San Antonio Medicine December 2023

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TABLE OF CONTENTS

THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY

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MEDICAL YEAR IN REVIEW BCMS Recollections: Dr. Fred Olin

By Andrew Ta ..................................................................................12

Revolutionizing Healthcare Through Augmented Intelligence

By Jayesh Shah, MD, MHA .......................................................14

Direct Primary Care – A Prescription for Healing the Doctor-Patient Relationship

By Monica Salas, MD and Prisiliano Salas, Jr., MD .....................16

Metro Health Offers Safety Tips for a Healthy Holiday Season

By The City of San Antonio Metropolitan Health District .............18

A New Approach to Holiday Eating

By Sara Hamilton, PsyD ............................................................20

Student-Run Free Clinics at UT Health San Antonio: Humble Beginnings and Dedication to Undeserved Communities

By Ruoxuan (Rosa) Su and Andrew Ta.......................................22

BCMS Celebrates an Employee Milestone By Monica Jones, BCMS COO ..................................................25 BCMS President’s Message .................................................................................................................................................8 BCMS Alliance Message ....................................................................................................................................................10 170 Years of Organized Medicine and Legislative Advocacy in San Antonio – Part 2 By Mary E. Nava, MBA.....................26 In Memoriam.............................................................................................................................................................................29 Book Review: The Future of AI in Medicine: Unlocking a New Era in Healthcare By David A. Schulz & ChatGPT 3.5..............32 5 Steps to Take Now to Prepare Your Practice for 2024 By Christopher Davis, CPA...............................................................34 37th Annual BCMS Auto Show ................................................................................................................................................36 San Fernando Health and Safety Fair ......................................................................................................................................38 The 1853 Club Luncheon .........................................................................................................................................................39 BCMS Vendor Directory .....................................................................................................................................................40 Auto Review: 2023 Mercedes-Benz GLS 580 SUV By Stephen Schutz, MD .....................................................................44 Recommended Auto Dealers .............................................................................................................................................46 PUBlISHED By: traveling Blender, llC. 10036 Saxet Boerne, tX 78006

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SAN ANTONIO MEDICINE • December 2023

DECEMBER 2023

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VOLUME 76 NO.12

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS. EditoriAl CorrESpondEnCE: Bexar County Medical Society 4334 n loop 1604 W, Ste. 200 San Antonio, tX 78249 Email: editor@bcms.org MAGAZinE AddrESS CHAnGES: Call (210) 301-4391 or Email: membership@bcms.org SuBSCription rAtES: $30 per year or $4 per individual issue AdvErtiSinG CorrESpondEnCE: louis doucette, president traveling Blender, llC. A publication Management Firm 10036 Saxet, Boerne, tX 78006 www.travelingblender.com

For advertising rates and information Call (210) 410-0014 Email: louis@travelingblender.com SAN ANTONIO MEDICINE is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS, its members, or its staff. SAN ANTONIO MEDICINE the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume responsibility should such advertising or editorial appear.

Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or discrimination.

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BCMS BOARD OF DIRECTORS

ElECTED OFFICERS John Joseph nava, Md, President Brian t. Boies, Md, Vice President Ezequiel “Zeke” Silva iii, Md, President-elect John Shepherd, Md, Secretary rajeev Suri, Md, Treasurer and Immediate Past President

DIRECTORS Woodson "Scott" Jones, Md, Member Sumeru “Sam” G. Mehta, Md, Member M. “Hamed” reza Mizani, Md, Member priti Mody-Bailey, Md, Member lubna naeem, Md, Member lyssa n. ochoa, Md, Member Jennifer r. rushton, Md, Member raul Santoscoy, do, Member lauren tarbox, Md, Member Jenny Case, Alliance Representative ramon S. Cancino, Md, Medical School Representative lori Kels, Md, Medical School Representative robert leverence, Md, Medical School Representative Keiko McManus, Md, Board of Ethics Chair John pham, do, Medical School Representative Cheryl pierce-Szender, Alliance Representative ronald rodriguez, Md, phd, Medical School Representative

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Elisa d. o’Hern Col, MC, FS, Military Representative George F. “rick” Evans, Jr., General Counsel Jayesh B. Shah, Md, TMA Board of Trustees Melody newsom, CEO/Executive Director

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 norys Alexandra Castro-pena, Md, Co-chair John Joseph Seidenfeld, Md, Co-chair louis doucette, Consultant david Schulz, Community Member Elizabeth Clanton, Md, Member Kristy Yvonne Kosub, Md, Member neal Meritz, Md, Member Jaime pankowsky, Md, Member Alan preston, phd, Member rajam S. ramamurthy, Md, Member Adam v. ratner, Md, Member

SAN ANTONIO MEDICINE • December 2023

Faraz Yousefian, do, Member Moses Alfaro, Student Member victoria Ayodele, Student Member tue Felix nguyen, Student Member niva Shrestha, Student Member Bethanne Bradshaw, Student Member Andrew ta, Student Member Monica Jones, BCMS Coo, Staff Liason trisha doucette, Editor

PRESIDENT’S MESSAGE

Dear Physicians, Colleagues and Friends of BCMS,

By John J. Nava, MD, 2023 BCMS President

As we near the end of another eventful year, I am honored to reflect on the collective achievements and challenges we've faced in the medical community. Our unwavering dedication to patient care, innovation and resilience has been commendable amidst the ever-evolving landscape of healthcare. A year ago, I recall hoping we could actually declare COVID-19 under control, that everyone was fully vaccinated, and even the most vulnerable had lower mortality numbers. Well, more people are vaccinated, and the meandering course of the public health response has carried many lessons. Death numbers are much lower, but the highest risk groups for hospitalization and mortality continue to be high risk. If you ask the man on the street, the pandemic may still be present, but is not very newsworthy as before. At least the level of alarm has subsided, maybe even to the degree where calm discourse can inform planning for the next crisis. It is a good practice to be grateful for what we already have, and we can build on that.

Throughout this medical year, we've witnessed remarkable advancements in technology, transformative research and an unyielding commitment to patient wellbeing. The ongoing battle against the global health crisis has demanded immense strength and adaptability, and your perseverance in providing exceptional care during these challenging times has been truly commendable. San Antonio has a longstanding commitment to responding to immigrant influxes. Since so many immigrants are here just on the way to finding work elsewhere, they typically do not stay here, but still benefit from attention to their basic needs in the short term. Both they and we are better for helping them.

In the face of adversity, we've shown remarkable unity, support and collaboration within our medical community. Our continuous efforts to elevate standards, improve patient outcomes, and enhance medical practices have not gone unnoticed. We had a successful year in Austin during the legislative session, and continued to support the private practice of medicine by the most highly trained representatives. We continue to resist the corporate practice of medicine by non-physicians and welcome an increased emphasis on the social determinants of health to help people enjoy a fuller life.

Yet, while celebrating our successes, it's essential to acknowledge the hurdles that persist. We must remain vigilant in addressing healthcare disparities, embracing diversity, and advocating for equitable access to 8

SAN ANTONIO MEDICINE • December 2023

healthcare for all individuals. Just recently, the smoldering Middle East war reignited, and the threat of an expanding conflict became a daily presence. We will have ample opportunities to promote healing and help the injured recover. At this point, there has appeared no Seer, no Oracle, who can reliably predict what the future holds. This most recent flare may be tamped down, and then the tenuous peace returns.

Or it could spread. I want to suggest another possibility. Maybe this time will be different, and the peace that results is more robust and durable. Until we believe it is a realistic societal goal, and move in that direction, it is unlikely to arise de novo. I dare not suggest that just wishing will meet the task, but it is a start. I, for one, look forward to the smoke clearing and the healing to begin.

As we move into the coming year, let us carry forward the lessons learned and the triumphs achieved. Together, let us continue to be beacons of healing, progress and compassion, always dedicated to advancing the frontiers of medicine for the betterment of humanity. Let us regain hope.

I extend my deepest gratitude to each one of you for your unwavering commitment and dedication to the medical field. Your expertise and passion remain the cornerstone of our collective success.

Wishing you all a joyful holiday season, and a prosperous and fulfilling year ahead.

With great respect and appreciation, John J. Nava, M.D. President, Bexar County Medical Society

Visit us at www.bcms.org

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BCMS ALLIANCE

A Successful Year for the BCMS Alliance

By Jenny Case, MSN, MBA, RN

The 2023 Alliance year was one for the books!

We donated 350 books to CHOSA, served dinner at the Bereavement Center, and donated 110 bike helmets to Coker Elementary. Several of our members participated at the state level during ALLMED. Past President of the BCMSA, Jenny Shepherd, was awarded the 2023 TEXPAC June Bratcher Award for Political Action and will serve as the President of TMAA in the coming year — May of 2024. We celebrated each other with camaraderie and fellowship at several dinners, including honoring our Past Presidents at our May luncheon and our Scholarship winners at our October luncheon.

It has been our pleasure to serve the Alliance, but the real joy has been working with such a wonderful group of women who made our jobs as Co-Presidents so easy. There was not a single obstacle our talented Board members were not willing to overcome!

We know the Alliance is in good hands with incoming President Victoria Kohler-Webb. The 2024 BCMS Alliance Board invites all physicians and their spouses to join them in their efforts next year towards legislative action, philanthropy and fellowship.

Gratefully, Jenny Case and Cheryl Szender Jenny Case, MSN, MBA, RN, is the 2023 CoPresident of the BCMS Alliance.

Cheryl Pierce-Szender is the 2023 Co-President of the BCMS Alliance.

L-R, Top Row: Past President Luncheon, Hard Hats for Little Heads. Middle: Installation, Book Share Program. Bottom: TMAA, Fall Luncheon.

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SAN ANTONIO MEDICINE • December 2023

MEDICAL YEAR IN REVIEW

BCMS Recollections:

Dr. Fred Olin

By Andrew Ta

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r. Fred Olin, a renowned orthopaedic surgeon who practiced in San Antonio from 1977 to 2006, had a life that was as diverse as it was fascinating. Born and raised in the bustling city of Chicago, Dr. Olin's educational path was far from conventional for a physician. He began his academic pursuits at the University of Illinois with a unique ambition — to become a veterinarian, drawn to the field for its academic rigor and diversity of care. He graduated with a Doctorate in Veterinary Medicine in 1961, and soon after, he married his wife, Sondra, who worked as a speech pathologist.

