OCTOBER EDITION, VOLUME 2014, NO. 10
CMS Meet the Candidates Reception By Shannon Boyle, CMS Communications and Marketing Coordinator
Capital Medical Society’s Meet the Candidates Reception was well received by all who attended on September 3rd. The Goodwood Carriage House provided a perfect venue for almost 80 physicians, dentists, and spouses to hear from an impressive group of candidates, incumbents, and winners of the primary election. In attendance were: Mayor of Tallahassee Andrew Gillum Tallahassee City Commission – Seat 2 Curtis Richardson Leon County Commission – District 1 Weser Khufu Leon County Commission – At Large, Group 2 Curtis Baynes Nick Maddox Florida Attorney General Bill Wohlsifer (LPF) Florida House – District 7 Halsey Beshears (REP) Florida House – District 8 Alan Williams (DEM) U.S. Congress Florida – District 2 Gwen Graham (DEM) Steve Southerland (REP)
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Dr. Alfredo Paredes, CMS President, presided over the program. He thanked our sponsors – Presenting Sponsor, FMA PAC, and Supporting Sponsor, Hancock Bank. Dr. Paredes explained that Capital Medical Society does not endorse candidates and is not a Political Action Committee. The evening’s program was not a fundraising event, but simply an opportunity to become acquainted with the local and state candidates. All the candidates in each of the races represented in the program were invited to attend. Each candidate was asked to address one of the questions related to their race, in three minutes or less. The questions were developed by the Steering Committee for the Meet the Candidates Reception, made up of CMS physicians, and were felt to represent key issues of importance to the practice of medicine. Candidates were provided with the questions in advance.
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1: Our Presenting Sponsor, FMA PAC: (l-r) Lauren Byrd, Sara Griner, Cindy Tyler, and Sarah Hickman.
2: Our Supporting Sponsor, Hancock Bank: (l-r) Debra McClellan, Brent Garrison, Diana Cureton, and Abby Smith.
3: Gentle Littles, Dr. Alma Littles, and Dr. Victoria Te with Mayor-elect, Andrew Gillum (second from right).
4: CMS President and emcee for the event, Dr. Alfredo Paredes, with Dr. Richard Thacker, who is on the Meet the Candidates Reception Steering Committee and is the CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1 originator of this event six years ago.
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
BOARD OF GOVERNORS Alfredo Paredes, M.D., President Joshua Somerset, M.D., President Elect J. Daniell Rackley, M.D., Secretary/Treasurer Nancy Loeffler, M.D., Immediate Past-President Robert Chapman, M.D. Garrett Chumney, M.D. Tracey Hellgren, M.D. Zan Batchelor, CMS Alliance President Vikki McKinnie, M.D. Hector Mejia, M.D. Margaret Havens Neal, M.D. Philip Sharp, M.D. Timothy Sweeney, M.D. Ernesto Umaña, M.D. Pam Wilson, Executive Director Family Medicine Residents William Carlson, M.D./Anna Hackenberg, M.D. Internal Medicine Residents Chris Rosadzinski, M.D./Prerna Satyanarayana, M.D.
PUBLICATION EDITOR Charles E. Moore, M.D.,
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Young Design
I N T H I S I SS U E :
CMS FAMILY FUN NIGHT
1 4 5 6 7 8 9 11 14 18 19 22 23
HAPPY BIRTHDAY! {OCTOBER BIRTHDAYS}
William Donnellan, Jr., M.D. – 2nd Andra Prum, D.O. – 2nd Lisa Cook, M.D. – 4th Roy Forman, M.D. – 4th Adrienne George, M.D. – 5th Kris Stowers, M.D. – 6th L. Steve Sarbeck, M.D. – 10th Tony Weaver, M.D. – 13th Jyotsna Dalal, M.D. – 14th Sandeep Rahangdale, M.D. – 14th Eliot Sieloff, M.D. – 14th Pat Woodward, M.D. – 16th
Scott Tetreault, M.D. – 22nd Patrice Bidwell, M.D. – 23rd Michael Wilhoit, M.D. – 23rd Stephen Richardson, M.D. – 24th H. Logan Brooks, M.D. – 25th David Dixon, D.O. – 25th Brewster Caldwell, D.O. – 26th Shaun Laurie, M.D. – 27th Kenneth Wasson, M.D. – 29th J.W. Richard Davis, M.D. – 30th Tom Hicks, M.D. – 31st
Happy Birthday! We are so glad you were born!
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at cmoore5186@aol.com and Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing. Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society. If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you. 2
CMS Meet the Candidates Reception CMS Foundation Holiday Auction CMS Foundation Scholarships CMS Lunch & Learn CMS Meetings Calendar CMS Alliance Reflections from the Editor Medical/Legal A Message from FSU COM Graduate Medical/Legal Book Review CMS Foundation CMS Foundation: We Care Network
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Did we miss your birthday? If so, please email Rosalie Carlin at rcarlin@capmed.org!
CMS MEET THE CANDIDATES RECEPTION
County Commission & City Commission & Mayoral 1. Explain how you have the skill set to help our profession? 2. How would you place healthcare on your priority list for County / City funding? 3. How can you help physicians and dentists provide better access to care for Leon County’s uninsured patients? State Representative & Senate & Attorney General 1. A bill passed in the House this past session that would have significantly expanded the scope of practice for nurse practitioners. What is your position on the continued debate in Florida to expand the “scope of practice” of nurse practitioners, allowing them to practice independently, without a supervising physician; prescribe controlled substances, and involuntarily institutionalize patients with mental health issues? Since this expansion is often justified as a means of increasing access to care, what other solutions do you recommend to meet access to care needs in Florida? 2. At its annual meeting in July of this year, the Florida Medical Association passed a resolution supporting Medicaid expansion, as long as the program “safeguarded patient access to care” by increasing physician payments to the same level as those paid by Medicare? What is your position on this resolution? 3. In March 2014, the Supreme Court invalidated medical liability caps in wrongful death causes of action that had been enacted to help stabilize the medical liability climate in Florida. The Florida Office of Insurance Regulation recently reported that between the years of 2003 and 2010, there were four insurance companies that offered medical malpractice insurance in Florida that cumulatively reported an increase in their net income of more than 4300%. What legislative strategy do you propose to bring medical liability insurance company profits in the state of Florida in line with other states and to proportionately reduce medical liability premiums? What do you suggest for a balanced system of tort reform?
