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OnCall

QUARTER FOUR 2020

THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

Tenna Wiles

Palm Beach County Medical Society CEO


Connecting practices to

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President’s Message Larry M. Bush, MD, FACP President, Palm Beach County Medical Society

SEPARATING MEDICAL ‘SCIENCE’ FROM POLITICS We have all heard that one should avoid discussing two things at the dinner table: religion and politics. Historically speaking, the legal definition of ‘Separation of Church and State’ in the United States (U.S.) can be traced back to a January 1, 1802, letter written by Thomas Jefferson and then published in a Massachusetts newspaper. In this letter, Jefferson addressed the Danbury Baptist Association in Connecticut who were worried about losing the freedom to practice their faith. Since that time, this paraphrased principle has been employed to convey the understandings of the intent and function of the ‘Establishment Clause’ and ‘Free Exercise Clause’ of the 1st Amendment to the U.S. Constitution, “disallowing any law respecting an establishment of religion, or prohibiting the free exercise thereof…”, words that forbid governmental establishment or preference of a religion and that preserve religious freedom from government intrusion. Hence forth, separation of church and state is too important a concept to be misused — especially not as a tool for silencing opposing views. As a privileged long-time editorial board member of two infectious diseases medical journals, I feel as strongly about ‘Separation of Medical Science and Politics’. My final On-Call message as this year’s president of the PBCMS highlights this important message. I am inspired by the editorial entitled, “Dying in a Leadership Vacuum” (NEJM, Oct. 8, 2020) written by Dr. Eric Rubin (editor-inchief), along others who comprise the medical editorial staff of this well-respected journal copyrighted by the Massachusetts Medical Society. In their opinion article, the authors present a series of events that we are told, based on medical science, have been poorly managed. They conclude by telling us that ‘truth’ is neither liberal nor conservative, and that when it comes to the response to the largest public health crisis of our time (COVID-19), our current political leaders have demonstrated that they are “dangerously incompetent”. Shortly after publication of this NEJM editorial another article entitled, “Suboptimal U.S. Response to COVID-19 Despite Robust Capabilities and Resources” was published as a viewpoint piece in JAMA (Oct. 13, 2020). Here, three non-medically trained authors inform us that, based on the Global Health Security (GHS) Index (which is made up of 140 questions and designed as a framework for benchmarking health security) that the U.S. had the highest ranking among 195 nations. None of these countries were fully prepared for a major health emergency. They then point out that currently the U.S. makes up <5% of the world’s population, but has accounted for more than 25% (correct number is 20%)

of global COVID-19 cases. However, they fail to provide us with the total whole test numbers from each country, what percent of each countries’ populace was tested, and what percentage of those tested proved positive, all of which are critically required data President, Larry M. Bush, MD, FACP needed to accurately place the results into comparative perspective. Also not taken into account is the Ro, or projected reproduction number of SARS-CoC-2. This numerical approximation is used to estimate the number of people who will become secondarily infected with a respiratory disease from an infected person during that individual’s infectious period. This value is not based solely on the particular respiratory pathogen. It also factors in how susceptible people are due to other illnesses that may compromise one’s immune system, as well as important environmental features such as demographics, socioeconomic status, and climate. Henceforth, it may well not be the same in each part of the world. In other words, comparing “apples to apples.” Presently, the COVID-19 case fatality rate in the U.S. mirrors that of the world (2.6%), and other than Germany (also 2.6%), is less than that of the UK, Spain, France, Italy, and Canada. The highlighted point in this article is that “despite its top overall ranking on the index, the U.S. received a low score on a key factor that can determine how well a country is able to react to a pandemic; public confidence in the government.” Although, many would certainly share the same sentiment, the overall issue is subjective, and in large part, a media-influenced emotion. Therefore, it is excluded from affecting any form of relied upon medical evidence. Furthermore, in the U.S., unlike many other nations, specific pandemic interventions are controlled by the individual states and not governed by a uniform national policy. Granting that one would like to believe that when a writer states that their piece is not about politics or opinion, you could be fairly certain it is about one or the other or both. Although I sincerely respect their opinions and adamantly defend their right to express them in these journals, I am somewhat disappointed by the fact that they claim to bolster their assertions based on their interpretation of the medical science. You may be well aware that when it comes to the science of respiratory diseases, evidenceproven scientific data has been researched, collected and implemented for multiple decades. Moreover, practice guidelines, such as those dealing with the diagnosis, treatment, and prevention of community acquired pneumonia (CAP), are produced by renowned and Continue on page 5

OnCall • Q4 2020

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BOARD OF DIRECTORS

TABLE OF CONTENTS

Larry Bush, MD President

Roger Duncan, MD                                         President-Elect Dawn Davanzo, MD Secretary

Claudia Mason, MD                                       Vice-President Martha Rodriguez, MD Treasurer

Marc J. Hirsh, MD Immediate Past President      Ayesha Abid Jose Arrascue, MD                                           Stephen Babic, MD                                         Shawn Baca, MD Andrew Berkman, MD Kleper de Almeida, MD Micheal Dennis, MD Jordy Godinez, MD Dianne Goldenberg

James Goldenberg, MD Joel Grunhut Henry Haire, MD James Heron, MD Ekaterina Kostioukhina, MD                           Brandon Luskin, MD                           Alan Pillersdorf, MD                                     David Shulan, MD Jack Zeltzer, MD

BOARD OF TRUSTEES Jose F. Arrascue, MD Chair Shawn Baca, MD Larry Bush, MD Dawn Davanzo, MD Roger Duncan, MD

Marc J. Hirsh, MD Brandon Luskin, MD Claudia Mason, MD Alan Pillersdorf, MD Brent Schillinger, MD Jack Zeltzer, MD

BOARD OF DIRECTORS President Vice-President Ivy Faske, MD President Emeritus Matt Gracey Treasurer Michael Dennis, MD Secretary Paul Wieseneck, MD Stuart Miro, MD Elaine Alvarez Ljubica “Jibby” Ciric Greg Goldin MD James Heron MD Jean Acevedo Steven Borzak, MD Don Chester

Alan Pillersdorf, MD Roshan Massoumi Maureen Whelihan, MD Brent Schillinger, MD Jose Arrascue, MD Mollie Shulan, MD Bob Broadway Ben Starling Madelyn Christopher Pat Thomas Bobbi Horwich Jack Zeltzer, MD Barbara James

DEPARTMENTS 2 4

President’s Report

President, Larry M. Bush, MD, FACP

Welcome New Members

FEATURES

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I am having a difficult time

saying farewell

Tenna Wiles PBCMS CEO

Women in Medicine

Woman Physician of the Year Alina Alonso, MD,

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Future of Medicine Summit (FOM)

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Centennial Gala and Heroes in Medicine Celebration

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COVID–19 Lessons Learned

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COVID-19 Task Force Highlights

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Cold and Flu Season

Director, Florida Department of Health, Palm Beach County

First Virtual Presentations

PBCMS Physician Leadership

Jose Arrascue, MD

Incoming President

Roger Duncan, MD

James Heron, MD

Brent Schillinger, MD

PBCMS STAFF DIRECTORY Tenna Wiles CEO Deanna Lessard Member Services & Physician Wellness Director

Mindi Tingler Director of Communications Katherine Zuber Membership Development & Events Director

Lauren Stoops Director of Development

Karen Harwood Director of Community Programs

John James Public Health & Disaster Services Director

Mindy Gonzalez Director of Finance & Administration

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 2019 Palm Beach County Medical Society, Inc. OnCall Journal is designed and edited by Mad 4 Marketing. Visit us on the web at mad4marketing.com 954.485.5448

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Q4 2020 • OnCall

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Dean Viskovich

During a Pandemic

Florida Healthcare Law Firm

All Aboard!