Before he began practicing as a veterinarian, however, Dr. Olin enlisted in the Army and spent two years in eastern Pennsylvania. After leaving, he brought his family to San Antonio and worked as a relief veterinarian at the zoo. Here, he gained many unique experiences and stories working with small animals, ranging from de-scenting skunks to removing venom from a four-foot rattlesnake for an exotic dancer.

As life would have it, however, Dr. Olin would not stay a veterinarian forever. In the late ‘60s, Dr. Olin’s wife needed an appendectomy, and the pair went to Methodist Hospital for the procedure. Serendipitously, he met the dean of the newly opening Long School of Medicine across the street. After seeing the facilities and sophisticated technology available, and the patients he could care for, Dr. Olin decided that he wanted to go to medical school. “I began to feel ambitious, and much to my wife’s horror, the medical school took me,” he joked.

So, in 1969, Dr. Olin went back to school, continuing to work as a veterinarian during his first two years of medical school. He graduated in 1973 in one of the school’s first classes, and completed a surgery internship at Bexar County Hospital (now University Hospital) through 12

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’74. With his abundant surgical experience as a veterinarian, he was set on applying to orthopaedic surgery, but disappointingly, he was rejected from these residency programs the first time around.

Although facing a setback, Dr. Olin remained steadfast and determined in his career goals. He contacted his mentor, Dr. David P. Green, an author and hand surgeon, and was connected to the University of Arkansas Orthopaedics Program. After an interview, he started his orthopaedic surgery residency a week later.

The whole time, however, Dr. Olin longed to return to the charm and character of San Antonio. “My family and I cheered as we crossed into Texas on July 1, 1977,” he said. Upon returning to San Antonio, he took over ownership of a private practice here. He remained for the rest of his career and retired in 2006. He shared, “I loved the work, and couldn’t wait to get to work in the morning. The gratification of seeing people returning to function, because of my tender ministrations was immense.”

Throughout his life, Dr. Olin saw medicine constantly shifting and changing. In addition to the continually evolving technologies and techniques, both Bexar County Medical Society (BCMS) and medicine as a whole greatly increased in diversity over the past several decades. He saw the first woman be elected the president of BCMS and has directly worked with the greater minority representation and diversity of thought in the Board of Directors and physician members.

The days of white, male physicians were fading away; underrepresented groups were becoming an integral part of medicine.

Dr. Olin also explained that the other big change has been the great availability of information within medicine. Patients can now search

MEDICAL YEAR IN REVIEW

up their discordant symptoms and connect them to potential diagnoses, forming a differential diagnosis of their own. Physicians today have to be more open-minded and patient as they address the concerns of their patients, acknowledging their ideas and thoughts about their treatment options.

Despite its challenges, Dr. Olin continued to argue that medicine is the best job available after the long training is completed. There is no other job that enables someone to become an expert in the sciences and profoundly impact the people they work with, and it is this human connection that is central to the practice of medicine. Dr. Olin relayed advice that he was given years ago: “The two most important things in the examining room are a stool with wheels and your [butt] on the stool.” Sitting, talking and watching are among the most important things a physician can do when with a patient, and these connections enable us to provide the best care possible.

As our interview wound down, Dr. Olin asserted that the two best things that happened to him were joining the Cavaliers Drum and Bugle Corps and marrying his wife. It was surprising to me because as someone who worked a long, successful career as an orthopaedic surgeon and whose work has made him a pillar of our community, he valued his time outside of work the most. Medical students and professionals are indoctrinated to prioritize their careers above all else,

from training that lasts more than a decade after high school to a grueling residency with long hours to the inescapable six-figure debt. In looking back, his rewarding career was not the centerpiece of his life; his most important experiences were the time he spent with his wife and with the drum corps community.

As I left his home, I appreciated his stories of surgery and medicine, but I was most impacted by the experiences he shared outside of work — the playful stories of his childhood, the way his eyes lit up when talking about his late wife, and the pride he exuded when reminiscing on the drum corps. Throughout his life and career, Dr. Olin has left an indelible mark on both medicine and the San Antonio community. ***This article was written based off an interview with Dr. Olin in his home, and do not necessarily reflect the current opinions of the Society.

Andrew Ta is a medical student at the Long School of Medicine, Class of 2026. He is the 2023 Student-Faculty Collaborative Practice President overseeing the six student-run free clinics and is the 2023-2024 writing lead for Connective Tissue, the school's literature and arts journal. Andrew is also a member of the BCMS Publications Committee.

Visit us at www.bcms.org

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MEDICAL YEAR IN REVIEW

Revolutionizing Healthcare Through Augmented Intelligence

By Jayesh Shah, MD, MHA

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n the ever-evolving landscape of healthcare, the dynamic interplay between human intelligence and artificial intelligence (AI) is reshaping conventional practices across diverse domains. Artificial intelligence, encompassing machine learning, natural language processing, visual applications, speech recognition and robotics, is fundamentally altering tasks that traditionally demanded human cognitive abilities.

Augmented Intelligence, a term emphasizing the harmonious fusion of human expertise and AI capabilities to enhance decision-making, holds significant promise, particularly within the realm of healthcare.

The Paradigm of Augmented Intelligence Augmented Intelligence envisions AI as an empowering tool for healthcare professionals rather than a replacement. In the context of healthcare, this concept entails synergizing human clinical acumen with AI-driven technologies to revolutionize patient management and treatment strategies. The convergence of machine learning, deep learning, natural language processing and image recognition facilitates a holistic approach to patient assessment and care. Recently, AI-supported mammography detected more cancers than two radiologists’ combined interpretation.

Harnessing Augmented Intelligence to Mitigate Physician Burnout The potential of Augmented Intelligence can be a solution to the pervasive issue of physician burnout. Administrative tasks, which often 14

SAN ANTONIO MEDICINE • December 2023

burden clinicians, can be alleviated through AI-powered tools like ChatGPT. These tools have the capability to transcribe patient conversations and generate comprehensive medical records, allowing physicians to focus more on direct patient care.

Navigating Challenges, and Ensuring Ethical AI Implementation and Role of Organized Medicine While the potential benefits of augmented intelligence are promising, there are inherent challenges to address: • Data Quality and Representation: The success of AI hinges on the quality and diversity of training data. Biases may emerge if the data doesn't adequately represent various populations.

• Regulatory Frameworks: The evolving regulatory landscape for AI in healthcare necessitates rigorous validation and oversight to ensure safety and efficacy.

• Mitigating Risk: Building AI models upon robust scientific literature is essential to avoid misdiagnoses and potential harm.

• Transparency and Trust: The opacity of AI can hinder acceptance.

Validation through multi-institutional trials and transparent initiatives can foster trust among clinicians and patients.

• Privacy and Security: Safeguarding patient data privacy and ensuring informed consent are paramount when implementing AI models in healthcare.

• Seamless Integration: For practical utility, AI models must seamlessly integrate into existing healthcare workflows and systems.

MEDICAL YEAR IN REVIEW

Organized medicine will have to take a lead in making sure that AI is implemented ethically, and physicians are leading the team as future AI resources are developed in the future.

Charting the Path Ahead The fusion of AI and healthcare portends a future where patient outcomes are enhanced, healthcare costs are streamlined, and clinician burnout is mitigated. By synergistically harnessing AI's analytical prowess with human clinical expertise, the journey towards more effective patient management becomes an achievable reality.

As we stand on the brink of this transformative era, it is imperative to navigate challenges judiciously while upholding ethical standards.

Amid this era of innovation, the collaboration between AI and clinicians holds the potential to unlock groundbreaking advancements in healthcare, ultimately enriching the quality of life for patients across the globe.

Augmented Intelligence's Potential Beyond Augmented Intelligence's capacity extends to enhancing treatment protocols, optimizing care coordination, and propelling research endeavors: • Personalized Treatment Plans: AI's data analysis capabilities can pave the way for tailored treatment plans for patients. By considering individual patient attributes, coexisting conditions and treatment responses, AI assists clinicians in customizing interventions for optimal outcomes.

• Enhanced Care Coordination: The multidisciplinary nature of patient care can be streamlined through AI-powered platforms, facilitating seamless communication and collaboration among healthcare professionals, ensuring comprehensive patient care.

• Expediting Research and Discovery: AI's data processing capabilities expedite healthcare research. By sifting through extensive datasets, identifying trends, and predicting potential breakthroughs, AI supports researchers in uncovering novel treatment modalities.

• Global Accessibility and Telemedicine: A significant aspect of AI is its potential to bridge geographical gaps. AI-driven telemedicine can disseminate expertise to remote and underserved areas, ensuring timely and effective interventions.

• Medical Education: ChatGPT could potentially be used as a physician’s digital assistant or to enhance clinical decision support systems.

A recently published study has spotlighted its ability to pass wellknown licensing exams, suggesting a useful role in medical education.

In Conclusion In the journey to revolutionize healthcare, Augmented Intelligence emerges as a potent ally. Its potential to redefine patient assessment, forecast complications, and facilitate proactive interventions is revolu-

tionary. A meticulous approach to address challenges and prioritize ethical considerations empowers healthcare providers and AI developers to pave the path for a new healthcare era.

As the healthcare landscape evolves, the harmonious collaboration between AI and clinicians holds the promise of unprecedented advancements. Together, they have the potential to elevate healthcare to new heights, enhancing patient outcomes while reshaping the essence of healthcare delivery.

Resources • Press G. Top 10 Hot Artificial Intelligence (AI) Technologies; 2017.

Available from: https://www.forbes.com/sites/gilpress/2017/ 01/23/top10-hot-artificial-intelligence-ai-technologies/ #445d61c31928. [Last accessed on 2020 Apr 30] • Kovarik C, Lee I, Ko J; Ad Hoc Task Force on Augmented Intelligence. Commentary: Position statement on augmented intelligence (AuI). J Am Acad Dermatol. 2019 Oct;81(4):998-1000 • Wang, C, Anisuzzaman, DM, Williamson, V et al. Fully automatic wound segmentation with deep convolutional neural networks. Sci Rep 10, 21897 (2020) • https://www.ama-assn.org/practice-management/digital/healthcare-ai-advances-rapidly-what-role-regulators • https://www.ama-assn.org/practice-management/digital/why-generative-ai-chatgpt-cannot-replace-physicians • https://www.ama-assn.org/practice-management/digital/future-aimedicine-and-what-it-means-physicians-and-practices-tom-lawry • Kristina Lång et al-Artificial intelligence-supported screen reading versus standard double reading in the Mammography Screening with Artificial Intelligence trial (MASAI): a clinical safety analysis of a randomized, controlled, non-inferiority, single-blinded, screening accuracy study, The lancet Oncology, Elsevier Publication, August 2023 • https://www.medicaleconomics.com/view/chatgpt-health-care-snext-big-thing• Kung TH, Cheatham M, Medenilla A, Sillos C, De Leon L, Elepaño C, Madriaga M, Aggabao R, Diaz-Candido G, Maningo J, Tseng V. Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models. PLOS Digit Health.

