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DOCTOR’SLife www.doctorslifetampabay.com

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 6, 2014 Tampa Bay Edition

EFFECTIVE RISK MANAGEMENT FOR 2015 ARE YOU READY FOR A 2015 AUDIT?

HISTORIC COURTHOUSE BECOMES ICONIC HOTEL

ALTERNATIVE CASHFLOW SOLUTIONS


What’s Inside From the Publisher Happy New Year

New Year’s Resolution: Effective Risk Management

Page 8

Page 4

Are You Ready for 2015 Audits? Page 10

Concierge Medicine Page 12

Physician Spotlight Dr. George Kamajian

Historic Treasure in the Heart of Downtown

Page 14

Connecting Doctors, Technology and Patients

The Legal Corner

Understanding Interpreter Requirements

Page 18

Advertisers

Page 16

Alternative Funding Options

7

The Florida Orchestra

23

JW Marriott

Medical Accounts Receivable Factoring

21

Aris Medical Solutions

Jarred Bunch

2

Page 6

3 24

KB Healthcare Consultants

5

Physicians Business Group

13

Rutherford Asset Planning

21

United Way

17

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Issue 6, 2014



From the Publisher

www.doctorslifetampabay.com

H

appy New Year! I hope you had the best holiday season ever. I have always found New Year’s resolutions to be a little funny. We have all created them, and if you’re like most, we have all forgotten them after 60 days. I am not saying that all resolutions are not carried out and conquered — there are a lot that are. However, that is not what I find funny. I find it funny we use a new year to set them. Why not a new month, new day or for that matter a new hour in our day? Life is too short to wait a whole year to make improvements in our lives. This year, make it a commitment to better one thing about you each day. Can you imagine the results after 365 days of consciously improving yourself? This issue is filled with some forward-thinking content. We discuss a way to effectively manage your financial risk in 2015 as a physician, get you prepared for an audit, show you a source for alternative cash flow solutions for your practice, and we sat down with Dr. George Kamajian for the Physician Spotlight and discussed how he has taken an alternative approach to running his practice. I was fortunate enough to be invited for a private tour of the new Le Méridien Tampa Hotel. Thank you to the GM, Brent Scarbo, and Chef Pete for showing me how this historic courthouse became an iconic hotel. I strongly suggest you make this a frequent stop throughout 2015. Just taking a tour is well worth the visit, but an evening dining at the Bizou Brasserie will keep you coming back for more. You can learn a little more about Le Méridien in our editorial showcase in this issue. I am dedicating this issue and year to my Uncle John H. Solcum. We lost him in December to a long and courageous battle against cancer. Life is short so wake up and treat each day as if it was your last. I hope you enjoy this issue of DLM and as always myself and the entire DLM team wish you a very Happy New Year. Be Well,

-Edd

EFFECTIVE RISK MANAGEMENT FOR 2015

Business Lifestyles and Opportunities

MAGAZINE

Vol. 2, Issue 6, 2014 Tampa Bay Edition

ARE YOU READY FOR A 2015 AUDIT?

HISTORIC COURTHOUSE BECOMES ICONIC HOTEL

ALTERNATIVE CASHFLOW SOLUTIONS

TAMPA BAY

Tampa Headquarters 1208 East Kennedy Blvd. #1029 Tampa Fl, 33602 813-419-7788 Group Publisher Edd Suyak publisher@doctorslifetampabay.com Creative Director Bryan Clapper Editorial Director Edd Suyak Assistant Editorial Director Danielle Topper Associate Publisher CJ Cooper Contributing Writers Scott Jarred Suze Shaffer Kathleen Hargreaves Paula MacDonald Edd Suyak Cheryl O’Neil Gowen Paula Bentley Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com

Edd Suyak Group Publisher publisher@doctorslifetampabay.com

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DOCTOR’SLife

www.doctorslifetampabay.com

Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.

Doctor’s Life Tampa Bay

Issue 6, 2014


What’s Next... The healthcare industry is continually responding to regulatory changes, technological advances and economic pressures. Our Healthcare Consultants can keep you ahead of the curve.

Call us today.

(813) 675-8800

(941) 365-4617

www.kbgrp.com 4830 W. Kennedy Boulevard, Suite 600, Tampa, Florida 33609 1990 Main Street, Suite 801, Sarasota, Florida 34236 6320 Venture Drive, Suite 203, Lakewood Ranch, FL 34202


