San Antonio Medicine March 2019

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Membership Growth

BCMS Membership Team “Kicks Butt” .........12 BCMS President’s Message ..................................................8 BCMS Legislative News ......................................................10 BCMS News........................................................................11 BCMS Honorees: Marvin Forland, MD Past as Prologue

by Sheila Hotchkin ..........................................................14 Opinion: Monopolistic Healthcare. Who wants that?

By Alan M. Preston, MHA, Sc.D. ......................................18 Why did you decide to become a physician?

By Ana I. Rodriguez, MD, from MacGregor Medical Center..24 Women in Medicine By Rosa I. Vizcarra, MD, FAAFP, Family Medicine & Geriatrics working for for WellMed/Palliative Care Program........................................................................................................26 Feature: CAST Med: Creating a Pipeline of Doctors and Researchers in San Antonio

By Eddie Muzquiz Rodriguez, PhD ..........................................................................................................28 Develop Your Practice to Grow and Thrive By Michal Waechter..................................................................30 UTHSCSA: The Value of an Academic Medical Center — A Conversation with William L. Henrich, MD, MACP, President and Professor of Medicine, UT Health San Antoio ........................................................32 Practice Group: Urology San Antonio Honored as Rezum Center of Excellence — Group is First In Texas to Receive Designation ..............................................................................................................34 Substantiated Healthcare Interventions By Ammar Navid Saigal, MPH ......................................................35 BCMS Circle of Friends Directory ..............................................................................................................36 Business of Medicine: Prospering Amongst Health Insurance Chaos by Allison De Paoli ............................41 In the Driver’s Seat ....................................................................................................................................43 Auto Review: 2019 Mercedes GLC AMG 63 Coupe By Steve Schutz, MD ................................................44 PUBLISHED BY: SmithPrint Inc. 333 Burnet San Antonio, TX 78202 Email: medicine@smithprint.net PUBLISHER Louis Doucette louis @smithprint.net ADVERTISING SALES: AUSTIN: Sandy Weatherford sandy@smithprint.net BUSINESS MANAGER: Vicki Schroder

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San Antonio Medicine • March 2019

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MARCH 2019

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VOLUME 72 NO. 3

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Adam V. Ratner, MD, President Rodolfo “Rudy’’ Molina, MD, Vice President John W. Hinchey, MD, Treasurer John J. Nava, MD, Secretary Gerald Q. Greenfield Jr., MD, PA, President-elect Sheldon G. Gross, MD, Immediate Past President

DIRECTORS Michael A. Battista, MD, Member John D. Edwards, MD, Member Vincent Paul Fonseca, MD, MPH, Member Michael Joseph Guirl, MD, Member David Anthony Hnatow, MD, Member Gerardo Ortega, MD, Member Manuel M. Quinones Jr., MD, Member David M. Siegel, MD, JD, Member Rajeev Suri, MD, Member Kelly King, Alliance Representative George Rick Evans, Legal Counsel Col. Charles Gregory Mahakian, MD, Military Representative Corinne Elizabeth Jedynak-Bell, DO, Medical School Representative Robert Richard Leverence, MD, Medical School Representative Robyn Phillips-Madson, DO, MPH, Medical School Representative Ronald Rodriguez, MD, PhD, Medical School Representative Brent W. Sanderlin, DO, Medical School Representative Alice Kim Gong, MD, Board of Ethics Chair

BCMS SENIOR STAFF Stephen C. Fitzer, CEO/Executive Director Melody Newsom, Chief Operating Officer Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Mary Nava, Chief Government Affairs Officer Phil Hornbeak, Auto Program Director Mary Jo Quinn, BCVI Director Brissa Vela, Membership Director Al Ortiz, Chief Information Officer

PUBLICATIONS COMMITTEE Kenneth C.Y. Yu, MD, Chair Kristi Kosub, MD, Vice Chair Carmen Garza, MD, Member Leah Jacobson, MD, Member Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam Ratner, MD, Member David Schulz, Community Member J.J. Waller Jr., MD, Member

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San Antonio Medicine • March 2019

PRESIDENT’S MESSAGE

Save a Life, Buttercup

By Adam Ratner, MD, 2019 BCMS President

“Suck it up, Buttercup.” I was reminded of these words when

A consequence of this culture is that medical students, graduate

one of my wise colleagues, Hans Bruntmyer, DO, was asked about

medical trainees, and practicing physicians deny or hide both their

medicine many of us “seasoned” physicians experienced. It was

is some stigma in inconveniencing colleagues with a physical illness,

the culture of medical training as well as much of the culture of

physical and mental illnesses often until it is too late. While there

probably even worse when my Dad was a surgical intern way, way

for many of us the thought of seeking mental health care is both

scrubbed in a case when the other intern complained about some-

cian and medical student suicides. This must stop now.

back in the middle of the last century. He and another intern were thing regarding the training program. The staff surgeon reportedly

looked over his glasses at that hapless intern and said, “The eman-

inconceivable and intolerable, despite the alarming rate of physiThere is good news. The regulatory environment has changed

favorably. Furthermore, at the Bexar County Medical Society’s Joint

cipation proclamation may have freed the slaves, but it did not free

Academic Collaboration Committee, we have discussed mental

With this training environment, it is not surprising that so many

the UT Long School of Medicine, at the UIW School of Osteo-

the interns and residents.”

physicians are suffering in silence. We have been trained and accul-

turated to “suck it up” in the face of all sorts of adversity. Because so many of us simply just put our heads down, work harder, and

compartmentalize our negative thoughts, we allow more bad things

to happen. First, by “sucking it up” we enable and make it easier

health and suicide prevention initiatives gearing up and running at pathic Medicine, as well as a very successful program run by our

military colleagues at SAUSHEC. One of the lessons learned is

that all physicians and medical students must participate, not just those who are currently in crisis.

For those of us who may not have access to one of these aca-

and more profitable for others to take advantage of us, our dedi-

demic programs, the BCMS is looking to collaborate with our ac-

“sucking it up” corrodes our self-esteem, denies us happiness, and

interest in a possible new mental health and suicide prevention pro-

Physician culture and the regulatory environment historically

nounce this event, we want you to come and bring your colleagues,

cation and our work ethic. Second, but perhaps more importantly, ultimately empties our souls.

ademic partners and sponsor an introductory event to gauge

gram designed and customized for BCMS members. When we an-

have been intolerant of physicians who showed “weakness” and

whether you think you need it or not.

Even having a “legitimate” physical illness or pregnancy meant hav-

save may be your colleague’s, your loved one’s, or perhaps, your

worse, any sign of anything remotely resembling mental illness. ing one or more colleagues inconvenienced. The pressure was on

to return to work as quickly as possible even if the ailing physician

would never permit their own patients to return to work under similar circumstances.

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San Antonio Medicine • March 2019

At the end of the day, we are each other’s keepers. The life you

own.

Dr. Adam Ratner is President of the Bexar County Medical Society and

serves as Professor and Assistant Dean of the University of the Incarnate Word School of Osteopathic Medicine and Chair of The Patient Institute.

BCMS LEGISLATIVE NEWS

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FEB. FIRST TUESDAYS NOW IN THE BOOKS The first ‘First Tuesdays’ of the 86th Legislative Session took place on Feb. 5. Physicians, BCMS Alliance members and students participated in several meetings with legislators and staff. A number of topics were discussed, including: graduate medical education (GME); physician loan repayment; Medicaid reimbursement; maternal mortality and telemedicine.

Many thanks to the attendees, who made our visits at the Capitol a success: Physicians - Dan Deane, MD; Pam Hall, MD; Alex Kenton, MD; Jayesh Shah, MD and John Shepherd, MD; Alliance members – James Duerr; Jennifer Lewis and Jenny Shepherd; and medical students, Marc Ghoson from UIW; and from UT Health – Phil Acosta; Dana Glaser; Karan Vir Goenka; Glory Hughes; Jessie Larouere; Swetha Maddipudi; Sharon Mathi; Jen Nordhauser; Cory Nun; Sushmitha Ramesh; Sabi Shrestha; Vanessa Trivino; Luke Verlinsky; Ryan Wealther and Chelsea Wu. Also in attendance was Brissa Vela, BCMS director of membership and special events.

The next First Tuesdays is on March 5. We encourage all our members to get involved and participate in at least one First Tuesday this session. To register, please visit: www.texmed.org/FirstTuesdays

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For local discussion on these and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava, chief government affairs officer at mary.nava@bcms.org.

From the top: 1 BCMS physicians, Alliance members and medical students visit with District 26 State Senator Jose Menendez (far left) during the Feb. 5 First Tuesdays visit to the Capitol.

2 BCMS physicians (l-r) Dan Deane, MD; Alex Kenton, MD and John Edwards, MD met with District 120 State Representative Barbara Gervin-Hawkins during the Feb. 5 First Tuesdays visit to the Capitol.

3 Freshman legislator, District 121 State Representative Steve Allison (leaning against desk), meets with BCMS physicians, Alliance members and medical students during the First Tuesdays visit to the Capitol on Feb. 5.

4 BCMS physicians, Alliance members and students representing the UIW and UT Health medical schools stop to visit with District 25 State Senator Donna Campbell on Feb. 5 during the First Tuesdays visit to the Capitol.

5 First Tuesdays attendees Dan Deane, MD; John Shepherd, MD and UIW medical student Marc Ghosen look on as Sweetwater Jaycees representative shows off the special guests in the state Capitol on Feb. 5.

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San Antonio Medicine • March 2019

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BCMS NEWS

Representatives of Merrill Lynch, a Circle of Friends Platinum Member, visited the Bexar County Medical Society

Michael Bertuzzi Senior Financial Advisor , Ruth Torres Financial Advisor, Luis Rene Farret Senior Resident Director- International Wealth Advisor, Tiffany Briggs Wealth Management Advisor, Ben Taylor Wealth Management Advisor.

Dr. Naji Tanios Kayruz, 58, died on Feb. 4 after he was struck by a vehicle while out riding his bicycle. Dr. Kayruz was a San Antonio-based surgeon and a member of the Bexar County Medical Society.

visit us at www.bcms.org

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BCMS NEWS

BCMS Membership

Team

“Kicks Butt” The BCMS Membership team includes (L-R) Gloria Stuart, Brissa Vela, Clemente Sanchez and Melody Newsom.

The Bexar County Medical Society recently received the "Kicked Butt" Award for 2018 from TMA for having the highest membership growth for the year. The award was presented at the TMA Winter Conference on Jan. 25.

BCMS is part of the top five metro county areas in the State of Texas. These counties compete every year to determine which medical society has the highest membership growth. The top five metro areas are, Travis, Tarrant, Dallas, Harris and Bexar Counties.

The BCMS Membership Department worked hard all year to increase its membership though new initiatives targeting newly licensed physicians and physicians just starting their careers. They also focused on getting the future generation of medicine, both residents and students, involved though initiatives like the Joint Academic Collaboration Committee.

BCMS membership offers marketing, networking and referral opportunities for its members through recently developed events, programs and initiatives. The Women in Medicine event has grown into a great recognition opportunity that highlights members for their dedication and commitment to the honored practice of med12

San Antonio Medicine • March 2019

icine. During 2018, BCMS members visited the Hill Country during a bus tour that offered a very personal networking opportunity.

During a very successful New Member Welcome event, local physicians, residents and students interacted with physician members and past presidents building great personal and professional relationships.

BCMS membership is also responsible for constantly working directly with the physician offices and group practices to keep all physician information up to date. A dedicated membership database specialist works daily to update each physician profile which provides the information that is available to the public via our Find a Doc website feature.