2023 Feb 9;2(2 Jayesh Shah, MD, MHA, is the President of the South Texas Wound Associates, PA, and Past President of the American College of Hyperbaric Medicine. He was re-elected as an AMA delegate in 2023, and serves as secretary on the Board of Trustees for the Texas Medical Association.

Visit us at www.bcms.org

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MEDICAL YEAR IN REVIEW

Direct Primary Care –

A Prescription for Healing the Doctor-Patient Relationship

By Monica Salas, MD, and Prisiliano Salas, Jr., MD

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s “open enrollment” is now upon us, many Americans will have the opportunity to evaluate and reconsider their healthcare benefits options. Given that medical costs are a significant expense for most, and insurance premiums seem to increase every year, this can be a challenging decision to make. Furthermore, wait times for medical visits are becoming longer and longer as appointments are becoming shorter and shorter. This has left patients, physicians and medical staff alike dissatisfied and with more questions than answers.

A refreshing solution to the conundrum of the traditional insurancebased medical model is Direct Primary Care (DPC). The DPC model

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SAN ANTONIO MEDICINE • December 2023

has been around since the turn of the century but has been gaining popularity over the past decade. It is a direct-to-consumer model of care that typically utilizes a fixed membership-based payment system rather than traditional insurance-claim payments. Not depending on insuranceclaim payments reduces overhead costs and allows the physician to spend more quality time with each patient. The result is a practice where patients truly feel cared for and physicians can again feel inspired.

Salveo Direct Care, our Direct Primary Care and Lifestyle Medicine practice, was born from a desire to put the focus back on the patient rather than staying the course in the insurance-claim driven system. We

MEDICAL YEAR IN REVIEW

spent several years practicing insurance claim-driven medicine but quickly became burnt out and disillusioned. Knowing there had to be another solution, we began looking for better ways of delivering care.

We quickly learned about DPC through the American Academy of Family Physicians’ yearly DPC summit. Dr. Prisiliano was able to attend in 2018 and came back on fire for change. After a lengthy discussion about career and life goals — reminding ourselves of our “why” in medicine — Dr. Monica was an easy convert.

The DPC model confers many advantages to the physician and patient alike. DPC practices, without insurance restrictions, and with a fixed monthly membership payment per patient, are able to generally carry a 300-800 patient panel per physician. This is in stark contrast to the average PCP panel size of 2,500-3,000 patients.1 Smaller panels, from the vantage point of the patient, equal greater appointment availability, improved office communication and more time with their physician. Patient satisfaction increases when patients feel their primary care office truly knows them and cares about their wellbeing. From the physician standpoint, smaller patient panels mean more fulfilling patient encounters. No insurance contracts mean less administrative burden and increased ability to truly practice medicine rather than treat an insurance-reimbursed diagnosis. Simply put, this means less physician burnout and happier patients.

Another advantage is the cost savings associated with a DPC membership. Insurance in general is designed to help you with big ticket items like a fire or car wreck for your home or auto, for example, but not for preventive or daily care like new tires or changing a lightbulb. The same logic applies to health insurance — it makes sense to use it for unexpected surgeries or hospitalizations, but rarely is it the most financially sound option for routine preventive care. It doesn’t make sense for primary care as visits with your PCP will drive up your health plan claims and increase your insurability risk, leading to higher insurance premiums and costs over time. A reasonable fixed monthly membership that covers all your primary care visits doesn’t hit your deductible or lead to increased insurance premiums over time. Rather, it can decrease your insurance premiums year over year and is much more affordable.

While the DPC model has many advantages, some physicians are hesitant to convert to a membership model due to concerns about financial stability. While it may seem counterintuitive, DPC practices can actually be quite financially stable over time. By charging a subscription fee and not billing insurance, doctors have a consistent and predictable source of income, reducing the reliance on the often-unpredictable payment-for-quantity-of-services reimbursement from insurance companies. Dr. Prisiliano has seen this first hand. He started an insurance-based medical practice previously, growing it to >7,000

patients between two physicians. This was before opening our current DPC clinic, which is much simpler and has much less administrative burden, with also only two physicians.

In conclusion, the shift of doctors to Direct Primary Care practices reflects a transformation in the healthcare industry towards more patient-centered, efficient and personalized care. By reducing administrative burdens, improving doctor-patient relationships, and offering financial stability, DPC is becoming an attractive alternative for physicians seeking a more fulfilling and sustainable healthcare career. Moreover, patients also benefit from increased accessibility, cost savings and transparency, making the transition to Direct Primary Care a win-win for both doctors and their patients.

Reference: 1. https://www.elationhealth.com/resources/blogs/how-many-patientsdoes-a-doctor-have-a-day#:~:text=The%20ideal%20average%20patient%20load,number%20is%20closer%20to%203%2C000 Drs. Monica Salas and Prisiliano Salas, Jr., are board certified in Family Medicine and Lifestyle Medicine, and each have more than a decade of experience. They are co-owners of Salveo Direct Care, where Dr. Prisiliano Salas is CEO, and Dr. Monica Salas is COO.

Visit us at www.bcms.org

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MEDICAL YEAR IN REVIEW

Metro Health Offers Safety Tips for a Healthy Holiday Season

By The City of San Antonio Metropolitan Health District

T

he holiday season is a perfect time to get festive, visit loved ones, and enjoy gatherings with family and friends. They create shared memories and bring loved ones together. Whether it is celebrating Christmas at your parents’ home or traveling to your favorite vacation spot for New Year’s Day, it is important to keep in mind that an increase in respiratory viruses is not uncommon during this season.

As holiday festivities are nearby and temperatures continue to drop, The City of San Antonio Metropolitan Health District (Metro Health) continues to encourage the community to take safety measures while they prepare for the upcoming celebrations. This includes practicing prevention measures against the top fall and winter respiratory viruses: flu, COVID-19, and the Respiratory Syncytial Virus (RSV).

Getting vaccinated is the first step toward protection. The Centers for Disease Control and Prevention (CDC) states it is safe for individuals to get the flu, COVID-19 and RSV vaccines at the same time. This will make it easier to stay up-to-date with CDC recommendations. If an individual prefers to get the three vaccines during different visits, there is no minimum waiting period between getting each vaccine.

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SAN ANTONIO MEDICINE • December 2023

Metro Health provides the following health and safety tips to enjoy the holiday festivities: • Stay up to date with COVID-19, flu and RSV vaccines. Vaccines will help protect you and your loved ones, especially older adults and those who are immunocompromised.

• If you feel sick, stay home to prevent spreading germs and consider joining the celebrations virtually.

• Do not serve any meals if you feel ill.

• Monitor your symptoms including fever, cough, chills, headaches, runny nose, sore throat, muscle or body aches, fatigue, vomiting or diarrhea.

For people with health insurance, most plans will cover the COVID-19 and flu vaccines at no cost to the individual. For those who don’t have health insurance or with health plans that do not cover the cost, they can get their COVID-19 vaccines from Metro Health clinics or pharmacies participating in the CDC’s Bridge Access Program.

MEDICAL YEAR IN REVIEW

The community can find providers offering the COVID-19 vaccine by visiting Vaccines.gov. Metro Health works with community agencies to host pop-up vaccine clinics. No appointments are needed. A list of available clinics can be found by visiting Covid19.SanAntonio.gov. The community is also encouraged to consult with their medical providers on recommended vaccines.

If you are vaccinated, you increase protection for yourself and those around you. Metro Health wishes the community a happy, healthy and safe holiday season.

At Metro Health, our mission is to prevent illness, promote healthy behaviors, and protect against environmental health hazards.

As the City’s community health strategist, Metro Health is committed to eliminating historically rooted social and racial disparities in health through innovative practices and partnerships, while building a robust and resilient workforce, and making our public health more responsive to communities as they confront future health threats.

For more information, visit sanantonio.gov/health.

Visit us at www.bcms.org

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MEDICAL YEAR IN REVIEW

A New Approach to Holiday Eating

By Sara Hamilton, PsyD

M

any people resign themselves to gaining weight over the holidays, promising to “get back on track” in the new year. They then find themselves hungry and discouraged at the end of January when, despite strict dieting and overexercising for three weeks, the scale hasn’t budged enough to be worth the misery. Taking a more sustainable, flexible approach to eating throughout the end of the year (without promises to throw yourself into bootcamp on January 1st!) can result in a much more pleasurable holiday season with fewer feelings of guilt or shame. Below are tips for providers and patients alike to reduce food-related stress during the holidays, and to help holiday eating patterns look more like patterns the rest of the year.

Don’t Threaten Yourself with Weight-Based New Year’s Resolutions Setting New Year’s Resolutions to restrict amounts or categories of food, or to do very intense exercises in the new year, sets the stage for overeating behaviors to occur in the preceding weeks. Guilt related to 20

SAN ANTONIO MEDICINE • December 2023

overeating causes us to double down on the perceived need for dramatic food-related resolutions. This intensifies our internal messages that the foods we are eating during the holidays are “for a limited time only,” activating a sense of scarcity. Feeling like food is scarce, even when it isn’t, increases the drive to consume food, often resulting in overeating.

We are better off setting New Year’s Resolutions that focus on behaviors, not results, and are realistic for our current functioning. If you don’t currently exercise, “I will walk for 10 minutes after dinner three nights a week,” is a more attainable resolution and much less likely to activate problematic eating, than a resolution to “walk five miles every day and lose 30 pounds by February 1st.”

Focus on Meals Rather Than Grazing Rather than having “just a little something” here and there throughout the day, focus on consuming your desired foods together as meals.

Grazing can distort our perceptions of how much we have eaten because it blunts our hunger cues without activating our fullness cues, so we miss messages from our bodies about our needs, and generally take

MEDICAL YEAR IN REVIEW

in more than we typically would during meals. Sitting down to eat rather than lingering in the kitchen or near a buffet can help to shift to a meal vs grazing mindset. Focusing on meals allows us to have the foods we enjoy, plan to meet our nutritional needs, and respond appropriately to our hunger and fullness cues. Limiting holiday foods to specific meals on specific holidays rather than partaking in holiday foods all day, every day throughout the season can help these foods maintain their significance and reduce the impact of taking in much more salt, sugar or fat than is typical in a short period of time.