Congressional 1. Now that the majority of the Affordable Care Act has been upheld by the Supreme Court, what specifically do you believe are its good points and what do you view as its bad points? What proposed solutions do you recommend to resolve those issues? 2. In 1997, Congress adopted the Sustainable Growth Factor (SGR) formula to reimburse physicians for Medicare patients. The current deadline for allowing the accumulated effects the SGR formula is March, 2015. What is your plan to repeal the SGR and replace it with an equitable and a cost basis formula for treating Medicare patients? The resulting comments and discussions before, during, and after the program were lively and informative – and, most importantly, focused on issues of importance to physicians. Our own Mollie Hill kept the speakers on time, and we conducted a straw poll ballot with the results sent to CMS members after the event. We thank our sponsors for making this event possible: Presenting Sponsor
FMA PAC Supporting Sponsor Hancock Bank Thank you to the Steering Committee for the Meet the Candidates Reception: Alfredo Paredes, M.D., Chair Andy Borom, M.D. Tracey Hellgren, M.D. John Katopodis, M.D. Alma Littles, M.D. Josh Somerset, M.D. Louis St. Petery, M.D. Richard Thacker, D.O. Hugh VanLandingham, M.D. Pam Wilson, Executive Director
CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
CMS FOUNDATION HOLIDAY AUCTION
Holiday Auction – The Best Party of the Year Will Be Here Soon! By Shannon Boyle, Communications and Marketing
The best party of the year is almost here!
Mark Your Calendar for the CMS Foundation Holiday Auction Thursday, December 4, 2014 • 6:30 pm University Center Club at Florida State University 1 Champions Way – Doak Campbell Stadium We will have electronic bidding again this year using BidPal! Kick off the holiday season, enjoy a fun evening with friends, and get your holiday shopping done early – jewelry, original artwork, autographed sports memorabilia, gift certificates, and much more! Call CMS at 877-9018 if you have an item to donate for the auction. We are happy to answer any questions & arrange for pick up! Proceeds benefit all programs of the CMS Foundation.
Invitations will be mailed in November. Auction Steering Committee: Scott Sellinger, M.D., Chair Shannon Boyle Jana Bures-Forsthoefel, M.D. Robert Campbell, M.D. Rosalie Carlin David Jones, M.D. John Mahoney, M.D. David Miles, M.D. Tony Weaver, M.D. Barbara Williams, M.D. Pam Wilson
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Coordinator
The Capital Medical Society Foundation is gearing up for this year’s Holiday Auction! After hearing rave reviews from last year’s attendees, it will be held at the same venue, the University Center Club at Florida State University (Doak Campbell Stadium). You don’t want to miss it! Mark your calendars – December 4 at 6:30 pm. Be on the lookout for your invitation in November! The Holiday Auction is the Capital Medical Society Foundation’s annual fundraising event for the CMS physicians and their spouses. Last year, the Auction raised over $63,000. All money raised at the Holiday Auction is used to help support the CMS Foundation, including the We Care Network and FSU College of Medicine medical student scholarships. Here is how you can help make the Holiday Auction a success: 1. Plan to attend. Mark the Holiday Auction on your calendar. We want everyone to attend. The entrance fee is $100 per couple. You will receive an invitation in November. 2. Be an Individual Sponsor. Support the CMS Foundation with a $100 tax-deductible donation. We will publish the names of our individual sponsors in our marketing materials. 3. Donate an item for the Auction. Do you have an item that you would like to donate? Call the CMS office at (850) 877-9018. 4. Give a Physician Group Sponsorship. If you belong to a large physician group practice, we encourage you to be a corporate sponsor. The donations and group practices will be listed in all our marketing materials, along with our local business sponsors. Your fellow physicians ask that your group become a sponsor at either the $500 or $1,000 level. These request letters have been mailed. CMS
CMS FOUNDATION SCHOLARSHIPS
CAPITAL MEDICAL SOCIETY FOUNDATION AWARDS $40,000 IN SCHOLARSHIPS TO FSU MEDICAL STUDENTS The Capital Medical Society Foundation awarded scholarships to nine students in their first or second year of medical school at the Florida State University College of Medicine. Dr. Frank Walker presented the scholarships to each of the recipients at the Capital Medical Society Membership Meeting at the Maguire Center for Lifelong Learning at Westminster Oaks on September 16. A committee comprised of Capital Medical Society members and chaired by local pediatrician, Dr. Frank Walker, chose the scholarship recipients. “Attending medical school is a very expensive proposition these days. My fellow physicians are pleased and proud to help support medical students, who have not only a financial need, but a desire to stay in Florida and practice medicine in Florida,� said Dr. Walker.
Medical Society Foundation more than 30 years ago. The Capital Medical Society Foundation will host their annual fundraising event, the Holiday Auction, in December to raise funds for these medical school scholarships. The 2014 scholarship recipients are: Allison Ellis, Jennica Hagberg, Samuel Muniz, William Nimmons, Nwamaka Onyeozili, Chirag Patel, Thomas Shakar, Drew Williams, and Israel Wootton. CMS Past and present scholarship recipients (l-r): Dr. Christie Alexander (2001) and Allison Ellis (2014).
