Editors: Ellen W. McKnight, M.D. | Erica Huffman, Executive Director
www.escambiacms.org
Bulletin JULY/AUGUST 2015 VOLUME 45, NO. 4
PRESIDENT’S MESSAGE God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference. Many groups have adopted the Serenity Prayer over the years, but I think it applies to physicians in these turbulent times of change. We are facing the challenges of trying to do more with less. The costs of practicing medicine are going up and reimbursement is going down. ICD-10 is looming just around the corner. Maintenance of certification (MOC) has become a big issue as the American Board of Internal Medicine continues to be under scrutiny for the way it uses the funds it receives from physicians who are being forced to comply with arbitrary requirements. There are some things we cannot change. For example, on October 1 we had better be ready to start coding with ICD-10. The so-called “Affordable” Care Act and “Meaningful” Use are still in place, too. Regardless of how we feel about them, these realities are here, and we have to accept them as part of the way we practice. I don’t always feel very serene about the loss of autonomy, over-regulation and unreasonable demands placed on us as physicians. But I have to remind myself that it does no good to stress out over things out of my control. That brings me to the second line of the Serenity Prayer: “The courage to change the things I can.” There are lots of issues facing us that we can change. However, we must have the courage to step out, speak up and raise a unified voice. The most significant way to do that is by being involved in organized medicine. Every summer the Escambia County Medical Society (ECMS) sends delegates to the Florida Medical Association’s (FMA) annual meeting. We craft resolutions and review those submitted by others across the state that will influence the legislative agenda for the year. In the years that I have been on the board, we have seen tremendous progress in improving the way physicians practice in medicine. Being active here locally with the ECMS and with the FMA gives each of us the opportunity to impact how we practice medicine in a very concrete way. Previously, we successfully defended our scope of practice, and we have tackled issues related
CONTENTS to malpractice and liability. This year our county medical society and others are addressing the important problems with maintenance of certification, continuing medical education, and prior authorizations – and how they impact your ability to practice medicine. Our very own Dr. McKnight has been leading the way in the fight against MOC. The American Board of Medical Specialties is a private organization (as are each of the individual boards) that has lobbied to make their product mandatory for physicians. They can set the price and we are required to pay-to-play. In other words, physicians are being forced to participate in MOC in order to get privileges and credentials with some organizations. I won’t go into all the ways that is wrong in this limited space, but the fact is that MOC has not been proven to improve patient safety or make us better physicians. I am glad to be a part of organizations like ECMS and FMA who are doing something to protect my freedom and ability to practice medicine. “The wisdom to know the difference.” It is a privilege for me to work with and serve alongside physicians who have been involved in organized medicine for a long time. They are invaluable in knowing what things we have tried in the past, what things we can change, and what battles aren’t worth fighting. Collectively, we can all benefit – as individuals and as a profession – by getting involved in a meaningful way with the issues that impact our practice of medicine. I wish for each of us to find the serenity to accept the things that are out of our control. There is no sense in being stressed out about them after all. But even more important, I urge you to become more actively involved in changing those things that we can. Let us have the courage to impact our profession through organized medicine. If there is an issue I mentioned above that you feel strongly about, talk to me or one of the other board members. We would be happy to share with you some ways you can make a difference.
Page 3 - Announcements Page 4 - Membership Page 6 - Medical/Legal Page 8 - Practice Mgmt. Page 14 - Foundation Page 15 - In the Community
SAVE THE DATE Tuesday, August 11, 2015 V.Paul’s Italian Ristorante Young Physicians Section Meeting Speaker: Patricia Clark Social Sponsor: Rick Lambert, CFP®, Financial Advisor Edward Jones & FD Insurance Sunday, September 27, 2015 Hemingway’s Bimini Beach Bar Women in Medicine Brunch Sponsors: Danna Gracey Insurance, Rick Lambert, CFP®, Financial Advisor - Edward Jones, Fisher Brown Insurance, Safe Harbor Tax Advisory, Physicians Indemnity, Plateful of Yum Founded in 1973
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8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 x2 Fx: 850-474-9783 Email: info@escambiacms.org www.escambiacms.org
E.C.M.S. Bulletin
The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.