Prioritize Eating What You Enjoy Feeling restricted at an abundant time of year can create feelings of deprivation and resentment that can then become apathy and anger, and fuel overeating. Including valued and preferred foods in smaller amounts, rather than forbidding them, can reduce the risk of overeating them later. Many people eat what they think they “should,” get full, still want dessert, eat it, feel too full, and then feel guilty. It makes for a much better physical and emotional meal experience to have a few bites of dessert early in a meal that meets your nutritional needs and wants, and then stop when you are comfortably full. Without being sluggish and remorseful, you’ll feel better able to engage with your family and friends.

meeting your nutritional needs. Stopping when you’re comfortably full will allow you to enjoy the gathering beyond the meal.

Holiday foods are a wonderful way to mark the passing of another year and to celebrate with family and friends; going completely without or overconsuming can contribute to a negative emotional experience at this time of year. Finding new ways to enjoy our favorites in moderation allows us to connect to the deeper meanings of the holidays without adversely impacting our mental and physical health.

Practice the techniques above and see if you feel better during and after the holiday season!

Dr. Sara Hamilton is a licensed clinical psychologist and the clinical director of the Bariatric Counseling Center. She believes successful health interventions focus on helping people to make changes that are meaningful to them and are sustainable long-term. At the Bariatric Counseling Center, she leads a multi-disciplinary team of providers that approaches the treatment of obesity from a behavioral health perspective.

Pick a Strategy It can be helpful to decide at a gathering if you’d rather try many foods or focus on consuming a larger portion of fewer foods. You might take a “Painter’s Palette” approach and put a dab of all the foods that appeal to you on your plate, with a focus on including proteins and produce in addition to starchier or sweeter offerings. If you prefer quantity to variety, you may focus on picking your favorite protein, produce, starch/sweet that is offered and consume larger portions of those top foods relative to what you would serve with the palette approach. These approaches allow you to enjoy your preferred eating style and foods, while Visit us at www.bcms.org

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MEDICAL YEAR IN REVIEW

Student-Run Free Clinics at UT Health San Antonio:

Humble Beginnings and Dedication to Underserved Communities

By Ruoxuan (Rosa) Su and Andrew Ta

I

n January 2005, on an early Saturday morning, Dr. Richard Usa- Nida Joy Emko, a family physician and clinical professor who has tine saw the first patients at the first San Antonio student-run free served as volunteer faculty at Alpha Home since 2005 and Medical Diclinic, dedicated to supporting the residents of Alpha Home, a rector of SAMM Clinic in 2017. We discovered three common themes non-profit long-term substance abuse center specifically for women. that encompassed the raw, underlying reasons for their passion to serve Initially, it began as a small program in which healthcare students at the student-run free clinics. and faculty volunteers saw patients once a week, serving as an interim primary care resource for patients who were otherwise neg- Dedication to Vulnerable Populations As healthcare professionals, our interactions with patients are lected by the healthcare system. Supported by more than a decade of experience serving at a free clinic at the University of California rooted in the four pillars of medical ethics: respect for autonomy, at Los Angeles as both a resident and attending physician, Dr. Usatine was the faculty founder of the Alpha Home Clinic and an integral component to the expansion of student-run free clinics within the University of Texas Health Science Center at San Antonio (UTHSCSA).

Now, nearly 20 years after the humble beginnings of the first free clinic, UTHSCSA has expanded to support not one, but six student-faculty collaborative practices to serve the greater San Antonio community, with each clinic dedicated to a uniquely underserved patient population. The broad reach of these clinics ranges from refugee patients at the San Antonio Refugee Health Clinic (SARHC) to LGBTQ+ patients at the Pride Community Clinic (PCC) to underinsured patients experiencing homelessness at Haven for Hope. Each week, the student and faculty volunteers serve more than 50 patients across San Antonio.

One fascinating aspect of these student-run free clinics involves the collaboration and dedication of the student and faculty teams. As full-time, working healthcare professionals and future healthcare students, how is it that they persistently volunteer to serve these populations, even when they have limited time on their hands?

To find out, we interviewed three faculty mentors who have been dedicated to the free clinics for the past 20 years: Dr. Richard Usatine, a family medicine physician with training in dermatology and founding member of the student-run free clinics; Dr. Moshtagh Farokhi, a public health dentist and Laureen Raelly, Dr. Andrew Muck, Zoie Fan and Maggie Lee at Refugee Health Clinic.

Dental Director at the SARHC since its inception; and Dr. 22

SAN ANTONIO MEDICINE • December 2023

MEDICAL YEAR IN REVIEW

Haven for Hope volunteers, Hira Asim, Ruoxuan (Rosa) Su, Dr. Richard Usatine, Dr. Yaritza Serrano Gomez, Dr. Tran Cao and Dr. Fehima Dawy.

beneficence, non-maleficence and justice. In the free clinic environment, patients who have otherwise been isolated by the healthcare system are a particularly vulnerable population, further inspiring the faculty volunteers.

It was precisely for this reason that Dr. Usatine entered the field of medicine 40 years ago. He had a goal of doing work that could help the underserved and devoted his time to provide free healthcare to individuals who were denied access to care at a free clinic during his residency. This cemented his ideals and “provided the practical experience that was necessary to provide care for individuals who were otherwise slipping through the cracks of our healthcare system.” Similarly, regarding patients at the Refugee clinic with urgent oral health needs that require emergent care, Dr. Farokhi states that her inspiration was driven by her desire to “make it easier for the refugees to receive healthcare and adjust to life in the United States.”

Mentorship and Growth The student-run free clinics provide an opportunity for future healthcare students — nurses, physicians, dentists and physician assistants — to develop their professional identity and learn from experienced faculty mentors.

For Dr. Emko, who, even as a medical student, envisioned a future in which she could work closely with medical students as a mentor, the free clinics were the perfect opportunity to be involved with students through mentorship. She shares that it is incredibly exciting to work with these students, as they keep things dynamic by continuously proposing fresh, innovative ideas on how to better provide for the unique patient populations. She also reminds us, however, that each clinic serves “real patients who are underserved and have been burned by healthcare before.” Thus, in order to provide the optimal care to these patients, care must be taken to establish trust and empathy between patient and provider, which are imperative aspects to becoming a compassionate healthcare professional.

The desire for continuous improvement is not an isolated occurrence; over the years, at each of the six clinics, numerous community service-learning projects have provided customized, patient-focused education programs and evaluations. Each of these projects share a common goal to assess the unique needs of the patient population and to develop educational programs and interventions to improve clinic workflow, patient knowledge and, most importantly, the underlying factors contributing to patient health and wellbeing. Not only have these projects positively impacted the surrounding community through continued on page 24 Visit us at www.bcms.org

23

MEDICAL YEAR IN REVIEW continued from page 23

outreach and education, but they have also given medical students the chance to learn firsthand about these social determinants of health and barriers to care our communities face.

Inspiring Moments Given the nearly 20-year history of the diverse student-run free clinics, there was, without a doubt, a plethora of enriching and inspiring moments shared by the patients, students and faculty.

One such case involves a strikingly heartwarming moment that occurred with Dr. Usatine and one of his former patients.

Back in 2006, Dr. Usatine diagnosed two women with severe hyperthyroidism at SAMM Clinic. Both were mothers who had slipped through the cracks of the healthcare system and remained undiagnosed and untreated for years. He helped them join CareLink, which permitted them to receive the necessary radioactive iodine treatment. Many years passed, and earlier this year, a woman appeared at the Haven for Hope Skin Clinic. Upon seeing Dr. Usatine, the woman asked him, “Do you remember when I was at SAMM Clinic and you diagnosed me with hyperthyroidism? That moment changed my life. I was really suffering, and you gave back my life and health.” It turned out that, even after 17 years, this woman still remembered her time at the clinic when she was able to find support in a vulnerable moment in her life.

Likewise, at the Refugee Clinic, Dr. Farokhi recounts how everything began with a simple goal of trying to solve the medical and oral health concerns of the refugee population, and how this single goal has led to so many doors opening to opportunities that 12 years ago would have never been fathomable. With the aim of continuously developing better ways to serve the community, Dr. Farokhi shares that whenever students approach her for community service-learning projects, she never hesitates to mentor them.

“This,” she emphasized, “is where the learning happens,” referring to the interprofessional collaboration in serving patients. “The work never ends. It starts on Wednesday nights, but it is an ongoing effort … the responsibility is grand, yet the rewards are far greater than any of the challenges.”

While these interactions were one of many hundreds and thousands, these memories undoubtedly have and will continue to flourish within the hearts of every individual — patients, students and faculty alike.

From the interviews with devoted faculty, student clinic coordinators and volunteers alike, the overarching consensus is that the student-run free clinics are the quintessential embodiment of dedication, steadfast commitment and passion towards addressing the wellbeing of patients in otherwise marginalized communities in healthcare. To 24

SAN ANTONIO MEDICINE • December 2023

Leticia Bland, PA-C, and Beverly Hu at the SAMM Clinic.

all current and future healthcare professionals, we encourage you to take a leap and serve at these student-run free clinics in any capacity possible. Or, as Dr. Usatine states, “I hope it nourishes you and allows you to keep going.”

To learn more or to volunteer in the clinics, please visit www.studentrunclinics.org/engaged/.

Ruoxuan (Rosa) Su is a medical student at the Long School of Medicine, Class of 2026. She is a student leader and clinic coordinator at the student-run free clinic, Haven for Hope.

Andrew Ta is a medical student at the Long School of Medicine, Class of 2026. He is the 2023 Student-Faculty Collaborative Practice President overseeing the six student-run free clinics and is the 2023-2024 writing lead for Connective Tissue, the school's literature and arts journal. Andrew is also a member of the BCMS Publications Committee.

MEDICAL YEAR IN REVIEW

BCMS Celebrates an Employee Milestone

By Monica Jones, BCMS COO

Cindy Barron, Verification Specialist with the Bexar Credential Verification, Inc. (BCVI), celebrated 25 years working with the Bexar County Medical Society on Friday, October 6. Cindy has performed many roles during her time at BCVI; she started doing medical licenses and insurance updates, progressed to data entry clerk, and then became one of our best verification specialists.

Cindy looks back on her time here at BCMS. She has been through three office moves — French Place, the IH10 office next to the Blood and Tissue Center, and now at our permanent location on 1604. She noted, “The credentialing department has always been one big room with cubicles, but we are now in a bigger space with double computer screens.” Cindy said that in the last 25 years, she has seen credentialing change from requesting/sending out packets, and receiving verifications through mail, to all processes performed electronically, explaining, “We use email and our website portal to receive packets and verifications.

We used to print all forms and fax them out. When the forms were returned, we had to file them in each doctor’s file and record when the verification was received. We used the phone a lot to follow-up, but now we use secure email to communicate as well as secure online files.

No more paper.”

Reflecting back, Cindy shared, “BCMS is a great place to work at. I like what I do. The people I’ve worked with in the past and now are great people to work with. When I first started, I was single. Since then, I got married and have four sons. Two have already graduated high school, and my last two are in high school — one received his certification in diesel mechanics and the other is working on his certification in welding.”

Cindy goes above and beyond by attending our BCMS events when possible. She donates blood every year at our annual BCMS Blood Drive and attends our annual Auto Show.

Thank you, Cindy, for your years of service and dedication here at BCMS through the BCVI program. Congratulations on this milestone. We look forward to working with you for many more years to come.

Monica Jones is the Chief Operating Officer for the Bexar County Medical Society. She has been with the Society for three years.

Visit us at www.bcms.org

25

LEGISLATIVE

170 Years of Organized Medicine and Legislative Advocacy in San Antonio – Part 2 Key medicine Issues through the years

By Mary E. Nava, MBA

In September, we explored a number of key advocacy issues that BCMS has addressed over the past 170 years. In our historical research, we found that BCMS members have been advocating for medical issues since 1916, as evidenced by the BCMS library archives. In Part 2 of this series, we discuss key medicine issues over the last 20 years, including legislative activities in which BCMS collaborated with TMA and TEXPAC. The “Prompt Pay” law, SB 418, enacted by the 78th Texas Legislature, became effective immediately upon the signature of the Governor on June 17, 2003. Prior prompt pay legislation passed during the 77th Texas Legislature, only to be later vetoed by the Governor, leaving physicians stunned by this action. Key features of SB 418 included much-needed reforms of the prompt pay statutes, providing some relief for physicians from insurance company payment-delay tactics on “clean claims,” unfair contracting and verification procedures. The law also addressed unfair definitions of “billed charges.” Initially, the Texas Department of Insurance (TDI) proposed regulations faced resistance from the TMA. However, after discussions with TDI Commissioner Jose Montemayor, who was once a featured guest presenter at a BCMS General Membership meeting, the final rules 26

were revised in favor of physicians. The adopted regulations better reflected the legislative intent of SB 418.

In 2007, under the leadership of BCMS President Delbert Chumley, MD, BCMS and TMA physicians joined a non-partisan coalition in support of Proposition 15, the constitutional amendment requiring the creation of the Cancer Prevention and Research Institute of Texas (CPRIT). Proposition 15 also authorized the issuance of up to $3 billion in bonds payable from the general revenues of the state for the purpose of scientific research on all forms of human cancer. BCMS physicians and staff attended a press conference in support of Proposition 15 at the main campus of the Cancer Therapy and Research Center, since re-named the UT Health MD Anderson Cancer Center. Voters approved the measure in November of 2007.

During the 2008 TMA Annual Meeting, TexMed, held in San Antonio, BCMS staff worked with TEXPAC staff to hold a special reception on the evening prior to the start of the conference. TEXPAC, the political action committee of TMA, sponsored the reception, which attracted over a dozen state representatives and senators from San Antonio and around the state for a meet and greet with physicians, TMA Alliance members and

SAN ANTONIO MEDICINE • December 2023

county medical society staff in attendance.

BCMS physicians work closely with TEXPAC to organize and host legislative receptions for elected officials and candidates for office. Members of the BCMS Alliance have played a huge part in helping to organize many of these events over the years.

BCMS’ influence in legislative advocacy proved to be successful when physician members joined the TMA to host a Health System Reform Town Hall meeting in August of 2009. The Town Hall, which took place in the Norris Conference Center inside Wonderland Mall of the Americas (formerly Crossroads Mall), attracted over 300 attendees, including patients, physicians, medical professionals and representatives from the offices of San Antonio-elected officials. Attendees provided input on their concerns regarding Health System Reform. In addition, throughout the month of August, BCMS members attended individual meetings with members of Congress to also discuss Health System Reform.

The following year, in April of 2010, BCMS held a press conference, in conjunction with TMA and other county medical societies across the state, to launch TMA’s “One Million Signatures” drive to fix the Medicare Sustainable Growth Rate (SGR). In 2015, the Medicare Access and CHIP Reauthorization

LEGISLATIVE

Act (MACRA) was passed and signed into law, replacing the SGR. In November of 2012, BCMS members joined with TMA to participate in a Medicaid Congress listening session led by Medicaid Congress co-chair John Holcomb, MD. The listening sessions, conducted across the state, offered opportunities to gather suggestions from physician members on suggested changes to the state Medicaid program.

Another hot topic important to physicians in San Antonio is the Geographic Practice Cost Index (GPCI). BCMS hosted a General Membership meeting in November of 2014, which featured former TMA director of research and data analysis Donna Kinney, CPA. She presented to a group of approximately 100 members about how GPCI was initially established, what it is intended to do and what components are used to calculate the payment formula. GPCI, through the Centers for Medicare and Medicaid Services (CMS), adjusts physician compensation for three physician payment components: physician work, practice expenses and medical malpractice insurance rates by individual payment localities, of which the state is divided into eight payment localities. San Antonio, despite being the second largest city in the state, falls under the “Rest of Texas” category, which adversely affects physicians when the fee component calculations are considered. Because the GPCI structure is budget-neutral, an increase to one area of the state would require a cut to another part of the state.

In December 2017, BCMS physicians and staff attended a news conference at City Hall promoting the importance of the Tobacco 21 ordinance under consideration at the time.

Tobacco 21 would raise the age for purchasing tobacco products from 18 to 21. Once again, BCMS physician members were front and center in support of the ordinance. BCMS President Leah Jacobson, MD, a member of the Tobacco 21 Steering Committee, spoke both at the news conference and testified before the City Council during the “Citizens to

be Heard” portion of the public hearing. Joining her in testimony were Dan Deane, MD and Joel Reyes, MD. San Antonio voters passed the ordinance in 2018. The next year, during the 86th Texas Legislative Session, San Antonio state legislators led efforts to pass a similar measure into law, becoming effective September 1, 2019.

The 87th Legislative Session started in 2021, in the midst of the COVID-19 pandemic.

Though in-person participation during the 87th Legislative Session came to a screeching halt for BCMS members and staff, except for a handful of physicians who were called up to testify in committee, all meetings with our legislators took place via Zoom. While not the preferred way to meet, Zoom has become “part of life” now, and its effectiveness in replacing in-person meetings allowed an added benefit to physicians’ time schedules. Important key legislation that passed during the 87th Session included HB 3459 — the prior authorization “Gold Card” bill, which would remove administrative prior authorization requirements for routine prescriptions and treatments. The legislation would allow physicians to earn a “Gold Card” exemption from health plans if the physician achieved a 90 percent approval rating per procedure and per health plan in one plan year, therefore earning a “Gold Card” for the next year; HB 133 — which would extend Medicaid coverage for eligible women to six months postpartum instead of 60 days after a woman gives birth or miscarries; HB 2658 — which would improve Medicaid coverage for children under 19 years of age, providing two consecutive six-month periods of coverage with verification of a child’s continued eligibility; SB 248 — which would establish licensure requirements for e-cigarette retailers and call for vaping products to be regulated the same as other tobacco products; and HB 1445 — which would eliminate a sales tax on outsourced medical billing services.

On the federal front, the No Surprises Act, enacted in December 2020, was closely watched by TMA during the rule-making

process. TMA filed a lawsuit in October of 2021, challenging the Health and Human Services interim final rule language. In February of 2022, the court released an opinion in favor of TMA. The final rule was released in August of 2022, which led to TMA filing a second lawsuit challenging certain provisions of the final rule. Then in November of 2022, TMA filed a third lawsuit challenging portions of the agencies’ July 2021 interim rules that artificially deflate the qualifying payment amount (QPA), resulting in under-reimbursements from health plans. A fourth lawsuit challenged the excessive processing fees proposed late in 2022 by Health & Human Services.

The 88th regular session of the Texas Legislature adjourned in May of 2023. TMA physician members, with support from the TMA Alliance and county medical societies, were back in person at the Capitol to fight for medicine’s issues. They were able to stop scope of practice creep, including two bills that would have enabled advanced practice registered nurses to practice independently. TMA also secured an increase in GME funding; improvements to women’s reproductive health, with a last-minute bill signed by the Governor that now provides some legal defenses under Texas’ abortion ban when treating certain potentially life-threatening pregnancy complications; an increase in physicians’ Medicaid payments of six percent to improve access to pediatric services and six percent in Medicaid payment rates for labor and delivery; extended postpartum Medicaid coverage from two months to a full year; protected medical liability reforms; prevented any new measures criminalizing patient care, thereby protecting the patient-physician relationship; built upon the success of last session’s Gold Card law by advancing further prior authorization reform restricting insurers from requiring more than one prior authorization request annually for vulnerable patients; protected vaccine laws; improved network adequacy; protected the 2019 Texas surprise billing law; and a state budget increase of $4.3 million for tobacco cessation and prevention. continued on page 28 Visit us at www.bcms.org

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LEGISLATIVE continued from page 27

Medicine’s issues/topics over the years from 2000-2023 (in no particular order): STATE TDI rules and regulations Tort Reform/Prop 12 Prompt Pay Sunset Review Texas Workers’ Compensation Commission Texas Medical Board (TMB)/ Medical Practice Act Scope of Practice Medicaid/CHIP PCCM/Primary Care Case Management HMOs Medical Liability Expert Witness Testimony Tax on Physician Services Physician Ownership Access to Care Business Activity/Franchise Tax Balance Billing Inadequate Networks In-store Clinics Medicaid Reimbursement Graduate Medical Education (GME) Silent PPOs Automatic Credentialing Regulation of physician oversight of physician extenders Expedited network provider membership for new physicians Cancer Prevention and Research Institute (CPRIT)/Prop 15 Health Plan Cost Transparency Obesity Tobacco use Immunization Rates Physical Education in schools Texas Advanced Directives Act End of Life Care Health Plan Smart Card Technology Health Information Technology Geographic Practice Cost Index (GPCI) Corporate practice of medicine Physician education loan repayment Mental healthcare funding Prescription monitoring system Patient-physician relationship Clinical autonomy Public health Dual-eligible