Sheldon Gross, MD, 2018 BCMS President, developed the BCMS Leadership Course which has partnered with Trinity University professors and has helped develop the careers and knowledge of its participants.

Through these and many other initiatives, BCMS membership staff has secured this great honor! They will continue to work hard to “KICK BUTT” in the future.

BCMS HONOREES

MARVIN FORLAND, MD Past as Prologue

By Sheila Hotchkin

E

ach morning at UT Health San Antonio brings the arrival of Marvin Forland, MD, MACP. He steps into the library and heads toward the door beside his portrait.

Entering his office, he sets his open briefcase behind his desk and turns his attention to working toward the greater good of the university – as he has done for a half-century.

Much has changed since 1968, when Dr. Forland left the University of Chicago to help start a new medical school in San Antonio on the site of a former dairy farm. UT Health San Antonio’s first graduating class had 33 students. Today, it enrolls 3,300 students in five schools. An entire campus – now one of three in San Antonio and Laredo – has sprung up around the original medical school.

The university’s reputation has grown, along with the quality of medical care in San Antonio.

But one thing has not changed: Dr. Forland – now an 85-yearold emeritus professor volunteering his time – goes to work every morning.

“This is what I like to do,” he says simply.

Tireless in retirement, Dr. Forland continues to innovate after five decades with UT Health San Antonio. In recent years, he has been instrumental in the creation and development of the Center for Medical Humanities & Ethics, which teaches ethics and professionalism while nurturing empathy and humanitarian values.

In 2014, the American College of Physicians celebrated Dr. Forland’s achievements with its Texas Chapter Centennial Award. Most recently, the Bexar County Medical Society honored Dr. Forland with a Distinguished Service Award in January 2019.

The Communitarian

An avid reader since childhood, Dr. Forland found himself drawn to books that glamorized medicine: Arrowsmith, The Citadel, and Microbe Hunters among them. He also greatly admired several of his friends’ fathers who were physicians.

“As I proceeded in school, it was quite clear to me that I was more continued on page 16

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San Antonio Medicine • March 2019

BCMS HONOREES continued from page 14

at what was then Robert B. Green Memorial Hospital downtown.

When his military service ended in 1964, he joined the faculty of the University of Chicago and met and married his wife, Ellinor. A few years later, he was invited to return to San Antonio to help start a new medical school and develop a program in kidney disease. In 1968, he returned to San Antonio for good.

Initially chief of the renal disease division, Dr. Forland helped initiate the new curriculum and the hemodialysis, kidney biopsy and transplantation programs at the medical school and affiliated hospitals. He rose through the ranks, becoming the medical school’s associate dean for clinical affairs.

Whether working across departments, institutions or the community, Dr. Forland became known for his collaborative spirit and sound advice, traits still very much evident today.

“I think my major contribution, perhaps, has been as a communitarian, trying to engage and work closely with others in whatever area of responsibility I was asked to undertake,” Dr. Forland said.

“The Candle That Lights Our Path”

interested in a caring profession rather than an entrepreneurial profession, and I found that I like sciences as well as literature,” he recalled in a videotaped 2010 interview. “I thought that medicine would satisfy most of these interests.”

After graduating from Colgate University, he completed medical school at Columbia University and residency at the University of Chicago. Two years of volunteer military service brought him to Fort Sam Houston’s Surgical Research Unit. Discovering that he was the only nephrologist in San Antonio, Dr. Forland volunteered 16

San Antonio Medicine • March 2019

Medical ethics has been taught at the Joe R. & Teresa Lozano Long School of Medicine since its inception, but ethics discussions had long relegated to the final months of medical school, when students’ minds were on their residencies. As associate dean, Dr. Forland sought to give ethics more prominence, with limited success.

Then, at retirement, Dr. Forland captured the imagination of then-School of Medicine Dean Steven Wartman, M.D., Ph.D., who proposed a combined program in medical ethics and humanism. With support from President Francisco Cigarroa, M.D., the Center for Medical Humanities & Ethics was born in 2002 and up-and-coming author Abraham Verghese, M.D., recruited as founding director.

Dr. Forland remains closely involved with the Center he helped

MARVIN FORLAND, MD, DISTINGUISHED PROFESSOR IN MEDICAL ETHICS

By Ruth Berggren, MD, MACP Director, Center for Medical Humanities & Ethics

When I became Acting Director of the Center for Medical Humanities & Ethics, I discovered that Marvin Forland, MD, MACP, came with the job.

As a newcomer to UT Health San Antonio, I had little background on this respected and kind clinician, teacher and Professor Emeritus who, as a founding faculty member, had a lifelong intellectual interest in medical ethics and the humanities.

I came to San Antonio in 2006 when our family made the decision to leave New Orleans after Hurricane Katrina turned our lives upside down. My hus-

conceive, sharing his wisdom first with Dr. Verghese and now with Ruth Berggren, M.D., MACP, who assumed the directorship in 2007.

“Dr. Forland is like the candle that lights our path and a driving force behind everything our Center does in preparing tomorrow’s healers to act with compassion and justice,” Dr. Berggren said.

Dr. Forland describes three priorities that have shaped his career: delivering quality health care, expanding the availability of care and enriching the medical school experience. The Center, he says, combines all three.

“It dazzles me, the range of activities that Dr. Verghese, Dr. Berggren and associated faculty and staff have been able to build here,” said Dr. Forland, citing the use of humanities, community service learning and global health in addition to traditional ethics instruction. “It far surpasses our initial plans.”

band had an outstanding job offer in Hematology & Oncology; I was assured of an associate professorship in Infectious Diseases. The exciting opportunity at the Center came barely a year later.

When I arrived, I knew Marvin only in passing. It did not take long to recognize how remarkable he is: He retired after a long, distinguished career in medicine and academia – and only then, in partnership with former Medical Dean Steven Wartman, MD, PhD, established the Center for Medical Humanities & Ethics in 2002. This Center, which reflects Marvin’s conviction about the central importance of ethical decision-making in medical education, is his legacy and great gift to our university and San Antonio community.

Over time, I also learned about his dedication to medicine as a profession rather than an enterprise, as well as his devotion to patients, students, and San Antonio. Never overwhelming, he was at my side – still is – every day for the past 11 years as a mentor and a vigilant but gentle presence, just as he was for my predecessor, Abraham Verghese, MD, MACP. Marvin helped us chart a path, a curriculum, and a fundraising strategy, making introductions to influential friends who care about humanism in medicine, excellence in educational offerings for medical students, and service to humanity. He broadened our outlook and showed the value of careful listening and observation skills that come through our McNay art partnership and our literature program, both powerful approaches to nurturing empathy. Marvin also embraced my vision of engaged scholarship through community service learning, a program now receiving national recognition by the Association of American Medical Colleges because we are preparing a compassionate, community-minded, culturally competent health care workforce for our country and state.

I have enjoyed warm recognition for the growth and success of our Center, but it is Marvin Forland, recently honored by the Bexar County Medical Society for a lifetime of distinguished service, to whom we owe a great debt of gratitude for staying the course. visit us at www.bcms.org

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OPINION

Monopolistic Healthcare Who Wants That?

By Alan M. Preston, MHA, Sc.D.

I

am always surprised how people can rationalize the merits of certain socialistic financial, market, economic, and healthcare systems as desirable when the evidence is clear and compelling all around us that capitalistic systems are superior to socialistic systems. Yet, people seem to gravitate to socialistic systems based on a conceptual framework, headline, or soundbite that when examined closely, I doubt there would be any support for such. For example, who would be in favor of a form of government where the government owns the means of production? Nevertheless, we have an increasing number of individuals in this country that are embracing components of such a system.

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San Antonio Medicine • March 2019

In the private sector, we are almost uniformly against a monopoly.

Even monopolies in a state's electricity industry is often opposed by 75 percent of citizens. The federal government has a long history of not supporting a monopoly. The Federal Government enforces three major Federal antitrust laws, (designed to break up a monopoly) and most states also have their own as well. Essentially, these laws prohibit business practices that unreasonably deprive consumers of the benefits of competition (i.e., a monopoly), resulting in higher prices for products and services. Let me underscore the position of the Justice Department on this issue; the lack of competition results in higher prices. This seems like common sense and a logical conclusion to draw about a monopoly.

OPINION

The three major Federal antitrust laws designed to break up monopolies are: • The Sherman Antitrust Act • The Clayton Act • The Federal Trade Commission Act. When people are polled about Medicare For All, about 70 percent claim to be in favor of Medicare for all. The real question is what do they really favor? Are they in favor of monopolistic healthcare or the idea that "Medicare for all" suggests FREE for all healthcare? These are two very different things. And make no mistake about it, Medicare for all would result in a single-payer system. A single-payer system is a monopoly! And to be crystal clear, a "single" payer system is not one where there are two or three or 50 private payers competing with the single payer; it is only one payer! No more private payers. No more employer-sponsored health plans; only Medicare for all…period!

However, many believe that as long as their healthcare is free, who cares if it is a monopoly? As long as the government pays for them to enjoy what they feel is their "right," they are OK having the government run the entire healthcare system. What are the costs to run such a massive free system for the benefit of all? A study by George Mason University found it would lead to a $32.6 trillion increase in federal spending over a 10-year period. To put that number in perspective, the annual receipts of the federal government to run the entire country is approximately $3.4 trillion and we spend annually approximately $4.3 trillion, creating an annual deficit of nearly a trillion dollars! The study’s author, Charles Blahous, wrote in The Wall Street Journal that even doubling taxes would not cover the bill for a national single-payer health-care system. Most people could not afford to double their taxes even if it meant they would get “free” healthcare.

To put it mildly, free stuff is expensive, and when we talk about free healthcare, it is enormous. And the politicians want to leave impressions in the minds of the voters that since healthcare is a "right," your time has come to have the federal government finance access to unlimited healthcare as a result of being a right versus a privilege! However, is that what a right means? The short answer is a resounding NO! Think about the second amendment. We all have a right to bear arms. That right is part of the Bill of Rights enshrined in our constitution and "the right of the people to keep and bear Arms, shall not be infringed." Does that suggest if you cannot afford a gun, the federal government will be obligated to pay you to make such a purchase? It is your right after all. And I think most would agree having the federal government pay for you to own a gun is an absurd no-

tion. And it is an absurd notion because a right does not confer a financial obligation on behalf of the federal government for you to enjoy such a right.

Nevertheless, when it comes to healthcare, those in support of Medicare for all are quick to correct me (when I point out what a right is) that healthcare is different. However, I am not talking about healthcare when I am talking about rights and the role of the federal government. To be redundant, I am talking about RIGHTS (and not necessarily healthcare) and the obligations of the federal government protecting our individual freedoms and liberties and rights, of which does not constitute a financial obligation on behalf of the federal government, are not designed to finance our decision to enjoy our rights. Thus, regardless what the "right" may be; guns, free speech, healthcare, none of these so-called rights confer an obligation on the federal government to pay citizens (or non-citizens) to enjoy such a right!

The Medicare for all crowd also thinks the reason that healthcare costs so much is because of greedy CEOs of insurance companies.

Take United Healthcare for example; the revenue in the third quarter for 2018 was approximately $56.6 million. The net profit was only 5.6 percent! In the financial circles, that is not exactly what one would characterize as "excessive" profits. The costs to run United Healthcare was only approximately 15 percent. The remaining 80 percent of the revenue went to pay doctors, hospitals, and pharmaceutical companies! The CEO's base salary is about $1.162 million.

His bonus was about $4.9 million. And he exercised stock options of about $11 million. Added altogether, he took home about $17 million. That represents approximately 0.03 percent of the 3rd quarter revenue or less than 0.01 percent of the annual revenue. It is simply not a credible argument to suggest that healthcare costs so much because the CEO is sucking out less than 1/10th of a penny of revenue. Sorry to disappoint those that reasoned the CEOs are the reason healthcare cost so much.