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Vision for the Bulletin:
Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond. A powerful instrument to attract and induct members to organized medicine.
Announcements 2015 Calendar of Events Tuesday, August 11, 2015 | 5:30 p.m. | V. Paul’s Italian Ristorante Young Physicians Section Meeting | Speaker: Patricia Clark “How to Win the Media” | 1 AMA PRA Category 1 Credit™ Social Sponsor: Edward Jones & FD Insurance Sunday, September 27, 2015 | 11:30 a.m. - 1:30 p.m. | Hemingway’s Bimini Beach Bar Women in Medicine Brunch Sponsors: Danna Gracey Insurance, Edward Jones, Fisher Brown Insurance, Safe Harbor Tax Advisory, LLC., Physicians Indemnity, Plateful of Yum Tuesday, October 20, 2015 | Pensacola Little Theater General Membership Meeting | Kevin Pho, M.D. 1 AMA PRA Category 1 Credit™ Social Sponsors: Dyken Wealth Strategies, Edward Jones Dinner Sponsor: Regions Bank Saturday, November 14, 2015 | Hilton Garden Inn on Airport Blvd. General Membership Meeting | FALL CME Conference Sponsors: Catalyst CRE, Edward Jones, Mag Mutual Insurance, Physicians Indemnity, Safe Harbor Tax Advisory, LLC.
Mission:
The mission of the Escambia County Medical Society is to promote the art and science of medicine in order to improve the health of our community. | Tradition – Honoring the history of medical care in Escambia and Santa Rosa counties. | Service – Serving the needs of our community through the service of our members in the practice of medicine. | Leadership – Meeting the challenges of the future and safeguarding our community’s health through organized collaboration on the local, state, and national level.
Save the Date October 20, 2015, Pensacola Little Theatre Kevin Pho, MD FREE FOR ECMS MEMBERS, TICKET PRICE: TBA “Connect and be heard: Make a difference in health care with social media” 1 AMA PRA Category 1 Credit™
2015 ECMS Delegates To The Florida Medical Association Escambia Delegates
Ad placement Contact Erica Huffman at 478-0706 x2 Ad rates 1/2 page: $350 · 1/4 page: $200 · 1/8 page: $150
Issa Ephtimios, M.D. Hillary Hultstrand, M.D. Brian Kirby, M.D. John Lanza, M.D. Jennifer Miley, M.D. Ellen W. McKnight, M.D. Thomas Westbrook, M.D.
Santa Rosa Delegates View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.
Susan Laenger, M.D. Kenneth Long, M.D.
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Membership New Members Robert Turnage, M.D. Cardiovascular and Thoracic Surgery West Florida Medical Group Cardiovascular & Thoracic Surgery 8333 North Davis Highway, 4th Floor Pensacola, FL 32514 (P) 850-969-7979 (F) 850-969-1839 www.westfloridamedicalgroup.com Gerald Mastaw Jr., M.D. Pain Management Medical Center Clinic 8333 North Davis Highway, Bldg. 1, 7th Floor Pensacola, FL 32514 (P) 850-474-8015 (F) 850-969-2840 www.medicalcenterclinic.com Moving Offices Dr. Karen Pennington has moved to Baptist Hospital located at: 1000 W. Moreno Street, Pensacola, FL 32501 Office: 850-469-7406
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Isn’t it time you called the med mal and cyber insurance specialists? Julie Danna and Arlene Gardner, your local medical malpractice specialists, have become well known throughout the state as strong advocates for health care providers, as well as creators of society and network insurance purchasing programs. Danna-Gracey is an independent insurance agency with a statewide team of specialists dedicated solely to insurance coverage placement for Florida’s doctors and healthcare providers, including medical malpractice, workers’ compensation, and cyber liability insurance. For a no-obligation assessment of your current coverage, call Julie or Arlene at 850.995.9119.
