San Antonio Medicine March 2022

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THE BUSINESS OF MEDICINE Educating the Whole Physician: The Case for Teaching the Business of Medicine

By John J. LoCurto, JD and Adam V. Ratner, MD, FACR .....12 Medical Leadership Training at UT Health San Antonio

By Ramon Cestero, MD and Robert Hromas, MD ...............14 Helping to Get and Keep American Open From the CDC .....................................................................16 What Every Physician Needs to Know About the ‘No Surprise Billing’ Act

By Jayesh Shah, MD, MSc, UHM, ABPM, CWSP, FAPWCA, FCCWS, FACHM, FUHM, FACP..........................18 Importance of Billing and Coding Education in Residency Training Programs By Sujitha Yadlapati, MD, Faraz Yousefian, DO and John C. Browning, MD, FAAD, FAAP, MBA .........................................................................20 Generational Doctors in Medicine By Jayesh Shah, MD, MSc, UHM, ABPM, CWSP, FAPWCA, FCCWS, FACHM, FUHM, FACP ......................................................................22 Maximizing Revenue in the Chaos of COVID-19. By Lindsey Herman Nolan, MHA, CMPE. ................................24 Good Things to Know About a COVID-19 Test From the CDC ..........................................................................26 Using Your Self-Test: COVID-19 From the CDC ..................................................................................................27 BCMS President’s Message .................................................................................................................................................8 BCMS Alliance President’s Message ..................................................................................................................................10 BCMS Provides COVID-19 Tests to Physicians ..................................................................................................................25 Book Review: “When Breath Becomes Air” Review by Rajam Ramamurthy, MD ................................................................28 Artistic Expression in Medicine By Averi White, MD ............................................................................................................29 The Experience of Diagnosis By Emily Sherry .....................................................................................................................29 In Memoriam: Fernando Guerra, MD, MPH; Beverly Henwood, MD; Ismael “Smiley” Flores ..........................................30-31 Physicians Purchasing Directory.........................................................................................................................................32 Auto Review: 2022 Mercedes CLA35 AMG By Stephen Schutz, MD..................................................................................36 Recommended Auto Dealers .............................................................................................................................................38

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SAN ANTONIO MEDICINE • March 2022

MARCH 2022

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VOLUME 75 NO.3

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BCMS BOARD OF DIRECTORS

ELECTED OFFICERS

Rajeev Suri, MD, President Brent W. Sanderlin, DO, Vice President Ezequiel “Zeke” Silva III, MD, Treasurer Alice Gong, MD, Secretary John J. Nava, MD, President-elect Rodolfo “Rudy’ Molina, MD, Immediate Past President

DIRECTORS

Vincent Fonseca, MD, MPH, Member Woodson "Scott" Jones, MD, Member Lubna Naeem, MD, Member Lyssa N. Ochoa, MD, Member Jennifer R. Rushton, MD, Member Raul Santoscoy, DO, Member John Shepherd, MD, Member Amar Sunkari, MD, Member Lauren Tarbox, Member Col. Tim Switaj, MD, Military Representative Manuel M. Quinones Jr., MD, Board of Ethics Chair George F. “Rick” Evans, General Counsel Jayesh B. Shah, MD, TMA Board of Trustees Melody Newsom, CEO/Executive Director Taylor Frantz, Alliance Representative Ramon S. Cancino, MD, Medical School Representative Lori Kels, MD, Medical School Representative

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SAN ANTONIO MEDICINE • March 2022

Ronald Rodriguez, MD, PhD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative

BCMS SENIOR STAFF

Melody Newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne Nino, Controller Mary Nava, Chief Government Affairs Officer Brissa Vela, Membership Director Phil Hornbeak, Auto Program Director August Trevino, Development Director Betty Fernandez, BCVI Director Al Ortiz, Chief Information Officer

PUBLICATIONS COMMITTEE John Joseph Seidenfeld, MD, Chair Kristy Yvonne Kosub, MD, Member Louis Doucette, Consultant Alan Preston, Community Member Rajam S. Ramamurthy, MD, Member Adam V. Ratner, MD, Member David Schulz, Community Member Taylor Sullivan, DO, Member Faraz Yousefian, DO, Member Neal Meritz, MD, Member Jaime Pankowsky, MD, Member Winona Gbedey, Student Member Cara J. Schachter, Student Member Niva Shrestha, Student Member Danielle Moody, Editor

PRESIDENT’S MESSAGE

COVID-19 and the Business of Medicine: Business as Usual or a Major Disruption?

By Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE, 2022 BCMS President

A great article in JAMA 2020 by Cutler et al1 highlighted what all of us are experiencing in the COVID-19 era – an epochal transition to the business of healthcare. Healthcare systems have morphed from a model that relied heavily on in-person treatment provided by healthcare practitioners to a more diverse payment framework that includes broadened payment options for telehealth, expanded scope of practice ability for nonphysician practitioners and increased opportunities for healthcare providers to practice across state lines. This transition in the business model is similar to what we have seen in the non-healthcare arena where online shopping has disrupted the traditional brick and mortar shopping models, a transition we never thought would affect the entrenched payment models of healthcare. To evaluate the impact of disruption on healthcare business models, we need to focus on the changes that will affect entities that provide healthcare (the provider), and the effectiveness of care patients will consume (consumer).

For hospital systems and practitioners (the provider), the financial challenges related to COVID-19 include direct and indirect costs of caring for patients. Increased direct costs are related to the higher complexity of care, longer lengths of stay and correspondingly more patient days associated with COVID-19. The challenge is whether providers get reimbursed appropriately for services rendered, especially for the underinsured or uninsured. The indirect costs are related to non-COVID patients delaying non-emergent care and postponing their outpatient visits/elective surgeries, thus causing providers to lose out on an established revenue source. As these elective visits and procedures resume, the challenges of capacity management at hospitals and delays in scheduling could frustrate patients out of seeking care, thus further negatively impacting patients and providers. Another challenge is the appropriate staffing of healthcare providers. To provide optimal care, hospitals recruit appropriately for the healthcare needs of the communities they serve, but it has been a challenge to right size as the volumes of elective procedures and hospital admissions have yo-yoed with the recurrent COVID surges. Challenges with recruitment also include a shrinking healthcare workforce (due to exhaustion, burnout or ‘the great resignation’), or a workforce that is more mobile across state lines, thus driving up costs for recruitment and retention of healthcare providers. All this has impacted the bottom line of hospitals and 8

SAN ANTONIO MEDICINE • March 2022

smaller physician practices, especially those with lower margins, causing many physician offices and institutions to close down and/or consolidate. The $2.2 Trillion CARES Act (Coronavirus Aid, Relief and Economic Security Act) helped several practices with some much-needed capital infusion, but the challenges to healthcare systems continues. All these factors have and will continue to significantly drive up the cost for providing healthcare, and insurance premiums have already started rising.

For patients (consumers), the challenges include getting healthcare via a medium they were not comfortable with (telemedicine versus in-person visits), or care by providers they were not used to (from physicians across state lines). The expanded telehealth policies were however very much needed, and the COVID-19 pandemic helped expedite it, with a possible long-term beneficial aspect of remote chronic disease management via telehealth and/or hospital-at-home services. Telehealth has its distinct advantages but has the challenges of maintaining patient-physician relationships. Another challenge is that hospital systems/practices have started outsourcing services to national conglomerates, further increasing the complexities of remote care across state lines and the expanded scope of practice for nonphysician practitioners.

