The Journal of Palm Beach County Medical Society (September-October 2011) by Palm Beach County Medical Society

The Journal of The Palm Beach County Medical Society

September - October 2011

The Circus of Medicine Has Another Ring In my first article, I wrote about three rings in the Circus of Medicine. After going to The Governance Institute Leadership Conference for hospital board members, I found there is a fourth ring that is more concerning than just dealing with local, state and national politics. The fourth ring involves the economists, the bean counters. We were presented with economic “facts” that all had the common theme of “unsustainable.” We were told that the US health care spending per capita in 2008 was $7,538. Next in line was Norway at $5,003, with figures adjusted for cost of living. Germany was $3,696. A hospital admission in the USA was $16,708 in 2006. Canada was $12,669 in 2007, Germany $4,566. We were told that if the current growth in healthcare expenses continues, the average American family will spend over 40% of their income in 2020 on health care! We will not be a popular profession! We do not hospitalize our patients more often, nor do we keep them in longer than other industrialized nations. But we sure do spend more once we have them! MRIs seem to be a standard test we use, and the costs for an MRI in the USA go from about $750 to over $2,000. We have huge differences in costs of care that do not correspond to local costs of living. We have dramatically different treatment habits that do not affect the outcomes of our patients. We were told that both our primary care physicians and, especially, our specialists, are paid more than our European colleagues when they use the Gross Domestic Product of a nation as a benchmark. (They do not compare us to the salaries of other professions in the USA or Europe.) The point here is these numbers are floating around in Congress, affecting the decisions made in Washington as well as every state capitol. The worst part is that our political leaders are being told that our outcomes aren’t significantly better than other countries. We may provide services sooner, but not necessarily better for common ailments. We may provide the best care in the world as relates to high risk super difficult problems, and have world renowned hospitals and specialists in them, but other countries equal us or are better than us in the areas of common problems and life expectancy. We spend an inordinate amount of money on people over 60. We spend huge amounts on end-of-life care, which skews the whole graph. We have large differences among even physicians treating the same disease or surgery even within the same hospital in Palm Beach County. We do not actively study or remedy these differences or even look to see if spending more results in a better outcome. Why does Medicare spend about $14,817 per person in McAllen, TX but only $7,947 in El Paso, TX? BTW…Blue Cross spent $2,266 in McAllen and $2,428

in El Paso in 2010. Our government is not ignorant of these differences. However, this does not mean that lowering physician income is the cure. There are no controls over the cost of drugs, nor the cost of devices such as orthopaedic joint prostheses or cardiac stents. Dr. Michado, current president of the Florida Medical Association is passionate about this issue. People and patients demand instant access to care, and have little desire to change their lifestyles that contribute to their problems, especially obesity and diabetes. Yet we get “blamed” for spending too much.

President’s Report

JAMES J. BYRNES, MD I PRESIDENT, PALM BEACH COUNTY MEDICAL SOCIETY

Nobody wants to discuss adequately the cost of end-of-life care. Should we spend $80,000 on a salvage chemotherapy cycle just to extend a life three to six months? Should we put a pacemaker in a 95-year-old, or start him on dialysis, especially if he is already suffering from dementia and is housed in a nursing home? We are at the mercy of the family’s emotions, too. How about the cost of premature babies? It seems we have lots of methods, and think we have the financial means, to do anything we, or the patients, think we can. “Unsustainable” is the phrase that jumped up again. How can we control the costs of health insurance when the government mandates what the companies must include? Should we not be allowed to provide our employees basic coverage we can afford rather than provisions that we/they don’t want or need? Does my 55-year-old nurse really need coverage for birth control pills or the morning after pill in her drug plan? There is also coming, in the new law, a clause that says insurance must provide these plus sterilization procedures. Oh, and you can’t refuse to provide this “benefit” on religious grounds unless you are registered as a tax-exempt church. We discussed ACOs. What a joke. We were told the ACO concept was put in the Affordable Care Act but was to be removed when it came to the Joint Conference Committee…. but that committee never happened. There was only one pilot project going on at the time in Virginia, and that ACO project LOST money! The bean counters do not believe that the majority of doctors/hospitals who form an ACO will ever see the advertised bonuses, and they will never get their start up costs back, estimated at $1.5 million! And the medical home? Nice idea without lots of hope. We cannot ignore these numbers that the folks in Washington, D.C. look at while they sit in a room sheltered from reality. We must stay active with our elected representatives, who, unfortunately, don’t always read all the bills they vote on. Their staffs remain ignorant of local healthcare issues.

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OnCall September - October 2011

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The Future of Medicine

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Director’s Desk

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AMA Update - Take Action Now: Tell Congress to Repeal Medicare’s Flawed SGR Formula

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Spotlight on Medicine: Palm Beach Center For Graduate Medical Education

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Multi-Stakeholder Medical Collaborative Considered for Palm Beach County

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Do You Know Who Your IRA Beneficiary is And Why It Matters?

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FPIC - Case Study: Inappropriate Documentation Constitutes Fraudulent Record

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5 Biases That Lead To Bad Decisions

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Med Memo

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PBCMS Membership

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For a complete list of presentations and panelists, go to www.pbcms.org

Palm Beach County Medical Society TENNA WILES I CEO, PALM BEACH COUNTY MEDICAL SOCIETY

Five years ago under the leadership of the PBCMS President Jose Arrascue, MD, the Palm Beach County Medical Society embarked on a journey for physicians to take a lead in transforming health care in Palm Beach County. In 2007, The Future of Medicine Initiative brought together physicians, hospitals, health care providers, business, government and community organizations and asked “what can we do to improve health care in our community?” The consensus was clear, we need to change direction and all sectors of the community must work together to: • Increase the number of people with access to health care and health insurance • Promote a culture of prevention and wellness • Improve patient safety and quality of care and • Enhance and support the viability of physician practices Over the past five years, new partnerships and community collaborations have developed, innovative plans have been undertaken and consensus for action established. The Future of Medicine leadership understands that attitudes around health system reform are diverse and we must come together to discuss issues, share views and develop a plan of action that is best for our community. This year’s Summit has been expanded to three days, October 27-29, and will be held at the Palm Beach Convention Center. Under the leadership of Michael Dennis, MD, the Future of Medicine Steering Committee and Host Committee have planned a dynamic conference featuring national, state and local health leaders. Please check out the detailed information on the on the Future of Medicine Summit, pages 15-16, and visit www.pbcms.org. We hope that you will join us. I would like to take this opportunity to thank the PBCMS physician leaders who have served on the Future of Medicine Steering Committee: Jose F. Arrascue, MD; James T. Howell, MD; Michael Dennis, MD; Stephen Babic, MD; Cynthia Clayton, MD; Claude Earl Fox, MD; Daniel Higgins, MD; Brent M. Schillinger, MD. They are the heart of this initiative. Special thanks to Scripps Florida for bringing an expanded dimension to our efforts and to our host committee, sponsors, and speakers for their contributions. Together we are “Creating a Healthy Future for Palm Beach County.” I look forward to seeing you at the Summit!