Physician Spotlight

Dr. George Kamajian, D.O. How long have you lived in the Tampa Bay area? 14 years What is your favorite Tampa Bay restaurant? Crabby Bills Where is your favorite place in Tampa Bay to relax? The beach at sunset How important is it for physicians to be involved with their communities and how important is it to you personally? This is where we eat. This is where we live. Our children go to the local schools. We shop at Publix. We buy gas at Sam’s Club. We share in the lives of all the members of our community whether we know it or not. We obtained our education courtesy of a publicly funded educational system. That means everyone around us helped to pay for our transition from college to physician. When we “give back” we are really paying the community interest on a lifelong debt we incurred becoming physicians. Community involvement should be second nature. What makes the Largo Clinic different than the typical medical clinic model? We are a cash practice. We rarely accept insurance. Our mission is to provide quality affordable health care to everyone. The uninsured and underinsured are always welcome. By not accepting insurance we are not locked into any contracts and our fees can be adjusted on an individual basis. By developing partnerships with other health care suppliers, laboratories and X-ray facilities we have negotiated special rates on those services that are frequently the same as those paid by insurance companies. We are a neighborhood practice. What was the deciding factor that got you to open your neighborhood practice which accepts anyone without insurance and in an affordable way? In 2004 I developed osteonecrosis of my knee resulting in replacement surgery. When I lost my knee, I lost my job as an ER physician. During my transition from a hot shot trauma doc to unemployed, I needed routine blood work. I lost my insurance when I lost my job. Quest Labs wanted $300 for a routine panel. I told them I had no insurance. They said, “too bad.” I said, “but I’m a doctor.” They didn’t care. Now I can get that same panel of labs for $25 for anyone who needs them. How is it that your medical office provides the same medical care, diagnostics and treatments at a fraction of the cost compared to traditional health care? We are an à la carte practice. That means patients choose what they want from the menu and pay only for that which they need. Simultaneously, we pride ourselves in being part of the community. I have a freezer full of fish because many times, our patients barter and that is all they can pay. And I don’t have to be greedy with our fees. House calls are a great American past-time. Do you still provide house calls and if so why? I love doing house calls because it puts me in contact with members of the community who have chosen to stay independent for as long as they keep their boots on. My father is one of those folks. He is 94 years old and lives in California. I like to think I’m helping my dad when I see some of these patients. In your opinion, do you believe the business model at which you use to practice medicine and treat your patients today should or could be the standard in health care? Do the math. 6

A past Fellow of the American College of Emergency Physicians, Dr. Kamajian came to Florida after practicing emergency medicine for 30 years in suburban Boston. Husband, father and physician, he is a graduate of the University of Pennsylvania, the Philadelphia College of Osteopathic Medicine and the University Hospital (Shands) of Jacksonville’s emergency medicine residency program. A recipient of Kellogg Foundation and U.S.A.I.D. grants, he has lectured internationally in Brazil and Armenia (formerly of the Soviet Union). Dr. Kamajian has published numerous medical articles, short works of fiction and, most recently, two books. I charge as low as $500 a year for unlimited outpatient access. That includes one full panel of labs and one annual EKG. If I can do it, so can anyone else….especially if they are not tainted by administrative middle men who hijack the health care system. If you do the numbers, 25 million uninsured Americans x $500 each = $25 billion annually to cover health care cost from a preemptive outpatient setting. Now, under the Affordable Health Care Act (Obamacare), that number exceeds $1 billion annually. Is there a difference between your membership neighborhood clinic and concierge medicine clinics? Think of us as a reverse concierge clinic. Instead of patients paying $10,000 for unlimited access for outpatient care we charge as low as $500. Knowing yourself: If you could go back in time and provide your younger self advice, what would it be? Invest in Apple.

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(PHI)

" Simplifying HIPAA "

Protected Health Information

!#!#$%! Am I Liable ????

Is Your Practice (PHI) AUDIT Ready!! • Did you conduct a Security Risk Analysis that is required when you applied your Meaningful Use incentive funds? • Do you have a Risk Management Plan in place based on your findings? • Does your HIPAA Security Officer understand what is required of them under State and Federal Law? • Do you have a FULL set Privacy and Security Policies, Procedures and Documentation required by Federal Law? If you answered NO to any of these questions, you are not HIPAA Compliant & may not pass that audit! CALL US TO FIND OUT WHAT YOU NEED TO DO TODAY!

ARIS Medical Solutions

877 . 659 . 2467

www.arismedicalsolutions.com

7 SIMPLE STEPS

Security Analysis Contingency Plan Breach Notification Privacy Policies Security Policies Documentation Resources & Solutions


New Year’s Resolution:

Effective Risk Management A

By Scott Jarred CEO Jarred Bunch Consulting

s the medical industry enters some uncertain times, successful physicians can face the pressure of multiple risks in their daily operations, such as adverse financial impact of regulatory or legislative changes, breach of patient confidentiality, and so on. For this reason, physician’s groups and practice owners can benefit from a dynamic risk management tool meant to effectively manage risks for which protection may not be available, control their insurance costs, and provide tax efficiencies, all of which can potentially have positive effects on a personal level. The New Year brings with it a new slate, and often prompts the perfect time to invent the “new you.” While we tend to just think of reinventing ourselves on a personal level, the New Year is the perfect time to explore strategies that can reinvent you on multiple levels; from your personal finances, to those of your business. As we started building our specialization in physicians, we noticed that many of them were part of physician’s groups, or even owned their own practices. Because of this, we found a smooth transition between the consulting services that we could offer them on a personal level, and our consulting services that we could offer on the business side of medicine. One of the most appealing business strategies we are skilled in helping our physician clientele implement lies in captive insurance planning.

WHAT IS A CAPTIVE INSURANCE COMPANY?

