2018 q1 oncall final

OnCall

QUARTER ONE 2018

THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

ACA Alterations Leave Many Wondering Page 8

AMA President Addresses PBCMS Page 12

Brandon Luskin, MD PBCMS 2018 President

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:

#6. Not working with the right agent or broker Find an independent agent specializing in malpractice insurance placement for your type of practice setting (solo, group, hospital, surgical center, etc.) and one who has an educational approach versus a sales orientation. Your agent should be strong enough within the malpractice insurance marketplace to fully and competently negotiate the best rates for you with the top insurers in your state.

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

Isn’t it time you called Matt Gracey, the med mal insurance expert?

Delray Beach • Jacksonville • Miami • Orlando • Panama City • Pensacola Matt@dannagracey.com • 800.966.2120 • www.dannagracey.com

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President’s Report

Brandon Luskin, MD President Palm Beach County Medical Society

This Is an Important and Challenging Time in Medicine

S

ince our Annual Gala in December, when I was installed as president of the Palm Beach County Medical Society, many people have asked me “What is your agenda?” My answer is simple: To lead and advocate for this caring, all-encompassing organization in its 99th year, and to be president for all the members as we further our commitment to make our voice heard to help shape the future of medicine and provide much-needed programs for our community such as Project Access.

This also is an important and challenging time to be a leader. I am ready for the challenge. The PBCMS was there for me a dozen years ago when I faced great desperation as the county attempted to coordinate their ER call schedules, and, as a hand surgeon — a specialty in short supply — I would have been required to work nearly 24/7 to accommodate their new ER call schedule. The medical society came to our aid, made sure we had a voice in the process and listened to us! I have been active in the Palm Beach County Medical Society for this reason.

When I started my Orthopedic Surgery residency in 1990, the topic of conversation at the scrub sink revolved around Orthopaedics and the nuances of the surgery at hand. Only five years later, those conversations extended to non-medical issues, such as emerging HMOs and problems with insurance companies.

Evolving and Ever-Changing Playing Field We physicians have been adapting to a constantly evolving and ever-changing playing field, with escalating degrees of stress and dissatisfaction. But we have adapted as a whole.

The changes we are now about to face are different! After four decades of economic war waged on physicians, the problems of the non-sustainability of our current health care system are bringing forth radical changes and squeezing us into a new paradigm of unfamiliar territory.

We are entering a time where individuals and families,

legislators and government are feeling the effects of growing health care costs and demanding greater value for their money. They are doing so in ways that had never been considered before, such as Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment Model (AAPM), and Physician Quality Reporting System (PQRS). To me, they seem like systems of allocating payment for jumping through hoops. The attention we must pay to these changes, which are very real and here to stay, will make physicians become further dependent on administrative infrastructures in our practice of medicine.

Today, I inherit the leadership at a critical time when others are seeking to drive health care in America in a direction that too frequently disregards physician input, and undermines the tremendous role of the physician–patient relationship — all of which places higher value to data points in a medical record rather than the quality of the medical visit itself. The potential for physicians in the future to be reduced to the level of a service technician by those who reimburse us for our services is probable.

Speak Out With One Voice We physicians must embrace these changes positively and productively, but we must have a voice in shaping the process. The economic, legislative and cultural forces that are now driving these changes are gaining immensity. Therefore, physician voices must be heard in similar aggregation as well, through avenues including our Palm Beach County Medical Society, the vital collaboration with the Florida Medical Association and the American Medical Association. We must speak out together and express a voice of medical reason as we continue to hold our profession to the highest standards.

Accordingly, I encourage you to treasure your valuable membership in PBCMS and influence others to join you as we all become more involved in our Medical Society so that we can all be heard together.

OnCall • Q1 2018

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Contents

PBCMS Contact Information: Tenna Wiles, CEO, Palm Beach County Medical Society • Tennaw@ pbcms.org 561-439-3940 • www.pbcms.org • 3540 Forest Hill Boulevard, Suite 101, West Palm Beach, FL 33406

FEATURES 6 8 10 12 14 16 18 19 20 22

ARTICLES 3 7 7

Florida Approves 9.5 Percent Workers’ Compensation Rate Decrease ACA Alterations Leave Many Wondering About Impacts on Patients 2017 Gala Pays Tribute to Notable Accomplishments of Society Members

President's Report Med Memo Welcome New Members

AMA President Addresses PBCMS at State of Medicine Dinner Is Your New Hire a Jekyll and Hyde?

Federal Tax Reform Act Changes Underway for 2018 The PBCMS Physician Wellness Program Is Underway

Page 18

Pursuing Constructive Addiction Treatment at the Height of the Opioid Abuse Crisis Physicians Can Be at Risk When Homebound Patients Refuse Help

Page 10

Award-Winning Training Program Offers Path to Health Care Career

Subscriptions to OnCall are available for an annual rate of $50. For more information contact PBCMS at (561) 433-3940. The opinions expressed in OnCall are those of the individual authors and do not necessarily reflect official policies of Palm Beach County Medical Society or its committees. OnCall is owned and published four (4) times per year by Palm Beach County Medical Society, Inc., 3540 Forest Hill Blvd., #101, West Palm Beach, FL 33406. (561) 433-3940. ©Copyright 2018 Palm Beach County Medical Society, Inc. OnCall Magazine is designed by MillerDesignPros, email us at m.miller@millerdesignpros.com • www.millerdesignpros.com