Bernie Sanders (and now increasingly the Democratic Party hopefuls) suggests that “the only long-term solution to America's health care crisis is a single-payer national health care program.” Really? I am sure there are many solutions! The challenge is in the definition of the word or concept of “solution.” One person’s solution is another’s problem. And suggesting that the government is the only solution via single payer is the definition of socialism. True believers in socialism have a view that ONLY the government can solve problems of the citizens (and in Bernie’s case, even non-citizens) they govern.

Thus, if you like the efficiency of the U.S. Postal system, with the compassion of the IRS at Pentagon prices; you’re going to continued on page 20

visit us at www.bcms.org

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OPINION

Monopolistic Healthcare

continued from page 19

love government-controlled healthcare! Furthermore, single payer can achieve lower cost; however, at the expense of the physicians and hospitals by cutting their reimbursements substantially, which would create a smaller supply of physicians and hospitals, and then waiting lines. And I was a tad surprised when a high-profile physician representative indicated that doctors like the idea of the "ease" of having only one payer to send their claims. What a tradeoff; ease of filing a claim form for a substantial reduction of their income. I don't think the provider community that supports the simplicity of a single payer system has thought this through. My reply to the physician representative was for him to ask the doctors if the ease of filing a claim is worth having their income cut up to 90 percent!

Just look at Medicaid; a federal/state run government program for the poor. Since the poor (133 percent of FPL) have little choice in their healthcare plans, the government, acting like a monopoly for this group, can pay physicians a lot less than they do for other government programs. Medicare pays better, however the government knows that If they cut the reimbursement of Medicare, there will be fewer and fewer providers accepting Medicare. This is because providers can earn a healthy living by taking commercial insurance 100 percent. However, if there are no other means by which a physician can seek payment, other than the government monopoly, one can expect the reimbursement rates to fall to that of Medicaid or

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San Antonio Medicine • March 2019

lower. If you earn money from healthcare, you would have to be very naĂŻve to think your income would not plummet under a federal government, monopoly run, single-payer system. Furthermore, when it is only the federal government mandating how and what needs to be on a claim form, I am not sure it will be easier than filing with many insurance companies.

Consider the impact of a single-payer system.

A monopoly or monopsony is the ultimate definition of control. The difference between a monopoly or monopsony is the former is a single seller, and the latter is a single purchaser. If you are a doctor, you would "sell" your medical services to one entity; the government. If there was no competition and the government felt the costs for healthcare was too much, they would simply pay less for the services.

Currently, even Medicare needs to be somewhat competitive, otherwise doctors would not take any Medicare patient. They can do this because there are many payers. When there is only one payer; i.e., the government, it becomes a take it or leave it environment. All or nothing! And I have a hard time believing that doctors would have the upper hand in negotiating with the federal government that is hostile toward high-income earners already. Finally, the government can begin lowering the gap of high-income earners to become closer to the low-income earners.

There is a move by politicians in the federal government to reduce the income gap. We have all heard how terrible it is that there is a widening gap between the highest income earners compared to the lowest income earners. What does that suggest? Reduce the number of high-income earners to be closer to the low-income earners. I can assure you that people earning $15.00/hour will not be making $150,000 next year in an effort to reduce the gap with high-income earners. Medicare for all can fix two social issues at the same time; pay less for healthcare by reducing the income of doctors and the impact will be a reduction of income between continued on page 22

OPINION

Monopolistic Healthcare

continued from page 20

high-income earners to low-income earners. And as a social metric, I never understood what one has to do with the other. If I eat Krispy Kreme doughnuts morning, noon, and night and increase my weight to 350 lbs., I can assure you that you will not become thinner as a result. One has nothing to do with the other. They are independent variables. The idea of reducing the income gap between the rich and the poor is one of the most misguided concepts in economics I have heard. North Korea is a great example of a utopian country where the income gap is nearly equal; everyone is poor! My hope is to increase the income gap. If we can get three billionaires to make a trillion, that would be enough in taxes alone to cut a trillion off of the annual deficit.

I suspect that most Americans would be quite vocal against granting such colossal market power to one private company (i.e., a monopoly). So why is it different when the single source of power is the federal government? Whether we consolidate power to a single private firm or a single government agency, it is still a consolidation of power, and thus zero competition is involved. Granted, having an iron-fisted monopoly can certainly command lower prices from the doctors, hospitals and pharmaceutical companies; however, how many of the doctors, hospitals, and pharmaceutical companies will agree to see such patients? And those providers that do agree; how long can they offer a plethora of services before they go broke with such a reduction of price controls and mandates? (And I use the word agree loosely given that a mandate or a take it or leave it stance, is hardly the concept of agreeing; it is coercion).

The inherent challenge with socialized healthcare, or any product for that matter, is that it creates major disruptions in the private sector, reduces innovation, reduces access, creates waiting lines and seldom if ever accomplishes the stated objective. The evidence is all around us. Venezuela is an excellent example of socialism gone amuck. The one choice of a loaf of bread may be cheap, but just not available; not a problem though, just get in line tomorrow a tad earlier!

The pro Medicare for all crowd also claims that Europe has a single payer and they claim it is great. Let’s take a look at cancer survival rates in the USA vs. England. The USA usually ranks first in the survival rate of cancer. Prostate cancer as an example has a 91 percent chance of the five-year survival rate in the USA compared to England which is about 55 percent. Part of the difference is due to the inherent waiting lines that socialistic healthcare inevitability creates.

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What is the advantage of having free care if you can’t access it when you need it? The costs of healthcare are one issue; however, quick access to quality providers is more important, particularly if you desire early detection, treatment, and exceptional outcomes. And as I stated in previous articles, one of the impacts of socialism is that it always creates scarcity, reduces competition, stifles innovation, and creates waiting lines! I certainly understand, that when people think their healthcare will be cheaper if it is government run, can be an appealing proposition; however, the reality throughout the world tells a very different story in those single-payer systems.

And when we compare countries that are embracing capitalism vs socialism, we can see that many of the European countries are abandoning socialism for capitalism; whereas the USA is moving in the opposite direction. The Index of Economic Freedom measures the degree of economic freedom in a country on a scale from 0 to 100, based on four complex sets of indicators: Rule of Law, Limited Government, Regulatory Efficiency and Open Markets. The USA now ranks No. 18 and moving away from economic freedom; a troublesome trend!

I hear the repeated talking points all the time when people claim that the USA no longer has the highest quality of healthcare compared to other nations. When pressed, they cite the Infant Mortality Rate of which the USA ranks about 55th compared to other nations . Prior to the passage of the PPACA, the USA ranked about 20th.

The PPACA was supposed to improve this metric! The PPACA did not improve this metric. However, that is not a fair proxy for the measurement of quality of healthcare for many reasons. The biggest being that a large increase of IMR is based on Sudden Infant Death

OPINION

Syndrome which usually occurs in months 4-6 of a baby's life.

Hardly a measure of our healthcare system having babies dying at home from suffocation. The IMR was the single most cited reason that the USA's healthcare system was broken and needed "reform."

And the way the IMR statistics is often presented, one would believe that our hospitals are terrible at infant care; a claim that is preposterous. We lead the world in managing some of the most vulnerable very low birth weight babies to a healthy status than any other industrialized country. An extremely low birth weight infant is one with a birth weight of less than 1,000 g (2 lb, 3 oz). Most extremely low birth weight infants are also the youngest of premature newborns, usually born at 27 weeks' gestational age or younger. Globally, the prevalence of very low birth weight is approximately 15.5 percent compared to the USA which is approximately 7 percent. And because of our tremendous high-quality healthcare system, we save 80 percent of this population. Not the case in other countries.

Seldom do we consider the reason WHY healthcare is expensive here in the USA. And unfortunately, in today’s world, too many people lack the capacity to reason and simply blame one aspect of a healthcare delivery system as to the woes of the entire system. One reason that healthcare costs continue to increase is directly due to government mandates! The government mandates that insurance companies offer “minimum essential benefits.� These benefits are neither minimum nor essential. They are however costly. And every time the government mandates that the insurance company offer some benefit, you the consumer pays for the mandate in the form of higher premiums or deductibles. Even when healthcare is not government-run, they insert themselves into the picture and the result is higher costs to everyone.

The ACA is full of engineering mechanisms designed to create a more "fair" and equitable healthcare system. However, all of that "fairness" has increased the costs of healthcare. Consider the decrease in rating bands. It went from a ten-fold band limit to four, meaning the highest premium costs could not be greater than ten times the lowest premium costs to now no more than four times.

If you were running an insurance company, would you take the highest cost members and lower their cost, so they are only a fourtime factor of the low-cost members premium? Or would you increase the low-cost members premium to be closer to the highest-cost members premium? Yes, the latter is what happened.

Consider the fact of removing the ceiling on lifetime maximums.

Sounds great; however, it is very costly to underwrite when there are no limits. No problem; just raise the premium! Increase the dependency to age 26 for families that still have their kids at home at that age. No problem; just raise the premium. Remove pre-existing

conditions so that everyone can have coverage for everything. No problem; just raise the premium. And as I discussed, minimum essential benefits are quite robust. No problem; just raise the premium. Yes, when the government tinkers with our "market-based" healthcare system, the market is no longer in control of creating a product that is affordable for millions of Americans.

The other good news here in the USA is that as we continue to get older, we live longer. And the Baby Boomer generation has boomed. And all of the innovations have kept us living longer. That comes at a price as well. Capital follows innovation and if one looks at countries that are more socialistic or communistic, there is little innovation because there is little desire by the citizens to innovate when the government will take the fruits of their intellectual property away from them. Also, since innovation and excess capital go hand-in-hand, it seems rather obvious to me that if 20 percent of our economy (Healthcare represents about 20 percent of GDP) evaporates out of the private sector in favor of the government sector, the private capital market and innovation will disappear as well.

Is that what you want with single-payer healthcare?

The Federal Government is notorious for adding layers and layers of administrative cost to any agency. Can you name an agency that has had a reduction in administrative costs? Probably not, which is one reason why the USA is about $20 trillion in debt!

Be careful when a politician dangles the word FREE! Not much in life is free, and ultimately someone must pay for all the free stuff.

And the payment for the free stuff comes in all shapes and sizes.

Longer waiting lines, fewer substitutes in services, higher deductibles, higher taxes, payment cuts, less innovation, and the politicization of our healthcare system. There are valid reasons why monopolies are illegal in the USA. How is Medicare for all any different? The only difference is that it becomes a government monopoly as opposed to a private monopoly and that seems like a terrible idea to me. However, I am one who likes choices and competition! Something tells me that if people understood than Medicare for all is a monopoly, I doubt 70 percent of the public would be in favor of such, particularly if we increased their taxes to pay for all of that free healthcare.

Dr. Alan Preston is an experienced Chief Executive Officer with a demonstrated history of working in the managed care and the healthcare industry. He has a Doctor of Science (Sc.D.) focused in Public Health, Health Services Research from Tulane University School of Public Health and Tropical Medicine.

He has been very involved in risk-sharing contracts, ACOs, Medicare Advantage including RAP scores, HEDIS, and STAR ratings which helps physicians and health plans alike in reducing MLR. Alan@Preston101.com. visit us at www.bcms.org

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WOMEN IN MEDICINE

WHY DID I DECIDE TO BECOME A PHYSICIAN?