Director’s Desk

Leadership and Partnership

2011 Board of Directors

James J. Byrnes, MD. . . . . . . . . . . . President Jack Zeltzer, MD. . . . . . . . . . . . . . . President-Elect K. Andrew Larson, MD. . . . . . . . . . First Vice President Richard Raborn, MD . . . . . . . . . . . Second Vice President Malcolm Dorman, MD. . . . . . . . . . Secretary Ronald Zelnick, MD. . . . . . . . . . . . Treasurer Lawrence Gorfine, MD . . . . . . . . . Immediate Past President Brandon Luskin, MD . . . . . . . . . . . Member at Large Michael Lakow, MD . . . . . . . . . . . . Member at Large Andrew Shapirio, MD . . . . . . . . . . Chair, Council on Communications Brent Schillinger, MD . . . . . . . . . . Chair, Council on Ethical & Judicial Affairs Richard Greenwald,, MD. . . . . . . Chair, Medical Education Daniel R. Higgins, MD. . . . . . . . . . Chair, Health Information Technology Larry Gorfine, MD. . . . . . . . . . . . . . Chair, Council on Legislation and Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on Medical/Legal Affairs Daniel Kapp, MD. . . . . . . . . . . . . . . Co-Chair, Council on Legislation and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Council on Medical/Legal Affairs David Soria, MD . . . . . . . . . . . . . . . Chair, Council on Public Health & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Emergency Medicine K. Andrew Larson, MD. . . . . . . . . . Chair, Council on Membership William Adkins, MD. . . . . . . . . . . . Chair, Retired Physicians Section Maureen Whelihan, MD . . . . . . . . Chair, Women Physicians Section Hatem Abou-Sayed, MD . . . . . . . Chair, Young Physicians Section Richard Shugarman, MD . . . . . . . Chair, Specialty Section Harish Madhav, MD. . . . . . . . . . . . Co-Chair, Ethnic/Minority Section Roger Duncan, MD. . . . . . . . . . . . . Co-Chair, Ethnic/Minority Section Randy Gershwin, MD. . . . . . . . . . . Chair, Hospital Relations Mark Rubenstein, MD. . . . . . . . . . Chair, Bylaws Stephen Babic, MD. . . . . . . . . . . . . Chair, MEDPAC Andrew Shapiro, MD. . . . . . . . . . . West District Representative Shawn B. Baca, MD. . . . . . . . . . . . . South District Representative Mark Brody, MD . . . . . . . . . . . . . . . Central District Representative Alan B. Pillersdorf, MD . . . . . . . . . AMA/ FMA Liaison Jose F. Arrascue, MD . . . . . . . . . . . PBCMS Services Liaison Jacqueline Pevny, MD. . . . . . . . . . Member at Large Joan St. Onge, MD . . . . . . . . . . . . . Member at Large Dyani Loo. . . . . . . . . . . . . . . . . . . . . Medical Student Representative

Palm Beach County Medical Society 2011 Board of Trustees

Lawrence Gorfine, MD Maureen Whelihan, MD Daniel R. Higgins, MD Jose F. Arrascue, MD Alan B. Pillersdorf, MD Brent M. Schillinger. MD

Mark Rubenstein, MD Jack Zeltzer, MD K. Andrew Larson, MD James J. Byrnes, MD Richard Raborn, MD

Staff: Tenna Wiles, CEO Tara Auclair Ryan, Director of Marketing and Community Relations Yvonne Shapiro, Director of Communications Ashley Eckes, Director of Disaster Services Deanna Lessard, Director Member Services & Education Nicola Chung, Project Access Program Director John James, Project Access Senior Program Coordinator Maria Turkki, Project Access Program Coordinator Mindi Tingler, Administrative Assistant Natalie Gonzalez, Receptionist Lauren Tomé, Receptionist Patricia Beele, Receptionist

OnCALL Managing Editor: Tenna Wiles Advertising Assistant: Yvonne Shapiro Subscriptions to OnCALL are available for an annual rate of $50. For more information, please contact Yvonne Shapiro at (561) 433-3940.

Last OnCall Issue

Available online at pbcms.org

The opinions expressed in OnCALL are those of the individual authors and do not necessarily reflect official policies of the Palm Beach County Medical Society, unless so stated. Advertising in OnCALL does not constitute endorsement by the Palm Beach County Medical Society or its committees. On CALL is owned and published (6) times per year by the Palm Beach County Medical Society, Inc. 3540 Forest Hill Blvd., West Palm Beach, FL 33406 (561) 433-3940 & (561) 276-3636. © Copyright 2011 Palm Beach County Medical Society, Inc.

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PHYSICIANS SPEAK OUT

CAN YOU empathize with this doctor? Are you just as frustrated, angry, or confused about the future of Medicine and your medical practice? If you are an employed physician, in a large group and/or a primary care physician, you need to share your fears, concerns and ideas with us now.

Regardless of your practice setting or specialty, you are facing challenges that you and your colleagues have never faced before, like if your hospital forms an ACO, where does that leave you? Significant changes brought about by health reform, escalating costs, hospitals gobbling up physicians’ practices, hyper-regulation, uncertainty in the marketplace, and the nationwide shortage of physicians are just the tip of the proverbial iceberg! We don’t know what you need from us unless you tell us. Join Palm Beach County Medical Society at this Listening Forum – we have organized to hear your concerns and your ideas. Please attend whether you are a PBCMS member or not. Monday, November 14, 2011, 6 pm – 7:30 pm. Airport Hilton - 150 Australian Avenue WPB Breakout groups will be held for the following groups • Employed Physicians • Primary Care Physicians • Solo and Small Group Practices • Large Group Practice There is no charge to attend. We want as many physicians to attend as possible to voice your opinion about your needs and challenges in this new era of Medicine. RSVP at 561-433-3940 or go to www.pbcms.org (events).

OnCall September - October 2011

Spotlight on Medicine: Palm Beach Centre for Graduate Medical Education By Leon Fooksman

fter graduating from medical school, Dr. Arlene Taylor wanted to learn everything about family medicine.

She enrolled at a Palm Beach Centre for Graduate Medical Education residency program and spent three years working with specialists in treating patients, understanding cutting-edge procedures, and getting the know-how to start her own practice. “I learned to do everything, and was well prepared to be competitive in my field,” said Dr. Taylor, who now has her own practice, North Palm Family Practice in Palm Beach Gardens. It’s a sentiment shared by many other alumni of Palm Beach Centre for Graduate Medical Education, Palm Beach County’s oldest medical student and graduate medical education center that emphasizes teamwork, intensive training, and retaining new doctors in the area. Some of the center’s programs date back to 1975. The osteopathic-focused center is spread across four acute inpatient hospitals affiliated with HCA, Inc.: Columbia Hospital, Palms West Hospital and the Children’s Hospital, St. Lucie Medical Center, and University Hospital and Medical Center. The center also has eight alliances with other hospitals, universities, a geriatric center, a hospice care facility, and a consortium. Each year, more than 100 medical students and residents are trained in two traditional internships, an internal medicine residency, dermatology residency (combined with internal medicine), family practice residency, pediatrics residency, emergency medicine residency, psychiatry residency, and hospice and palliative care fellowship. The psychiatry, pediatrics and emergency medicine residencies are the only such programs in the region between Miami and Orlando.

“With multiple facilities and so many programs, this allows for greater depth of training,” said Dr. Bradley Feuer, past-president of Palm Beach County Medical Society and a graduate of Palm Beach Centre for Graduate Medical Education who has served as the center’s director of medical education since 1991. “We combine clinical exposure with progressive patient management coupled with comprehensive didactics rooted in evidence-based medicine. We also stress citizenship, research, and community service to set a high standard of professionalism. Our graduates are highly sought after.” Dr. Feuer added: “Our faculty members are 100 percent voluntary. Beyond setting the example to our residents for community service, they don’t teach because they are paid to do so. They teach because they have a true passion for it.” The center has partnered with Nova Southeastern University’s College of Osteopathic Medicine, the Kansas City University of Medicine and Biosciences, and the Georgia Campus of the Philadelphia College of Osteopathic Medicine to provide an academic year’s worth of core training for their third-year medical students. For the center’s externship elective rotations, traditional internships and residency programs, medical students and new doctors come from across the country. “Many of the medical students have completed the center’s core rotation programs and return to do their residencies because they got to know the faculty and the facilities so well,” said Joanne Guccio, administrative director of medical education at Palm Beach Centre for Graduate Medical Education in Palms West Hospital. Dr. Claude Jones still remembers the support he got during his internal medicine residency from 2005-2008. Now the medical executive director of Lake County (Fla.) Health Department, Dr. Jones said the dedication of the center’s faculty, administration, and nursing staffs in training the residents to understand all facets of medicine, including public health, gave him a competitive edge.

