The Official Publication of the Palm Beach County Medical Society
Alan B. Pillersdorf, MD & Richard Rendina
Salute the heroes among us
Quarter Two 2013
Find out why we are the only agency endorsed by the Palm Beach County Medical Society. We make it our practice to genuinely care about yours. As a long-time supporter of the Palm Beach County Medical Society, we do much more than just negotiate the best med mal rates available. We are financially and actively involved, both locally and statewide, in seeking solutions to some of healthcare’s most pressing issues. Call us today to see what we can do for you.
The Providers’ Insurance Specialists ���Healthcare ����������� ��������� �������
Delray Beach • Jacksonville • Miami • Orlando • Pensacola 800.966.2120 • firstname.lastname@example.org • www.dannagracey.com
Did you receive money back on your premium last year? Many doctors have through the Palm Beach County Medical Society Workers’ Compensation Program. The rates for all physicians throughout the state are set by the State of Florida. Your practice will pay the same price no matter where you choose to secure coverage. However, under the OptaComp program, you may be eligible for a potential dividend of up to 24.8%. Your membership with the PBCMS can provide savings that can be paid back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over the past six years to Florida medical societies’ members: $600,000 of that went to PBCMS members. The OptaComp (rated “A” by A.M. Best) program is endorsed by the PBCMS and is offered by Danna-Gracey, Inc. For more information, please call Tom Murphy at 800.966.2120.
The Providers’ Insurance Specialists ���Healthcare ����������� ��������� �������
President’s Report Andrew Larson, MD
Quarter Three 2013
President, Palm Beach County Medical Society
A Great and Busy Start to 2013.
The first few months of 2013 have been busy ones for me and for the Palm Beach County Medical Society. Aside from welcoming and integrating new members to our board, our members have participated on the political stage nationally and at the state level. This includes attendance at the American Medical Association’s National Advocacy Conference in February at which time we visited with several aides and members of Congress and an additional day trip in March to meet with legislators at the state level while the house and senate were in session. Our members recently worked with Palm Beach County Medical Society Services to host the 10th Annual Heroes of Medicine Luncheon at the Kravis Center on May 9th. The event was emceed by Liz Quirantes from CBS 12 News and was attended by more than 400 physicians, nurses, community activists, and family members. Proceeds from this highly successful luncheon help support Project Access and make essential health care more accessible locally in Palm Beach County. Congratulations to the organizers of this wonderful, well-attended event. With a lot of help from our friends in the Florida Medical Association the state legislature did pass two bills which have significant implications for physicians in the state of Florida.One successfully blocked attempts to include assessments on malpractice insurance premiums should the state’s CAT fund require additional funding due to a
major catastrophe such as an intense hurricane striking Florida. With many malpractice insurance policies costing over fifty thousand dollars annually the CAT assessment would have been several thousand dollars per physician and the CAT fund would have been disproportionately funded by physicians as opposed to the state citizenry as a whole. Tort reform was also addressed as Senate Bill 1792 assures that physicians have a constitutional right to access to legal counsel, allows access by the defendant physician in a malpractice lawsuit to speak with and formally interview the plaintiff’s treating physicians without the presence of the plaintiff or the plaintiff’s attorney, and tightens expert witness standards such that the plaintiff’s expert witnesses must be in the exact specialty as the defendant physician. Collectively, these changes move Florida in the direction of becoming a more physician-friendly environment in which to practice. I have heard many comments related to the expansion in Florida of the Medicaid program. As many of you are aware no action was taken by the state legislature to accept federal funding or to implement a Medicaid expansion using only state funds. Our medical society has been following this issue closely but has not taken a collective position on the issue. This stance is similar to that being taken by the Florida Medical Association. The issue is politically charged and divisive and organized medicine wishes to maintain as much relevance as possible with as many members of the state house
and senate as possible. In addition, there is not a consensus amongst our own board members as to what the correct path forward is on this issue. Believe me, as a physician I want health care to be accessible to as many people as possible and would like to see our Society as a conduit for a positive movement in that direction but sometimes it’s best not to be the first horse out of the gate especially when billions of dollars are at stake. I welcome any and all input on this important issue. Our Palm Beach County delegation to the Florida Medical Association’s annual meeting will be in Orlando from July 26th through the 28th advocating for the passage of resolutions supported by our county society and by our tri-county South Florida Caucus. There is still time to draft and submit resolutions to be heard and I encourage any of our membership who would like our society to amplify your voice this summer with our support to contact me or any other board member so that your ideas may be discussed. Furthermore, we intend to have a full delegation of over 20 in Orlando this summer and those of you who are FMA members and would like to attend on our county society’s behalf are invited to contact Tenna Wiles at 561-4333940 to express your interest. Thank you all for entrusting me with your leadership. Yours in good health,
Andy Larson President PBCMS
QUARTER TWO 2013
ON CALL MAGAZINE
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Brokers welcome. Broker must accompany client during client’s initial visit to this community. Both the client and Broker must execute the Developer’s Registration Form on the initial visit. Broker must also execute the Developer’s Broker Participation Agreement. Canyon Trails is being developed by Boynton Beach Associates XXIII, LLLP. Valencia Reserve and Valencia Cove is being developed and sold by Boynton Beach Associates XIX, LLLP. The complete offering terms are in an offering plan available from Sponsor. File No. H09-0015. Valencia is designed for residents aged 55 & older and is intended to meet the exemption under the Federal Fair Housing Act. The homes at The Preserve at Bay Hill Estates are being sold by Palm Beach West Associates III, LLLP. The Bridges is being developed and sold by Boca Raton Associates VI, LLLP. Oral representation cannot be relied upon as correctly stating representations of the developer. For correct representations, make reference to the documents required by section 718.503, Florida statutes, to be furnished by a developer to a buyer or lessee. Prices subject to change without notice. ©2013 1100-740 5-7-13
Heroes in Medicine 2013 PBCMS Services Report Be Prepared is the Motto to Follow When Testifying in a Malpractice Lawsuit How to Prepare for Times of Unexpectadly Low Cash Flow 2013 FMA Legislative Update Join the Mobile Revolution
03 Presidents Report 24 MED MEMO 26 MED Society News
22 About the Cover:
Alan B. Pillersdorf, MD and Richard Rendina of the Rendina Companies commemorate 10 years of the Heroes in Medicine Awards. Dr. Pillersdorf and the late Bruce Rendina helped launch the event in 2003.
