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JANUARY 2015

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VOLUME 68 NO. 01

James L. Humphreys, MD

2015

BCMS PRESIDENT

Inside: Medical Ethics

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Medical Ethics

By Ruth Berggren, MD, FACP....................................12

The right or wrong of business BCMS President’s Message ..............................................8 BCMS Alliance..................................................................10

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Opinion: Book examines Nazis’ impact on medicine by Jeffrey J. Meffert, MD ..............................................17 BCMS News ................................................................................................................................20 Lifestyle: Historic Texas Cemeteries, by Julie Catalano ............................................................24 Lifestyle: Culinaria San Antonio ..................................................................................................26 Business of Medicine: Skills required for today’s healthcare leaders by Joseph P. Gonzales, MHA, FACHE, PMP ....................................................................................28 UTHSCSA Dean’s Message by Francisco González-Scarano, MD ......................................................32 HASA: HIE perspectives by Vanessa I. Hill, MD, FAAP ........................................................................34 BCMS Circle of Friends Services Directory ..........................................................................................35 Book Review: ‘The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics” written by Barron H. Lerner, reviewed by Fred H. Olin, MD ..............................................................41 Business of Medicine: PODs, fraud and ‘Who’s my doctor?’ by Pamela C. Smith, PhD ............41 In the Driver’s Seat ................................................................................................................................43 Auto Review: Ford Fusion Energi by Steve Schutz, MD ........................................................................44

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Opinion: Medical Nazis: (When rules rule) by Robert Johnson, MD ................................................16

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The ethics of epidemics

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BOARD OF DIRECTORS

OFFICERS James L. Humphreys, MD, President Leah Hanselka Jacobson, MD, Vice President Maria M. Tiamson-Beato, MD, Treasurer Adam V. Ratner, MD, Secretary Jayesh B. Shah, MD, President-elect K. Ashok Kumar, MD, Immediate Past President

DIRECTORS Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member John Robert Holcomb, MD, Member John Joseph Nava, MD, Member Carmen Perez, MD, Member Oscar Gilberto Ramirez, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Miguel A. Vazquez, MD, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Bonnie Harriet Hartstein, MD, Military Representative Rebecca Christopherson, BCMS Alliance President Gerald Q. Greenfield Jr., MD, PA, Board of Censors Chair Donald L. Hilton Jr., MD, Board of Mediations Chair George F. "Rick" Evans Jr., Legal Counsel

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom

DIRECTOR OF COMMUNICATIONS Susan A. Merkner

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Fred H. Olin, MD, Chair Estrella M.C. deForster, MD, Member Jay S. Ellis Jr., MD, Member Jeffrey J. Meffert, MD, Member Rajam S. Ramamurthy, MD, Member J.J. Waller Jr., MD, Member

6 San Antonio Medicine â€˘ January 2015

PRESIDENT’S MESSAGE

Starting the new year with

ENTHUSIASM

By James L. Humphreys, MD 2015 BCMS President

elcome to 2015! As we head into a new year, it will un-

valuable

doubtedly be as full of new challenges to physicians and

asset in this

medical practices as the last few have been. Maybe it is just the

project.

cooler weather buoying my spirits but I do have a renewed en-

Our state legislature begins a new session this month as well.

thusiasm to start the year and am determined to keep finding

I won’t dwell on this topic at any length here as it will certainly

enjoyment in practicing medicine and taking care of people in

be a topic for future President’s Messages. We have been diligent

our community.

in preparing for the upcoming fights over old, perennial topics

This will be a pivotal year for the Bexar County Medical So-

such as scope of practice encroachment and graduate medical

ciety as we set out on the journey of building our new home at

education funding, as well as new, hot issues such as price trans-

long last. I was active in BCMS just before we left the West

parency in medicine. As always, we will work in conjunction

French Place facility and transitioned to our current location. It

with the Texas Medical Association to coordinate our political

has worked pretty well for our needs these last few years but

maneuvers, and I am hopeful for a successful session for medi-

never felt like home since it was always to be a temporary park-

cine in 2015.

ing place for the society. It is with a sense of relief that I look

Lastly, I would like to say what an honor it is for me to hold

forward to our new home as the search has been quite long for

this office. I have thoroughly enjoyed my involvement with

just the right land or building on which to take the plunge.

the Bexar County Medical Society, and I am particularly look-

Starting any project of this size can induce anxiety since it al-

ing forward to working with Steve, the board of directors,

ways costs more than we would hope or project, and we will def-

BCMS staff, and all of you to make this a great year for our

initely be relying on a combined effort of our members and

society. I am especially grateful to my wife, Janis, and my

community partners to minimize our debt on the building and

daughter, Madison, who have been so patient with me and

maintain fiscal prudence for the good of the society. We are for-

tolerant of all the time I have spent sitting in meetings. Their

tunate to have Steve Fitzer back on board at this time as I think

support means the world to me, and I could never do this

he will be the right man to help us achieve our goal of having a

without them behind me.

suitably prestigious home that we can actually afford. I would

It is going to be a busy year, so let’s get to it.

be remiss at this point if I did not again highlight the extraordinary effort that Dr. Buddy Swift has put in on this from the time

James L. Humphreys, MD, is the 2015 president of the Bexar

we sold the building on French Street (if not before). He has

County Medical Society. He is a pathologist with Precision Pathology

been absolutely instrumental in this process and an incredibly

in San Antonio.

8 San Antonio Medicine • January 2015

BCMS ALLIANCE

Alliance offers many programs, volunteer opportunities By Rebecca Christopherson 2015 Bexar County Medical Society Alliance President

I cannot believe that 2015 is upon us! As the Bexar County

Another worthwhile way to become involved is by participat-

Medical Society Alliance’s new president, I want to extend a

ing in First Tuesdays at the Capitol. The dates include Feb. 3,

Texas-sized hello to you all! I look forward with enthusiasm to

March 3, April 7 and May 5. As always, if you are interested in

serving Bexar County’s family of medicine and the greater com-

any of these programs, please do not hesitate to email me, and

munity at large this year.

I will put you in contact with the appropriate person and answer

The BCMS Alliance was founded as the Auxiliary to the Bexar

any questions you may have.

County Medical Society on Oct. 29, 1917, at the Menger Hotel

We have an exciting and varied calendar planned for this year.

“to create fellowship among the families of physicians and to foster

Please make plans to attend the BCMS/BCMS Alliance Officer

activities in benevolent, philanthropic, charitable and patriotic

Installation Jan. 24 at Oak Hills Country Club. Our New Mem-

endeavors.” As we enter our 98th year, I want to extend a hearty

ber Welcome Luncheon is slated for February and our Past Pres-

welcome to our new members and an invitation to physicians and

ident’s Luncheon in May. We currently are working on several

their spouses who are not yet members to join the Alliance.

social events to be held in the evening for members and their

In 2015, we will continue our philanthropic endeavors, which

spouses, such as “Sips and Dips” and other interest groups.

include our “Be Wise…Immunize” program, “Hard Hats for Lit-

This year is a great year to become an Alliance member, and I

tle Heads” and our Junior Volunteer Council (JVC). The JVC,

encourage you to either join now for the first time or to renew

which was created in 2014, is composed of high school-age stu-

your current membership. For existing members, TMAA will send

dents who are children of members of the BCMS Alliance and/or

out a second dues renewal statement Jan. 31 so keep an eye out

BCMS. It is a student volunteer organization for those youth in-

and check your mail boxes.

terested in serving the Bexar County community in a volunteer capacity. I also want to extend an invitation to new and old members alike to sign up and serve as an Alliance committee chair or com-

Lastly, I want to extend a special thank you to our 2014 Alliance president, Cindy Comfort, for her guidance and assistance in helping me prepare for this year. She has been an invaluable mentor, and her shoes will prove difficult to fill.

mittee member. We have several committee openings – Doctor’s Day, Book Club, Yearbook and Hospitality, to name a few. I know

Rebecca Christopherson is the 2015 president

that in today’s world our time is precious. Any level of participa-

of the Bexar County Medical Society Alliance.

tion is welcomed. If your schedule does not permit involvement, please know that your dues will go toward our numerous community projects.

10 San Antonio Medicine • January 2015

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MEDICAL ETHICS

THE ETHICS OF EPIDEMICS By Ruth Berggren, MD, FACP

Infectious diseases are a study in contradiction. They prey opportunistically on the poor, sick and defenseless. At the same time, they are ruthlessly democratic, spreading despite political boundaries, race, wealth and other factors we naïvely count on for protection. I chose to specialize in infectious diseases because I was struck by how they preferentially wreak havoc on the down-and-outers of society. This is as true now as ever. Dr. Paul Farmer, who cofounded the international aid group Partners in Health, calls it “the leading ethical question of our times.” The Ebola outbreak in West Africa clearly illustrates this point. The disease has taken hold in developing countries that are among the least prepared to cope. As of this writing, the confirmed worldwide death toll is nearly 7,000 and growing – with all but a handful in West Africa.

ALTRUISM AND SELF-INTEREST While I have focused on the unequal burden of disease throughout my career, something else is increasingly clear to me: When it comes to the threat of a pandemic, altruism and self-interest are one and the same. If helping our fellow human beings isn’t reason enough to stand shoulder to shoulder with West Africans in the fight against Ebola, then how about stamping out the disease at its source to prevent it from taking hold elsewhere? By working toward the greater good, wealthy countries protect themselves. World Health Organization director-general Dr. Margaret Chan summarizes the lessons of Ebola bluntly: “First, the outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die.” However, “when a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk. Our 21st century societies are interconnected, interdependent and electronically wired together as never before.” 12 San Antonio Medicine • January 2015

As the Ebola crisis gained momentum in 2014, we should have focused outward for reasons of justice and self-interest. Instead, many of us chose to look inward. A Catholic school in Louisville, Ky., reportedly asked a school teacher to take a 21-day leave of absence due to “strong parent concerns” after she returned from a mission trip to Kenya – in East Africa, several thousand miles from the outbreak. The teacher resigned over the episode. A health professional from Bellevue Hospital Center, which cared for New York’s first Ebola patient, was told by her longtime hairdresser to find someone else to cut her hair. The cremated remains of the first U.S. Ebola victim, Thomas

MEDICAL ETHICS

were rewarded with unscientific quarantines and other fear-based responses. This is hardly the first epidemic to cause panic. We experienced this during the early days of the AIDS crisis in the 1980s, and yet we are indulging in the same paranoia today. One group has learned the lessons of the past: AIDS activists who, recalling their own experiences with hysteria, as well as the doctors and nurses who stood by them, have come out strongly against one-size-fits-all Ebola quarantines. No one disputes that a patient with symptoms compatible with Ebola plus known risk factors must have a mandatory quarantine until the disease either is ruled out or resolved. But a returning healthcare worker without fever should not be forcibly incarcerated or stigmatized. Stigma that deters qualified Ebola volunteers from helping to stop the disease paradoxically puts all of us at greater risk of an uncontrolled outbreak. There are some hopeful signs that the United States is becoming more clear-eyed about Ebola. Among them: In the waning days of 2014, Time magazine named the Ebola fighters as its Person of the Year.