We should be coming back soon to the post-pandemic ‘new normal’, but the biggest impact will be assessing how the increased cost of healthcare affects healthcare delivery by providers and the consumption of healthcare by patients. Changes in payment policies coupled with increased costs across the healthcare system may have expediently addressed the acute needs of the pandemic, but the repercussions of these changes will have a paradigm shift on the business of healthcare in the very near future.

References: 1. Cutler DM, Nikpay S, Huckman RS. The business of medicine in the era of COVID-19. JAMA 2020; 323(20): 2003-2004 Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE is the 2022 President of the Bexar County Medical Society, Tenured Professor and Vice Chair of the Department Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio.

BCMS ALLIANCE

Finding Balance

By Taylor Frantz, RDN, LD

I think most people that are married to medicine would agree that their partner’s worklife inevitably creeps into their personal and family life more often than they would like.

Being a physician is more than just a job − it’s a lifestyle, a personality trait and a calling.

Regardless of your stage in life, it can be difficult to navigate the challenges of finding worklife balance.

My husband is an emergency physician, so we have the benefit of a shift work lifestyle.

However, this comes with the cost of ever-changing start and end times and a constant shifting from days and nights throughout the month. My day-to-day is more static; the needs of our children and our household vary little month-to-month. It can be exhausting for both of us for very different reasons. Even still, my husband and I try our best to support each other in the roles we play for our family.

According to a study conducted in 2020, over fifty percent of all physicians had reported burnout due to the increased stress brought on by the pandemic. As we now pass into our third calendar year of COVID-19, I personally expect this number to creep higher. Seeing my own husband come home from work feeling burnt out and exhausted, I can’t help but feel, at times, helpless. This is a common theme I hear when talking to other physician families. Medical life is hard enough in the best of times, but coupled with the ongoing pandemic, it can be very challenging to find that balance.

Here are some of my strategies: • Be intentional with your time. Time away from work is often so limited, so being intentional with that time is key. Finding meaningful ways to spend that time together will leave you feeling rested and recharged.

• Keep a calendar. Keeping a calendar that you both can access can help with managing expectations and planning. Studies have shown that the act of just planning an event makes people feel happier.

• Set Goals. Having a firm reason to keep pushing through brings out new motivation.

Write out your goals with your partner − family vacation, loan repayments, a new car, kid’s college, early retirement, etc.

• Communication. Speak to your partner about your needs and feelings; having effective, open communication is the backbone of a strong and healthy relationship.

• Find Support. Find a support system of people that understand the unique life that is being married to medicine. Seek the support of casual network friends or find fellowship in a formal organization (like the BCMS Alliance).

Taylor Frantz, RDN, LD is the 2022 President of the BCMS Alliance.

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SAN ANTONIO MEDICINE • March 2022

THE BUSINESS OF MEDICINE

Educating the Whole Physician: THE CASE FOR TEACHING THE BUSINESS OF MEDICINE

By John J. LoCurto, JD and Adam V. Ratner, MD, FACR

The century-old medical education paradigm emphasizes the basic sciences and clinical training. While this traditional approach churns out physicians with deep knowledge and technical proficiency, it does not prepare them for the business of practicing medicine. By omitting the business of medicine from their curricula, medical schools squander a chance to ready their students for the commercial, regulatory and legal environments in which they will treat patients. The cost of this omission is more than just a missed opportunity. Unprepared students are prone to exploitation, frustration and burnout. While there may be no easy way to bridge the gulf between how medicine is taught and how it is practiced, integrating the business of medicine into the four-year curriculum would surely help.

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THE BUSINESS OF MEDICINE

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raditional medical education begins with the basic sciences.

During their first two years, medical students examine the body, its structures and the systems those structures comprise.

They study biochemistry to understand their future patients at the cellular and molecular levels. And they are immersed in ologies – microbiology, physiology, histology, pathology, pharmacology and so forth.

When they emerge from their first two years, medical students embark on a two-year stint of practical training. Rotating through hospitals and clinics, they encounter core disciplines, specialties and patients – the embodiment of the scientific principles they have studied for so long.

And when their four years are up, they are rewarded with even more training, in the form of internships, residencies and graduate medical education. This system, which dates to 1910 and the Flexner Report, produces “a high level of excellence.”1 After 112 years of experience in this educational paradigm, it is fair to ask – is excellence enough?

New physicians must, of course, be knowledgeable and clinically skilled. Our medical education system excels at fostering essential competencies. Medical students grow into new physicians who, by and large, are prepared to diagnose, prescribe, treat and operate. What our traditional system does not do quite so well – or perhaps at all – is prepare medical students for the business of practicing medicine. New physicians may be able to distinguish nephritic from nephrotic syndrome, but they cannot differentiate a nose from a tail or a claim from an occurrence. They can identify neoplasia but not read an employment contract, much less identify the contractual terms (like a non-compete provision) that could metastasize out of control. New physicians may be able to perform a procedure but not bill for it. They are, in short, equipped to treat but not to practice.

When they finally join the health care system and workforce after roughly a decade of training, new physicians are vulnerable. Unaware of the commercial, regulatory and legal complexities that await, they run a gauntlet of pitfalls that range from the simple and personal (living too far from the hospital during residency) to the consequential and career-altering (referring patients in exchange for gratuities). The aspirations that called so many to careers in medicine evaporate and are quickly replaced by the stress of educational debt and preoccupation with Relative Value Units (RVUs). The difference between the way that medicine is taught and how it is practiced is jarring and leads to disillusionment, burnout and even moral injury.2 Viewed against this backdrop, it may seem that a sea change – a fundamental reorganization of how we educate and train new physicians – is necessary. Perhaps. But even small adjustments will help. Incorporating the business of medicine into medical school curricula would be a good place to start.

At the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM), the business of medicine is threaded into the curriculum. It shows up in small-group case studies that learners encounter weekly in their first two years. The vignettes that learners analyze often introduce facts about a patient’s insurance coverage, the price of drugs

or programs available to defray the cost of care. While these issues are not central, learners absorb them, ask questions and develop awareness.

The business of medicine surfaces again during third year when learners attend periodic sessions on an array of practical issues, ranging from the revenue cycle to conflicts of interest. And it returns during the fourth year. Learners may elect to pursue a non-clinical clerkship in the business of medicine that allows them to explore topics of interest, such as loan repayment, investing during residency, moonlighting, medical malpractice, federal health care programs, third-party payers, concierge medicine, the direct primary care delivery model and more.

This litany probably sounds more radical than it really is. UIWSOM is not trying to remake medical school into business or law school; nor does it aim to produce PhDs in health care economics. The objective is rather more modest: to prime learners for what lies ahead. UIWSOM strives to ready its learners and trigger their curiosity, all without disrupting the basic science and clinical education that medical school imparts. The hope is that, by supplementing the traditional curriculum, learners will evolve into physicians who are able to spot issues, respond effectively and recognize when they need assistance. By introducing its learners to the business side of their vocation, UIWSOM endeavors to form physicians who are more adept at negotiating the demands of the environment in which they will practice medicine, and who are able to protect their consciences and aspirations while doing so.

UIWSOM’s integration of the business of medicine into its curriculum should come as no surprise. Osteopathic medicine is holistic, focusing on the whole patient rather than discrete symptoms, injuries or diseases. Just as osteopathic medicine embraces the whole patient, osteopathic medical education at UIWSOM seeks to educate the whole physician. And that means preparing medical students for the challenges and opportunities of the business of medicine.

References 1. Cooke, M., Irby, D. M., & O'Brien, B. C. (2010). Educating Physicians: A Call for Reform of Medical School and Residency. Stanford, California: Jossey-Bass.

2. Talbot, S. G., & Dean. W. (2018, July 16). Physicians aren't 'burning out.' They're suffering from moral injury. STAT. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/.