John Dalton

Executive Director

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The New Healthcare Landscape

Martha M. Rodriguez, M.D

Natalie PerezMendez, MS-3


New Members

PALM BEACH COUNTY MEDICAL SOCIETY

RETIRED

Dolores Arnold, MD Michael Aronsohn, MD Otolaryngology Leonard Benedict, MD Adam Bromberg, MD Emergency Medicine Jerome E. Bernstein, MD Jeffrey Collins, MD Internal Medicine Lawrence H. Brickman, MD Teresita Fox, MD Pedicatrics Susan B. Giesecke, MD James Gerard Houle, MD Otolaryngology Joseph Goldberg, MD Stuart H. Isaacson, MD Neurology Murray R. Gordon, MD Linda Kiley, MD Obstetrics and Gynecology Marilyn Kassirer, MD Daniel S. Kovacs, MD Plastic Surgery Mario Ludmer, MD Tara Martinez, DO Colon and Rectal Surgery, General Surgery Fredric W. Pullen V, MD Mauricio E. Melhado, MD Cardiovascular Disease Name: Gary V. Prim, MD Sharab Mohamed, MD Internal Medicine Patricia A. Randall, MD Negar Mohamed, MD Internal Medicine Irving P. Ratner, MD Harvey Montijo, MD Orthopedic Surgery Joseph H Richman, MD Gail M. Pezzullo-Burgs, MD Obstetrics and Gynecology Jeanne A. Rodman, MD Steven A. Pollack, MD Cardiovascular Disease Irwin M. Suna, MD Amit Rastogi, MD CEO Jupiter Medical Center Medicine Col. Jose R. Thomas-Richards, DO Howard Routman, DO Orthopedic Surgery Protection Norman Wiesenthal, MD Jason Sevald, MD Emergency Medicine Investment Steven Howard Schuster, MD Plastic Surgeon Nagarakere Shankaraiah, MD Pediatrics WealthRESIDENTS Creation Kingsley Ndubisi Anurugwo Carl Spirazza, DO Family Medicine Retirement Jodi Star, MD Psychiatry - Child and Adolescent MEDICAL STUDENTS Michael M. Tuchman, MD Neurology Samantha Pavlock Gary M. Wolfson, MD Internal Medicine

FINANCIAL PLANNING FOR TODAY'S HOSPITALIST

Ganesh Giri

For membership information contact Deanna Lessard at deannal@pbcms.org or 561-433-3940 x105.

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Continued from page 2

respected academicians and sanctioned by such major medical societies as the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS). These guidelines are regularly revised, leading to the entire removal of some prior recommendations and replacing them with new ones, all in the name of evidence-based medical science. Nevertheless, even though most clinicians follow these evidence-based medical science guidelines, to this day such diseases remain the leading cause of infectious diseases death worldwide. It was not until the year 2002 that the world was introduced to a novel coronaviruses, SARS-CoV-1 virus (Severe Respiratory Syndrome), capable of significant respiratory failure and systemic disease. The final mortality rate and need for mechanical ventilator support associated with this first novel coronavirus pandemic was 10% and 30%, respectively. These numbers are magnitudes greater than what we have experienced (the numbers of which continue to decline) during the COVID-19 crisis in the United States. In the wake of SARS, the medical scientists warned us (Clin Microbiol Reviews, Oct., 2007), “the presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb and that the possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.” However, much to the chagrin of many in the scientific community as well as two governmental executive branch administrations (republican and democrat), this scientific warning was neither heeded nor followed, thus the arrival of the Middle East Respiratory Syndrome MERSCoV 2012 pandemic. Alarmingly, the MERS outbreak carried with it an even greater need for mechanical ventilation (50%-89% of all patients) and a devastating 36% rate of mortality. As the COVID-19 pandemic progresses, we may come to learn that much of the scientific dogma and dictums that we have universally accepted as selfevident “truths” may not have been as firmly rooted in evidence as we had been led to and hoped to believe. In full disclosure, my physician wife and I consistently adhere to the facial covering and social distancing CDC non-pharmaceutical mitigation recommendations, and habitually encourage and ask all others to do the same. Nevertheless, I would be remiss in my roles as an Infectious Diseases specialist and medical editor if I did not ask you for your opinion and interpretation of a recently published study (MMWR, Sept. 11, 2020) analyzing the characteristics of symptomatic adults who received positive and negative SARS-Cov-2 test results. From the 314 total patients included in the study, 154-tested positive, referred to as ‘case patients’, and 160-tested negative, referred to as ‘control patients’.

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Somewhat unexpectedly, the percentages of individuals in both groups who claimed to have always worn a mask was quite similar; 70.6% of positive case patients and 74.2% of negative controls. Although numerically this would suggest that 100% compliance with wearing a mask might have been a dependable protective barrier, this conclusion does not meet statistical significance and obligates each of us to question why. Moreover, the proportion of patients who tested positive who reported close contact (42%) with a person with COVID-19 (mostly household family members) was three-times that (14%) of the negative controls, thus laying ground to question the medical science as to whether other mitigation measures were as, or perhaps more important, than facial covers in limiting the chances of becoming infected in what would seem to be a potentially very contagious environment. Although much of our public health effort to combat COVID-19 has focused on disease control strategies (encouraged by the CDC as well as the PBCMS) in public settings (as it should be), the fact that the estimated household secondary attack rate is 17.1%, percentage much greater than in the community setting, (Clin Infec Dis. Oct. 12, 2020), it should become very clear, at least it has to me, that the true nature and determinants of household transmission are poorly understood. Perhaps our respected and looked to scientific colleagues (some of whom sit on the editorial board of the NEJM) should redirect their focus on a more effective and resourceful testing strategy and not solely critical of the amount of tests being performed. Feasibly, a more scientifically-based household mitigation prevention strategy as well as post-exposure anti-viral research (similarly to oseltamivir post- influenza exposure), in addition to the obvious need to be compliant with facial covering, could and should be the focus of the valued CDC (e.g., recent guideline changes in the management approach with post-contact-patients). Instead, we have been inundated with political debate as to the grave threat the public would certainly be exposed to with the implementation of anticipated governmental irresponsible actions, such as carefully planned re-openings of schools, businesses, and houses of religious worship. Today’s current events bring back vivid personal memories surrounding my involvement in the 2001 Anthrax bioterrorism attacks. Following the report of the Index Case of Inhalation Anthrax due to Bioterrorism in the United States (NEJM Nov. 29, 2001), I was invited to participate in a closed-door investigatory meeting at the US Department of Defense in Washington, D.C. Included among the gathered guests were various high-level governmental officials as well as renowned medical and public health experts (some still employed by or advisors to the CDC and NIH). Many of these experts had co-authored the consensus statement, ‘Anthrax as a Biologic Weapon: Medical and Public Health Management’ (JAMA, 1999), a document created from what was believed to be hardened scientific