PBCMS STAFF Tenna Wiles
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Director of Public Health & Disaster Services
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R E A L E S TA T E D E V E L O P M E N T
Creating Healthcare Real Estate Solutions
for more than
Ÿ Development Ÿ Leasing &
Tenna Wiles, CEO
CEO, Palm Beach County Medical Society
Board of Directors K. Andrew Larson, MD President
PBCMS Physicians – Leadership in Action
Ronald Zelnick, MD President Elect
Kudos to our PBCMS members that have most generously donated their time and talents. Whether it is serving as a Project Access Volunteer, a member of the Medical Reserve Corp, serving on the PBCMS Board or PBCMS Council or Committee, representing their colleagues at the FMA and AMA serving in a leadership role at their hospital or being engaged in the political process, this is a tremendous force of good for the profession and the community.
The FMA Annual meeting will be held in July in Orlando. PBCMS will be sending a delegation of 20 physicians, Be sure to mark your calendars for two exciting fall events. October 10-11. The Future of Medicine Summit promises to be outstanding and will be held October 10-11. Our Annual Installation Gala is scheduled for November 23 with some spectacular surprises in store. The more you participate, the more we accomplish together. I look forward to hearing from you.
We recently honored our 1, 200 PBCMS Services volunteers and our Heroes in Medicine. In spite of the major challenges facing the medical profession, our physicians, health care and community partners and volunteers continue to go above and beyond in their service to the community.
Steven Babic, MD First Vice President
James Howell, MD Second Vice President
James Goldenberg, MD Secretary
Shawn Baca, MD Treasurer
Jack Zeltzer, MD Immediate Past President
Sandra Blair Alliance Representative
Lisa Oliveri Medical Student
Tulisa La Rocco, MD
Beth-Ann Lesnikoski, MD Marc Hirsh, MD Hatem Abou-Sayed, MD Kishore K. Dass, MD Jeffrey Davis, DO Michael Dennis, MD Roger Duncan, MD Richard Greenwald, MD Aviv Katz, DO Brandon Luskin, MD Andrew Shapiro, MD Kenneth Woliner, MD
This issue of On Call highlights our heroes, award recipients, donors and volunteers. You are my personal inspiration, and I thank you for all you do. In the coming issues of On Call and MedLink , we would like to continue to feature “good news” stories. We invite you to share with us your accomplishments and “good news.” We also invite you to become engaged in shaping health care policy.
Board of Trustees Brent Schillinger, MD Jack Zeltzer, MD Lawrence Gorfine, MD James J. Byrnes, MD Alan Pillersdorf, MD Jose F. Arrascue, MD Malcolm Dorman, MD K. Andrew Larson, MD Ronald Zelnick, MD Steven Babic, MD James Howell, MD James Goldenberg, MD
Follow Us! For the latest news & information on PBCMS QUARTER TWO 2013
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IS Protecting the practice of medicine The American Medical Association is proud to help the Florida Medical Association (FMA) address concerns that federal interference is diminishing the role of state legislatures and medical boards in licensure and scope-of-practice issues. We believe physicians, not federal government bureaucrats, are best suited to regulate the practice of medicine and make clinical judgments that affect patient health and safety. Be a part of it. ama-assn.org/go/memberadvocate
Congratulations to our Heroes of the Year! Palm Beach County Medical Society Services held its 10th Annual Heroes in Medicine Awards held on May 9th. More than 400 people attended, and Liz Quirantes, anchor on CBS12 News, served as mistress of ceremonies. Over $40,000 was raised to benefit Project Access, a community-based program to increase access to health care for the uninsured. QUARTER TWO 2013
ON CALL MAGAZINE
2013 HeroEs In Medicine
Front row: Mary Prokop, RN; Diane Esposito ARNP; Ronda Ayala, RN; Alan B. Pillersdorf, MD; Brent M. Schillinger, MD; Lisa Oliveri; Kelly Conroy Back row: Nickerson Geneve, DO; Michael Dennis, MD; Alexander Kasmere; Lauren Rosecan, MD; Wilda Patterson-Julias, RN; Kimberly LaRue; Jordan Camp; Jennifer Rose; Mary Eileen Koehler, RN; Ari Robinson; Darci McNally, LCSW; Frank Cirisano, MD; Argentina Brito, MD; Paul Coulson; Philip Colaizzo, MD; Yasmeen Scuderi; Gaetano Scuderi, MD; Saima Siddiqi; Ronald L. Cohen, MD
Bruce Rendina Professional Hero: Kelly Conroy, Palm Beach Accountable Care Organization Community Outreach Hero: Jupiter Volunteer Clinic Health Care Educator Hero: Diane Esposito, ARNP, Palm Beach Atlantic University Health Care Innovation Hero: Gaetano Scuderi, MD, Research Company Cytonics Corporation Health Care Provider Hero: Mary Prokop, RN, St. Mary’s Medical Center Student Heroes: Jordan Camp, Palm Beach Gardens Community High School, Lisa Oliveri and Saima Siddiqi, Charles E. Schmidt College of Medicine at FAU Physician International Hero: Dror Paley, MD, Paley Advanced Limb Lengthening Institute at St. Mary’s Medical Center Physician Local/National: Brent M. Schillinger, MD, Dermatology Associates, P.A.