John J. LoCurto, JD is Assistant Professor of Medical Jurisprudence and Health Policy at UIWSOM.

Adam V. Ratner, MD, FACR is Professor of Radiology, Health Policy & Medical Humanities and Assistant Dean of Strategic Initiatives at UIWSOM, and served as the 2019 President of the BCMS.

Visit us at www.bcms.org

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THE BUSINESS OF MEDICINE

Medical Leadership Training AT UT HEALTH SAN ANTONIO

By Ramon Cestero, MD and Robert Hromas, MD

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edicine is football, not golf. It takes detailed planning for complex teams to care for the most acutely ill patients.

Leading these teams requires more than just the ability to treat patients. Health professionals leading teams need to combine clinical expertise with knowledge of the human, financial and organizational systems that enable healthcare delivery. Today’s healthcare leader must also have the capacity to foster collaboration, cooperation and adaptation in a rapidly changing environment.

Academic healthcare providers face unique challenges in leadership positions, as they are often placed in team management roles without the benefit of training in finance, regulatory reporting, human resources, management principles, communication skills, information technology and cybersecurity. Today’s health leaders require significant management skills and leadership vision in addition to clinical acumen.

As one of the largest health care groups in South Texas, UT Health San Antonio (UTHSA) employs over 5,000 health care providers in all disciplines, but prior to 2018, we did not offer any formal business and management educational programs for their leaders. In response to this perceived need, a comprehensive leadership program was designed to focus on leadership training and professional development tailored to healthcare professionals.

Through a collaborative agreement between the UT Health San Antonio Joe R. and Teresa Lozano Long School of Medicine and the Center for Professional Excellence at the UT San Antonio Carlos Alvarez College of Business, two business and management leadership programs were created: the Executive Development Program for Emerging Health Leaders (EDP) and the UTSA Executive Master of Business Administration for Healthcare Leaders (EMBA). Designed for junior and mid-career physician, scientist and nurse leaders, the EDP is a comprehensive, 12-month interdisciplinary program which combines current leadership skills assessment and career planning for development, business principles and executive coaching to provide an introduction to leadership and management topics. For physicians, scientists and nurses in senior leadership positions, we created the EMBA, extending the standard UTSA Executive MBA into the healthcare industry with dedicated health-related courses and topics.

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Executive Development Program for Emerging Health Leaders (EDP) Designed for junior and mid-career academic healthcare faculty already serving in leadership positions, the EDP provides comprehensive management education and professional development to professionals as they manage their initial leadership positions. Through participation in the EDP, participants can strengthen their organizational capabilities, enhance communication skills, develop an understanding of their leadership strengths and weaknesses and gain an appreciation for the role of budgeting, data analytics and personnel management play in health care. The program provides a forum for health professionals to take the next step in their leadership journey through knowledge, experiences and relationships that will positively affect how they perform their job, work with colleagues and team members, and care for their patients.

The EDP seeks to advance participants’ knowledge, skills and abilities across four core areas: Communication, Influence, Professional Development and the Fundamentals of Administration. Specific focus areas include leadership, negotiations and conflict management, the art and science of persuasion, leading change, effective communication, building successful teams, individual leadership strength assessments, analytics and decision-making, talent management and human resources, operations management, and financial management.

Over the year, participants experience monthly three-hour (now virtual) teaching modules, and then have pre- and post-session assignments. Award-winning faculty from within UTSA College of Business and local subject matter experts lead each module, providing real-world business expertise not typically found in leadership programs at academic medical centers. Using skills acquired during the course, participants work on a small case study project that identifies a critical problem they are currently experiencing that touches on one or more topics covered in the EDP program. During the final course session, students then pitch their case study in smaller groups and a select subset of case studies to be reviewed in the larger class, where EDP students share their perspectives and discuss potential solutions to the problems.

Since the EDP program inception, over 60 UTHSA faculty have graduated, and the vast majority have found it to have been helpful in

THE BUSINESS OF MEDICINE

their leadership roles. According to post-course surveys, 100% of the students felt the EDP prepared them for current and future leadership challenges, 97% stated the EDP met their expectations and was worth the time investment, and 94% felt the EDP has prepared them to take on a more significant leadership role or more managerial responsibilities.

UTSA Executive Master of Business Administration for Healthcare Leaders (EMBA) Designed for senior faculty in significant management roles, such as division chiefs or department chairs, the Executive Master of Business Administration for Healthcare Leaders provides an intensive education in management and business administration, allowing academic medical professionals to successfully navigate critical challenges, create value-based solutions and excel as leaders in the health care industry.

Taught by UTSA College of Business faculty, the EMBA extends the standard UTSA Executive MBA curriculum into the healthcare industry, with the goal of complementing specialized health care expertise with general business knowledge and leadership skills. A special emphasis is placed on health data analytics and cybersecurity, both areas of expertise at UTSA. This complete Master of Business Administration Degree consists of five semesters (21 months) and includes 15 required courses (43 credit hours) covering areas of leadership, accounting, business analytics, organizational behavior, marketing, communication, negotiation, financial management, healthcare policy, innovation, entrepreneurship and corporate governance. As part of the program, students participate in an international field experience to gain exposure to the growing role of globalization in health care. Participants are also provided an executive coach in order to support them in developing a career vision, developing specific goals that align with personal professional trajectory and enhance the skills required to bring the vision to life.

Since inception in 2018, over 15 faculty in senior leadership positions have matriculated from the EMBA program.

We recognize that health care is currently facing novel and complex issues that require astute and innovative solutions. Such solutions will require new ways to approach old problems, and novel training to iden-

tify those new approaches. Healthcare providers know these issues firsthand and are in the best position to solve them. To do that, healthcare providers need to become leaders as well as caregivers, yet leadership training is often missing from traditional medical education at any level.

In conjunction with the UTSA Carlos Alvarez College of Business, the UT Health San Antonio Joe R. and Teresa Lozano Long School of Medicine has created educational programs specifically designed for the growth and development of our healthcare leaders in academic medicine. For more information, contact Ramon Cestero, MD at: cesteror@uthscsa.edu.

Ramon Cestero, MD is professor of surgery at the UT Health San Antonio Joe R. and Teresa Long School of Medicine and is the director of UTHSA Executive Leadership Programs.

Robert Hromas, MD is Dean of the UT Health San Antonio Joe R. and Teresa Long School of Medicine and is a member of the Bexar County Medical Society.

Visit us at www.bcms.org

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THE BUSINESS OF MEDICINE

What Every Physician Needs to Know About the ‘No Surprise Billing’ Act

By Jayesh Shah, MD, MSc, UHM ABPM, CWSP, FAPWCA, FCCWS, FACHM FUHM, FACP

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et me start by sharing a story of a patient to help your understanding of surprise medical billing. The patient was a young diabetic male. He developed a wound on his foot, which became infected, and had to go to the emergency room. Then, he was admitted to an inpatient facility. He required various services from a variety of physicians during his hospitalization including surgical, hospitalist, specialist, anesthesia, pathology and radiology services. He ended up having his toe amputated during his hospitalization and was then discharged home.

The patient was happy with the medical outcome, as he only lost his toe and was able to save his foot. But in the next 30 days, he started receiving large, unexpected medical bills. Upon checking with his insurance, he was told that some of the services he received were out of network, so he was responsible for the balance of those bills.

Surprise medical billing generally happens when a patient receives out-of-network emergency care or receives care from an out-of-network physician or provider at an in-network facility. In these situations, the patient can get caught in between the provider and the insurance company. Some patients incurring surprise medical bills end up losing their savings, and some have faced unnecessary hardships trying to pay these surprise bills.