medical evidence. Following my detailed presentation of the events surrounding the index case of Anthrax, more than one participant (some seen regularly as COVID-19 pundits in the national media and current members of the Center for Infectious Disease Research and Policy as well as the World Working Group on Pandemics) humbly approached me to let me know that it was obvious that the science on which they had based their consensus guideline was either incorrect or outdated. Interestingly, shortly after that conference, a new concensus statement entitled; ‘Anthrax as a Biological Weapon, 2002: Updated Recommendations for Management’ was published in JAMA by the same group of individuals. Ten years after the Anthrax attacks, my wife, Dr. Maria Vazquez-Pertejo, and I were invited to write an Ideas and Opinion article in the Annals of Internal Medicine (Jan 3, 2012), aimed at retrospectively detailing the ‘lessons learned’ and offering an opinion as to whether or not we were now ‘better prepared’. You be the judge. Likewise, in May of this year both the NEJM and Lancet published ‘evidence based medical facts’ warning of serious proven safety concerns associated with the use of hydroxychloroquine for the treatment of SARS-CoV-2, only to RETRACT these articles one month later after coming to the realization that the arrived at conclusions were based on inaccurate scientific data. These almost unparalleled retractions occurring at such esteemed and universally relied upon medical publications can only lead one to wonder if the editors of the NEJM and Lancet rushed to publish (ask me about my interactions with NEJM during Anthrax 2001) what turned out to be poorly scrutinized data? Imaginably, as a response to the boastful unproven remarks emanated from 1600 Pennsylvania Avenue, touting the clear benefits of this antimalarial drug. The point of these accounts is to remind all of us in the medical community of a thought that I, and probably you, undoubtedly often muse over, “if I only knew then what I know now.” The body of science that fashions our medical practice is a dynamic and not static being. Dogma and dictums that we had regularly grown accustomed to hearing -- proclaimed by physicians and students on hospital wards and in the ICUs (i.e., SIRS = Sepsis) as if they were “medical gospel” -- have since been replaced by new science. I cogently suspect that when the COVID-19 pandemic eventually comes to an end, much of the same will have transpired. Although I, like everyone else, have at various times been mislead by leaders (both medical, corporate, and political) more than once in my lifetime, I still choose to take one’s words at face value as being sincere, and their actions as well intentioned. “Leadership does not depend on being right.” – Ivan Illich. While I believe that healthy skepticism and questioning are at times

warranted and justified, negative and mean-spirited cynicism can only be detrimental and harmful to the cause at hand. The key pandemic management questions go far beyond “science.” How safe is safe and how best to balance saving the most lives versus saving the most of our way of life, are “political questions” that must be answered with due deference to the interests and opinions of the public, and not left just for the medical scientists to decide. In Albert Camus’ famous book, The Plague, the protagonist is asked the question, “how do you manage the wave of patients?” He replies that the only way to fight the plague is with decency. He is then asked, “what is decency?” To which he answers, “doing my job.” “Let’s hope that we all continue to do our jobs, and I have no doubt that this pandemic will come to an end, after all, that is the human spirit and experiment.” On a different note, it has been my honor and privilege to serve as your president of the Palm Beach County Medical Society throughout this past somewhat unprecedented and tumultuous year. I sincerely hope that you have found that I have upheld my oath of office and have helped to maintain the reputation and integrity of this extraordinary collection of physicians, nonmedical generous lay persons and dedicated staff.

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OnCall • Q4 2020

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I am having a difficult time

saying farewell

As I am coming to the end of a long career as CEO of Palm Beach County and Palm Beach County Medical Society Services, I am experiencing very mixed feelings. It is difficult to leave a fulfilling career behind. A close friend counseled me over the past year that I would know when it was time to say farewell, and she was correct. It does not make it any easier. I am most grateful to have had the opportunity to serve as CEO for the past 22 ½ years and an honor to work with outstanding physicians, business, community leaders, and volunteers who shared a commitment to providing quality healthcare. As I look back, it has been an amazing journey. There have been many challenges and memorable experiences. When I first began as Executive Director, I worked with Jana Rasmussen, MD President and the Board of Directors to create a mission, vision and goals to build upon past accomplishments and chart a new direction for the Society. The plan was forward thinking and served as our road map for the future of the Society. Although times have changed and new issues have emerged, this document has remained our guiding foundation.

Mission

Palm Beach County Medical Society is a not for profit organization dedicated to uniting physicians to serve the common interest of the profession, developing and maintaining the highest professional and ethical standards of the medical profession, advocating the interests of physicians and their patients and collaborating with others to improve the community’s health.

Vision

Palm Beach County Medical Society will be the leader in promoting the scientific and ethical practice of medicine. A recognized educational and informational source for

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physicians and our community. The champion of quality health care for all. The unifying force representing the physician community.

Goals

• Serve as an educational and informational source for physicians and our community. • Advocate effectively for its members and their patients. • Support and develop effective partnerships between individuals, professionals, institutions, and the community to address health issues. • Address the professional needs of physicians. • Improve communications with our members and enhance community awareness of the Palm Beach County Medical Society. • Increase the membership of the Medical Society and identify barriers to membership. • Establish a process to strengthen and evaluate the effectiveness of the Medical Society. • Promote ethical standards of the medical profession. The accomplishments and recognition the Society has achieved is the result of strong, innovative volunteer leadership willing to step forward to lead. Early on, our physician leaders recognized that the Society could do and be more. What was needed was the creation of a 501.c3 charitable organization to allow foundation support grants, and donor contributions. Three physicians Brent Schillinger, MD, Mas Massoumi, MD and James Howell, MD were the founding members of Palm Beach County Medical Society Services who shared a vision that physicians could more actively participate in the community. This was a game changer. The leadership and partnership of physicians was celebrated and sought after. Most notable was the response of the Society to 9/11 and the first case of Anthrax being diagnosed in Palm Beach County by our current PBCMS


President Larry Bush, MD. Physician leadership was responsible for working in partnership with the Palm Healthcare Foundation to bring together hospitals, government agencies, first responders, public health and emergency management to create the Heath Emergency Response Coalition (HERC). Jeff Davis, DO and Jean Malecki, MD were our physician champions. HERC became a national, award recognized model that has been replicated throughout the nation. Over the years, HERC has addressed major public health crises including hurricanes, H1N1, Opioid Response, and today COVID–19. Medical malpractice rates skyrocketed, and Palm Beach County physicians led a spirited opposition. I will never forget in 2002 when Dr. Stephen Babic requested that the Society provide signs for a physician march outside Boca Raton Regional Medical Center. This was followed by Town Hall meetings with close to 1,000 physicians participating, physician marches, trips to Tallahassee and ongoing advocacy efforts led by PBCMS Presidents Ross Stone, MD, Alan Pillersdorf, MD, William Ludwig, MD and many others. The voices of physicians were heard, and Florida Constitutional Amendment 3 passed. Advocacy has always been a top priority of the Society and physicians have led in response to reimbursement, physician shortages, access and quality of care, scope of practice and health care reform. Led by Jose Arrascue, MD and inspired by the AMA, the Future of Medicine Initiative was launched in 2006, to create a road map for the future of healthcare. A time-honored Society tradition, the Annual Summit has featured national and local physicians and health care experts. Dr. Michael Dennis has played a leadership role, as Chair of the Summit for the past 13 years and a leadership team.