Emcee Liz Quirantes and PBCMS Chairman K. Andrew Larson, MD
Two physicians received special one-time awards: Excellence in Medical Education: Michael Dennis, MD, founding chair of the FAU Schmidt College of Medicine Dick Van Eldik, MD Distinguished Service Award: Alan B. Pillersdorf, MD, Plastic Surgery of Palm Beach, P.A.
ON CALL MAGAZINE
QUARTER TWO 2013
Co-chairs Greg Quattlebaum and Sally D. Chester, RN
Heroes Gaetano Scuderi, MD, and daughter Yasmeen Scuderi
Jupiter Volunteer Clinic Diane Williams (Jupiter Volunteer Clinic Coordinator); Dr. Dan Boss (JVC Volunteer Physician and Medical Director); John Couris (President and CEO Jupiter Medical Center);Dr Alina Alonso (Director, Palm Beach County Health Department);Stacey Brandt (VP Marketing and Strategic Business Development Jupiter Medical Center); Mayor Karen Golonka (Town of Jupiter); Amy Pepper (Project Manager- Jupiter Medical Center); Dr. Ron Surowitz (Volunteer Physician)
Carol Van Eldik; Richard Van Eldik, MD; Dick Van Eldik, MD, Distinguished Service Award Recipient Alan B. Pillersdorf, MD and former Hero Emanuel Newmark, MD
Brian C. Butler, Marji Rendina, Michael and Lainie Rendina
Dr. Alan Pillersdorf
Other 2013 Heroes in Medicine that were honored are: Bruce Rendina Professional Heroes: Kerry Diaz, Kimberly LaRue, Clare Oâ€™Keeffe Community Outreach Heroes: Ronda Ayala, RN; Jay Feinberg, Brian Fuller, DeAnna Warren Health Care Educator Heroes: Nickerson Geneve, DO; Ari Robinson, Stephanie B. Stiepleman Health Care Innovation Heroes: W. Anthony Lee, MD; Daniel Cane & Michael Sherling, MD Health Care Provider Heroes: Darci McNally, Eugenia Millender, ARNP, PhD (c), RN; Kathi Voege-Harvey, FNP, ARNP; Mary Ellen Koehler, RN; Wilda Patterson-Julias, RN Student Heroes: Paul Coulson, Alexander Kasmere, Jennifer Rose, Yasmeen Scuderi Physician International Heroes: Argentina Brito, MD; Frank Cirisano, MD Physician Local/National Heroes: Ronald L. Cohen, MD; Philip Colaizzo, MD; Kishore K. Dass, MD; Howard Goldman, MD; Lauren Rosecan, MD;
( Continued on Page 18 )
James Howell, MD and Excellence in Medical Education Award Recipient Michael Dennis, MD
Jack Zeltzer, MD; Hero of the Year Dror Paley, MD and Douglas Dedo, MD
QUARTER TWO 2013
ON CALL MAGAZINE
2013 PBCMS Services Report to the Community
Creating A Healthy Future For Palm Beach County This Past Years Accomplishments
PBCMS Services was founded in 2001 by a dedicated group of physicians committed to extending the reach of the Palm Beach County Medical Society into the community. Twelve years later, PBCMS Services is an integral partner of the Palm Beach County health care delivery system. The vision of Palm Beach County Medical Society Services to “Create a Healthier Community.” The commitment and dedication of our Board of Directors and over 1,900 volunteers and community partners provides us the opportunity to shape the future of health care in our community. Through clearly defined volunteerdriven programs, PBCMS Services continues to make significant accomplishments.
• Served 7,000 uninsured patients • Established a partnership with Mental Health Association to expand mental health services • Expanded Project Access network to more than 650 physicians and providers • Increased 1919 Society • Future of Medicine expanded to launch Triple Aim Diabetes Initiative • Launched Community Call to Action for Obesity • Engaged in Community Health Planning Initiatives and Collaboratives
2013 Board of Directors
Douglas Dedo, MD President
Michael Dennis, MD Vice President
Ivy Faske, MD Secretary
Don Chester Treasurer
Brent Schillinger, MD Immediate Past President
Douglas Dedo, MD, President Palm Beach County Medical Society Services
Under the leadership of Douglas Dedo, MD the PBCMS Services Board of Directors are people who work diligently to provide opportunities, identify priorities, and develop resources to achieve the organization’s vision of “Creating a Healthy Future for Palm Beach County.”
William Adkins, MD Brenda Atkins Cynthia Clayton, MD Tammy Clarke Ronald Davis, PhD Bradley Feuer, DO, JD Marsha Fishbane, MD Judy Goodman, Esq. Matt Gracey Daniel Higgins, MD Robert Hill Stuart B. Himmelstein, MD James T. Howell, MD Heather Siegel Miller, Esq. Alan B. Pillersdorf, MD Greg Quattlebaum Andrea Stephenson Jim Sugarman Kimberly Warth
Project Access Project Access is a network of physicians who donate care to low income uninsured residents of Palm Beach County. To date Project Access volunteers have provided over $9.3 million in care to over 7,000 patients.
HERC HERC is a nationally recognized coalition of more than 60 public health agencies, 15 hospitals in the county and two specialty care hospitals, physician offices, law enforcement officers and emergency responders. HERC exists to coordinate and improve the delivery of health care emergency response planning, preparedness and response.
Medical Reserve Corps MRC volunteers work to improve the health and safety of our community by organizing and utilizing public health and other volunteers to respond to disasters and other public health needs.
Future of Medicine Initiative Now in its 7th year the Future of Medicine Initiative has brought together healthcare and community leaders to define issues, establish partnerships and explore and implement opportunities to improve the quality of health care in our community.