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Multi-Stakeholder Medical Collaborative Considered for Palm Beach County By Leon Fooksman

cross the country, unique alliances of businesses, insurance companies, hospitals, physicians, and consumers are creating longlasting improvements to health care systems that millions of people depend on every day. From sparsely populated areas like Humboldt County, Calif. to big cities like Boston, Kansas City, Detroit, and Cincinnati, the people who receive health care, provide health care, and pay for health care are joined together in collaboratives that lift the overall quality of local medicine for all residents and reduce its costs through initiatives once seen as unthinkable.

strategies on making the county more competitive, partially through improving access and containing rising costs of the healthcare system. That information will be shared with Florida Chamber of Commerce Foundation’s Six Pillars plan, which concentrates on six key issues to support a stronger state economy.

Could Palm Beach County be next?

During the process, many participants suggested creating a diverse, multi-stakeholder health care collaborative in the county. A formal meeting group has begun looking at potential models, including the one in Cincinnati. In many ways, the group will be asking: Are Palm Beach County’s leaders ready to build upon previous accomplishments and engage new stakeholders to work together to improve the health of all the county’s residents by changing the delivery system?

“The only way to make true and sustainable change to health care is to have real partnerships,” said Sharron DiMario, who has played a role for nearly 20 years in improving Cincinnati’s health care as a stakeholder working at the Health Collaborative.

“There is a compelling case to be made for stakeholders, both public and private, to agree on common goals and work collectively on addressing those goals,” said Mike Jones, president and CEO of the Economic Council of Palm Beach County.

DiMario will be a featured speaker on Oct. 28 at the three-day 2011 Future of Medicine Summit V at Palm Beach County Convention Center.

Health care costs have long spiraled across the nation, making our medical system the most expensive in the world. Spending on doctors, hospitals, drugs, and other medical expenses consumes as much as one out of every six dollars earned in the country. The financial burden has hurt the global competitiveness of American companies and drained the resources of millions of families, even those with insurance.

The Cincinnati collaborative is focused on public reporting of clinical data, payment reform, quality improvement at the practical level, claims data analysis, doctor/patient engagement, and enhancing the use and benefits of electronic health records. It is also growing the patientcentered medical home model across the region. The city’s health care reforms have caught the attention of Palm Beach business, government and medical leaders who are taking a hard look at what they can do to increase efficiency and reduce costs during the economic slump. Since 2008, the Economic Council of Palm Beach County and other organizers have worked on creating a “living” document with goals and I 11 I

In Palm Beach County, the problem is eroding the primary care infrastructure. To develop a better primary care safety net, the county needs to overcome economic and political pressures, as well as competing organizational missions and corporate cultures, according to the 2011 “Strengthening the Primary Care Safety Net in Palm Beach County” report developed by consultant, Tripp Umbach, Inc. In a county with a roughly 11 percent unemployment rate and about 265,000 people

OnCall September - October 2011

without health care insurance, a more formal system of communication and joint-strategic planning focused on the primary care safety net needs to be created, the report said. “There are many places that residents can receive health care but each organization operates independently of each other with minimal referral plans or strategy in mind. While there is a culture of meeting and project collaboration in Palm Beach County between many organizations, it seems that many organizations continue to operate in silos,” the report said. These are the kind of issues that have been addressed through healthcare alliances across the nation. Many of these groups are part of the Aligning Forces for Quality, a Robert Wood Johnson Foundation program, to enhance health care in targeted communities, reduce racial and ethnic disparities in medicine, and provide models for national health care reform. Consisting of physicians, nurses, patients, consumers, purchasers, hospitals, health plans, and other stakeholders, each of the 16 Aligning Forces communities is promoting, among other things, equitable care, health care cost measurement, and initiatives to improve the safety and care for patients in transition between facilities. They are making big and small reforms in their communities. For instance, Healthy Memphis Common Table has developed a report addressing disparities in local health care, evaluating differences in the type of care received by patients of different races, ethnicities and languages. The report also set recommended steps to move from discussion to action. And Maine Quality Counts has led an initiative to work with 11 hospitals in reducing the amount of time spent waiting in emergency departments, ensuring that patients who are discharged from a hospital are not readmitted because they missed important elements of their care, and improving how they communicate with diverse patients. The work in Cincinnati is producing even more changes. One of the

Health Collaborative’s largest initiatives is expanding the patientcentered medical home model, an interconnected delivery system that brings down costs while offering incentives for doctors, clinics and hospitals to provide quality care. It stresses preventive care, reduces duplicate tests and unnecessary treatments, and relies on a patient’s primary care physician to connect electronically to specialists, labs and other health care providers. Today, there are 39 primary care practices, totally about 180 physicians, operating under the patient-centered medical home model in Cincinnati, said DiMario, the collaborative stakeholder who is also the director of community initiatives for Employers Health. Organizers are hopeful that they will demonstrate a link between patient-centered medical homes and fewer unnecessary emergency room visits and hospital readmissions. “We’re starting to make a real impact,” she said. Started in 1992, the collaborative formed in the midst of an initiative to make health care expenses more transparent at a time when medical costs were spiking in the region, said Melissa Kennedy, the agency’s director of operations. Years later, the public reporting of health care data has transformed the system, bringing accountability to patient care and driving down the costs. This, and the many other reforms, was the result of research, diverse viewpoints and collaboration from the organization’s 30-member board of directors and dozens of other committee members who represent all the stakeholders in the area’s health care system. “We’re doing everything with an eye toward the future,” Kennedy said. “We’ve all come together to fix things.”

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AMA FOUNDATION Holiday Sharing Card The holiday season is just around the corner and now is the time to show your generosity by participating in the Holiday Sharing Card sponsored by the Palm Beach County Medical Society Alliance. Your contribution will support medical school programs and provide needed financial assistance to medical students and students pursing a health related career. Just make a contribution and we will include your name on the Holiday Sharing Card sent to Palm Beach County Medical Society Alliance members.

Donate to one of the following projects; American Medical Association Foundation (AMA-F), listing the medical school of your choice; or “Something Special” our local scholarship fund benefiting residents of Palm Beach County pursuing a healthcare profession. Simply return the completed form below and a check for $25 (bronze), $50 (silver), or $100 (gold) made payable to the Palm Beach County Medical Society Alliance Foundation (PBCMSAF) by November 22, 2010. Your entire donation is Tax Deductible! Deadline for contributions is December 9, 2011

Please list name on Holiday Card as: Address:______________________________________________________________ City/State:

Zip:

Telephone:

Check one: *AMA-F (Name of Medical School) “Something Special” local scholarship fund Donation Amount (check one) $25 (Bronze)* $50 (Silver)

$100 (Gold)

Please make check payable to: PBCMSAF Inc. and mail to: PBCMS Alliance, 3540 Forest Hill Blvd, West Palm Beach, Fl. 33406 Attn: MJ Higgins