The scholarship fund has been one of the most successful and well-respected programs established by the Capital
Scholarship recipients: (l-r) Israel Wootton, Thomas Shakar, and William Nimmons.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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LUNCH AND LEARN
LUNCH & LEARN “Managing Stress in the Medical Practice” On September 17th, Tracey Morse, Ph.D., Licensed Psychologist, gave an excellent program on “Managing Stress in the Medical Practice”. You can reach Ms. Morse at (850) 556-7944.
CAPITAL MEDICAL SOCIETY LUNCH & LEARN FALL 2014 Capital Health Plan, 1491 Governors Square Boulevard Wednesday, October 22, 2014 “Medical Records: Handling Subpoenas;
Tallahassee State Bank sponsored the September 17th Lunch and Learn. Sharon Weeden, Ben Graybar, and Mary Colonese were in attendance as representatives of Tallahassee State Bank. You can reach Ms. Weeden at (850) 205-5161 or sharonweeden@talstatebank.com.
Charging for Copies” Hear about the costs for reproduction of medical records and handling medical records subpoenas. Speakers: Allison Dudley, J.D., Florida Board of Medicine Executive Director, and Lontejuana Cooper, PhD,
This seminar was held at the Capital Health Plan on Governor’s Square Blvd – and we thank them for providing this lovely venue.
RHIA, CPM, FAMU Health Informatics and Information Management Program Sponsor: Centennial Bank
Wednesday, November 19, 2014 “Local Solutions to HIPAA Secure Communications” Do the new Transition of Care and Meaningful Use requirements that are required for all offices, regardless of size, have you confused? Do you know how Interfacing, DIRECT Protocols, HISP, HealtheWay, and HIE apply to those requirements? We’ll show you how our set of Care Coordination tools tame these new standards while providing you with a simple HIPAA Our speaker, Tracey Morse, Ph.D.
compliant replacement to phone/fax/mail paper communications. Beyond this, there will be helpful tips for those striving for meaningful use compliance. Speaker: Zach Finn, HIE Networks Sponsor: Tallahassee State Bank
TIME: 12 NOON TO 1:30 PM (SEMINARS START AT 12:30 PM) PLACE: CHP AUDITORIUM, 2ND FL., 1491 GOVERNORS SQ. BLVD. COST: $10 PER SEMINAR/PER PERSON. YOU CAN RSVP FOR ALL SEMINARS, OR ONE AT A TIME!
FOR MORE INFORMATION AND TO REGISTER, CALL ROSALIE CARLIN AT 877-9018. Our sponsor, Tallahassee State Bank – (l-r) Mary Colonese, Ben Graybar, and Sharon Weeden.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS MEETINGS CALENDAR
2014 MEETINGS CALENDAR October 21, 2014 CMS Membership & CME Meeting “Caring for Patients Impacted by Interpersonal Violence” 2 Hour Required CME Suzanne Harrison, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 18, 2014 CMS Membership & CME Meeting “Women’s Health” David Dixon, D.O. and Stephanie Lee, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
December 4, 2014 CMS Foundation Holiday Auction 6:30 pm FSU University Center Club
Meet with Dr. Dussia on November 8, 9 AM at Goodwood Plantation learn how clinicians can use the strategies of the rich to acquire assets and protect them. Meet experts on financial planning, banking and asset protection. Go to FinancialIntelligenceforClinicians.expert to register for a day of applicable knowledge about money and how it affects medical practitioners. There are scholarships available for medical residents and medical students.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
CMS ALLIANCE
On September 8, 2014, CMS Alliance members, Melissa Inglese, Sarah Ho, and Zaneta Batchelor, presented a $500 check to Pam Wilson for the 2014 CMS Foundation Holiday Auction. We thank the CMSA for their support.
On September 24, 2014, the CMS Alliance presented a $900 check to Nigel Allen, Executive Director of Big Bend Hospice Foundation, in memory of Jean McCully. Pictured: (l-r) Hien Guyer, Amy Pagano, Sarah Ho, Melissa Inglese, Nigel Allen, Zaneta Batchelor, and Tracy Morales.
C M S A l l i a nce Fa mi l y F un Day • Recognizing New Mem bers Saturday, November 1, 2014 10:00 am – 2:00 pm
Maclay Gardens State Park Food! Family Fun Activities! No participation fee except $6.00/vehicle park entrance fee
RSVP to cneelyo@yahoo.com 8
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
REFLECTIONS FROM THE EDITOR
THE GUNS OF AUGUST. SERIOUSLY By Charles Moore, M.D.
Who has not read Barbara Tuchman’s book? Few, I dare say, who read this. And here we are, an exact one hundred years later. As I write this, about the middle of the month, I ask myself “who needs the killing of an obscure Archduke of Somewhere to start a war that will end up with the loss of 15 million lives, three empires, and a good deal of civilization?” The downing of flight 17 might be another sort of means, with its loss of 298 ordinary, non-Ducal people. The Germans had their very carefully fabricated “Schlieffen Plan,” which having spent so much time devising, they then, being pragmatists and not wanting to waste a good plan, had to use. Poor Belgium. Poor France. And England, who in some obscure treaty signed I think sometime in the 1880s was bound by it to defend Belgium. As someone said, and as everyone knows, how easy to start a war, and how impossible to stop it. This August we have, of course, “The Putin Plan.” Humiliated by the loss of the Soviet Imperial boundaries, and even further by our own “cock-a-doodle-doing” that we had won the Cold War, Putin has been almost understandably broody. Russia humiliated is not an entity, as history shows, to be readily dismissed. Their humiliation, much to the same degree as Germany’s by the Versailles treaty, demands action and retribution. So comes Putin, somewhat as Hitler. But Putin learned a good lesson from der Fűhrer: Don’t invade a country all at once, right now, and get everyone overly excited, but do your invading piecemeal, bit by bit, denying all, and allowing the world to adjust to what you are doing by easy degrees; and so conquer at your leisure. Never mind this ISIS bunch or the Israeli-Palestinian war of words and weapons, which are whole further equations. I am only hoping you will indulge my desire to shed a certain tear on your shoulder. Good old Cap Scan, so tolerant, after all, of any written word including my own, and cheaper to spill the beans to than a Shrink, bless ‘em, too.
