and expertise. 4. The legislation contains provisions that increase transparency around the PA process by requiring MA plans to provide certain data and information to the Centers for Medicare & Medicaid Services, providers, and beneficiaries. For instance, the transparency provisions require MA plans to provide detailed data on the applicability of PA requirements for covered items and services, the rate at which PA requests are approved, how PA appeals and denials are adjudicated, and other relevant data that will help government officials and stakeholders evaluate the benefits and drawbacks of PA requirements with greater precision. 5. The legislation requires HHS to engage in rulemaking to protect beneficiaries from care disruptions caused by PA requirements as they transition between MA plans. Such protections will prevent Medicare beneficiaries from experiencing treatment delays when they exercise their right to change MA plans in accordance with current law. Evidence suggests that targeted, meaningful improvements to the MA prior authorization process could improve administrative efficiency and patient health outcomes. Physicians routinely cite prior authorization as both a top administrative
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MEDICAL/LEGAL CONTINUED FROM PREVIOUS PAGE
burden and a top barrier to providing patients with timely medical care. For instance, survey data has found that 94% of physicians experience at least some delays in delivering treatments to their patients because of PA requirements. Additionally, 79% of physicians report that PA requirements have caused patients under their care to abandon their recommended courses of treatment. Moreover, 30% report that PA requirements have caused a patient under their care to experience a serious adverse medical event, such as being hospitalized or requiring emergency medical intervention. Finally, PA requirements consume 16 hours per week of physician time on average, and 85% of physicians describe the burden of PA requirements as “high” or “extremely high.”i The FMA believes HR 3173, through the provisions outlined above, would reduce this kind of harm and waste within the MA program and help ensure that the 26 million Medicare beneficiariesii enrolled in MA plans receive the prompt, appropriate medical care they are entitled to. HR 3173 would have an especially significant impact in Florida. Our state is home to more than 4.6. million Medicare beneficiaries, just over 50% of whom are enrolled in an MA planiii. Additionally, the impact of this legislation will almost certainly grow over time. According to research conducted by Florida officials, people ages 65 and above are projected to represent 24.3% of the state population in 2030, compared to 20.4% todayiv. Moreover, the proportion of Medicare beneficiaries enrolled in MA plans has grown steadily over the past 16 years, and the Congressional Budget Office projects continuation of this trendv. The Improving Seniors’ Timely Access to Care Act of 2021 represents an opportunity to enact significant, urgently needed reforms that will reduce unnecessary administrative waste and improve care for the majority of Medicare beneficiaries in Florida and nationwide.
2020 AMA prior authorization (PA) physician survey, American Medical Association Medicare Advantage in 2021: Enrollment Update and Key Trends, Kaiser Family Foundation iii Id iv Florida: An Economic Overview, Dec. 30, 2020, The Florida Legislative Office of Economic and Demographic Research v Medicare Advantage in 2021: Enrollment Update and Key Trends, Kaiser Family Foundation i
ii
Reprinted with permission by the Florida Medical Association 12
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
ALLIANCE CORNER
A MESSAGE FROM THE PRESIDENT Happy Summer! Thank you all for your interest and support so far this year. It has truly been a gift to gather with old friends and welcome new ones over the last few months. I hope that you will continue to engage, as we have exciting plans for the remainder of the year. In February, we gathered at Lee’s Place to hear more about their story and involvement in Tallahassee. We also presented them with a $1,500 check.
In March, we held a play date at Tekesta Park with physician families from the Capital Medical Society, and soon after, we met with Dr. Sandeep Rahangdale and the third-year FSU College of Medicine Tallahassee Regional Campus students. At the FSU meeting, we also had the opportunity to hear from Dr. Maria Pouncey of the Panhandle Educational Consortium and took a tour of the new regional campus. In late March, our Celebration Awards Dinner committee gathered to put together some beautiful floral arrangements for this annual event.