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Save the Date On Saturday, January 30, 2016 ECMS will host our Annual Inaugural Ball in conjunction with our donor gala at the Pensacola Yacht Club. The donations on this evening will benefit the Escambia/Santa Rosa County Medical Society Scholarship Endowment Fund which benefits students from the Florida State University College of Medicine Pensacola Campus. Fourth year medical students who receive the ECMS Michael Redmond Scholarship must demonstrate an interest in returning to Northwest Florida to practice medicine after completing their residency training. More information including ticket prices and sponsorship opportunities will be sent out at a later date. 2016 Inaugural Ball President-Elect Brian Kirby, M.D. Saturday, January 30, 2016 Pensacola Yacht Club
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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Medical/Legal THREE COMMON MISTAKES IN TRANSFERRING OWNERSHIP OF A PRACTICE by Jim Stroud, CPA
Physicians and dentists spend their careers building top quality practices, but devote too little attention to the architecture and terms by which the practices will be transferred at their retirement, death or disability. In our experience there are three areas, which if neglected, will lead to problems at the crucial point when the ownership of this valuable asset changes hands. Determining Value Our clients are most concerned with the value of their practice. While some practitioners underestimate the value of their practice, many overestimate the amount which can be captured in the sale of the practice interest they own. A common mistake is to use a value read about or heard from a transaction elsewhere. That transaction price might have been determined by a purchaser who was limited in the amount they could pay, such as a hospital. The transaction might have occurred in a state with a higher managed care payer mix than your practice, or in a state with different non-compete laws regarding healthcare professionals. Practice valuations vary widely and for many reasons. Two practices in the same city and same specialty could have much different values. The terms of the transaction are another powerful force on sales prices and are rarely publicized. Even if you get the value accurately determined, there are still ways to create problems in the monetization of your practice value. Clear Conversations The documents relative to the transfer of a group practice ownership percentage should reflect the plan to sell at a future date, and the design of the manner by which the price will be determined. Even for valuable practice interests absent a clear design, the potential buyers may feel tricked by a plan to transfer your share of the practice if it is developed late in your career. The time for this understanding is when the younger doctors are brought in to ownership. Buy-sell agreements and cross purchase agreements serve to clarify expectations at the time of their drafting, but should be reviewed every few years for relevance to the current situation, and any needed changes made. The greater the price desired for a practice, the more the need for clear design, pricing and terms. With a good legal architecture and a fairly determined price, your practice liquidation is almost ready for your time to sell, except for one additional issue. The Fine Print The legal obligation to pay the fairly determined price is often accomplished by the purchase of life and/or disability insurance on the selling practitioner. That can become a problem if the policies are never obtained, or the premiums payments are halted. In this situation, the buyer has a responsibility to pay a price agreed but with no funds to pay it. I can assure you that no one will be pleased with the outcome of this situation. Compound this problem with the common mistake of letting the practice price be set by the amount of life insurance proceeds (which could be afforded when the transfer architecture was designed) and you have a purchaser obligated to pay too much and with nothing but after tax dollars from their future earnings. The CEO, chief emotional officer, at home will not respond well to this deal. If you have a valuable practice, and you negotiate a fair price and terms for its sale, this can be a valuable way to exit your professional career and move to your next endeavor of success. It takes a little planning and periodic monitoring to gain top value.