COMMUNITIES DESTROYED

Eric Duncan, sat uncollected for months despite the fact that they pose no risk. Louisiana’s attorney general got a temporary restraining order to keep them out of his state. In a Dec. 11 essay, Duncan’s nephew writes that the indignity Duncan faces even in death is very upsetting to the family. The Ebola panic that took hold in the United States in 2014 was out of proportion with the actual risk. Perhaps most damaging: Those who set aside fear for their own safety to care for Ebola patients – and, in doing so, shield the rest of the world – were too often rewarded with stigma and isolation. These were the exemplars of medical ethics and justice. They

I’m hopeful that the focus is returning to the real crisis. Let’s recall these words from Dr. Craig Spencer, who recovered from Ebola himself after treating patients in Guinea through the humanitarian aid organization Doctors Without Borders. “While my case has garnered international attention, it is important to remember that my infection represents but a fraction of the more than 13,000 reported cases to date in West Africa – the center of the outbreak, where families are being torn apart and communities destroyed,” Dr. Spencer said. “Please join me in turning our attention back to West Africa, and ensuring that medical volunteers and other aid workers do not face stigma and threats upon their return home. Volunteers need to be supported to help fight this outbreak at its source.” We ignore his counsel at our own peril. Ruth Berggren, MD, FACP, is a professor of medicine specializing in infectious diseases and director of the Center for Medical Humanities & Ethics, part of the School of Medicine at the University of Texas Health Science Center at San Antonio. She is a BCMS member visit us at www.bcms.org

MEDICAL ETHICS

THE RIGHT OR WRONG OF BUSINESS By Forrest Smith, FHFMA “Reports indicate that starting in the 1980s soon after it was formed, Healthsouth established a fraudulent strategy that allowed it to dominate and take control of the entire rehabilitation and surgical outpatient for-profit marketplace…The fraud went undetected for 15 years and in the last five years [it amounted to] $2.7 billion. It was only when the Enron and WorldCom scandals focused attention on deviant accounting practices that the fraud was exposed.” In October 2011, Aaron Beam presented at the South Texas Chapter of the Healthcare Financial Management Association (HFMA) Fall Institute in San Antonio, on “Healthsouth: The Wagon to Disaster”. In case you do not recognize the name, Aaron Beam was the chief financial officer of Healthsouth when it collapsed amid scandal, fraud and corruption. Beam has been kind enough to permit me to use much of his presentation in the preparation of this article. Beam freely admits to his part in the collapse of Healthsouth. His presentation focused on why it was allowed to happen and what he should have done instead of being part of it. We in HFMA are the financial backbone of the healthcare industry. As such we are responsible for insuring that the nonfinancial professionals of our industry, our patients and the public in general feel they can rely on the financial information we produce. To that end we have to know and understand how events such as Healthsouth can happen.

ETHICAL COLLAPSE We have all heard that “Success breeds success” and that “If power corrupts; absolute power corrupts absolutely.” While not used directly in Beam’s presentation, both sayings are truly interwoven in it. Beam, quoting from the book, “The Seven Signs of 14 San Antonio Medicine • January 2015

Ethical Collapse: How to Spot Moral Meltdowns in Companies Before It’s Too Late” by Marianne M. Jennings, JD, shows us what to watch out for. I strongly recommend this book for reading by every HFMA member as well as every member of the board of all organizations. The seven signs listed in the book and in Beam’s presentation are: 1. Pressure to maintain those numbers 2. Fear and silence 3. Young ’uns and a bigger-than-life CEO 4. Weak board 5. Conflicts 6. Innovation like no other 7. Goodness in some areas atones for evil in others. We have all felt the “pressure to maintain those numbers” whether it is maintaining a high “current ratio,” keeping patient collections at high levels, keeping the accounts receivable and days in receivable low, or improving any of the many financial facts and figures used to analyze performance. These are all used to set goals which are often used in our performance evaluations. There is no question that setting goals and objectives are important. But if we bend to the “pressure to maintain those numbers” by reporting false, erroneous or fictitious numbers, we are in fact committing fraud. This is exactly what happened with Enron, WorldCom and Healthsouth. As Beam noted, it is not always our own desire to obtain the numbers, it is often the desire of our superiors. The leader with high moral and ethical traits is most often what we call a “natural leader.” People will respond simply because they are asked to. In his presentation Beam pointed out that leaders without natural leadership abilities have to resort to other tactics. This person is

MEDICAL ETHICS

often loud, boastful and arrogant. They frequently use profanity to intimidate in order to get what they want, the way they want it. They throw fits and tantrums if things are not the way they want them to be. They find this form of intimidation works well with those who will do anything to avoid conflict. And they know that when the data is made to reflect what the leader wants it to be, they can always blame the person who conforms rather than take any blame themselves. This leader has to find the right person: the yes person. They will reward them for being faithful even when they know what is being done may not be correct or even legal. And they become experts in creating fear in younger employees and those who can be cowered. No one wants to lose their job, and a weak person does not want to be branded a nonconformist or an obstructionist. Many find it easier to give in than stand their ground or resign. When the fraud or manipulation is discovered, the corrupt leader can, and will, throw the yes person to the wolves. Beam spent time in federal prison, whereas his boss was acquitted.

WEAK BOARD OF DIRECTORS Another sign that ethical collapse can occur is a weak board of directors. Such a board is a prescription for disaster. A board is weak when the majority of the voting members are appointed through the efforts of a corrupt and unethical CEO. These members are often the CEO’s “yes men.” A board also is weak when it is not informed of its responsibilities and duties. A weak board frequently does not have outside representation such as a banker, clergy, independent accountant and legal representation. I believe the first thing needed to strengthen a board of directors is education. They must understand that they have a legal responsibility for the running of the organization and that they can be held legally and fis-

cally liable for what the organization does or fails to do. Every member of the board should be required to read the “business practice act” of every state in which the organization has operations. In Texas this is known as the “Texas Business Organizations Code” and can be found at the Texas Secretary of State website. The organization’s attorney or compliance officer should be required to make frequent presentations to the board and inform them of their duties, responsibilities and legal liabilities and any changes that have been enacted since the last presentation. Because repetition breeds boredom try changing who makes this presentation. Bring in an outside person, and include the senior and junior management in at least an annual briefing. Necessity is the mother of innovation – no, that’s invention. But the principle is still the same. There is plenty of room for innovation as long as it does not cross the line of right from wrong. HFMA members are required by their code of ethics to practice honesty and integrity while presenting fair and objective financial information. We subscribe to the generally accepted accounting principles, and cooking the books is not one of them. The corrupt individual may call it innovation, I call it outright fraud. Changing dates of accounts payable and accounts receivable to maintain value is not part of our code. To look the other way when we know it is happening makes us just as culpable as the person who actually performs the act.

DON’T LOSE EVERYTHING So what do you do should you encounter a supervisor who has low morals, poor or no business ethics and integrity, and wants it his way or the highway? First of all, do not commit an illegal act. As Beam pointed out, nothing is worth you losing everything, your friends, family, and all personal assets as well as possibility going Continued on page 42 visit us at www.bcms.org

OPINION

Medical Nazis:

(When rules rule) By Robert Johnson, MD

Turns out I broke the law the other day. I wasn’t aware of it. You wouldn’t have known to watch me strolling from my office, across the parking lot and into the hospital. I’m not sure if it was a misdemeanor or felony; punishable by flagellation, jail time, or drone strike. I’m pretty sure you’ve done it as well, and that’s my defense in court (but Mikey did it, too, Your Honor). It was a breezy afternoon, with a few high cumulus clouds playing hide-and-seek with the sun. I was headed to the OR after an office from you-know-where, with a patient’s X-rays and clinic notes innocently tucked beneath my arm. As you all probably know, and I now know, that’s a HIPAA no-no (say that three times backwards). What if I’d been, God forbid, mugged or kidnapped? Anyone know the current street value of a stranger’s MRI report and hemoglobin levels? I would have been legal had I placed said contraband in a locked briefcase (chained to my wrist?). Like a briefcase lock will keep out the bad guys! Now here’s a scary story. A colleague was showing an in-patient his X-rays on a hospital computer in the presence of a cleric (invited to watch by the patient). During the course of pulling up the films, another patient’s name briefly flashed across the screen. The pastoral care representative announced to the doctor that he had just committed a HIPAA violation and, if it happened again, he would be reported (Father, I have sinned ...). Seems that hospital employees, volunteers, and family members have been deputized by HIPAA (administration?).

Friend of mine who is CEO of a medical device company related to me the story of a recent inspection at his corporate offices by the U.S. Food and Drug Administration (FDA). They will periodically show up unannounced to spot-check for safe medical practices, etcetera, a little like the Department of Health keeping its thumb on restaurants. It was warm in the facility, and several of the visitors took off their jackets. They were packin’ 9mm semi-automatics. Yes, you read that right — I said the FDA, not the FBI! Then there’s Qui Tam, which has been around for a while. Turn in your doctor for Medicare fraud, and share in the reward, plus a free dinner for two at Denny’s. A lengthy menu of potential infractions is available online. It’s just a little too reminiscent of the 1930s in Nazi Germany. The paramilitary Brownshirts (aka the SA), recruited from rankand-file citizenry to spy for the government. Their technique was to organize into small squads and infiltrate the populace. Those who broke the rules were beaten up, their stores forcibly boycotted, or worse — squealed on by the clergy.

GOOD IDEA GONE TOO FAR Where does it end? Ever discussed your patient’s surgery with their family in a crowded waiting room? Ever announced the results of Mrs. Smith’s blood work in her semi-private room, with Mrs. Jones six feet away in the next bed? How do we fix that one? Continued on page 18

16 San Antonio Medicine • January 2015

OPINION

Book examines

Nazis’ impact on medicine By Jeffrey J. Meffert, MD

“The Death of Medicine in Nazi Germany,” written by Wolfgang Weyers, is an older book, but I have been thinking about it a lot lately as talking heads, bloggers and passionate letter-writers describe President Barack Obama as a fascist dictator and pontificate about the Affordable Care Act being at least as bad as the Holocaust, if not worse. Sometimes it is worth cutting through the hyperbole and hysterical posturing to remember what REAL Nazis do and what REAL oppression of the practice of medicine looks like. On the face of it, this book is rather “dermatocentric” but everything that happened in dermatology happened throughout the German medical field. Why is there a move to change the name of “Reiter’s disease” to “reactive arthritis”? The story of Dr. Hans Reiter is a typical one of the era. Reiter was an early party member, big on theories of eugenics, and a fervent anti-Semite. In the early 20th century, many of the iconic figures of German medicine were Jewish, including some of the best professors in the universities. Reiter managed to put up with them as long as he had to, but once the Nazi party and its newly elected chancellor were able to influence the laws and politics of the land, Reiter’s career rise was meteoric, rapidly soaring through academic ranks at the University of Berlin.