These surprise medical bills also happen because many insurance companies have narrow networks. A narrow network means insurance companies do not contract with enough physicians, providers and facilities, which also causes a problem for the patient with access to more affordable care.

Congress stepped in to protect patients by prohibiting balance billing in these scenarios (with certain exceptions) and removing the patient from these surprise medical billing disputes. When Congress 18

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passed the No Surprises Act, it sought to promote fairness in surprise medical billing payment disputes between insurance companies and providers. The Act also specified various factors that should be considered during the independent dispute resolution (IDR) process.

The IDR process that was approved by Congress incentivized both insurance companies and providers to act in good faith and resolve disputes amongst themselves, keeping patients out of these discussions.

The IDR process must be overseen by an independent and neutral arbiter who must consider several factors in deciding whether to select the provider’s or payer’s offer. Factors the arbiter examines include: • the “qualifying payment amount” for comparable items or services furnished in the same geographic area; • prior contracted rates during the previous four plan years; • market share of both parties involved; • provider’s training and experience; • patient’s acuity/complexity of furnishing the item or service; • if the provider is a facility, teaching status, case-mix and scope of services; • demonstration of good faith efforts by providers and facilities to enter into a network agreement.

But on September 30, 2021, the U.S. Department of Health and Human Services (HHS) and other agencies departed from the language passed by Congress, which was designed to create a balanced IDR process. The interim final rule benefits commercial health insurance companies. According to the process under the rule, arbiters under the

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IDR must rebuttably presume that the qualifying payment amount (an amount that is supposed to be the median in-network rate under the law but is deflated based upon the rulemaking methodology) is the appropriate out-of-network rate.

The Texas Medical Association (TMA) was the first to file a lawsuit challenging this rebuttable presumption, which gives outsized weight to the “qualifying payment amount.” This is a narrow but critical provision of the rule issued on September 30, 2021 by HHS and other agencies. After a few weeks, the American Hospital Association (AHA) and the American Medical Association (AMA) separately filed another lawsuit.

There were many other associations and independent physicians who also have filed a lawsuit. Currently, the matter is in court.

The AMA and TMA strongly support protecting patients from unanticipated medical bills. But a problematic IDR process can reduce access to care by discouraging meaningful contracting negotiations and reducing physician networks. The good news is that the legal challenge does not prevent the laws’ core patient protections from moving forward. It seeks only to align the IDR factor language with the law to promote a more meaningful method of resolving disputes between health care providers and insurance companies.

Several applaud Congress for seeking to protect patients from surprise medical bills. Physicians will need to be familiar with the new law, which is generally effective January 1, 2022.

Among other things, the new law: • bans balance billing (i.e., billing beyond an allowed cost-sharing amount) for emergency services; • bans balance billing (i.e., billing beyond an allowed cost-sharing amount) for out-of-network services performed at in-network facilities with certain exceptions; • generally limits cost-sharing for the services referenced above (where balance billing prohibitions apply) to the in-network cost-sharing for these services; • requires that health care providers and facilities give the patient an

easy-to-understand notice explaining the applicable billing protections, who to contact for any concerns when a provider or facility has violated the protections, and patient consent is required to waive certain billing protections (i.e., the patient must receive notice of and consent to being balance billed by an out-of-network provider); and • imposes certain good faith estimate requirements.

For more information on the law and its implementing rules, please visit https://www.texmed.org/uploadedFiles/Current/2016_Practice_Help/Insurance/Commercial_Insurance/311042_Update_Surprise_Billing_white_paper.pdf.

Hopefully, a legal challenge will bring a balance so patients can receive the best care that is affordable and accessible. Several would like to see the triple aim of health care achieved in the United States of improving the experience of care, improving the health of populations and reducing per capita costs achieved in the United States.

References 1. Centers for Medicare and Medicaid Services. Ending surprise medical bills. https://www.cms.gov/nosurprises 2. Harris PA. AMA says surprise billing proposal in Congress is a step forward. American Medical Association. https://www.amaassn.org/press-center/press-releases/ama-says-surprise-billing-proposal-congress-step-forward . Published May 23, 2019.

3. Texas Medical Association. TMA moves for victory in challenge to unfair arbitration rule. https://www.texmed.org/Template.aspx?id= 58365&terms=Surprise%20medical%20billing. Published Dec. 13, 2021.

4. Texas Medical Association. TMA sues feds over unfair rule for surprise billing law. https://www.texmed.org/Template.aspx?id =58062& terms=Surprise%20medical%20billing . Published Oct. 29, 2021.

5. Robeznieks A. Federal action on surprise medical bills: what doctors should know. American Medical Association. https://www.amaassn.org/delivering-care/patient-support-advocacy/federal-action-surp rise-medical-bills-what-doctors-should?utm_medium=ppc&utm_ campaign=pe-digital-ads-surprise-billing&gclid=CjwKCAiAxJSPBhAoEiwAeO_fP_R_2xDIVRQl02oMWi3tUf2IvgU0fK07SSEoVSqI WNzemAy9eM1zXRoCYusQAvD_BwE . Published Jan. 26, 2021.

Jayesh Shah, MD, MSc, UHM, ABPM, CWSP, FAPWCA, FCCWS, FACHM, FUHM, FACP is Immediate Past president of the American College of Hyperbaric Medicine and serves as medical director for two wound centers based in San Antonio. In addition, he is president of South Texas Wound Associates, San Antonio.

He is also the past president of both the American Association of Physicians of the Indian Origin and the Bexar County Medical Society and is a current member of the Board of Trustees of the Texas Medical Association.

Visit us at www.bcms.org

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THE BUSINESS OF MEDICINE

Importance of Billing and Coding Education in Residency Training Programs

By Sujitha Yadlapati MD, Faraz Yousefian, DO and John C. Browning MD, FAAD, FAAP, MBA

R

esidency training across specialties is based on gaining clinical knowledge in the field, developing diagnostic acumen, mastering appropriate use of therapeutic options and increasing surgical experience. Traditionally, residency programs are evaluated on their ability to ensure specific numbers of patient encounters and minimum surgical volumes, a formal schedule of didactic sessions and clinical exposures to related subspecialties. A resident's competency is confirmed based on measurable outcomes. However, a successful transition to clinical practice requires various other skills. These skills include the ability to lead a team of support staff and allied health professionals, provide high-quality health care at an economical price while following government regulations and private insurance policies, and do all of this in an environment that fosters teamwork, efficiency, collaboration and economic security. This is a vital component of proper billing and coding to comply with Medicare, Medicaid and commercial payer regulations.

These skills should be considered part of the Accreditation Council for Graduate Medical Education (ACGME) terms systems-based learning.

Why should billing and coding be important to a resident physician?

Literature supports a high rate of error in physician coding for professional services,1 suggesting that residency training in this area is inadequate to meet the needs in clinical practice. As many residents graduate and go into practice as early-career physicians, having a financially 20

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healthy practice depends on advertising, business management skills and, most importantly, effectively coding and billing. While reimbursements may vary between specialties, this is particularly true for primary care specialties due to narrow margins and reliance on outpatient visits for the primary source of their incomes. Additionally, accurate coding is required to comply with Medicare, Medicaid and commercial payer regulations.