ECMS | 6
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Practice Management DECODING THE IMPORTANCE OF ENCRYPTION: WHY IT’S ESSENTIAL FOR ANY CYBER SECURITY STRATEGY Encrypting data is very important in healthcare, not only for HIPAA compliance, but also for protecting your patients’ health data from potential cyber threats. As a physician it remains your responsibility to protect your patients’ data from cyber risks. Many physicians, however, are not entirely clear on what encryption does or how it makes a difference in their security efforts. By definition, encrypting data makes it unreadable. When encrypted, data is converted into a form often called ciphertext that cannot be understood by another party without the key . If data is encrypted, even if it has been stolen, the data can still remain unreadable. Encryption is achieved through software programs that apply algorithms to the original data. This scrambles it into a new, unreadable, form. These algorithms change frequently making it even more difficult to unencrypt, but a key will help you decrypt your data. The HIPAA security rule is very specific about encrypting patient data whether at rest or in transit. If your patient data remains unencrypted in either of these states the Department of Health and Human Services will fine you. If unencrypted data is stolen from your practice, not only will you experience a huge financial loss, you’ll have to notify all your patients, possibly damaging your reputation . If encrypted data is stolen you will not be charged a fine nor do you have to notify patients. In addition to properly encrypting and protecting your patient’s data, it’s important to be aware of the things that put it at additional risk. Taking data out of your EHR by e-mailing it to yourself, pasting it into documents for easier review, etc. puts it at further risk. Data that resides in an on-premise server or in-house server could also be at risk—especially if the secret to decryption is stored on the desktop. Here are a few tips for avoiding these additional risks : • Encrypt data between uses • Avoid regular email, only use encrypted emails • Get IT help – having someone with the right expertise help you could make all the difference in keeping data secure • Be careful with Gadgets – any device that is or can be taken off site should be encrypted Though going through the necessary steps to ensure your patients’ data is encrypted may be a hassle, in the long run it will help protect you and your reputation from financial and personal damage, as well as your patients’ data. Overall, encryption is an essential part of your practice’s or hospital’s cyber security strategy. Works Cited Maliyill, Tim. 2014, July 31. Why encryption is crucial to your organization. http://www.healthcareitnews.com/blog/why-encryptioncrucial-your-organization Rose, JD, MBA, Rachel V. 2014, May 8. The Importance of Encrypting Protected Health Information. http://www.physicianspractice.com/blog/ importance-encrypting-protected-health-information Torrieri, Marisa. Data Encryption 101 for Medical Practices. http:// www.mckessonpracticesolutions.com/resources/editorials/dataencryption
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Practice Management RISING NUMBER OF MEASLES CASES CREATES NUMEROUS PATIENT SAFETY ISSUES by Debbie Hill, RN, MBA, LHRM, CPHRM, Patient Safety Risk Manager, The Doctors Company New cases of measles (rubeola) are once again making national headlines. In 2014, there were 644 reported cases of measles across 27 states with 23 reported outbreaks. That was the highest number of annual cases for any year since the disease was declared to have been eliminated from the United States in 2000. As more measles cases are diagnosed in 2015, physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety. Measles outbreaks most often occur in the United States when an unvaccinated traveler gets the disease while traveling in other countries and then spreads it to individuals who have not been vaccinated.2 In addition, the anti-vaccine movement has contributed to the recent spread of measles by creating pockets of unvaccinated people. Given the disease was essentially eliminated from the United States, some physicians may not be familiar with the clinical manifestation of the disease and may not consider measles as a potential diagnosis. Since initial presenting symptoms of measles are similar to those of upper respiratory infections, measles may be misdiagnosed before a patient presents with the familiar red rash. Exposure to measles in a medical office or facility is a serious patient safety issue because of the potential for complications from the disease, including death. The disease is airborne and extremely contagious; 90 percent of unimmunized individuals who are exposed to the disease could be infected.3 An infected individual is considered contagious from four days before to four days after the rash appears. The rash usually appears 14 days after a person is exposed; however, the incubation period ranges from 7 to 21 days. To protect staff and patients, medical offices should establish screening protocols that limit exposure risk from infected individuals. Unlike hospitals, most medical offices are not equipped with negative pressure isolation units that offer better protection from airborne diseases. Your practice, however, can reduce liability risks and promote patient safety by: • Developing screening protocol for patients calling in with symptoms of upper respiratory infections and measles. Staff should query the individual regarding exposure to known measles cases, travel abroad, and immunization status. • Documenting all discussions with patients and parents of minors regarding measles, including the risks and benefits of inoculation. When patients/parents decline measles immunization, consider using an informed refusal form: http://www. thedoctors.com/ecm/groups/public/@tdc/@web/@kc/@patientsafety/documents/form/con_id_001221.pdf. Patients who contract measles and claim that their physician never discussed inoculation represent a potentially significant liability. • Providing serologic testing for immunity, when necessary, and documenting all related discussions with patients who are unsure of their immunity status against measles. • Ensuring that immunization tracking is up to date and well documented in the medical record so that patients remain on schedule. • Complying with state laws for the provision of vaccines to healthcare workers. Ideally, healthcare workers should demonstrate evidence of immunity