POLITICAL INDOCTRINATION As his authority grew, undesirable faculty were muscled out while loyal party hacks were fitted in. At first Jewish professors could not teach non-Jewish students, and about this time many required medical school courses were replaced by political indoctrination. Later on Jewish physicians were no longer allowed to treat Aryan patients and, later still, not officially allowed to treat anyone at all. All this was a prelude to their being shipped off to the camps with all the other Jews, Communists, homosexuals, gypsies and other “undesirables.” While Reiter was not guilty of the most hideous human subject “experiments,” he saw nothing wrong and plenty to gain by using concentration camp inmates in Typhus vaccine research and other public-health projects.

At the war’s end, Reiter was stripped of his academic titles but, curiously, not his medical license, and he was allowed to practice until his death in 1969. He was not considered a big enough fish to include in the 1946-47 “Doctors’ Trial,” a subset of the Nuremburg Tribunals. Some two dozen senior physicians were tried for their participation in war crimes, and while some were acquitted and others imprisoned, seven were executed. Hanging was reserved primarily for those who willingly lent their medical expertise to the torture and inhumane experiments of the death camps. Not every German physician was as enthusiastic as Hans Reiter but many others profited from the rapid academic advancement and business opportunities created by the sudden vacancies in their ranks. More than a few committed suicide in 1945 in shame and fear of the judgment to come. More noble doctors fought actively to defend their colleagues, some helping set up hidden practices, and still others resigning their own academic positions rather Continued on page 19 visit us at www.bcms.org

OPINION

MEDICAL NAZIS Continued from page 16

Sign language? Passing a written note that must be immediately eaten? Ear plugs? Everyone gets a private room? It seems to me that the semiprivate room is the quintessential HIPAA violation. Have we created a problem by drawing attention to it? Reminds me of when my kid whacks his arm on the counter, and only cries if someone noticed. For 30 years I’ve practiced without a single incident related to patient privacy. We’ve created an expensive cure for an illness that barely exists. We all understand the importance of privacy. No one should throw medical records in the trash, or talk publicly about a patient’s health issues. We’ve already got that covered with “primum non nocere — first do no harm.” Some old fart said that two millennia ago; we don’t need government decrees to enforce common sense. Robert Johnson, MD, is an orthopaedic surgeon, a BCMS member and frequent contributor to San Antonio Medicine.

18 San Antonio Medicine • January 2015

OPINION BOOK EXAMINES NAZIS’ IMPACT ON MEDICINE Continued from page 17

than fire good people who did not deserve that abuse. These brave souls were too few and unable to slow the remaking of German medicine into an arm of the Nazi party. American medicine, on the other hand, actually profited in the 1930s with the immigration of many of the best and brightest physicians who saw the future of German medicine and escaped the coming nightmare while they still could. So let’s try and keep the rhetoric a bit more realistic. Is the president really as bad as Adolph Hitler? No. Is saying Medicare wants you to use an electronic medical record really the same as mandating that a physician with a Jewish wife isn’t allowed to treat Aryan patients? Absurd. Is expanding Medicaid really the same as shipping off all your Jewish doctors to concentration camps? That is an insult to the victims of the Holocaust and all those who fought against it. Remember, once upon a time there were REAL Nazis who destroyed their country and corrupted the physicians they didn’t kill outright. To liken the current changes in medical economics to that awful time in human history proves ignorance of both. Jeffrey J. Meffert, MD, is a member of the dermatology faculty at the University of Texas Health Science Center San Antonio and a past chair of the BCMS Communications/Publications committee.

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BCMS NEWS

Call for resolutions for 2015 Do you have a TMA policy change suggestion or recommendation for a stance on an issue? Submit your resolutions now to the BCMS Delegation to TMA. The deadline is Jan. 9. For a sample resolution form, more information or to submit completed resolutions, contact Mary E. Nava, BCMS Chief Governmental and Community Relations Officer, at 210-301-4395 or at Mary.Nava@bcms.org.

Honoring our past â€Ś Building our future BCMS is purchasing land to build its new headquarters. To donate and learn more, visit http://bcms.org/building.html.

20 San Antonio Medicine â€˘ January 2015

BCMS NEWS

BCMS General Membership Meeting addresses GPCI By Mary E. Nava, MBA BCMS Chief Governmental and Community Relations Officer BCMS hosted a general membership meeting Nov. 17 featuring TMA's director of research and data analysis, Donna Kinney, CPA, who presented a discussion on an important reimbursement calculation, the Geographical Practice Cost Index (GPCI). Approximately 100 doctors attended the meeting at the Omni Hotel Colonnade to hear about how GPCI was initially established, what it is intended to do, what components are used in order to calculate this payment formula, and what options are available for possible consideration. GPCI is, by law, an attempt by the federal government, through the Centers for Medicare and Medicaid Services (CMS), to compensate physicians for three physician fee components: physician work, practice expenses, and medical malpractice insurance rates by individual payment localities. Currently, the state is divided into eight payment localities: Austin, Beaumont, Brazoria, Dallas, Fort Worth, Galveston, Houston and "the rest of Texas" (which includes San Antonio). Ms. Kinney's presentation is expected to be available on DVD after Jan. 1. For local discussion on this and other advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava at Mary.Nava@bcms.org.

22 San Antonio Medicine â€˘ January 2015

Above: BCMS members listen to a presentation Nov. 17 at the Omni Hotel Colonnade on the Geographical Practice Cost Index (GPCI). At right: TMA's Donna Kinney (left) is greeted at the BCMS meeting Nov. 17 by BCMS past president and current board member John R. Holcomb, MD.

BCMS NEWS

Unsung Hero honored Elizabeth Leyendecker, practice administrator at Bucay Center for Dermatology and Aesthetics, was named the BCMS Unsung Hero for November. The Unsung Hero program allows BCMS members to recognize their office managers/administrators for their dedication and hard work in assisting physicians in delivering the best attention and care to patients. Leyendecker was nominated by Vivian Bucay, MD, who wrote: “Elizabeth’s dedication, commitment, attention to detail and above all compassion to our patients have earned her this award.” Physician members: Please remember to recognize your "Unsung Hero." Monthly deadlines and additional information are at www.bcms.org. Vivian Bucay, MD (left), congratulates Elizabeth Leyendecker, the BCMS Unsung Hero for November 2014.

Noteworthy Jaime R. Garza, MD, DDS, was elected chairman of the Texas State University System Board of Regents Nov. 7 for the 2014-15 term. Dr. Garza is a professor of surgery, professor of otolaryngology, and assistant dean for South Texas affairs at the University of Texas Health Science Center San Antonio. He is president and CEO of Texas Plastic Surgery and Renew Center at Stadia. Dr. Garza is a BCMS member.

In Memoriam Robert L.M. Hilliard, MD, died Dec. 1, 2014, at age 83. A BCMS life member, Dr. Hilliard was an obstetrician-gynecologist and a former San Antonio City Council member.

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LIFESTYLE

Destination:

HISTORIC TEXAS CEMETERIES

Their stillness draws thousands of visitors to peaceful oases where some of Texas’ most famous — and infamous — sons and daughters lay. From the humblest marker to the most elaborate monument, these final resting places serve as living history lessons where characters who played a part both large and small in the story of Texas are gone but not forgotten.

By Julie Catalano

TEXAS STATE CEMETERY, AUSTIN 909 Navasota Street 512.463.0605 Cemetery.state.tx.us Photography by W. K. Erwin There are two ways to qualify for burial at Texas State Cemetery: 1) be automatically eligible by law as a state official such as judges, legislators and state board members, or 2) make an outstanding contribution to Texas in some way — art, sports, education, business, philanthropy, literature and the like. “Not everybody is approved,” says Harry Bradley, longtime superintendent of the only official state cemetery in the country, “but people usually don’t apply unless they think they have a chance.” Home to legendary Texas figures like Stephen F. Austin (“the Father of Texas”) and General Edward Burleson — the first occupant of the cemetery on its founding in 1851 — the 21-acre TSC is just one mile east of downtown’s capitol building. Austin’s hilltop gravesite “is the focal point of the cemetery,” adds Bradley, but governors John Connally, Ann Richards, “Ma” and “Pa” Ferguson and nine others also draw interested visitors, as do such luminaries as author James Michener, folklorist James Frank Dobie, and politician and educator Barbara Jordan. The grounds themselves underwent a $5 million renovation in the mid1990s, says Bradley, and are “the biggest selling point, better than most country clubs.” Each year more than 15,000 students visit what Bradley calls “an outdoor museum. We teach Texas history by walk24 San Antonio Medicine • January 2015

ing through the cemetery.” Open 365 days a year, free guided 45-60 minute group tours are held Monday-Friday. Reservations are required; call 512.463.6600. A self-guided audio tour can be obtained at the visitor’s center or downloaded from the website.

EASTSIDE CEMETERY DISTRICT, SAN ANTONIO Boundaries: East Commerce and S. New Braunfels 210.215.9274 | Sanantonio.gov/historic/ Photography courtesy of San Antonio Office of Historic Preservation Listed as a National Register Historic District, 103 acres of graves on San Antonio’s east side are a study in diversity — City Cemeteries 16, Agudas Achim, African-American, Knights of Pythias, Hermann

LIFESTYLE

Sons, Dignowity, St. Joseph’s Catholic, and the Confederate Cemetery are just a few of the mind-boggling array of 31 individual cemeteries. Dating back to the 1850s, members of fraternal and military organizations, business leaders, and some of the most familiar names in the city are found here, including notable King William family grave sites of Steves, Guenther and Groos, and household names like Frost, Tobin, Maverick and Menger. The markers are mostly modest, but there are some standouts: Ludwig Mahncke’s tree-trunk style monument is an example of the Woodmen of the World monuments, fitting for the San Antonio Parks Commissioner; the mausoleum of Clara Driscoll (“Savior of the Alamo”) in the Alamo Masonic Lodge cemetery; and the “Woman with Children” statue at the Winn family gravesite carved by Italian sculptor Pompeo Coppini, best known for the heroes cenotaph in front of the Alamo. Ironically, a simple stone marks what lies beneath — by far the most unusual grave in this or any cemetery, that of millionaire oil widow Sandra West, whose last wish was that she be buried in a lace nightgown behind the wheel of her favorite Ferrari. She got her wish, and both driver and car rest forever in Alamo Masonic Lodge cemetery. Guided tours are seasonal; call the San Antonio Office of Historic Preservation or check their website for special events. For self-guided tours, search the website of the Office of Cultural Affairs Neighborhood Tours (saculturaltours.com) for park and walk maps of City Cemeteries Nos. 1, 5 and 6.

GLENWOOD CEMETERY, HOUSTON 2525 Washington Avenue 713.864.7886 | Glenwoodcemetery.org Photography courtesy of Preservation Houston One of the most beautiful cemeteries in the state, the privatelyowned Glenwood was established in 1871 along the north bank of the Buffalo Bayou in the style of 19th century romantic garden cemeteries that took advantage of natural features and rural settings. The result is 88 acres of serene, parklike atmosphere with curving paths and stunning statuary — the perfect ambience for the who’s who of Houston and other prominent citizens. “Glenwood is unique in that it has hillsides,” says Richard Ambrus, executive director, “and there are lots of different venues within the cemetery, each with its own style.” Undoubtedly its most famous resident is billionaire Howard Hughes, whose family plot (he’s buried with his parents) is “rather understated and conservative,” says Ambrus. Other notables include film legend Gene Tierney (Lee), the last president of the Republic of Texas Anson Jones, impresario Edna Saunders, Texas Governor Ross Sterling, and Charlotte Baldwin Allen, known as “the mother of Houston.” Guided 90-minute walking tours are held on the fourth Saturday of February, May, August and November, in conjunction with Preservation Houston (preservationhouston.org) who has been giving Glenwood tours for about 30 years. Admission is $10 per person by reservation, and the very popular public tours “end up selling out every time,” says Jim Parsons, architecture walks chairman at PH. “Everybody’s curious about who is buried there.” (Private tours for individuals and groups can be arranged in advance by contacting the cemetery directly.) The bucolic surroundings provide an alluring otherworldly feeling that draws joggers, bicyclists, even (leashed) dog walkers. “Glenwood is a good place to find your center in the middle of all the construction going on in Houston,” says Parsons. “It’s the one thing that doesn’t change.” For further reading: “Houston’s Silent Garden: Glenwood Cemetery, 18712009” (University of Texas Press, 2010). visit us at www.bcms.org

LIFESTYLE

EAT, DRINK, GIVE. Culinaria San Antonio Restaurant Week

Special to San Antonio Medicine 26 San Antonio Medicine â€˘ January 2015

LIFESTYLE

When Culinaria started San Antonio Restaurant Week in 2010, the goal was to encourage more local dining in what is traditionally a slower time for restaurants. Little did the group know that the success of San Antonio Restaurant Week would make such an impact that the restaurants would request (also see: beg, plead, urge) Culinaria to add a second week during the year. So, with the continued success of the week in August, Culinaria will add a Restaurant Week to the calendar of events and start the year with delicious dining Jan. 19-24. Culinaria has always had big plans for San Antonio Restaurant Week seeing the need to encourage residents and visitors to support local favorite restaurants, try new ones and take some of the intimidation out of fine dining. Other markets in the United States had their own events and even had two separate times of the year in which they hosted their weeks, but Culinaria’s plans included starting small and growing with restaurant participation and attendance. As the popularity has grown, a record number of restaurants participated in August, while the number of diners supporting the restaurants also increased. That slow week of the year now has turned into one of the busiest, competing with Valentine’s Day and Mother’s Day, two of the record-breaking days of the year for the industry. The addition of a second pricing tier also provided the chance for more restaurants to come on board. Each participating restaurant must offer a three-course, prix-fixe menu at one of two price levels. Tier one features a $15 lunch and a $35 dinner, while tier two has a $10 lunch and a $25 dinner. The restaurants are allowed to add wine, beer or cocktail pairings or even additional courses, but Culinaria requires that they at least meet the three-course menu offering at the set price. Not only does the week of promotion allow restaurants the chance to increase business through new customers and regular patrons, it also gives them the opportunity to leave their menu for a bit and explore new dishes. It’s a chance to show their creativity without committing to a permanent menu change and to hear feedback from guests. For other restaurants, it’s a chance to offer guests a menu favorite at a special price. “Restaurant Week is a time of the year that appeals to a larger audience, as you can pick and choose which restaurant features a menu that speaks to you. You can certainly dine out in a different venue for lunch and dinner in all parts of the city. My best advice is always to make a plan and invite a friend,” said Suzanne TarantoEtheredge, Culinaria president/CEO.

San Antonio Restaurant Week is a success for the restaurants and also offers a chance for them to give back to Culinaria. From each lunch purchased, $1 is given to Culinaria, and $2 from each dinner goes back to the organization for the mission and causes it supports. Culinaria is a nonprofit organization that promotes San Antonio as a culinary destination through its annual events such as Restaurant Week, the 5K Wine and Beer Run (March 21) and Festival Week (May 13-17), along with a few smaller events throughout the year. While Festival Week is how the organization started and includes a series of events that bring U.S. and international visitors, it has acted as a springboard for both the Wine and Beer Run and Restaurant Week, which are able to stand alone but all support the mission of promoting San Antonio as a culinary destination. As a nonprofit, Culinaria supports culinary scholarships, assists chefs and individuals in the beverage industry enduring personal hardships through the Hope for Hospitality program and also is working toward the development of the Culinaria Urban Farm. The organization has been in the capital campaign phase of the creation of the Culinaria Urban Farm and expects to see the plans start becoming a reality in 2015. The purpose of the Culinaria Urban Farm is to encourage the values of a farm-to-table diet by educating San Antonio on how to raise one’s own produce and transform it into a healthy – yet very tasty -- meal. Eat, drink, give at San Antonio Restaurant Week Jan. 19-24. Visit www.culinariasa.org for a list of participating restaurants along with available menus. Reservations for lunch or dinner are made directly with the restaurant, and while it is not always required, it is a good idea during this busy time. It’s also a great opportunity to schedule a meeting or to catch up with a friend or colleague. In addition to the website, keep up with Culinaria by liking them on Facebook (/CulinariaSanAntonio), or following them on Twitter or Instagram (both CulinariaSA). Or call 210822-9555. visit us at www.bcms.org

BUSINESS OF MEDICINE

Skills required for today’s healthcare leaders By Joseph P. Gonzales, MHA, FACHE, PMP Today’s complex environment found in the healthcare arena may require a different set of skills for healthcare leaders. Factors such as intense competition, increased regulation, and tighter reimbursements all impact on those skills; additionally, one must continue to improve clinical quality, engage employees and improve patient satisfaction.

LEADERSHIP SKILLS One factor that remains a constant in most healthcare organizations is that today’s leaders are challenged with a difficult balancing act: meeting the needs of their communities and patients served while needing to achieve and track desired organizational metrics. In this article I will identify some assumptions associated with the importance of leadership, and list some skills that may be crucial to success in today’s healthcare environment. From the 2011 Deloitte paper: “Leadership by design: An architecture to build leadership in organizations,” certain assumptions that relate to the importance of leadership were identified. Assumption No. 1: Leadership matters. The research is clear: Leadership is critical to the success of organizations and societies. In his book, “Good to Great,” Jim Collins initially hypothesized that leadership would not differentiate truly great performance from good or average performance. Yet, when he 28 San Antonio Medicine • January 2015

finished his research, Collins determined that leadership was a driving factor of great business performance. Further, it seems that the absence of leadership creates risk. The application to today’s healthcare environment is that the absence of good stable leadership in key positions may be limiting the organization from making full progress toward success. Assumption No. 2: Leaders are made, not born, for the situation at hand. Gifted leaders “showed up” to lead at the right time having already gone through a set of experiences — including hardships and defining moments — that shaped them for success. The likelihood is that if the appropriate time and preparation is put into any executive search, the organization will benefit by selecting the leader that is a good fit for the position. Assumption No. 3: The term leadership is definable. Too often leadership is mistaken for a description of a person. To define leadership we must first separate a leader (as an entity) from leadership (as action). Let’s build a general definition of leadership by looking at the problems organizations face through a framework developed by Keith Grint at Warwick Business School. Grint divides problems into three categories: First, there are tame problems. These are problems that we have seen before and to which we know the solution. The approach to tame problems is management — it is about getting the right process and resource in place and then managing it.

BUSINESS OF MEDICINE Next, there are crises. Crises require someone to take control of the situation and provide an answer to the problem. Crises require neither leaders nor managers, but commanders — people in authority who know how to handle the crisis being faced. And finally, there are what we call wicked problems. These are problems that we haven’t seen before. There is no common definition of the problem, there is certainly no known solution, and there are many stakeholders involved — all of whom purport to have the “right” answer. So in today’s dynamic healthcare environment, it is probably appropriate to develop, seek, or be a leader who can manage, lead and collaborate to solve a multitude of wicked problems.

SKILLS NEEDED Most people associated with leading various aspects of healthcare today should realize that about the only thing constant is change itself, and the only change to that is the increased rate of change. It is approaching “warp speed” today. I’ve reviewed a few articles that speculate as to what today’s healthcare leaders need to deal with these factors. In March 2014, SSI-Search, a national, retained executive search firm, identified the following as the top three skills for healthcare leaders now:

“First is interconnectivity. Going beyond organizational intelligence, we need leaders who understand how to engage themselves at the synapse or the flow of information. Time is at such a premium, and the amount of information so vast, that leaders can no longer act in a linear fashion. Nimble leaders who engage with their organizations in a nonlinear and inclusive fashion will be most successful. Healthcare is too important, and healthcare organizations increasingly complex, that the time for synaptic leadership is here.” Note: They define the term “synaptic leadership” as the leaders who know how to engage themselves in the flow of information to lead and foster change (The brain relies on synapses to exchange information. This exchange of information is at the heart of leading change.) “Second is innovation. All healthcare leaders will be challenged to think in new ways, to adjust to change and to lead change while carving out new models of care. The term Innovation has become increasingly important and as a skill is highly recruited. While the concept has been around for a long time, and with a growing number of chief innovation officers in place to prove it, innovation is recognized as a critical element of success. Innovation as an element of healthcare’s overall strategy is beginning to solidify. The phrase “innovate or die” has a new ring of truth to it.” “Third is communication. This is not a new skill, but it has new Continued on page 30

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BUSINESS OF MEDICINE Continued from page 29

meaning when it is coupled with “interconnectivity” and the race for information. Finding new and better ways to communicate greater amounts of data and information will become increasingly important. Great leaders have always needed to rely on strong communication skills. Moving to a data-driven culture will create new demands on a healthcare leader’s communication skills. The accelerated availability of data has rendered the decision of what is useful and what to communicate as important as how to communicate it.” They conclude: “Leading change at the vortex of information, creating agile, systematic response mechanisms, communicating vast amounts of information and building organizations with the ability to act on that information – that will be the holy grail of leadership” in the future. In Becker’s Hospital Review, 2014, the article excerpted here, “Tomorrow's Top Healthcare Leaders: Five Qualities of the Healthcare Leader of the Future,” was written by J. Stephen Lindsey, FACHE, principal at Ivy Ventures, LLC, and John W. Mitchell, MS, hospital advisor at Ivy Ventures, LLC. The article states that the following qualities will define dynamic leadership in the future: 1. The healthcare leader of the future will be an independent

30 San Antonio Medicine • January 2015

thinker who understands the emerging healthcare market. They state that executives can think independently by learning to focus on the problem and gather information by taking a hard look at what is not working, and by staying in close contact with their major stakeholders and customers. A number of solutions to the problem should be considered before an opinion is given. 2. The healthcare leader of the future will be passionate about serving the needs of the customer. Legendary management consultant Peter Drucker once said, "Management is doing things right; leadership is doing the right things." To serve the customer, executives will spend more time talking and listening to their customers. For hospital administrators, this means rounding in patient rooms and waiting areas every day and staying close to the medical staff. For providers of services to hospitals, this means providing a unique solution to a hospital's competitive challenges through proven service improvement. 3. The healthcare leader of the future will be a change agent for their organization. Successful executives must be able to quickly assess their markets and develop, communicate and execute plans while managing constant change. 4. The healthcare leader of the future will have the ability to mo-

BUSINESS OF MEDICINE

tivate and inspire. Talk about the future, and how your organization will be a part of it. Then, work with your stakeholders to identify specific, measurable goals that will need to be met for your organization to be successful in the future. Good communication is the key to motivating and inspiring others. Tell your story in simple terms, and repeat it often. 5. The healthcare leader of the future will run a lean, high-quality organization. This takes constant attention and focus — and agreed-upon metrics. Every detail needs attention. Have a written plan, such as an annual and 90-day plan for each manager in the organization, and always challenge your assumptions by asking, "Why are we doing this?" The article concludes with another quote from Drucker, “Effective leadership is not about making speeches or being liked; leadership is defined by results, not attributes." An inspired and empowered workforce will hold themselves accountable. Have a plan and set goals. Staffing ratios, productivity, denials, wait times, patient (customer) satisfaction, quality outcomes and market share are just a few metrics that managers must help establish and improve over time.