In large studies comparing billing and coding exposure in a variety of settings, including hospital-based sites, community health centers and private practice in pediatrics, surgery and dermatology, many residents indicated that their exposure to billing is inadequate during residency training.2,3 Private practice settings gave residents more exposure to billing issues than the other two settings, but most felt that the training was inadequate regardless of the setting.4 One of the biggest challenges for teaching billing and coding is that no written curriculum on these topics is currently available. Studies and curricula comparing resident billing and coding practices to that of the residency faculty members who teach them may help illuminate gaps in proper billing and coding practices. To this end, programs may need to enhance faculty skills in billing and coding to ensure that they feel competent training trainees. During residency training, comparing resident and attending E&M coding with the established benchmarks

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of the Medical Group Management Association (MGMA) can help determine if billing is done at the correct level of complexity in comparison to faculty or practicing physicians, preventing significant revenue loss to their teaching clinics.

As medical coding systems undergo frequent changes, billing for outpatient evaluation and management (E&M) services becomes increasingly complex. There are over 70,000 ICD-10 codes and several coding modifiers.5 The result is improper billing by physicians, resulting in billions of dollars in annual costs to the United States health care system.1 In several questionnaire-based studies across several specialties that examined residents' confidence in billing once they became independent practitioners, it was found that there was a general lack of confidence in billing abilities and a general wish to have more training in this area incorporated into the residency curriculum.2 It is crucial for busy resident physicians to understand E&M coding and apply codes correctly.

There are several reasons for this, including funding needs of residencies, compliance with Medicare and Medicaid regulations and educational objectives. To this end, the Accreditation Council for Graduate Medical Education has included coding and billing as part of its core competencies in specialties such as dermatology.6 Programs can use residency milestones to track billing and coding competence and incorporate teaching through didactics and daily practice.

Resident education can be centered around three key aspects of billing and coding for E&M visits (1) medical history; (2) physical examination and (3) medical decision-making. In addition to this, education on procedure codes and modifiers relevant to each specialty should also be emphasized. It is important to evaluate the short- and long-term effectiveness of teaching these key components after incorporating them into the didactic curriculum. For example, assessing simple knowledge recall of key elements can be done through 'traditional' exams containing multiple-choice questions (MCQs) or through group discussions among residents and faculty.7 Measuring advanced skills, such as knowledge applications for the actual coding of visits, may require strategies such as mock billing scenarios7 or quarterly reviews.

Feedback on a resident's billing practices in the actual coding of visits may require strategies, such as mock billing scenarios or quarterly reviews and feedback on a resident's billing practices.

Including medical administration and practice management content to residency curricula is not without potential pitfalls. Arguably, completing administrative tasks, including review of billing practices and other paperwork, is a less desired part of medical practice for many physicians. However, ensuring timely reimbursement through proper billing and coding is crucial to practicing medicine and is a critical skill to develop. Thus, we believe that integrating some content on billing and coding during residency training may prove, in the long run, to be a beneficial skill.

References 1. Improper T, Information P, Elimination IP, Act R, Services H. Medicare Fee-for-Service 2011 Improper Payments Report. Published online 2011:1-51. http://www.cms.gov/Research-StatisticsData-and-Systems/Monitoring-Programs/CERT/Downloads/Me dicareFFS-2011CERTReport.pdf: Medicare FFS 2011 CERT Report; 2012.

2. Paz KB, Halverstam C, Rzepecki AK, McLellan BN. A national survey of medical coding and billing training in United States dermatology residency programs. J Drugs Dermatology. 2018;17 (6):678-682.

3. McDonnell PJ, Kirwan TJ, Brinton GS, et al. Perceptions of Recent Ophthalmology Residency Graduates Regarding Preparation for Practice. Ophthalmology. 2007;114(2). doi:10.1016/ j.ophtha.2006.10.027 4. Serwint JR. Multisite survey of pediatric residents’ continuity experiences: their perceptions of the clinical and educational opportunities. Pediatrics.

5. Salz T. How ICD-10 will affect your practice. Med Econ. 2011 Oct 10;88(19):64, 71-2. PMID: 22175202.

6. Turiansky GW, Loo D. The Dermatology Milestone Project. J Grad Med Educ. 2014;6(1s1):44-46. doi:10.4300/jgme-06-01s1-04 7. Tran J, Cennimo D, Chen S, Altschuler EL. Teaching billing and coding to medical students: A pilot study. Med Educ Online.

2013;18(1):1-2. doi:10.3402/meo.v18i0.21455 Sujitha Yadlapati, MD is a PGY-2 dermatology resident at HCA Corpus Christi Medical Center - Bay Area Program.

She is also a board-certified family medicine physician. Her professional interests include skin cancer prevention, cutaneous oncology, procedural dermatology and complex medical dermatology. Dr. Yadlapati is a member of the Texas Dermatological Society.

Faraz Yousefian, DO is an intern at the Texas Institute for Graduate Medical Education and Research (TIGMER) in San Antonio, Texas. He is very passionate about mentoring nascent physicians and educating the general populous about skin diseases and the steps they can take to prevent them. Dr. Yousefian is a member of Bexar County Medical Society.

John Browning, MD, FAAD, FAAP, MBA is board-certified in pediatrics, dermatology and pediatric dermatology. He is an adjunct associate professor at UT Health San Antonio, assistant professor at Baylor College of Medicine and clinical faculty at the UIW School of Medicine. Dr. Browning is a member of the Bexar County Medical Society.

Visit us at www.bcms.org

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THE BUSINESS OF MEDICINE

Generational Doctors in Medicine

By Jayesh Shah, MD, MSc, UHM, ABPM, CWSP, FAPWCA, FCCWS, FACHM, FUHM, FACP

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hoosing a career in medicine is a long-term commitment that can add financial burden, so most students shy away from choosing the field. Many of them who want to become doctors in high school change their path in college because of the vigorous requirements and the years of school required to reach their goal.

Growing up in India, I was the first doctor in my family. Most of my family members were engineers. Just like in the U.S., it is very competitive to become a doctor in India. I had to be ranked in the first 600 out of 1.8 million students in 12th grade. I still remember how happy my parents were when I was able to secure an admission to a medical college. I watched my daughter, Prachi, work very hard from high school through undergrad to get all the prerequisites, MCAT and all other rounded experiences that medical schools require for admissions.

It made me think that it was relatively more competitive to get into medical school in the U.S. compared to India.

I have now been in the U.S. longer than the years I lived in India. I have been practicing Undersea and Hyperbaric Medicine for the last 27 years in San Antonio. My kids were born and raised in San Antonio and observed me working as a doctor. For me, practicing medicine was my calling and I loved what I did. I am sure my passion to serve and help patients positively influenced my children. My daughter Prachi

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chose to become a physician and my son Aj completed his Bachelor’s in Computer Science. Both kids went to the same middle and high school, but their paths were different. Apart from observing me and my doctor friends around me, we as parents did not try to convince them to choose a career in medicine. I always told them to follow their dreams and choose the career they preferred. I did warn them about the years of time commitment and hard work that was needed. I informed them about being prepared for lifelong learning as they witnessed me taking my board re-certification exams every 10 years. Like any other field, there is no end to learning, no matter how long you practice medicine.

Prachi’s interest in medicine grew when she took a course in Medical Sociology as a Public Health major. For the final assignment in her Medical Sociology class, she was involved in a project about menstrual hygiene and the stigma surrounding menstruation. Her research revealed that this issue was global, including in the United States. Prison inmates and the homeless were severely affected. Women without hygienic sanitary products increased their chance of developing gynecological infections and obstetric complications during pregnancy. She carried her efforts with a few other classmates into “PERIOD,” a nonprofit organization, and opened its first chapter at UTSA. Through

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this organization, over 700 menstrual hygiene packages were delivered to homeless shelters like SAMMinistries and Haven for Hope. The program has grown since. Her involvement in the PERIOD organization not only taught her skills necessary to be a good leader, but also reassured her in her decision to pursue medicine.