A lifelong passion for healing is fulfilled

By Dr. Ana I. Rodriguez, from MacGregor Medical Center

I

was exposed to the medical field early in life. My mother was a high school science teacher and my father was a general and pediatric surgeon. While shadowing my father during summers I loved the interaction I observed with the patients and realized I wanted to do more than just surgery. I wanted to follow up and assist with their healthcare over time. My passion was later reinforced when my mother decided to go to medical school and she would take me to the anatomy labs. I found it fascinating how the human body worked and how a doctor could help heal it.

Being a single parent, my mother had to quit her medical career

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San Antonio Medicine • March 2019

to care for my sisters and me. She was the driving force to move to the states and finish my college years and then continue my medical education here. As an immigrant from Puerto Rico it was very difficult to adjust and find my niche. Opposite from Dr. Rosa Vizcarra’s experience, I remember to this day when I met with the pre-med advisor who told me that it would be very difficult to be accepted into medical school in this country and to seek an alternate career. I went home and I cried out of anger and told myself: “I am going to prove him wrong.” In the process, I met my future husband and we both applied to college and moved away from El Paso, him to pursue his business degree and me to go to medical

WOMEN IN MEDICINE

school. We both moved away to the East Coast to pursue our studies. It was quite an adventure and in the process I had my first child. I had to take a year off but it was OK. I was not your traditional medical student by any means. I was very proud to walk the graduating stage with my 6-month-old daughter over 27 years ago. Knowing residency would be challenging, we moved back to Texas to be closer to our families and to our culture.

During my daughter’s pregnancy I was told that I had gestational diabetes. I was in shock. What?? I’ve always been called “Skinny Ana” since I was, and still am, a “stick.” I always watched my family struggle with obesity and the problems that stemmed from it like diabetes, hypertension, strokes and heart attacks. So, my sisters and I refused to gain any weight and tried not to do too much of the Puerto Rican or Mexican ‘diet.’ As I got older and busier, balancing career and family, I found it hard to exercise so I had to watch what I ate.

With time, my dad had a severe stroke from his diabetes/hypertension at age 51, my mother developed diabetes and grandma had a heart bypass. I kept telling myself “I need to exercise. I need to exercise. I don’t want to be like my dad with insulin, diabetes, stroke and neuropathy.”

I realized I spend so much time at work and caring for my family that I had not much time for anything else. We were all too busy multi-tasking and at the end of the day there was hardly any time left. As I and my kids were getting older and I was getting ready to have more ‘me’ time, life suddenly changed. In a span of three years, I lost my younger sister to cancer, my father to another stroke, my brother-in-law to violence and my grandma to “old age” at 95. It was too much for my mother and she died three years later of depression and dementia at 71. So, I did the only thing I knew. I got busier at work and at home. Unfortunately, that led me to become more isolated from the few friends I had.

When EMR’s (electronic medical records) came about I became involved in learning how to use it. It kept me from focusing on the pain of my lost family. So I became the “superuser.” I created templates, learned shortcuts and climbed that steep learning curve.

I became more efficient and documented better. I learned how to use a hybrid of dragon, templates and free-style documentation.

The medical practice got electronic interfaces with several major labs, hospitals and radiology companies. So information was readily available. I loved it. I did not have to go to medical records to look for labs anymore. But with every technological advance there

are issues with privacy, cyber attacks, security, maintenance, etc.

So it is another expense to keep up with. Our practice does have a website and has a patient portal. We also have a presence on Facebook and get patient feedback in different ways. Then came the world of ‘meaningful use’ and I jumped at the opportunity to participate. And so we did. Then it ended and now we are in the world of CCM, ACO’s and MACRA, etc… so I also got involved and created programs and workflows to participate.

In the meantime, my husband was getting worried that I was spending too much time with work and not enough with my social life, so he made it his job to avoid that. Our circle of friends grew and I started going out to more medical conferences and meetings.

With time, I met Dr. Vizcarra and then her friends became my friends and I met other female physicians at other events. At their insistence, I decided to participate in the half marathon for Rock n’ Roll in San Antonio. Boy, was that an experience!

I started training and refused to stay behind. I had to work much harder and, being older than all of them and no quitter, up that steep hill I went. Six years later, I am running at a slower pace than before due to lack of time but getting ready to do another “racation.”

One of my close friends and I travel the U.S. at least once per year and make a “girls” weekend to run and spend time catching up. Some of us go as cheerleaders and others as participants, but the goal is the same: Participate, enjoy each other and be grateful we can.

So now I look back in time and give thanks that despite all the hardships and personal “losses” I have remained a compassionate physician dedicated to provide the best care possible to my patients despite all the time constraints and “red tape” we find from insurers on a daily basis. As one of my patients told me this past week; “Doctora, how do you manage to smile after such a long day?” I looked back at her and told her “Why not? After all, we are still here and I am able to provide the assistance and care you need. We have known each other for a while and this is what I wanted to be doing when I chose medicine as a career.” She hugged me and gave me a kiss. I then put on my running shoes and headed out to enjoy the outdoors.

Dr. Ana I. Rodriguez works at MacGregor Medical Center.

visit us at www.bcms.org

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WOMEN IN MEDICINE

WHY DID I DECIDE TO BECOME A PHYSICIAN?

Following my path and overcoming every obstacle

By Dr. Rosa I. Vizcarra, MD, FAAFP

It

was a typical hot summer afternoon and I hurried to finish my clinic rounds and make a stop home to say ‘hi’ to my daughters, husband and elderly parents living with us. Then it was off to a medical lecture sponsored by a local neurologist. As a barely new physician in San Antonio, I was there to get some knowledge and meet the specialists and other local MD’s. It was not hard to say ‘hello’ to the girl a chair away from me and, from there, the rest is history. “Dr Ana” like many of her patients know her, and who is a well-known primary care doctor in the area, and me became not just colleagues but best friends. More than six years later we are still lucky that we found each other as we share values, ethics and history. Lots of it!

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Since then we have spent innumerable hours together. We are not strangers to stress, conflict and challenges and often our conversations revolve around healthcare and how to best serve our patients.

We talk family, politics, finances, technology and exercise. And, of course, fashion!

Back in our day, it was not difficult to know that we wanted to be doctors, although for different reasons, but similar outcomes; one from families with successful doctors and another one with no one involved in healthcare at all; both dreamers without boundaries, both have moved across the country and have seen and lived with bias in our profession. I remember once being told by a physician, “I know you are capable and good enough because you had to work

WOMEN IN MEDICINE

twice as hard as everybody else, not just because you are a doctor but because you are female, you are a foreigner and you have an accent.” I did not think much of it, I honestly did not feel discriminated or anything; but I took it as a true statement.

I went to medical school in a different country and to enter training in the U.S. I had no idea how to do it. I did not think about migrating to the U.S. before I fell in love and decided to take an adventure and follow “my path.” Back then, I did not imagine that I would always have to repeat “I am Dr. Vizcarra” more than three times during patient encounters; or that patients and their families would still call me ‘nurse’ or ‘miss’ or ‘la senorita.’ I would also often hear the phrase “you don’t look like a doctor.” I had to learn to let all of that slip as long as it was not clearly in a way to make me feel diminished. I know better, now, that I will always be ‘A Doctor’ even if people don’t want to accept it. The hardest thing is to keep the reins and mark boundaries with patients and or families looking for conflict. It is an ongoing battle that comes with the title of female physician and, honestly, I don’t know if male physicians feel the same, but my male friends don’t really mention much about it.

After 22 years, five different moves from the Northeast to the Southwest, a residency training, a subspecialty, academic titles, private practice and group practice; I can say I have practiced medicine in most settings including the most private and sacred places like in patients’ homes and intensive care units. It is here where you have the deepest conversations and where you feel honored or in the deepest despair. It is here where you feel that you know so much and you know nothing at all; where you cry with people or eat the bread they offer you; where you see the young and the old and where you talk about life and death.

Yes, I have been desperate and I have left places to cry my heart out for those patients and their families and for circumstances of unfair life. I pray and I talk to myself often and sometimes I call my husband. It is not easy to do what we do, but it is not hard either. It is a beautiful combination of feeling useful and fulfilled. It is not underrated to say that a passion for the profession exists – and should exist! And we get paid for it! My mom used to tell me that it was not just a profession, that medicine was a calling, as sacred as priesthood. She believed in science, but mostly in God, she said.

When I lost her to Alzheimer’s over a year ago, after riding the ride and after seeing the text-book chapter of dementia unfold in front of my eyes, I did not know how to grieve. I thought I was prepared.

I knew ‘everything’ that was expected. But facing death in my own house was different. There is nothing like it, yet it gets better. I eventually learned NOT to rationalize everything and I am still working on it. It is very difficult for many reasons to be human and not just

a doctor, right? One minute you are a mother and the next you are a wife, then a daughter, a sister, a friend, and it never ends.

Every time I feel overwhelmed by documentation, requirements, billing, collections, Medicare cutbacks, and even when I receive checks from Medicaid for $0.75 cents for a visit, I remember how much my colleges get paid in other countries for the same functions. It doesn’t mean that I don’t agree with changes that should happen at higher levels in this country in regards to payment systems and overall care delivery.

It is just that I feel privileged for what I do.

Yes, we run, both of us. I did it many years ago just for fun and because I can’t stay still, I guess.

I stopped running after moving to Texas because life with a new baby, a new job, elderly parents moving in and a teenager, finally breaks the habit. Not that it was not good. I tried here and there, hit and miss, and always with the greatest support from the main person in my life “the husband” (by the way, did I say he was making his debut as a new stay-at-home dad when we moved to Texas… a story for another time). Then we moved to San Antonio and found Ana and started talking to her about running for fun and to get out; she accepted the challenge and after early and late runs, keeping each other at pace through text messages, phone calls, etc. we have done at least three half-marathons! Ana has turned out to be a great partner because she has consistency, persistence and keeps the pace.

If you go faster it is OK, and if you go slower it is OK. You can bring the full armor or be just barely awake with your old tennis shoes because it doesn’t matter what you wear. What matters is that you always stay strong, stay together and lift each other up.

Running is like life. There are ups and downs, easy trails, harder trails, both hilly and flat. Sometimes it smells beautiful like after a light rain with a breeze that is thin and velvety and you see green and the most vibrant colors. Other times you go through a path with an awful smell, bumpy roads with many rocks that you have to slow down for and watch your ankles. It could be gray and dry and cloudy and slippery and muddy, or hot and humid, terribly windy or terribly cold. And if you go too far, you can get lost. But what will always save you is to keep moving; don’t lose sight of the end and, once you reach the end, then you start the next run.

Dr. Rosa Vizcarra practices family medicine and geriatrics working for WellMed’s Palliative Care Program.

visit us at www.bcms.org

27

FEATURE

CAST Med: Creating a Pipeline of Doctors and Researchers in San Antonio By: Eddie Muzquiz Rodriguez, PhD In August 2019, CAST Med will open its doors at Brooks, inspiring the next generation of medical professionals and adding to the muchneeded pipeline of doctors and researchers in San Antonio. The school will be a place where the classroom meets the real world through experiential learning and where educators work with students to address their needs and ignite their passion, creating opportunity for all students in San Antonio.

With 1 in 6 employed individuals in San Antonio working in health care or biomedical sciences, it is one of the largest and fastest-growing sectors in the local economy. CAST Med will focus on connecting students to three career pathways: medical, biomedical research, and public health. Its first class of 150 9th graders will begin in August 2019.

Open to all Bexar County students, the school will be tuition-free and, unlike magnet schools, does not have any entrance requirements.

CAST Med is open to all students who are eager to dive into medical careers and or research and hungry for a flexible and dynamic learning experience, one that accounts for their voices in helping shape the classroom.