Perhaps, over these past years I should have written something here about my wonderful, annual, and sometimes biannual experience going to “The Republic Children’s Hospital” in Simferopol, once scarcely heard of but now become better known as being the capital of what was “The Autonomous Republic of Crimea.” Come to think of it, though, there are a number of you out there who may remember when Dr. Alexander Astakov, the CEO and Medical Director of that hospital, visited Tallahassee early in 2008. We tossed him a nice party at Jubilee Cottage, Goodwood, with various notables present, including even Mr. O’Bryant. Dr. Alexander, who’s English is limited but far better than our Russian, made a very graceful speech, even in translation, thanking Mr. O’Bryant for the medical equipment and supplies that TMH had so generously given his hospital, so much in need of so much. Dr. Alexander Astakov making a point.
Wine and a little vodka was slung about, the latter condescendingly Russian, for as winners of the Cold War it was the least we could do to encourage the Russian economy toward a more enlightened Capitalism and, furthermore, demonstrate that we were all, now, good drinking buddies. Sadly, I now look upon my bottle of Stolichnaya critically, guiltily, thinking that with every martini I make using it I am aiding and abetting the onceagain enemy. I mourn that Russia, and Mr. Putin, now seem so sadly so. I mourn the cessation of my ventures to Crimea, in the company of the five other surgeons who gave of their time and treasure, coming along to do their bit of magic on a charming motley of orphans much in need of their expertise. Look, I do not pretend, because of those nine or ten trips I have made to Crimea, to present myself as any “expert” on the area. But I did learn the Russian alphabet, CONTINUED ON PAGE 10
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
REFLECTIONS FROM THE EDITOR
and could declaim in the original a whole stanza of Pushkin’s “Eugene Onegin,” fully rewarded with much laughter over my accent. I have been to Sevastopol and its fabulous harbor, visited Balaclava, (“Charge of the Light Brigade”) where I was amazed to see the Soviet built submarine pens (totally abandoned, but I dare say soon to be reactivated) deeply dug beneath a mountain looming beside the bay. I have been to a brilliant piano concert in Simferopol. I have visited Yalta a few times, and admired the beauty of that coast line. I enormously enjoyed being a lecturer at the Crimean State University Medical School, where English is the second language. I have made friends of surgeons and nurses in the hospital. At every juncture we were all of us treated with a welcoming, delightful smile; and the banquet and toasts at the end of our stays, laced with real vodka, are not to be forgotten. We had established such a rapport between ourselves, Americans, and them, CrimeanUkrainians. The generosity and warmth of our team was as much appreciated as we Svetlana Astakov appreciated the generosity and warmth of and I have a beer. theirs, the doctors and nurses, and so many who had so welcomed us. The language barrier made hardly a difference. The children were our bond, along with the smiles, and the sharing of experiences from which we learned probably more than they. But, as of March, just as we were prepared to go once more, it became “no more.” There is no doubt in my mind that Crimea was an easy mark for Moscow, for Crimea has long been oriented in that direction. Money, by way of the Czars and Commissars had flowed freely into that lovely peninsula, warm and beckoning, an escape from the cold winters of the north to what amounted to the Russian-Soviet version of Palm Beach or the Riviera. All that dried up with the creation of an independent Ukraine, and Crimea a part of it as the result of the curious grant by Khrushchev back in the early fifties; then no one dreamed, certainly not K., that there could be any entity other than the Soviet Union. But being on the very eastern fringe of Ukraine, Crimea was rather forgotten by the government in Kiev. Perhaps it is no wonder it was so easy for Putin. But now, once again, an iron curtain has descended. I cannot 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
get in touch with friends, even by e-mail. I have the eerie but distinct impression that from their end they think it perhaps advisable not be seen in communication with Americans. What we might have been for them and those orphans is no longer acceptable to Mother Russia. But I have heard from one of Dr. Astakov’s daughters, a lawyer, who has taken the very hard decision to leave her parents and friends in Crimea, absconding to a law firm in Kiev. She writes in her quite good English, “We all are in despair here because of the war on the East of Ukraine. Some of my friends are there right now and I get only little rare reports from them…My parents don’t like all these changes a lot but they obviously won’t leave Crimea in any case…and don’t really understand my thoughts about Russia, occupation and love to Motherland.” (Ukraine) As for Dr. Astakov, who served so well and faithfully for 20 years as the CEO of the Republic Children’s Hospital, his energies utterly committed to the welfare of the Crimean Children, he has been replaced by some Moscovian apparatchik. I hate to think of him moving from his office, where we would meet for tea and Crimean crumpets each morning before our surgeries. As for so many, he has been compelled to clear and clean out all his hospital memories, to move with his wife into a future now become so uncertain. Writing this, I marvel at how little we learn from history. The guns of August blaze away in the east of Ukraine; back and forth across the Gaza-Israeli border; in Syria-Iraq where the newly resurrected, but old cruelties of a Caliphate arise, complete with beheadings; and toss in wherever else you like, certainly in Nigeria where the Boko-Haram practice their industry of terror. Well, it’s not, at least for now, the start of some Great World War III, but it is all too suggestive of nothing good. Meanwhile, gratefully, you and I continue on our way, doing our thing, surrounded by peace and plenty. Let us count ourselves blessed. That said…and enough of that, at that…now that I have become a grandparent, curiosity obliges me to wonder about the world, and what it will be like when my grandson is my age in 2094. Will the wars and guns of August, or guns of any month be by then no more? Will we find a way to peace, leaving rancor, religious and political, to rest? We can, can’t we, at least hope for the best.