She also chose the path of medicine because she had first-hand experience of taking care of her wheelchair-bound grandmother at home.

She witnessed her grandmother when she had her first stroke. As she helped caring for her at home for the past seven years, she learned a lot from watching her grandmother’s life change drastically, with multiple strokes and dementia until her last breath.

This experience helped her realize the unique health needs of this patient population. By this time, she was sure she wanted to become a physician.

Like me, she also realized that becoming a physician was her natural calling. I am certain she chose the field of medicine knowing what to expect after observing me practice medicine since her childhood.

Prachi completed her first year of medical school. While reviewing her curriculum and watching her study at the University of Incarnate Word School of Osteopathic Medicine, I noticed how her medical school education is slightly different from when I became a doctor. I

received one- and one-half years of vigorous education in biomedical sciences followed by three years of clinical education via clinical rotations and clerkships. While for Prachi, right from the first year, clinical case-based studies were incorporated with basic sciences. There is a more holistic approach to their medical education. Most of the education is now self-directed, which requires medical students to do a lot of self-study.

In conclusion, I would advise parents not to force their kids to choose their profession, but instead allow them to follow their natural calling. The only advice I gave my kids was to follow their passion and to be the best in whatever path they chose. It is this passion that will allow them to get through the difficult tribulations that will come in whatever path they decide to go. I was happy that my son found his passion in Computer Science and my daughter decided to become a physician who will be serving our community soon.

Jayesh Shah, MD, MSc, UHM, ABPM, CWSP, FAPWCA, FCCWS, FACHM, FUHM, FACP is a wound care specialist certified in Internal Medicine and Hyperbaric Medicine and is a member of the Bexar County Medical Society. Prachi Shah is a medical student at UIWSOM.

Visit us at www.bcms.org

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THE BUSINESS OF MEDICINE

Maximizing Revenue IN THE CHAOS OF COVID-19

By Lindsey Herman Nolan, MHA, CMPE

M

aintaining a successful medical practice has always been challenging, but even more so as the healthcare landscape changes daily amid the always changing pandemic. Physician practices continue to fight the same challenges as before the pandemic, now with the added stress and chaos due to COVID-19.

Medical practices are facing staffing shortages, increased hostility from patients and the constant pressure of patient needs, all the while trying to maintain profitability.

Because of all of these factors, it is more important than ever for medical practices to focus on maximizing their revenues. Practices cannot afford to absorb lost revenues from ineffective billing or collection processes any longer. With the financial stress of COVID-19, providers should be working to collect every dollar for their services. Below we break down various opportunities to maximize revenues for each visit.

Telehealth: While not a formal part of the billing process, telehealth is an option that is still seeing relatively good reimbursement rates compared with the time and expense required to implement. Telehealth visits allow providers to see and follow up on patients quickly, without added labor expense. Reimbursements, although not as large as they were during the initial pandemic surge, are still higher than they were pre-pandemic. There are also still many telehealth waivers in effect that allow for easy compliance and increased flexibilities with the use of telehealth services. In addition, many technologies, such as EMR systems, now have built-in telehealth capabilities to make scheduling, appointments and documentation easier than ever. Telehealth remains one of the most cost-effective ways to treat patients.

Accurate Demographics: Although billing is typically classified as a back-office responsibility, the process starts as soon as a patient schedules their first appointment with the front office. It is crucial that the front desk ensures that all information is input correctly, especially when the responsible party or subscriber is someone other than the patient. While it sounds tedious, many insurance carriers will take the opportunity to deny claims if there is incorrect information, even if everything else is correct on the claim.

Eligibility Checks: Another front office responsibility is insurance verification and eligibility. It is easy to skip this step to save time, but it is crucial to ensure that the office confirms that patients are actively enrolled

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in their insurance plans and that they understand the plan details. Unfortunately, many patients enroll in insurance plans from their employer without understanding the nuances, and when it comes time to use insurance, there is a lot of confusion and frustration. Confirming insurance information and educating patients at the time of visit can prevent denials and collection issues from both patients and insurance carriers alike.

Time of Visit Collections: For years, best practice in medical practice management has been collecting at the time of service for patient’s responsibility. This includes everything from co-pays, deductibles, coinsurance and self-pay fees. Offices are significantly more likely to collect revenue if the collection takes place while the patient is captive in the office. In addition to the increased revenues, collecting at the point of service also eliminates the administrative burden of sending invoices, managing collections and potentially having to write off bad debt. It is important to ensure that every practice has a collection policy that includes time of visit collections.

Managing your Revenue Cycle: “What is measured, gets managed” – this phrase, attributed to management icon Peter Drucker, could not be truer in a medical practice’s revenue cycle. With the busy day-to-day operations in medical practices, it is easy to overlook the billing and revenue cycle. However, it is crucial for someone to be tracking key indicators to ensure that billing and collections are being worked appropriately. These indicators include things such as open encounters, days in accounts receivable, accounts receivable aging and denial rates.

Healthcare systems and providers are facing some of the toughest challenges in years, and without ensuring profit for the work being done, many organizations face a grim future. Providers are continuing to treat patients; now we must ensure that they are being appropriately compensated to do so.

Lindsey Herman Nolan, MHA, CMPE is the President/CEO of Nolan Practice Management, a consulting firm based in San Antonio that focuses on the business management of independent, physician owned medical practices. She is also the Secretary of San Antonio Medical Group Management Association.

The Bexar County Medical Society is a Silver Sponsor of the San Antonio MGMA.

SAN ANTONIO MEDICINE

BCMS Provides COVID-19 Tests to Physicians The Bexar County Medical Society received a shipment of 8,660 rapid result COVID-19 tests to distribute to physicians and all major medical groups starting in January. The BCMS helped neighboring counties, including Fredericksburg’s Hill Country Memorial Hospital by giving out 1,000 tests.

Left to Right: Monica Jones, Betty Fernandez and Danielle Moody sort COVID-19 tests at the Bexar County Medical Society office.

Vivian Bucay, MD, FAAD receives tests kits from the BCMS.

Ana Rodriguez, MD of MacGregor Medical Group unpacks tests kits.

Visit us at www.bcms.org

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SAN ANTONIO MEDICINE

Book Review of “When Breath Becomes Air”

By Rajam Ramamurthy, MD

Randomly browsing through the shelves, it could have been at the airport, I picked up the book titled, “When Breath Becomes Air” by Paul Kalanithi, MD. Recently my eyes seem to focus on topics that deal with ‘end of life,’ like a magnet wand that snaps onto metal objects on the beach as the metal detector scans the sand. We do choose our reading very often to feed our intimate thoughts; thoughts I could not or would not share as I stood at my husband’s bedside day after day that fateful month of April in 2016.

“Breath Becomes Air,” a New York Times Best Seller, was written by Dr. Paul Kalanithi, a surgeon in his final year of training in neurosurgery when he was diagnosed with lung cancer. Paul’s richness of language surprised me, for we in medicine generally chuckle when we speak of notes surgeons write. The depth of his thoughts reflects his vast reading of serious writings. There is almost a cadence to his style like this one I quote; “I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town of fifteen thousand, six hundred miles from my new college dormitory at Stanford and all its promise.” I almost felt ashamed and kept apologizing to Paul for deriving this vicarious pleasure of reading his beautiful writing when he was laying his life open as the ravaging lung cancer was greedily robbing him of life and all that could have been.

The book throbs in your hands as though Paul has infused his life into its pages. Paul goes to visit a close friend in New York City, but Lucy refuses to go. She has to sort out many things about how their relationship is moving; Paul not sharing with her his concerns about the diagnosis of what is happen-

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ing, with his health being one of them. Tears welled up in my eyes as I read the part where Paul was going to talk to his wife Lucy about the x-ray report. “Lucy picked me up from the airport, but I waited until we were home to tell her. We sat on the couch and when I told her, she knew. She leaned her head on my shoulder and the distance between us vanished.”

The book is the third in a row of books that I read that brings to our conscience the topic of death that we physicians avoid. What makes life meaningful enough to go on living? It is a question each one of us gracefully donning our senior citizen cloak have to give some serious thought to.

There is one prognosis in life that is so easy to pronounce, yet we never do, and most of us in the medical profession don’t. That is the eventuality of death. Everyone dies; the physician’s knowledge and experience should place them in the best possible position to guide each patient through their illness and recovery or sometimes through illness and death, with as much compassion and guidance. As per Paul, “when there is no place for the scalpel, words are the surgeon’s only tool.”

Oh! There is so much more that Paul expounds that I read and reread. This passage about God really answered some questions that arise and nag my scientific thinking. “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspect of human life: hope, fear, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” His writing touches

upon so many aspects of humanity as though he, in his death, has comforted many.

There are aspects of Paul’s story that I do not comprehend, I never have; it has always troubled me when terminally ill patients begot children. Who am I to judge a soul standing at the edge of life? I so want to move away from such thoughts and leave those of you daring enough to pick up and read a book such as this to awaken your feelings in so many spheres of life.

Rajam Ramamurthy, MD is Professor Emeritus of Pediatrics and Neonatology at UT Health San Antonio. Dr. Ramamurthy is an active member of the BCMS Publications Committee.

SAN ANTONIO MEDICINE

Artistic Expression in Medicine

By Averi White, MD

Mi Corazón, Oil Pastel

By Averi White, MD

At the beginning of quarantine, I began exploring with oil pastels.

“Mi Corazón” is a tribute to my boyfriend, who was born in Medellín, Colombia and is now in cardiology fellowship. I completed this painting for him during our 63 days apart in quarantine.

Averi White, MD is a PGY-2 resident in Internal Medicine at UT Health San Antonio.

The Experience of Diagnosis

By Emily Sherry

First, it’s me asking, “When did this begin?”

Very quickly I responded, “I’m glad you came in.”

After his history, vitals and physical, I summarize back his story, Let him know we’re talking with radiology and the laboratory.

He shakes and he worries, “Will I need surgery?”

I can’t definitively answer that yet, without diagnostic perjury.

It’s too late in the day for our usual consults, Tomorrow we’ll have more scans and results.

The scans come back, there’s definitely a mass; Blocking the pancreatic head, it’s not something that will pass.

I break the news—there’s a tumor. The pain that comes and grows— Unfortunately, it’s not acute, or constipation, or stones.

He asks, “What say you? How’s the biopsy?”

I’m confused and alone, I haven’t a proxy.

We walk with you sir and we’ll do what you prefer, To support you in waters that are unknown and a blur.

For now, he’s got warm tea and a blanket, a book and a rosary, And in a little while we’ll know just how much to hurry.

I’ll keep coming by, I’ll listen to his abdomen, lungs and heart; I’ll care for the person of the present, who can’t be found in a chart.

Emily Sherry is a fourth-year medical student at the UT Health Long School of Medicine.

Visit us at www.bcms.org

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SAN ANTONIO MEDICINE

IN MEMORIAM Fernando Guerra, MD, MPH Fernando Guerra, MD, MPH was a pediatrician and public health and general preventive medicine physician. He passed away on Friday, January 21, 2022 at the age of 82. He served as Metro Health Director from 1987 to 2010. Dr. Guerra was in public health for over 40 years, retiring from Metro Health in 2010. According to Metro Health, he was involved in the response to the HIV epidemic, Hurricane Katrina, H1N1 and extreme weather events. He was also nationally recognized for his expertise in public health. The Bexar County Medical Society extends sympathy to the family and friends of Dr. Guerra.

At right: Dr. Guerra inspecting a child with burns. Dong Ba Thin, Vietman 10th AVN, Dispensary, February 22, 1966.

Above: Dr. Guerra with his wife, Beverly Purcell-Guerra in Ecuador.

Photo by Roberto (Bear) Guerra

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SAN ANTONIO MEDICINE • March 2022

SAN ANTONIO MEDICINE

IN MEMORIAM Beverly Henwood, MD Beverly Henwood, MD passed away on Saturday, January 15, 2022 at the age of 73. She was born in Winnipeg, Manitoba, Canada on April 20, 1948 and attended medical school at Ottawa University. Dr. Henwood completed her residency in family practice at the Civic Hospital in Ottawa and later worked at the Cancer Clinic in Ottawa, Ontario. Dr. Henwood and her husband Robbie have operated Henwood Family Medicine and Dentistry for the past 35 years. She was a member of the Bexar County Medical Society since 1981 and served as the President of the San Antonio Chapter of the Texas Academy of Family Practice. The Bexar County Medical Society extends sympathy to the family and friends of Dr. Henwood.

If there is a physician you know who has passed away, please email us at editor@ bcms.org, and provide us more information about them and their passing.

IN MEMORIAM So Long Dear Friend and Colleague...You Will Be Missed

By Mary E. Nava, MBA, Chief Government Affairs Officer

On Thursday, Jan. 22, 2022, the BCMS family lost our longest serving employee, Mr. Ismael “Smiley” Flores, who had been with BCMS for over 30 years. Smiley, as he was known to all who knew him, was a friendly individual, who enjoyed helping others. His role as coordinator of many of the organization’s internal projects and day-to-day activities was appreciated by all the staff. From Print Job Coordinator to Event and Meeting Setup Assistant to Mail Courier, Smiley was an active and respected member of the team, who always stood ready to help. For us, his colleagues, Smiley was like a dad to some of us, a grandpa to others and a friend to all.

Born on January 20, 1937 in Floresville, Smiley eventually moved to San Antonio. A 1954 graduate of Sidney Lanier High School, Smiley went on to become a successful Printer with the Muller Printing Company, where he remained until his retirement in 1989. After just one year of retirement from Muller Printing Company, Smiley decided to return to work and joined BCMS in 1990, where he remained until his death.

Most recently, Smiley was honored for his 30+ years of service during the company Christmas luncheon. Soon after his passing, the BCMS staff gathered to remember Smiley and share fond memories of special times past and recognized how much Smiley will be missed by everyone.

The Flores family stated that Smiley enjoyed working and took great pride in all he did. Smiley often spoke of the great friends he had at BCMS and how much he enjoyed going to work each day.

Smiley was preceded in death by his wife of 56 years, Martha Flores, and a son, Victor Flores. He leaves behind 5 children, 14 grandchildren, 34 great-grandchildren and 11 great-great grandchildren.

Mary E. Nava, MBA is the Chief Government Affairs Officer at the Bexar County Medical Society.

Visit us at www.bcms.org

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PHYSICIANS PURCHASING DIRECTORY Support the BCMS by supporting the following sponsors.

Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.

ACCOUNTING FIRMS

Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness.

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”

ATTORNEYS

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”

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ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life.

We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.

Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

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

Shawn P. Hughes, JD Senior Vice President, Private Banking 210-283-5759 shughes@broadway.bank 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

SAN ANTONIO MEDICINE • March 2022

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 Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need.

Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

BUSINESS CONSULTING

Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems.

Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities.

Betty Fernandez

Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

FINANCIAL ADVISORS

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community.

Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner” Elizabeth Olney with Edward Jones (HH Silver 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 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

FINANCIAL SERVICES

Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning.

Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

“People Bank with People” “Your Practice, Our Promise” Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

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

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying.

For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies.