Providing a strong foundation in math and science with small class sizes, CAST Med will also embed college coursework so all students have the chance to graduate with 30 hours of college credit from the partnering community college. School partners include UT Health, the University of Texas at San Antonio and San Antonio College.

Some initial partners include the Bexar County Medical Society, the Children’s Hospital of San Antonio and Mission Trail Baptist Hospital.

Hospital partners are working now with school leaders to design pathways and curriculums, ensuring that students are receiving instruction that mirrors the real world and fills gaps in workforce needs.

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What’s most exciting is that CAST Med students will learn by tackling real world problems through project-based learning methods intended to sharpen critical thinking and problem-solving skills, as well as expose students to the challenges in their own communities, instilling empathy and creating a sense of agency.

CAST Med is part of The Centers for Applied Science and Technology or CAST — a network of tuitionfree, industry-led, careerthemed schools in San Antonio founded by Charles Butt and H-E-B in partnership with area industries. While each school has the autonomy to create ecosystems that best serve its students, all schools strive to do three things: graduate students with marketable skills, expose them to careers that match their interest and fortify them with transferable college credits that jumpstart their higher education goals.

Committed to growing doctors and researchers who reflect the communities they serve, CAST Med is working to recruit 50 percent of its students from within the San Antonio Independent School District and the rest from all parts of Bexar County. It will link students to industry professionals through job shadowing, internships, mentorships, clinical and research opportunities and summer enrichment programs.

Of the 1.5 million residents in San Antonio, more than 63 percent identify as Hispanic. And yet, only 23 percent of medical professionals in the city identify as Hispanic. CAST Med aims to increase the number of Hispanic and Latino students entering the medical and health fields.

Know someone who would make a great CAST Med student?

Encourage them to apply today. The school will accept 150 ninth grade students to its inaugural class, with applications being accepted through February. The school, which will include a 215-seat auditorium and state of the art lab spaces for bioscience, biotech and anatomy labs, will also host visitors during an open house upon completion of renovation of the building prior to the beginning of

SAISD CAST MED High School at Brooks City Base | McChesney/Bianco Architecture

FEATURE

the 2019-2020 school year.

While we have several wonderful industry partners, CAST Med is still looking for healthcare and bioscience companies willing to offer mentoring opportunities for students, donate medical and science equipment and connect teachers with externships so they can enhance their subject-matter expertise and teaching skills. For more information on how to join the growing list of partner organizations, contact info@castschools.com.

This is a school that has the potential to change the trajectory of countless families in our city. To track our progress and stay up to date with news and events follow CAST MED on Twitter and Instagram or join our email list by contacting info@castschools.com.

They say it takes a village to raise a child, but it takes a city to build their schools. Join us as we make history.

Dr. Eddie Rodriguez is the CAST Med Principal. A 28-year veteran in education, he most recently served as the founding principal of Harlandale ISD’s STEM Early College High School at Palo Alto College. visit us at www.bcms.org

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BUSINESS

Develop

Your Practice to Grow and Thrive

By Michal Waechter

“What do you do?” someone will ask.

“Business development for physician practices and healthcare companies” is my typical answer. Inevitably, the next question is “So…is that like marketing?”

There is no doubt that marketing is an essential piece of growing patient volume in a new or established practice and ensuring organizational stability for the future.

Brand awareness, market visibility, audience reach, targeted Well, yes. And, no. messaging, reach, frequency and online presence are all truly valuable tactics. But business development is about so much more.

Development includes traditional marketing strategies but digs deeper to assess the true maturation of a business and create organic strategies to advance in the market. We ask relevant questions tailored to the current position and desired position of the practice.

Are there specific types of patients you are looking to attract? Do you want to subspecialize within your area of clinical specialty?

What types of talent are you hoping to add to your team? Where do you want your practice to be in one year, three years, or five years? What does your ideal clinic space look like? How will the growth of your practice affect your family and friends? The depth of development strategy comes in the form of rounding out each of these aspects to achieve a higher level of practice evolution than simply growing patient volume.

Most often, patient volume is the name of the game in the immediate moment. I get it. We live in an era of decreasing reimburse30

San Antonio Medicine • March 2019

ments and increasing costs. But what most physicians have trouble understanding (no offense) is that it is possible to attract a higher QUALITY of volume and decrease inefficiency and WASTE by putting more focus on the most effective integrated strategies that fit the context of your practice. If you feel like you’re spinning your wheels… you probably are.

You likely have a small office team and you likely have a fair bit of turnover. You may even have someone related to you working for you. Hiring someone to focus on business development fulltime is not feasible, nor is it necessary. You simply need someone who can get to know your practice inside and out and and helps execute a strategy of advocacy for you. A fresh, objective, and critical set of eyes is hugely beneficial in identifying opportunities and shortfalls.

As with anything where you’re looking to create long-term change, you have to commit. There is no crash development plan or volume-building pill that can help you. Development is not something that comes in waves or that you can invest in short-term and expect to continue generating a return. Investment in integrated strategy must be consistent and ongoing. Lack of presence in the market is the quickest way to lose relevance and to be forgotten.

You don’t have to aspire to be a multi-million dollar practice and you don’t have to be a solo practitioner to need help. There are always tactics that you could be leveraging that you may have overlooked. You chose medicine for noble reasons that begin with helping patients. For development, seek out someone who has the expertise and experience to guide you and your business. You didn’t go to school to be a “marketer.” And, guess what, neither did I. Michal Waechter, MHA, FACHE, is a principal with Waechter Consulting Group. Michal@WaechterConsulting.com

visit us at www.bcms.org

31

UTHSCSA

The value of an academic

medical center A conversation with William L. Henrich, M.D., MACP, President and Professor of Medicine, UT Health San Antonio Q. What exactly is an academic medical center?

Academic medical centers, including UT Health San Antonio, play a central and vital role in the health and well-being of our nation. Like other academic centers, UT Health San Antonio trains the doctors, nurses, dentists and other health care professionals of the future. Additionally and critically, we also are a thriving scientific research enterprise that simultaneously delivers leading-edge patient care to thousands of our fellow community members.

Our missions are complementary and embedded in all we do.

The unique feature of an academic medical center is that three missions — patient care, research and education — guide and shape its existence.

Q. What do such centers mean for a local economy?

The financial benefit of a center such as UT Health San Antonio to the local community is enormous. We are the hub of the bioscience economy, now surpassing $40 billion in San Antonio. We collaborate with multiple organizations in the community to make bioscience efforts successful. We have partnerships with The University of Texas at San Antonio, Southwest Research Institute and Texas Biomedical Research Institute. We share grants. We have a long-standing, robust and growing relationship with military medicine in San Antonio.

Moreover, at UT Health San Antonio, there are a number of commercial spinoffs each year that come from bioscience endeavors, and we now have around $240 million in sponsored programs in research.

These spinoffs and sponsored programs invariably lead to more investments in support structure. So every $1 in federal support we receive is translated into about $7 in community benefits. UT Health San Antonio is an accelerator of financial growth for the city.

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Taken together, we represent a substantial investment in San Antonio’s bioscience and educational future. Without UT Health San Antonio, the city and region would have a much more difficult, if not impossible, time plotting a way forward in medicine and the biosciences.

Q. What do such centers mean for health care and for patients?

Without UT Health San Antonio, there wouldn’t be a steady supply of doctors, dentists, nurses and health professions caregivers in San Antonio or the region. The shortage of providers would be devastating.

As for patient care, we have affiliation agreements with our primary partner, the Bexar County Hospital District. University Hospital is our primary teaching hospital. There we treat many of the most badly injured patients in its Level 1 Trauma Center and the most complex illnesses in every area of hospital medicine.

And in our physicians practice, we have over 100 subspecialties in medicine providing care for thousands. We now have multiple locations around the city in which to deliver that service. We’re taking primary care to where people live.

This is unique to an academic medical center. You can’t separate our teaching function from our patient care or from our scientific research. They all feed off each other and, together, benefit the individual patient, the community and society.

Q. What are some of the obstacles you face?

State-supported academic medical centers such as UT Health San Antonio face very specific challenges. Because state support has declined over the years, we now depend on our clinical practice to subsidize education and research. Without the clinical mission, we would not be able to have the robust research capabilities we have nor deliver a first-class education to our students, which we do every day.

A related challenge is offering a compelling case to society that education is the future of the country. Whoever owns the knowledge

UTHSCSA

economy will own the future. It is very important for our state legislators to invest in higher education and in health-related education in particular. Without it, Texas will not be able to compete. We are grateful for the support we are receiving and have received. It is an ongoing investment that continues to pay tremendous dividends for our state.

We are worth the investment.

Q. What are you excited about?

We are accomplishing so much in myriad areas, and in ways that can only be achieved by an academic medical center. We are attracting the best students and recruiting and retaining world-class faculty members. More and more we’re being recognized for the extraordinary research we’re accomplishing every day.

We have a new partner in cancer care. The UT Health San Antonio MD Anderson Cancer Center provides the absolute best in cancer research, care and treatment right here in San Antonio. We’re building a new facility for one of the world’s premiere aging research institutes, the Sam and Ann Barshop Institute for Longevity and Aging Studies.

And our new Biggs Institute for Alzheimer’s and Neurodegenerative Diseases will take a truly comprehensive approach to battling these horrible diseases.

I believe these huge initiatives, such as in cancer and neurodegenerative diseases, can be accomplished only by an academic

medical center precisely because we, unlike other institutions, bring to the challenge the power of all three missions — education, research and patient care.

Q. What is your ultimate goal?

Our goals are rooted in our multiple missions. We will continue to be a world-class academic health center, transforming health and health care for all. We will reduce health care costs through preventive medicine, and we will work tirelessly to eradicate the world’s deadliest diseases.

It is because we are an academic medical center that we are able to accomplish these worthy goals. And you — our community and the world at large — are why we remain steadfast in our commitment to make lives better.

The University of Texas Health Science Center at San Antonio, now called UT Health San Antonio, is one of the country’s leading health sciences universities. With missions of teaching, research, healing and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced 35,850 alumni who are leading change, advancing their fields and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways we make lives better, visit www.uthscsa.edu. visit us at www.bcms.org

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PRACTICE GROUP

Urology San Antonio Honored as Rezum Center of Excellence

Group Is First in Texas To Receive Designation Urology San Antonio has been honored as the first Center of Excellence in Texas for the Rezum System. Rezum is an innovative minimally invasive treatment option for men with benign prostatic hyperplasia (BPH). Urology San Antonio has treated over 250 patients using the Rezum System.

“It’s a real honor for Urology San Antonio to be named a Center of Excellence. Since my initial exposure to the Rezum System during its early clinical trials, I was impressed and excited in the potential this new technology held,” says Christopher Cantrill, M.D. of Urology San Antonio. “Now after treating hundreds of patients in practice with the Rezum, I continue to be impressed with its ability to make a significant positive impact on the quality of life of my patients with a fraction of the risks compared to prior treatments.”

Urology San Antonio worked with researchers to develop the Rezum System in order to better serve patients who were hesitant to opt for more risky surgeries or take additional medication to treat their BPH symptoms. BPH is a localized, enlargement of the prostate gland in aging adult men. Nearly 12 million U.S. men suffer from BPH-related symptoms that may require therapy. BPH causes significant quality of life issues including lack of sleep, anxiety, challenges with sexual function and limits to daily activities.

Rezum is administered on an out-patient basis and can be performed under oral sedation or local anesthesia. Rezum uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms such as frequency, urgency, irregular flow, weak stream, straining, and getting up at night to urinate. Following the Rezum treatment, patients begin seeing improvements in as little as two weeks.