In April, the scholarship committee honored three outstanding registered nursing students who plan to work in Tallahassee or the Big Bend area. We enjoyed meeting these students at our scholarship luncheon and presenting Carina Valencia with $2,000, Andrew Maldonado with $1,000, and Alyssa Szorcsik with $1,000. TC Federal Bank representatives sponsored this luncheon and presented these students with flowers. In mid-April, we met at Cascades for a short walk to support Florida Medical Association Alliance’s Walk for Wellness program. We also enjoyed connecting with members of CMS at their Catch My Stride! event at the Tallahassee Museum. We finished our spring semester with a brief viewing of the TMH Northeast Emergency Respite Room.
Thank you to the amazing executive board members, committee chairs, and committee members for all the work that they have done to make our spring and fall programs successful. We plan to continue giving with CMSA during our break. Thank you all for your time and engagement.
Warmly, Codie Bryant CMS Alliance President
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VIEWPOINT
BOOK REVIEW: EMPIRE OF PAIN BY PATRICK RADDEN KEEFE By Frank Skilling, M.D. The tragedy, and it’s fully that, of the ongoing opioid crisis can be placed at the feet of one family: the Sacklers. There is no other conclusion possible after one reads Empire of Pain. From the perspective of the author, if it hadn’t been for the Sacklers in their unique position atop a small pharmaceutical company that developed, promoted, and sold OxyContin®, the public health scourge our nation is living with would not have happened. There is a lot of blame to go around in this epidemic of preventable addiction and deaths, but the Sacklers are primarily responsible. A succinct explanation might be: No Sacklers, No OxyContin®, No Opioid Crisis. Patrick Radden Keefe, a staff writer of The New Yorker and author of previous award-winning Say Nothing, has tackled the history of a family that recapitulates the American Dream played out over four generations. From their parents’ start as immigrants, the second generation Sacklers became doctors, entrepreneurs, advertisers and, most importantly, owners of a small pharmaceutical firm. After acquiring the patent rights to a long-acting opioid, their familyowned company began a campaign to treat a previously unknown condition of “chronic pain.” Claiming that thousands of Americans were suffering from such pain, the company’s promotion meshed with the new goal of treating pain as the “fifth vital sign.” The latter was an indicator that gained traction with the American Hospital Association in promoting the treatment of pain in hospital settings. Using persuasive marketing that targeted physicians, the family-owned Purdue Pharma pushed the outpatient use of long-acting opioids by mostly primary care providers. Their sales reps claimed that the long-term use of OxyContin® didn’t cause addiction. Purdue’s sales personnel blanketed the country promoting the product and its successors, always with patent protection. With cunning maneuvers, Purdue co-opted the FDA and circumvented the normal approval processes required for narcotics. Some high-ranking FDA administrators who had signed off their approval of Oxycontin® even obtained lucrative positions with Purdue after leaving their governmental supervisory positions. Meanwhile, state boards of medicine were limited by statute and administrative procedures from investigating and closing the “pill mills” which sprang up, first in the mid-West, and later in Florida. The major pharmacy chains, including CVS, were also complicit in supplying opioids they knew were being over-prescribed or diverted into criminal drug rings. 14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
As investigations progressed, the Sackler family “lawyered up,” and used their clout at state and federal levels to conceal their involvement with the crisis. The only felony convictions were of two corporation officers, neither a family member, who “took the fall” to prevent the Sacklers from being directly implicated. After pleading guilty to minor federal drug infractions, they were barred from future positions in the pharmaceutical industry. Both were rewarded with extensive “retirement” packages. Even as one of the second generation Sacklers was pushing Purdue salespeople for more growth, the family denied knowing about the crisis or accepting any responsibility for it. The latest development is the six-billiondollar settlement with various states that the family has agreed to without accepting responsibility. As befits the desire for legitimacy by their family, the Sacklers donated enormous sums to various universities and national charities for recognition by having buildings named after the family. The “Sackler Wing” was prominent in the National Gallery of Art in Washington, D.C. While the Sackler immigrants started out with the concept that they must always preserve their good name, the attempt by the second-generation physician entrepreneurs to buy their exalted status and the family’s place in history through philanthropy is now being reversed. Institutions like New York’s Metropolitan Museum of Art and Yale University are removing the Sackler name from their buildings, and some universities are no longer accepting donations. The younger Sackler generations feel that they shouldn’t be stigmatized because they were not directly involved, but Keefe makes a strong point that there is plenty of blame to go around for all generations. The Sackler family has shown no remorse for its actions even as survivors of victims have faced them in open court. In the 1970s, the ophthalmology department at the University of Miami held grand rounds that were open to all members of the local medical community. I vividly remember Dr. Ed Norton, who was always known as “The Chief,” telling a group of local ophthalmologists, “If you lose your good name in this community, you will never regain it.” Reading Empire of Pain reminded me of Mario Puzo’s The Godfather, published over 50 years ago. The similarities of an immigrant family that turned to crime and then used its great wealth to gain acceptance in society is overwhelming. The big difference is that the Corleone family killed its rivals, but the Sackler family killed its customers. It is unlikely that the multi-billiondollar settlement will wash the blood off their hands or restore honor to the family.