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Women’s health Maternal and child health State budget Physician workforce Border Health Price transparency in healthcare Occupations tax Preferred provider benefit plans Exclusive provider organizations ER temporary holds EPI pens in schools Telemedicine E-cigarettes Direct contracting for primary care Controlled substance registration program (CSR) TDSHS Medicaid OIG Utilization review appeals Health plan drug formularies Health plan network directories Expanded balance billing mediation Medication step therapy Tobacco 21 – raising the age for using tobacco products Maintenance of certification Virtual credit cards Texting while driving Infectious diseases Parents’ right to know about vaccine exemptions DNR orders Prior Authorizations/Gold Carding Pharmacy Benefit Managers (PBMs) Tax on vape products Redistricting Uninsured Health Emergency Response Medicaid expansion Abortion Medical marijuana White-bagging policies Nonmedical switching Copay accumulators Emergency care Patient choice limitations by disincentivizing cash payments Healthy Food is Good Medicine pilot program Opioid crisis Contraception

SAN ANTONIO MEDICINE • December 2023

FEDERAL Medicare SGR Medicare Physician Payment Cuts Federal Prompt Pay The CHAMP Act Federal health system reform ACA MACRA Federal 21st Century Cures Act ICD-10 Coding No Surprises Act

CITY COUNCIL ACTIVITIES AND PARTICIPATION: Fluoride Campaign Smoke-Free San Antonio Coalition Tobacco 21 Ordinance

Mary E. Nava, MBA, is the Chief Government Affairs Officer for the Bexar County Medical Society. She has been with the Society for 23 years.

SAN ANTONIO MEDICINE

OLIVER HENRY JOHNSON, JR. MD

In Memoriam

Kaye Evan Wilkins, DVM, MD September 22, 1934 – October 25, 2023

Oliver Henry Johnson, Jr., MD June 7, 1946 – November 3, 2023

Dickey Huey, MD November 11, 1942 – November 2, 2023

Oliver Johnson, Jr., MD, was a retired Anesthesiologist who dedicated 30 years to the medical field. He chaired the BCMS Physicians Health and Rehabilitation Program for 28 years.

Dr. Johnson’s passion for photography took him on photo trips around the world, and BCMS is honored to feature his work in San Antonio Medicine magazine.

Hilario Trevino, MD November 10, 1931 – November 23, 2023

Visit us at www.bcms.org

29

BOOK REVIEW

The Future of AI in Medicine: Unlocking a New Era in Healthcare

By David A. Schulz & ChatGPT3.5

Rounding the bases to hit a homerun, “The AI Revolution in Medicine: GPT-4 and Beyond,” takes four authors: Peter Lee (VP of Research and Incubations at Microsoft), Carey Goldberg (health science and medicine reporter), Isaac Kohane (inaugural chair of Harvard’s Department of Biomedical Informatics), and Sébastien Bubeck (principal research manager in the machine learning foundations group at Microsoft Research) to confirm results. Together, they’ve produced a work that enlightens, inspires, astonishes and warns.

Much of it is in the form of problems asked of ChatGPT-4 and its responses, followed by analysis and a review of its accuracy (pretty high: when given a full battery of USMLE problems, GPT-4 answered correctly more than 90 percent of the time — and provided detailed reasoning behind its answers).

Here, our goal is simpler: encourage readers to access the free GPT-3.5 now available and 32

test the book’s virtuosity against the everchanging impact of “smart computing” on professional healthcare. To achieve it, I’m cowriting with the AI itself, as it seems the most reasonable way to introduce y’all.

To get on the same page, let’s ask the AI to explain itself: What are you?

I am ChatGPT, a computer program created by OpenAI. I'm based on the GPT-3.5 architecture, which stands for "Generative Pre-trained Transformer 3.5." I'm designed to generate human-like text based on the input I receive. My primary function is to provide information, answer questions, assist with tasks and engage in natural language conversations with users like you.

I don't have consciousness, emotions or awareness. Instead, I generate responses by predicting and generating text based on patterns and information present in the large dataset I was trained on, which includes a wide

SAN ANTONIO MEDICINE • December 2023

range of text from the internet. My responses are generated algorithmically, and I aim to be helpful and informative to the best of my abilities based on the input you provide. If you have any questions or need assistance with something, feel free to ask, and I'll do my best to assist you.

Can you explain how AI can augment healthcare providers and patients? And, how is GPT-4, the subject of this book, different from 3.5?

The cornerstone of the AI revolution in medicine is GPT-4. This advanced AI model represents a significant leap forward in technology from previous releases. Its enhanced natural language understanding and generation capabilities make it a powerful tool for healthcare professionals. It can process complex medical information with unparalleled accuracy, paving the way for more precise and informed decision-making.

BOOK REVIEW

If you wanted to point to only five features for a readership of healthcare providers, what would impress them the most?

Enhanced Diagnostics: Precision and Timeliness GPT-4's diagnostic accuracy is a gamechanger. It excels in analyzing vast datasets, including patient medical records, lab results and imaging, enabling physicians to make quicker, more accurate diagnoses. This capability has the potential to significantly reduce diagnostic errors and improve patient outcomes.

Personalized Treatment Plans: Tailoring Care for Individuals Beyond diagnosis, GPT-4 delves into personalized treatment recommendations. It takes into account each patient's unique medical history, genetics and preferences. Physicians can use this information to tailor treatment plans, optimizing therapeutic outcomes and minimizing adverse effects.

Efficient Documentation: Liberating Physicians' Time Physicians often grapple with extensive paperwork and documentation. GPT-4 can alleviate this burden by automating medical charting and documentation tasks. This enables doctors to redirect their focus towards what truly matters: patient care.

Drug Discovery and Research: Accelerating Innovation AI, including GPT-4, plays a pivotal role in drug discovery. By rapidly analyzing vast datasets, predicting potential drug candidates, and simulating their effects, AI expedites the development of novel treatments and therapies. This promises hope for previously incurable conditions.

Patient-Provider Communication: Bridging the Gap GPT-4's natural language capabilities facilitate seamless communication between patients and healthcare providers. It can generate easy-

to-understand explanations of medical conditions and treatment options, empowering patients to actively engage in their healthcare journey. Improved communication fosters trust and compliance, enhancing overall patient care.

Chat-3.5, intriguingly, is yet unaware of the subject book itself, its last “training session” was two years prior to publication. Yet, the books’ authors highlight precisely the same arenas, and promise the same level of provider-augmentation hinted above. In the book, it becomes clear that GPT-4 has the ability to both clear desks of paperwork, and minds of busy-work.

When presented a standard problem in nursing, the administration of an IV drip of “Zosyn 3.375g in 50 mL D5W to run over 20 minutes,” and asked, “How many drops per minute do I set if the IV tubing has a drop factor of 15?” the response is both mathematically verified and Chat “shows its work” for proof; but that’s just the beginning.

Asked to create a web-app for the general problem, it provides the code for simple JavaScript web application to calculate the drops per minute for an IV infusion. Asked to define it in Excel terms, it delineates a spread sheet formula and layout. Asked to create a pocket-sized, easy-to-read card for common values?

“Sure, here’s an example of a table that you could print on a small card to quickly look

up the drops per minute for common values of infusion volume and infusion time, assuming a drop factor of 15:” (above) “The AI Revolution in Medicine: GPT-4 and Beyond” lives up to its title — the explanations and examples have a clarity rarely seen in technical surveys. It proved so enjoyable, I indulged in both Kindle and Audiobook editions. The “spoken word” is an acid-test for readability — the eye accepts what the ear finds jarring. The book proved worthy of both a close read and a close listen. In example after example, the authors prove their point: that the future of AI in medicine is bright, but it requires active engagement from physicians and healthcare professionals.

They encourage physicians to view AI as a valuable ally, not a replacement. Collaboration between the medical community and AI developers is essential to ensure responsible and effective AI deployment.

“Together,” the authors say, “we can harness the power of AI to enhance patient care, improve outcomes, and usher in a new era of healthcare excellence. The future is here, and it's time to embrace it.”

David Alex Schulz, CIPP, is a founding partner of Cyber Risk Associates of San Antonio, devoted to the privacy and security of information. He is a member of the BCMS Publications Committee.

Visit us at www.bcms.org

33

SAN ANTONIO MEDICINE

5 Steps to Take Now to Prepare Your Practice for 2024

By Christopher Davis, CPA

Ready or not, a new year is just around the corner. No matter how this year is going for you and your practice, steps you take between now and the end of this year can go a long way toward building a strong foundation for 2024.

Here are five practical actions you and your team can implement before the new year starts to make 2024 your best year yet: 1. Review and Reconcile First, review and reconcile your financial statements to ensure accuracy and identify any discrepancies. During this review, medical practices should compare the information within these statements to the corresponding source documents, such as invoices, receipts, bank statements and vendor invoices. The main objective is to verify that all the financial transactions recorded in the statements accurately reflect your practice's business activities.

Reviewing financial statements helps identify any errors, omissions or inconsistencies that might have occurred during the recording process. It also allows the practice to spot any fraudulent activities or irregularities that could impact the financial health of the business. By ensuring the accuracy of financial statements, medical practices can make more informed decisions regarding fiscal management and budgeting for the new year.

If any discrepancies or errors are identified during the review, appropriate corrective actions should be taken immediately. This could involve revising journal entries, contacting 34

vendors or clients for clarification, or conducting further investigations into questionable transactions. Regularly reviewing and reconciling financial statements is crucial for maintaining the financial integrity of a medical practice and assisting in the preparation of accurate tax returns.

2. Billing and Coding Updates Practice managers should evaluate and update billing and coding procedures to optimize reimbursements and minimize errors.

Evaluating and updating billing and coding procedures is crucial for medical practices to optimize reimbursements and minimize errors in financial operations. Effective billing and coding practices ensure that healthcare services are accurately documented, coded and billed to insurance companies, Medicare and patients.

To optimize reimbursements, medical practices need to ensure that coding procedures align with the current industry standards, guidelines and regulations. This involves staying up to date with the latest coding revisions, such as the ICD-10-CM and CPT coding systems, and understanding the specific coding requirements of different insurance providers.

During the final few months of the year, practices should review coding processes and look for opportunities to improve accuracy and efficiency. This could include a coding audit to identify any coding errors or inconsistencies and taking steps to rectify them promptly.