women and young physicians on the board and in Society programs. The James Byrnes, MD Medical Education Fund and Poster Symposium has mobilized our physicians to support the growth and expansion of graduate medical education programs in Palm Beach County. The contributions of medical students, residents and faculty has significantly strengthened the Society. The contributions of the 22 PBCMS Presidents that I have had the honor of working with have shaped PBCMS. To each of you and the dedicated board members, I say thank you. I am so very proud of how the Society and Services continues to address COVID-19 and grateful to our community partners for their support. None of these efforts would have been possible with out the support of our PBCMS members, Circle of Friends, community partners and funders and donors. It has been an honor and privilege to work with the PBCMS staff, dedicated and truly talented individuals who I consider as family. Every ending has a new beginning, and I am looking forward to creating the next chapter of my life. I am confident the Society and Services will have great success with Roger Duncan, MD, President PBCMS, Ivy Faske, MD, President PBCMS Services and Kelly Skidmore, CEO. Thanks for the memories, I will miss you all greatly. Tenna Wiles PBCMS CEO

Partnering with healthcare and community organizations has resulted in successful programs such as Project Access, founded by Ivy Faske, MD, and Physician Wellness inspired by Stefan Pasternack, MD and Shawn Baca, MD. Cultural Competency, Care Coordination, The Conversation Project, and Ethical Issues and most recently, the Opioid Task Force, chaired by Brent Schillinger is playing a major role in educating physicians and healthcare professionals. A positive impact of the South Florida Physician Leadership Academy led by James Goldenberg MD is being realized with the increased engagement of

Lifetime Achievement Award, Tenna Wiles, November 2020 OnCall  •  Q4 2020 

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Celebrating Inspirational Women in Medicine Alina Alonso, MD, Director, Florida Department of Health, Palm Beach County

Woman Physician of the Year

Alina Alonso, MD, Director,

Florida Department of Health, Palm Beach County Woman Physician of the Year

“We will remain champions for the healthiest community in the nation, empower the youth to choose healthier lifestyles, build healthier communities and improve access to care with the help and support of our many partners in this community.” --Alina Alonso, M.D. (floridahealth.gov)

Few Physicians in Palm Beach County have been more in the thick of the COVID-19 pandemic than Dr. Alina Alonso. Her leadership and expertise, ability to

Dawn Davanso, MD

serve as liaison between disparate organizations and providers and dedication to the community earned her the honor of “Woman Physician of the Year,” presented by PBCMS at the “Celebrating Inspirational Women in Medicine” event in September. The celebration was part of Women in Medicine month and centered on critical issues that challenged women physicians and our entire society in recent months: the COVID-19 pandemic, systemic racism and gender inequity.

Ekaterina Kostioukhina, MD

Claudia Mason, MD

Martha Rodriquez, MD

For the first time in its history, PBCMS has four women physicians and one female medical student serving on the Board of Directors; Dawn Davanso, MD, Ekaterina Kostioukhina, MD, Claudia Mason, MD and Martha Rodriquez, MD, and Ayesha Abid, MS. In addition, Ivy Faske, MD is serving of Palm Beach County Medical Society Services and is joined by Maureen Whelihan, MD. Dr. Rodriquez, who served as event chair, commented, “Now more than ever women must unite and uplift each other to lead our world to endless destinations.” Honoree Dr. Alonso has been serving the medically underserved in Palm Beach County since 1989. She oversees a staff of 750 employees, who provide a full range of primary and preventive services through seven health centers strategically placed throughout the county. No stranger to chaotic crisis situations, she has received training in bio-chemical terrorism and weapons of mass destruction, and communicable and emergent diseases. Her experience includes handling the clinical operations of the first case of terrorist related inhalation Anthrax in the United States in 2001.

Ayesha Abid, MS

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Q4 2020  •  OnCall

Ivy Faske, MD

Maureen Whelihan, MD


Martha Rodriquez, MD

Sarah Steele

PBCMS paid tribute virtually to women physicians, residents, and students in an event, sponsored by MMR Healthcare and Martha Rodriguez, MD. The evening celebration included a presentation by Sarah Steele and a video featuring inspirational insights on leadership by Catherine Lowe, MD, Guari Argawal, MD, and Ivy Faske, MD.

Catherine Lowe, MD

Guari Argawal, MD

Ivy Faske, MD

OnCall  •  Q4 2020 

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FIRST VIRTUAL FUTURE OF MEDICINE HUGE SUCCESS More than 300 participants signed in to hear impactful presentations

The pandemic may have forced a shift in format, but the Future of Medicine Summit (FOM) was a huge success, according to the event Chair Michael Dennis, MD., who reported a record attendance for each of the five sessions held during October. “Each session was outstanding,” he said, “and the virtual format allowed us to engage high caliber speakers and attract attendees who may not have otherwise been able to come to West Palm Beach. We’ve received positive feedback from physicians, who found the presentations informative, inspiring and valuable.” Founded in 2007 by Jose Arrascue, MD, the Future of Medicine Initiative brings together community leaders to define issues, establish partnerships and implement strategies for change. At the annual Summit, national and community health care leaders gather to explore the “hot topic” issues facing healthcare.  Susan Bailey, MD, President American Medical Association (AMA), opened the summit series with her presentation on the “Critical Role of Health Care During COVID-19.” Her emotional opening reminded physicians and health care professionals that they were trained to be heroes and have proven to be so during this crisis. “A hero’s journey is a physician’s journey,” she said. She provided details about the actions the AMA is taking to be a “passionate defender of the independent physician,” be an information resource, provide support for telemedicine, be a source of PPE, and be a voice for physicians before Congress, among other activities.

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“Our goal is to help remove obstacles in providing quality patient care and let doctors be doctors,” she stressed. Dr. Dennis said that the stature of Dr. Bailey was the perfect way to launch this virtual series for professionals in the field. “The AMA is a powerful ally in patient care, giving strength to physician voices in courts and legislative bodies across the nation,” stated Dr. Dennis. “We are honored to have the organization’s president provide a national perspective on this crisis we all share.” Dr. Bailey, an allergist/immunologist from Fort Worth, Texas, was elected president of the American Medical Association in June 2020. In private practice with Fort Worth Allergy and Asthma Associates for more than 30 years, she completed her residency in general pediatrics and a fellowship in allergy/immunology at the Mayo Graduate School of Medicine in Rochester, Minn., and is board certified in allergy and immunology, and pediatrics. The Florida Medical Association President Michael Patete, MD, FACS, a board-certified otolaryngologist in private practice in Venice, Florida, began the program with a discussion about the partnership between the national, state and county medical societies and physicians throughout Florida. Dr. Patete is a specialist in head and neck plastic surgery and has practiced medicine for more than 30 years. Part two of FOM featured “The Impact of COVID-19 on Medical Education” presented by Alan Tunkel, MD, Senior Associate Dean for Medical Education and Chief of Medical Education