BOARD OF DIRECTORS Brandon Luskin, MD

Roger Duncan, MD

Berna Buyukozturk

James Goldenberg, MD

Milad Khoury, MD

Stefan Pasternack, MD

President

Treasurer/Chair, Council on Finance & Adminstration

Medical Student

Past President/Physician Leadership Academy

Resident

Chair, Physician Wellness

Member at Large

Henry Haire, MD

Leslie Perla, MD

President-Elect/Chair, Council on Advocacy & Legislation

Shawn Baca, MD

Krishna Kishor, MD

Vice Chair, Women Physicians

Chair, Council on Medical Education

Larry Bush, MD First

Stephen Babic, MD

Kleper de Almeida, MD

Vice Chair, Council on Ethical & Judicial Affairs

James Heron, MD

Ekaterina Kostioukhina, MD

FMA/AMA Liaison

Vice President/Chair, Council on Member Services

MEDPAC

Vice Chair, Council on Advocacy & Legislation

Michael Dennis, MD

Vice Chair, Council on Communications & Technology

Robert Tome, MD

Andrew Berkman, MD

Vice Chair, Council on Member Services

Member at Large/Chair, Council on Ethical & Judicial Affairs

PBCMS Services Liaison

Hitesh Kapupara, MD

Claudia Mason, MD

Vice nChair, Council on Finance & Administration

Chair, Women Physicians

Jose F. Arrascue, MD Stephen Babic, MD

Shawn Baca, MD Larry Bush, MD

James Goldenberg, MD Marc Hirsh, MD

Brandon Luskin, MD Alan Pillersdorf, MD

Brent Schillinger, MD Robert Tome, MD

Jack Zeltzer, MD Chair

Michael Dennis, MD

Matt Gracey

President

Secretary

Ivy Faske, MD

Jean Acevedo William Adkins, MD Elaine Alvarez

Ljubica “Jibby” Ciric Patti Corbett Andrew Larson, MD Heather Miller, Esq. Alan B. Pillersdorf, MD

Nancy Proffitt Greg Quattlebaum Brent M. Schillinger, MD Brandyce Stephenson Maureen Whelihan, MD

Paul Wieseneck Jack Zeltzer, MD

Marc Hirsh, MD

Secretary/Chair, Council on Communications & Technology

Immediate Past President

Dawn Davanzo, MD

Alan Pillersdorf, MD Ronald Zelnick, MD Chair, Med/Legal Committee

Jack Zeltzer, MD Chair, By-Laws Committee

BOARD OF TRUSTEES

2017-2018 BOARD OF DIRECTORS

Vice President

Don Chester Treasurer

Jose F. Arrascue, MD Brenda Atkins Nancy Beard Steven Borzak, MD Tish Carlo

OnCall • Q1 2018

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Feature

Florida Approves 9.5 Percent Workers’ Compensation Rate Decrease Will Lower Rates Last?

By Tom Murphy his is not a misprint. Effective January 1, 2018, the state of Florida decreased the statewide overall rate level by 9.5 percent, which will apply to both new and renewal workers’ compensation policies from now until the next change.

Many clients have asked me how Florida can have an almost 10 percent rate decrease after the state just increased the rates almost 15 percent effective January 1, 2017. This is a good question and one that many are struggling to answer. Regardless, this is good news for all Florida medical practices and businesses alike.

Florida Insurance Commissioner David Altmaier and Florida’s Chief Financial Officer Jimmy Patronis both agree that the lower rate will help Florida job creators and support the state’s growing economy, and they both say they will try to work with the legislature in 2018 on proposals to keep rates down.

T

Difficult Uphill Battle Although Commissioner Altmaier, CFO Patronis, and others are touting

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Q1 2018 • OnCall

this decrease, they are not talking about the difficult uphill battle they face trying to reverse the major 2016 Supreme Court of Florida decisions that have dismantled the workers’ compensation system reforms that were enacted

future rates will continue to rise and this current rate decrease will evaporate. However, a glimmer of hope for all Florida employers is the prospect that the governor will appoint three new Supreme Court Justices prior to the end

The lower rate will help Florida job creators and support the state’s growing economy.

Tom Murphy Danna-Gracey Inc.

in 2003, which may eventually lead to higher rates as claims payments and attorney fees increase due to these decisions. Florida workers’ comp carriers are already seeing an increase in employee benefits payments and legal fees, and I fully expect these lower rates to be short term.

Unless the Florida legislature enacts reforms that can withstand the current Florida Supreme Court decisions, the

of his tenure. The 2003 reforms clearly helped Florida move from one of the worst states to one of the best in terms of workers’ compensation stability and have been a driving force for Florida’s strong economic growth.

Tom Murphy, Workers’ Compensation and Medical Malpractice Insurance Specialist, Danna-Gracey Inc. 561-276-3553 or 800-966-2120 Murphy@dannagracey.com, www.dannagracey.com

LEGISLATIVE BREAKFAST

Med Memo

MEDPAC and FMA PAC Fundraiser

Mark Your Calendar March 1, 2018

Womens’ Physician Painting Party Danna-Gracey Office, Delray Beach March 14, 2018

Health Care Connection Lost Tree Golf Club, Atlantis March 24, 2018

Doctor’s Day Celebration

(L to r) State Representative Matt Willhite, Stephen Babic, MD and Brandon Luskin, MD at the Legislative Breakfast.

South Florida Science Center & Aquarium, West Palm Beach April 11, 2018

Health Care Connection West Palm Beach Marriott, West Palm Beach April 20, 2018

15th Annual Heroes in Medicine Luncheon Kravis Center, West Palm Beach May 9, 2018

Health Care Connection Lost Tree Golf Club, Atlantis June 1, 2018

Talent Show Atlantis Country Club, Atlantis August 3-5, 2018

(L to r) Shawn Baca, MD and State Representative Rick Roth at the well-attended event in December.

(L to r) PBCMS President Brandon Luskin, MD, State Representative Lori Berman, Ankush Bansal, MD, FMA PAC President-Elect Jason Goldman, MD and PBCMS Past President Stephen Babic, MD at the December 28, 2017 MEDPAC and FMA PAC fundraiser for Rep. Berman, who won the special primary election for the Florida Senate in District 31,which includes Lake Worth, Lantana, Boynton Beach and Delray Beach. Berman, a Democrat, will face Tami Donnally, who is vice chairwoman of the Palm Beach County Republican Party, in the general election April 10.