SIMPLER TIMES
LITERACY AIN’T EVERTHANG By Charles D. Williams, M.D., FACR, FAAP (“Pedro”) This I don’t understand. Recently I read this in a newspaper: “Current market valuations coupled with increasing volatility has expanded option premium and created substantial opportunity in the option market for those investors and speculative risk tolerance and basic understanding of options.” I read it again and again. Still I don’t understand. It seems to me that some folks git educated beyond their intelligence and use big words and hard words to sound uppity and to confuse us. Many of my folks weren’t educated but literacy ain’t everythang and sometimes it complicates thangs. Even though my Dad wudn’t educated, I did understand him. Once Dad said, “Since I ain’t educated, I’ll have to use my head.” What I remember most about growing up in Moultrie was the people and their smiles, their handshakes, their compassion in times of need and their strength in times of trial. But it was in their simple words that I received samples of their wisdom. There was something remarkable about their understanding of the most complex circumstances. These difficult problems were made simple by just a few simple words, well chosen. From Daddy I heard: “You’re only as good as your word. Trust comes from your hand. You give a man your hand and it’s good as done.” At least Dad’s word and others like him meant more than all those complicated fancy words you could put on paper or in a contract and at least you could understand them. These folks with simple words did know about respect, honesty, fairness, and hard work.
dogs, gits up with fleas; and when the horse dies, it’s time to git off.” I can imagine an over educated intellect taking phrases like beauty is only skin deep and saying pulchritude possesses solely cutaneous profundity or phrases like birds of a feather flock together and saying members of an avian species of identical plumage congregate or phrases like as the ball bounces and saying thus is the erratic manner and direction in which the resilient spheroid exhibits its’ compressive elasticity when propelled against a surface. “Pek” Gunn, post laureate of Tennessee once said: “Once I used high sounding phrases But one day at last I found Truth in story simply stated Renders it no less profound” Once Daddy said, “Pedro, if you sass your Mama, don’t mind yore teacher and don’t do yore homework, I’m goin to take you out behind the barn and skin you alive.” This I understand.
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 $40,000 for the CMS Foundation’s We Care Network.
Grandma also used simple words and phrases which have stuck with me over the years. Phrases like: “There’s no right way to do a wrong thing; play with fire and you git burned; whoever lies down with
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DONATE TO THE CMS FOUNDATION
We Thank Our Donors We thank the following donors who made a gift to the CMS Foundation this past month:
We Care Network Anonymous – to purchase dentures through the We Care Network Dental Patient Assistance Fund Dr. and Mrs. Charles D. Williams – for More Simpler Times We Care Network Ensure Nutritional Shake Drive Aribah Ahmed Anonymous Elaine Geissinger Drs. Robert and Linda Miles Dr. and Mrs. Shawn Ramsey The Julia Revell St. Petery, M.D. Scholarship in Pediatrics Endowment – In Memory of Dr. Julia St. Petery Dr. and Mrs. D. Paul Robinson The Charles D. “Pedro” Williams, M.D. Scholarship Endowment Dr. and Mrs. Charles D. Williams – In Honor of Peter E. Loeb, M.D.
Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend. 16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
DONATE TO THE CMS FOUNDATION
The Impact of Private Support: 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 $120.7 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 2020-21, which ended June 30, 2021, more than $8.4 million in healthcare 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 CMS Foundation 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. $44,000 was awarded in 2021. An additional $1,500 was awarded from The Anesthesiology Associates of Tallahassee Scholarship Endowment. ➢ 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 2021, the CMSF awarded a total of $15,000 in grants to Elder Care Services for their In-Home Services Program, the Big Bend Hospice Foundation for bereavement services, and to Lighthouse of the Big Bend for aids for the visually-impaired. 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) The Capital Medical Society Foundation – Area of Greatest Need 2) The Capital Medical Society Foundation General Endowment 3) We Care Network 4) We Care Network Endowment 5) The Ronald G. Pickett Endowment 6) The CMS Foundation Physician Wellness Fund 7) The CMS Foundation Scholarship Fund 8) The Anesthesiology Associates of Tallahassee Scholarship Endowment 9) The Julia Revell St. Petery, M.D. Scholarship in Pediatrics Endowment 10) The Julia Revell St. Petery, M.D. Scholarship in Pediatrics Fund (unendowed) 11) The Charles D. "Pedro" Williams, M.D. Scholarship Endowment Gifts should be made payable to the CMS Foundation. 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: Pam Irwin Executive Director pirwin@capmed.org or (850) 877-9018 or (850) 559-8611 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS FOUNDATION: WE CARE NETWORK
Amanda Stephens, D.O. Ronald Sullivan, M.D. Christopher Sundstrom, M.D. John Thabes, M.D. Ernesto Umana, M.D. Beatriz Cepeda Valery, M.D. Kaisa van der Kooi, M.D. David Vermess, M.D. Tony Weaver, M.D.
THANK YOU To our CMS members and We Care Network partners who provided healthcare to new patients in April 2022. Your generosity and support of the We Care Network makes a difference. Physicians Christopher Babl, M.D. Clifton Bailey, M.D. Marie Becker, M.D. David Bellamy, M.D. Eric Berenson, M.D. Michael Bernhardt, M.D. Viet Bui, M.D. David Burns, M.D. Carlos Campo, M.D. Raymond Cottrell, M.D. Marilyn Cox, M.D. Chesley Durgin, M.D. Jerry Ford, M.D. Alexander Franz, M.D. Hong Gao, M.D. Romyll Garcia, M.D. W. Harris Green, M.D. Okanta Jackson, M.D. Fang Sarah Ko, M.D. Amulya Konda, M.D. Maribel U. Lockwood, M.D. Kurt Luhmann, M.D. Megan March, M.D. Hector Mejia, M.D. Christopher Murphy, D.O. Thomas Noel, M.D. Mitchell Peabody, D.O. Jorge Perez de Armas, M.D. James Renehan, M.D. Pablo Rengifo-Moreno, M.D. Tim Ruark, M.D. Jamey Sarvis, M.D. Gadi Silberman, M.D. Joshua Somerset, M.D. Robert Steinmetz, M.D.