Ivy Faske MD, Alan Pillersdorf MD, Stefan Pasternack MD, Brent Schillinger MD
MRC Volunteers in Action
Hippocrates Society As PBCMS and PBCMSS take an increasingly proactive role in improving the health of our community, the need for financial support also increases. We thank each of the following Medical Hospital Staffs for serving our community and for being members of the 2013 Society.
Steven Varady, MD, Jose Arrascue MD, Kavitha Neeukonda, .American Medical .Association , Carol Beasley, Institute of Healthcare Improvement, Jim Kupel, Crescendo Consulting at Future of Medicine Summit
• Bethesda Memorial Hospital • Boca Raton Regional Hospital Medical Staff • Delray Medical Center Medical Staff • JFK Medical Staff • Wellington Regional Medical Center
1919 Society Since 1919, PBCMS physicians have dedicated themselves to their patients and the community. The 1919 Society is a Leadership Giving Society which has demonstrated a long-term commitment to our community. Thank you to 1919 Society Members
Dr. Jose F. Arrascue Dr Jeffrey Berman Dr. Clarence L. Brumback (Deceased) Dr. James J. Byrnes Dr. Malcolm Dorman Dr. J. John and Judy Goodman
Dr. Howard Green Dr. Beth-Ann Lesnikoski Dr. Alan and Rhona Pillersdorf Dr. Brent Schillinger Dr. Ida Sebastian
Heroes In Medicine The 10th Annual Heroes in Medicine Award luncheon recognized outstanding individuals and organizations and community leaders who have made a significant contribution to healthcare and have demonstrated a commitment to community service.
Mary Russell EdD,RN HERC Member of the Year
2013 Heroes In Medicine Award Recipients
Bruce Rendina Professional Hero: Kelly Conroy, Palm Beach Accountable Care Organization Community Outreach Hero: Jupiter Volunteer Clinic, Funded by Quantum Foundation Health Care Educator Hero: Diane Esposito, ARNP, Palm Beach Atlantic University Health Care Innovation Hero: Gaetano Scuderi, MD, Research Company Cytonics Corporation Health Care Provider Hero: Mary Prokop, RN, St. Maryâ€™s Medical Center Student Heroes: Jordan Camp, Palm Beach Gardens Community High School, Lisa Oliveri and Saima Siddiqi, Charles E. Schmidt College of Medicine at FAU Physician International Hero: Dror Paley, MD, Paley Advanced Limb Lengthening Institute at St. Maryâ€™s Medical Center Physician Local/National: Brent M. Schillinger, MD, Dermatology Associates, P.A. Excellence in Medical Education: Michael Dennis, MD, founding chair of the FAU Schmidt College of Medicine Dick Van Eldik, MD Distinguished Service Award: Alan B. Pillersdorf, MD, Plastic Surgery of Palm Beach, P.A.
Dana Oaks,CEO West Palm Hospital, Project Access Hospital of the Year
Ed Knuckles, Medical Reserve Corps, Member of the Year
Recognizing Excellence The following individuals and organizations were recognized at the 2013 Annual Dinner Project Access Surgical Physician of the Year: David Weinstein MD Project Access Medical Physician of the Year: Margaret Lynn Clements DO Project Access Hospital of the Year: West Palm Hospital Project Access Provider of the Year: Laser & Surgery Center HERC Leadership Award:Brenda Atkins HERC Member of the Year:Mary Russell EdD,RN Medical Reserve Corps Member of the Year:Edward Knuckles PBCMS Services Leadership Award:Michael Dennis MD
David Weinstein MD, Project Access Surgical Physician of the Year
In 2013 we will continue our efforts to create a healthy future for Palm Beach County • Evaluate the local impact of the new state and federal health care policy on physicians, health care providers, companies and patients • Expand Project Reach to assist the uninsured who have fallen through the cracks of the medical system in obtaining health care • Expand our efforts to provide mental health services to uninsured • Provide quality health care to uninsured residents with urgent medical needs and no insurance
Many Thanks to Our Generous Funders
• Admirals Cove Cares Charitable Foundation • Allegany Franciscan Ministries • B4BC • The Ernst & Gertrude Ticho Charitable Foundation • Florida Department of Health • Health Care District of Palm Beach County • Healthcare REIT • Jarden Consumer Solutions Community Fund • National Association of County & City Health Officials (NACCHO) • Palm Healthcare Foundation • Quantum Foundation • Rendina Companies • United Way of Palm Beach County • Urban Areas Security Initiative (UASI)
• Develop and promote the health care emergency preparedness , response, and recovery for our community • Train medical professionals to prepare hospitals and agencies for mass casualty emergencies and emerging issues • Advance the Future of Medicine Initiative to improve patient quality and safety, prevention and wellness, physician liability and many other important issues • Develop and implement the Triple Aim Diabetes Initiative and Call to Action on Obesity Collaborative • Further develop the Physician Census
Jose F Arrascue MD and Michael Dennis, MD
Dr. Jose F. Arrascue Dr. Clarence L. Brumback (Deceased) Dr. James J. Byrnes Dr. Malcolm Dorman Dr. J. John and Judy Goodman Dr. Howard Green Dr. Beth-Ann Lesnikoski Dr. Alan and Rhona Pillersdorf Dr. Brent Schillinger Dr. Ida Sebastian
Palm Beach County Medical Society Services is a 501c3 charitable organization which relies on the generosity of our donors. Please visit us at www.pbcms.org to learn more about our programs. If you would like to learn how you can support our mission, please contact us at 561-433-3940 or pbcms.org.