FMA Annual Meeting Loews Sapphire Falls Resort at Universal Orlando

PBCMS Participates in Florida Legislative Session Palm Beach County Days PBCMS members Shawn Baca MD, Brandon Luskin MD , Stephen Babic MD, Dawn Davanso MD, and Tenna Wiles CEO attended Palm Beach County Days in Tallahassee on January 5-6, 2018.

After meeting with members of the Palm Beach County Legislative Delegation, Dr. Luskin testified on the Opioid Crisis and told the panel that 200,000 to 300,000 Floridians undergo knee and hip replacement surgeries every year, with the majority of them requiring more than a week’s worth of painkillers after their procedures. “It is almost infeasible for some of these people to get back to the clinic within a seven-day time frame,” he said.

For a summary of Legislative Issues visit www.pbcms.org.

Call for Nominations for Delegates to FMA House of Delegates Did you know that Palm Beach County Medical Society has one of the largest delegations to the Florida Medical Association and the American Medical Association? PBCMS is respected for its strong leadership in representing physicians and addressing policies impacting our patients. What issues are affecting your practice at this time? In order to have your voice heard, we encourage you to serve as a delegate in the House of Delegates or submit a resolution. Nominations are now open for physicians to serve as Delegate for the FMA Annual Meeting to be held August 3-5 at the Loews Sapphire Falls Resort at Universal Orlando. This is an excellent opportunity to join with your colleagues in shaping the future of medicine.

Resolutions must be submitted no later than May 1st. For additional information, contact Amanda at 561-433-3940, x106 or amandak@pbcms.org.

Welcome New Members!

Helen Gooch Armstrong, MD Ellen Babinsky, DO

Rodolfo Carrillo, MD Joshua Jacob Solano, MD

Your Voice Matters. Join MEDPAC Today!

Jose Arrascue, MD Shawn Baca, MD Hilton Becker, MD Lawrence Brickman, MD Richard Cartledge, MD Ronald Giffler, MD James Goldenberg, MD, FAAN Henry Haire, MD Stuart B. Himmelstein, MD Marc Hirsh, MD

Leslie Levine, MD Brandon Luskin, MD Alan L. Mitchell, MD Norman Henry Pevsner, MD Howard Sabarra, MD PA Yrma Mirta Signo, MD Christopher Shea Virtue, MD Michael Stuart Zeide, MD Ronald Stuart Zelnick, MD

OnCall • Q1 2018

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Feature

ACA Alterations Leave Many Wondering About Impacts on Patients Repeal of Individual Mandate Is Biggest Change

W

ith all the recent changes to the federal Affordable Care Act (ACA), many physicians and medical professionals are left wondering: what impact will the changes have on patients’ access to health care in 2018 and beyond?

This is a big question — with few clear-cut answers and resolutions on how it will all trickle down locally.

Let’s start with what is known about the ACA changes affecting patients and their ability to take charge of their own care in the age of the internet and digital marketing.

The biggest change was in December as part of the tax overhaul approved by the

By Leon Fooksman Republican majority in Congress and supported by President Trump. It was a repeal of the ACA’s individual mandate, thus ending the requirement that people buy a health insurance policy or pay a penalty.

According to the Congressional Budget Office in its analysis of the repeal’s effects, as many as 13 million people would lose their health insurance by 2027 and increase individual market premiums by 10 percent.

The other big change happened in October. That’s when the Trump administration took the steps to allow states to scale back the mandatory benefits, with the goal of creating leaner, less-expensive plans and with the aim of attracting

younger, healthier customers to the ACA marketplaces.

The proposed rules by the Centers for Medicare and Medicaid Services (CMS) offer an array of modifications to how the individual and small-business marketplaces are run. They give states wide latitude in carrying out the ACA’s “essential health benefits” — 10 categories of care that individual market insurers must cover to ensure consumers can access a full range of benefits.

Under this plan, states must select a “benchmark” plan to set the standard for how generously insurers must cover essential benefits, which include categories such as maternity care and mental-health

American Medical Association (AMA) Legislative Priorities for 2018 INSURER ISSUES • Creating state legislative campaigns to address insurer practices and working with medical associations to enact new rules • Advocating that regulators support and enforce strong policy ENDING THE OPIOID EPIDEMIC • Advocating to policymakers and payers to end prior authorization for medication-assisted treatment • Working with payers to remove barriers to multidisciplinary pain care PRIOR AUTHORIZATION • Pushing state legislation to address prior authorization and step therapy • Advocating to national policymaking organizations (e.g., NCOIL, NAIC) for regulation of utilization management programs and entities REGULATORY RELIEF • Working to eliminate, streamline, align and simplify the many federal rules and regulations imposed on physicians • Improving the usability of electronic health records, making practice data available to physicians and holding vendors accountable for their products

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PROTECTING ACCESS TO COVERAGE • Advocating to retain gains made by the ACA in coverage and preserving patient protections like the ban on pre-existing condition exclusions • Working to stabilize the individual insurance market and improve the affordability of premiums and copayments • Maintaining the strength of safety net programs like Medicaid and the Children’s Health Insurance Program MEDICARE PHYSICIAN PAYMENT REFORM • Advocating for payment system changes that support improvements in care rather than simply adding new administrative burdens • Working to simplify administrative requirements in payment models to improve professional satisfaction TELEMEDICINE • Modernizing state medical practice acts to lay the groundwork for adoption of telemedicine • Promoting model legislation to ensure physicians are paid for the care they provide via telemedicine (This is a partial list of AMA priorities. Visit the AMA website for a full list and explanations: www.ama-assn.org/about/national-advocacy)

Up-and-Coming Physician Leaders Address Advocacy

What is the Physician Leadership Academy?