to work with patients who are suspected of having measles or patient populations, including infants, who are susceptible to measles themselves. For more information, go to http://www2a.cdc.gov/nip/statevaccapp/statevaccsapp/ default.asp. Advising those who may have come in contact with an infected individual to contact their physician immediately. • Ensuring that office staff members are trained to use personal protective equipment and proper isolation techniques when working with an infected individual. Physicians who are not familiar with diagnosing measles should obtain additional training. It is essential to be knowledgeable about signs and symptoms, potential complications, diagnostic testing, and infection control recommendations from the Centers for Disease Control and Prevention. Follow these tips if you or your staff suspects a patient has measles symptoms: • Minimize the risk of exposure to others by admitting the patient through a separate entrance and isolating him or her in an exam room. If possible, schedule the patient at the end of the day. It is preferable that the exam room not be used until the following day since the virus can live on surfaces for up to two hours. Keep the exam room door closed. • Place a surgical mask on the patient and ensure that all office staff members wear protective equipment, including gloves, eye protection, masks, or an N-95 particulate respirator (properly fit-tested), if needed. • Follow standard disinfection and sterilization procedures for exam rooms. • Obtain specimens for disease testing. Report suspected cases to the local health department. • Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing measles in some individuals. As an alternative, Immunoglobulin, if administered within six days, can offer some protection against measles or lessen the manifestation of the disease. • Contact your local health department for additional guidance. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. References 1CDC: Measles Cases and Outbreaks. http://www.cdc.gov/measles/cases-outbreaks.html 2CDC: Frequently Asked Questions about Measles in the US. http://www.cdc.gov/measles/about/faqs.html/ 3CDC: Transmission of Measles. http://www.cdc.gov/measles/about/transmission.html ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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Practice Management CYBERSECURITY: PROTECTING YOUR ELECTRONIC HEALTH RECORDS by Jeremy A. Wale, JD, ProAssurance Risk Resource Advisor With the increased use of technology comes increased risk of cyberattacks. Anything transmitted or stored electronically is at risk of being stolen by a hacker. Many people don’t believe—or understand why—medical information is valuable or at risk. According to a compilation of data breach statistics, there were 783 security breaches in the United States in 2014. Of those, 42.5% were breaches of medical or healthcare information. This equated to over eight million individual records being accessed or stolen by cyberattacks.1 Large healthcare systems, hospital networks, and individual healthcare providers have all been attacked, but the size of the entity is no clear indication of the size of the breach. For example, one Blue Cross Blue Shield attack yielded only 300 records, while a large system in Tennessee yielded approximately 4.5 million records. Several individual physician practices were breached as well, yielding as many as 7,500 records from one practice.12 Why are medical records targeted? Medical records seem to be targeted because they contain all of an individual’s personal information: finances, social security numbers, health information, and family information. This gives thieves more potential uses for the stolen information, including applying for credit cards, store accounts, or other lines of credit. They also can use the information to steal healthcare services. These are just a few reasons why a medical record can fetch up to $50 on the black market, while a credit card number may only earn $5.3 Another example of how valuable a medical record may be: a security firm CEO shared an example of a black market advertisement to sell ten Medicare numbers. “It costs 22 bitcoin—about $4,700 according to today’s exchange rate.”4 The transition to electronic health records has given criminal hackers more opportunities to steal medical records. The chief information officer for a hospital system in Salt Lake City states his hospital system “fends off thousands of attempts to penetrate its network each week.”5 Another reason is ease of access. Some hospitals and healthcare providers are using systems that have not been updated in more than ten years.6 While hospital systems and healthcare providers rush to prepare for ICD-10 implementation and meaningful use, cybersecurity seems to be falling through the cracks. Many healthcare systems “do not encrypt data within their own networks.”7 Once a hacker penetrates whatever security the system does have, the unencrypted information is there for the taking. Criminals also use stolen medical records to fraudulently bill healthcare insurance providers and Medicare/Medicaid. The victims may not discover the theft for several months—or even years. In some instances, victims have received debt collection requests for medical services they never received. What can you do to safeguard electronic medical records? When implementing or updating an EHR system, talk to your vendor about cybersecurity. Ask whether the stored information is encrypted. It also is a good idea to determine if or when the vendor will provide security updates for your EHR software. Organizations may need to “invest more money and employee talent in shoring up the walls around their electronic data.”8 Cybersecurity is a highly specialized area that requires a certain expertise. Your EHR vendor may be able to provide some assistance in this area, but remember their expertise is creation and functionality. Hiring in-house cybersecurity experts or contracting with a cybersecurity firm specializing in this area may be the best options to protect your organization and your patients. Several organizations, such as the Department of Homeland Security, the American Hospital Association, the Centers for Medicare & Medicaid Services, and the National Institute of Standards and Technology, offer guidance and resources on cybersecurity. Their web addresses are included in the endnotes of this article.9 These are just a few of the vast number of resources available to organizations regarding cyber-security. References 1.