A captive insurance company is a property and casualty insurance company, which is best utilized as a supplement to existing coverage, providing a more effective total risk management strategy. Essentially, the captive is formed to cover the risks of its parent company. Many risks that captives can provide protection from are either not available through commercial property and casualty insurance companies, or may be too costly to obtain. And in a field that is not only subject to frivolous lawsuits, but is heavily affected by regulatory and legislative changes, these are the exact risks that can keep physicians up at night. Thus, the captive provides them with a tool to subdue this anxiety, effectively managing several different types of risk they may face by designing an insurance program structured specifically for their unique situation.

HOW DOES IT WORK?

This strategy can be implemented by physician’s groups or practice owners to more effectively manage risk, and can also double as a unique strategy in the area of tax efficiency. Complying with section 831b of the tax code, a captive allows businesses to segregate up to $1.2 million of corporate risk domestically in a given year. The money that you are paying in premiums into the captive qualifies as a tax deductible contribution, simultaneously setting that money aside for future claims. Your money being held in the captive can then be managed through our 8

firm’s direct access to institutional money managers, allowing surplus distributions to be generated, which are then taxed at favorable capital gains rates. In other words, down the road you could essentially declare dividends to the owners of your captive, again with these surplus earnings only being taxed on capital gains rates. Many of our clients who are part of physician’s groups have medical malpractice captives, which every doctor in the group contributes to. While smart, again you are only protecting one area of risk. What about regulatory changes that can affect your paycheck, loss of a professional license, breach of patient data, HIPPA violations, or loss of a partner? A physician’s group can implement a customized captive based on the needs of each of physician, and act as a supplement to protect against a wider range of risks. In addition to this, a captive can present a number of flexible opportunities in multiple areas of your individual financial life, including wealth accumulation and transfer, asset protection, and business succession planning. For example, many of our physician clientele establish trusts with the help of their estate planning attorneys. If that physician wants to implement an irrevocable trust for the benefit of their children or grandchildren, the captive can be coordinated with this. Structuring the trust to own 100 percent of the captive’s surplus distributions provides an effective strategy for the beneficiaries, through increases in the captive’s profitability and investment gains. This structure would also protect the captive’s surplus distributions from creditors.

WHAT’S THE CATCH?

Forming a captive insurance company is a strategy that should have a long-term plan, and involves several initial steps that must be properly negotiated in order to achieve a successful result. Establishing and structuring a captive should only be done with the guidance of appropriately qualified tax and legal advisors. Captives are not a new concept; concepts that echo the very features of today’s captives can be traced back to the 1920s, when several corporations formed wholly owned insurance companies. Stamped into knowledge as a “captive” by Fred Reiss, these insurance companies have stood the test of time since 1957. We work with only the premier providers of captive insurance companies in the industry, and their feasibility specialists work with our clients to design, implement, gain regulatory approval, and manage

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the captive going forward. Through their industry experience and knowledge concerning the rules and guidance issued by regulatory bodies such as the IRS regarding captives, we have been able to connect our clients with the highest degree of professional service. Our providers have also streamlined the implementation process by allowing our clients access to structures that have already undergone the necessary legal and regulatory review process. Effective risk management is a key component in the business of medicine. A Captive Insurance Company is a unique strategy that we can help implement for our clients, providing protection in your business life, and even your personal life as well. Disclosures: Aside from providing general informational material, Jarred Bunch Consulting, LLC does not structure, implement, or manage captive insurance companies. Such services are offered by a third party vendor. Coordination with your overall financial strategy can be completed by Jarred Bunch Consulting, LLC, and consultation with industry professionals concerning your particular situation will be performed regarding your eligibility and need for a captive insurance plan. Issue 6, 2014

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Are You Ready for 2015 Audits? By Suze Shaffer Aris Medical Solutions Do you know what agencies may be auditing you? Let’s talk about Centers for Medicare and Medicaid (CMS) first. If you adopted Electronic Health Records (EHR) and applied for the meaningful use incentive money that was offered, you may be subject to an audit. CMS hired Figliozzi and Associates to audit the recipients of the incentive funds. Most medical practices are busy learning the new EHR/EMR software. While making sure they meet all the percentage requirements of the core measures, they forget to read the requirement for the measure that simply states “Protect Electronic Health Records.” When you select YES to this question, you are attesting that you have performed a security risk analysis, implemented security updates as necessary, and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. If you have not performed this very important task, your money can and will be recouped by CMS if you are audited. These audits are random, so do not think if you are a small practice they will not audit you. Next, the Office for Civil Rights (OCR) is also interested in how you protect patient data. The security rule has been around since 2005, although it has not really been enforced until now. CMS reintroduced this rule with the meaningful use criteria as we mentioned above. Yes, a Security Risk Analysis (SRA) is required under the security rule. However it is so much more than just your network they are interested in. A true SRA must include a review of the administrative, physical, and technical safeguards you have in place to protect patient data. It should also include a review of your policies and procedures. The security rule is about 75 percent policies and procedures on how you protect patient data. You are probably wondering, what does all of this have to do with the OCR? It only takes ONE patient complaint to trigger an audit from the OCR. If you do not have a full set of privacy and security policies and procedures, you could be found in willful neglect. If you have a data breach, that will trigger an audit as well. The fines can be substantial, even up to $1.5 million per violation, per year! The OCR has also trained the state’s attorney general on HIPAA compliance. Each state is handling this in their own way. Some states have hired their own “HIPAA” department and are sending these employees into practices as patients and documenting violations as they go through the triage. While others are surfing websites of practices looking for 10