Physicians who graduated in the 2017 class of The Physician Leadership Academy of South Florida have many thoughts on what it takes to be a true advocate for their patients. Here are their personal leadership credos.

Kleper N. F. de Almeida, MD: Fight for what is right, remaining ethical and magnanimous.

Henry M. Haire, MD: How to enrich lives, help dreamers become doers, to give.

James “Jim” C. Heron, MD: To allow people to recognize their similarities, to resolve their difference and to be allowed to participate in the process of change. To learn from prior experiences, to adjust to new problems, and to understand sometimes there is no right answer, but there can be a best answer agreed upon by those affected.

Hitesh Kapupara, MD: Life is very complex: Not a single theory applies to everyone. Ultimately what it comes to is “balance in everything.” All “good” is what gives/spreads energy. All “bad” is what gives/spreads energy. My goal is to spread energy around me as much as I can! It all starts with improving “me” first.

Krishna S. Kishor, MD: Live with integrity and passion Ekaterina “Ekat” Kostioukhina, MD: Doing the right thing is my daily guiding principle.

Geetika “Nikki” Klevos, MD: Work hard and laugh often. Appeal to the greater good in people — to their nobler purpose. Be a transformational leader.

The Physician Leadership Academy (PLA) of South Florida, held under the auspices of the Palm Beach County Medical Society/Services, is in partnership with Broward County Medical Association and Dade County Medical Association. PLA is a complimentary program funded through a grant from The Physicians Foundation and endorsed by the Florida Medical Association.

Effective physician leadership will continue to be critical for patients and the medical profession as health care systems continue to evolve. With attendance at all sessions, the Physician Leadership Academy offers up to 18 South Florida physicians with: • at least 40 AMA Category 1 CME credits • a diverse array of leadership skills training • tools to make significant impacts in current and future roles • vital information about health care issues facing Floridians • access to a growing professional network The PLA experience helps physicians who want to build and/or improve their leadership skills. Physicians learn about and enhance organizational management skills, develop continuing relationships with colleagues and strengthen their leadership roles in the diverse communities of South Florida. The program includes an opening weekend retreat and six sessions.

For more information on PLA, contact Jim Sugarman at 561-433-3940 ext.103 or JimS@pbcms.org.

services. This means states won’t have to choose from a limited, fixed menu of benchmark plans – instead, they can select à la carte. For example, Florida could choose the maternity care standards from one benchmark plan and the mental health services from another.

So this brings us back to our question: what impact will these changes have on patients’ access to care?

Concerning the CMS proposal, it could give states the ability to put together all sorts of plans, which could result in a much-reduced set of benefits for consumers. That means insurers could make plans less appealing to someone they don’t want to cover — like a person with chronic, long-term conditions such as diabetes or arthritis.

Again, it’s difficult to clearly answer the question because a lot is simply not known.

Through it all, President Trump has remained committed to improving health care and giving patients more ability to manage their care. He’s called for repealing and replacing the ACA with reforms that “expand choice, increase access, lower costs, and at the same time, provide better health care.” The president’s goals include: • Ensuring people with pre-existing

• Providing legal reforms to protect doctors and patients “from unnecessary costs” that drive up insurance costs and to bring down the price of high-cost drugs.

It’s been another shaky year for the ACA. By all account, 2018 looks to be just as unpredictable.

One thing is clear: no matter what happens with the ACA, Americans are deeply concerned about their health care. A recent poll by The Associated Press-NORC Center for Public Affairs Research found that 48 percent of Americans named health care as the most important topic for lawmakers. That’s an increase of 17 points over the past two years.

President Trump has remained committed to improving health care and giving patients more ability to manage their care.

Leon Fooksman, Staff Writer OnCall

health conditions are guaranteed “access” to health insurance, “and that we have a stable transition for Americans currently enrolled in the health-care exchanges.”

• Giving people who buy their own health coverage tax credits and expanded health savings accounts to help pay for their coverage, as well as flexibility about the design of their plans.

Leon Fooksman, OnCall Staff Writer, leon@digitalstoryline.com, Twitter at @compellingstory

Bethesda congratulates

Brandon Luskin, M.D. Wishing you a year of success!

OnCall • Q1 2018

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Palm Beach County Medical Society and Services Board of Directors

2017 Gala Pays Tribute to Notable Accomplishments of Society Members Brandon Luskin, MD Installed as 2018 PBCMS President

C

EO Tenna Wiles and Mistress of Ceremonies Liz Quirantes, Channel 12 WPEC-TV, welcomed nearly 500 guests to the 2017 Palm Beach County Medical Society Gala on December 2, 2017 at the Kravis Center Cohen Pavilion in West Palm Beach, to pay tribute to the 2017 PBCMS President Shawn Baca, MD and celebrate the installation of Brandon Luskin, MD, as the 2018 President.

Highlights of the Starfish & Snowflake Gala included the presentation of the Excellence in Medicine Award to Mark A. Rubenstein, MD. This highest honor bestowed by the Medical Society recognizes the values of altruism, compassion, leadership and dedication to patient care. Stefan Pasternack, MD, was honored with the Medical Society’s President’s Award.

The 2018 president, Brandon J. Luskin, MD is an Orthopedic Hand Surgeon in practice in Boynton Beach and Boca Raton, FL. He graduated Magna Cum Laude from SUNY University at Buffalo in 1985 where he remained to

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Q1 2018 • OnCall

2017 PBCMS President Shawn Baca, MD passes the gavel to the 2018 president Brandon J. Luskin, MD.

do research with two-time Nobel Prize nominee Robert Guthrie, MD. Dr. Luskin attended the State University of New York Health Science Center at Syracuse for medical school and completed his orthopedic surgery training at the Long Island Jewish Medical Center in New York City. His interest in hand and

microsurgery led him back to Buffalo for a one-year fellowship at the prestigious Hand Center of Western New York.