2. 3. 4. 5. 6. 7. 8. 9.
Identity theft resource center breach report hits record high in 2014. Identity theft resource center Web site. http://www.idtheftcenter.org/ images/breach/DataBreachReports_2014.pdf. December 31, 2014. Accessed May 8, 2015. Identity theft resource center breach report hits record high in 2014. Identity theft resource center Web site. http://www.idtheftcenter.org/ images/breach/DataBreachReports_2014.pdf. December 31, 2014. Accessed May 8, 2015. Murphy T, Bailey B. Hackers mine for gold in medical records. The Boston Globe. February 6, 2015. Accessed April 28, 2015. Shahani A. The black market for stolen health care data. NPR website. http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/ the-black-market-for-stolen-health-care-data. February 13, 2015. Accessed April 28, 2015. Humer C, Finkle J. Your medical record is worth more to hackers than your credit card. Reuters website. http://www.reuters.com/ article/2014/09/24/us-cybersecurity-hospitals-idUSKCN0HJ21I20140924. September 24, 2014. Accessed April 28, 2015. Humer C, Finkle J. Your medical record is worth more to hackers than your credit card. Reuters website. http://www.reuters.com/ article/2014/09/24/us-cybersecurity-hospitals-idUSKCN0HJ21I20140924. September 24, 2014. Accessed April 28, 2015. Shahani A. The black market for stolen health care data. NPR website. http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/ the-black-market-for-stolen-health-care-data. February 13, 2015. Accessed April 28, 2015. Radcliffe S. Patients beware: hackers are targeting your medical information. Healthline News website. http://www.healthline.com/healthnews/hackers-are-targeting-your-medical-information-010715#1. January 7, 2015. Accessed April 28, 2015. http://www.dhs.gov/topic/cybersecurity, http://www.aha.org/advocacy-issues/cybersecurity.shtml, http://www.nist.gov/cyberframework/ index.cfm, http://www.cms.gov.