CMS
MEDICAL/LEGAL
Physicians Given ‘SAFER’ Way to Implement and Use Electronic Health Records By David B. Troxel, M.D., Medical Director, The Doctors Company
Problems with electronic health record (EHR) implementation and use are common and can affect patient safety and increase liability risks. Examples of EHR problems include: • Not adequately addressing known problems with EHR use, such as “alert fatigue” as a result of too many alerts. • Problems locating where lab and x-ray results are filed (or misfiled). • Difficulty correcting progress note entry errors. • Unnecessary operational complexity. • Failure to use a team approach involving physicians and other healthcare professionals in leadership positions to ensure that their clinical concerns are met. • Unwillingness by vendors to modify their systems to meet the complex workflows of the real-world practice setting. To assist in the implementation and use of EHRs, the Office of the National Coordinator for Health Information Technology recently released a practical, useful, and comprehensive suite of tools: the Safety Assurance Factors for EHR Resilience (SAFER) Guides. It’s recommended that all physicians, medical groups, and healthcare institutions that are considering implementation or replacement of an EHR visit the SAFER Guides website and spend an hour becoming familiar with those guides that address the areas of greatest interest or concern. These free guides—which can be downloaded or used online at www.healthit.gov/safer—provide a well-organized work plan for tackling the organizational complexities of EHR implementation and use. In order to ensure that clinically important considerations are addressed, the guides apply a structured team approach involving everyone whose professional life will be permanently affected by the EHR. The guides are designed to help healthcare organizations conduct self-assessments to optimize the safe use of EHRs in the following nine areas, the last three of which should be of most interest to physicians:
• • • • • • • • •
High Priority Practices Organizational Responsibilities Contingency Planning System Configuration System Interfaces Patient Identification Computerized Provider Order Entry with Decision Support Test Results Reporting and Follow-Up Clinician Communication
Each of the nine SAFER Guides begins with a checklist of recommended practices that indicates the extent to which each recommended practice has or has not been implemented. Links embedded in each checklist open the corresponding practice worksheet that gives the rationale for each recommended practice, examples of how to implement each practice, likely sources of input into the assessment of each practice, and fields to record team members and follow-up actions. The guides are designed to help deal with safety concerns created by the continuously changing landscape that healthcare organizations face. When using the guides, changes in technology, clinical practice standards, Meaningful Use, and/or HIPAA Security Rule requirements should be taken into account. Because the guides are designed to help organizations prioritize EHR-related safety concerns, clinician leadership in the organization should be engaged to assess whether and how any recommended practice affects the organization’s ability to deliver safe, high-quality care. To optimize EHR-related safety and quality, collaboration between clinicians and staff should lead to a consensus about the organization’s future path. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11
CMS
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COMMUNITY PHYSICIANS RECEPTION WEDNESDAY, OCTOBER 15
GOODWOOD MUSEUM & GARDENS 6:00-8:00 PM You and a loved one are cordially invited to the 2014 Community Physicians Reception. Relax and enjoy some good food, fun and music. Network with old friends and meet the newest members of some of our local medical groups.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
“POLST” CONTINUED FROM PAGE 9
it if the patient has lost decision-making capacity. Of course,
older, frail people nearing the end of their lives, it needs
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including those who represent the citizenry in the public
HeartLungSugicalAssociates.com
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and humane careall forother each of us. carriers. Capital Regional Heart and Lung Surgical Associates acceptsethical Capital Health Plan and most insurance CMS
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10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 13
A MESSAGE FROM FSU COM GRADUATE
FSU COLLEGE OF MEDICINE Graduate Abby Peters, M.D. Paying it Forward
On August 22, 2014, Dr. Abby Peters, (Class of 2011) delivered the following address to the Class of 2018 at the FSU COM White Coat Ceremony and Class of 2015 Gold Humanism Honor Society Induction. Dr. Peters (Tallahassee Pediatrics) and her husband Gregory Peters, M.D. (Bixler Emergency Department) have returned to practice in Tallahassee after completing their residencies at Wake Forest Medical Center. Distinguished faculty, fellow physicians, guests, I want to welcome and congratulate the Class of 2018, the Gold Humanism Honor Society inductees, and especially their families who have supported and helped these students for so many years in obtaining their goal of entering medical school. I am truly honored to be here this evening and have never addressed an audience more important to me than is this one. The students represent the future of medicine. Tonight, we are here to witness you symbolically join this noble profession by donning your white coat. Today you become part of a tradition; the physician as a servant of the sick. Your ability to touch lives starts right now. Never doubt that you can make a difference. You have made two great choices: Medicine and Florida State. One of our very own attending physicians Dr. Stine once shared with me that medicine was the most interpersonally and spiritually rewarding profession he could imagine. I must admit- I agree. As a graduate of this medical school, I can assure you that Florida State will give you the tools to become an incredible
14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
physician – dedicated to a professional calling. The one on one patient and attending time we experience at FSU is second to no other medical school in the country. As a student I was unaware of just how brilliant our medical training model is. Being an important part of the medical team as a student is in fact unique. It was through this notable autonomy and responsibility that I followed my heart to the specialty of pediatrics as a 4th year student. It was day one of my PICU rotation and a little girl was airlifted to us for a drowning event. I remember looking at her lifeless body and praying quietly to myself for a miracle. However, as we put in lines, reviewed blood gases, and struggled to maintain her vital signs I was left with a deep sense of human fragility. My attending physician gave me at the time what I thought was an incredible burden, but looking back the opportunity to be very independent with a family in need of support. To be able to tell this family that “although your little girl’s life on earth was short, she touched so many lives, including my own” is an experience I will never forget. I feel fortunate to have trained at a medical school that fosters, nurtures, and develops compassion, empathy, and dedication to the community. Unknowingly, you will gain a skill set over the next four years that most physicians learn in residency and beyond. When you leave FSU to begin your residency training, the confidence and comfort with which FSU graduates care for patients and families is acknowledged early on. You will be competent, courageous, enthusiastic, professional, and well-equipped to take on the next part of your career.