Dr. Luskin’s practice in Florida largely focuses on surgery of the hand and upper extremity. He has been practicing with Orthopaedic Surgery Associates Inc. since 1997. He is board certified in orthopedic surgery and hand surgery.

He is a member of the American Society for Surgery of the Hand, the Florida Medical Association and Palm Beach County Medical Society. He has served as a Board of Delegates to the Florida Medical Association. He has been active in the PBCMS for nearly a dozen years as president-elect, treasurer, secretary, and vice president.

Dr. Luskin maintains hospital privileges at Bethesda Health, Delray Medical Center, and Boca Raton Regional Hospital. Dr. Luskin is the proud father of two daughters, a son and is married to Julie Luskin.

The Excellence in Medicine Awardee is Mark A. Rubenstein, MD who is an integral part of every aspect of the com-

Mistress of Ceremonies Liz Quirantes at the podium with honoree Dr. Mark Rubenstein and his wife Jessie.

munity at large including the hospitals where he is on staff, the Palm Beach County Medical Society where he has served in almost every capacity including President in 2006. He also has served on multiple committees with the Florida Medical Association, and today he is the Chairman of the Council on Ethical and Judicial Affairs.

Dr. Rubenstein’s illustrious career started at Tulane University followed

by Upstate Medical Center in Syracuse, NY, where he accomplished his internship and residency. His residency was completed at Johns Hopkins University in Physical Medicine I Rehab where he became Chief Resident.

Dr. Rubenstein has distinguished himself as being a very fair physician as well as a patient advocate. He also served as a Delegate to the American Medical Association and Chair of the PBCMS Medical Legal Committee.

In addition, he has been involved in his own specialty organization where he is currently on their board and has been Secretary of the Florida Society of Physical Medicine I Rehab. He is in the forefront of managing the opioid problems in the county and serves on multiple com-

mittees to help guide treatment options, the management of opioids, and works with physicians who have had problems with opioids. He also has authored several articles on the management of opioid use.

Dr. Rubenstein is an outstanding asset to the community. He has served for the past nine years as a board member of the Palm Healthcare Foundation and has been active in Admirals Cove. He is a treasure and is revered by both the Palm Beach County Medical Society and the Florida Medical Association.

Dr. Rubenstein is an outstanding physician most deserving of the Excellence in Medicine Award.

The President’s Award honoree, Stefan A. Pasternack, MD, relocated to Palm Beach County 11 years ago following a prestigious career in Washington DC. Dr. Pasternack is an active leader and a member of the Board of Directors of the Palm Beach County Medical Society. He is known for his expertise in medical and executive life stress and frequently presents at meetings of PBCMS, the Florida Psychiatric Society and the American Association of Medical Society Executives.

In the past year, Dr. Pasternack has been instrumental in developing and implementing the PBCMS Physician Wellness Program and serves as Task Force Chair. Through his outstanding

President Shawn Baca, MD presents the PBCMS President’s Award to (l) Stefan A. Pasternack, MD.

The annual Festival of Trees Silent Auction was again a huge success. Career Source captured two of the four awards and Elaine Alvarez, SloBody Studio and Jim Sugarman (pictured above) won the other awards as judged by State Attorney Dave Aronberg, Ben Dugan, Tax Collector Anne Gannon, Shannon Materio and Marcy Zeltzer. The beautifully decorated trees were admired by the hundreds of guests at the reception at the Starfish & Snowflake Gala.

leadership and commitment to physician wellness, PBCMS is one of a few county medical societies nationwide to implement a Physician Wellness Program.

Dr. Pasternack maintains a busy lecture and teaching schedule as a member of the faculty of the Florida Psychoanalytic Institute and as Affiliate Professor at the Schmidt College of Medicine at Florida Atlantic University. For many years the Consumer Research Council and Marquis Who’s Who in Health Care have recognized Dr. Pasternack as one of the “Top Psychiatrists in America.”

PBCMS is honored to recognize Dr. Pasternack for his outstanding leadership and contributions to Palm Beach County‘s medical community with the President’s Award.

Thank You to the Hippocrates Society for Your Support Bethesda Memorial Hospital Medical Staff Boca Raton Regional Hospital Medical Staff JFK Medical Center Medical Staff Jupiter Medical Center Medical Staff Wellington Regional Medical Center Medical Staff

OnCall • Q1 2018

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AMA President Addresses PBCMS at State of Medicine Dinner

P

alm Beach County Medical Society (PBCMS) President Brandon Luskin, MD, introduced honored guest David O. Barbe, MD, MHA, the president of the American Medical Association (AMA), at the annual PBCMS State of Medicine Dinner in January. Dr. Barbe addressed AMA priorities and provided an overview of  “The State of Medicine� with a focus on advocacy, connection and education.

David O. Barbe, MD, MHA, a down-to-earth, board-certified family physician from Mountain Grove, Mo., became president of the American Medical Association in June 2017. A member of the AMA Board of Trustees since June 2009, Dr. Barbe has a long history of service to organized medicine. He has been a member of the AMA, the Missouri State Medical

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(L to r) Dawn Davanzo, MD; Shawn Baca, MD; AMA President David O. Barbe, MD; Palm Beach County Mayor Melissa McKinlay, and Stephen Babic, MD pose at the State of Medicine dinner.

Association and the American Academy of Family Physicians for 30 years.

Dr. Barbe was elected to two terms on the AMA Council on Medical Service, serving as its chair from June 2008 to June 2009, and participated in the development of much of the AMA policy related to coverage of the uninsured, health care system reform, Medicare reform and health insurance market reform.