SAN ANTONIO MEDICINE • December 2023

Staff training and education on coding updates before the year ends can play a vital role in minimizing errors and maximizing reimbursements in the coming year.

In addition to coding, evaluate and update billing procedures. This involves verifying that medical claims are submitted accurately and in a timely manner. Practices should review billing workflows to identify any bottlenecks or areas for improvement. It is essential to check for common errors, such as missing or incorrect patient demographics, incorrect insurance information or incomplete documentation.

By optimizing billing and coding procedures, medical practices can maximize reimbursement rates, reduce claim denials, and minimize the risk of audits or penalties due to non-compliance. This not only improves the financial health of the practice but also ensures that patients receive accurate billing information and that insurance claims are processed efficiently.

Medical practices should involve billing and coding experts or consultants who can provide guidance and support in navigating the complexities of the reimbursement process. These professionals can assist in identifying areas for improvement, implementing best practices, and training staff on proper coding and billing procedures.

3. Grab Available Deductions Medical practices can strategically plan for

SAN ANTONIO MEDICINE year-end purchases or investments to take advantage of available tax deductions. One common strategy is to consider purchasing necessary equipment, supplies or technology before the end of the year. These purchases can qualify for tax deductions under section 179 of the internal revenue code, which allows businesses to deduct the full purchase price of qualifying equipment in the year of purchase, rather than having to depreciate it over several years. This deduction can help reduce the practice's taxable income for the current year, potentially resulting in significant tax savings.

Medical practices should assess equipment needs, considering any upcoming upgrades or replacements, and determine whether it would be advantageous to make these purchases before the end of the year to take advantage of the section 179 deduction.

Another consideration for year-end purchases or investments is to evaluate opportunities for making contributions to retirement plans, such as a simplified employee pension (SEP) IRA or a 401(k) plan. By contributing to these plans before the end of the year, medical practices can not only provide retirement benefits to employees but also receive tax deductions for the contributions. These deductions can help reduce the practice's taxable income for the year and potentially result in tax savings.

It's important for medical practices to consult with a qualified tax accountant who is knowledgeable about healthcare accounting and tax regulations. They can provide advice specific to the practice's financial situation and help identify potential purchases or investments that qualify for tax deductions.

4. Check for Tax Changes Consulting with a tax professional is crucial for medical practices to ensure compliance with any changes in tax laws or regulations.

Tax laws and regulations are dynamic and subject to frequent updates and revisions, particularly in the healthcare industry. Staying informed and up to date on these changes is essential to avoid penalties, maximize deductions, and maintain compliance.

Engaging a tax professional who specializes in healthcare accounting and tax regulations

can provide valuable guidance and assistance to medical practices. These professionals have expertise in interpreting complex tax laws and can help practices understand how the changes may impact financial operations. Tax professionals monitor changes in tax codes, regulations and reporting requirements specific to the medical field. They help practices navigate these changes and ensure that business practices align with the new regulations.

This includes providing advice on proper record-keeping, reporting and documentation procedures to meet compliance requirements.

Additionally, tax accounting professionals can conduct periodic tax reviews and assessments to identify any potential areas of noncompliance or tax-saving opportunities. They can analyze the financial records and transactions of medical practices to identify potential tax deductions, credits or incentives for which the practice may qualify.

Through consultation with tax professionals, medical practices can benefit from accurate tax planning and strategies tailored to specific circumstances. These professionals can help practices optimize tax position, reduce the risk of errors or non-compliance, and ensure that any tax-related issues are addressed promptly and appropriately. It is important for medical practices to establish an ongoing relationship with a reputable tax professional who can provide guidance throughout the year, not just during tax season. Regular communication and collaboration with these professionals can help practices stay on top of any changes in tax laws or regulations and ensure continued compliance and financial stability.

5. Set Goals and a Budget Creating a budget and setting financial goals is essential for medical practices to ensure financial stability and growth in the upcoming year. This process involves developing a formal plan that outlines the practice's anticipated income, expenses and financial objectives.

To begin, medical practices need to assess historical financial performance, and project revenues and expenses for the upcoming year.

This can be done by analyzing previous financial statements, considering factors such as pa-

tient volume, fee schedules, insurance reimbursements and anticipated changes in the healthcare landscape. Based on this analysis, practices can establish a budget that allocates resources appropriately for various operational expenses such as staff salaries, rent, utilities, medical supplies, marketing and other overhead costs. The budget should reflect the practice's financial reality while ensuring that expenses align with revenue projections.

In addition to budgeting, it is crucial for medical practices to set specific financial goals for the upcoming year. These goals can vary depending on the practice's unique circumstances and objectives. Some common financial goals may include increasing revenue, reducing expenses, improving profitability, expanding services, or achieving a certain level of savings or investment. Setting financial goals provides a clear direction and motivation for the practice to work toward. It helps prioritize efforts, allocate resources effectively, and make informed decisions. Practices should set realistic and measurable goals that can be tracked and evaluated regularly to gauge progress and make adjustments as needed.

To support the creation of a budget and set financial goals, medical practices may consider engaging the services of a financial advisor or consultant. These professionals can provide expertise in financial planning and help practices develop a comprehensive budgeting and goal-setting process that aligns with the practice’s specific needs. By creating a budget and setting financial goals, medical practices establish a framework for financial success. It allows monitoring of financial performance, informed decision-making, and adaptability to changes in the healthcare industry while working toward long-term objectives.

The professionals at Sol Schwartz & Associates have been supporting physicians and medical practices since 1980. Our healthcare practice team stands ready to assist you and your practice as you prepare for 2024. To learn more, contact Christopher Davis at cbd@ssacpa.com of the Sol Schwartz & Associates healthcare practice team. www.ssacpa.com/practice-areas/healthcare/ Visit us at www.bcms.org

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BCMS AUTO SHOW

37th Annual BCMS Auto Show BCMS held our 37th Annual Auto Show on Thursday, October 19. Over 250 BCMS physicians and family members attended. It was a beautiful evening filled with food, drinks and a live performance by Nathan Bibiano. Thank you to our Sponsors: Brenner’s Steakhouse, Fogo De Chao, Genesis Care, Hard Rock Café and Peace of Cake. Thank you to the following Dealerships: Gunn Acura, Audi Dominion, Northside Chevrolet, Chuck Nash Auto Group, Bluebonnet Dodge, Northside Ford, Northside Honda, Gunn Honda, Jaguar Land Rover San Antonio, North Park Lexus, North Park Lexus at Dominion, North Park Lincoln, Mercedes-Benz of Boerne, Mercedes-Benz of San Antonio, North Park Subaru, North Park Subaru at Dominion, Porsche of San Antonio, Cavender Toyota and North Park Toyota for displaying their attractive vehicles and making the night so special. Save the date for next year’s Annual Auto Show, October 17, 2024.

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SAN ANTONIO MEDICINE • December 2023

BCMS AUTO SHOW

Visit us at www.bcms.org

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BCMS SAN FERNANDO HEALTH FAIR

San Fernando Health and Safety Fair On Saturday, October 7, physicians, residents, medical students and volunteers participated in the 30th Annual San Fernando Health and Safety Fair. What a successful event! The BCMS “Ask a Doctor” booth surveyed over 70 attendees, asking if they have received their COVID-19 vaccination, flu shot, and if childhood vaccinations were up to date. Our volunteers passed out informative vaccination hesitancy documents and guided the non-vaccinated to the Metro Health Clinic, which was strategically placed next to our “Ask a Doctor” booth. Metro Health reported a total of 91 vaccinations administered. BCMS physicians helped attendees read their screening results, fielded questions and provided guidance.

BCMS medical students staffed the blood pressure station who saw over 100 attendees.

Special thank you to Dr. Wendy Kang, Dr. Mary Nguyen, Dr. Carlos Orozco, Dr. Junda Woo and Dr. Wendy Wu for helping us make the San Fernando Health and Safety Fair a triumph.

It would have not been possible without their dedication to serving others.

For more information on the San Fernando Health and Safety Fair, go to www.sfhsf.org.

For Vaccination Hesitancy Information and COVID-19 information, go to the BCMS website at www.bcms.org/CVMEL.php.

“Thank you to all those involved with planning this community event. I am honored to help keep our community healthy.

I was able to connect with my colleagues and meet new friends. It was wonderful to see all the volunteers present, especially medical students and high school students who willingly gave up their free time to help their community.” –Dr. Mary Nguyen

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SAN ANTONIO MEDICINE • December 2023

BCMS 1853 LUNCHEON

1853 Club Luncheon The 1853 Club met on October 10, 2023 at the BCMS headquarters. Michael Clark from Aspect Wealth Management was our guest speaker.

The next luncheon for the 1853 Club will take place on January 9, 2024 at 11:30 a.m. at the BCMS headquarters. Spouses or guests are welcome to join us.

If you are interested in receiving information about this and other 1853 Club events, please call the BCMS Membership Department at 210-301-4371 or email membership@bcms.org.

Visit us at www.bcms.org

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Shop Vendors Who Support BCMS BCMS Vendor Directory We encourage you to use our supporting vendors whenever you or your practice needs supplies or services.

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.”

ASSET WEALTH MANAGEMENT

Aspect Wealth Management (★★★ 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.

Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Your wealth. . .All aspects”

BANKING

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

Thomas M. Duran SVP, Private Banking Team Lead 210-283-6640 TDuran@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 groups and individual physicians.

Our local insurance professionals are some of the few agents in the

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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

210-503-0003 kevin@genicslabs.com Artyom Vardapetyan Managing Partner 210-503-0003 www.genicslabs.com “Accurate results in record time.”

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.

Robert Lindley SVP | Private Banking Team Lead 210-343-4526 Robert.Lindley@amegybank.com Denise Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com Scott Gonzales Assistant Vice President | Private Banking 210-343-4494 Scott.Gonzales@amegybank.com www.amegybank.com “Community banking partnership”

Livingston Med Lab (HH Silver Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics.

Robert Castaneda (CEO) 210-316-1792 Robert@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

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!”

CLINICAL DIAGNOSTICS

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology.

Yulia Leontieva Managing Partner, Physician Liaison 210-503-0003 yulia@genicslabs.com Kevin Setanyan Managing Partner

SAN ANTONIO MEDICINE • December 2023

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

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.

Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Your wealth. . .All aspects”

GERIATRICS/PRIMARY CARE

Conviva Care Center (HHH Gold Sponsor) Conviva’s value-based care model allows physicians to deliver high quality, personalized care and achieve better outcomes, while feeling free to focus on health equity and patient outcomes.