OnCall September - October 2011

Do You Know Who Your IRA Beneficiary Isand Why It Matters? Patricia C. Corbett, CFP® Vice President Financial Advisor Morgan Stanley Smith Barney, Boca Palmetto, Branch 600 561-393-1535

eciding whom to designate as a beneficiary for your IRA might seem like an easy decision—you probably want your money to go to someone near and dear to you. But is the person (or people) you’re thinking of actually named as the beneficiary on the particular IRA you opened all those years ago? To be certain, it’s wise to review your beneficiary designation form every few years, or whenever you’ve had a change in circumstances, such as a birth of a child or grandchild or change in marital status. Changing your beneficiary is easy—you simply complete a new beneficiary designation form. Keep in mind that a will or trust does not override this form, or the IRA document itself (which may have “default” beneficiary designations that control even if no beneficiary designation is on file), unless you name your estate or trust as your beneficiary. Because beneficiary designations are important estate-planning documents, you may want to review them with your attorney. You have the option of naming primary and contingent beneficiaries. The primary beneficiary is your first choice to receive your retirement benefits and can be more than one person or entity. If you choose more than one primary beneficiary, you may specify a percentage to be paid to each person and indicate whether a beneficiary’s share will be void if he or she predeceases you or if that share will pass to his or her children. This situation typically comes into play when you designate equal shares to all your children. You also can name a minor as a direct beneficiary of an IRA, but your local probate court (as well as your IRA custodian) may require the appointment of a guardian for the minor. A contingent beneficiary is someone you designate to receive your IRA only if all primary beneficiaries predecease you, pass away at the same time as you or disclaim their rights to the IRA assets. It’s important to note the distributions from an IRA may have tax consequences for your beneficiaries. While taxes shouldn’t be the primary determining factor in naming your beneficiaries, ignoring the impact of taxes could have significant consequences for your family. A tax advisor can help you weigh the pros and cons in order to make sure your wishes are executed in a tax-efficient manner. Remember to look at your IRA assets in context with the rest of your estate before making any decisions. To help ensure that your wishes can be executed as you intended, discuss your beneficiary designations, wills and other estate matters with your tax and legal advisors and other members of your advisory team.

A Primary Beneficiaries Primer When naming a primary beneficiary, some designations to be familiar with are all my children, per stirpes and per capita. Terminology and definitions may vary from state to state, however, so you should consult with an attorney before making a final decision. Per Stirpes: Also known as “rights of representation” in some states, per stirpes means that the children of a beneficiary who predeceases you will share equally in the portion of your IRA originally left to the nowdeceased child. Per Capita: This method divides your IRA assets among your beneficiaries and the descendants of any beneficiary who dies before you. For example, if you name your three daughters as your primary beneficiaries and one of them dies before you, each of her own three children will receive a share equal to that of your other two daughterssplitting the IRA into five equal parts. In addition, remember that being precise is better than being vague or general. For example, it’s not uncommon for people to name “All My Children” on a form. However, the better practice is to list, in fact, the children being designated, and then decide if their share is held “per capita” (meaning if the child dies before you, your IRA assets will be divided among your surviving children, with the remaining children sharing equally) or “per stirpes” (meaning that your deceased child’s children will receive the shares). Articles are published for general information purposes and are not an offer or a solicitation to sell or buy any securities or commodities. Any particular investment should be analyzed based on its terms and risks as they relate to your specific circumstances and objectives. Clients should always check with their tax and legal advisor before engaging in any transaction involving IRAs or other tax-advantaged investments. Tax laws are complex and subject to change. Morgan Stanley Smith Barney LLC, its affiliates and Morgan Stanley Smith Barney Financial Advisors do not provide tax or legal advice. This material was not intended or written to be used for the purpose of avoiding tax penalties that may be imposed on the taxpayer. Individuals are urged to consult their personal tax or legal advisors to understand the tax and related consequences of any actions or investments described herein. Article by Morgan Stanley Smith Barney LLC. Courtesy of your Morgan Stanley Smith Barney Financial Advisor. © 2011 Morgan Stanley Smith Barney LLC. Member SIPC. 04/11 GP11-00529P-N04/11

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It would be difficult to recall a time in the history of American medicine as challenging, contentious, and confusing as it is today. Consumers of health care across the Nation – along with their care givers and insurers – are scrambling for solutions to problems when even some of the questions need clarification. This is an urgent time for Cooperation, Collaboration, and Contact with the most recent information. And that is exactly what the Future of Medicine Summit V has been designed to do. Thanks literally to hundreds on the Medical Society staff, the Steering Committee, and our dedicated Hosts and Sponsors, the program is designed for YOUR benefit. The event will be easily accessible at the Convention Center in West Palm Beach on the afternoon of Thursday, October 27, all day the 28th, and morning of the 29th. CME credits are available.

Stephen Babic, MD

Jose F. Arrascue, MD Chair, Steering Committee Cynthia Clayton, MD

HOST COMMITTEE Francisco Acosta Alina Alonso, MD Mary Barnes Bob Broadway Davide Carbone Don Chester John D. Couris Corinne Danielson Trish Ernst Charles Felix Shawn Griffin Rick Herman Mike Jones Christine Koehn Trish Lowry Stuart Markowitz, MD Heather Siegel Miller, Esq. Linda Quick Brent M. Schillinger, MD Ben Starling Andrea Stephenson Joan St. Onge, MD Marge Sullivan Marcia Teele Patsy Westall Maureen Whelihan, MD Ronald Wiewora, MD

I fully understand the demands placed on you in your practice. However, this program has much to offer so that your future in medicine is guaranteed to be successful and satisfying – and hopefully enjoyable! Please make an effort to attend. You will not be disappointed. Michael T.B. Dennis, MD Chairman, Future of Medicine Summit V

STEERING COMMITTEE

Michael Dennis, MD Summit Chair

You and your patients will enjoy our three panels bringing the newest level of understanding from the research and clinical points of view on Obesity, Oncology, and Over 60 (Healthy Aging). We have an impressive gathering of nationally recognized speakers focusing on topics of AMA/FMA concerns, the health of the American health system, medical economics including payment reform, and practice management. Other panels will address medicine and the law, medical education, access to and quality of care, women’s health, and information technology. Space does not allow mentioning every single item but it is fully covered in the brochure being distributed to you.

Claude Earl Fox, MD

James T. Howell, MD Co-Chair, Steering Committee Daniel Higgins, MD

Brent M. Schillinger, MD

THANK YOU TO OUR SPONSORS COMMUNITY LEADER

Michael Dennis, MD

COMMUNITY PARTNER

The Berlin Family Foundation Bethesda Memorial Hospital Boca Raton Regional Hospital Medical Staff Delray Medical Center Health Care District of Palm Beach County JFK Medical Center Medical Staff South Florida Palliative Medicine Specialists, Inc.

COMMUNITY FRIEND

Comerica FirstPath Lab Florida Public Health Institute JFK Medical Center Jupiter Medical Center Palm Healthcare Foundation Shutts & Bowen University of Miami Miller School of Medicine

PREMIER EXHIBITOR

1450 Inc. Abacoa Insurance Group Abaco Accounting & Payroll Services, Inc, Chase Danna-Gracey Janus Center for Psychiatric Research PNC Bank VITAS Palliative Care Solutions

EXHIBITOR

Alzheimer’s Community Care Arden Courts Barrett, Liner & Company Blue Cross and Blue Shield of Florida Fit to the Max - Wellness Solutions For Your Practice Health Care REIT – Management Services Group Lubell & Rosen South Florida Regional Extension Center

NON-PROFIT ADVOCATES

Alzheimer’s Association, Southeast Florida Chapter Area Agency on Aging Children’s Services Council Diabetes Education and Research Center Mental Health Association Palm Beach County Division of Senior Services Palm Beach Infectious Disease Institute Palm Beach County Library System, Main Library Quantum House Sari Asher Center for Integrative Cancer Care

MEDICAL STUDENT SPONSORS

Cynthia Clayton, MD Michael Dennis, MD Daniel Higgins, MD James T. Howell, MD Jack Zeltzer, MD

OnCall September - October 2011

KEYNOTE SPEAKERS Peter Carmel, MD President, American Medical Association

Alice Gosfield, Esq. Gosfield & Associates

Dr. Carmel is a pediatric neurosurgeon at the University Hospital of the New Jersey Medical School, professor and chair of the school’s Neurological Surgery Department, and co-medical director of the Neurological Institute of New Jersey.