Featuring:

159 Rehab beds

(L to r) Shawn Baca, MD; Brent Schillinger, MD; David O. Barbe, MD, and Brandon Luskin, MD on the tour of the Trauma Hawk Hangar at Palm Beach International Airport following the Leadership Forum.

The event was preceded by an afternoon Leadership Forum at the Trauma Hawk Hangar on Southern Boulevard where Dr. Barbe and society leadership shared ideas about the state of medicine. Dr. Barbe was very impressed by the scope and depth of the PBCMS programs and events from the Opioid Task Force to the Physicians Wellness Program. Participants included Dr. Stephen Babic, Dr. Brandon Luskin, Dr.

Shawn Baca, Dr. Jose Arrascue, Dr. Brent Shillinger, Dr. Michael Dennis, Dr. Robert Tome, Dr. Alina Alonso, Darcy Davis and Roger L. Kirk, all of whom were escorted on a tour of the facilities. The state-of-the-art hangar facility at the Palm Beach International Airport was developed by the Health Care District, the host of the meeting, and functions as the base of operations for the Trauma Hawk program.

Feature

Is Your New Hire a Jekyll and Hyde?

How to Avoid Dual Personalities

By John Dalton

I

f you’re like me, you remember hanging around the house on a cold winter Saturday afternoon watching the Creature Double Feature on some obscure UHF channel. For those of you not familiar with this treat, Wikipedia describes Creature Double Feature as a syndicated horror show that was broadcast in the Boston and Philadelphia area during the 1970s and 1980s, and it also aired under names such as Sci-Fi Flix and Creature Feature. There you are bundled up watching as the announcement comes on, “And todays’movies will include the ‘Invisible Man’ and ‘Dr. Jekyll and Mr. Hyde’. ” Great, you think,

two of my favorites. You hunker down and get ready for some great, scary science fiction stories.

Remember the story of Dr. Jekyll and Mr. Hyde? It was about a lawyer who was investigating the odd behaviors found in his friend Dr. Jekyll and the seemingly unknown Mr. Hyde. As we move through this thriller we find out that in trying to contain the darker side of his personality, Dr. Jekyll creates a potion that will isolate it and hopefully allow him to rid it from his personality all together. But

14

Q1 2018 • OnCall

no, and as the kids say today, it was a major fail. Instead of containing it, he actually releases and amplifies this trait, and Mr. Hyde is released onto the streets of London. This was scary stuff to me, and I was sure glad it was only a story.

Jump ahead a few decades, and now I find that this story wasn’t very far-fetched — albeit not so dramatic. I see this difference in personality play out over and over again in my professional life. The person who is so charming and happy is only that way because he is lying to your face. The salesper-

son who is interviewing and has great numbers actually can only produce a fraction of them when hired, and finally, the pleasant front desk girl who is nice as pie during the interview turns out to be the psychotic Ms. Hyde not four weeks later. We have all seen this happen in our workplace, and it might be happening right now.

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How? Our company’s 90-day temp-to-perm program gives John Dalton you the opportunity to observe a candidate prior to ever having the employer/employee relationship begin.

Think of it as a prolonged on-the-job interview where you get to monitor a person as they grow into (or sometimes out of the job) while never being fully responsible or liable for any unemployment, tax liability, payroll cost or even re-advertising the position. Contact Optimum RTS to see how we can replace your Jekyll and Hyde personality with a new candidate for your company.

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OnCall • Q1 2018

15

Feature

Federal Tax Reform Act Changes Many Material Revisions Affect Health Care Organizations

By Lou J. Fuoco, CPA

P

resident Trump signed the Tax Cuts and Jobs Act of 2017 into law on December 22, 2017.

While much of the Tax Cuts and Jobs Act (TCJA) publicized material has focused on federal tax laws affecting individuals, there are numerous changes applicable to both taxable and tax-exempt health care organizations.

Summarized below are several material changes that may affect your health care organization.

Please note that these changes generally are effective for years beginning after December 31, 2017 and may be temporary or phased out over the next 10 years.

TCJA highlights affecting federal taxable health care organizations: 1. Lowers the Federal corporate income tax rate to a flat rate of 21 percent.

2. Repeals the Federal corporate alternative minimum tax.

3. Certain qualified business assets acquired and placed in service after September 27, 2017 may be fully expensed and increases the Internal Revenue Code Section §179 limitation to $1 million.

4. Disallows certain entertainment expense deductions but retains the 50 percent deduction for business-related meals.

5. Net operating losses incurred for years’ post December 31, 2017 will be limited to 80 percent of a taxpayer’s taxable income in each year. Net operating losses incurred prior to years beginning after December 31, 2017 remain unlimited. Generally, losses can no longer be carried back.

6. Increases the gross receipts threshold for the availability of a taxpayer to elect the cash method of accounting for certain corporations and partnerships.

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Underway for 2018 TCJA highlights affecting federal tax-exempt health care organizations: 1. Imposes a 21 percent excise tax payable by the employer on compensation paid in excess of $1 million to an applicable tax-exempt organization’s covered employees.

2. Amounts paid or incurred by employers relating to certain employee fringe benefits will be treated as unrelated business income. Employee fringe benefits include (1) any qualified transportation fringe benefit (2) any parking facility used in connection with qualified parking and (3) any on-premises athletic facility.

3. Activities which constitute an unrelated trade or business must now be reported separately on a Federal Form 990-T. Aggregating (or netting) a taxpayer’s unrelated trade or business activities and corresponding income/ losses are no longer permitted.

4. Net operating losses incurred in unrelated trade or business activities must generally follow the rules for Federal taxable healthcare organizations as outlined above.

5. Interest on bonds issued after December 31, 2017 to advance refund another bond is no longer excluded from gross income.

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Lou J. Fuoco The Fuoco Group health care tax advisers will be discussing these new federal tax provisions in greater detail in early 2018.