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BRANDON MCFARREN BMCFARREN@CATALYSTCRE.COM • 850.698.6068 WWW.CATALYSTCRE.COM ESCAMBIA ESCAMBIA COUNTY COUNTY MEDICAL MEDICAL SOCIETY SOCIETY IN IN CONJUNCTION CONJUNCTION WITH WITH SANTA SANTA ROSA ROSA COUNTY COUNTY
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Practice Management SCRIBES: OLD CONCEPT, NEW MODEL by Teresa McMillan, MSA, RN, CPHRM, LHRM; Laura Martinez BSN, RN, MS, CPHRM, FASHRM, VP Risk Management; Mary Gregg, MD, FACS, MHA, Chief Medical Officer, SVP In light of the many challenges today’s physicians face, their managers are dusting off the old concept of “scribes”. Some providers find that the use of scribes helps them meet increased time demands while maintaining the good quality of care they desire to deliver. Scribes working in healthcare today are assisting physicians with duties that include all aspects of a patient’s visit. The use of scribes to assist providers with medical record documentation is particularly gaining in popularity. According to Lewis in Medical EconomicsI, a scribe may assist physicians by: • transcribing details of the physical exam • recording physician’s consultations with patient, family members and others • navigating the electronic health record • documenting procedures performed • checking the progress of and reviewing lab, x-rays, et cetera • recording physician-dictated diagnoses, prescriptions and instructions for patient discharge and follow-up The Joint Commission (TJC) does not support the use of scribes to enter orders for physicians or practitioners due to the additional risk added to the processII. Organizations that choose to use scribes are required to demonstrate compliance with a number of TJC’s standards in Human Resources, Information Management, Leadership and Rights and Responsibilities of the Individual. TJC standards with regard to the use of scribes include, but are not limited to: • A job description that recognizes the unlicensed status and clearly defines the qualifications and extent of the responsibilities (HR.01.02.01, HR.01.02.05) • Orientation and training specific to the organization and role (HR.01.04.01, HR.01.05.03) • Competency assessment and performance evaluations (HR.01.06.01, HR.01.07.01) • If the scribe is employed by the physician, all non-employee HR standards also apply (HR.01.02.05 EP 7, HR.01.07.01 EP5) • If the scribe is provided through a contract then the contract standard also applies (LD.01.03.09) • Scribes must meet all information management, HIPAA, HITECH, confidentiality and patient rights standards, as do other hospital personnel (IM.02.01.01., IM.02.01.03, IM.02.02.01, RI.01.01.01 The CMS directs that scribed documentation services include the following: • who performed the service, • who recorded the service, • qualifications of each person, and • signed and dated by both the physician and the scribeIV. Organizations should also review the requirements of third party payers, as they may have specific guidelines for documentation completed by scribes. Risk Management Suggestions: The implementation of new or revised processes in an organization such as the hiring of scribes presents some risk exposures. AHIMAVsuggests that prior to hiring scribes; medical practices should review individual state laws to ensure compliance and proper use of scribes by physician extenders. Additional tips include: • Orient and train the scribes specific to the needs of your organization • Complete competency assessment and performance evaluations • Restrict the scribes’ use of verbal orders • Require identification to reduce confusion by patients • Require all entries in the medical record are signed and dated • Require providers to review information prior to authentication • Develop a contingency plan should a scribe not be available Scribes may have a new role in healthcare. By applying sound risk management principles to their practices, scribes may enhance a physician’s efficiency and improve patient safety efforts at the same time. I
Lewis, M. Medical Economics. Scribes can help document care, boost efficiency at medical practices. Oct 10 2013.
II
The Joint Commission.”Standards FAQs.” May 2011.
III
The Joint Commission, “Standards FAQs.: July 2012.
IV
Cahaba Government Benefit Administrators, LLC. Guidelines for the Use of “Scribes” in Medical Record Documentation Reminder. April 11, 2013.
V AHIMA. Using Medical Scribes in a Physician Practice. Journal of AHIMA 83, no. 11 (November 2012): 64-69 [expanded online version]. The information presented in this Article is intended as general information of interest to physicians and other healthcare professionals. The recommendations and advice published herein do not reflect or establish a standard of care and do not establish rules for the practice of medicine. The publication of this information is not intended as an offer to insure such conditions or exposures, or to indicate that MAG Mutual Insurance Company will underwrite such risks for the reader. Our liability is limited to the specific written terms and conditions of actual insurance policies issued.
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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Foundation In June the ECMS Foundation Board nominated and selected three new doctors to join the board. Currently the board includes: Foundation President Paula Montgomery, M.D.; ECMS President Christopher Burton, M.D.; George Smith, M.D.; John Lanza, M.D.; Donna Jacobi, M.D.; Wayne Willis, M.D.; and Douglas Tappan, M.D. “In May Dr. Douglas Tappan our Foundation Vice President passed away suddenly. He will surely be missed. With the passing of Dr. Tappan we wanted to add new physicians who will actively recruit more interest among community colleagues to become more involved with the ECMS Foundation. The ECMS Foundation established the We Care program back in the early 1990’s, currently operates the Go Seniors Voucher Transportation Program through the ECMS Office, and has recently established the Escambia/Santa Rosa County Medical Society Scholarship Endowment Fund through the Florida State University College of Medicine. On January 30, 2016 the ECMS Foundation will be hosting a donor gala in conjunction with the ECMS Annual Inaugural Ball. The ECMS Foundation will be awarding an additional $50,000 check for the endowment. We are asking for our members and guest to donate with us,” says Dr. Paula Montgomery, Foundation President If you would like more information about any of our Foundation programs or would like to make a tax deductible donation please contact Erica Huffman, Executive Director.