at the Brown University Alpert Medical School. Dean Tunkel oversees at Brown the offices of Medical Education; Student Affairs, Admissions; Financial Aid; Medical School Administration, and master’s degree programs such as Gateways to Medicine, Health Care and Research and the Medical Physics Graduate Program. Dr. Tunkel was joined by FAU Resident Dr. Sharmin Akhter, who studied psychology and public Health at Boston University. After working as a clinical assistant at Memorial Sloan-Kettering Cancer Center for two years, she went on to attend St. George’s University. She currently serves as a PGY-3 Chief Resident in internal medicine at Florida Atlantic University (FAU). Jacob Musinsky, a MS4 at FAU Schmidt College of Medicine, also was part of the presentation. A native of Boca Raton, Florida, he earned his bachelor’s degree from Wesleyan University and worked in clinical research at Memorial Sloan Kettering Cancer Center. He received a Ph.D. in experimental pathology before earning a medical degree at the College of Medicine and Dentistry of New Jersey in Newark. He completed a Residency in internal medicine at the Hospital of the Medical College of Pennsylvania in Philadelphia and a Fellowship in infectious diseases from the University of Virginia Health Sciences Center in Charlottesville. “Health Policy: Decision 2020” was the topic of session three, featuring Reporter Marc Caputo, of POLITICO and Chris Clark, Senior VP of Public Affairs, Florida Medical Association. Marc Caputo joined POLITICO Florida from the Miami Herald in January 2015. The Key West native writes the Florida Playbook and covers politics throughout the state. He started at the Herald in 2003 and helped expose campaignfinance scandals that led to two federal convictions. Chris Clark joined the FMA in 2017 after serving as chief of staff for Florida Senate President Don Gaetz for eight years. Prior to his work in the Senate, Clark served in several positions in the administration of Gov. Jeb Bush, including serving as his personal aide during the campaign and first two years as Governor. In 2009, he founded CM Consensus LLC, a Tallahassee lobbying firm. “When COVID-19 and Opioid Addiction Collide” was the topic of FOM session four, presented by Robert Stutman, Former DEA Special Agent and previous speaker for PBCMS. Stutman’s 25-year career positioned him as one of the nation’s highest profile drug busters and even an assassination target of the Colombian Cartel. Today he is frequent public

speaker and media expert regarding the evergrowing prescription drug epidemic. FOM culminated on October 26 with a panel discussion, “New Reality of Medical Care Delivery.” Rick Cameron, President and Managing Director, Barycenter Advisors, served as moderator with panelists including: Terry Adirim, MD, Senior Associate Dean for Clinical Affairs, Florida Atlantic University; Andrew Berkman, MD, Internal Medicine, JFK Medical Center; Lincoln Mendez, CEO, Boca Raton Regional Hospital, Baptist Health South Florida; Robert Mino, Vice President, Life Sciences, Business Development Board; and Richard Rendina, Chairman and CEO, Rendina Healthcare Real Estate.

Special Thank You to our sponsors C & A Johnson Foundation Michael Dennis, MD MMR Healthcare Rendina Healthcare Real Estate Trustbridge MEDICAL SPECIALISTS OF THE PALM BEACHES, INC. We are honored to celebrate the past 20 years of medicine in Palm Beach County and we look forward to the future.

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OnCall  •  Q4 2020 

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CENTENNIAL GALA AND HEROES IN MEDICINE CELEBRATION

The Palm Beach County Medical Society (PBCMS)

Services will honor the recipients of the 17th Annual Heroes in Medicine awards at the annual gala on December 5, 2020, which will be held virtually. The Society’s President Larry Bush, MD will be honored and incoming President Roger Duncan, MD installed. Net proceeds from the gala support PBCMS Services programs, including COVID-19 Response, Project Access, Disaster Services, Opioid Task Force and Care Coordination. Heroes in Medicine awards spotlight those individuals and organizations in Palm Incoming President Beach County that provide outstanding service to meet needs of people in local, Roger Duncan, MD national and/or global communities. Nominees complete a rigorous review process, including in-person interviews selected by community leaders and volunteers. Heroes in Medicine is made possible by the generous support of Rendina Healthcare Real Estate.

2020 Heroes in Medicine are: 2020 Physician Hero award, goes to Nuclear Medicine Specialist Norman Pevsner, MD. He was nominated because of his litany of scientific, patient care and philanthropic contributions. For example, he developed the first Cardiac Stress SPECT scanning test in South Florida and serves as an instructor and lecturer as part of his belief that “being good doctors is the key to better health care and self-fulfillment.” Among his many industry association and community roles include being elected as a Fellow to the American College of Radiology, donating computer libraries to medical students at Nova Southeastern University, and serving as a long-time board member of Physicians Resource Network. Dr. Pevsner has been driven to make a difference in health care for the citizens of Florida and the nation.

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Bruce Rendina Professional Hero: Patrick McNamara, CEO, Palm Beach Health Foundation, receives this award as a professional, who is not a direct provider of patient care, but uses his abilities to improve the health of the community. He has built vital partnerships, strengthened relationships with system partners and created innovative approaches of solving complex health problems. Recently, he worked with the Southeast Florida Behavioral Health Network to help unify the county-wide system of care for the addicted. Community Organization Hero: FoundCare, Inc. Originally an AIDS support program, this organization today operates as a comprehensive community health center to help meet the unmet health care needs of Palm Beach County residents, giving every patient the same highquality standard of care regardless of insurance


coverage. “We will always do our best to provide the resources they need to take charge of their health; because everyone deserves the right to be healthy,” states FoundCare. Health Care Educator Hero: Miguel Lopez-Viego, Jr., MD, Baptist Health Physician Group. A Cuban immigrant, this hero arrived in Miami at age 2 and has since built a reputation as one of South Florida’s top general and vascular surgeons. Starting as the chief editor of a trauma handbook during his residency in Dallas, he has remained committed to the education of medical students and residents. The patience and enthusiasm with which he has led medical students has inspired countless students to pursue careers in general and vascular surgery. Health Care Innovation Hero: Kathy Schilling, MD, Lynn Women’s Health & Wellness Institute. As Medical Director and Radiologist, Dr. Schilling has innovated a new care pathway for the over 65,000 women who seek breast-imaging services at any one of our breast centers. Through this new approach, we will be able to identify those women who are higher risk for developing the top diseases that kill women. She sees the possibility, forges ahead with passion and conviction, and takes the necessary steps out of the ordinary and into the extraordinary. Health Care Provider Hero: Brittany Reidy, RN, Medical Team Director, Bahamas Relief Cruise. Within a few days after Hurricane Dorian, this critical care and trauma intensive care nurse set up and ran an impromptu triage care area for evacuees. The experience inspired her to take 14 additional humanitarian trips to Grand Bahama and Abaco. She also organized a prosthetic clinic for Bahamian storm survivors who either lost their prosthetics or had never had artificial limbs. Humanitarian Award: Nancy Brinker, The Promise Fund. Nancy Brinker spent four decades growing the Susan G. Komen Foundation and changing forever the awareness of breast cancer in memory of her sister, who died at age 36 from the disease. More recently, she helped to start The Promise Fund whose mission is to reduce and prevent the progression of breast and cervical cancer, especially among the underserved, in Palm Beach County. Lifetime Achievement Award: Gordon Johnson, MD, Anatomic & Clinical Pathology. Now retired, this dedicated pathologist has redefined what it means to give back. He mentors young people in

an effort to bring more diversity into the medical field. He tutors high school students, sponsors food pantry activities and helps underserved children participate in sports. Dr. Johnson is committed to making a difference where possible. He is a strong advocate for youth and medically underserved individuals. Leadership Award: Tulisa LaRocca, MD, University of Miami Miller School of Medicine/JFK Medical Center. The best test of effectiveness in a teacher or educator is to actually see the light in the student or resident. When you are in the room with Dr. LaRocca, the whole room glows. Her passion is contagious, inspiring and sincere.