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Dentists Jean-Pierre Bastien, D.M.D. Brittney Craig, D.M.D. Walter Colón, D.M.D. Alan Dransfield, D.M.D. Ben Grooters, D.D.S. Aixa Guzman, D.M.D. William McFatter, D.D.S. Russell Walther, D.D.S. Facilities Advanced Urology Institute Airway Works, LLC Anesthesiology Associates Apalachee Bay Family Dental Apalachee Primary Care Bastien Dental Care BioTelemetry, Inc. Bond Community Health Center Brittney K. Craig, DMD Capital Eye Consultants, PA Capital Periodontal Associates Care Point Health & Wellness Center CESC Dental Clinic Dermatology Associates Digestive Disease Clinic Enhanced Endodontics Eye Associates of Tallahassee Florida Cancer Specialists & Research Institute Gadsden County Health Department HCA Florida Capital Hospital Cancer Center HCA Florida Capital Primary Care Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Madison Medical Center Neighborhood Medical Center North Florida Women’s Care North Monroe Medical Center Periodontal Associates of North Florida Radiology Associates of Tallahassee Red Hills Oral & Facial Surgery Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Diagnostic Imaging
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Tallahassee Ear, Nose, and Throat Tallahassee Enhanced Care Tallahassee Memorial HealthCare Tallahassee Memorial HealthCare Family Medicine Residency Program TMH Physician Partners Cancer and Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Heart Rhythm Clinic TMH Physician Partners Hospitalists Group 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 TMH Wound Healing Center Tallahassee Orthopedic Clinic TOC Canopy Tallahassee VA Clinic Vascular Surgery Associates Wakulla County Health Department Wakulla Medical Center Womens Clinic Women’s Imaging Center
Please contact Diana Bixler at dbixler@capmed.org or 201-0130 if you are a We Care Network volunteer and you provided volunteer specialty care in the month of April 2022, 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 April 2022:
Ebonie Allen, APRN
Ben Grooters, D.D.S.
Charlie Richardson, M.D.
Briano Allen, D.D.S.
Hantz Hercule, M.D.
Carla Robertson, APRN
Anne Ananga, APRN
Amit Jain, M.D.
Andres Rodriguez, M.D.
Jonathan Appelbaum, M.D.
Anneka Johnson, APRN
Tim Ruark, M.D.
Aaron Appiah, M.D.
Keyla Juszczyk, APRN
Karen Russell, M.D.
Megan Bassett, APRN
Stefanie Kreamer, M.D.
Expedito Salvador, P.A.
Jean-Pierre Bastien, D.M.D.
Elaine Larkins, APRN
Lucilita Salvador, P.A.
Kendra Brady, APRN
Jessica Lea, APRN
Kyla Shillington, APRN
Sherry Bramblett, APRN
Ashok Manocha, B.D.S.
Benjamin Shivar, P.A.
Daniel Breivogel, APRN
Ovidiu Marina, M.D.
Gadi Silberman, M.D.
Fran Bridges, APRN
Damon McMillan, M.D.
Joshua Somerset, M.D.
Patrick Brown, M.D.
Marie Methellus, APRN
Bhavik Soni, M.D.
Viet Bui, M.D.
Kelley Miller, APRN
Anthony Speights, M.D.
Efrein Carbonell, M.D.
Marcia Morris, APRN
Alanna Steaple, APRN
Carlos Castro, M.D.
Manoela Mota, M.D.
Franckel Taylor, APRN
Stephanie Chandler, APRN
Jayan Nair, M.D.
Faye Tinson, APRN
Victor Chou, D.M.D.
Thomas Noel, M.D.
Ernesto Umana, M.D.
Melba Colon-Renta, M.D.
Abiodun Ogunremi, APRN
Ramona Vossler, RDH
Walter Colon, D.M.D.
Chukwuma Okoroji, M.D.
Leonard Waldenberger, M.D.
Jill David, APRN
Rose Origa, APRN
Jeffrey Wasserman, D.O.
Nathalie Esellem, APRN
Paresh Patel, M.D.
Eula Weaver, APRN
Alberto Fernandez, M.D.
Mitchell Peabody, D.O.
Shana Wood, APRN
Sharron Foster, M.D.
Jorge Perez de Armas, M.D.
Dale French, D.O.
Lisa Perkins, APRN
Judy Griffin, APRN
Brandi Richardson, APRN
DURING THE MONTH OF APRIL 2022, THE WE CARE NETWORK: RECEIVED 201 REFERRALS, WITH 116 PATIENTS NEW TO THE PROGRAM
SCHEDULED 64 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$270,719 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
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Cap Scan Newsletter 1204 Miccosukee Road Tallahassee, FL 32308
Happy ! r e m m Su