Alice G. Gosfield, Esq., of Philadelphia’s Alice G. Gosfield and Associates, PC, has a national practice limited to health law and healthcare regulation with a special emphasis on physician representation, managed care, quality, fraud and abuse, and medical staff issues.

T.R. Reid Author & Reporter T. R. Reid, of the nation’s best-known reporters for The Washington Post, his books and documentary films, and National Public Radio. His latest book ‘The Healing of America,” is a national best-seller.

Madelyn Butler, MD Past President, Florida Medical Association Madelyn Butler, MD is the immediate past president of the Florida Medical Association and is the past president of the FMA PAC. She has provided public education as Channel 8’s medical expert in OB/GYN. Madelyn was the recipient of the Outstanding Physician’s Award in 1998.

Jeff Goldsmith, PhD President, Health Futures Jeff Goldsmith, PhD. is also Associate Professor of Public Health Sciences at the University of Virginia. He was the recipient of the Corning Award for excellence in health planning from the American Hospital Association’s Society for Healthcare Planning in 1990, and received the Dean Conley Award for best healthcare in 1985, 1990 and 1995 from the American College of Healthcare Executives.

Cecil Wilson, MD Past President, American Medical Association Cecil Wilson, MD, an internist from Winter Park, Fla., served as president of the AMA from June 2010 to June 2011. Dr. Wilson has been a member of the American Medical Association (AMA) Board of Trustees (BOT) since 2002 and served as chair of the AMA-BOT from 2006 to 2007. Dr. Wilson has also been a member of the AMA House of Delegates since 1992.

Sharron DiMario Director, Community Initiatives, Employers Health Coalition, Inc. Sharron DiMario, Director of Community Initiatives for the Employers Health Coalition, Inc. (EHCO), a business health coalition impacting over 2 million covered lives. From September 1996 through June 2010, she was President and Executive Director of the Employer Health Care Alliance (EHCA), a non-profit alliance of employers working to support and influence improvements in the quality and cost-effectiveness of health care services in Southwest Ohio, Northern Kentucky and Southeast Indiana.

SCRIPPS FLORIDA Paul Kenny, PhD

Scott A. Busby, PhD

Paul Kenny, PhD is currently Associate Professor Departments of Molecular Therapeutics and Neuroscience, The Scripps Research Institute, Jupiter. Staff Scientist (20052006) Department of Biochemistry, The Scripps Research Institute, Jupiter, Florida. Post-doctoral Research Associate (2000-2005) Department of Neuropharmacology, The Scripps Research Institute California.

Scott A. Busby, PhD joined the lab of Dr. Patrick Griffin in 2004, one of the first labs established at Scripps Florida. He joined Opko Pharmaceuticals in May 2011, as a Team Leader in their efforts to develop lung cancer diagnostic tests based on peptoid chemistry. During his career, Dr. Busby has published over 25 articles in peer reviewed journals.

Roy G. Smith, PhD Roy G. Smith, PhD is an internationally recognized scientist focused on the quality of life of the elderly through research. At Scripps Florida, he chairs the newly formed Department of Metabolism and Aging.

I 16 I

PANELISTS AND PRESENTERS Mary Jane Saunders, PhD, Florida Atlantic University TAMING THE OBESITY EPIDEMIC: Paul Kenny, PhD, Scripps Florida Cynthia Clayton, MD, Palm Beach County School Health Advisory Committee Florenzia W. Davis, PhD, Palm Beach County Health Department K. Andrew Larson, MD, The Center for Advanced Surgical Care Ronald A. Romear, MD, Infants and Children LIVING HEALTHY OVER SIXTY Roy G. Smith, PhD, Scripps Florida Juergen Bludau, MD, Brigham and Womenâ&#x20AC;&#x2122;s Hospital Mark L. Brody, MD, Brain Matters Research Joseph G. Ouslander, MD, Florida Atlantic University Jaime Estremera-Fitzgerald, Area Agency on Aging LATEST ADVANCEMENTS IN CANCER RESEARCH, TREATMENT AND CARE Scott A. Busby, PhD, Opko Health Georges Hatoum, MD, JFK Comprehensive Cancer Center, Radiation Oncology Louise Morrell, MD, Boca Raton Regional Hospital Lynn Cancer Institute Jerome Spunberg, MD, South Florida Radiation Oncology SHAPING OUR FUTURE TOGETHER: MEDICAL EDUCATION, COST, QUALITY & ACCESS IN PALM BEACH COUNTY Sharron DiMario, Employers Health Coalition, Cincinnati, OH Ed Goldman, MD, Practice Communications Claudia Mason, MD, Cleveland Clinic Robert Kozol MD, University of Miami Miller School of Medicine Alina Alonso, MD, Palm Beach County Health Department James Byrnes, MD, President, Palm Beach County Medical Society Jonathan Gavras, MD, Blue Cross and Blue Shield of Florida Moderator: Claude Earl Fox, MD, MPH, Florida Public Health Institute INNOVATIONS IN HEALTH CARE TECHNOLOGY Tim Gueramy, MD, Docbook MD Lisa Rawlins, South Florida Regional Extension Center Deborah Ann Mulligan, MD, Nova Southeastern University Christoher R. Seymour, Compass Management and Consulting Clay Williams, Forte Interactive Pete Martinez, Palm Beach Medical Education Corporation MEDICINE AND THE LAW Dave Aronberg, Esq., Assistant State Prosecutor Special Council Jean Acevedo, Acevedo Consulting Jeff Cohen, Esq., Florida Healthcare Law Firm Heather Siegel Miller, Esq., Broad & Cassell Tim Monaghan, Esq. / James A. Farrell, Esq., Shutts & Bowen Moderator: Judith Goodman, Esq. FOR WOMEN, BY WOMEN: MIND, BODY AND SEX Maureen Whelihan, MD, Gynecology Addie Dissick, MD, Internal Medicine Talya Kupin, MD, Ophthalmology Eunice Cordoba, MD, Neurology Priti Kothari, MD, Psychiatry Kathleen Minnick, MD, General Surgery I 17 I

OnCall September - October 2011

Case Study: Inappropriate Documentation Constitutes Fraudulent Record Editor’s Note: This case study analysis reflects an actual First Professionals’ case.

Case Analysis This case involved a patient undergoing surgery who experienced cardiac arrest without successful recovery. Timing factors in the anesthesia record were inconsistent with the Code Blue documentation. According to the times recorded in the nurse’s record on the code sheet, anesthesia monitoring would have stopped 10 minutes before resuscitation began. The anesthesiologist, being certain that there was no time lapse in the monitoring of the patient, assumed his time documentation in the anesthesia record was wrong and adjusted the record to coordinate the times with the code sheet in an effort for clarification. At trial, it was discovered that the anesthesiologist had altered the record. Consequently, the medical record was deemed fraudulent, and the case rendered indefensible. During the criminal investigation that was initiated against the anesthesiologist for the record alteration, it was determined that there was indeed a 10-minute time difference between the anesthesiologist’s wristwatch and that of the clock on the operating room wall.