A MESSAGE FROM FSU COM GRADUATE
I believe the White Coat Ceremony is a time to recognize the wonderful human attributes associated with the medical profession. As a way to do this I would like to ask you to reflect with me about the kind of doctor you want to be. By this I do not mean the specialty you may enter (although pediatrics is great!), but rather the humanistic qualities you would like to have as a practicing physician. I will give you a few ideas to consider.
will thank you…..for your kindness, dedication, time, and interest. I encourage you to never let these two words become commonplace. They are intended to be a sign of gratitude and respect. Take the time to recognize the importance of your work and to remind yourself that practicing medicine is in fact a privilege. For you have been given a unique skill set and have the opportunity to add quality of life to those around you.
Be a doctor who learns from and respects all members of the health care team, including the most important member, the patient. Allow your patients and their families to teach, humble, and inspire you. I kept a journal during medical school and in preparing for this ceremony reflected on various influential moments. The excerpt I will share with you now is from my first trip to Filipina, Panama in 2008 with FSUCares. “It was the last day of clinic and a sweet older lady with a gentle spirit sat in front of me. She had no real complaints other than minor aches and pains. I felt inclined to let her know that she was strong and had a beautiful smile. At the end of our encounter, she grabbed my hand and with tears in her eyes said, thank you. “Thank you.” These are two very simple words, often taken for granted. However, I can tell you the sincere gratitude and happiness emanating from her words made a lasting impression on me. Patients
Be humble. We will never respect others if we consider ourselves superior to them. I have a strong interest in caring for children with special health care needs. However, even with this interest I confess that at times I judge. Questions regarding true quality of life, burdens placed on families, and morality in pursuing endeavors to extend the inevitable have all raced through my mind. It is human nature to judge, but I encourage you to evaluate difficult or special patient populations outside of the medical setting. As a resident, I had the opportunity to volunteer at Victory Junction, a camp for children with special health care needs. After spending one week in a cabin with adolescent girls with cerebral palsy (most of whom required great assistance with bathing, dressing, grooming, eating, and taking medications), I walked away rejuvenated and with the utmost respect for these girls and what they contribute to the world. They may CONTINUED ON PAGE 16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15 15
A MESSAGE FROM FSU COM GRADUATE
not have had perfect bodies, but they had perfect hearts that we can only strive to emulate. Similarly, I volunteered with a group of 7-8 year old girls with HIV. I have never in my life been more overcome by a group of children. Volunteering with little girls who had to adhere to difficult drug regimens and face the stigma that comes along with living with HIV through no fault of their own was challenging. However, the only images I remember are their smiles and how they chose to live life courageously. One little girl who was wise beyond her years shared with me that she wanted to “leave a legacy of not how the world is, but how the world should be.” Be a doctor who understands and is proud of what you know, but more importantly, recognizes what you don’t know. While you will cure many patients during the course of your career, you will also be in involved in the care of patients with illnesses you cannot cure. Remember that even in these situations there is always something positive you can do for every patient. Over the past three years, I have had the opportunity to work with exceptional children and their families. Each family has a unique experience in confronting illness and its treatment. However, the honesty, dignity, and hope with which children and families face indiscriminate disease have truly been an inspiration to me. During my training I cared for a three year old little boy with a congenital glycosylation disorder, an inherited condition that affects many parts of the body. After battling pneumonia for four weeks, he passed away in his mother’s arms at 4 a.m. on a Friday. I had developed a strong bond with this family and was able to attend his funeral. Following the service, his father embraced me and said, “thank you for taking such good care of my son.” Crying, I was taken aback by this comment. His son had passed away and he was thanking me? However, as I reflected upon this father’s words I recognized that in this moment it was not about being a highly trained medical professional. It was about being willing to be genuinely human with a mother and a father who adored their child. As physicians we have the opportunity to bear the burdens of others. True love is shown when we bear one another’s burdens, when we help each other in hard times, and when we get involved in each other’s lives. Yes I had cared for his
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
son medically, but I believe our time spent together in prayer, celebrating victories over the disorder, and seeing this little boy filled with joy and us joyful with him mattered more. Being able to be present and to help patients at the end of life is both a great gift and a great responsibility. Over the next 4 years you will learn to take a comprehensive history, perform a careful physical exam, obtain appropriate diagnostic tests, and develop accurate assessments and plans. Some of you may be stepping into this journey with trepidation, wondering if you have what it takes. Let me assure you that each of you has been carefully chosen because you have the exact talents and characteristics to succeed in medical school. And not just to succeed, but to be great. Yes competency is the most important aspect of being a physician, but beyond being competent, I encourage you to look outside of the diagnosis and treatment and realize your purpose might be to hold a hand, to engage in a friendly conversation, or to help a family through the grieving process. And the good news is that at Florida State you will know your patients well enough to feel comfortable doing so. Do not take these moments for granted. These experiences provide humility and perspective. I will close by saying it is worthwhile to reflect upon why you have chosen medicine as your career. Each of you has been influenced by family, friends and mentors. They deserve your lasting gratitude. Many of my role models are sitting right behind me. I cannot express to you enough how invested the college of medicine faculty are and how much they truly enjoy seeing us make the transition from books to clinical medicine. I am very proud that you are here and wish you every success in your training and in your life as a physician. I will leave you with one of Dr. Van Durme’s favorite quotes and one that I reflect upon often, “I don’t know what your destiny will be, but one thing I do know: the only ones among you who will be really happy are those who have sought and found how to serve” by Dr. Albert Schweitzer. Thank you for your time and congratulations. CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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MEDICAL/LEGAL
HIPAA Security Risks Assessments - Are you ready? By Michael R. Lowe, Esq., Michael R. Lowe, P.A., www.lowehealthlaw.com or 407-332-6353