“BPH really changed who I was, so when I saw Dr. Cantrill and he explained Rezum I was immediately interested,” explains Michael Garcia, a patient at Urology San Antonio. “The whole thing was

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San Antonio Medicine • March 2019

quick, and I noticed improvements in a few weeks. I’m off the meds, I feel great – Rezum really gave me my quality of life back.”

Highlights of the therapy include: • • • • • • • •

Performed in-office and patients can return home immediately Does not require general anesthesia Relieves symptoms safely and effectively Is an alternative to BPH medications Provides noticeable symptom improvement within two weeks Preserves erectile and urinary functions Allows patients to return to regular activities within a few days Is considered medically necessary by Medicare and is covered by most private insurance.

Patients interested in a consultation should contact Urology San Antonio at (210) 582-5505 or to learn more about Rezum and schedule an appointment online, visit urologysanantonio.com.

About Urology San Antonio

Urology San Antonio is the largest and most respected Urology group in South Texas. With eight locations and 37 providers, Urology San Antonio offers comprehensive care that is convenient for patients. All providers at Urology San Antonio treat general urology and each physician is trained in subspecialties such as urologic cancers, overactive bladder, female sexual medicine, kidney stones, fertility, and incontinence. More information about Urology San Antonio can be found at urologysanantonio.com.

HEALTHCARE INTERVENTION

Substantiated Healthcare Interventions Targeting the Behavior of Cigarette-Smoking

By Ammar Navid Saigal, M.P.H. Societal burden as a result of the behavior of smoking cigarettes

development of smoking-related morbidities and early mortality as-

ated with other hazardous behaviors. Smoking is the leading cause

thing from psychotherapy to nicotine chewing gum to stopping

is disproportionately great compared to the costs to society associ-

sociated with the practice. These sorts of interventions include any-

of death in the United States and has been implicated in the patho-

abruptly (known as the “cold turkey�) method. If initiated early

cans annually. Because of this, many interventions have been

developing lung disease. Regardless, interventions that are successful

burden to society associated with this behavior. These interventions

associated with this behavior.

genesis of many cancers that claim the lives of millions of Ameridesigned and implemented over the years attempting to reduce the are best thought of in terms of prophylactic primary prevention

and direct behavioral intervention.

Primary prevention has shown to be most effective at the societal

enough, these behavioral interventions can reverse the course of

at getting smokers to quit will always reduce the burden of mortality To conclude, interventions that target the dangerous behavior

of cigarette smoking are most effective when implemented early in

the course of the habit and can be approached from either primary

level and includes such measures ranging from large public bill-

preventative or direct behavioral varieties of intervention.

iting the availability of tobacco products to vendors and consumers

References:

boards emphasizing the health hazards of cigarette smoking to lim-

alike. This mode of intervention will afford protection to individuals

on the basis of not allowing for the initiation of tobacco product

use as a hobby or lifestyle attribute. By preventing individuals from

taking up smoking, public health authorities seek to attack the problem at its source, thereby stopping it from developing into a chronic

health issue later in life.

Direct behavioral intervention methods include practices that aim

to encourage susceptible individuals (regular cigarette smokers) to

quit the behavior entirely, thereby aiming to secondarily prevent the

1) Eur J Cardiovasc Prev Rehabil. 2003 Dec;10(6):476-85.

What can we do in secondary prevention of cigarette smoking?

Haustein KO.

2) Am J Public Health. 1992 June; 82(6): 827–834.

Prevention of cigarette smoking through mass media intervention and school programs. B S Flynn, J K Worden, R H SeckerWalker, G J Badger, B M Geller, and M C Costanza

3) URL: http://www.cdc.gov/tobacco/campaign/tips/re sources/data/cigarette-smoking-in- united-states.html

visit us at www.bcms.org

35

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

ACCOUNTING FIRMS 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.”

ACCOUNTING SOFTWARE

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward.

Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

ASSET MANAGEMENT

Merrill Lynch ( 10K Platinum Sponsor) We are uniquely positioned to help physicians integrate and simplify their personal and professional financial lives. Our purpose is to help make financial lives better through the power of every connection.

John M. Albert |The Farret Team | Financial Advisor 210.278.3816 john.albert@ml.com www.fa.ml.com/farretgroup “Life’s better when we’re connected®”

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San Antonio Medicine • March 2019

Avid Wealth Partners (HHH Gold Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and well-served by a team that's committed to helping you avidly pursue the future you want, and that's our difference.

Eric Kala CFP®, CIMA®, AEP®, CLU®, CRPS® Founder & Wealth Management Advisor 210.446.5752 eric.kala@nm.com avidwealthpartners.com “Plan it. Do it. Avid Wealth”

ATTORNEYS

Constangy, Brooks, Smith & Prophete (HHH Gold Sponsor) Constangy, Brooks, Smith & Prophete offers a wider lens on workplace law. With 190+ attorneys across 15 states, Constangy is one of the nation’s largest Labor and Employment practices and is nationally recognized for diversity and legal excellence.

Kathleen Barrow Partner 512-382-8796 kbarrow@constangy.com William E. Hammel Partner 214-646-8625 whammel@constangy.com John E. Duke Senior Counsel 512-382-8800 jduke@constangy.com www.constangy.com “A wider lens on workplace law.”

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice.

Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com

Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

Norton Rose Fulbright (HHH Gold Sponsor) Norton Rose Fulbright is a global law firm. We provide the world’s preeminent corporations and financial institutions with a full business law service. We deliver over 150 lawyers in the US focused on the life sciences and healthcare sector.

Mario Barrera Employment & Labor 210 270 7125 mario.barrera@nortonrosefulbright.com Charles Deacon Life Sciences and Healthcare 210 270 7133 charlie.deacon@nortonrosefulbright.com Katherine Tapley Real Estate 210 270 7191 katherine.tapley@nortonrosefulbright.com www.nortonrosefulbright.com “In 2016, we received a Tier 1 national ranking for healthcare law according to US News & World Report and Best Lawyers”

Thornton, Biechlin, Reynolds, & Guerra (HHH Gold Sponsor) Worried about the TMB, government audit, or investigation? From how to avoid TMB complaints to navigating the complex regulations of government agencies like Medicare and Medicaid, we stand ready to guide and protect our clients.

Robert R. Biechlin, Jr., Partner (210) 581-0275 rbiechlin@thorntonfirm.com Michael H. Wallis Partner (210) 581-0294 mwallis@thorntonfirm.com Kevin Moczygemba, Associate 210-377-4580 kmoczygemba@thorntonfirm.com https://thorntonfirm.com “Protecting Physicians and Their Practices”

ASSETS ADVISORS/ PRIVATE BANKING

BB&T (HHH Gold Sponsor) Banking Services, Strategic Credit, Financial Planning Services, Risk Management Services, Investment Services, Trust & Estate Services — BB&T offers solutions to help you reach your financial goals and plan for a sound financial future.

Claudia E. Hinojosa Wealth Advisor 210-248-1583 CHinojosa@BBandT.com www.bbt.com/wealth/start.page "All we see is you"

BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability.

We work hard and together with our clients to accomplish great things.

Jeanne Bennett EVP | Private Banking Manager 210 343 4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President Private Banking 210.343.4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President Private Banking 210.343.4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210.343.4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

BankMD (HHH Gold Sponsor) We believe Physicians deserve specialized products and services to meet the challenging demands of their career and lifestyle.

Moses D. Luevano

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Market President 512-663-7743 mdl@bankmd.com www.bankmd.com “BankMD, "Specialized, Simple, Reliable" Banking for Doctors”

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.

Joseph Bieniek Vice President Small Business Specialist 210-247-2985 jbieniek@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com

BBVA Compass (HHH Gold Sponsor) We are committed to fostering our clients’ confidence in their financial future through exceptional service, proactive advice, and customized solutions in cash management, lending, investments, insurance, and trust services.

Josh Collins SVP, Global Wealth Executive 210-370-6194 josh.collins@bbva.com Mary Mahlie SVP, Private Banking 210-370-6029 mary.mahlie@bbva.com Mark Menendez SVP, Wealth Financial Advisor 210-370-6134 mark.menendez@bbva.com www.bbvacompass.com "Creating Opportunities"

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

Ken Herring 210-283-4026 kherring@broadwaybank.com Daniel Ganoe Mortgage Loan Originator 210-283-5349 www.broadwaybank.com “We’re here for good.”

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 some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com

RBFCU (HHH Gold Sponsor) RBFCU provides special financing options for Physicians, including loans for commercial and residential real estate, construction, vehicle, equipment and more.

Novie Allen Business Solutions 210-650-1738 nallen@rbfcu.org www.rbfcu.org

Synergy Federal Credit Union (HHH Gold Sponsor) BCMS members are eligible to join Synergy FCU, a full service financial institution. With high savings rates and low loans rates, Synergy can help you meet your financial goals.

Synergy FCU Member Service (210) 750-8331 or info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

First National 1870, a division of Sunflower Bank, N.A. (HH Silver Sponsor) First National 1870 is a regional community bank dedicated to building long-term relationships founded on sound principles and trust.

Jamie Gutierrez Business Banking Officer 210-961-7107 (Direct) Jamie.Gutierrez@firstnational1870 .com www.FirstNational1870.com “Creating Possibility For Your Medical Practice”

BUSINESS CONSULTING Waechter Consulting Group (HH Silver Sponsor) Want to grow your practice? Let our experienced team customize a growth strategy just for you.

Utilizing marketing and business development tactics, we create a

plan tailored to your needs!

Michal Waechter, Owner (210) 913-4871 Michal@WaechterConsulting.com “YOUR goals, YOUR timeline, YOUR success. Let’s grow your practice together”

DIAGNOSTIC IMAGING Touchstone Medical Imaging (HH Silver Sponsor) Touchstone Medical Imaging provides a wide range of imaging services in a comfortable, service oriented outpatient environment while utilizing state of the art equipment, the most qualified radiologists and superior customer service.

Patrick Kocurek Area Marketing Manager 210-614-0600 x5047 patrick.kocurek@touchstoneimaging.com www.touchstoneimaging.com/ locations "We provide peace of mind, giving compassionate care to our community with integrity"

FINANCIAL ADVISOR

Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals.

Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you.

Elizabeth Olney, Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabetholney "Making Sense of Investing"

FINANCIAL SERVICES

Merrill Lynch ( 10K Platinum Sponsor) We are uniquely positioned to help physicians integrate and simplify their personal and professional financial lives. Our purpose is to help make financial lives better through the power of every connection.

John M. Albert |The Farret Team | Financial Advisor 210.278.3816 john.albert@ml.com www.fa.ml.com/farretgroup

“Life’s better when we’re connected®”

SWBC ( 10K Platinum Sponsor) SWBC helps physicians keep order in both their personal and business financial matters. For individuals, we stand ready to assist with wealth management and homebuying services. For your practice, we can help with HR administrative tasks, from payroll services to securing employee benefits and P&C Insurance.

Gil Castillo SWBC Wealth Management 210-321-7258 gcastillo@swbc.com Kristine Edge SWBC PEO – Professional Employer Organization 830-980-1207 kedge@swbc.com Jon M. Tober SWBC Mortgage – Sr. Loan Officer NMLS#212945 210-317-7431 Jon.tober@swbc.com Debbie Marino SWBC Insurance & Benefits 210-525-1241 dmarino@swbc.com www.swbc.com SWBC family of services supporting Physicians and the Medical Society

Avid Wealth Partners ( Gold Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and wellserved by a team that's ommitted to helping you avidly pursue the future you want, and that's our difference.

Eric Kala CFP, CIMA, AEP, CLU, CRPS Founder & Wealth Management Advisor 210.446.5752 eric.kala@nm.com avidwealthpartners.com “Plan it. Do it. Avid Wealth”

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.

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visit us at www.bcms.org

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 37

Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

BankMD (HHH Gold Sponsor) We believe Physicians deserve specialized products and services to meet the challenging demands of their career and lifestyle.

Moses D. Luevano Market President 512-663-7743 mdl@bankmd.com www.bankmd.com “BankMD, "Specialized, Simple, Reliable" Banking for Doctors”

Elizabeth Olney with Edward Jones ( Gold Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals.

Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you.

Elizabeth Olney Financial Advisor (210) 493-0753 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

New York Life Insurance Company (HHH Gold Sponsor) We specialize in helping small business owners increase personal wealth by offering tax deferred options and providing employee benefits that enhance the welfare of employees to create a more productive workplace.

Eddie L. Garcia, MBA, CLU Financial Services Professional Ofc 361-854-4500 Cell 210-920-0695 garciae@ft.newyorklife.com Becky L. Garcia Financial Services Professional Ofc 361-854-4500 Cell 210-355-8332 rlgarcia@ft.newyorklife.com Efrain Mares Agent 956-337-9143 emares@ft.newyorklife.com

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San Antonio Medicine • March 2019

www.newyorklife.com/agent/ garciae “The Company You Keep”

RBFCU (HHH Gold Sponsor) RBFCU Investments Group provides guidance and assistance to help you plan for the future and ensure your finances are ready for each stage of life, (college planning, general investing, retirement or estate planning).

Shelly H. Rolf Wealth Management 210-650-1759 srolf@rbfcu.org www.rbfcu.org Capital CDC (HH Silver Sponsor) For 25 years, Capital CDC has worked with hundreds of small businesses and partnered with multiple financial institutions, to assist with financing of building acquisitions, construction projects, and machinery and equipment loans.

Cheryl Pyle Business Development Officer – San Antonio & South Texas 830-708-2445 CherylPyle@CapitalCDC.com www.capitalcdc.com “Long-term, fixed-rate financing for owner-occupied commercial real estate.”

HEALTHCARE BANKING

Amegy Bank of Texas ( Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

Jeanne Bennett EVP | Private Banking Manager 210 343 4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President Private Banking 210.343.4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President Private Banking 210.343.4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210.343.4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

BBVA Compass (HHH Gold Sponsor) We are committed to fostering our clients’ confidence in their financial future through exceptional service, proactive advice, and customized solutions in cash management, lending, investments, insurance, and trust services.

Josh Collins SVP, Global Wealth Executive 210-370-6194 josh.collins@bbva.com Mary Mahlie SVP, Private Banking 210-370-6029 mary.mahlie@bbva.com Mark Menendez SVP, Wealth Financial Advisor 210-370-6134 mark.menendez@bbva.com www.bbvacompass.com "Creating Opportunities"

HEALTHCARE CONSULTING

Digital Telehealth Solutions (HHH Gold Sponsor) Physicians are reimbursed for providing none face-to-face care coordination services to eligible Medicare patients with multiple chronic conditions. We Provide Chronic Care Management and Remote Patient Monitoring within our Home Telemonitoring Program.

Dr. Jorge Arango CEO 956-227-8787 Dr.jorgearango@gmail.com Rosalinda Solis Business Development Director 361-522-0031 r.solis@digitaltelehealthsolutions.com Eduardo Rodriguez Marketing Director 210-294-2069 eddie.r@digitaltelehealthsolutions.com www.digitaltelehealthsolutions.com “Improving Patient outcomes and lower unnecessary 30-day readmissions”

HOSPITALS/ HEALTHCARE SERVICES

Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with

disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com

INFORMATION AND TECHNOLOGIES

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward.

Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting” Y&L Consulting (HH Silver Sponsor) We are an IT Consulting company that specializes in Software Managed Delivery, Business Process Outsourcing Managed Services, IT Staff Augmentation, Digital and Social Media with experience in the Medical industry.

David Stich Senior VP of Strategic Partnerships 210-569-3328, David.stich@ylconsulting.com Marisu Frausto Account Executive 210-363-4139, Marisu.frausto@ylconsulting.com www.ylconsulting.com/ “Your success is our success.”

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org 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.”

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.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and 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

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 some of the few agents in the

state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair.

Keith Askew, Market Manager kaskew@proassurance.com Mark Keeney, Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com

INTERNET TELECOMMUNICATIONS

Digital Telehealth Solutions ( Gold Sponsor) Physicians are reimbursed for providing none face-to-face care coordination services to eligible Medicare patients with multiple chronic conditions. We Provide Chronic Care Management and Remote Patient Monitoring within our Home Telemonitoring Program.

Dr. Jorge Arango, CEO 956-227-8787 Dr.jorgearango@gmail.com Rosalinda Solis Business Development Director 361-522-0031 r.solis@digitaltelehealthsolutions.com Eduardo Rodriguez Marketing Director 210-294-2069 eddie.r@digitaltelehealthsolutions.com www.digitaltelehealthsolutions.com “Improving Patient outcomes and lower unnecessary 30-day readmissions”

LUXURY REAL ESTATE

Kuper Sotheby’s International Realty (HHH Gold Sponsor) As real estate associates with

Kuper Sotheby’s International Realty, we pride ourselves in providing exceptional customer service, industry-leading marketing, and expertise from beginning to end, while establishing long-lasting relationships with our valued clients.

Nathan Dumas Real Estate Advisor, REALTOR 210-667-6499 nathan@kupersir.com www.nathandumas.com Mark Koehl, Real Estate Advisor, REALTOR (210) 683-9545 mark.koehl@kupersir.com www.markkoehl.com "Realtors with experience in healthcare and Physician relations"

Phyllis Browning Company (HHH Gold Sponsor) Our expertise is your advantage.

We have served the buyers and sellers of premier Texas properties for over 29 years, earning our reputation as the very best independent residential real estate firm in San Antonio and the Hill Country.

Craig Browning MBA, GRI, ALHS, REALTOR® (210) 408-2500 x 1285 cbrowning@phyllisbrowning.com www.phyllisbrowning.com Robin Morris CRP, GDS, GRP, REALTOR® Director of Relocation & Business Development 210-408-4028 robinm@phyllisbrowning.com “Premier Properties, Singular Service, Exceptional Agents”

MARKETING ADVERTISING SEO

Veerspace (HHH Gold Sponsor) We're a nationwide digital advertising agency that specialize in growing aesthetics practices through videography and social media. Office contact number is 210-969-7850.

Michael Hernandez President/ Founder 210-842-3146 Michael@veerspace.com Anna Hernandez Marketing Specialist 210-852-7619 Anna@veerspace.com

MEDICAL BILLING AND COLLECTIONS SERVICES Commercial & Medical Credit Services (HH Silver 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.”

MEDICAL SUPPLIES AND EQUIPMENT

Henry Schein Medical (HHH Gold Sponsor) From alcohol pads and bandages to EKGs 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 “BCMS members receive GPO discounts of 15 to 50 percent.”

PHYSICIAN SERVICES

SWBC ( 10K Platinum Sponsor) SWBC helps physicians keep order in both their personal and business financial matters. For individuals, we stand ready to assist with wealth management and homebuying services. For your practice, we can help with HR administrative tasks, from payroll services to securing employee benefits and P&C Insurance.

Gil Castillo, SWBC Wealth Management, 210-321-7258 gcastillo@swbc.com Kristine Edge, SWBC PEO – Professional Employer Organization 830-980-1207 kedge@swbc.com Debbie Marino, SWBC Insurance & Benefits, 210-525-1241 dmarino@swbc.com Jon M. Tober SWBC Mortgage – Sr. Loan Officer NMLS#212945 210-317-7431 Jon.tober@swbc.com www.swbc.com SWBC family of services supporting Physicians and the Medical Society

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 39

PRIVATE EQUITY

Rastegar Equity Partners (HHHH 10K Platinum Sponsor) Rastegar Equity Partners is a Private Equity Commercial Real Estate Investment Firm. Rastegar focuses on building portfolios to generate above market current income along with long-term capital appreciation.

Kellie Rastegar 818-800-4901 kellie@rastegarep.com Ari Rastegar 917-703-5027 ari@rastegarep.com Sandy Fliderman 646-854-9996 sandy@rastegarep.com www.rastegarep.com

PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio.

Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more!

President, Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet” San Antonio Group Managers (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising.

Tom Tidwell, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Rastegar Equity Partners (HHHH 10K Platinum Sponsor) Rastegar Equity Partners is a Private Equity Commercial Real Estate Investment Firm. Rastegar focuses on building portfolios to

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San Antonio Medicine • March 2019

generate above market current income along with long-term capital appreciation.

Kellie Rastegar 818-800-4901 kellie@rastegarep.com Ari Rastegar 917-703-5027 ari@rastegarep.com Sandy Fliderman 646-854-9996 sandy@rastegarep.com www.rastegarep.com

KW Commercial (HHH Gold Sponsor) We specialize in advising Medical Professionals on the viability of buying & selling real estate, medical practices or land for development Marcelino Garcia CRE Broker Assciate 210-381-3722 Marcelino.kwcommercial@gmail.com Leslie Y. Ayala Business Analyst/ CRE Associate 210-493-3030 x1084 Leslie@kwcommercial@gmail.com www.GAI-Advisors.com “Invaluable Commercial Real Estate Advice for The Healthcare Professional”

RESIDENTIAL REAL ESTATE

Kuper Sotheby’s International Realty (HHH Gold Sponsor) As real estate associates with Kuper Sotheby’s International Realty, we pride ourselves in providing exceptional customer service, industry-leading marketing, and expertise from beginning to end, while establishing long-lasting relationships with our valued clients.

Nathan Dumas Real Estate Advisor, REALTOR 210-667-6499 nathan@kupersir.com www.nathandumas.com Mark Koehl, Real Estate Advisor, REALTOR (210) 683-9545 mark.koehl@kupersir.com www.markkoehl.com "Realtors with experience in healthcare and Physician relations"

Phyllis Browning Company (HHH Gold Sponsor) Our expertise is your advantage.

We have served the buyers and sellers of premier Texas properties for over 29 years, earning our reputation as the very best independent residential real estate firm in San Antonio and the Hill Country.

Craig Browning MBA, GRI, ALHS, REALTOR® (210) 408-2500 x 1285 cbrowning@phyllisbrowning.com www.phyllisbrowning.com Robin Morris CRP, GDS, GRP, REALTOR® Director of Relocation & Business Development 210-408-4028 robinm@phyllisbrowning.com “Premier Properties, Singular Service, Exceptional Agents”

RETIREMENT PLANNING

New York Life Insurance Company ( Gold Sponsor) We specialize in helping small business owners increase personal wealth by offering tax deferred options and providing employee benefits that enhance the welfare of employees to create a more productive workplace.

Eddie L. Garcia, MBA, CLU Financial Services Professional Ofc 361-854-4500 Cell 210-920-0695 garciae@ft.newyorklife.com Becky L. Garcia Financial Services Professional Ofc 361-854-4500 Cell 210-355-8332 rlgarcia@ft.newyorklife.com Efrain Mares, Agent 956-337-9143 emares@ft.newyorklife.com www.newyorklife.com/agent/ garciae “The Company You Keep”

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K 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 range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley, Branch Director 210-301-4362 bwhitley@favoritestaffing.com

www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

United States Air Force (HH Silver Sponsor) As a doctor in the USAF you can practice medicine without the red tape of managing your own practice. Our doctors are free from bureaucracy and paperwork and can focus on treating their patients MSgt Robert Isarraraz, Physician Recruiter Robert.isarraraz@us.af.mil 210-727-5677 www.airforce.com/careers/ "Caring For Those Protecting The Nation"

TELECOMMUNICATIONS ANSWERING SERVICE

TAS United Answering Service ( Gold Sponsor) We offer customized answering service solutions backed by our commitment to elite client service. Keeping you connected to your patients 24/7.

Dan Kilday Account Representative 210-258-5700 dkilday@tasunited.com www.tasunited.com “We are the answer!"

For questions regarding services, Circle of Friends sponsors or Joining our program.

Please contact August Trevino program director: Phone: 210-301-4366, email August.Trevino@bcms.org, www.bcms.org/COf.html

BUSINESS OF MEDICINE

SOLUTIONS:

PROSPERING AMONGST HEALTH INSURANCE CHAOS

By Allison De Paoli

Physicians are more and more pressed for time and resources today than ever before. There is too much paperwork, too little reimbursement and not nearly enough time with patients to satisfy most doctors. On top of that, an insurance company is often second guessing your decisions and trying to change the way you treat your own patients.

No wonder burnout is rampant!

Most agree that the current system is not working well for patients or for providers. The solutions require moving out of a known quantity, the dreaded insurance reimbursement arrangement where no one seems to know what care actually costs, to a more transparent method of practice.

By putting the provider back in charge of how services are priced and how they are delivered, the cost is disaggregated or broken into its component parts. I know this can sound scary. However, who knows better than a doctor as to what the value of their skill is and how best to deliver it?

Solutions

An Internist’s solution might be to look to a Direct Primary Care (DPC) model of practice. If you own your practice and set your own fees, you can manage your time – and your life – more effec-

tively. It isn't necessary to see 12 patients an hour to cover your costs. DPC puts the fate of a practice squarely in the hands of the physician, but the rewards can more than outweigh the risks: • Patient care is completely in your control • You know what your revenue per patient will be • You control your schedule and care able to spend what you deem an appropriate amount of time with each patient A surgeon or other specialist’s solution might be to look to bundled pricing or direct contracting with employers to grow their practice. One method is to work with the employer through their Third Party Administrator (TPA) or direct employer to physician contract that then connects to self-funded employers. A company can negotiate with employers and providers for specific covered services.

That way, all are billed on a bundled basis and all parties know exactly what the fee arrangement is ahead of any procedure. The result is a triple win: • The physician and facility are paid an agreed upon price at or immediately after the surgery is performed • The patient receives quality care and has a direct relationship with the surgeon • The employer generally pays 50 percent of the network rate

continued on page 42

visit us at www.bcms.org

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BUSINESS OF MEDICINE continued from page 41

Another solution offers a specific method that physicians use to increase their volume of patients and improve their bottom line: • Review all the surgeries you perform • Choose the 10 you perform most and presumably enjoy performing the most.

• Track metrics (you might already have this information) o success rates, o cases performed, o complication rates and any other necessary information A solution may be found by contacting a service that connects surgeons directly to patients; register and provide the information they request. Once registered, you will begin to receive a request for proposals for only the surgeries you want to perform. The result can be a new and consistent flow of surgeries that you can choose to perform and determine the cost. Payment terms between the payer of care and the surgeon are agreed upon up front and there are no insurance issues to deal with.

Bundled prices for outcome-based care are also a solution. The administrative side is clean and simple which enables the physician to spend more time with the patient and doing work that he or she loves… rather than paperwork!

This allows employers hungry for solutions to offer best in class care at a more reasonable cost.

Hospitals may use bundled pricing and direct contracting to improve their already solid market position. Already recognized as a location of choice for several surgical specialties, their goal is to continue to grow and make their facility the location of choice for surgeons of all specialties.

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Employers are moving to the bundled-pricing model to control cost and increase quality. Each stakeholder gains something in this scenario: • Surgeons have a quality facility to work in, with a steady stream of available patients • Patients have access to a quality facility with known quality metrics and proven outcomes • Employers have a known entity held to specific standards of care with a known cost • The Hospital has a steady stream of patients whose bills are paid promptly.

Outcome-based care was a solution discussed at the Healthcare Financial Management Association (HFMA) conference in Las Vegas this June. Because margins are already squeezed on all sides and C-Suite executives – of an individual practice or a large facility – there is a lot of trepidation about how to move to this model. The general consensus at the HFMA conference is that bundled pricing and direct contracting are coming; let’s figure out how to make it work for us.

In summary, every market is unique, and the solutions need to be local. Access to care and social determinants are huge issues in San Antonio. Moving to a more outcome-based approach, that works for patients, payers (mostly employers) as well as providers can help us address many of the issues we face here – Diabetes, Kidney Disease, Maternal Mortality, Infectious Disease, as well as many others.

Allison De Paoli is the founder of De Paoli Professional Services. She can be reached at acdepaoli@depaoliprofservices.com or by calling 210-857-4322.

RECOMMENDED AUTO DEALERS AUTO PROGRAM

• • • •

We will locate the vehicle at the best price, right down to the color and equipment.

We will put you in touch with exactly the right person at the dealership to handle your transaction.

We will arrange for a test drive at your home or office. We make the buying process easy!

When you go to the dealership, speak only with the representative indicated by BCMS. GUNN AUTO GROUP

GUNN AUTO GROUP

Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230

Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX

GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154

GUNN Honda 14610 IH 10 W San Antonio, TX

Rudy Solis 210-558-1500

Esther Luna 210-690-0700

Bill Boyd 210-859-2719

Eric Schwartz 210-680-3371

GUNN Acura 11911 IH 10 W San Antonio, TX

Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Cavender Audi 15447 IH 10 W San Antonio, TX 78249

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

Coby Allen 210-625-4988

David Espinoza 210-912-5087

Rick Cavender 210-681-3399

Gary Holdgraf 210-862-9769

GUNN AUTO GROUP

KAHLIG AUTO GROUP Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX

North Park Subaru 9807 San Pedro San Antonio, TX 78216

William Taylor 210-366-9600

James Godkin 830-981-6000

Mark Castello 210-308-0200

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Mazda 9333 San Pedro San Antonio, TX 78216

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX

North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257

Scott Brothers 210-253-3300

Tripp Bridges 210-308-8900

Justin Blake 888-341-2182

Stephen Markham 877-356-0476

Northside Ford 12300 San Pedro San Antonio, TX Marty Martinez 210-525-9800

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211

North Park Lincoln 9207 San Pedro San Antonio, TX

North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257

Justin Boone 210-635-5000

Sandy Small 210-341-8841

James Cole 800-611-0176

Porsche Center 9455 IH-10 West San Antonio, TX

Barrett Jaguar 15423 IH-10 West San Antonio, TX

Matt Hokenson 210-764-6945

Victor Zapata 210-341-2800

Land Rover of San Antonio 13660 IH-10 West (@UTSA Blvd.)

San Antonio, TX Ed Noriega 210-561-4900

Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org

AUTO REVIEW

2019 MERCEDES GLC AMG 63 Coupe

By Stephen Schutz, MD

We have apparently reached an inflection point. Electric cars are not only inevitable, but they stand ready, like barbarians at the gate, to upend our automotive lives, like right now. Ok, really later this year and on into 2020 and beyond. But all automotive prognosticators say that electric cars will replace internal combustion engines soon and forever.

Or will they? I hate to be a party pooper, but I’ve noticed that the best-selling vehicle in the U.S. is the thirsty non-electric Ford F-150 pickup truck, extra thirsty 700-plus HP non-electric Hellcat Challengers and Chargers are selling strongly, Toyota is having trouble moving fuel sipping Priuses, and Chevy just discontinued the mostly electric Volt.

One of the reasons I’m skeptical of an all-electric future happening soon is that many modern cars powered by internal com-

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San Antonio Medicine • March 2019

bustion engines feature ever increasing fuel efficiency and horsepower coupled with emissions that drop every year. Today’s gasoline powered internal combustion engines run the gamut from gas sipping three cylinder units to the incredibly stout aforementioned Hellcat V8. I believe there’s a lot of life left in these automotive “dinosaurs.”

Take the GLC AMG 63S Coupe I recently tested. This vehicle, oddly named like a confirmation code, is actually a fastback GLC stuffed with one of Mercedes’ most potent V8s. And it’s a blast to drive.

But before we get to that, let’s take a moment to acknowledge a reality of 2019 that I’ve addressed before: cars are dying and SUVs and crossovers are taking their place. It’s reality. In 2018, fully 70 percent of passenger vehicles sold were SUVs or crossovers.

AUTO REVIEW

The GLC 63S Coupe is a sedan-ish vehicle that rides on the GLC SUV platform. Like its BMW analogue, the X4, the GLC 63S combines the SUV advantages of a higher seating position and enhanced crumple zones with the handling and acceleration of a sports sedan. If that sounds like alchemy to you, that’s because you don’t understand how much software tweaks can optimize handling and how easily modern turbochargers can produce what used to be impossible levels of horsepower.

Naturally, “sedanifying” a compact SUV creates a vehicle that may or may not be attractive to the beholder. The GLC 63S’s front end is the same as the GLC SUV while the greenhouse and rear end are very coupe-like, which, not surprisingly, results in a cramped back seat and a polarizing design. It certainly isn’t ugly, but I can’t imagine anyone looking at this Mercedes and describing it with the adjectives, “sleek,” understated,” or “elegant.” Nevertheless, I predict that in 10 years this will be what most non-SUV four-door cars look like.

The interior is very 2019 Mercedes, which is to say excellent.

Mercedes more than BMW or Lexus has gone their own way rather than just emulate the industry benchmark Audi, and I’m grateful for that. Prominent round air vents, a stand-alone central infotainment screen, and a cool steering wheel dominate your view when you sit in the driver’s seat of the GLC AMG 63S, but everything looks and feels like quality, which it should given its base price of just over $80,000. Expensive cars should make you feel special when you’re driving them, and Mercedes has that whole thing down.

Having said that, the best thing about the GLC AMG 63S isn’t sitting in it or looking at it, it’s driving it. Obviously, a 503HP twinturbo 4.0L V8 enhances the fun factor, but Mercedes’ engineers clearly spent a lot of time on the test track when they developed

this car. Handling is sports sedan-like despite a 4511lbs curb weight, and beaucoup speed – think 0-60MPH in 3.3 seconds – is readily available thanks to that delicious AMG V8. Which sounds loud, obnoxious, and amazing btw. Take that Tesla.

High-dollar German cars inevitably come with an extensive (and expensive) list of options and option packages, and that’s the case with the GLC AMG 6.3S. For one thing, choosing to add that “S” adds $7,600 to the price of the already pricey GLC AMG 6.3. The S option bumps the engine output by 74HP, but unless neighborhood or doctors’ parking lot bragging rights matter to you, I’d go with the (plenty fast) GLC AMG 6.3.

Electric cars may be right around the corner, but until they actually move the needle saleswise I’m going to enjoy wonderfully emotive internal combustion vehicles like the Mercedes GLC 63S. They’re fun!

As always, contact Phil Hornbeak at 210-301-4367 to get information about options and your best BCMS deal on a new vehicle.

AUTHOR’S NOTE: regular readers know that I am unenthusiastic about electric cars, but that doesn’t mean I’m blind to their appeal. While few American cars make people truly excited to buy them, most Tesla customers are thrilled to buy and own their cars.

So I’m intrigued. Despite a very short supply of press cars, I will do what I can to find a Tesla to review.

Stephen 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. visit www.bcms.org 45 45 visit us us at at 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 Eye Center, PA San Antonio Gastroenterology Associates, PA San Antonio Infectious Diseases Consultants San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA Sound Physicians South Alamo Medical Group South Texas Radiology Group, PA The San Antonio Orthopaedic Group Urology San Antonio, PA

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of February 25, 2019.

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San Antonio Medicine • March 2019