Risk Management Discussion Documentation is a key tool for defending medical malpractice cases. Improper documentation or the lack of supporting documentation may actually contribute to a finding of negligence. Consider the following recommendations: • Document with specificity • Never alter the medical record • Corrections to the records should be initialed and dated contemporaneous with the correction made • Never use “White Out” or otherwise attempt to cover original record entries – line through an erroneous entry and initial and date the change made. • Provide an explanation in the record for inconsistencies • Document your medical rationale • Ensure the same integrity of documentation made electronically • Entries should be legible, and contain sufficient detail to clearly demonstrate why the course of treatment was undertaken or not undertaken • Documentation should support the diagnosis, justify the treatment, and be accurately dated and timed • Ascertain if timing inconsistencies exist and determine the etiology • All OR staff should synchronize timing devices prior to every procedure • Seek legal or risk management advice when uncertainty arises This information does not establish a standard of care, nor is it a substitute for legal advice. The information and suggestions contained here are generalized and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide only. I 18 I

5 Biases That Lead to Bad Decisions Nancy Proffitt MBA, CBC Executive Business Coach Proffitt Management Solutions

A growing body of research reveals that our behavior and decisions are influenced by an array of strong psychological undercurrents. Scientists have identified five flaws in how we think when making decisions. They’re hardwired into our thinking process, so we often fail to recognize them. 1. Loss Aversion We experience the pain associated with loss much more vividly than we do the joy of experiencing a gain. For example, if egg prices go down, sales go up. But if egg prices rise proportionately, sales dip by 250 percent. Consumers stop buying them because the price has increased. This response flies in the face of traditional economic theory, which dictates that people should react to price fluctuations with equal intensity, regardless of whether price rises or falls. In reality, we illogically overreact to perceived losses. This also explains why people are much more likely to buy meat when it’s labeled 85 percent lean instead of 15 percent fat. Similarly, twice as many patients opt for surgery when told there’s an 80 percent chance of survival, as opposed to a 20 percent chance of dying. 2. Commitment We have a tendency to stick with the status quo. When we’ve invested our time and money in a project, it’s difficult to let go—even when things clearly aren’t working. History shows us how hard it was for Lyndon B. Johnson and George W. Bush to find solutions to the wars in Vietnam and Iraq, respectively. They were strongly influenced by the forces of commitment and aversion to loss.When CEOs and boards of directors are charged with making critical strategy decisions, determining the best outcomes often proves challenging when strong egos and competitive personalities are added to the mix. 3. Value Attribution It takes enormous energy to consciously work through all possibilities and risks when weighing important decisions, so the brain looks for shortcuts. But these shortcuts also present traps because they largely occur without our awareness. Value attribution serves as a quick mental shortcut to determine what’s worthy of our attention. When we encounter new objects, people or situations, the value we assign to them shapes our future perceptions of them. If, for example, we see a poorly dressed street performer playing music in a subway station, we assume he’s a struggling amateur with little talent, even when the music is good. These assumptions were proved true when Joshua Bell, one of the finest violinists alive, participated in a field study for the Washington Post. While Bell, dressed in jeans and a baseball cap, played a $3.5 million Stradivarius, subway travelers rushed by without paying attention. While he certainly sounded far from mediocre, he looked the part—and commuters attributed the value they perceived (appearances) to performance quality. The Bell experiment illustrates why we may turn down a pitch or idea based on appearances, rumors or any other peripheral value. It also explains why we may blindly follow the advice of someone who has been highly recommended. Becoming aware of our brain’s tendency to make assumptions can help us prevent disastrous mistakes and missed opportunities.

4. Diagnosis Bias When we encounter new people at a party, we quickly diagnose them by placing tags on them, such as “approachable” or “standoffish.” This helps us quickly decide if we want to engage them in conversation. By employing this mental shortcut, we fail to see a person’s good qualities. Nowhere is this clearer than in job interviews. Practitioners, department heads or managers value their intuition and think they have a refined ability to truly see and understand an applicant. They overestimate their ability to form objective opinions and underestimate their subconscious biases. Decision Effectiveness Decisions are the lifeblood of action, and little gets done without them. A recent Harvard Business Review article recommends a decision audit to identify key organizational needs, using the following short survey:1 How do your organization’s decision abilities stack up against the competition? • Quality: When looking back on critical decisions, how often have you chosen the right course of action? • Speed: How do you rate the speed of your critical decisions in comparison to your competitors’? • Yield: How often do you execute critical decisions as intended? • Effort: How much effort does your company or medical practice put into making and executing critical decisions? 5. The Certainty Bias Leaders forget the mind’s fallacies. They believe in their people and senior team. They are generally confident that colleagues are well-intentioned, with the company’s best interests in mind. After gathering as much information as possible and weighing all of the arguments, leaders must make decisions and embrace an attitude of certainty and confidence. Persuading others to execute the plans is the next step. Certainty, however, can lead to other errors, such as failure to adjust plans, when required, and shutting out conflicting information. The only way to counteract the certainty bias is to encourage dissonance. Perhaps Alfred P. Sloan, president of General Motors in its prime, said it best. After adjourning a meeting shortly after it began, he announced: “Gentlemen, I take it we are all in complete agreement on the decision here… Then I propose we postpone further discussion of this matter until our next meeting to give ourselves time to develop disagreement and perhaps gain some understanding of what the decision is all about.” Nancy Proffitt MBA, CBC is President of Proffitt Management Solutions. We are committed to helping healthcare organizations implement the best business decisions which result in better patient care and profitability.

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Med Memo September - October 2011 EDUCATIONAL OPPORTUNITIES

OnCall September - October 2011

Office Manager’s Institute Series

November 4-5. “Thirtieth Annual Echodardiography Symposium” Doral Marriott Resort. 11 Cat. 1 CME Credit. For additional information call 786-596-1667 or contact juliez@baptisthealth.net

2011-2012 Office Manager Institute Series – Delray Beach Golf

November 12-13. “Third Annual Coronary CTA in the ED: A Hands-on Workshop” Fontainbleau Hotel, Miami Beach. 16.5 Cat. 1 CME Credit. For additional information contact juliez@baptisthealth.net

We are excited to be expanding our OMI series to Delray Beach this season. We have lined up some great presentations. We are offering four sessions (October, January, March & May) and they will be held at the Delray Beach Golf Club 2200 Highland Avenue, Delray Beach on the third Wednesday of each month from 11:30 am – 1:00 pm

November 13-16. “Eleventh Annual Emergency Radiology Symposium” Fontainbleau Hotel, Miami Beach. 18.5 Cat. 1 CME Credit. For additional information contact juliez@baptisthealth.net Twenty-Six Annual Sanford H. Cole, MD, Memorial OB/GYN Symposium January 27, 2012. Miami Marriott Dadeland. For additional information contact maidap@baptisthealth.net or call 786-596-1667

OFFICE MANAGER’S INSTITUTE Wednesday, Oct. 19, 20911 11:30 am - 1:00 pm Delray Beach Golf Club 2200 Highland Avenue, Delray Beach “Minimizing the Risk of Embezzlement in the Medical Office” Presented by Todd Blum, MHA, MBA, CMPE Todd is the Chief Executive Officer of Ear, Nose & Throat Associates of South Florida, PA, a 27 physician single specialty medical group. Mr. Blum joined the practice in July 1999 and has over 15 years of health care experience in hospital, physician practice management and private practice settings. Cost: $25 for members and staff, $35 nonmembers and staff. You can register on line at www.pbcms.org

& CC Attention Practice Administrators, Managers & Physicians!