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your Notice of Privacy Practices to ensure it has been updated to meet the Omnibus Rule requirements. So you see, you need to prepare for audits. It is no longer “if” you get audited, it is now “when.” Here are some helpful hints to help you prepare for the upcoming audits: 1. Covered entities and business associates are both required to conduct a Security Risk Analysis. There are free tools available even one from the Department of Health and Human Services (HHS). Keep in mind no matter which tool you use, it is only a starting point. 2. Create a risk management plan based on the findings from your risk analysis. Review HHS’s security matrix to understand what is required and what is addressable. Keep in mind addressable does not mean optional. Addressable means you must have reasonable and appropriate safeguards in place based on the size of your organization. 3. All covered entities must have the ability to monitor their audit

Issue 6, 2014

logs from either their EHR/EMR software or a device which connects a user to Electronic Protected Health Information (ePHI). The purpose behind this requirement is to monitor for abnormal activity. This abnormal activity could be the result of a rogue employee or a cyberattack. 4. Make sure you have assigned a HIPAA privacy officer and a HIPAA security officer. Everyone in the practice needs to know who these people are by these titles. In a small practice it could be just one person. If an auditor calls your office, they will ask for your privacy officer, your security officer, or possibly your compliance officer. 5. Every practice needs to have in place a breach notification plan in the event of a data breach. Most importantly, you must have an IRT (Incident Response Team) in place that includes an IT professional, a forensic IT company, and a health care attorney along with your own personnel. After you suffer from a data breach is not the time to put this team together. Time is of the essence when notifying your patients. Federal law states you have 60 days to notify your patients that are involved in a data breach. However, some states are much more stringent, therefore state law would trump federal law. Some states now even require the state attorney general be notified as well. Know your state law! 6. Contingency planning is a must whether you have a server based or a cloud based EHR. You must have a plan in place to protect and restore ePHI in the event of an emergency or a disaster. Your plan will be very different based on where your ePHI is located. This security standard has three required and two addressable components. 7. Business associate agreements are a must. If your Business Associate (BA) has a data breach and you do not have an agreement in place and do not have any documentation that your BA is HIPAA compliant you could be faced with the same fines and penalties as the BA. Even though a practice may not be responsible for a BA’s subcontractor, if the subcontractor or the BA has a data breach, the practice is ultimately responsible for the cost of the data breach. Make sure anyone who accesses, creates, maintains, or stores YOUR ePHI is HIPAA compliant. 8. Protected health information is obviously located within your EHR, but since more and more equipment now stores ePHI, it is necessary to review your workflow to determine where ePHI is located. This is required since you must have procedures in place when you replace your computers and other office equipment to ensure ePHI is properly removed or the device is destroyed. 9. Technical safeguards has several categories in the security rule. Some are required standards while others are labeled addressable. With that said you could be fined and penalized a detrimental amount of money if you do not have what they consider reasonable and appropriate safeguards in place. For instance, even though encryption is addressable, if your server, computer, or laptop is stolen and it is not encrypted, you could be faced with a $1.5 million fine! 10. Policies, procedures, and documentation are the backbone of HIPAA compliance. You are required to have up-to-date privacy and security policies and procedures that cover all the requirements of the security rule. Last but certainly not least, DOCUMENTATION! The Office for Civil Rights (OCR) is famous for saying… If it’s not documented, it didn’t happen and doesn’t exist. Documentation must be stored for a minimum of six years, however it can be digitally stored and not necessarily on paper.

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Concierge Medicine: IS IT THE RIGHT CHOICE FOR YOU? By Kathleen A. Hargreaves CPA Kerkering Barberio

A

bout two years ago, my father-in-law told me that he had begun a concierge relationship with his physician. For an extra fee of about $1,500 per year, he received some additional benefits and the knowledge that his physician would have more time to spend with him, because he had cut down on the number of total patients that he saw. Today, my father-in-law is very happy with the arrangement and doesn’t resent the extra money this costs. Concierge medicine is not really new, but the concept has been gradually gaining momentum. When I helped set up my first concierge client over ten years ago, there were very few physicians practicing under that model in anywhere the country. Since that time, there has been a surge in demand from both patients and physicians for a stronger and more focused partnership, and concierge medicine seems to fill that need. What exactly is concierge medicine? Just as the name implies, the concierge physician offers services that are above and beyond those typically offered. Prices differ by physician, and by the type of services actually offered. Today, approximately 10 percent of primary care physicians are considering a move to concierge medicine in the next three years. In addition to improving the quality of their relationships with patients, 12

many doctors making the switch to the concierge model also cite more flexibility in their schedules and a less taxing patient load as reasons for exploring this method of care delivery. There are two popular ways to practice concierge medicine. Under the full opt-out method, the physician does not accept Medicare (you must “opt-out” for this reason), managed care or commercial insurance products, and charges the patient the full cost of providing primary care medicine. Such relationships usually cost $5,000 or more, depending on the age and health status of the patient. The patient pays, usually in advance, and the physician must provide services according to the contract that he or she has with the patient. These practices have high-end amenities that patients enjoy, and the physicians carry a smaller patient load to accommodate the extra services offered. An added benefit is that practice overhead decreases

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significantly, because there is no need to file insurance paperwork. The physician could potentially eliminate the entire department in his or her practice. No elaborate practice management system is required, either; only an accountant or clerk to send out bills and post payments, and simple business accounting software. Under an alternative method, the physician continues to participate with insurance companies and Medicare, and the patients pay a fee for non-covered insurance services (i.e., services that the insurance companies do not consider necessary). The fee the physician charges under this method is much lower than the fee charged under the full opt-out method, because insurance will cover sick and some well visits; however, the fee enables the physician to limit the number of patients seen and allows for a better quality of life. Under this model, the insurance department and complex practice management systems must be retained, because claims still need to be filed. If you are interested in making the move to a concierge medical practice, how do you determine which method would work best for you? First, you will need to evaluate your existing patient demographics. If you happen to have a wonderful professional reputation and patients who can afford to spend the money and desire more personalized care, then the opt-out method could be the best option for your new business model. If you currently serve more middle and lower income clients, then you may want to think about the alternative method and retain some insurance and Medicare coverages. Obviously, both methods have a degree of risk associated with them, and your success is dependent upon proper planning. Here are eight points to consider when planning a concierge medicine practice: 1. Determine what style of concierge medicine works best for you under your current patient population—opt-out or alternative.

You should have a clear vision of the services that you will offer, the number of patients you will accept and will need to be successful, and the price points for services before you begin to market the new model to patients directly. 2. Research the demographics of your practice area (think location, location, location). 3. Determine patient acceptance. Talk with your patients (the ones who you would most want to retain) and find out if they are open to the concept of paying for concierge services. Several of my clients have employed outside marketers to send letters and follow-up to gauge patient support and acceptance of the concept. This step can take a year to complete. 4. Engage an experienced accountant to prepare a budget, design the accounting system and assist in the planning process. The number of patients that you need in order to be successful depends on the type of practice and the amount that you are charging per patient. 5. Draft contracts for patients. You should retain an attorney who has had experience with concierge practices. 6. Hire a marketing firm or advertising agency. Again, experience in the area will help. 7. Begin patient contracting. 8. Don’t forget to opt-out of Medicare if that is the course that you are pursuing. Kathleen Hargreaves joined Kerkering Barberio in 1992 and was admitted as shareholder in 1997. She leads the firm’s Healthcare Advisory Services practice and specializes in individual and business tax consulting. Kathleen and her team provide best practice service solutions to healthcare industry organizations, including all physician specialties, laboratories, hospitals and ambulatory surgery centers.

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UNLOCKING HISTORIC TREASURE IN THE HEART OF DOWNTOWN

Le Méridien Tampa By Paula MacDonald

F

rozen in time, the majestic federal courthouse building in downtown Tampa was an undiscovered treasure in the heart of the city. For over 13 years, its contents remained a mystery to downtown workers and visitors who passed the stately columned entrance and marveled at the beauty of this structure. The building was constructed in 1905 by supervising architect of the U.S. Department of Treasury, James Knox Taylor, and was originally designed as a U.S. Post Office. Later, it served as a customs house and courthouse, where many of Tampa’s infamous mob trials played out. On June 7, 1974, the Beaux Arts style building was added to the U.S. National Register of Historic Places. Owned by the City of Tampa, 601 North Florida Avenue was vacated by the federal courts in 1998, when a new courthouse was constructed a few blocks to the north. Fully aware of the historic 14

value of the structure, city leaders paid to keep the building airconditioned to prevent further deterioration of its architecture, while waiting for the right opportunity to return the building to its former glory. That opportunity became reality in June 2014, when the historic courthouse building re-opened its doors to the public as Le Méridien Tampa, a luxury, full-service, boutique hotel that incorporates culture, art and cuisine to help guests discover or “unlock” their local destination during travel. Providing an

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French-inspired restaurant Bizou Brasserie features an eclectic mix of traditional courthouse marble and modern European fixtures.

The iconic second floor entrance to the restaurant showcases marble and stately columns.

A mixture of old and new, as modern room amenities blend with original doors from the former federal courthouse.

eclectic mix of modern European style with its historic courthouse elements, Le Méridien is a sensory delight for locals and outof-towners alike. The $26 million renovation took over a year and a half to complete, and was led by Memphis developer Gary Prosterman of Development Services Group, Inc. As guests walk up the steps and through the massive 4-story columns, they know that they’ve arrived at a destination that is totally unique to Tampa. Inside the second-floor entrance, Frenchinspired restaurant Bizou Brasserie provides an invitation to dine and drink in style. Flanked by marble walls and wood ceilings, the former courtroom is transformed into a warm, inviting space to gather for breakfast, lunch, dinner or even Sunday brunch. Thursday and Friday “Work Release” happy hours offer a great meeting place for downtown workers and residents to relax and Issue 6, 2014

Guests at the first floor entrance are greeted with signature Le Méridien “arrival art” featured in the lighted canopy above.

Once a sally port entrance leading defendants to and from court, the pool area offers an urban oasis in downtown Tampa.

unwind in a lively environment with an attentive service staff. Le Méridien has quickly become a favorite with Tampa’s legal and medical community, serving as hotel partner for the USF Center for Advanced Medical Learning and Simulation (CAMLS). When visiting Le Méridien Tampa, be sure to look for many historic elements that are incorporated into the building’s construction, including repurposed doors and courtroom elements. On the first floor in “The Hub” lobby area, the business center is constructed of an original judge’s bench, complete with emergency buzzer and nameplates, and the host desk in Bizou Brasserie is actually a former witness box. The renovation of this majestic building, which was overseen by the Tampa Historic Preservation Commission, ensures that many elements of this treasure will remain a part of the city’s history for many generations to come.

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Connect 4 Medical CONNECTING DOCTORS, TECHNOLOGY AND PATIENTS H

igh-quality care and efficiency — Centers for Medicare and Medicaid Services (CMS) emphasized these two points with the release of its 2015 Medicare Physician Fee Schedule. Physicians (regardless of specialty), advanced practice registered nurses, physician assistants, clinical nurse specialists, and certified nurse midwives (or the provider to which such individual has reassigned his/her billing rights) are eligible to bill Medicare for Chronic Care Management (CCM) beginning in 2015. With a known shortage of primary care access in the United States, national telemedicine platforms such as Connect4MD become important in filling a care coordination gap, and a very useful advancement in managing population transitional care and chronic care. “Health care is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes,” said CMS principal deputy administrator Jonathan Blum in a written statement. “We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits.” In the final rule, CMS has adopted CPT 99490 for Medicare CCM services, which is defined in the CPT professional codebook as follows: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensating, or functional decline, comprehensive care plan established, implemented, revised, or monitored. Connect 4 Medical clinical and technology experts support a physician in achieving the five capabilities your practice will need to perform the above: 1) Evaluation of your EHR for specified purposes,

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2) a real-time electronic care plan, 3) Ensure beneficiary access to care, 4) Facilitate transitions of care, and 5) Coordinate care. We enhance your intimate relationship with the patient, and achieve ability to bill the CCM. The national average reimbursement will be $40.39 per beneficiary per calendar month and, Connect 4 Medical offers providers a connectivity between fee-for-service and value-based reimbursement. By developing and implementing a CCM program, you will grow internal processes and critical skill sets for population health management, all the while receiving fee-for-service payment to support those activities. For more information on integrating chronic care management or telemedicine inside your organization, email customerservice@ connect4medical.com or call (800) 840-1360.

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The Legal Corner

Are Physicians Required to Provide Interpreters for Deaf or Hearing-Impaired Patients? By Paula Bentley Attorney and Licensed Health Care Risk Manager Gunster

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any physicians are unaware of their legal obligations with regard to communicating with deaf and hearingimpaired patients. Under Title III of the Americans with Disabilities Act (ADA), private health care practices are required to provide reasonable accommodations to ensure effective communication with patients who have communication disabilities, including those who are deaf or hearing impaired. Because a practice’s failure to comply with the ADA can result in significant penalties, it is imperative that private health care providers understand ADA Title III requirements. In addition to being subject to civil monetary fines imposed by federal regulatory agencies, medical practices that participate in federal health programs such as Medicare or Medicaid can be sued in private lawsuits for failure to comply with ADA requirements. Because a successful plaintiff can recover attorney’s fees under the ADA, attorneys have an added incentive to take on such cases. As a result, ADA lawsuits against physicians and hospitals have become more common in recent years. Simply put, the ADA requires medical practices to provide appropriate auxiliary aids and services to ensure that communication with patients who are deaf or hearing impaired is as effective as communication with others. This duty extends not only to the patient, but also to family members, friends and companions of the patient. Auxiliary aids and services include qualified interpreters, assistive listening devices, note takers, written materials, computer-aided transcription devices, and telecommunication devices. A “qualified” interpreter means someone who is “able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.” The ADA does not require the provider to honor the patient’s choice of auxiliary aid. The provider may make the ultimate decision as to which auxiliary aid or service is to be used in a particular situation, as long as the result is effective communication with the deaf or hearing-impaired individual. According to the Department of Justice (DOJ), the agency charged with enforcing the ADA, “the key to deciding what aid or service is needed to communicate effectively is to consider the nature, length, complexity, and context of the communication as well as the person’s normal method(s) of communication.” Reasoning that the hearing-impaired individual knows best which auxiliary aid or service will achieve effective communication with the health care provider, the DOJ recommends that the provider consult with the individual prior to determining which aid or service will be used. Although not required to honor a patient’s request for an interpreter, a health care provider should carefully consider any decision to refuse such a request. Courts have found that the determination of whether an interpreter is necessary for effective 18

The DOJ suggests that an interpreter will generally be needed where the information being communicated is extensive or complex, such as when taking the medical history of a patient who uses sign language, discussing a serious diagnosis and its treatment options, or obtaining informed consent and permission for treatment. communication depends heavily on the specific circumstances of the encounter. The DOJ suggests that an interpreter will generally be needed where the information being communicated is extensive or complex, such as when taking the medical history of a patient who uses sign language, discussing a serious diagnosis and its treatment options, or obtaining informed consent and permission for treatment. Many medical practices regularly rely on written notes or interpreting by companions when communicating with hearingimpaired patients. Exchanging notes may be an acceptable method of communication regarding simple matters, but other aids will likely be needed for more complex subjects. In addition, if the individual has limited ability to read or understand English, written notes would not be an appropriate choice. Use of accompanying adults as interpreters is not advisable, as these persons often lack the impartiality and specialized vocabulary needed to interpret effectively and accurately in a health care setting. In addition, using family members or friends as interpreters may raise patient confidentiality issues. The DOJ warns

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that minor children accompanying a person who uses sign language may only be used to interpret in an emergency situation in which no qualified interpreter is available. The responsibility to provide auxiliary aids and services falls on the health care provider. The provider may not require a patient to bring an interpreter with them. In addition, the provider must pay for the interpreting services, or any other auxiliary aid or service, regardless of whether that cost exceeds the amount that the provider will receive for the services rendered. Although there is an exception if use of a particular auxiliary aid will result in an “undue burden” on the practice, this burden is determined based on the practice’s overall resources, rather than a comparison between the cost of the interpreter or other aid and the medical fees paid by the patient. In addition, the DOJ advises that the entity is still expected to provide another effective aid or service, if possible, which will not result in an undue burden. Health care practices may require reasonable advance notice from people requesting aids or services, but may not impose excessive Issue 6, 2014

advance notice requirements and must honor “walk-in” requests for aids and services to the extent possible. The ADA does not require that a medical practice maintain written policies and procedures regarding accommodations for disabled individuals, but it is highly recommended that such policies be developed and implemented before a problem arises. Such policies can provide strong evidence of a provider’s compliance with the ADA when a plaintiff brings a claim alleging failure to ensure effective communication. Policies should address: procedures for evaluating a patient’s communication needs and determining what auxiliary aid or service is appropriate in a particular circumstance; procedures for securing auxiliary aids and services; notification to patients regarding the availability of auxiliary aids and any advance notice requirements; and proper documentation of the practice’s accommodation efforts in the patient’s medical record. Finally, proper training of office staff is essential to the ongoing implementation of these policies.

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Medical Accounts Receivable Factoring A CASH FLOW SOLUTION FOR HEALTHCARE PROVIDERS By Cheryl O’Neill Gowen CEO/President Alternative Funding Options

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s a medical provider your biggest asset is your accounts receivable (“A/R”) – the payment you expect to get from Medicaid/Medicare, HMOs, private insurance, personal injury lien settlements, or worker’s compensation insurances. Unfortunately, due to the current inefficiencies and bureaucratic nightmares in our healthcare system, a medical provider has to wait 15-150 days, or more, to monetize this asset. That hinders the provider’s ability to conduct business, pay staff, order supplies, pay rent, advertise and grow the business. Most providers turn to their local banks for working capital loans, but most of these banks have limits, strict requirements and hindrances that make it difficult to obtain these loans. Some banks don’t want to lend against A/R while others only focus on large medical providers with substantial history. Luckily, providers have other cash flow options – MEDICAL FACTORING! Medical factoring is a type of invoice financing where a factoring company provides a medical provider with an advance payment based on the provider’s outstanding accounts receivable (claim/invoice). The factor advances funds and waits for the claim to be paid from the third party insurance carriers. Medical factors will consider any 20

provider that bills third party insurance carriers, i.e. doctors, doctor groups, DME/HME, Home Healthcare companies, Medical Transport and Transportation companies, Imaging Centers, Labs, Urgent Care Centers, and many more. Here’s how it works: • A medical provider establishes a relationship with a factoring company. continued on page 22

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YOU CHOOSE A SPECIALIST FOR YOUR HEALTH DO THE SAME FOR YOUR DEBT FINANCING. • MEDICAL ACCOUNTS RECEIVABLE FACTORING • REVOLVING LINES OF CREDIT • TERM LOANS • EQUIPMENT LEASES

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continued from page 20 • A medical provider submits bills to the 3rd party insurance carrier. • A medical provider submits a copy of the billings to the factoring company in a format and procedure compliant with HIPAA regulations. • The factoring company advances between 70-80 percent of the NET COLLECTABLE VALUE. This is important since the advance is not based on gross billings, but rather on the expected net collectable value. Funds are wired or directly deposited into the provider’s bank account within 24-48 hours. This timing and advance rate will change if your receivable is related to personal injury or worker’s compensation. • The remaining 20-30 percent is a financing cushion or reserve in case some bills do not pay or are erroneous. • Once the bill is paid by the third-party insurance carrier the factoring company returns the 20-30 percent reserve money minus a factor fee ranging from as low as 1.5-3 percent for the first 30 days then 0.5-1 percent per 15 days thereafter. Usually there are no upfront costs as all the underwriting expenses are paid out of the first funding (typically $300-$1500). Some may charge a due diligence fee upon signing of the term sheet. Larger healthcare providers (such as hospitals) may require an on-site audit. They also might qualify for a line of credit secured by the receivables. Medical receivables factoring is a great way for medical providers to bridge the cash flow gap that is oftentimes created by slow payments from insurance carriers and other third-party payers. The beauty of medical factoring is that it is determined solely by the provider’s ability to generate bills (claims/ invoices) thereby providing access to capital for smaller or nonbankable providers. There are no limits – you grow, you factor. Most importantly, the provider now has a clear understanding of when cash flows will come in and can finally create a bill payment routine allowing for him/her to concentrate on treating patients!

HOW TO CHOOSE THE BEST MEDICAL FACTORING COMPANY

Selecting the right medical factor is critical, given the importance of this type of financing for the growth of your business. However, choosing the right factor may seem difficult because not all factoring companies will finance medical receivables and the ones that do, you need to ask the right questions. Follow these steps to help you choose the right medical factoring company.

of the founding executives have prior experience. Also, ask how they are funded – are they using their own investments, hedge funds, or a line of credit? b.) In what areas do you specialize? Some medical factors are generalists, but most focus on specific industries, such as hospitals, nursing homes, medical offices, or diagnostic imaging centers. Make sure that the factors you speak with and select are comfortable with your specific field. If you are unsure, ask the factors to provide references. c.) Do you charge a due diligence fee? This question is important since due diligence fees vary a lot from company to company. Some charge fairly high upfront fees, while others charge nominal fees which sometimes can be deducted from your first funding. Make sure you understand how much they charge and what they use these funds for. d.) Will I need to pay for an audit? Medical factoring companies often conduct an audit of your billing practices before providing financing. Factors want to make sure that you are billing insurance companies correctly and that you are getting paid as expected. Larger healthcare institutions (especially hospitals) may require an on-site audit, which can be expensive. e.) Can you work with Medicare/Medicaid? Most medical factors can work with conventional insurance companies (e.g., HMOs, PPOs, etc.). However, only a few factors can work with Medicare and Medicaid claims. Medicare and Medicaid claims cannot be assigned like a conventional insurance claim. Consequently, the factor needs to use a special process to finance those claims. If you invoice Medicare and Medicaid, make sure that the factoring company can finance those claims. f.) What opportunity size are you most comfortable with? Most factors claim that they can finance a large range of opportunities – say, from $50,000 to $5,000,000. Some might go as low as $25,000 as long as you have at least 6 months of billing and collection history. Most factoring providers specialize in opportunities of a certain size.

STEP 3 – IDENTIFY THE BEST PROPOSALS

STEP 1 – FIND CANDIDATES

The easiest way to find medical factoring companies is to search for them on the Internet. Alternatively, ask colleagues in the healthcare field to recommend companies. I suggest the latter since your colleagues can give personal testimonials on the factoring company’s performance.

Comparing factoring proposals is not always easy, since companies offer different programs. You generally need to find the average cost per dollar for each proposal so you can make an accurate comparison. Note that the factoring rate alone is not always a good indicator of total cost. Also, keep in mind that the cost is only one aspect that you should be investigating. You should also consider: • Are they easy to work with? • Are they forthcoming with information? • Are they helpful? • Do you feel comfortable with them?

STEP 2 – EVALUATE CANDIDATES

STEP 4 – FINAL SELECTION

The next step is to interview the factoring companies. It’s best to develop a list of questions beforehand. However, the following list identifies some questions to ask. a.) How long in business? The medical factoring industry has been growing rapidly. There are a number of new companies in the business. Ideally, you want to work with a company that has been in the business for a few years and is HIPAA compliant. If the company is new, ask if any 22

Once you have reviewed the proposals, make a final determination. Select a company that you are comfortable with and that offers a competitive program. If you don’t have the time to do this research, you should consider working with a broker that has access to these medical funding sources who can do the work for you. They usually don’t charge a fee since they get paid directly by the funding source.

Doctor’s Life Tampa Bay

Issue 6, 2014


T he Flor ida Orchest r a

Upcoming Concerts T a m pa , S t. P e t e & C l e a rwa t e r Raymond James Pops

New Year’s from Vienna to New York Welcome the New Year with celebratory sounds from Vienna to Broadway

Jan 9 - 11

Tampa Bay Times Masterworks

Tchaikovsky’s Violin Concerto

Tchaikovsky’s beloved Violin Concerto, featuring violinist Jennifer Koh, together with his Symphony No. 4

Jan 16 - 18

Tampa Bay Times Masterworks

Romeo and Juliet

Prokofiev’s Romeo and Juliet on a program with Barber and Copland

Jan 23 - 25

Tampa Bay Times Masterworks

FAure’s Requiem

Join Music Director Designate Michael Francis in Faure’s glorious Requiem

Feb 7 & 8

Jennifer Koh, violinn

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