SWBC’s services supporting Physicians and the Medical Society.

Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com

HEALTHCARE BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking.

Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick

Amegy Bank of Texas (HH Silver 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”

HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER

Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

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”

INSURANCE Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options.

Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu

TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you.

Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan.

Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”

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) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians.

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) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more.

Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com

continued on page 34 Visit us at www.bcms.org

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PHYSICIANS PURCHASING DIRECTORY ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent).

Mike Rosenthal Senior Vice President, Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

INTERNET TELECOMMUNICATIONS

Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber – our expertise allows us to deliver customized solutions and a rewarding customer experience.

Clayton Brown Regional Vice President of Sales – San Antonio 210-693-8025 clayton.brown@upnfiber.com Aron Sweet – Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman – Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello – Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”

INVESTMENT ADVISORY REAL ESTATE

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates).

Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

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MEDICAL BILLING AND COLLECTIONS SERVICES

Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems.

Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice.

Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.”

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 PAYMENT SYSTEMS/CARD PROCESSING

First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking.

SAN ANTONIO MEDICINE • March 2022

continued from page 33

Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

MEDICAL SUPPLIES AND EQUIPMENT Henry Schein Medical (HH Silver 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.”

MOLECULAR DIAGNOSTICS LABORATORY

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases.

Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

MORTGAGES

SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying.

For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies.

SWBC’s services supporting Physicians and the Medical Society.

Jon Tober Sr. Loan Officer Office: 210-317-7431

NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober

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 Medical Group Management Association (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.

Alan Winkler, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates).

Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, purchases and practice transitions.

Brad Wilson, Agent 210-573-6146 Brad.Wilson@carr.us www.carr.us

“Maximize Your Profitability Through Real Estate” Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management.

Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”

RETIREMENT PLANNING

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community.

Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”

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.

Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

Visit us at www.bcms.org

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AUTO REVIEW

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SAN ANTONIO MEDICINE • March 2022

2022 Mercedes GLA35 AMG

AUTO REVIEW

By Stephen Schutz, MD

Since the introduction of the original Ford Explorer over 30 years ago, American families have been increasingly relying on SUVs for transportation. Not surprisingly, automotive manufacturers from everywhere have rushed to create SUVs to satisfy the seemingly unquenchable thirst for these types of vehicles. And it’s not stopping.

Ten years ago, it would have been hard to imagine an Aston Martin or Lamborghini SUV, and now we have those in addition to a Ferrari SUV expected soon.

While the success of the Explorer and other SUVs followed by the proliferation of many other SUV models was completely predictable,

terous and in your face than the GLA45 AMG, the GLA35 AMG is a nice “tweener.”

No GLA is a sports car, though. My test vehicle was zippy and nimble around town, capable on B-roads and good on the highway. But at no time did it exhibit BMW M-car-like handling or Lexus highway manners. I’d say the GLA35 AMG’s sweet spot is day-to-day driving: trips to work, HEB and your son’s baseball practice.

Of course, the GLA’s diminutive size will limit who and what you carry. It seats five, but only four will fit comfortably, and the two people who sit in the back seat shouldn’t be too tall due to headroom

a related trend, the “SUV-ization” of cars was less easy to foresee.

It all started with the first Subaru Outback, introduced in 1995.

Based on the Legacy Wagon, the Outback combined tough guy styling elements—a roof rack, lots of lower body cladding, etc.—and a slightly higher ride height to create a vehicle that looked like it could do most of what an SUV could off-road. Thanks to that and ubiquitous TV commercials featuring the lovable pitchman Paul Hogan (aka Crocodile Dundee), the Outback became a hit.

Not long afterwards, other manufacturers launched similar cars— the Subaru Crosstrek, Audi Allroad and Volvo Cross Country are just three examples—and now there are many to choose from.

Enter the Mercedes GLA, now in its second generation. The current GLA, based on the A-class car, looks quite SUV-ish, unlike the last one, which looked like some kind of large insect. The GLA’s styling isn’t as boxy as the (mechanically-related) GLB, but the GLA is certainly trying hard to look like its big brothers the GLC and GLE. Helping the cause are black plastic accents around the entire lower part of the body as well as aluminum roof rails, to which, presumably, active young professionals will attach ski and bike racks.

The inside of the GLA is standard Mercedes fare, albeit without the grandeur of the venerable S-class sedan. The prominent round air vents that I (and others) admire are there, as is a big rectangular screen that houses all of the gauges as well as many other functions. Mercedes is doing away with the two-screen way of doing things, and I applaud them for it.

The GLA comes in three flavors, the standard GLA250, the sportier GLA35 AMG, and loud-and-fast GLA45 AMG. Most customers will choose the first option, and I expect the last one to be very niche given its high price point and very extroverted personality, but the GLA35 AMG that I tested may end up being surprisingly popular.

In fact, I’d call that version the Goldilocks GLA. Happy to be better looking, quicker and more fun than the base model, but also less bois-

limitations. In addition, there’s not much cargo space behind the rear seats.

All GLAs are powered by 2.0 liter turbocharged four-cylinder engines. The GLA250’s produces 221HP, the GLA35 AMG’s makes 302HP and the big daddy GLA45 AMG puts out a prodigious 382HP (an astounding number for a four-cylinder engine).

Fuel economy is 25MPG city/34MPG highway for the GLA250, 23/29 for the GLA35 AMG and 20/27 for the GLA45 AMG. The GLA250 comes well-equipped as standard—this is a Mercedes, after all—but AWD and numerous other doodads can be added as options. All GLA AMGs have standard AWD, by the way.

Pricing starts at $37,450 for the GLA250, $48,600 for the GLA35 AMG and $56,000 for the GLA45 AMG. Options add to those numbers (considerably if you’re not careful), and in our microchip-constrained world, discounts are hard to come by. As always, calling Phil Hornbeak and buying or leasing through the BCMS will get you the best deal possible.

The Mercedes GLA is a prime example of an “SUV-ized” car that combines a car-like driving experience with extra utility and capability.

It’s small, fuel efficient and comes with all the advantages that Mercedes ownership provides: luxurious interiors, well-engineered powertrains and suspensions, and superior dealers.

As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.

Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.

Visit us at www.bcms.org

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11911 IH 10 West San Antonio, TX 78230

Audi Dominion 21105 West IH 10 San Antonio, TX 78257

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX

Coby Allen 210-696-2232

Rick Cavender 210-681-3399

Charles Williams 210-912-5087

William Boyd 210-859-2719

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130

Northside Ford 12300 San Pedro San Antonio, TX

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216

14610 IH 10 West San Marcos, TX 78249

Matthew C. Fraser 830-606-3463

Marty Martinez 210-477-3472

Paul Hopkins 210-988-9644

Mark Hennigan 832-428-9507

Kahlig Auto Group

Kahlig Auto Group

Kahlig Auto Group

Kahlig Auto Group

Land Rover San Antonio 13660 IH 10 West San Antonio, TX

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX

North Park Lincoln 9207 San Pedro San Antonio, TX

Cameron Tang 210-561-4900

Tripp Bridges 210-308-8900

James Cole 210-816-6000

Sandy Small 210-341-8841

North Park Mazda 9333 San Pedro San Antonio, TX 78216

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

9455 IH 10 West San Antonio, TX 78230

John Kahlig 210-253-3300

James Godkin 830-981-6000

Al Cavazos Jr. 210-366-9600

Douglas Cox 210-764-6945

Kahlig Auto Group

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216

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

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

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

Raymond Rangel 210-308-0200

Phil Larson 877-356-0476

Gary Holdgraf 210-862-9769

Justin Boone 210-635-5000

Kahlig Auto Group

Kahlig Auto Group