Kim Gary Senior Physician Recruiter 812-272-9838 KGary4@humana.com www.ConvivaCareers.com “Fuel Your Passion & Find Your Purpose”

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center (HHH Gold Sponsor) UT Health provides our region with the most comprehensive care through expert, compassionate providers treating patients in more than 140 medical specialties at locations throughout San Antonio and the Hill Country.

UT Health San Antonio Physicians Regina Delgado Business Development Manager 210-450-3713 delgador4@uthscsa.edu UT Health San Antonio MD Anderson Mays Cancer Center Laura Kouba Business Development Manager 210-265-7662 norriskouba@uthscsa.edu https://uthscsa.edu/ Appointments: 210-450-1000 UT Health San Antonio 7979 Wurzbach Road San Antonio, TX 78229

HOSPITALS/ HEALTHCARE SERVICES

Equality Health (HHH Gold Sponsor) Equality Health deploys a wholeperson care model that helps independent practices adopt and deliver value-based care for diverse communities. Our model offers technology, care coordination, and hands-on support to optimize practice performance for Medicaid patients in Texas.

Cristian Leos Network Development Manager 210-608-4205 cleos@equalityhealth.com www.equalityhealth.com Reimagining the New Frontier of Value-Based Care. Visit www.equalityhealth.com

focus on growth.

Cynthia Marshall Business Performance Advisor 210-558-2520 cynthia.marshall@insperity.com Dayton Parker Business Performance Advisor 210-558-2517 dayton.parker@insperity.com www.insperity.com “Insperity’s mission is to help businesses succeed so communities prosper”

INSURANCE

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.”

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 healthcare 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 healthcare 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

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, RPLU, ARM AVP Market Manager, SW Division 512-658-0262 Fax: 844-293-6355 Kirsten.Baze@medpro.com www.medpro.com

INVESTMENT ADVISORY REAL ESTATE

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Alamo Capital Advisors is 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 development acquisitions and sales, lease representation and financial (RE)-structuring for existing investments.

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

MEDICAL BILLING AND COLLECTIONS SERVICES Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL SUPPLIES AND EQUIPMENT

HR HUMAN RESOURCES Insperity (★★Silver Sponsor) Insperity’s HR solutions offer premium service and technology to facilitate growth by streamlining processes related to payroll, benefits, talent management and HR compliance. We provide the tools to help you lighten your administrative load, maximize productivity and manage risks – so you can

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.”

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

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.”

PHYSICIAL SUPPORT SERVICES

Provider's Choice Scribe Services (★★★ Gold Sponsor) Our accurate and complete documentation helps our customers focus on what’s most important, their patients. Let us take on the task of documenting your patient encounters, it’s what we do.

Yoceline Aguilar COO yaguilar@pcscribes.com 915-691-9178 Luis Chapa MD/CEO 210-796-4547 lchapa@pcscribes.com https://www.providerschoicess.co m/ “An Unparalleled Scribe Experience”

PRACTICE MANAGEMENT

Equality Health (★★★ Gold Sponsor) Equality Health deploys a wholeperson care model that helps independent practices adopt and deliver value-based care for diverse communities. Our model offers technology, care coordination, and hands-on support to optimize practice performance for Medicaid patients in Texas.

Cristian Leos Network Development Manager 210-608-4205 cleos@equalityhealth.com www.equalityhealth.com Reimagining the New Frontier of Value-Based Care. Visit www.equalityhealth.com

continued on page 42

Visit us at www.bcms.org

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BCMS Vendor Directory PROFESSIONAL ORGANIZATIONS Healthcare Leaders of San Antonio (HH Silver Sponsor) We are dedicated to nurturing business connections and professional relationships, exchanging knowledge to enhance leadership, and creating career opportunities for healthcare and other industry leaders in a supportive community.

David Neathery President 210-797-8412 healthcareleaderssa@gmail.com Gary Meyn, LFACHE Vice President 210-912-0120 gmeyn@vestedbb.com https://healthcareleaderssa.com/ “Come, Learn, Connect!”

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!

Kevin Barber President 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.

Lindsey Herman Nolan, MHR, CMPE President info4@samgma.org www.samgma.org

new development acquisitions and sales, lease representation and financial (RE)-structuring for existing investments.

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

RETIREMENT PLANNING

Oakwell Private Wealth Management (★★★ 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.”

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Alamo Capital Advisors is 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

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continued from page 41

TRANSCRIPTION SERVICES

Provider's Choice Scribe Services (★★★ Gold Sponsor) Our accurate and complete documentation helps our customers focus on what’s most important, their patients. Let us take on the task of documenting your patient encounters, it’s what we do.

Yoceline Aguilar COO yaguilar@pcscribes.com 915-691-9178 Luis Chapa MD/CEO 210-796-4547 lchapa@pcscribes.com www.providerschoicess.com/ “An Unparalleled Scribe Experience”

Visit us at www.bcms.org

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AUTO REVIEW

2023 Mercedes-Benz GLS 580 SUV

By Stephen Schutz, MD

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SAN ANTONIO MEDICINE • December 2023

AUTO REVIEW

Mercedes-Benz continues to be a leader in the luxury automotive arena, setting high standards for comfort, performance and technology. The 2023 GLS 580 SUV continues that tradition, offering a blend of sophistication, power and innovation that makes it a strong contender in a highly competitive segment.

The GLS 580 features a distinctive design that conveys a sense of luxury and prestige. Mercedes has successfully incorporated its signature design elements into an SUV that’s both elegant and imposing.

The front showcases the brand's three-pointed star — too big, in my opinion — framed by a big grille and modern LED headlights. The body lines flow smoothly from front to rear, giving the GLS 580 a commanding stance, which I like, and the (optional) 21-inch alloy wheels add a touch of sportiness. Narrow LED taillights in the rear are seamlessly integrated, contributing to an overall harmonious design. This is a good-looking vehicle.

When it comes to the interior though, the GLS 580 doesn't exude luxury to the same extent as some of its competitors, particularly the Lexus LX 600. While it includes high-quality materials like plush leather upholstery, hand-finished wood trim and attractive metal accents, discerning buyers may find that some of the finishes don't reach the level of luxury expected in this price range. My two cents is that the GLS interior is no longer as nice as that of the S580 sedan (or the aforementioned Lexus).

I blame electrification. Switching focus to making all of their vehicles completely electrified by 2035 has, in my opinion, forced Mercedes and other manufactures to decontent their internal combustion vehicles to save money.

Nevertheless, seating comfort is excellent in all three rows, with ample legroom and headroom for passengers of all sizes. The front seats offer heating, cooling and massage functions for added comfort on long journeys. The second-row is fine, and the third row can actually accommodate adults in reasonable comfort. Thank you, Mercedes!

In addition, the GLS’ cabin offers ample storage space, and the rear seats can be easily folded down (electronically) to provide a substantial cargo area, making it capable of handling large loads when needed. The power-operated tailgate simplifies loading and unloading, and the low cargo floor ensures that heavy items can be easily maneuvered into place.

The dashboard features dual 12.3-inch displays that serve as the centerpiece of the infotainment system. Mercedes’ MBUX system is intuitive and responsive, providing access to a variety of functions, including navigation, entertainment and connectivity options. Voice control and gesture recognition add to the user experience. As MBUX evolves, I like it more and more.

Under the hood, the GLS 580 features Mercedes’ familiar 4.0-liter

V8 biturbo engine paired with an EQ Boost mild-hybrid system. This powerplant delivers 483 HP and 516 lb-ft of torque, with an additional 21 HP and 184 lb-ft of torque available for short bursts when needed. The result is confident and smooth acceleration that takes the GLS 580 from 0 to 60 MPH in 5.2 seconds. The EQ Boost system also contributes to improved fuel efficiency by capturing energy during deceleration. Nevertheless, the EPA rates the GLS 580 at just 18 MPG city/23 highway.

The 9-speed automatic transmission shifts very smoothly, contributing to a comfortable driving experience.

Despite its size and weight, the GLS 580 handles pretty well. The standard air suspension adjusts to all road conditions, offering a soft ride in Comfort mode and a more responsive feel in Sport mode. The optional E-Active Body Control system further enhances handling.

While time spent behind the wheel of the GLS 580 is very pleasant, it isn’t the most engaging vehicle on the road. It’s a big SUV, are you surprised?

The GLS 580 is equipped with a range of advanced driver-assistance features, including adaptive cruise control, lane-keep assist, blind-spot monitoring and automated emergency braking. Presumably, these systems work together to provide a safer driving experience.

One interesting new feature is the augmented reality navigation system, which overlays the usual turn-by-turn directions onto a live video feed of the road ahead. I didn’t get the chance to test this new gizmo, but I think it points toward the future.

Not surprisingly, the GLS 580 comes with a hefty price tag. The $106,000 starting price tag will be a barrier for some potential buyers, especially since most customers add thousands of dollars in options and option packages, but it should be noted that the V6-powered GLS 450 base price is “just” $83,000.

The Mercedes GLS 580 is an excellent large luxury SUV for people who want a plush vehicle to tool around town in, haul kiddos or use for road trips. I wish its interior were as lux as the S-Class’ is, but it’s still very nice, and the driving experience is about as good as it gets in this market segment.

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 U.S. Air Force. He has been writing auto reviews for San Antonio Medicine magazine since 1995.

Visit us at www.bcms.org

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Kahlig Auto Group

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

Coby Allen 210-696-2232

Anthony Garcia 210-681-3399

Domingo Saenz 210-341-3311

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

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

William Boyd 210-859-2719

Matthew C. Fraser 830-606-3463 Kahlig Auto Group

Northside Ford 12300 San Pedro San Antonio, TX

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

14610 IH 10 West San Antonio, TX 78249

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

North Park Lexus 611 Lockhill Selma San Antonio, TX

Marty Martinez 210-477-3472

Jaime Anteola 210-744-6198

Tim Rivers 832-428-9507

Cameron Tang 210-561-4900

Jose Contreras 320-308-8900

Kahlig Auto Group

Kahlig Auto Group

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

North Park Lincoln 9207 San Pedro San Antonio, TX

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

James Cole 210-816-6000

Sandy Small 210-341-8841

James Godkin 830-981-6000

Chris Martinez 210-366-9600

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

Spencer Herrera 210-581-0474

Justin Boone 210-635-5000

Kahlig Auto Group

As of November 1, 2023, our loan rate will be

5.5% for 60 months with approved credit.

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

Jordan Trevino 210-764-6945