HEROES IN MEDICINE FINALISTS ARE: STUART BAGATELL, MD

University of Miami/JFK Internal Medicine Residency Program

JOY FULLER, ARNP

Shenandoah Medical Care Center

NIGEL JAGOO, MEDICAL STUDENT Edward Via College of Osteopathic Medicine — Auburn

DEBORAH LIEBERMAN, RN

Bethesda Health — Baptist Health South Florida

GEORGE LUCK, MD

Charles E. Schmidt College of Medicine – FAU

CHRISTINE LYNN

Christine E. Lynn College of Nursing – FAU

EUGENIA MILLENDER, PHD College of Nursing – FSU

JEAN MONICE, MD Foundcare, Inc.

TIM STAPLETON, CEO

Florida Medical Association

KELLY WILSON

FirstLantic Healthcare

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Dr. Fee notes a communication lesson learned: “Initially, I was trying to be very reassuring with the physicians and saying, ‘We’re going to get through this and everything’s going to be OK and this will be over soon.’ In retrospect, that’s not true ... What I would have done differently is say, ‘We’ll have to just see,’ but maybe not be too reassuring.”

What Lessons Did We Learn from COVID-19? David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company Group, and Laura Kline, CPCU, MBA, Senior Vice President, Business Development, The Doctors Company

Each year, The Doctors Company assembles healthcare leaders to discuss the most pressing issues affecting physicians, practices, and systems across the spectrum of care. The 2020 Executive Advisory Board meeting gathered top healthcare executives for a virtual discussion of shared pandemic experiences and lessons learned that can help healthcare organizations navigate through COVID-19 and beyond. Here are some top meeting takeaways:

1.) Change your own mindset to succeed.

Andrew Racine, MD, PhD, system senior VP and chief medical officer at Montefiore Medical Center in the Bronx, New York, reflects on his experience with COVID-19 at the heart of the crisis in NYC: “Everything about what you are used to doing and how you are used to doing it had to be discarded, had to be put aside... Where were you going to do things? What kind of equipment were you going to use? Who was going to do things?” He advises, “You have to be flexible. You have to adapt to the circumstances.” And, “You have to be proactive.”

2.) Plan for what’s coming next.

Dr. Racine says that Montefiore has systematized lessons learned: “We have a very detailed plan about what will happen if we get 10 percent more patients than we currently have, if we get 20 percent more patients than we currently have, if we get 100 percent more patients than we currently have.” And Martin Fee, MD, senior VP and chief clinical officer at Hoag Memorial Hospital Presbyterian in Newport Beach, California, and an infectious disease specialist, describes contingency plans that incorporate not only medical realities, but political ones—factoring for predicted executive actions from California’s governor.

3.) Communicate with honesty, empathy, authenticity, and consistency. Dr. Racine describes the need for empathy in effective communication: “People were frightened. They were anxious. They were angry, they were grieving. And the communication had to acknowledge that.” In addition, Dr. Racine stresses authenticity: “People were not going to accept communication coming from just anybody”— which was why Montefiore’s communications came from their CEO.

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4.) Recognize the pandemic’s silver lining: Innovation.

Dr. Fee says Hoag had been planning on a nine-month telehealth implementation in 2021, “but all the regulatory and financial barriers came down and we were able to launch that very quickly.” Overall, the rerouting of usual workflows “forced us to be innovative quickly,” says Dr. Fee, “which I think was a silver lining.” Chad Anguilm, MBA, VP of in-practice technology services at Medical Advantage Group, a subsidiary of The Doctors Company, says that sustained shifts across technology and workflows are already progressing: “Like we saw with telehealth— the big boom in the spring—we’re seeing something similar with wearables now where we’re getting many requests to start integrating wearables into the EHR systems. To have that constant flow of data from those with chronic conditions” could positively impact physicians’ ability to treat patients in real time.

5.) Expect malpractice claims to increase—know what to document and transfer risk John E. Hall, Jr., Esq., of Hall Booth Smith, P.C., predicts filing of COVID-19-related cases will peak in 18 months to two years. Mr. Hall encourages physicians and practices to document daily life now, because juries will forget. He recommends documentation of daily infection control measures, as well as noting who is working hard to procure personal protective equipment (PPE), coordinate with labs, and so on. This will make it easier later to contact staff members who can attest as witnesses that providers made their best effort to reduce risks. Awareness of risk transfer opportunities may also be protective. Jacob Zissu, Esq., of Clausen Miller, P.C., points out: “It may be that the injury alleged is attributable to the acts or omissions of your vendor or an independent contractor.” He advises, “Think about risk transfer as if it’s a Swiss Army knife with multiple tools . . . The best position to be in is to have multiple risk transfer options available.” 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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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The First Horizon Medical Private Banking team is a group of experienced financial professionals dedicated to the specialized needs of physicians, hospital administrators, and other medical services providers. We understand the pressures you face in your challenging field. That’s why we’ve designed our services to fit around you and your often-hectic schedules. Our family of companies can provide you a variety of services from banking guidance to investment, retirement, and estate planning. We are available whenever you need us. Give us a call today to learn more. The First Horizon Medical Private Banking team is a group of experienced financial professionals dedicated to the specialized needs of physicians, hospital administrators, and other medical services providers. The First Horizon Medical Private Banking team is a group of experienced financial professionals dedicated to the specialized needs of We understand the pressures you face in your challenging field. That’s why we’ve designed our services to fit around you and physicians, hospital administrators, and other medical services providers. your often-hectic schedules. Our family of companies can provide you a variety of services from banking guidance to investment, retirement, and estate planning. We are available whenever you need us. Give us a call today to learn more. We understand the pressures you face in your challenging field. That’s why we’ve designed our services to fit around you and your often-hectic schedules. Our family of companies can provide you a variety of services from banking guidance to investment, retirement, estate ©2019 First Horizon Bank.and Member FDIC. planning. We are available whenever you need us. Give us a call today to learn more. NEW 10/19

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We understand the pressures you face in your challenging field. That’s why w your often-hectic schedules. Our family of companies can provide you a vari retirement, and estate planning. We are available whenever you need us. Giv ©2019 First Horizon Bank. Member FDIC.

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COVID-19 Task Force Highlights PBCMS Physician Leadership “The pride we can all feel in the way our diverse healthcare workforce has come together is overwhelming, and it has become a foundational element within our healthcare culture. We have been challenged, and we have risen to the occasion in the most professional of self-sacrificing ways — at times with the ultimate sacrifice. “Physician leadership has helped drive this cultural shift.” –– Peter B. Angood, MD, President and CEO, American Association for Physician Leadership®, “Physician Leadership in Crisis and Recovery” (April 28, 2020)

COVID-19 had just begun to tighten its grip of terror and confusion in March when the PBCMS physician leadership, staff and support professionals jumped into collective action to create calm and support along with a steady flow of factual information whenever members needed it. Collaboration and commitment were the watch words, according to those involved, that lead to swift and effective action. One of the first initiatives was the formation of the COVID-19 Task Force, a cross section of Society physician leadership, staff, Circle of Friends members and consultants charged with positioning PBCMS as the trusted resource. The Task Force was chaired by Dianne Goldenberg and consists of three Subcommittees: Communications, chaired by Dr. James Heron; Practice Management, chaired by Dr. Jose Arrascue; and Community, chaired by Dr. Ivy Faske. Additional responsibilities of the Task Force included the development and execution of myriad physician town hall meetings, panel discussions and webinars on many important topics. In early April the Task Force launched the COVID-19 Resource Center, an online central repository of useful information and resources directed specifically at all physicians and health care professionals in Palm Beach County. PBCMS Society President Larry M. Bush, MD, FACP, affiliate professor of clinical medicine at the FAU Charles E. Schmidt College of Medicine, announced the resource center by saying: “We’ve always been a trusted resource for our members, but this crisis has revealed a more immediate need for relevant, comprehensive and timely support for physicians and health care professionals in our local community.”