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The PBCMS Physician Wellness Program Is Underway The Physician Wellness Program (PWP) program creates a safe harbor for physicians to obtain care, avoid burnout, achieve work-life balance and an improved quality of life.

The practice of medicine is a highly stressful profession, and physician burnout is of great concern to the medical community. Burnout manifests

itself with disengagement, drepression, substance abuse, early retirement and even suicide.

PWP, which has been funded by the charitable support of those who support and believe in our mission, offers PBCMS members six complimentary, confidential counseling sessions during a calendar year. The self-referred

program is designed for physicians to learn the best practices to be proactive to address and prevent burnout. PWP psychologists and licensed mental health counselors have a great deal of experience in counseling physicians, and they have been thoroughly vetted

by PBCMS physicians. The 24/7 support line is 1-800-530-9757.

Physician Wellness Committee Shawn Baca, MD Bruce Bensadon, Ph.D. Russell Bourne Jr., Ph.D. Ali Chaudhry, MD Anthony Dardano, MD Stefan Pasternack, MD, Chair Norman Henry Pevsner, MD Scott Rice, MD Bruce L. Saltz, MD Abbey Strauss, MD Michelle Lizotte-Waniewski, Ph.D.

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Pursuing Constructive Addiction Treatment at the Height of the Opioid Abuse Crisis

By Michael Frost, MD hile increased focus and ed to patients and treatment programs attention to the opioid for other illnesses, including long-term, epidemic is an important multifaceted clinical care, rather than fistep in addressing addic- nite courses of therapy. tion, data show we still have many chalEveryone approaches addiction with a lenges ahead of us if we are to slow and different background, lifestyle and set of ultimately reverse the upward trajectory experiences, and it is imperative to meet of drug and opioid abuse in the U.S. them where they are with a treatment More than 64,000 Americans died program that is accessible, realistic and from drug overdoses last year, and ac- sustainable. Treatment should include ac- to treat addiction. There is a significant cording to a new report from the U.S. cess to a full spectrum of evidence-based need for funding to generate and offer Centers for Disease Control and Pre- care, including withdrawal manage- incentives to develop innovative and vention, we’ve seen about a 20 percent ment, inpatient and outpatient care, clinically validated treatment options for increase in overdose deaths between medication-assisted treatment and ad- people suffering from substance abuse year-end 2015 and 2016. Furthermore, equate therapy for co-occurring mental disorders. Federal funding is critical, overdose deaths from opioids have more health disorders. Settings need to be but it is equally important that funding than quadrupled since1999. designed to help promote healing and is properly dispersed at the state level We must address this epidemic at its staffed by specialists with extensive ex- so local solutions can be implemented roots by more effectively treating those pertise in the field of addiction medicine based on the specific needs of the area.

It is essential now more than ever currently addicted while also focusing and mental health counseling. on prevention. There is no such thing The addiction crisis has torn families for healthcare providers to focus on as a one-size-fits-all treatment. There- apart and devastated entire communi- creating a comprehensive, positive and fore, successfully addressing this crisis requires proactively bringing comprehensive and personalized solutions to A community-based approach to people who are suffering from addiction treatment can help build an additional or are at risk.

Addiction is not an acute illness, yet constructive and compassionate local we continue to treat it as such, both in support network for patients. thinking and in medical practice. HHS’ 2016 report “Facing Addiction in AmerMichael Frost, Medical Advisor ica: The Surgeon General’s Report on Sunspire Health Alcohol, Drugs, and Health” summed up the challenge: “We must help every- ties, leaving a trail of crime, homelessness evidence-based patient experience from one see that addiction is not a character and poverty in its wake. While family in- beginning to end, with treatment plans flaw — it is a chronic illness that we must volvement is a critical part of addiction tailored to each patient’s long-term approach with the same skill and com- treatment, helping to improve commu- recovery needs.

Everyone has a role to play to compassion with which we approach heart nication through a community-based apdisease, diabetes, and cancer.” proach to treatment can help build an ad- bat our substance abuse crisis. It is not Decades of comprehensive research ditional constructive and compassionate enough to expect that any specialized have helped us to understand that ad- local support network for patients. This group can provide the solution. We must diction is a disease, not an opinion. It has type of community engagement pro- all come together from a point of educasignificant effects on the brain as well as vides important aftercare services that tion and understanding to mobilize and the rest of the body and can develop as contribute to long-term recovery, includ- synchronize services in our communities a result of biological or environmental ing sober living and access to doctor’s that contribute to a holistic effort, giving factors, or often a combination of the appointments and group or individual each individual the opportunity to thrive. two. As a verified and scientifically val- therapy sessions, among others. idated disease, addiction deserves the Since the 1970s, only about five new Dr. Michael Frost, Medical Advisor, Sunspire Health, same level of attention and care provid- classes of medicine have been developed www.sunspirehealth.com

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OnCall • Q1 2018

19

Feature

Physicians Can Be at Risk When Homebound Patients Refuse Help

By Robin Diamond, MSN, JD, RN

M

ore than ever, physicians are focusing on treatment plans that include the kind of care patients need at home. However, physicians face potential liability when patients refuse help that is offered or neglect to follow up as instructed.

If a patient sues, even a verdict in favor of the physician does not negate the time, expense, and emotional impact of a lawsuit. Consider this example: A 67-year-old male with a history of obesity, hypertension, hypercholesterol, atrial fibrillation, and cardiovascular disease had seen the same physician for 20 years. During one hospitalization, the patient was put on the blood thinner Coumadin. The physician and the discharge nurse both educated the patient and his wife about the risks of Coumadin use and the importance of having blood work done every month.

Nevertheless, the patient did not keep the first appointment for the monthly blood test (INR). The physician’s staff called

to schedule a follow-up visit, but the patient did not return the call. Two days following the call, the patient fell at home.