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Save the date for
Future of Medicine Summit VII Thursday, October 10, 2013 Friday, October 11, 2013
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Friend Sally and Don Chester Susan Nefzeger GL Homes Greg Quattllebaum Table Sponsors Alan B Pillersdorf, MD Bethesda Memorial Hospital Medical Staff Brito Medical Center Boca Raton Regional Hospital Medical Staff Delray Medical Staff Good Samaritan Medical Center Medical Staff JFK Medical Center Medical Staff Jupiter Medical Center Modernizing Medicine PBCMS Alliance Scripps Florida St. Mary’s Medical Center
Wellington Regional Medical Center Wellington Regional Medical Center Medical Staff Contributors Blue Ocean Press Hoffman’s Chocolates J&R Printing & Graphics, Inc. Lesser, Lesser, Landy & Smith Jim Sugarman Jack Zeltzer, MD Village Tavern, Boyton Beach Media South Florida Hospital News and Healthcare Report The Palm Beach Post Music & Entertainment Monte Lambert, Piano Thomas Sebastian, Piano
“BE PREPARED” Is the Motto to Follow When Testifying in a Malpractice Lawsuit If you’re faced with a malpractice lawsuit, you may feel that the entire litigation process— from discovery to trial—is beyond your control. But there is one very important element that you can control: your own testimony. Because the courtroom differs from the exam room or the surgical suite, and because opposing counsel’s job is to attempt to discredit you, being prepared is a must.
Physicians can start the preparation process by reviewing these basic tips before testifying: 1.Limit Your Answers
2.Provide a Careful, Precise Answer
Whether you’re on the witness stand or in a deposition room, your only obligation is to answer the question you were asked. You may be tempted to provide additional information that you think is relevant, but you could inadvertently harm your case. Stay within the scope of the question. Your attorney—not you —has responsibility for making sure that all relevant information is introduced.
When you answer precisely, you remove ambiguity from your testimony. But be sure not to box yourself in. If you are asked for a complete list of your actions, answer carefully. Unless you are absolutely sure you’ve provided every element, leave the list open. For example, if you are asked to detail the steps you took before arriving at a diagnosis, it is acceptable to say, “At this time, these are the steps I remember taking.”
Keep your cool. You lose credibility when you become sarcastic, raise your voice, or get defensive. Opposing counsel may try to provoke you. Don’t take the bait. If you can feel your blood pressure rising, pause for a moment to collect yourself before answering the question.
The facts will come out in your deposition or at trial, so there is no point in trying to avoid an admission, even if you think that making it will hurt your case. When opposing counsel asks a question, don’t obfuscate. Quickly provide a clear answer. Dancing around the issue will only give it more prominence.
The Doctors Company provides Litigation Education Retreats as an exclusive benefit for members facing claims. At these one-day seminars, litigation experts offer essential advice about what makes a winning case, and physicians learn the skills necessary to aid in their own defense. Find more information at www.thedoctors.com/LER. Contributed by The Doctors Company. For more risk tips, patient safety tips, and physician practice tips, visit www.thedoctors.com/patientsafety.
ON CALL MAGAZINE
How to Prepare for Times of Unexpectedly Low Cash Flow Your patient log, not to mention the long hours you put in, tells you that your practice is thriving and lots of people are eager for your services.
interest rates, so you’ll want to borrow carefully and pay back as soon as you can. But when cash flow is a problem, it can keep you running smoothly.
So with all that traffic, how could your practice ever experience a cash flow crunch?
Ramp Up Your Receivables
Actually, it’s more common than you think, especially among small businesses such as healthcare practices, which may lack the large cash reserves necessary to get over those humps when the bills keep coming and the receivables lag behind. According to a national survey by the Enterprise Council on Small Business, cash flow matters are the third leading cause of concerns for small business owners, after poor sales and regulations. If anything, success can create cash flow issues. The busier you get, the more likely you are to need additional space, new equipment and more employees— all of which create regular costs that can sap your cash reserves. As with most foreseeable problems, the best way to deal with a cash flow emergency is to prepare in advance.
Secure a Line of Credit
Hearing “the check’s in the mail” from a patient won’t do you much good when you’ve got bills that must be paid right now. Consult your attorney to see whether you might want to consider encouraging your paying patients with a nominal discount if they pay before the due date.
Use Credit Cards Wisely Credit cards can certainly help a practitioner get out of a cash flow jam with ready access to funds. But take care not to assume too much debt or to mess up your credit rating in the process. One vital step is to assiduously separate your personal and business cards, and avoid overextending your cards. Business credit builds slowly over time, based on your track record of paying off loans and lines of credit responsibly and promptly. The more you pay attention to such details, the better positioned you’ll be to meet the next cash drought that comes your way.
Mary Helen Johnson Vice President PNC Healthcare Business Banking
Unlike a loan, where you might receive a set amount for a specific purpose, such as renovating the office or buying a major new piece of equipment, a business line of credit gives you access to the money you need, at your convenience. Whereas a loan is a one-time event, a line of credit is ongoing, and it’s there when (and only when) you need it. 1) If you’re not facing cash issues, the account rests. You don’t pay any monthly payments until you actually use the line of credit and begin paying the money back.2 Of course, you want to use the line of credit judiciously. Lines of credit usually come with variable
QUARTER TWO 2013
ON CALL MAGAZINE
2013 FMA LEGISLATIVE SESSION REPORT The 2013 legislative session concluded on Friday, May 3rd. Of the nearly 1850 bills filed, only 286 of them passed. The FMA tracked 300 bills and numerous amendments on behalf of our members For a detailed report on specific legislation visit www.pbcms.org
Key Bills That Passed Medical Liability Reform contains three important provisions designed to help improve Florida’s medical liability climate for Florida physicians
1.Ensure a Physician’s Constitutional Right to Counsel A recent Florida Supreme Court decision has the effect of limiting and even prohibiting non-defendant physicians from speaking to their attorney about non-privileged information. The bill ensures that a health care practitioner has the right to consult with an attorney for the purposes of obtaining legal services if the practitioner is scheduled for a deposition, is called as a witness or receives formal or informal requests of discovery.
2. Give Parties Equal Access to Medical Fact Witnesses Florida law prohibits a non-party physician from disclosing a malpractice plaintiff’s medical history and condition to a defendant in a medical malpractice case without the plaintiff’s consent. The bill addresses this unfairness by permitting prospective defendants or their counsel, after receiving a claimant’s notice of intent to initiate a medical malpractice lawsuit, to interview the claimant’s treating health care providers without the presence of the claimant or the claimant’s attorney after providing notice.
3. Require Fairness in the Use of Medical Experts Florida law does not require that an expert witness be of a same or similar specialty as the defendant physician. 22
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What constitutes a “similar” specialty is undefined and has led to situations where physicians in one specialty have been allowed to testify against a physician in an entirely different specialty. The bill corrects this problem by restricting the categories of experts who are qualified to testify against health care provider specialists by permitting only those providers in the same specialty as the provider against whom the testimony is offered.
CAT FUND MALPRACTICE ASSESSMENT EXEMPTION Provides a 3-year extension of the medical malpractice insurance exemption from assessments levied by the Florida Hurricane Catastrophe Fund (CAT Fund)..
EPINEPHRINE AUTO-INJECTORS / SCHOOLS Gives private and public schools the authority to purchase and store epinephrine auto-injectors, also known as “epi-pens,” on school grounds. The legislation requires schools that possess such auto-injectors to adopt a protocol developed by a licensed physician for the purpose of training school personnel to administer the device in the event of an allergic reaction.
TEXTING WHILE DRIVING Provides penalties for texting while driving. First-time violators would be subject to a $30 fine plus court costs. The offense is classified as a secondary non-moving violation, which means drivers could only be charged if they are stopped for another reason. The bill was amended to allow law enforcement officers to access a driver’s cell phone records only in cases where accidents caused a death or injury.
QUARTER TWO 2013
PHYSICIAN DISPENSING/ WORKERS COMP Revises provisions relating to reimbursement for prescription medications under the Workers’ Compensation Law. The bill is a negotiated compromise between employer/business interests, dispensing physicians and drug repackagers. The bill will not impede or prohibit physicians from dispensing medication to workers’ comp patients.
OPTOMETRY Expands optometric scope of practice by authorizing optometrists to prescribe oral medications under specified conditions. In order to obtain this authority, an optometrist must undertake a 20-hour course and an examination on general and ocular pharmaceutical agents. The bill establishes a statutory formulary of 14 different oral pharmaceutical agents in four categories: analgesics; antibiotics; antivirals; and anti-glaucoma agents. The final bill is a compromise supported by the Florida Optometric Association and the Florida Society for Ophthalmology.
DAUBERT/SCIENTIFIC TESTIMONY Changes the legal standard under which courts consider whether expert testimony will be admitted in a particular case.
BIOSIMILARS Establishes requirements and conditions under which pharmacists may make substitutions of a prescribed biologic drug. A biosimilar is a highly similar version of a biologic product, but it is not an exact copy.
CANCER DRUG PARITY /PDMP Began as a bill creating an exception to
CON laws for skilled nursing facilities within specified areas of the state. It was subsequently amended in the final days of session to only streamline the CON review process for such facilities. In the final hours of the legislative session the bill was amended to incorporate several issues from other bills. . The provisions create the “Cancer Treatment Fairness Act” to require certain individual and group health insurance policies or HMO contracts that provide coverage for cancer treatment medications to provide coverage for oral medications in a manner no less favorable than those provided for other cancer treatments, such as injectable or intravenous medications. These provisions become effective July 2014. Second, it was amended to appropriate $500,000 for the administration of the Prescription Drug Monitoring Program Finally, it was amended to authorize the Miami Children’s Hospital to add 10 beds for labor and delivery care and treatment of pregnant women meeting specified criteria.becomes law.T hird, the bill was amended to authorize the Department of Health to designate a hospital meeting specified criteria as a Level II trauma center.
IMPAIRED PRACTIONERS Monitoring Program (PDMP). Implements changes for impaired practitioner services provided by PRN/IPN. It clarifies that PRN/IPN is authorized to assist students enrolled in a school or program to become licensed as health care practitioners as defined in ch. 456, F.S. In addition, the bill provides that each board or profession within the Division of Medical Quality Assurance has the authority to ask any license applicant to undergo an evaluation for impairment. The bill also subjects radiologic technologists to the impaired practitioner provisions in Florida law.
IMPAIRED PRACTITIONERS Modifies provisions of current law regarding impaired practitioners. The bill redirects fees collected for certification of EMTs and paramedics into the Medical Quality Assurance Trust Fund, providing necessary clarification and funding for including EMTs and paramedics within the scope of impaired practitioner services. In addition, the bill clarifies the
Department of Financial Services must defend any action for injunctive, affirmative or declaratory relief against PRN/IPN involving emergency interventions on behalf of practitioners or students.
MEDICAID FRAUD Contains provisions intended to help prevent Medicaid fraud and abuse, primarily by modifying existing statutes relating to provider controls, reporting and accountability. The FMA was able to obtain amendments to the bill to protect provider rights to administrative hearings, prevent the state from excluding consideration of addenda or modifications made to medical records in an audit process, and to remove provisions that would have extended the timeframe in which providers are required to retain Medicaid records.
BUDGET Included in the $74.3 billion budget for fiscal year 2013-2014 are allocations for the Statewide Medicaid Residency Program, funding for the federally required increase in Medicaid reimbursement rates for primary care providers as mandated by PPACA, funding for the development of Florida Diagnostic Related Groups (DRG) for Medicaid hospital inpatient services, and funding for the inclusion of critical congenital heart disease testing within the Newborn Screening Program. The budget provides $80 million in graduate medical education funding to pay for additional residency training positions for new physicians in the state. This allocation will provide for approximately 700 new residency slots. In addition, the budget includes $5.2 million in funding for specific residency positions at the Florida State University College of Medicine and the University of Florida College of Medicine. Preference for these residency slots (13 at each medical school) will be given to underserved rural areas that are determined by the Department of Health to have a primary care physician shortage. The budget also allocates $2.5 million to Lakeland Regional Medical Center to plan, design and construct facilities that support graduate medical education in Polk County.
Bills That Failed PATIENT PROTECTION AND AFFORDABLE CARE ACT The House and Senate failed to agree on a plan for extending health care coverage to Floridians between 100 and 138 percent of the Federal Poverty Level pursuant PPACA. The Senate proposal, Senator Negron, would have made Florida eligible for about $55B in federal subsidies over a 10-year period by providing coverage to persons with incomes of up to 138 percent of the federal poverty level. SB 7038 would have amended the existing Florida KidCare Act to implement the expanded coverage program. Those in the program would pay small premiums for private insurance, copays for doctor visits and hospital stays (as little as $2) and would qualify for health reimbursement accounts. The House proposal, HB 7129, was spearheaded by Representative Corcoran. House leadership opposed using any federal dollars for expanding care. HB 7129 would have used $237M in state general revenue to provide 115,000 Floridians with insurance coverage. Participants would have received up to $2,000 a year for the purchase of insurance but would have been required to provide a $25 monthly premium payment.
• PATIENT COMPENSATION SYSTEM • CONTROLLED SUBSTANCE PRESCRIBING • MEDICAL LIABILITY/PRESUIT NOTIC • DOCTOR OF NURSING PRACTICE/TITLE • BALANCE BILLING • NEEDLE & SYRINGE EXCHANGE PILOT PROGRAM • CRNAs/Physician Supervision • HMO “Bait and Switch” • NICA • TELEMEDICINE • SURGICAL ASSISTANTS For a full summary of these bills visit www.pbcms.org
QUARTER TWO 2013
ON CALL MAGAZINE
Med memo Quarter Two 2013
SAVE THE DATES
FMA Annual Meeting
July 26-28, 2013
FMA Annual Meeting Orlando Bonnett Creek More info: www.celebratemedicine.com
October 10-11, 2013 Future of Medicine
West Palm Beach, Kravis Center More info: www.pbcms.org/FOMSummit PBCMS ANNUAL
presented by the Palm Beach County Medical Society & Services
The 2013 FMA Annual Meeting will be held July 26-28 at the Orlando Bonnett Creek. The meeting will feature Outstanding CME Programs, Poster Symposium, and House of Delegates. Alan B. Pillersdorf MD is a candidate for FMA President-elect and Dr. Mark Rubenstien is a candidate for AMA Delegate. For additional information, or to register go to www.celebrate medicine.com
Project Access Receives $13,000 Grant Award from Admirals Cove. Nicola Chung, Director of Project Access, Tenna Wiles, CEO of PBCMS, and Christopher Speed, President of Admirals Cove Cares Charitable Foundation
AMA House of Delegates
November 23, 2012, 6:30 p.m West Palm Beach, The Kravis Center
Call for Delegates
Future of Medicine Mark Your Calendars: The 2013 Future of Medicine Summit is scheduled for October 10-11 at the Kravis Center. Once again, PBCMS will feature local and national speakers on a wide variety of topics and Scripps researchers partnering with local physicians. Michael Dennis, Michael Dennis, MD MD, leads a dynamic Summit Leadership Team comprised of Future of Medicine Initiative founder and chair, Jose Arrascue, MD, James Howell, MD, Ron Davis, PhD, Stefan Pasternack, MD, Steve Babic, MD, Jack Zelnick, MD, and James Goldenberg, MD For sponsorship and exhibitor opportunities, contact Sherra Sewell at email@example.com
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Palm Beach County, the third largest delegation in the state will be represented by 20 delegates at the FMA Meeting. Working in partnership with Broward and Dade County Medical Associations, the South Florida Caucus is a strong voice for physicians. This year the South Florida Caucus is presenting seven resolutions for consideration. This is an excellent opportunity to take an active role in shaping health policy. For additional information about serving as a Delegate, please contact Tenna Wiles at firstname.lastname@example.org
Alan Pillersdorf, MD
2013 Membership Campaign: Strength in Numbers
Jose Arrascue, MD
PBCMS has launched its 2013 membership drive with the goal of recruiting 100 new members by the end of the year. Any new member who joins between now and August 31st will be entered in a drawing for an ipad mini. If you have questions about membership or would like us to follow up with a prospective members, please contact Deanna Lessard at 561-433-3940 ext. 28.
Mark Rubenstein, MD
QUARTER TWO 2013
The AMA House of Delegates will be held June 15-19 at the Hyatt Regency , Chicago. Alan Pillersdorf, MD, Jose F Arrascue, MD, and Mark Rubenstein, MD, will represent Palm Beach County as members of the Florida Delegation. Project Access Receives $13,000 Grant Award from Admiralâ€™s Cove.
Read how your colleagues all over the United States are taking advantage of the latest technology by using the DocBookMD app to securely send HIPAA-compliant messages directly from their iPad, iPhone and Android devices. A patient arrives in the emergency department (ED) after injuring his toe while mowing his lawn. The ED physician determines that the wound can be treated with antibiotics and local care. He calls the on-call orthopedic surgeon. The ED physician describes the wound and what is shown in the X-rays to the orthopedic surgeon. The orthopedic surgeon is unsure of the diagnosis, having just treated a patient who lost his toe due to necrosis after being lost in follow up. The orthopedic surgeon must decide whether to accept the ED diagnosis or go to the ED and see the patient in person. Due to his recent experience, the orthopedic surgeon requests that X-rays and photos of the wound be sent to his smartphone through DocBookMD. Within minutes, the orthopedic surgeon reviews the images and agrees with the ED physician’s assessment of the wound. The patient does not need to see a specialist. The patient is released from the ED much quicker and received more appropriate care. The orthopedic surgeon could be sure the wound was not severe and did not require him to see the patient in the ED. He avoided an unnecessary trip to the ED and was able to participate in his family event.
DocBookMD Physicians in the Dallas metropolitan area now have access to a tool that can help them communicate more efficiently and
Join th e Mobile Revolut ion save time and money in the process. That tool is DocBookMD, a physicians only smartphone app that allows physicians to: • Send HIPAA-compliant text messages and photos. Message content can include diagnosis, test results, or medical history. Physicians can also add a high-resolution image of an EKG, an X-ray, lab report, or anything that can be photographed with a smartphone. • Assign an urgency setting to outgoing text messages. Physicians can assign each message a 5-minute or 30-minute response time. If the physician does not answer the message within 5 minutes or if the message does not get to the physician, the sender will receive a message back stating that the message did not make it. • Enable enhanced notifications. The physician can enter a cell phone number to receive text messages or an email address to receive notifications that DocBookMD messages are waiting. The email feature will send a weekly reminder to view their DocBookMD messages. • Search a local county medical society directory. Physicians can look up other physicians in their county by first or last name or by specialty. Physicians can then contact other physicians by messaging, office phone, cell phone, or email.
• Search a local pharmacy directory. Physicians can search for a local pharmacy alphabetically or find a pharmacy by zip code. Users can also create a “favorites” list of physicians or pharmacies. DocBookMD is offered through county and state medical societies to their members and is currently available throughout over 30 states. Texas Medical Liability Trust (TMLT) — the state’s largest medical professional liability insurance provider —sponsors DocBookMD in Texas and makes it possible for physician members of participating county medical societies to use the app at no charge.
Can you text that to me? DocBookMD has been available since 2010 and currently more than 600 Dallas-area physicians use the app. Dallas nephrologist Ruben Velez, MD uses the DocBookMD texting feature frequently.
“It has made communication better and faster, particularly about patients in hospitals,” he says. “I can also get a summary about discharged patients from the hospital.” Dr. Velez also uses the app to find contact information for referring physicians. One of the most popular features of the app is texting, as DocBookMD offers physicians one of the only ways to text patient information securely and in a ( Continued on Page 26 )
QUARTER TWO 2013
ON CALL MAGAZINE
MED SOCIETY NEWS Quarter Two 2013
A Warm Welcome To Our Newest Members Ira Agatstein, MD Miami Specialty: Internal Medicine
Robert L. Mellman, MD Boca Raton Specialty: Gastroenterology
Sepalika Wasanthalal, MD Atlantis Specialty: Nephrology
Vincent Apicella, DO Wellington Specialty: Family Medicine
Yvonne Moreno, MD Atlantis Specialty: Radiology
William Whetsell, MD Atlantis Specialty: Radiology
Luis Antonio Bobeica, MD Delray Beach Specialty: Internal Medicine/Geriatrics
Cassandra Beth Onofrey, MD West Palm Beach Specialty: Opthalmology
Shirley S. Zelikovsky, MD Boynton Beach, FL 33437 Specialty: Holistic Family Medicine
Ira Braunschweig, MD Atlantis Specialty: Radiology
Bruce Phillips, MD Boca Raton Specialty: Radiation Oncology
Samuel Falzone, MD Wellington Specialty: Ob/Gyn
Robert Brian Sussman, MD Boynton Beach Specialty: Ob-Gyn
Danielle DeGennaro Manolakos, DO Boca Raton Specialty: Internal Medicine
Yoel R. Vivas, MD Boynton Beach Specialty: Electropyhsiology/Cardiology
ON CALL is a quarterly publication, advertising rates and deadlines can be found at: www.pbcms.org/advertise
Nathaniel Virije, DO Hospital: Wellington Regional Biyebelemo Ekpete, DO Hospital: Wellington Regional
Follow Us! The latest news and information on PBCMS
( Continued from Page 25 ) way that meets HIPAA requirements. “As we say, a photograph is worth a thousand words, and with DocBookMD, I can have the emergency department physicians send me all the information, with a photograph of a hand injury, or a face laceration,” says Austin plastic surgeon Rocco Piazza, MD. “I know right where it is, and I can tell them right away what we need to do or where we need to go, assess whether it’s something I need to see right now, or if it can wait until morning.” Texting features are one reason why medical professional liability carriers 26
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sponsor the app and support its use among physicians. They believe DocBookMD can improve communication helping physicians practice safe medicine. TMLT Chairman Stuart McDonald, MD, uses DocBook and is “particularly excited about the ability to contact physicians through a secure network to request consults or provide follow-up information. This saves a significant amount of time that would previously be spent on hold or waiting for a return call,” Dr. McDonald says. “The ability to know whether or not my message has been read in a timely manner helps prevent delays in patient care.”
QUARTER TWO 2013
Medical Society Benefits In addition to helping physicians communicate and collaborate, DocBookMD also helps medical societies build membership. This benefits physicians by creating a stronger medical society and a louder voice for physician advocacy. Physicians also have access to a broader referral base and more opportunities for networking and community-building.
Join DocBookMD DocBookMD is available for iPad,iPhone, and Android devices and is provided at no charge to members of the Medical Society. To register or for more information, please visit www.docbookmd.com.
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