SUMMARY Regardless of the specific changes and what the future may hold for healthcare in the United States, it is safe to assume constant and rapid change. This will require all healthcare leaders to help the system work more reliably and efficiently to deliver the highest-value care and better health for a growingly diverse population. As a healthcare leader you will need to actively continue to develop your skills, and develop the discipline of continuous skill development. This article couldn’t cover every critical competency a leader may need to be successful, but here are a few others that you may want to add to your toolkit: cultural competency, teamwork, patient- and family-centered leadership, and community outreach. Joseph ”Joe” P. Gonzales is a specialist master with Deloitte Consulting, LLP, and adjunct faculty with the University of Texas at San Antonio’s MBA program, business of healthcare track.

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UTHSCSA DEAN’S MESSAGE

Education, treatment address women’s reproductive health By Francisco González-Scarano, MD One of the recurring themes of my tenure as dean is my own discovery of the depth and breadth of our school, its departments, and the expertise and talent of the faculty. With 17 clinical departments and 15 clinical divisions, in addition to seven basic science departments, there is a lot of territory to cover. An excellent case in point is our Department of Obstetrics and Gynecology (OB/GYN), an area in which we offer the widest array of expertise and clinical services to an equally extensive number of people in Central and South Texas. The chair of the department, Dr. Robert Schenken, sums it up nicely, "We provide a coordinated, multi-disciplinary line of preventive and other specialty services from our caring experts to address the unique needs of women of all ages." Dr. Schenken is a reproductive endocrinologist with more than 30 years’ experience helping women through fertility and other issues. With 23 board-certified physicians covering the full gamut of services, the department includes general obstetrics and gynecology, a Fertility Center, Maternal Fetal Medicine (MFM), pelvic floor and reconstructive surgery (urogynecology) and gynecologic oncology. The Fertility Center focuses on the diagnosis and treatment of conditions that cause infertility, as well as in helping couples to build healthy families through in-vitro fertilization and other specialized treatments. They provide state-of-the-art services in a caring, supportive environment with an exceptional success rate. Dr. Randal Robinson, who has 20-plus years’ experience as a reproductive endocrinologist, explains it simply: “We take care of some of the most challenging patients. They can present with underlying medical conditions or other issues that make a normal pregnancy difficult to achieve or sustain, and we enable many of them to create a family.” The department’s goal is to place advanced fertility therapy within the reach of more patients. They offer packages to meet the needs of our diverse patient population – with outcome rates on the same level as local and national averages. The great success of our Fertility Clinic owes much to the credit of the experience and skill of our faculty and other staff such as Arthur Chang, PhD, who is the director of the assisted reproductive laboratory. Dr. Chang and the physicians work with modern equipment and are current with the latest fertility research and developments to help families achieve their goals. 32 San Antonio Medicine • January 2015

Dr. Robinson indicates that the facility has state-of-the-art technology, including pre-implantation genetic screening for genetic conditions or diseases. It also has cryogenic storage for fertility preservation for both female and male patients facing chemotherapy or radiation therapy – this includes the ability, on site, to preserve eggs and sperm. All egg retrieval, fertilization, genetic screening, analysis, cryogenic storage, and the many other aspects of these services are done at UT Medicine’s Fertility Center at the Medical Arts & Research Center (MARC). To facilitate storage of sperm and eggs for men and women undergoing cancer treatment, the department partners with the Livestrong Foundation to offer a reduced-price program for those who have survived cancer and may need financial assistance for embryo and oocyte cryopreservation. The department also includes skilled surgeons who are able to correct abnormalities of the reproductive organs. These surgeries involve the use of the Da Vinci robot at University and St. Luke’s Baptist hospitals, and run the gamut from common conditions such as removal of fibroids to more complex issues such as resecting parts of a damaged or deformed uterus while still preserving fertility. The department’s Maternal Fetal Medicine (MFM) providers offer referring physicians various options, including a one-time consultation, co-management of care, or a complete transfer of care of the pregnancy to UT Medicine. We provide all referring providers with a detailed letter summarizing the patient’s visit and our recommendations. Genetic testing and diagnosis is an important part of this service, which includes prenatal genetic testing via blood and amniotic fluid and detailed 3-D and 4-D ultrasound with bloodflow visualization -- all of which are important for the diagnosis of genetic problems or issues. Our MFM team treats patients who have diabetes, hypertension, autoimmune diseases, previous miscarriages/stillbirths, congenital defects, HIV as well as any other issues that complicate pregnancy. A crucial aspect of the MFM service is our close relationship with the team of neonatal specialists in the Department of Pediatrics at University Hospital. The two groups (the Department of OB/GYN and the Department of Pediatrics’ neonatologists) meet weekly as part of the process. They review every case as a team, discussing de-

UTHSCSA DEAN’S MESSAGE

tails of the condition, and how to provide the best outcome and delivery experience for the patient and her baby. This comprehensive, team approach improves outcomes. The team also involves the mother and father in planning. The parents go on a tour of the neonatal unit to familiarize them with the environment and monitoring equipment. If requested, the parents will have a consult with a neonatologist who provides the parents an opportunity to ask questions, discuss their child’s condition, and feel comfortable about the birth. Ultimately, the patients are grateful to know what to expect for the labor and delivery. Susan Crum, RN, MSN, OB/GYN clinic director, emphasizes the attention to detail as well as the caring nature of the staff when explaining what keeps our patients loyal to the practice. She indicates that patients trust the group and know that they always have their best interests in mind.

BEYOND PREGNANCY The department offers many other services related to women’s reproductive health, including one of the region’s few board-certified urogynecologists, Dr. Elizabeth Casiano. As an OB/GYN and a surgeon, she specializes in pelvic floor disorders, including urinary and fecal incontinence, vaginal fistulas and congenital or acquired vaginal anomalies. Urogynecologists undergo three years of additional training after completing four years of general obstetrics and gynecology training. Prolapse is very common in two patient segments – younger women who have pelvic floor damage from childbirth, and older women who have degenerative conditions. Though common, many women do not seek help because they may be embarrassed or are simply not aware that there are many surgical and nonsurgical treatment options. Our gynecologic oncology service is staffed by nationally recognized physicians and clinic staff who specialize in treating cancers of the vagina, cervix, uterus, ovaries, vulva and fallopian tubes. Patients can be referred to us for diagnosis, treatment or screening. Our providers, such as Kevin Hall, MD, chief of the Division of Gynecologic Oncology, and Edward Kost, MD, specialize in the surgical treatment of all gynecologic cancers, with an emphasis on many advanced-stage endometrial and cervical cancers. They offer patients the latest advances in minimally invasive surgery (also via the Da Vinci robot) which promotes shorter hospital stays, less postoperative pain, and very small, cosmetically pleasing incisions. The department also has the only female gynecologic oncologist in the region, Dr. Georgia McCann, who is fellowship trained and certified in robotic surgery. Treatments include intraperitoneal chemotherapy for ovarian cancer, a relatively new development in which chemotherapy drugs are introduced directly into the abdom-

inal cavity via a catheter. We also offer the latest in other types of chemotherapy, including access to Phase I and II clinical trials through our Cancer Therapy & Research Center (CTRC). This department is one of the few clinics in town offering a dedicated adolescent OB/GYN clinic. Dr. Kristen Plastino says that girls 13 years of age or younger can begin to establish a relationship with an OB/GYN. Teen health and wellness are a priority in which comprehensive, accessible, continuous and coordinated care are the primary focus.

RESEARCH The department has an active role in current research affecting all areas of women’s reproductive health and ranks 13th nationally in funds received from the National Institute of Health (NIH) in this category. The research and treatment covers various issues such as hormonal carcinogenesis in breast and gynecological malignancies, hormone-mediated gene regulation, and many other areas. Some of the ground-breaking studies include examination of importance of cytokine growth factors or CD44 in the etiology of endometriosis and the ability of estrogen receptor-beta agonists to re-sensitize breast tumors that are resistant to treatment. Our department participated in recently completed NIH-funded studies that garnered national attention after publication in the New England Journal of Medicine. These studies revealed a new medication, Letrozole, achieved the best fertility outcomes in women with polycystic ovary syndrome (PCOS), a major cause of infertility. Additionally, women with unexplained infertility were found to be best treated with clomiphene as compared to Letrozole or gonadotropins. The Center for Pregnancy and Newborn Research is internationally recognized for its work studying the effect of the maternal environment on fetal development and subsequent newborn and adult health: “Developmental Origins of Health and Disease.” Researchers led by Dr. Leslie Myatt investigate the effect of maternal obesity and diabetes, two clinical problems with major relevance to South Texas, on pregnancy outcomes using cutting-edge research techniques. This department is another great example of academic medicine’s role in public health – and UT Medicine’s dedication to tackling the toughest issues facing women and their families. To learn more, visit http://uthscsa.edu/obgyn. Dr. Francisco González-Scarano is dean of the School of Medicine, vice president for medical affairs, professor of neurology, and the John P. Howe III, MD, Distinguished Chair in Health Policy at the University of Texas Health Science Center at San Antonio. His email address is scarano@uthscsa.edu. visit us at www.bcms.org