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Jose Arrascue, MD

James Heron, MD

Brent Schillinger, MD

The online Center continues to provide up-to-date information on such topics as: practice management resources, timely news, telemedicine support, sources for testing and PPE supplies and various CME/educational/ wellness webinars and events. In a recent survey conducted by PBCMS, 75% of respondents said they rely on the society for COVID-19 information. As an infectious disease expert, Dr. Bush provided regular videotaped messages, participated in town hall updates and worked closely with the Florida Department of Health. “The amount of information and misinformation flooding the inboxes of physicians and health care professionals can be overwhelming,” said Dr. Bush. “We can best serve these critical individuals by synthesizing the information and providing clear and easy access to valuable resources.” James Heron, MD, agreed serving as a trusted source of information was a critical role for the Society, and noted that long before COVID-19, “there was heart disease, cancer, lung disease and other chronic issues that can’t be ignored. We have to make sure patients take care of themselves, whether it’s the flu shot, regular check-ups, even frequent handwashing.” Dr. Heron saw the toll isolation from COVID-19 caused in his own practice and has worked with his patients to encourage “physical distancing, while staying socially in touch.” “We have to hear what patients are saying and give them the opportunity to ask questions they haven’t had the chance to ask in months,” he said, explaining that becoming a trusted information source required communicating across multiple platforms, including emails, websites, and virtual town halls in order to reach as many people as possible. “This was a collaborative effort, as we all wanted to be there for each other and our patients,” said Dr. Heron. “Leadership is working together, feeding off of each other, learning together.”


He explained that topics were adjusted based on what the committees determined was needed and wanted, whether it was PPE or telemedicine, for example. “We were listening and watching and responding to needs, as being a resource also helped patients.” Dr. Brent Schillinger, who chaired the mental health educational sessions, identified early on the need to address the mental stress frontline health care workers were facing, as well as the urgent necessity to disseminate useful, accurate and positive information. “From the get-go, we had to put out a positive message for physicians and the public,” he said. “Early on, we shared guidelines for doctors and their practices. We wanted people to see that doctors’ offices are among the safest places to be. “As a Society, we’ve always understood the need for education. We had our first seminars, starting in March. Personally, I saw the need for mental health education right away.”

players stepped up their game to go above and beyond to become a source of calm, information and support.” He recalled that all members of this group participated, including community leaders, all of whom realized how important it was to work fast to make a difference. “For example, during many Zoom calls these past months, Dr. Arrascue clearly demonstrated his passion for the impact this virus was having on patients and doctors,” he said. “He was living it every day in his practice, and on every call recounted how he was seeing patients dying along with increasing stress on care-givers of all types. His engagement and sense of urgency helped move us all forward. “This wasn’t just an exercise; it was real stuff,” Cameron stressed. “We couldn’t wait for local politicians or others for consistent messaging. We had to advocate for our physicians as well as patients whom they serve every day.”

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Cold and Flu Season During a Pandemic By: Dean Viskovich, Florida Healthcare Law Firm

Dean Viskovich

Florida Healthcare Law Firm

What options do doctors have in determining if a patient has the flu or COVID-19? The days of assuming a sniffle and low fever during the Fall are just signs of the common flu are long gone. The challenge doctors now face is determining whether a cough, temperature and sore throat is the flu or COVID-19. If the symptoms are essentially the same for both illnesses, what’s a doctor to do? In the old days before Fall of 2019, a doctor would order a lab test to see if the patient tested positive for the flu. Today, a doctor who is faced (in person or virtually) with a patient with fever, chills, cough, runny nose, headaches and fatigue now must know if it is the seasonal flu or COVID-19. Ordering a COVID-19 test may seem like the obvious choice, but a more efficient alternative exists. Instead of a standalone COVID-19 test, ordering a comprehensive respiratory pathogen panel is a better decision. Ordering a COVID-19 test and getting a negative result while the patient continues to be symptomatic is cause for uncertainty and concern for both the doctor and patient. Many people are under orders to notify their employer or school as well as quarantine for a period of time, on top of isolating from friends and family. A lab panel that targets multiple pathogens at the same time, including the flu and COVID-19, can provide much needed peace of mind. Finding out that you don’t have COVID-19 but instead have the flu with a single set of lab tests would not only be a relief to the patient, but also to the doctor. Doctors need to be aware of the option to order updated lab panels that include both the flu and COVID-19 test. There is currently a cost differential for both the patient and doctor for a COVID-19 test vs. a full respiratory pathogen panel. The Clinical Lab Fee Schedule (CLFS) reimburses labs for the COVID-19 PCR test at $100. The respiratory pathogen panel price will vary depending on the number of viruses targeted, but a panel having 3-5 targets is reimbursed at a rate of

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Q4 2020  •  OnCall

$142.63. As you increase the number of pathogens targeted, that reimbursement rate climbs higher. With a comprehensive respiratory pathogen panel not only would patients and doctors have better and more complete information about the illness in question, but concerns regarding patient financial responsibility should be reduced. In addition, patients should check with their insurance company as many have waivers regarding coinsurance, copays and deductibles for services provided during the pandemic. Labs are currently revising their respiratory pathogen panel to add COVID-19, but the practice is not universal. Labs allowing doctors to electronically order a comprehensive respiratory panel that includes both the flu and COVID-19 is an option that should be considered the new normal. Dean Viskovich is an attorney with the Florida Healthcare Law Firm with over 25 years’ experience representing healthcare providers and businesses. He is licensed in both Florida and New York and regularly consults on regulatory compliance related issues and with particular focus on laboratory business operations and dynamics.

For more information he can be reached via email at dean@floridahealthcarelawfirm.com


All Aboard! When you hear the term On-Boarding the first thing that pops into mind (if you’re not in HR) is that we must be going on a cruise. After all, isn’t that what you do when you get on a ship? Although this might be true, it also applies to the activity of hiring a new employee and their first few days and weeks in their new position. I often get asked about employee retention and how to reduce turnover. My simple answer is retaining your employees starts on Day One and continues every day thereafter. As an employer we can never lose sight that we need our staff maybe even more than they need our jobs. This means it is our responsibility to provide a work atmosphere that is conducive to a happy employee that feels good about working for you.

1.) So why is On-Boarding important? a.)

Research and conventional wisdom both suggest that employees get about 90 days to prove themselves in a new job. The faster new hires feel welcome and prepared for their jobs, the faster they will be able to successfully contribute to the organization’s mission. (SHRM)

b.) Half of all hourly workers leave their jobs within the first 120 days c.) Used in conjunction with HRM best practices, effective on-boarding will result in a faster learning curve for new hires, improved communication, and a more productive and engaged workforce.

Here are a few tips that will help you with building that atmosphere for your new hires and start your on-boarding process: 1.) Before their first day a.) Prepare the paperwork b.) Discuss role, goals, and duties with their supervisor c.) Prepare workstation d.) Give access to any tool they might need e.) Create accounts f.) Assign required reading g.) Provide a job description with responsibilities

John Dalton

Executive Director

1.) First day

a.) b.) c.) d.) e.) f.)