Enforcement of HIPAA by the United States Department of Health and Human Services Office of Civil Rights (“HHS/ OCR”) has been rampant in recent years and is at an all-time high. There are many recent high profile breach cases involving 7-figure settlements with Covered Entities and Business Associates. One of the salient and most important lessons to glean from those settlements is the fact the HHS/OCR noted that the Covered Entities never performed adequate security risk assessments (“SRAs”) as part of their HIPAA compliance programs. SRAs are required by law to be performed by every Covered Entity and Business Associate. Additionally, the completion of a SRA is a core requirement to meet Meaningful Use objectives for hospitals and physicians looking to take advantage of HITECH provisions and Meaningful Use incentive payments and reimbursements. Unfortunately, most Covered Entities have not performed an adequate SRA and/or documented one, and many have not performed one at all. Failing to perform one and document a SRA places your organization, whether it is a Covered Entity or Business Associate at significantly increased risk of a HIPAA violation and potential fines and penalties. It also places your organization at risk of a possible breach or loss of Protected Health Information (“PHI”) and electronic PHI or ePHI. Covered Entities and Business Associates should perform a SRA immediately if they have not done so and document their performance of it. An effective SRA includes the following elements: (1) Identifying all ePHI that the organization creates, receives, maintains or transmits and the manner in which it does so including gathering data and collecting it. (2) Identifying and documenting all potential threats and vulnerabilities to ePHI including hacking, theft, and other malicious actions and software measures. (3) Assessing an organization’s current security measures including password and encryption protection for both stored ePHI and email transmission, physical security measures such 18
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
as alarms and locks on doors, and administrative safeguards such as well written HIPAA security policies and procedures. (4) Determining the likelihood of a threat occurrence such as theft or hacking of ePHI and determining the potential impact of any such threat occurrence. Be sure not to overlook potential destruction of ePHI due to natural causes such as a hurricane (after all this is Florida). (5) Determining levels of risk and the likelihood of a threat occurrence occurring, as well as developing an action plan in the event that a threat occurrence actually materializes (for instance, having off site back up of all ePHI and a well written breach notification internal investigation and corrective action plan in the event of a breach). (6) Finalizing written documentation of the SRA. Many Covered Entities and Business Associates perform SRAs but do not document them either properly or fully. HHS/ OCR looks for documentation in every investigation and audit that it conducts. Without appropriate documentation, an organization may not be able to successfully defend a HIPAA complaint, investigation or audit. (7) Conducting periodic reviews and updates of a SRA. Don’t just implement one and forget about it! (8) Consider obtaining cyber liability and/or HIPAA defense insurance. There are many tools which Covered Entities and Business Associates can use to perform a SRA. In fact, HHS released a Security Risk Assessment Tool on its website on March 28th of this year. While that Tool is not necessarily intended to be a standalone document and assessment, it can be useful in completing an effective SRA. Of note, any organization conducting a SRA may discover issues, breaches or other potential HIPAA or privacy and security issues or violations during a SRA. Therefore, it is advisable and strongly recommended to always retain experienced and competent health care legal counsel to assist in conducting a SRA in order to not only address issues which may arise but also to preserve any applicable work product privileges. Bottom line – if your organization has not performed a SRA or properly documented one, it should do so immediately in order to reduce its risk profile under HIPAA. CMS
BOOK REVIEW
Book Review By Nancy B. Clark, M.Ed.
Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices by Kevin Pho, M.D., Susan Gay 217 pages I have been aware of this book for some time as it is annoyingly advertised on several of the RSS feeds to which I subscribe. Having put together a faculty development CME accredited workshop on social networking in medicine at about the same time as the book was being published, (2012) I was curious to see what they covered, but unwilling to pay $50 for the book. When Pam asked me to review it, I no longer had an excuse and was pleasantly surprised by the book. It was an easy, even pleasant read. Pho covers the landscape of social media and medicine in a practical, concrete manner. Pho, or KevinMD, his blog identity, makes no apologies for openly advocating physicians entering the fray of social media for the sake of their reputations, practice, careers and patients. He spends the first three chapters presenting testimonials from physicians who have done so successfully to illustrate that it can be done and to lessen any anxiety over the prospect.
Chapter 5 breaks down 12 sites (Angie’s List, Healthgrades…) that are used for finding physicians and that allow patients to review physicians. This was the most eye opening chapter for me and likely essential reading for anyone in practice concerned about the accuracy and completeness of the profiles these sites are providing patients. The demographics of each review site is presented, followed by a clear description of how the site works, then how providers are rated, and finally how providers can interact with, react and respond to the site. The next chapter offers strategies to protect one’s online reputation such as using reviews to improve your practice, setting alerts, and responding to negative reviews. A thoughtful, if brief, chapter on professionalism follows that advocates for the development of social media policies and offers a physician’s charter for professionalism in the digital age. The useful Appendix contains lists of recommended blogs to follow as well as specific blog articles on the topics covered in the book. Pho provides links to sample institutional social media policies and 4 national reputation management companies. Any provider who picks up this book needs to be past precontemplation of sticking their toe into the social media waters. As I read this book, I saw the utility of using it as a textbook for an elective on social media and medicine for 4th year medical students. To neglect teaching this disruptive technology is to do a disservice to our future physicians. Nancy Clark is the director of medical informatics education for the FSU College of Medicine. She can be contacted at nancy.clark@ med.fsu.edu. CMS
In Chapter 4, each of the major social media sites (LinkedIn, Facebook…) are discussed in a structured manner, giving the basics of creating an account and step by step strategies for using the site. He then offers suggestions for maximizing the resource to your purposes.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19
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CMS FOUNDATION
DONATE TO THE CMS FOUNDATION
We Thank Our Donors We thank the following people/ organizations who made a donation to the CMS Foundation last month:
We Care Network Anonymous – for the We Care Dental Network
CMS Foundation Scott Tetreault, M.D.