HASA

HIE perspectives: How exchange of health information can improve children’s health By Vanessa I. Hill, MD, FAAP The value of exchanging health information electronically is clear: more information at the point of care, decreased duplicative testing and imaging, coordinated care between hospitalized patients and the primary care providers, and population health management. A system designed for adults, however, will not meet the unique needs of children. In September 2000, the Agency for Healthcare Research and Quality and the AAP Center for Child Health Research sponsored a meeting of experts to identify the information technology needs in pediatric care. They concluded that systems for exchanging information in pediatric care must take into account the following: • “Widely divergent pediatric subpopulations, as well as the unique physiology and diseases of children and special interventions for them; • (The need for) connectivity and system integration at the community level, since it is imperative for pediatric practices and institutions to be connected closely to the public health authority and the schools; and • Consumer health information that addresses the needs of the whole family.” Exchanging health information in outpatient pediatric settings is perhaps even more valuable than in acute care delivery. Recognizing that well-child care includes assessments of growth; consideration of social and family issues; universal screening for hearing and vision defects and anemia; and targeted screening of subgroups of patients calls for a highly functional system. This takes on even more meaning when considering that some children change custody/ legal guardianship during their lives, including children who are adopted, in foster care, in state custody and those whose parents are divorced. An example of how a pediatric-specific health information exchange system and data analytics are making a difference can be found in Pennsylvania’s Lehigh Valley. A system is being used to link healthcare entities with the education community to improve outcomes of childhood chronic conditions, such as asthma and diabetes, and boost immunization 34 San Antonio Medicine • January 2015

rates. In addition, ways to reduce student absences and missed parent workdays are being explored. Moreover, reports generated by health information systems are being provided to schools, summer camps, after-school programs and Head Start, which often need immunization records, results of screening tests, and data on infectious disease history, chronic medications, special healthcare needs and physical limitations. The exchange of health information to improve quality and clinical decision support is on the horizon. The Utah Pediatric Partnership to Improve Healthcare Quality is developing a patient summary tool to assist in collecting, maintaining and sharing information to aid in clinical decision-making for children with chronic and complex medical conditions. As the exchange of health information becomes more common, pediatricians should continue to advocate for systems that address their needs and those of their patients. Vanessa L. Hill, MD, FAAP, is CMIO Children’s Hospital of San Antonio and associate professor of pediatrics at Baylor College of Medicine. Dr. Hill currently is an ex-officio Healthcare Access San Antonio (HASA) board member, representing Children’s Hospital of San Antonio, and has been instrumental in helping HASA build a strong and useful HIE for the Bexar and surrounding counties’ pediatric population. For more information, contact Kim Harris at 210-918-1372 or visit www.hasatx.org.

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.

• ACCOUNTING FIRMS Anderson, Johns & Yao CPAs (HH Silver Sponsor) We strive to provide a professional and friendly atmosphere for all your accounting and financial needs Ann Yao, CPA/PFS, 210-696-9400 yao@ajycpa.com www.ajycpa.com San Antonio based CPA firm with 30 plus years of experience Padgett Stratemann & Co. LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally-owned CPA firms, providing sophisticated accounting, audit, tax, and business consulting services. Vicky Martin, CPA 210-828-6281 Vicky.Martin@Padgett-CPA.com www.Padgett-CPA.com Offering Service. More Than Expected. On every engagement. Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets. Jim Rice, CPA, 210-384-8000, ext 112 jprice@ssacpa.com www.ssacpa.com Dedicated to working with physicians and physician groups

• ATTORNEYS Pulman, Cappuccio, Pullen, Benson & Jones (H Bronze Sponsor) The attorneys at Pulman, Cappuccio, Pullen, Benson & Jones, LLP have over 150 years of combined experience providing exemplary representation for clients. Eric Pullen, 210-222-9494 EPullen@pulmanlaw.com

• BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with 5 core values; Attention, Accountability, Appreciation, Adaptability & Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett, 210-343-4556 jeanne.bennett@amegybank.com Karen Leckie, 210-343-4558 karen.leckie@amegybank.com www.amegybank.com Community Banking Partnership

BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance. BB&T offers banking services to help you reach your financial goals and plan for a sound financial future Ed L. White, Jr. 210-247-2985 ewhite@bbandT.com www.bbandt.com

BBVA Compass (HHH Gold Sponsor) A multinational banking group providing financial services in over 30 countries,and to 50 million clients throughout the world. Commercial Relationship Manager Zaida Saliba, 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie, 210-370-6029 mary.mahlie@bbvacompass.com www.bbvacompass.com Working for a better future

Broadway Bank (HHH Gold Sponsor) Broadway Bank is a full service personal and commercial bank with a specialized Healthcare banking team committed to supporting our medical community. We offer 40 convenient locations in San Antonio, Austin and surrounding areas. Ken Herring, 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com We’re here for good.

Crockett National Bank (HHH Gold Sponsor) Crocket National Bank is a leading Texas community bank specializing in mortgage, ranch and commercial real estate lending providing superior customer service and competitive financial products. Lydia Gonzales, 210-384-9304 lydiagonzales@crockettnationalbank.com www.crockettnationalbank.com Doing what we promise.

Frost (HHH Gold Sponsor) As one the largest Texas-based banks,Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Lewis Thorne, 210-220-6513 lewis.thorne@frostbank.com www.frostbank.com Frost@Work provides your employees with free personalized banking services.

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are one of the few agents in the state that specialize in Medical Malpractice and all lines of insurance for the medical community. Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com Baptist Credit Union (HH Silver Sponsor) It is Baptist Credit Union’s mission to meet our members needs by providing extraordinary service, quality financial products, and personal financial education. Sarah Chatham 210-525-0100, ext 201 memberservices@baptistcu.org www.baptistcu.org We commend your dedication to the health & wellbeing of our community. Cadence Bank (HH Silver Sponsor) Cadence Bank is a full-service financial institution serving commercial, consumer, treasury and wealth-management clients in Texas and the Southeast. Margarita Ortiz, 210-764-5500 maggie.ortiz@cadencebank.com Steve Edlund, 210-764-5573 steve.edlund@cadencebank.com http://cadencebank.com Explore Cadence Bank’s innovative financing options and treasury management solutions. Citi Commercial Bank (HH Silver Sponsor) Chris McCorkle 210-408-5014 christopher.a.mccorkle@citi.com www.citi.com Continued on page 36

visit us at www.bcms.org

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 35

Firstmark Credit Union (HH Silver Sponsor) Address Your Office Needs. Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs. Competitive rates, favorable terms, and local decisions. Gregg Thorne, SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org St. Joseph's Credit Union (HH Silver Sponsor) A Credit Union providing savings, checking, IRA, club, and CD accounts. Plus, Auto, signature, Lines of Credit, MasterCard and Real Estate Loans. Armando Rodriguez 210-225-6126 arodriguez@sjcusatx.net www.sjcusatx.com Better Rates on Auto loans, Signature loans and Platinum MasterCard Jefferson Bank (H Bronze Sponsor) Full service bank specializing in mortgages, wealth management & trusts. Ashley Schneider 210-734-7848 ext 7848 aschneider@jeffersonbank.com www.jeffersonbank.com Security Service Federal Credit Union (H Bronze Sponsor) Business financing, specializing in low interest commercial real estate transactions Luis Rosales, 210-845-8159 lrosales@ssfcu.org BCMS members can get up to half a percent off the origination fee Texas Farm Credit (H Bronze Sponsor) Rural, homestead and acreage lending. Tiffany Nelson, 210-798-6280 www.texasfcs.com

• CATERING Corporate Caterers (H Bronze Sponsor) A locally owned family franchise business serving the San Antonio area. Ricardo Flores 210-789-9009 rflores@corpcatererstex.com

Heavenly Gourmet Catering (H Bronze Sponsor) 210-496-9090 www.heavenlyg.com

• CONTRACTORS/ BUILDERS

Huffman Developments (HHH Gold Sponsor) Steve Huffman, 210-979-2500 Shawn Huffman, 210-979-2500 www.huffmandev.com San Antonio Retail Builders (HH Silver Sponsor) Specializing in remodeling/finish out of medical offices. H.B. Newman 210-446-4793 brett@texaspremiercapital.com Next 6 months Architectural Space Plan / Rendering No Cost or Obligation

• CUSTOM HOME BUILDERS

Diamante Custom Homes (HHH Gold Sponsor) Experience your new custom homebuilding process through San Antonio’s leading designbuild firm. Over two decades of streamlining the balance between your budget and your dreams. The name you know from the builders you trust! Keith Norman, 210-341-6430 knorman@diamantehomes.com www.diamantehomes.com Special promotions for all BCMS members – call us today!

• EDUCATION Alpha Bilingual Preschool (H Bronze Sponsor) Our mission is to provide young children with an integral early education in a Spanish immersion environment. Tania Lopez de Pelsmaeker 210-348-8523 tldp@hotmail.com Give your children the gift of speaking a second language.

36 San Antonio Medicine • January 2015

• ELECTRONIC MEDICAL RECORDS

Greenway Health (HHH Gold Sponsor) Greenway Health offers a fully integrated electronic health record (EHR/EMR), practice management (PM) and interoperability solution that helps healthcare providers improve care coordination, quality and satisfaction while functioning at their highest level of efficiency. Jason Siegel 512-657-1259 jason.siegel@greenwayhealth.com www.greenwayhealth.com

• FINANCIAL SERVICES

Northwestern Mutual Wealth Management Company (HHHH Platinum Sponsor) Comprehensive Financial Planning Insurance and Investment Planning Estate Planning and Trust Services. Eric Kala CFP, CLU, ChFC, Wealth Management Advisor 210-446-5752 eric.kala@nm.com www.erickala.com

As one the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com Commercial leasing for a doctor’s business equipment and vehicle. Platinum Wealth Solutions of Texas LLC (HH Silver Sponsor) Comprehensive financial planning firm who assists medical professionals to protect their income, their wealth, their practice and legacy. Tom Valenti, 210-998-5023 tvalenti@jhnetwork.com Eric Gonzalez, 210-998-5032 ericgonzalez@jhnetwork.com www.platinumwealthsolutionsoftexas.com Understanding the uniqueness in the financial life as a physician. Bold Wealth Management (H Bronze Sponsor) Comprehensive Investment Advisory and Retirement Planning Services for Businesses and Individuals. Richard A. Poligala, 210-998-5787 richard.poligala@natplan.com www.boldfinancialgroup.com Complimentary no-obligation retirement plan review to BCMS members

• GOLF Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction,confidence, and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com Get what you deserve… Maximize your Social Security benefit!

Frost Leasing (HHH Gold Sponsor)

TPC San Antonio (H Bronze Sponsor) 18-hole championship golf courses designed by two of golf's most innovative architects, Pete Dye and Greg Norman. Matt Flory, 210-491-5816 www.tpcsanantonio.com

• HOSPITALS/ HEALTHCARE SERVICES

First Choice Emergency Room (HHH Gold Sponsor) The nation's oldest and largest

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY network of independent freestanding emergency rooms. Patients seen almost immediately. Board-certified physicians and emergency-trained registered nurses. In-house CT scanner, ultrasound, digital X-ray and COLA/CIA accredited on-site lab to handle emergencies 24/7/365. Hardy Oak Boulevard 24-hour 210-451-8340 Nacogdoches Road 24-hour 210-447-7560 Tezel Road 24-hour 210-437-1180 www.fcer.com Check in online – free, easy, fast!