There is a $25 charge for each lunch program for PBCMS members and their staff and $35 for non-members & staff. Register online at www.pbcms.org for the entire series and save $10 - $90 members and $130 for non-members. Topics and dates are as follows: • October 19th - Minimizing the Risk of Embezzlement in the Medical Office • January 18th - Healthcare Reform 101 • March 21st - ICD-10 Coding Tips to Avoid Denials • May 16th - Accountability – People do Exactly What We Let Them Do

2011-2012 Office Manager Institute Series – Hilton- PB Airport Attention Practice Administrators, Managers & Physicians! We have lined up informative educational programs and speakers for 2011 – 2012. Sessions are scheduled October 2011 thru June 2012 and will be held at the Airport Hilton 150 Australian Avenue, WPB on the first Wednesday (with the exception of January 2012 luncheon) of each month from 11:30am – 1:00 pm There is a $25 charge (includes lunch) per program for PBCMS members and their staff and $35 for non-members & staff. Members can save money by purchasing the entire series of 9 programs now for only $200 ($25 savings) if you register by October 3rd. Non-members $290 Topics and dates are as follows: • October 5th - Turning Good Employees into Great Employees • November 2nd - How to Develop & Implement a Practice Analysis • December 7th - Mobile Medical Computing - Changing the Medical Community • January 11th - Coding & Compliance 2012 (11:30 – 2:00) • February 1st - Google Plus • March 7th - How to Handle Difficult Employment Situations • April 4th - Stark & Anti Kick Back Laws & Other Hot Legal Issues • May 2nd - Managed Care Contracting – It’s More Than Just the Rate • June 6th - Managing Your Denials

WHITE COAT CEREMONY The inaugural class of FAU’s new medical school in the Charles E. Schmidt College of Medicine., time honored White Coat Ceremony. Sixty-four students received their first doctor’s white coat - the pre-eminent symbol of physicians for more than 100 years. I 20 I

President’s Report - Continued from pg 2 The speakers at The Governance Institute still report that the powers that be do not believe that addressing the malpractice issue will lower costs, that we don’t change our behaviors quickly, our ordering habits just because the malpractice risk is less. I beg to differ, as the practice of defensive medicine is something we have been vaccinated with and it will takes years to change habits….but that doesn’t mean it is impossible, especially in our younger physicians. On a happier note, the PBCMS Health Plan starts Jan. 1, 2012, and offices are being enrolled now. My office, with six insured, will save about $2,000 per month! The plan uses Blue Cross Blue Shield, a major stable insurer, but you must respond NOW when the agents call your office. We have two excellent, stable agencies working with

us on a program based on the Marion County Medical Society Plan, which has been in existence for over 30 years. BCBS is allowing only ONE open enrollment period at this time, and that time is NOW. No second chances. The program is only being offered to offices in Boynton Beach and south due to a lack of response from offices in the central and northern areas of the county. Hopefully, we will add on the rest of the county later. If you are in the south, you must act now! You must be a member of the PBCMS to qualify, and the office must be owned by a physician. Stay active! Stay involved! The Future of Medicine Summit starts Oct. 27th.

Spotlight on Medicine: Palm Beach Centre for Graduate Medical Education - Continued from pg 10 “What struck me most was the training. It gave me a real solid foundation and prepared me for all areas of medicine. It’s a real tribute to the program,” Dr. Jones said.

With strong support of faculty and residents, Palm Beach Centre for Graduate Medical Education has a perfect, first-time, board-certification pass rate across all of its programs.

Palm Beach Centre for Graduate Medical Education not only supports students and residents but also the broader community, Dr. Feuer said.

“I was ready to work when I finished,” said Dr. Taylor, whose first job out of the program in 2005 was overseeing the newly started Columbia Primary Care, an HCA clinic in West Palm Beach.

The center’s Critical Incident Stress Management Team, adopted from the military and law enforcement, trains peers to assist medical students and residents in adjusting to difficult situations that include grief, trauma or disaster. The center also has disaster response teams, comprised of board-certified fellows and residents-in-training, to help medical facilities in Florida and across the Southeast, during and after incidents like hurricane strikes. All the programs emphasize mandatory didactics. Students and house staff are excused from their duties to attend mandatory lectures. Every week, for instance, a cardiologist teaches students, interns, and residents how to interpret and read EKGs in detail. And every month, students or interns present cases on patients diagnosed with typical and atypical malignancies and how they were managed. Presentations are accompanied by radiological studies, pathology slides, and gross specimens, while attending physicians comment and formulate a plan of care.

Dr. Taylor attended Palm Beach Centre for Graduate Medical Education while a student at Nova Southeastern University College of Osteopathic Medicine. She said she could have gone to do her residency at other major hospitals in South Florida, but chose the center because “it felt like family.” “All these years later, my heart is still there,” Dr. Taylor said. For information on Palm Beach Centre for Graduate Medical Education, call (561) 863-3910 or email PBCGME@HCAHealthcare.com. Leon Fooksman is a writer for On Call. You can reach him at leon@digitalstoryline.com.

Classified Ads BIOPHOTONICS THERAPY that stimulates the immune system, apparatus available for treating blood-borne diseases. Success with AIDS, Hepatitis C and Hospital Staff Infectious diseases. USA Patents held # 6951,548B1. Looking for medical group interested in pursuing research and patient treatment. Results published in international journals. Contact: George Einstein, PhD, DSc HC, Professor of Biophotonics. Phone: 561-213-1131 SEEKING TO PURCHASE OFFICE BASED PRACTICE Geriatric Internest/Cardilogogist wantint to return to Palm Beach area, seeking to purchase office based practice from someone interested in retiring after December 2011. Call Marian: 941-256-8886 or 407-855-1121

PRIMARY CARE PHYSICIANS We’re seeking an Associate for our growing outpatient practice in Boynton Beach. Generous salary, benefits and growth prospects. Send resume to resumes@primus-fl.com

PBCMS Membership Applicants Joshua Seth Ackerman, MD 634 Edgebrook Lane, West Palm Beach, FL 33411 Phone: 561-429-6918 Fax: 561-371-3745 Specialty: Obstetrics and Gynecology Medical School: American University of the Caribbean 2005 Internship: Greenville Hospital 2005-2006 Residency: Long Island Jewish Hospital 2006-2007 Fellowship: Mt. Sinai Jamaica 2007-2009 Hospital Affiliations: Palms West Hospital Date of Birth: 3/29/1979 Dominique Deltor, MD 7305 N. Military Trail, West Palm Beach, FL 33410 Phone: 561-718-5537 Fax: 561-718-5537 Specialty: Anesthesiology Medical School: Universite D’Etat D’Haiti 1990 Internship: Nassau County Medical Center 1998-1999 Residency: Stony Brook University Hospital 1999-2002 Board Certification: Anesthesiology Hospital Affiliations: VA Medical Center Date of Birth: 12/22/1963 Pierre Camil Deltor, MD 649 US Highway One Suite 2, North Palm Beach , FL 33408 Phone: 561-775-6455 Fax: 561775-6456 Specialty: Internal Medicine Medical School: Universite D’Etat D’Haiti 1985 Residency: Universite D’Etat D’Haiti 1988-1991 Residency: Nassau County Medical Center 1999-2002 Board Certification: Internal Medicine Hospital Affiliations: St. Mary’s, Good Samaritan, Palmetto General, Palm Beach Gardens Medical Center, Jupiter Medical Center, JFK Medical Center, Wellington Regional, Palms West Hospital Date of Birth: 07/06/1961 Jeffrey Fenster, MD 3355 Burns Road, Suite 201 Palm Beach Gardens, FL 33410 Phone: 561-296-5225 Fax: 561-296-5226 Specialty: Cardiology Medical School: Tel Aviv University 1995 Internship: Beth Israel Medical Center 19951996 Residency: Beth Israel Medical Center 1996-1998 Fellowship: Jackson Memorial Hospital 1998 Board Certification: Interventional Cardiology Hospital Affiliations: Jupiter Medical Center Daniel Fortier, MD 1552 Palm Beach Lakes Blvd., West Palm Beach, FL 33401 Phone: 561-659-7411 Fax: 561-659-7423 Specialty: Internal Medicine Medical School: SUNY Health Science Center 1981 Internship: Boston City Hospital 1981-1982 Residency: Boston City Hospital 1982-1984 Board Certification: Internal Medicine, Geriatric Medicine, Hospice and Palliative Medicine Hospital Affiliations: Good Samaritan Hospital, St. Mary’s Hospital James Goad, MD 12953 Palms West Drive, Suite 201, Loxahatchee, FL 33470 Phone: 561-795-5130 Fax: 561-795-4160 Email: Not Provided Specialty: Surgery-GS Medical School: University of Arkasas 1997 Internship: LSU Health Science Center 1997-1998 Residency: LSU Health Science Center 1998-2002 Board Certification: American Board of Surgery Hospital Affiliations: Palms West Hospital & Wellington Regional Medical Center Date of Birth: Not Provided. Faustino Gonzalez, MD 5300 East Avenue, West Palm Beach, FL 33407 Phone: 561-848-5200 Fax: 561-273-2197 Specialty: Internal Medicine Medical School: Universidad Central Del Este (Uce) E 1981 Internship: Jersey City Medical Center 1982-1983 Residency: Jersey City Medical Center 1983-1985 Board Certification: Internal Medicine, Hospice and Palliative Medicine. Hospital Affiliations: Palms West Hospital, Wellington Regional Medical Center, JFK Medical Center & Hospice of Palm Beach County Claude A. Harmon, MD 10141 Forest Hill Blvd., West Palm Beach, FL 33414 Phone: 561-793-6500 Fax: 561-798-0619 Specialty: Radiology - Radiation Oncology Medical School: Medical College of Georgia 1979 Internship: University of Miami/ Jackson 1979-1980 Residency: University of Miami/Jackson 1980-1982 Fellowship: NI HWG Manuson Oncology 1982-1985 Board Certification: American Board of Radiology & American Board of Internal Medicine Hospital Affiliations: Wellington Regional Dominic J. Kleinhenz, MD 9970 Central Park Blvd, Suite #400, Boca Raton, FL 33428 Phone: 561-483-1600 Fax: 561-451-4732 Specialty: Orthopaedic Surgery Medical School: Case Western Reserve University 1972 Internship: University of Michigan Hospital 1972-1973 Residency: University of Michigan Hospital 1973-1974 Fellowship: University of Michigan Hospital 1974-1977 Board Certification: American Board of Orthopaedic Surgery Hospital Affiliations: North Broward Medical Center, West Boca Medical Center & Boca Raton Community Hospital Nelson Iafrance (Medical Student) 1315 North Federal Highway, Boynton Beach, Fl 33435 Phone: 561-733-2929 Fax: 561-736-8467 Medical School: Florida Atlantic University Date of Birth: 11/25/1987 Adrian Lavina, MD 3399 PGA Blvd., Suite 350, Palm Beach Gardens, FL 33410 Phone: 561-624-0099 Fax: 561-624-7373 Specialty: Ophthalmology Medical School: University of Miami 1997 Internship: JMH 1997-1998 Residency: Vanderbuilt University 1998-2001 Fellowship: Vanderbuilt & University of BC 2001-2003 Board Certification: American Board of Opthalmology Hospital Affiliations: Good Samaritan