New ECMS Foundation Board Members Ellen W. McKnight, M.D.
Jennifer Miley, M.D.
Kurt Kruger, M.D.
Joanne Bujnoski, M.D.
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
In the Community SACRED HEART NEWS New Cardiovascular Specialists Sacred Heart Medical Group Cardiovascular Specialists welcomes two new specialists to the practice. Dr. Charles Wyatt, Cardiovascular Surgeon, to its Cardiology team. Dr. Wyatt is board-certified in general and thoracic surgery with expertise in both conventional and endovascular approaches to the heart and vascular system. In a previous position, he was Chief of the Transcatheter Aortic Valve Replacement (TAVR) program. Dr. Issam Al-Bitar, Interventional Cardiologist, is boardcertified in internal medicine, general cardiology, interventional cardiology, and nuclear cardiology. He has extensive training in nuclear cardiology and nuclear testing. Common procedures Dr. Al-Bitar performs include cardiac catheterizations, balloon angioplasty and stenting, roto-ablations, stress testing, echocardiography, and the installation of pace makers. Dr. AlBitar has been practicing interventional cardiology medicine for more than 20 years. Dr. Wyatt and Dr. Al-Bitar have offices on the Sacred Heart Pensacola campus and can be reached at 850-416-4970.
New Urgent Care Center and Pediatric After-Hours in Pace Sacred Heart Medical has opened its new Urgent Care Center, located at 4435 Hwy 90 in Pace, providing walk-in medical care for minor illnesses and injuries, seven days a week from 8 a.m. -- 7 p.m., with limited hours on holidays. The Urgent Care Center in Pace shares the same building with The Children’s Hospital at Sacred Heart’s Pediatric AfterHours. The pediatric clinic is open Monday through Friday, 5 to 11 p.m., and Saturday and Sunday, from noon to 10 p.m. The clinic’s pediatric-trained staff is available to care for most nonlife-threatening medical issues in children of all ages, including asthma, allergies, colds and flu, cuts, fever, rashes, sprains and more.
BAPTIST HEALTH CARE NEWS Baptist Medical Group Welcomes Hospitalist Karen Pennington, M.D. Baptist Medical Group (BMG) is pleased to welcome new physician Karen Pennington, M.D., to its growing hospitalist program and expansive physician network. As a hospitalist with the Pensacola-based health care organization, Dr. Pennington will be exclusively dedicated to caring for patients admitted to Baptist Hospital in Pensacola, Fla., and Gulf Breeze Hospital in Gulf Breeze, Fla. Dr. Pennington is a caring internal medicine physician who joins BMG after serving the Gulf Breeze area for more than 25 years with Live Oak Medical Associates and in private practice. She completed her residency and internship at University Hospital in Jackson, Miss., and earned her medical degree from the University of Mississippi School of Medicine. She’s known for her outstanding doctor-patient relationships and has close ties to our surrounding area.
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Baptist Medical Group Welcomes Zheng Topp, M.D., Oncology-Hematology Baptist Medical Group is pleased to welcome fellowshiptrained oncologist Zheng Topp, M.D., to its multispecialty physician network. Dr. Topp offers quality, dedicated care to adult cancer patients. Dr. Topp earned her medical degree at the University of Mississippi School of Medicine in Jackson, Miss., and completed residency in internal medicine at the University of Virginia Health Systems in Charlottesville, Va. She completed a fellowship in hematology-oncology at the Scripps Clinic in San Diego, Ca. As part of Baptist Medical Group – Oncology, Dr. Topp joins Drs. David Mann, Sherif Ibrahim, German Herrera and Nutan DeJoubner at the Baptist Towers, 1717 North E St., Suite 231, in Pensacola.
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY