2017 oncall q1 final

THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

QUARTER ONE 2017

Shawn Baca, MD 2017 PBCMS President

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President’s Report HAPPY NEW YEAR!

SHAWN BACA, MD President, Palm Beach County Medical Society

I would like to thank everyone for the privilege of serving as your President of the Palm Beach County Medical Society.

Your county medical society is here to help you achieve your professional goals, as well as the overall goals of our medical community. I invite you to utilize your membership to its’ fullest extent. Your membership includes many educational opportunities such as practice management and discounts on many products and services, such as practice insurance and leisure opportunities. Your membership can also be the vehicle to help you participate in the political process. As you know, 2017 will be a watershed year for medicine.

We have been pushed to the edge with dysfunctional EMR’s, ICD-10, programs such as Meaningful Use, and now MACRA. These programs were designed to “improve the quality of care” but most of us feel that it only creates more busy work and is the beginning of more rationed health care. This does not include the “old problems” such as low reimbursement and a broken malpractice system.

For too long, people have equated the practice of medicine with the healthcare delivery system. If you look at the advances in medicine over the last 10 years, you can truly say that we live in an age of miracles. Doctors and our research partners have responded to the challenges of our times, and hit it out of the park. The basic problem is that the economy has failed to grow at the same rate as the creation of new medical treatments. The government, rather than embracing new medical technologies,

tries to restrict them with misplaced costs and regulations. We should utilize these innovations to raise the GDP. The issue is the delivery of health care. I want to make it very clear that the practice of medicine is great. It is the delivery system that doesn’t work. The high cost of medications and insurance does not reflect the values of physicians.

Physicians’ salaries are only about 5% of the US health care dollar. The higher numbers that you see quoted in the press for physician’s payments include a physician’s overhead. Physician overhead is running conservatively between 60% and 70% and continues to rise. We are disproportionately regulated and it seems that there are few attempts to reduce the other 95 percent of health care costs.

No system that has been designed to ration healthcare has ever proven to keep patients satisfied and lower health-care inflation. Currently we are left with a healthcare delivery system that is in poor balance. We need an American solution to an American problem.

Hopefully in the future we will see more choices and more competition among insurers, manufacturers, and products, so that we can see the lower prices.

This can be accomplished, if many of the government induced costs and buredensome rules and regulations, are scaled back.

On a daily basis, we can go to any doctor’s lounge and hear grumbling.

We need to recognize that we can do more than just complain, and actually make a difference. Politics start locally.

The PBCMS is here to help you have a voice. We participate with the FMA and the AMA and help shape agendas in Tallahassee and Washington. We also take time to help educate our elected officials.

The legislative committee welcomes new members and invites you to come to our meetings. Volunteer to be a delegate to the annual FMA meeting. Advocacy can be as simple as taking a few minutes educating your interested friends and patients on how the system can be fixed.

Never miss an opportunity to write your local officials. They rely on your expertise to vote, if you’re not in their ear, they will be listening to someone else. We can all make a difference in shaping public opinion, one person at a time.

Best wishes on a healthy and prosperous new year.

Shawn Baca, MD, FACR. President Palm Beach County Medical Society

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There are many ways you could be wasting money on your malpractice insurance Did you know that most doctors unknowingly waste money on malpractice insurance, which is one of the largest expenses in a medical practice each year?

Some of the most common ways doctors continually spend too much include:

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With such a large expense and such costly mistakes possible, you deserve the best available assistance.

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Contents PBCMS STAFF

BOARD OF DIRECTORS

Tenna Wiles, CEO

Shawn Baca, MD

Deannal@pbcms.org

07 Choosing to Lead

President

Tennaw@pbcms.org Deanna Lessard, Director of Member Services & Education

Brandon Luskin, MD

President-Elect

Helena Wiley, Finance

Marc Hirsh, MD

Finance@pbcms.org

First Vice-President

Mindi Tingler, Operations Director

Larry Bush, MD

FEATURES Meet the 2017 Board of Directors

09 Inaugural Year for the Physician

Leadership Academy of South Florida

10 Watch for the Signs: Screen All

Mindit@pbcms.org

Secretary

Lauren Stoops, Project Access Program Director

Robert Tome, MD

Laurens@pbcms.org

Treasurer

Graciela Gordillo, Project Access System Coordinator

James Goldenberg, MD

11 Palm Beach County Medical Society

Gracielag@pbcms.org

Immediate Past President

Karen Harwood, MSW, CCM, Care Coordinator Karenh@pbcms.org John James, Director of Disaster Services Johnj@pbcms.org Stuart Miro, MD, Triple Aim Diabetes Initiative Stuartm@pbcms.org Jim Sugarman, Development Coordinator Jims@pbcms.org Gwendolyn Marrero, Care Coordinator Gwendolynm@pbcms.org Katherine Zuber, Administrative Assistant Katherinez@pbcms.org Pamela Richards, Services Administrative Assistant Pamelar@pbcms.org Jane Scaturro, Administrative Assistant Reception@pbcms.org

On Call Magazine is designed by Forming Brands info@formingbrands.com or www.formingbrands.com

Subscriptions to On Call are available for an annual rate of $50. For more information contact PBCMS at (561) 433-3940.

The opinions expressed in On Call are those of the individual authors and do not necessarily reflect official policies of Palm Beach County Medical Society or its committees.

On call is owned and published four (4) times per year by Palm Beach County Medical Society, Inc., Forest Hill Blvd., #101, West Palm Beach FL33406. (561) 433-3940 & (561) 276-3636. ©Copyright 2013 Palm Beach County Medical Society, Inc.

Stephen Babic, MD Andrew Berkman, MD Kleper de Almeida, MD Michael Dennis, MD Roger Duncan, MD Ekaterina Kostioukhina, MD Henry M. Haire, MD James Heron, MD Hitesh Kapupara, MD Krishna Kishor, MD Beth-Ann Lesnikoski, MD Stefan Pasternack, MD Alan Pillersdorf, MD Ronald, Zelnick, MD Jack Zeltzer, MD Ben Childs, Medical Student Jinendra Satiya, MD Resident

Patients for Suicidal Thoughts

Task Force on Medical Marijuana

12 Medicine in 2017 15 The Lifeblood of Your Practice 16 Starfish & Snowflakes Gala 18 Community Health Worker Care

Coordination Training Program

ARTICLES 03 President's Report 19 Med Memo 19 Welcome New Members

BOARD OF TRUSTEES Jose Arrascue, MD Stephen Babic, MD Shawn Baca, MD Larry Bush, MD James Goldenberg, MD Marc Hirsh, MD Brandon Luskin, MD Alan Pillersdorf, MD Maureen Whelihan, MD Ronald Zelnick, MD Jack Zeltzer, MD

Cover Photo Mark Haworth/Limelight Portrait Studio QUARTER ONE 2017

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QUARTER ONE 2017

Choosing to Lead MEET THE 2017 PBCMS BOARD OF DIRECTORS The decision to take on a leadership role is an important one. As a board member, physician leaders affect the future of the medical profession through shaping health policy and advocating for positive legislation and health policy. Physician leaders are also asked to speak out on public health issues. As a leader they must examine problems, take risks, deal with change, build consensus, and set direction.

Shawn Baca, MD President

Brandon Luskin, MD President-Elect

Marc Hirsh, MD First Vice-President

Larry Bush, MD Secretary

Robert Tome, MD Treasurer

James Goldenberg, MD Immediate Past President

Stephen Babic, MD

Andrew Berkman, MD

Most importantly they are the ambassadors to our members.

We encourage you to reach out to the Board Members with your ideas and recommendations.

Kleper de Almeida, MD

Michael T.B. Dennis, MD

Roger Duncan, MD

Ekaterina Kostioukhina, MD

Henry M. Haire, MD

James Heron, MD

Hitesh Kapupara, MD

Krishna Kishor, MD

Beth-Ann Lesnikoski, MD

Stefan Pasternack, MD

Alan Pillersdorf, MD

Ronald, Zelnick, MD

Jack Zeltzer, MD

Ben Childs Medical Student

Jinendra Satiya, MD Resident

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Inaugural Year for the Physician Leadership Academy of South Florida Congratulations to the eighteen south Florida physicians who were selected as participants in the inaugural class of the Physician Leadership Academy of South Florida (PLA) for 2016-2017. The PLA is providing training and workshops on developing their leadership skills, information about health care issues facing Floridians and tools which will enable them to make significant differences in the leadership roles they presently hold and those they anticipate holding.

The Academy, under the auspices of the Palm Beach County Medical Society/ Services (PBCMSS) is being held in collaboration with the Broward County Medical Association (BCMA) and Dade County Medical Association (DCMA).

During the first year of the PLA, six physicians were selected by the three local Medical Associations to participate in the Academy. PBCMSS was awarded the grant from The Physicians Foundation and the Academy has been endorsed by the Florida Medical Association, which is also providing CMEs. During seven sessions held over eight months, physicians in the program are carrying out leadership self-assessments and attending sessions on advocacy, media and communications, cultural competency, conflict resolution, building medical teams and becoming transformative leaders. In addition participants are working in six teams on six leadership projects which each team selected from amongst 20 topics. At their graduation in May 2017 each team will present the progress made on their projects.

Steering Committee members overseeing the PLA are James Goldenberg, MD serving as Chair along with Paco Arrascue, MD and Alan Pillersdorf, MD from Palm Beach County; Dana Wallace, MD and David Perloff, MD from Broward County and from Dade County Eduardo G.

Front Row seated: Vania E. Fernandez, MD; Anele Manfredini, MD; Shahnaz Fatteh, MD; Daniela Anca Botoman, MD. Second Row: Keyvan Nouri; MD; Hitesh Kapupura, MD; Kleper DeAlmeida, MD; Vasana Cheanvechai, MD; James Heron, MD; Barbara Pena, MD; Geetika Klevos, MD; Ekaterina Kostioukhina, MD; Krishna Kishor, MD. Third Row: James Goldenberg, MD, Steering Committee Chair; Abram Berens, MD; Andrew Sherman, MD; Oleksandr N. Kryvenko, MD; Bob Addleton, Retreat Facilitator and Physician Leadership Coach; Jose Rosa-Olivares, MD; Henry Haire, MD

Martinez, MD and Andrew Nullman, MD. Other members of the Steering Committee are Cynthia Peterson, Executive Vice President of the Broward County Medical Association; Patricia Handler, Executive Vice President of the Dade County Medical Association and Tenna Wiles, Chief Executive Officer of the Palm Beach County Medical Society/ Services.

Following confirmation of the grant from The Physicians Foundation for a second year of the PLA, the three south Florida medical associations will accept new applications from physician members of the three participating counties. Thanks to The Physicians Foundation grant, the cost for participants to attend the first and second years is free.

PLA ADVOCACY DAY On January 21, 2017, the day after the Presidential inauguration, the focus of the January’s session of the PLA was physicians and political advocacy.

Dr. James Howell, who had served as

Former State Representative Kelly Skidmore with Broward County Commissioner Nan Rich

Florida’s Secretary of Health, spoke about his fascinating and at times complex history of working with legislators. Dr. Stephan Babic, a physician advocate for over 40 years, provided an overview of some of the FMA and AMA past and current legislative issues and the impact of some of the advocacy efforts he has played. Joe Gagen, JD, a national trainer from Austin Texas, presented an interactive session on working with legislators.

Continued on page 20

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Watch for the Signs: Screen All Patients for Suicidal Thoughts

By Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company

THE SUICIDE OF A PATIENT IS A TRAGEDY FOR ANY PHYSICIAN.

Patients with suicidal thoughts or ideation appear occasionally in physician encounters. The Joint Commission recently noted that the rate of suicide is increasing, and suicide is now the 10th leading cause of death in the United States.1 Most people who commit suicide received healthcare services in the year prior to death, usually for reasons other than mental health issues or suicidal thoughts. It’s a strong reminder that any patient—no matter what issue is being treated and in any setting—could be at risk for suicide.

The patient’s well-being should be the primary concern, but physicians also must consider the potential legal liability that can come from failing to adequately screen patients for suicide risk and taking the proper steps when needed.

The remorse a physician may face over missing signs can be compounded by legal action claiming the physician is accountable for the patient’s demise.

A consistent and formal screening process, plus a response plan, will protect both the patient and the physician.

Case Study: Reviewing Patient’s Full

HISTORY IS KEY

A recent case illustrates how even if the patient denies suicidal ideation when asked, the physician could be held liable for the suicide if there were other risk factors to consider. The case involved a 60-year-old woman with chronic back pain from an auto accident 10 years earlier, treated by her family practitioner over several years for pain, depression, and hypertension. Prior to her death, the woman had three appointments with the doctor over nine months for insomnia, pain medication adjustment, antidepressant medication monitoring, and blood pressure checks.

The notes from the last encounter state: “No energy; insomnia; denied suicidal thoughts and denied feeling depressed.”

Six days later, the patient overdosed on a combination of sleeping medication and anti-anxiolytics. Notes in the medical record from the next-to-last appointment said the patient “complained of insomnia; increased depression and increased anxiety; referral to psychologist.”

However, she did not see the psychologist and the family practitioner’s office did not follow up. The defense experts said that the doctor should have considered the entire history instead of just the last visit and concluded the patient was at risk of suicide.

HOW TO HELP PREVENT TRAGEDIES

These are some key strategies for ensuring that a physician practice or hospital is sufficiently addressing suicide risk in patients: • Establish a formal policy on screening and responding to suicide risk.

Establish a policy that stipulates what screening will be done and how to respond to suspected risk. All employees should be trained. The policy should include front desk staff

and other non-clinicians, who may pick up on signs that the patient could be suicidal.

• Implement an effective screening process. The questions typically asked on intake can be more of a formality than a true screening. Ask specific questions that can reveal situations that might put the patient at risk for depression and suicide. Examples include asking whether the patient has recently experienced the loss of a family member, a change in marital status, a change in jobs, sleeping difficulty, or loss of appetite.

• Connect with the patient. If in the screening process, the patient demonstrates suicidal tendencies or it’s suspected that the patient may be suicidal, refer the patient immediately to a mental health professional or ask the patient’s permission to contact family members or outpatient treatment providers.

• Do not be deterred by HIPAA. The patient privacy law can leave clinicians thinking that they may not discuss their concerns about suicide with the patient’s family. The patient can give permission for the physician to talk to others about his or her healthcare, and refusal to grant that permission might be considered another sign of suicidal risk.

• Establish a relationship with mental health professionals for referral. In a hospital setting, the physician should always know who is on call for patients with psychiatric risks. In other settings, the physician should establish a referral relationship with at least one or two professionals who can be called as needed.

Continued on page 20

Palm Beach County Medical Society Task Force on Medical Marijuana

By Brent Schillinger, MD

The Palm Beach County Medical Society Task Force on Medical Marijuana is in the process of developing a set of guidelines to help Florida physicians in their management of patients with medical marijuana (MM). This would be helpful to those physicians who are certified and involved in recommending MM as well as for those physicians who manage patients who are utilizing MM as recommended by another physician.

The task force is a subcommittee of the council on legislation. At present the guidelines are still a work in progress, but a number of specifics are being considered. One concept being considered is that patients who receive recommendations for medical marijuana should be encouraged to sign a patient contract similar to the contract patients sign when prescribed opiates for chronic pain. This contract would assign a list of responsibilities to which each patient would have to follow.

The task force is also in the process of developing a simple chart, based on peer-reviewed literature that would give specific guidelines on dosage and THC/CBD/terpene ratios for each of the MMJ medical indications. This will greatly enhance to quality of care for these patients by providing a more specific recommendation for each individual patient rather than just a general recommendation for MMJ without respect to dosage or ingredient percentages.

Physicians should be aware of those patients presenting with contraindications to MM. The task force is suggesting that contraindications should include a personal or family history of schizophrenia or other serious psychiatric problems.

The psychiatric community has expressed this concern and there has been a recommendation that physicians should conduct a short screening psychiatric examination before ordering MM. Physicians should discuss the risk of psychological addictive potential of MM with each patient.

There clearly are many issues the task force will be dealing with as the MMJ landscape evolves here in the state of Florida. The task force intends to coordinate its recommendations with the Florida Medical Association and will be providing valuable input to the Department of Health as the rules for MMJ are developed. If you have any specific MMJ related issues please contact the task force at pbcms@pbmcs.org.

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Medicine in 2017: SHOULD PHYSICANS BE MORE ACTIVE IN SHAPING POLITICAL AND SOCIAL FACTORS IMPACTING THEIR PROFESSION?

By Leon Fooksman

In entering the medical profession, physicians take an oath to do what they can to make their patients healthy -- to the fullest extent of their abilities.

Today, in order to be an effective physician, that commitment entails understanding not only their patients’ medical needs but it also requires understanding the political and social factors shaping the medical profession.

Welcome to medicine in 2017.

As we know, physician advocacy has roots dating back to Hippocrates in 500 B.C.E. Modern medicine requires physicians to advocate on behalf of their patients to their health insurance companies, as well as their families, and even their employers.

But that’s not enough. Physicians also have to be educated about the constantly shifting winds in Washington, Tallahassee and other political places, and how new policies and funding mechanisms shape the delivery of healthcare.

So if a patient could benefit from a treatment not covered by his health insurance, what should the physician do next? Should the physician get more involved in the medical necessity review with the insurance company? Or, if there’s really no way the insurance will cover the treatment, should the physician get involved in finding a solution through government or industry lobbying?

That’s all up for debate as the role of physicians as advocates for their patients is changing.

Perhaps there’s no better time than now for physicians to get involved in shaping the future of medicine. The obvious big issue: new Trump Administration with all its uncertainties. What will happen to the Affordable Care Act? What will Tom Price be like as Secretary of U.S. Department of Health & Human Services (assuming 12

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he’s confirmed)? What will be the future of MACRA (the federal law that, among other things, establishes new ways to pay physicians for caring for Medicare beneficiaries)?

Just with Dr. Price, there’s a lot of support and opposition in the medical community.

More than 8,000 doctors under the voice of the National Physicians Alliance are against him, ciding his oppoisition to Obamacare. Meanwhile, the American Medical Association (AMA) supports Dr. Price’s nomination (althought it’s not “an endorsement of every policy position he has advocated”), over his prior interactions with the AMA, and opendoor policy to hearing out the concerns of many physician organizations.

Like so many other issues, understanding the policies of what the future secretary of Department of Health & Human Services believes in is important in being an educated physician today. Being knowledgable and informed will better serve patients who aren’t educated about their healthcare benefits. These patients are increasingly turning to their doctors and healthcare professionals for answers, wanting to know everything from how to deal with their insurance company to how to find the cheapest medication.

The extent of physican advocacy is a big topic of discussion among physicians.

In the United States, the clearest expression of the role of physician advocate is in the AMA’s Declaration of Professional Responsibility: Medicine’s Contract with Humanity, explains Joshua Freeman, MD, a physician educator in Kansas City. The declaration states: “Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.”

QUARTER ONE 2017

Dr. Freeeman writes in his blog: “Advocacy for patients is generally considered an appropriate role for physicians by physicians, but advocacy for social, economic, educational and political change is far less widely accepted.”

That’s true, but the times are chaning.

He makes another good point about physician advocates – that many are getting involved in politics for all the right reasons, but, in the end, they aren’t always helping their patients.

In his blog, he wrote: “When we look at the American political landscape, we see a fair number of physicians involved in politics. It could be argued that, in these roles, they are advocating for social, economic, educational, and political changes. What is disconcerting is that the majority of these physician politicians seem to ignore the second half of that sentence, “…that ameliorate suffering and contribute to human wellbeing”. They are often found among, and sometimes as leaders, in advocating policies that slash the social safety net, decrease funding for public education, and oppose universal health insurance.

Too frequently, they act as agents of their own social class than as advocates for those most in need.”

Continued on page 21

AMERICAN MEDICAL ASSOCIATION LEGISLATIVE ISSUES FOR 2017 Drug Price Transparency Americans spend billions of dollars each year for their products, the least they can do is let us know what we're paying for.

Medicare Physician Payment (MACRA) MACRA implementation should break through unnecessary red tape and empower physicians to provide the best possible care for patients.

Opioid Abuse Opioid misuse, addiction, overdose and death have become an epidemic in America and more must be done to address this urgent issue.

Telemedicine Correctly implemented, telemedicine can improve access to care, care coordination and quality while reducing the rate of growth in health care spending.

Graduate Medical Education Cuts to graduate medical education could limit patients access to care, jeopardize the ability of residency programs to train physicians and increase physician shortages.

(Source: AMA’s Patients Action Network)

FLORIDA MEDICAL ASSOCIATION 2017 LEGISLATIVE AGENDA Here are some of the many 2017 legislative goals of the Florida Medical Association regarding licensure/regulatory issues, public health and safety, Medicaid issues, insurance/HMO reforms, and many other topics.

Pain Clinics Seek legislation that allows state law regarding the standards of practice and registration of pain clinics to supersede any local ordinance and explicitly prohibits counties and municipalities from passing such laws.

Health Insurance Reform Seek legislation to reform Florida’s health insurance laws and improve upon four major hassle factors physicians face on a daily basis: prior authorization; fail first protocols; retroactive denials; and bait and switch.

Medicare Annual Physical Examinations Advocate that Annual Wellness Visits (AWV) only be performed by patient’s primary care physician or their designee.

Raising Cigarette Taxes in Florida Support legislation to further raise the excise tax on cigarettes to at or above $2/pack in order to further tobacco control efforts within the State of Florida.

Preschool Vision Screening Support legislation that requires the State of Florida to develop guidelines regarding vision screening for children prior to them entering kindergarten.

Tort Reform Support legislation that will increase the burden of proof for negligence in cases involving supplemental diagnostic testing in order to reduce costly and unnecessary testing for defensive purposes.

Telemedicine Oppose any legislative proposals that would allow a health care provider without a Florida medical license to provide telemedicine and telehealth services to Floridians.

(Source: FMA 2017 Legislative Agenda)

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ƚƚŽƌŶĞLJ <ĂƌŝŶĂ 'ŽŶnjĂůĞnj ǁŝůů ƉƌĞƐĞŶƚ Ă ůŝǀĞ ǁĞďŝŶĂƌ ŝŶ ĨŽůůŽǁͲƵƉ ƚŽ ŚĞƌ :ĂŶƵĂƌLJ ĂƌƚŝĐůĞ͘ ^ŚĞ ǁŝůů ƉƌŽǀŝĚĞ Ă ĚĞĞƉĞƌ ůĞŐĂů ůŽŽŬ Ăƚ ǁŚĂƚ ƉƌŽǀŝĚĞƌƐ ƐŚŽƵůĚ ďĞ ĂǁĂƌĞ ŽĨ ǁŚĞŶ ƌĞǀŝĞǁŝŶŐ ƚŚĞŝƌ ŵĂŶĂŐĞĚ ĐĂƌĞ ĐŽŶƚƌĂĐƚƐ͘ ŽƉLJ Θ WĂƐƚĞ ƚŚŝƐ ůŝŶŬ ĨŽƌ ĐŽŵƉůŝŵĞŶƚĂƌLJ ƌĞŐŝƐƚƌĂƚŝŽŶ͗ ŚƚƚƉƐ͗ͬ​ͬĂƚƚĞŶĚĞĞ͘ŐŽƚŽǁĞďŝŶĂƌ͘ĐŽŵͬƌĞŐŝƐƚĞƌͬϲϵϮϮϰϭϱϲϮϵϬϳϰϳϭϯϴϱϴ

͞ ŽŵƉůŝĂŶĐĞ DĞĂƐƵƌĞƐ ƚŚĂƚ ǀĞƌLJ WŚLJƐŝĐŝĂŶ WƌĂĐƚŝĐĞ ^ŚŽƵůĚ ,ĂǀĞ ŝŶ WůĂĐĞ͟ DĂƌĐŚ ϮϯƌĚ͕ ϮϬϭϲ ϭϮͲϭƉŵ ^d

ƚƚŽƌŶĞLJ :ĂĐƋƵĞůŝŶĞ ĂŝŶ ǁŝůů ƉƌŽǀŝĚĞ ĂƚƚĞŶĚĞĞƐ ǁŝƚŚ Ă ĐŽŵƉƌĞŚĞŶƐŝǀĞ ůĞŐĂů ŽǀĞƌǀŝĞǁ ŽŶ ƌĞŐƵůĂƚŽƌLJ ĐŽŵƉůŝĂŶĐĞ ĂŶĚ ĐŽŵƉůŝĂŶĐĞ ƉůĂŶ ĚĞǀĞůŽƉŵĞŶƚ ĨŽƌ ƉƌĂĐƚŝĐĞƐ͘ ŽƉLJ Θ WĂƐƚĞ ƚŚŝƐ ůŝŶŬ ĨŽƌ ĐŽŵƉůŝŵĞŶƚĂƌLJ ƌĞŐŝƐƚƌĂƚŝŽŶ͗ ŚƚƚƉƐ͗ͬ​ͬĂƚƚĞŶĚĞĞ͘ŐŽƚŽǁĞďŝŶĂƌ͘ĐŽŵͬƌĞŐŝƐƚĞƌͬϭϭϭϵϵϮϲϲϯϭϵϮϵϯϳϳϮϴϭ

͞DĂŶĂŐĞĚ ĂƌĞ ŽŶƚƌĂĐƚƐ͗ tŚĂƚ͛Ɛ ,ŝĚŝŶŐ ŝŶ WůĂŝŶ ^ŝŐŚƚ͍͟ Ɖƌŝů ϮϬƚŚ͕ ϮϬϭϲ ϭϮͲϭƉŵ ^d

ƚƚŽƌŶĞLJ ĂǀĞ ĂǀŝĚƐŽŶ ŽĨ ƚŚĞ &ůŽƌŝĚĂ ,ĞĂůƚŚĐĂƌĞ >Ăǁ &ŝƌŵ ǁŝůů ƉƌĞƐĞŶƚ Ă ůŝǀĞ ǁĞďŝŶĂƌ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ ĂďŽƵƚ ĐŽŵŵŽŶ ƚƌĂƉ ĚŽŽƌƐ ŝŶ ŵĂŶĂŐĞĚ ĐĂƌĞ ĐŽŶƚƌĂĐƚƐ͘ ,Ğ͛ůů ĚŝƐĐƵƐƐ ƚŚĞ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ƐĞĞŵ ŚĂƌŵůĞƐƐ͕ ƚŚĞ ŚŝĚĚĞŶ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ĂƉƉĞĂƌ ƚŽ ďĞ ƚŚĞƌĞ ďƵƚ ĂƌĞŶ͛ƚ ĂŶĚ ŚŽǁ ƚŽ ŶĞŐŽƚŝĂƚĞ ŝƚ Ăůů͘ ŽƉLJ Θ WĂƐƚĞ ƚŚŝƐ ůŝŶŬ ĨŽƌ ĐŽŵƉůŝŵĞŶƚĂƌLJ ƌĞŐŝƐƚƌĂƚŝŽŶ͗ ŚƚƚƉƐ͗ͬ​ͬĂƚƚĞŶĚĞĞ͘ŐŽƚŽǁĞďŝŶĂƌ͘ĐŽŵͬƌĞŐŝƐƚĞƌͬϯϯϭϮϲϵϱϴϲϱϱϭϳϲϮϵϭϴϱ

MEMBERSHIP BENEFITS ADVOCATE

EDUCATE

CONNECT

Advocacy involvement at the local, state, and federal levels

Cutting edge medical education programs

Opportunities for patient referrals

Opportunities for your voice to be heard

Practice Management Resources

Participation in the SFL Caucus and Representation at FMA House of Delegates

MedLink- PBCMS weekly electronic newsletter

Networking events throughout the year for physicians/staff

OnCall Magazine Subscription Access to Continuing Medical Education events throughout South Florida

Access to Member Database

Exclusive “Member Only” programs Online Classified Ads Board Speaking opportunities

Members Only Practice Management Programs and online Resources Community Resources for physicians and patients

OTHER BENEFITS Mediation of patient and physician complaints • Physician and PBCMS sponsored Health Insurance Plan for members and staff • Rebate on Worker’s Compensation • Discounts on Medical Liability Insurance • DocbookMD access – HIPAA compliant messaging with colleagues • Member Discounts and two for dining and entertainment deals

FOR MORE INFORMATION Visit www.pbcms.org or Call 561.433.3940.

Starfish & Snowflake Gala THE 2016 ANNUAL GALA INSTALATION

Palm Beach County Medical Society and Services Board of Directors

Over 400 guests honored 2016 PBCMS President James Goldenberg, MD and celebrated the installation of Shawn Baca, MD as 2017 PBCMS President at the Starfish and Snowflake Gala on December 3, 2016 at the Kravis Center Cohen Pavilion in West Palm Beach.

The 2016 Excellence in Medicine Award, the highest honor awarded by the Medical Society, was presented to Brent Schillinger, MD, which recognizes highest values of altruism, compassion, leadership and dedication to patient care. John “Jack” Alley, MD was presented with the Lifetime Achievement Award.

Thank you to this year’s sponsor Trustbridge and our reception sponsor Medical Specialists of the Palm Beaches, Inc. Special thank you to the Host Committee and our Sponsors for making the evening such a great success.

The inaugural holiday hall of trees silent auction featured 32 beautifully decorated trees. Winners included Slobody Yoga for best holiday traditions, Whimsical Masterpiece - Summit Animal Hospital, Creative Genius -Angels Light Up the World provided by Visiting Angels, Made Me Smile - Red, White and Blue provided

by Jim Sugarman and Most Unusual/Most Unique - Water World provided by First Path

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ON CALL MAGAZINE

2017 PBCMS PRESIDENT SHAWN BACA, MD Dr. Baca grew up in Albuquerque NM, and obtained his undergraduate degree and medical degree at the University of NM in Albuquerque.

He moved to Florida in 1987, and did his internal medicine training at Mount Sinai Medical Center in Miami Beach.

During his training, he was named intern of the year, given the Furlong award for outstanding performance by a medical resident, and served as chief medical resident. He did his clinical and research fellowship at the University of Miami, with his research focused on osteoarthritis.

Dr. Baca has been practicing with Rheumatology Associates of South Florida since 1992. He is board certified in internal medicine and rheumatology.

He is a member of the American College of Rheumatology, American College of Physicians, Florida Medical Association (FMA), Florida Society of Rheumatology, and the Palm Beach County Medical Society (PBCMS). He has served as treasurer on the medical executive

QUARTER ONE 2017

committee of the Boca Raton Regional Hospital, and as a delegate to the FMA. He has served as the President Elect of PBCMS, and has previously served as a Member at Large, Treasurer, Secretary, and Vice President. He has been the primary investigator of several clinical trials. He was a clinical assistant professor in the department of Rheumatology at the University Miami Jackson Memorial Hospital for several years, and is currently an Affiliate Clinical Professor at Florida Atlantic University's Charles E. Schmidt College of Medicine. He also serves on the Continuing Medical Education Committee at Boca Raton Regional Hospital.

Dr. Baca has been recognized over the years as a top doctor by Best Doctors in America, Super Docs, People's Choice Award-Royal Women's Club of Boca Raton, and US News and World Report.

He has participated in the free clinic through the Arthritis Foundation since 1994, and maintains hospital privileges at Boca Raton Regional Hospital and Delray Medical Center.

EXCELLENCE IN MEDICINE AWARD BRENT SCHILLINGER, MD As a Diplomate of the American Board of Dermatology Dr. Schillinger manifests exceptional professional skills, compassion and dedication that surpass expectations. He also has made significant contributions to the health and well-being of patients, their families and the community on a local, state and national level.

Dr. Schillinger received his medical degree from Downstate Medical Center, State University of New York and completed his dermatology residency at the same institution. He cares for patients regardless of their ability to pay and is a member of Project Access. Dr. Schillinger has been recognized by his peers as a gifted leader and served as treasurer, secretary and president of the PBCMS. He is a founding member, vice-president and president of PBCMS Services. He has served on the Leadership Team for the Future of Medicine since its inception and has been responsible for the implementation of the Conversation Project, addressing the end of life issues. He served the FMA as Chair of two standing committees and a member of the Board of Governors.

He continues to serve as a Delegate representing Palm Beach County. In addition, he has served as President of MEDPAC. Dr. Schillinger has been highly engaged in local, state and national professional organizations. These include the AMA, PBC Dermatology Society, American Academy of Dermatology, Florida Society of Dermatology and Dermatologic Surgery, American Society for Dermatologic Surgery and the Academy of Radio and Television Health Communicators; amongst others. He held two academic appointments; Nova Southeastern Collage of Medicine and FAU School of Nursing and developed an academic graduate medical education program for dermatology residents.

His community volunteerism includes Hospice Care where he established an innovative option for end of life concerns.

Also, he participates in the Florida Department of Professional Regulation expert witness panel. He served on the Palm Beach County Cultural Council board of directors and chaired the public relations committee of the World Trade Center Palm Beach. At present, he serves on the Board of Directors for

Arts Garage. He currently provides his expertise in health care legal mediation.

Dr. Schillinger is now working with the PBCMS and the PBC Sheriff’s Department to remove tattoos for ex-gang members without cost. He has participated in numerous international medical missions including Jamaica, Peru, Cuba and Colombia. Dr. Schillinger is most highly regarded by his colleagues and has distinguished himself as a healer, teacher, leader and innovator and is most deserving of the Excellence in Medicine Award.

LIFETIME ACHIEVEMENT AWARD JOHN ALLEY, MD Dr. Alley or “Jack” as known to the Greater Boca Raton Area is the quintessential physician. Jack served in World War II with the Combat Engineers.

He graduated University of Rochester Medical School in NY, completing his residency at the VA hospital in Coral Gables and a fellowship in cardiology at Jackson Memorial Hospital. Jack moved to Boca Raton in 1957 to practice medicine admitting patients to Bethesda Hospital and later the “new” community hospital he helped establish in Boca Raton. He was the first president of the Medical Staff holding badge #001.

Retiring from practice in 2005, he was appointed the Hospital’s first Medical Director, serving five years as the liaison between medical staff and administration.

Atlantic University in the Anthropology Department. He developed and taught “The Environmental Basis of Disease” and received the Dean’s Public Service award for 26 years of pro bono service. He was a frequent speaker in our community on health matters and served on Boca’s Environmental Advisory Board and Palm Beach County’s Environmental Control Hearing Board. He was instrumental in forming Boca’s Emergency Medical Services in 1974 and was active in post Hurricane Andrew mobile medical services into hard hit low income communities.

Alley is an avid conservationist and a longtime supporter of the Sierra club and helped found the Gumbo Limbo Nature center in Boca Raton. He has received numerous commendations from the City of Boca Raton for helping preserve some of our natural spaces. Jack is respected and beloved by patients, students and many within our community.

Dr. and Mrs. Alley

Jack is a lifelong member of the Palm Beach County Medical Society giving many lectures on environment and disease to local schools. He was also an adjunct professor at Florida QUARTER ONE 2017

ON CALL MAGAZINE

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Community Health Worker Care Coordination Training Program SCHOLARSHIPS FOR PBCMS MEMBERS’ STAFF OFFERS PATHWAY TO NEW HEALTHCARE CAREER Palm Beach County Medical Society Services is excited to offer a training program for Community Health Workers.

Care Coordination Program. This program has been developed under the leadership of PBCMS Past President, Jose Arrascue MD. The Pilot Program which concluded in November was successfully completed by 24 students.

Throughout the United States, the community health worker field is burgeoning, both in interest and demand. The field is also rapidly expanding into new areas of health and community wellness as community health workers continue to improve chronic disease management programs, health insurance enrollment, immunization drives, HIV/AIDS treatment, access to mental health services and maternalchild health interventions. Palm Beach County Medical Society Services CHW Care Coordination Training Program offers the full complement of education hours and content areas that healthcare professionals need to fulfill the training requirements (30 CEUs) for the certification application as a community health worker (Florida Certification Board Provider Number 5284-A).

The training will be offered at Career Source Palm Beach County 3400 Belvedere Rd. West Palm Beach FL March-May (excluding April 14 & 21).

Classes will be held Fridays from 1pm4pm. Cost is $999.00, and includes all classes, course materials and simulation sessions. Scholarships are available for PBCMS members’ staff.

Care Coordination Graduation

CHW CARE COORDINATION TRAINING PROGRAM WILL INCLUDE: • Overview of chronic disease symptoms and management

• Strategies to work as a team member to improve patient/client outcomes

• Scope of Community Health Worker Care Coordinator job responsibilities

• Tools to develop a comprehensive community resource directory

• Cultural sensitivity, competency and diversity training

• Motivational interviewing - patient/ client engagement skills

• Understanding professional responsibility and tools for patient advocacy

For more information please contact Karen Harwood at 561-433-3940 ext.

114 or via email at karenh@pbcms.org.

Application deadline: February 17, 2017.

Application available @ www.pbcms.org/ care-coordination-program/

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ON CALL MAGAZINE

QUARTER ONE 2017

Med Memo QUARTER ONE 2017

SAVE THE DATE March 8, 2017 at 11:30am Healthcare Connection Atlantis Golf Club, Lake Worth March 27, 2017 at 2:30pm Conversation Project Palm Beach State College April 2, 2017 from 2:00-5:00pm Doctors Day The Beach Club, Lake Worth

Irv Seldin, Stephen Babic, MD and Michael T.B. Dennis, MD State Attorney Dave Aronberg and Shawn Baca, MD

April 21, 2017 at 11:30am Heroes in Medicine Kravis Center, Cohen Pavilion

PBCMS ANNUAL STATE OF MEDICINE/LEGISLATIVE DINNER

Bobbi Horwich, Andrew Berkman, MD, County Commissioner Dave Kerner and Emanual Newmark, MD Kari Oeltjen and Jeff Berman, MD

Advocacy in Action. PBCMS and MEDPAC Annual State of Medicine Dinner “What Does the Future Hold?” was held on Tuesday, January 31, 2017 at the Airport Hilton West Palm Beach. Thank you to our Featured Speakers.

WELCOME NEW MEMBERS

Brenda James and David Becker, MD FMA Pres.

Senator Kevin Rader and Alan Pillersdorf, MD

Luis Arles Alvarez, MD Frank Andrew Celigoj, MD Dawn M. Davanzo, MD Juan Carlos Galvez, MD Rasha Lawrence, MD Irma Lopez, MD Leslie H. Perla Richard J. Price, MD Irfam Raheem, MD Judith Virginia Redd, MD Andrew Savin, MD Shelley Singh, DO Residents Gene Posca, MD Jinendra Satiya, MD Angel Ramos, MD, FAU

Kleper de Alemida and Malcolm Dorman, MD

Ryan Haffey, Hitesh Kapupara, MD and Henry Haire, MD

QUARTER ONE 2017

ON CALL MAGAZINE

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We are honored to celebrate the past 20 years of medicine in Palm Beach County and we look forward to the future.

Medical Specialists of the Palm Beaches is the largest group of primary care and multi-specialty physicians. Today, we have 34 locations and over 75 physicians. Our highest priority is our patients’ health and well-being.

Our Doctors Specialize in: Family Medicine | Internal Medicine MSPB Gold Concierge Healthcare | Cardiology Hematology/Oncology | Neurology Pulmonology | Gastroenterology Our Services Include: Diagnostic Imaging | Nuclear Stress Test V-Boutique, Vein and Aesthetics Center Physical Therapy | Pathology and Histology Lab Please visit our website www.MSPB.md for more information or call us today at (561) 966-7700. Let us help you choose the right MSPB doctor(s) for you and welcome you to the family.

Continued from page 10 Be sure to document when and how the contact was made and any follow-up. Remember that simply advising the patient to seek help is insufficient. Contact the mental health professional directly and arrange for the patient to be seen quickly. Be sure to follow up to confirm that the patient has seen the mental health professional.

• Establish safety procedures for the patient who may be suicidal. Once this risk is established, the clinician is responsible for protecting the patient from self-harm. That means keeping the patient away from sharp objects, medications, and bed sheets. Having the patient wait in a typical exam room may not be safe because the patient would have access to scissors, scalpels, needles, and other such items. When appropriate, ask the patient to put on a hospital gown and remove from the

room the patient’s shoelaces, belt, and any other items that could be used for harm.