Select Rehabilitation of San Antonio (HHH Gold Sponsor) At Select Rehabilitation Hospital of San Antonio, we provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges. Miranda Peck, 210-482-3000 mipeck@selectmedical.com http://sanantonio-rehab.com/ Offers patients a higher degree of excellence in medical rehabilitation.

South Texas Sinus Institute (HHH Gold Sponsor) The South Texas Sinus Institute is a state of the art facility dedicated to in-office Balloon Sinuplasty using the unique Painless Sinuplasty Anesthetic Linked Method. Sue Musgrove, 210-225-5666 stsisue@gmail.com www.southtexassinusinstitute.com. We will offer convenient same day or lunch appointments to BCMS members.

Warm Springs Medical Center Warm Springs Thousand Oaks Warm Springs Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate,expert care during the rehabilitation process

& support recovery through education & research. Central referral Line 210-592-5350 Joint Commission COE Elite Care 24 Hour Emergency Center (HH Silver Sponsor) We are a fully equipped emergency room open 24 hours a day and 7 days a week, staffed by experienced emergency physicians. We provide the same level of emergency medical care that you would receive in a hospital ER. Rosie Clark 210-771-0141 rclark@elitecaremarketing.com www.elitecareemergency.com Get seen by an experienced physician within 10 minutes. Methodist Healthcare System (HH Silver Sponsor) Palmira Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Seasons Hospice and Palliative Care (HH Silver Sponsor) Deb Houser-Bruchmiller 210-471-2300 dhouser@seasons.org www.seasons.org Southwest General Hospital (HH Silver Sponsor) Southwest General Hospital is a 327-bed, state-of-the-art hospital located in San Antonio, Texas. Southwest General offers comprehensive healthcare services. Craig Desmond, 210-921-3521 Elizabeth Luna, 210-921-3521 www.swgeneralhospital.com

• HUMAN RESOURCES

Employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page. John Seybold, 210-447-6518 jseybold@employerflexible.com www.employerflexible.com BCMS members get a free HR assessment valued at $2,500.

Pinnacle Workforce Corp HR. Services (H Bronze Sponsor) Dan Cardenas, 210-344-2088 dancardenas@pinnacleworkforce.com

• INFORMATION TECHNOLOGY

Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes. Stephanie Stephens, 210-332-4924 sstephens@dahill.com www.dahill.com Allison Royce Business Technologies (H Bronze Sponsor) Business Technology Provider, specializing in HIPAA Compliant Managed IT Services and IT Support since 1993. Jeff Tuttle, 210-564-7000 jtuttle@allisonroyce.com www.allisonroyce.com PitCrew IT Services (H Bronze Sponsor) Provides reliability for your business computers or network, enabling you to operate smoothly. Eric Murcia, 210-547-0305 eric@pitcrewit.com

• INSURANCE

Blue Cross Blue Shield of Texas (HHH Gold Sponsor) Edna Pérez-Vega, 210-558-5162 Edna_Perez-Vega@bcbstx.com www.bcbstx.com

Frost Insurance (HHH Gold Sponsor) As one the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment, insurance services to individuals and businesses. Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com Business and personal insurance tailored to meet your unique needs.

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Donnie Hromadka 512-338-6151 dhromadka@humana.com www.humana.com

Texas Medical Association Insurance Trust (HHH Gold Sponsor) Created and endorsed by the Texas Medical Association (TMA), the Texas Medical Association Insurance Trust (TMAIT) helps physicians, their families, and their employees get the insurance coverage they need. James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org We offer BCMS members a free insurance portfolio review. Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States. Crystal Metzger James L. Hayne Jr. 210-222-2161 www.catto.com Continued on page 38

visit us at www.bcms.org

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 37

Texas Drug Card (H Bronze Sponsor) The Texas Drug Card program is a FREE statewide Rx assistance program available to all residents. Todd Walker 512-569-5547 twalker@texasdrugcard.com http://texasdrugcard.com/index.php

• INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH Platinum Sponsor) Texas Medical Liability Trust is a physician-owned health care liability claim trust, providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 14,000 doctors in all specialties who practice in all areas of the state. TMLT is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, the Dallas, Harris, Tarrant, and Travis County Medical Societies. Patty Spann, 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended Partner of the Bexar County Medical Society.

Katy Brooks, CIC, 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com Serving the medical community. The Doctors Company Medical malpractice insurance (HH Silver Sponsor) We relentlessly defend, protect and reward the practice of good medicine. As the patient safety industry leader, we proudly offer a comprehensive selection of CME opportunity and risk-mitigation resources. Kirsten Baze, 512-275-1874 KBaze@thedoctors.com www.TheDoctors.com

• INTERNET/ TELECOMMUNICATIONS

Time Warner Cable Business Class (HHH Gold Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterprise-class technology and communications that are highly reliable, flexible and priced specifically for the medical community. Rick Garza, 210-582-9597 Rick.garza@twcable.com Time Warner Cable Business Class offers custom pricing for BCMS Members.

• MARKETING SERVICES Medical Protective Medical Malpractice Insurance (HHH Gold Sponsor) Medical Protective, the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Thomas Mohler, 512-213-7714 thomas.mohler@medpro.com www.medpro.com

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are one of the few agents in the state that specialize in Medical Malpractice and all lines of insurance for the medical community.

Know Your Doctor SA (HH Silver Sponsor) Increase your practice’s unique marketing/communications program. Connect with SA community through video, advertising, PR and medical opinion e-news. Limited to 300 physicians. Lorraine Williams, RN 210-884-7505 LWilliams@KnowYourDoctorSA.com www.KnowYourDoctorSA.com Phiskal LLC Marketing and Promotion (H Bronze Sponsor) A leading edge marketing and development firm using proprietary Artificial Intelligence engines to enhance your presence with websites, apps & database applications. Sundeep Sadheura 210-865-4520 Sunnys@phiskal.com HTTP://PHISKAL.COM/

38 San Antonio Medicine • January 2015

• MEDICAL BILLING AND COLLECTIONS SERVICES

DataMED (HHH Gold Sponsor) Providing your practice with the latest compliance solutions, concentrating on healthcare regulations affecting Medical Billing and Coding changes allowing you and your staff to continue delivering excellent Patient Care. Anita Allen, 210-892-2333 aallen@datamedbpo.com www.datamedbpo.com BCMS members receive a discounted rate for our billing services. Commercial & Medical Credit Services (H Bronze Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda, 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com Make us the solution for your account receivables. PriMedicus Consulting Inc. (H Bronze Sponsor) A physician-founded and built company, dedication to your success. Sally Combest MD., 877-634-5666 s.combest@primedicusconsulting.com www.primedicusconsulting.com PriMedicus Consulting for the Health of Your Practice. Urgent Care Billing Solutions, LLC (H Bronze Sponsor) UCBS provides superior practice management services and revenue optimization services to the healthcare community in a virtual office environment. Ann DeGrassi, CMIS 210-878-4052 adegrassi@ucbillingsolutions.com www.urgentcarebillingsolutions.net

• MEDICAL SUPPLIES & EQUIPMENT

Henry Schein Medical (HHHH Platinum Sponsor)

From alcohol pads and band aids to EKG’s and Ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines, and pharmaceuticals serving office based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com/medical BCMS members receive GPO discounts of 15%-50%. McKesson Medical-Surgical (H Bronze Sponsor) MCKESSON is a leading distributor of Medical Supplies and Equipment. Karan Cook, 210-573-2117 karan.cook@mckesson.com

• MEDICAL TRAINING

LINRON® Bioskills Training Institute (HHH Gold Sponsor) LINRON® is dedicated to providing hands-on medical training to healthcare professionals who want to improve their clinical skills and offer their patients the latest in treatment modalities while using state-of-the-art medical equipment and technology. Yolanda S. Garza, RN 210-572-2434 yolanda.garza@linrontraining.com www.linrontraining.com

• ORGANIZATIONS Fundacion Teleton USA (HH Silver Sponsor) Ricardo Guzman Hefferan guzman@teletonusa.org www.teletonusa.org

• PAYMENT SYSTEMS/ CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by 250-plus business associations. Tanner Wollard, 979-219-9636 Tanner.Wollard@e-HPS.com http://www.heartlandpaymentsystems.com/ Lowered cost for American Express; next-day funding.

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY • PUBLICATION MANAGEMENT FIRM Traveling Blender (H Bronze Sponsor) Publication Management Firm Janis Maxymof, 210-413-9731 janismaxymof@gmail.com 10% discount on display advertising in magazine for Circle of Friends members.

• PRINTING SERVICES SmithPrint (H Bronze Sponsor) SmithPrint offers custom printing, branding, graphic design, signage and more! Robert Upton 210-846-5268 Robert@smithprint.net http://www.smithprint.net/ New customers: 10% discount on print materials at SmithPrint.

• REAL ESTATE/ COMMERCIAL Cano and Company Commercial Real Estate (HH Silver Sponsor) Experienced and respected commercial real estate representation. We specialize in office leasing, property acquisition, and commercial real estate investment. Dennis Cano, Agent 210-731-6613 www.canoandcompany.com Dennis@canoandcompany.com Effective commercial real estate solutions for your practice and investments.

Stream Realty Partners (H Bronze Sponsor) Carolyn Hinchey Shaw 210-930-3700 cshaw@streamrealty.com www.streamrealty.com

• REAL ESTATE/ RESIDENTIAL Kuper Sotheby's International Realty (HH Silver Sponsor) Joe Salinas III, 830-456-2233 Joe.Salinas@SothebysRealty.com JoeSalinas.com My hometown roots are based in Fredericksburg while my home away from home is San Antonio. Local knowledge, exceptional results. Embrace your new life ... I'll help you become a connoisseur! Becky Aranibar Realty Group Keller Williams (H Bronze Sponsor) Offering Real Estate Services to the San Antonio Medical Community. Carlo G. Aranibar, MBA, 210-862-4022 BARgrouptx@gmail.com www.beckyaranibar.com Offering free comparative market analysis to determine your home's value.

• REAL ESTATE/ INVESTMENTS Texas Premier Capital (HH Silver Sponsor) A real estate development company offering and managing real estate investment funds in

the South Texas area. H.B. Newman 210-446-4793 brett@texaspremiercapital.com Rick Carter 210-367-7909 rick@texaspremiercapital.com www.texaspremiercapital.com

• RESEARCH STUDIES/ BIOTECHNOLOGY

range of staffing services to help members improve cost control, increase efficiency, and protect their revenue cycle! Brian Cleary 210-301-4362 BCleary@FavoriteStaffing.com www.favoritestaffing.com/public/medicalsocieties/bexar_count y/bexarcounty_index.aspx Favorite Healthcare Staffing offers preferred pricing for BCMS members.

• TRANSCRIPT SERVICES

ICON Development Solutions (HHHH Platinum Sponsor) We are a respected clinical research organization that has an extensive reputable history in diabetes research. Depending upon the current studies, ICON may establish working relationships with local physicians. Your expertise may be invaluable to our efforts to identify subjects Dr. Dennis Ruff 210-283-4572 dennis.ruff@iconplc.com www.iconplc.com Find out how ICON can help your Practice.