Be ready to welcome your new team member Give a tour of your facility Explain your expectations (be honest) Induct into company culture Assign a mentor Share a break or lunch with them

1.) First Week / Month

a.) Assign the first project b.) Explain expectations for the following week and ask for a self-assessment c.) Provide your feedback ~ Mention high points d.) Assign a mentor e.) Share a break or lunch with them

Days 45 through 180 a.) b.) c.) d.) e.) f.) g.)

On day 45, hold a “How are things going” meeting a.) Discuss their perceptions and those of your team b.) Point out strengths and areas of improvement c.) Listen to them Invite them to corporate-sponsored event Be available for phone conversations Check in with mentor Day 90: Have a formal Review (Ask employee for self-assessment prior to this meeting) Watch for mood or personality shifts and ask the tough questions If applicable, ask them to be a mentor

If you would like more information, Optimum RTS is here to assist you with any of your hiring and HR needs. Contact John Dalton jdalton@optimumrts.com or 561-408-2192 OnCall  •  Q4 2020 

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The New Healthcare Landscape You may be wondering, how is healthcare changing in 2021? Simply put, healthcare will not change. What will change is how healthcare is delivered and how providers delivering care will be compensated. Since the ACO model came out in 2012, we have seen a shift towards the valuation of quality, not quantity. The terms “pay per performance,” “value model,” “shared savings,” are all attempts at delivering the same message: we must provide the best possible healthcare while minimizing costs. This defines the new landscape for healthcare. Therefore, on January 1, 2021 we will turn the page into a new way of billing for primary care services. The first big change will come with the codes for E/M (evaluation and management). The ICD10 codes 99213-99215 and their components will be a thing of the past. The shift towards a team approach to healthcare will be part of a new billing model that weighs heavy on clinical decision-making. CMS hopes to shift our mentality to a more comprehensive approach to patient care. The time and effort put into evaluating a patient before they ever enter the exam room will all impact how the visit is coded. This includes reviewing their diagnoses, their prior consultations, and all of the medical issues prior to the visit. Once we see the patient, the complexity of the evaluation and diagnosis and each of their impacts will drive how we are ultimately compensated. For example, imagine if a patient comes to see you for a cough. If the issue is straightforward and is due to a simple allergy or medication reaction, it will be compensated differently from a cough resulting from a post obstructive pneumonia due to a lung tumor seen on a chest X-ray. Since in the latter case the post visit coordination and the morbidity and mortality of the patient is much more complicated and the compensation for the visit will reflect this extra complexity. The goal of “patient over paperwork” is to reduce the clinician’s time spent documenting and unnecessarily clicking in the EHR. It remains to be seen if this will ultimately play out as intended.

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Q4 2020  •  OnCall

Martha M. Rodriguez, M.D

Natalie Perez-Mendez, MS-3

In addition to quality of care, CMS has another goal that is driving other new payment models for the new year. CMS is seeking “to give up” or “to share” risk with healthcare services providers by introducing the Primary Care First and Direct Contract Payment models on January 1, 2021. The Primary Care First Model is a five-year model that will pay a capitation fee for fee-for-service Medicare patients and a flat fee for billed visits with an added quarterly bonus based on proof of improved healthcare quality. So far, 917 practices in the country have been approved for this model based on their last 3 year data. The Direct Contract model, another five year model, consists of practices or groups of practices with large fee-for-service populations who will share a bigger portion of risk with CMS. If the participants can demonstrate the goals of improved healthcare access and optimized healthcare quality at a reduced cost, then it is clear these models will become the new norm. Yes, a lot of changes are coming. This is why we must stay informed on the evolution of healthcare so that we are prepared and able to adapt. The best way to prepare for the new landscape is to educate ourselves as much as possible. I strongly recommend the educational sessions offered by the Palm Beach County Medical Society as well as the FMA and the ACP. All of these resources will serve a crucial role in how we maneuver through these new landscapes. The more education we embrace, the easier this big shift will be. As more information regarding the new payment models becomes available we will continue to publish more articles in effort to share the critical information.

If you would like more information, please contact MMR Healthcare 561-364-8056.


Healthcare Heroes: Yes, Pandemic Lawsuits Will Become Viral Matt Gracey, CEO of Danna-Gracey, Independent Agents Specializing in Insurance for Healthcare Providers What a spicy, hot pandemic stew of lawsuits is brewing in America! This is particularly true in the healthcare world since this is a mother lode of a healthcare crisis. Simmering now and headed to a boil are incredibly strong factors: Fear; sadness; isolation; divisiveness; suspicion; and distrustfulness of authority, of others, of scientists, of doctors, of politicians, of neighbors, of darn near everyone. Throw in a predicted unemployment rate up to 30%, with over 36 million already out of work. Add an economic downturn second only to the Great Depression. Economic desperation drives many lawsuits.

Matt Gracey, CEO

doctors risking their and their families’ lives every day to help their patients. See why we are concerned about what doctors are facing on the other side of this hot pandemic kitchen we call America? Start now – protect your practice and yourself! Work on strengthening every one of your patient relationships, be empathetic, and be great with your communications, documentation, and expressions of care and concern. Review your med mal coverage with an expert. Dust off every risk management technique you have learned. Most of all, remember that you are a hero and are loved.

Sprinkle in a healthcare system very much based on employer-supplied coverage that has mostly now been terminated for the unemployed, disrupting long-term doctor / patient relationships, the best of which are the foundation of successful risk management to avoid being sued. Add a bitterly politically divided country with a hotly contested election for our top elected positions. Stir in a hundred-year pandemic for which we are ill prepared, as we fumble for swift, effective, coordinated responses. Fold in a judicial system that judges doctors according to “standards of care” at a time when few standards, besides washing our hands frequently, are even agreed upon. Overlay that now-boiling stew with the most highly litigious culture in the world, in a country that produces vast quantities of lawyers every year, with plaintiff and class-action-happy lawyers chasing dog-bite cases with billboards, mass emails, and doctors’ mistakes with letters of intent to sue. Then throw all of that into a very-hot oven for an undetermined amount of time with highly educated

OnCall  •  Q4 2020 

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PRST STD US POSTAGE

PAID WEST PALM BEACH, FL PERMIT NO.515 3540 Forest Hill Blvd. Suite 101 West Palm Beach, FL 33406 RETURN SERVICE REQUESTED

Cheers to

100 Years!

Celebrating a Century of Medical Excellence

Palm Beach County Medical Society Installation Gala & Heroes in Medicine Celebration PRESENTED BY

PALM BEACH COUNTY MEDICAL SOCIETY SERVICES

SATURDAY, DECEMBER 5, 2020 $100 PER PERSON

6:30 P.M. Pre-Event Celebration & Silent Auction 7:00 P.M. Program & Entertainment

J O I N

U S

I N

G R A T I T U D E

AS WE HONOR OUR PRESIDENT LARRY BUSH, MD AND WELCOME INCOMINg PRESIDENT ROgER DUNCAN, MD

AS WELL AS OUR 2020 HEROES IN MEDICINE RSVP BY NOVEMBER 20, 2020

www.pbcms.org â&#x20AC;¢ 561-433-3940

Profile for Palm Beach County Medical Society & Services

2020 Q4 OnCall  

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