OnCall September - October 2011

Jorge L. Macia, MD 115 SE 4th Street, #513, Boynton Beach, FL 33435 Phone: 561-732-2701 Fax: 561-732-0354 Specialty: Family Medicine Medical School: UACA 1991 Internship: Wayne State 1993-1994 Residency: Wayne State 1994-1996 Board Certification: American Board of Family Medicine Hospital Affiliations: Bethesda Memorial Hospital Date of Birth: 5/9/1953 Alex S. Mirakian, M.D 3355 Burns Road, Palm Beach Gardens, FL 33410 Phone: 561-775-7075 Fax: 561-775-7858 Specialty: Radiation Oncology Medical School: Monash University 1990 Internship: Peter Maccallum Cancer Institiute 1995-2000 Residency: MD Anderson Cancer Center 2000-2001 Fellowship: Beth Isreal Medical Center 2001-2003 Board Certification: American Board of Radiology-Radiation Oncology Hospital Affiliations: JFK Medical Center, Columbia Hospital, Palms West Hospital, Wellington Regional Medical Center & Palm Beach Gardens Medical Center Karla K. Noel, MD 6427 Lake Worth Road, Greenacres, FL 33463 Phone: 561-433-1033 Fax: 561-433-6435 Specialty: Family Medicine Medical School: Indiana University 1997 Internship & Residency: Lehigh Valley Hospital 1997-2000 Hospital Affiliations: Applied at Palms West Date of Birth: 4/8/70 Sumithra Vattigunta MD 3401 PGA Blvd., Suite 200, Palm Beach Gardens, FL 33410 Phone: 561-422-1277 Fax: 561-472-7066 Specialty: Hematology-Oncology Medical School: Rangaraya Medical School 1994 Internship: New York Methodist Hospital 1996-1997 Residency: New York Methodist Hospital 1997-2000 Fellowship: Roswell Park Cancer 2000-2003 Board Certification: American Board of Internal Medicine-Internal Medicine and Hemotology & Oncology Hospital Affiliations: Jupiter Medical Center, Palm Beach Gardens Medical Center, Wellington Regional Medical Center, Palms West Hospital & St. Mary’s Medical Center Guangsheng G. Wang, MD PO Box 186, Boynton Beach, FL 33425 Specialty: Pathology Medical School: Zhangjiang Medical College 1983 Internship: Residency: University of Cinncinnati 1994-1998 Fellowship: Medical College of Wisconsin 1998-1999 Board Certification: American Board of Pathology & Hemopathology and Pathology-Anatomic & Clinical Hospital Affiliations: Bethesda Memorial Hospital Date of Birth: 10/24/1957 Frederick Kent Williams II, MD 5301 South Congress Avenue, Atlantis, FL 33462 Phone: 561-548-1273 Fax: 561-548-1572 Specialty: Internal Medicine Medical School: University of South Florida 1989 Internship: Ohio State University 1989-1990 Residency: Ohio State University 1990-1992 Board Certification: American Board of Internal Medicine Hospital Affiliations: JFK Medical Center Date of Birth: 2/20/1963 Brian J. Young, MD 7408 Lake Worth Road, Suite 100, Lake Worth, FL 33467 Phone: 561-616-2301 Specialty: Radiology Medical School: SUNY at Buffalo 1986 Internship: Millard Fillmore Hospital 1986-1987 Residency: Hahnemann University 1987-1991 Fellowship: University of Pennsylvania 1991-1993 Board Certification: American Board of Radiology Hospital Affiliations: Palm Beach Gardens Medical Center

Medical Student applicants: 1. Ali Alagely 2. Kathryn Anderson 3. Kristen Baker 4. Ben Barton 5. Megan Behm 6. Mary Ellen Billington 7. Katherine Boylan 8. Andrew Brown 9. John Ciotti 10. Brad Constant 11. Jacqueline B. Cortizo 12. Brittany Cerankosky 13. Stephanie K. Demetriou 14. Thomas Difato 15. David Dillon 16. Janelle Marie Donovan 17. Eric Downes 18. Lindsey B. Elmes 19. Mary Anne Estacio 20. Ryan Evans 21. Timothy M. Finnegan 22. Rachel Fowler 23. Nicole Fregosi

24. Rochelle Freire 25. Samantha Gammon 26. Sarah Gennette 27. Cynthia Giraldo 28. Stacy Goldblaum 29. Stephanie Hernandez 30. Ryan Hidalgo 31. Richie Huynh 32. Katie Jerzewrki 33. Benjamin Katz 34. Christopher Kline 35. Angerika Yumi Kojima 36. Raven Lambert 37. Tania Lopez 38. Douglas J. McConnell 39. Juliet E. Meir 40. Sebastion Millette 41. Jennifer Moscoso 42. Lisa Oliveri 43. Kinjal Patel 44. Shawn Singh Rae 45. Louis Richman 46. David Rotberg 47. Patrick Jeremy Roth

48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65.

Benjamin Saylor Adam Schertz Kimberly Seifert Susie Sennhauser Nataly Shildt Wendy Song Saima Siddiqi Kristen Simmier Lisa Sonnenblick Jonathan Stern Raphael Sturm Crystal Tenn Yen Vuong Andrew Wagner Nicholas Warren Jeffrey D. Wilcox Benjamin Wolk Rica Zantua

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PAID 3540 Forest Hill Blvd., Suite 101, West Palm Beach, FL 33406 RETURN SERVICE REQUESTED

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