Florida Society of Anesthesiologists – in honor of Alfredo Paredes, M.D.
In Honor Charles Williams, M.D. – in honor of Billy Baker
Charles Williams, M.D. – for More Simpler Times
The mission of the Capital Medical Society Foundation is to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified.
How to Buy Dr. Williams’
REASONS TO DONATE You can make a donation to the CMS Foundation in
More Simpler Times
memory of someone who has passed away or you can make a donation in honor of someone, such as a fellow physician you hold in high esteem or has
By Shannon Boyle
taken care of you or your family. CMS will send a letter to those you honor.
We are very grateful to Dr. Charles Williams that he has decided to donate to the We Care Network, proceeds from the sales of his new book and sequel, More Simpler Times.
ENDOWMENT FUNDS CMS Foundation has created three endowment funds in order to establish long-term financial stability to meet our mission. You can donate at any time to one of the CMS Foundation’s Endowment Funds. 1) The General Endowment Fund 2) The We Care Network Endowment Fund 3) The Scholarship Endowment Fund Checks should be made payable to the CMS Foundation and indicate on the “For line” to which Fund you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308.
22 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
The cost is $20 per book. You can buy copies of the book at: • The CMS office – 1204 Miccosukee Road • The Gift Shop at Capital Regional Medical Center • The Gift Shop at Tallahassee Memorial Hospital • Tallahassee Nurseries – 2911 Thomasville Road • My Favorite Things – 1410 Market Street, B2 • Feathered Pony Boutique – 2522 Capital Circle NE, #3 CHECKS SHOULD BE MADE OUT TO: CMS FOUNDATION. THIS MEANS YOU ARE MAKING A TAX-DEDUCTIBLE DONATION TO YOUR CMS FOUNDATION.
CMS FOUNDATION: WE CARE NETWORK
Thank you! To our CMS members and We Care partners who saw new patients for the We Care Network in August 2014.
We thank our referring providers from August 2014: Eboni Allen, ARNP Anne Ananga, ARNP
Your generosity and support of the We Care Network makes a difference.
Marie Becker, M.D. Shelby Blank, M.D. Jonna Bradley, ARNP Sherry Bramblett, ARNP
Physicians
William McFatter, D.D.S.
Marie Becker, M.D.
E. Lynn McLarty, D.D.S.
Robert Bradford, M.D.
Jim McSoley, D.M.D.
Tallahassee Orthopedic and Sports
Kendall Campbell, M.D.
Joseph Camps, M.D.
Lawrence Pijut, D.M.D.
Physical Therapy
Michael Cavallaro, M.D.
David Dolson, M.D.
Frank Swerdzewski, D.D.S.
Tallahassee Outpatient Surgery
W. Harris Green, M.D.
James Sykes, D.M.D.
Celeste Hart, M.D.
Jay Walton, D.D.S.
Ken Kato, M.D.
Lawrence Weaver, D.D.S.
Michael Mangan, M.D.
Ed Zapert, D.M.D.
Tallahassee Memorial
Tim Broeseker, M.D.
HealthCare
Center TMH Family Medicine Residency Program Women’s Imaging Center
Steven Ostrov, M.D. Rodolfo Oviedo, M.D.
Facilities
Timothy Paulk, M.D.
Affordable Dentures
L. Steve Sarbeck, M.D.
Anesthesiology Associates
William Sawyer, M.D.
Beachton Denture Clinic
Hardeep Singh, M.D.
Capital Regional Medical
Robert Snider, M.D.
Dermatology Associates
Joseph Soto, M.D.
Desloge Home Oxygen
James Trimble, M.D.
Leon County Dental Clinic
Anthony Wright, M.D.
Pathology Associates
Jessica Yoon, M.D.
Radiology Associates
Dentists
Southeastern Surgery Center
Eric Amundson, D.D.S.
Tallahassee Diagnostic
Imaging
M. Darrh Bryant, D.M.D.
Tallahassee Endoscopy Center
Susan Byrne, D.M.D.
Tallahassee Health Imaging
Walter Colón, D.M.D.
Cynthia Evans, ARNP Judy Griffin, ARNP Laurie Grubbs, ARNP Celeste Hart, M.D. Susan Horton, ARNP
Seven Hills Surgery Center
Brian Beck, D.M.D.
Susan Dunbar, ARNP
Sarah Hinson, ARNP
Center
Joshua Somerset, M.D.
Lysmar Dinguis, M.D.
The We Care Network strongly encourages our volunteer physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. You can send your value of donated services via fax to Monica Demott, R.N. at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
Amit Jain, M.D. Charles Kent, M.D. Esaias Lee, M.D. Ronald Machado, M.D. Donald Michel, M.D. Chitra Mony, M.D. Rose Origa, ARNP Winston Ortiz, M.D. Paresh Patel, M.D. Stephen Quintero, M.D. Stephen Richardson, M.D. Temple Robinson, M.D. Frank Swerdzewski, D.D.S. Tallahassee VA Clinic Marianne Towler, ARNP Quandra Whaley, ARNP Barbara Williams, M.D.
Please contact Monica Demott, R.N. at mdemott@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of August 2014 and your name is omitted.
During the month of August, the We Care Network: Received 61 referrals, with 35 patients new to the program
Scheduled 32 appointments with volunteer physicians and dentists
$41,126 in donated care was reported by We Care volunteers
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 23
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