Med MT, Inc. (H Bronze Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records. Ray Branson 512-331-4669 branson@medmt.com www.medmt.com The Med MT solution allows physicians to keep practicing just the way they like.

• STAFFING SERVICES

As of December 15, 2014

Favorite Healthcare Staffing (HHHH Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive

For more information, call 210-301-4366, email August.Trevino@bcms.org or visit www.bcms.org.

THANK YOU

to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA Clinical Pathology Associates Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Institute for Women's Health

Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA Renal Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA

Contact BCMS today to join the 100% Membership Program!

South Alamo Medical Group South Texas Radiology Group, PA Tejas Anesthesia, PA Texas Partners in Acute Care The San Antonio Orthopaedic Group Urology San Antonio, PA Village Oaks Pathology Services/Precision Pathology WellMed Medical Management Inc.

*100% member practice participation as of December 15, 2014. visit us at www.bcms.org

BOOK REVIEW

‘The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics’ Written by Barron H. Lerner Reviewed by Fred H. Olin, MD

One of our colleagues recommended that I read “The Good

The book explores the changes in the medical profession’s atti-

Doctor,” by Barron H. Lerner. I must admit that I don’t recall

tudes and behaviors primarily in the field of patient autonomy.

what brought it up, but whatever it was, I’m glad he did it. This

Dr. Philip makes decisions for his patients that bother Dr. Barron

book is several things at once: it’s a biography of the author’s father,

as he becomes more aware and more interested in the subject of

a physician from the era of “medical paternalism;” a bit of an au-

medical ethics. As he aged, the elder Dr. Lerner developed Parkin-

tobiography of the author, an academic physician whose interests

son’s disease, and when his care at home became too difficult for

lie in medical ethics and medical history; and a discussion of pa-

his wife, the family found it necessary to have him admitted to a

tient autonomy, beneficence, familial interactions, DNR requests,

nursing home … a fate he never wanted for any of his relatives.

medical consents, how much should we tell a patient about his or

As he became more demented, the physician-son was confident

her condition, etc. It sounds dull, doesn’t it? It’s not. The younger

that his physician-father would never want to have extreme meas-

Dr. Lerner is a really good storyteller.

ures performed to preserve a poor quality of life, so he asked his

Dr. Barron Lerner’s father, the late Dr. Philip Lerner, was an internist and infectious disease specialist, educated in Boston, who

dad if he would want hospital admission and even ICU care with a respirator. He was astonished when the answer was “yes.”

practiced in Cleveland for many years. He kept detailed journals

At this point in writing, I became stuck. I couldn’t figure out

of his cases, thoughts and feelings that were used by his son as the

how to end the review. So, Google to the rescue: I decided that I

basis for much of this book. Dr. Philip’s background was based

couldn’t finish it up any better than The New York Times reviewer

on the concept that the doctor knew best, that the patient’s job

did in June 2014:

was to follow recommendations, and that his patients were his pa-

“ ‛The Good Doctor’ poses a fundamental riddle faced by every

tients, almost as if he somehow had the exclusive right to treat

historian: How can we question the decisions and attitudes of our

them when their problem fell into his purview. He also was the

forebears without having experienced the contexts that shaped

primary physician for several of his elderly relatives, something

them? It makes for a particularly compelling discussion when the

that would not be allowed today. There is evidence in his journals

players are father and son, sharing as their lives’ work an ethically

that he might have participated in what I have heard called “passive

charged, ever-changing profession.”

euthanasia” for at least one of these relatives. He is reported to have talked hospital personnel into allowing him to take controlled

Fred H. Olin, MD, is a semi-retired orthopaedic

substances from the hospital to use for homebound or nursing

surgeon and chair of the BCMS Communications/

home patients … something else that would be impossible to do

Publications Committee.

legally today. visit us at www.bcms.org

MEDICAL ETHICS BUSINESS Continued from page 15

to prison. If you are aware that an illegal act has been committed, it should be reported to the proper authorities immediately. Using the chain of command is always preferable but may be bypassed when the person committing the act is in that chain. The compliance officer is always an excellent resource. Remember: “Silence is not always golden” when dealing with acts that are unethical, immoral or illegal. Silence is the same as consent; failure to report such acts can make you liable the same as if you performed the act yourself. And never forget, if the act is unethical, immoral or illegal, the end never justifies the means. NOTE: Thanks to Aaron Beam for permission to use his presentation and materials in the preparation of this article.

REFERENCES www.yiw.edy.au Healthsouth Chronology This is also the name of his book which is available at www.aaronbeam.net. St. Martin’s Press, 175 Fifth Avenue, New York, NY 10010. Forrest Smith has more than 30 years’ experience in healthcare. He has an MBA from Trinity University in San Antonio. He is a Certified Healthcare Financial Professional (CHFP), certified by the Healthcare Financial Management Association (HFMA.org) and is a Fellow of HFMA. Smith is retired but works part-time for a large physician group in San Antonio and does limited consulting. Smith is active in HFMA and may be reached at smithforrest@att.net. 42 San Antonio Medicine • January 2015

Tom Benson Chevrolet 9400 San Pedro Ave. Gunn Acura 11911 IH-10 West

* Fernandez Honda 8015 IH-35 South

Ingram Park Auto Center 7000 NW Loop 410

Gunn Honda 14610 IH-10 West (@ Loop 1604) Ancira Chrysler 10807 IH-10 West Cavender Audi 15447 IH-10 West

Ingram Park Auto Center 7000 NW Loop 410

Mercedes-Benz of Boerne 31445 IH-10 W, Boerne * Gunn Infiniti 12150 IH-10 West

Ancira Ram 10807 IH-10 West

Mercedes-Benz of San Antonio 9600 San Pedro Ave.

North Park Subaru 9807 San Pedro Ave.

Ancira Dodge 10807 IH-10 West BMW of San Antonio 8434 Airport Blvd.

Ingram Park Auto Center 7000 NW Loop 410 Ancira Jeep 10807 IH-10 West

* Mini Cooper The BMW Center 8434 Airport Blvd.

Ingram Park Auto Center 7000 NW Loop 410 Cavender Buick 17811 San Pedro Ave. (281 N @ Loop 1604)

Batchelor Cadillac 11001 IH-10 at Huebner Cavendar Cadillac 801 Broadway

* Ancira Volkswagen 5125 Bandera Rd.

Northside Ford 12300 San Pedro Ave.

* North Park Lexus 611 Lockhill Selma

Cavender Toyota 5730 NW Loop 410

Ingram Park Nissan 7000 NW Loop 410 * The Volvo Center 1326 NE Loop 410

Cavender GMC 17811 San Pedro Ave. * North Park Lincoln/ Mercury 9207 San Pedro Ave.

Porsche Center 9455 IH-10 West

visit us at www.bcms.org

AUTO REVIEW

Ford Fusion Energi plug-in hybrid could energize particular lifestyles By Steve Schutz, MD As you might imagine, I get asked about cars a lot. What’s the best car out there? What vehicle do you recommend to most people? What should I buy? My answers are always the same. 1) There are no lousy cars anymore, so you can’t really go wrong no matter what you buy, and 2) Cars are tools. Think about how you live your life and buy a vehicle that will help you do what you do. Buy the best tool for your particular life circumstances. My work life involves a daily 9 mile each way commute to my office, and usually my car sits in my parking space all day until I

44 San Antonio Medicine • January 2015

drive home. The Ford Fusion Energi plug-in hybrid that I tested recently turned out to be a surprisingly good tool for the job of getting me to and from work. For the record, I don’t like standard hybrids and have made that clear over the years in many columns. I don’t want the extra complexity and weight of batteries and a motor just to get the same fuel economy I can already get from a small diesel. That doesn’t compute for me. But a plug-in hybrid that lets me drive to the office and back in electric-only mode every day? That’ll work

because I can – and did – go three full days without using any gasoline at all. As in the engine never started, and I didn’t use a drop of gas during those three days.

NO ENGINE FOR THREE DAYS Doing that was easy, by the way. The plugin Fusion, called the Energi in Ford-speak, is expected to be able to drive 20 miles on a full charge, and my experience – admittedly under ideal circumstances – tells me that that figure is conservative. All I did was plug the Fusion Energi into the standard electrical

AUTO REVIEW

socket in my garage overnight and then drove it to work in the morning and back home in the afternoon. The engine never started for three days, and it could have been longer if I really wanted it to be. If I had access to a plug near my parking spot during the day, my enhanced range would allow me to round at an outlying hospital and also stop at the store for milk and eggs before I came home. But 20 miles or so of electric driving is pretty good, especially since you can’t help but drive frugally in order to forestall the sound of the engine turning on. Plug-in ability aside, the Fusion Energi drives a lot like the regular Fusion, if that Fusion were carrying 500 pounds of extra weight. The ride is plush, road noise is minimal, and you always feel completely comfortable with what the car is doing. Having said that, at no point do you feel like doing anything that might be described as energetic or enthusiastic driving. Let's say this Fusion

is you after you've put on your Thanksgiving and Christmas weight. And then some. The exterior design of the Fusion has been garnering praise for its slick shape and Aston Martin-esque grille, and I’ll second all that. While the last version of the Fusion was nothing if not anonymous, this one looks contemporary and sharp. No wonder Fusion sales now nip at the heels of the perennial class leaders, the Toyota Camry and Honda Accord. Inside the Fusion Energi everything will look very familiar to owners of a Ford Focus or Explorer. And that’s a good thing as those models – like all Fords of what will inevitably be called the Mulally era – have cabins that feature excellent materials with soft touchpoints and quality plastics. And then there’s My Ford Touch, a touch screen-driven user interface that controls the audio, HVAC, phone and navigation systems. Yes, you can work it – and I did – with voice commands, but if you choose to use the touch screen be ready for a distracting experience. You get used to it in time, but it could – and needs – to be better.

THE PERFECT DRIVETRAIN? Naturally, the Ford Fusion Energi has

beaucoup stand-alone options and packages, but regardless of what you choose, expect to pay north of $40,000. That's uncomfortably close to Audi/BMW territory, but, it should be said, not Audi/BMW plug-in hybrid territory. As always, call Phil Hornbeak for information about the Fusion Energi or any other vehicle you're investigating. Since I already broached the subject of cars-as-tools and what I think of hybrids and plug-ins, what do I think is the perfect car/SUV drivetrain? A diesel-powered car that’s also a plug-in hybrid. You could do your daily commute using electric power only, and then use the frugal diesel engine when it was needed, such as when you took a long trip or were in need of extra power, like while passing on the freeway or towing a trailer. Anyway, the Fusion Energi is a car that makes sense in a way that standard hybrids don't and can’t, thanks to its ability to plug into the grid and thereby avoid the use of gasoline. The best way to decide if it makes sense for you is to think about your life and determine which vehicular tool best fits it. Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. For more information on the BCMS Auto Program, call Phil Hornbeak at 3014367 or visit www.bcms.org. visit us at www.bcms.org

46 San Antonio Medicine â€˘ January 2015