• Monitor the patient closely. If feasible, have staff or the patient’s family monitor the patient continuously, in person or on video, until the next step of care. If continuous monitoring is not possible, check on the patient frequently. Carefully document the monitoring procedure, including frequency and type as well as observed patient behaviors.

• Call for help if needed. Call for additional help if the facility has no ability to isolate the patient from dangerous items or provide adequate monitoring, and also if the patient has

already left against medical advice.

State laws vary regarding how and when a patient may be held against their will.

Note: In addition to her legal experience, Robin Diamond has a master’s degree in psychiatric nursing from Vanderbilt University. Reference; 1Detecting and treating suicide ideation in all settings. The Joint Commission. https:// www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf.

Accessed November 14, 2016. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

Follow Us www.facebook.com/ PalmBeachCountyMedicalSociety

Advertise With Us!

OnCall is a quarterly publication sent to all PBCMS members and more. advertising rates and deadlines can be found by calling us 561-433-3940

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ON CALL MAGAZINE

QUARTER ONE 2017

Explore PBCMS.org

The Official Website of Your Medical Society.

Read Our Blog • Watch Videos • Listen to PodcastsÊ Read the Latest OnCall • Physician ResourcesÊ and Learn About Member Benefits Continued from page 12 So in 2017, with the winds of political change blowing much harder than in years past, many physicians have to ask themselves how much harder are they willing to work to advocate for their patients. Sure, they have to be willing to keep up with the long hours of work, pursue continuing education, and spend time consulting other doctors and health professionals. But now, they need to determine if they should get more involved with Palm Beach County Medical Society, Florida Medical Association, and other physician groups to shape the political and social factors impacting medicine.

Creative and strategic thinking make design a tool that can overcome the competitive landscape, better your relationship with patients and grow your business.

We are DESIGNING BETTER BUSINESS!

By getting more involved, physicians would impact all sides of the doctorpatient relationship.

Leon Fooksman is a writer for On Call Journal. He can be reached at leon@digitalstoryline.com or on Twitter at @ compellingstory.

CALL 561.630.1939 info@formingbrands.com Twitter • Instagram • Facebook @ formingbrands4u www.formingbrands.com

The Lifeblood of Your Practice.

By Michelle Beckman of the Fuoco Group

Billings and accounts receivable are the lifeblood of most companies. In the healthcare industry, the complexity and importance of effective billing operations is even more critical than in most other industries. Insurance companies and other payers have a confusing and complex process for claim submissions that makes it harder and harder for physicians and other service providers to get paid for the work they perform.

Patients hold off on paying until the insurance company reimbursement is received and documentation confirming the patient’s share of the billing is received, thereby delaying collection efforts. Furthermore, the new regulatory challenges from The Affordable Care Act and the Patient Protection Act, make it even more important for providers to collect the money they are owed.

Continued from page 9 In addition former State Representative Kelly Skidmore educated participants about the state legislative process and she and Broward County Commissioner Nan Rich spoke during a Lunch and Learn session on their experiences while working in Tallahassee. Ms. Rich also shared some of the key differences between the roles of county commissioners and state legislators. Many issues were covered and including creating effective, high impact interactions with public officials; understanding that a health care leader must be a health care issues educator and political activist and the importance and value of being involved with MEDPAC and FLMPAC. Some key points covered during the session were: • Knowledge is power.

• Be affable and issue focused.

• Being honest and ethical.

• Being a person of your word.

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Some figures that will alarm most doctors include only 70% of claims are paid the first time they are submitted. The remaining 20% are denied and 10% are ignored. Of the 30% not paid, 60% are never resubmitted to payers. With other factors contributing to collection efforts, statistics show that over $125 billion dollars are left on the table annually by American medical practices.

The key to increasing your receivables success is to establish performance metrics for your accounting team. You can only manage what you measure so knowing the success rate of collections efforts is the first step. Simplifying and automating the revenue cycle is a major step to reclaim unpaid funds. Electronic health records, online patient portals and practice management systems provide

• Networking with likeminded advocates.

• Helping politicians with issues even if they are not directly related to you.

• Trying to be bipartisan as outstanding political health advocates are on both sides of the aisle.

Some key roles the FMA plays are: • Following healthcare issues and how they affect the doctors and their patients • Presenting potential bills for consideration • Seeking to amend bills • Taking positions of importance to Florida’s physicians and more Some key objectives reflecting current AMA’s policy on health reform • Assuring individuals currently covered do not become uninsured • Taking steps towards achieving coverage and access for all Americans.

• Maintaining key reforms, ie coverage for pre-existing conditions, parental

QUARTER ONE 2017

better opportunities for providers to cut costs and improve results.

There are several key best practices that should be employed to improve medical accounts receivable management and most start with automation. Strong software tools can identify denied claims before submitted, manager payer contracts, report on daily aging of receivables, create claim process workflows, business and analytics tools, electronic remittances and advanced tracking of denials, underpayments or unpaid claims.

coverage for young adults • Stabilizing and strengthening individual insurance market • Ensuring low and moderate income patients secure affordable and adequate coverage • Ensuring Medicaid, CHIP, and other safety net programs are adequately funded • Reducing regulatory burdens that detract from patient care and increase costs • Providing greater cost transparency throughout the health care system • Incorporating common sense medical liability reforms • Continuing advancement of new physician-led payment models to achieve good outcomes, high quality and lower spending trends.

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www.facebook.com/ PalmBeachCountyMedicalSociety

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PAID WEST PALM BEACH, FL PERMIT NO.515

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

Palm Beach County Medical Society Services

Honoring Outstanding Healthcare Heroes!

Friday, April 21, 2017 11:00 am - Silent Auction / Reception 12:00 pm - Awards Ceremony Kravis Center for the Performing Arts, Cohen Pavilion 701 Okeechobee Blvd. West Palm Beach, Florida

Sponsorship Opportunities Available 561-433-3940 or visit www.pbcms.org/events/heroes-in-medicine/

Founding Benefactor Rendina Healthcare Real Estate