His wife took him to the emergency department, where she told the staff that she had been unable to drive him to his appointment for blood work, but she had made sure he took his Coumadin as prescribed. The patient’s INR was extremely elevated, with a reading of 8.8. The patient was diagnosed with a bilateral subdural hematoma and underwent a bilateral craniotomy. He was discharged home but due to problems with his coordination and confusion, he visited the emergency department several more times over the next few months.

The patient sued for malpractice, claiming the physician failed to properly manage the medication regimen and failed to monitor blood levels, resulting in the fall, subsequent injury, and poor recovery. He also claimed the doctor failed to warn him of the risk of bleeding from the Coumadin.

The case went to trial. Because of the doctor’s thorough documentation, the jury agreed that he had properly educated the patient and made the right resources available to monitor the effects of the Coumadin. The jury found that the patient’s failure to schedule his lab appointments and follow-up appointment caused the injury and, therefore, found in favor of the physician.

Some Refuse Any Help While this patient failed to follow physician instructions, other homebound patients simply refuse any help. A recent study found that between 6 percent and 28 percent of patients eligible for home healthcare refuse these services, and similar trends are seen with other types of assistance for patients at home. Patients often say they are managing just fine and don’t need help, while others don’t want strangers in their homes or they worry about the cost of co-pays for home care. That means some patients are not getting the follow-up and supportive care that the doctor outlined in the care plan.

And when the patient doesn’t follow up, it can put the physician at risk.

Non-Compliance Most Common Patient behaviors were contributing factors in 25 percent of internal medicine closed claims studied by The Doctors

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Q1 2018 • OnCall

Company. Of these factors, noncompliance with the treatment plan was the most common, accounting for nine percent of internal medicine claims.

This was followed by seven percent of claims resulting from patients failing to make a follow-up appointment or referral, and four percent of claims resulting from patients failing to take medications as prescribed.

Tips to Reduce Risk The potential malpractice risks to physicians are increasing as more care is moved from a health care setting to the patient’s home. The following are tips to reduce risks when treating homebound patients: • Conduct a risk analysis to determine how likely the patient is to comply with instructions. Consider the following: patient’s age, ability to drive, socioeconomic status, whether patient lives alone, and history of failing to comply with appointments or medication instructions.

Document that: • The patient received proper discharge instructions.

Patient behaviors were contributing factors in 25 percent of internal medicine closed claims studied by The Doctors Company Robin Diamond, MSN, JD, RN The Doctors Company

• Resources were made available to overcome compliance challenges.

The physician or practice made a good-faith effort to follow up and intervene if the patient was not in compliance.

• Schedule the follow-up appointment before the patient leaves the office. Give the patient contact information for community home health resources.

• Educate the patient about why community resources are provided and draw a distinction between what is and is not offered.

Patient reluctance to follow the discharge plan is often caused by lack of understanding about what type of follow-up care is needed. Taking time

to document patient discussions gives homecare providers valuable information to ensure patients are following the plan — and also will demonstrate, in the event of a lawsuit, the high quality of care provided.

Robin Diamond, MSN, JD, RN, Patient Safety Consultant, The Doctors Company, www.doctorscompany.com Note: The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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Award-Winning Training Program Offers Path to Health Care Career Throughout the United States, the community health worker field is burgeoning, both in interest and demand.

The field also is rapidly expanding into new areas of health and community wellness as health care professionals continue to improve chronic disease management programs, health insurance enrollment, immunization drives, HIV/AIDS treatment, access to mental health services and maternal-child health interventions.

Palm Beach County Medical Society Services (PBCMSS) offers an award-winning, nationally recognized Community Health Worker (CHW) Care Coordination Training program.

The PBCMSS model for the CHW Care Coordination Training Program was recognized for its innovative approach to patient care education and honored as the recipient of the 2017 American Association of Medical Society Executives Profile of Excellence. In fact, many of the graduates have obtained new positions, achieved promotions, increased pay and greater job satisfaction due to

Care Coordination Training Begins March 2

By Karen Harwood this exceptional training. And almost all the graduates gave the program high marks calling it “essential,” “useful,” and very instructive. Many called out the Motivational Interviewing session most enlightening and helpful in dealing with their patients.

Community health workers now can earn the full complement of education hours and content areas that health care

professionals need to fulfill the training requirements (30 CEUs) for the HCW certification application. (Florida Certification Board Provider Number 5284-A).

CHW Care Coordination Training Program includes: • • • • • • •

Overview of chronic disease symptoms and management Scope of Community Health Worker Care Coordinator job responsibilities Cultural sensitivity, competency and diversity training Understanding professional responsibility and tools for patient advocacy Strategies to work as a team member to improve patient/client outcomes Tools to develop a comprehensive community resource directory Motivational interviewing — patient/client engagement skills

Karen Harwood, Director of Care Coordination Services, PBCMS, 561-433-3940 ext. 122, karenh@pbcms.org, https://www.pbcms.org/care-coordination-program

The HCA Palm Beach Hospitals are proud to support the Palm Beach County Medical Society.

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Meet Our 2018 HEROES at the

15th Annual Heroes in Medicine Awards Luncheon

presented by

Palm Beach County Medical Society Services Friday, April 20, 2018 The Cohen Pavilion at the Kravis Center 11 am to 2 pm • $125 per person Honorary Chair – Alan Pillersdorf, MD • Co-Chairs – Greg Quattlebaum and Jibby Ciric Founding and Presenting Sponsor – Rendina Healthcare Real Estate Benefactors – Trustbridge and Acevedo Consulting • Grand Patron – The Palm Beach Post Sponsor – South Florida Hospital News & Healthcare Report Proceeds from the event benefit Project Access, which provides resources and health care for low income, uninsured residents of Palm Beach County as well as other valued programs of the non-profit PBCMS Services For more information on sponsorship opportunities, event advertising and ticket sales, go to

www.pbcms.org or call 561-433-3940